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PubMed2001

Affective disorders in cultural context.

This article reviews epidemiologic and ethnographic evidence for the cultural shaping of the causes, symptomatology, and course of affective disorders. Cross-cultural research demonstrates much overlap of depression with anxiety, somatoform, and dissociative disorders, raising questions about the universality of the prototypical representation of depression in North American psychiatry. Culture-specific symptoms may lead to under-recognition or misidentification of syndromes of mania and depression in many ethnocultural groups. Cultural idioms of distress may employ symptoms related to affective disorders to express sentiments and perceptions that do not in themselves indicate psychopathology. Socially mediated cognition about the self and specific modes of interpersonal interaction influence the course of depression. This article discusses some implications of these findings for the recognition and treatment of affective disorders among culturally diverse populations in primary care and mental health care settings.

Adult↗
PubMed1995

[Hysterical emergencies].

Most probably common in emergency departments, but still not well studied in this context, the disorders formerly called "hysteria" are now included in the group "Somatization, undifferentiated somatoform, conversion and dissociative disorders" (SSCD disorders) DSM IV. Their common presentation is that of idiopathic somatic symptoms linked with mental disorders. In the emergency department these symptoms confront physicians who generally do not have extensive psychiatric training. The symptoms occur, and disappear, undetermined by the patients, who are genuinely ill and not malingering. Aside from the somatisation disorder, which by definition is chronic, invalidating and rare, the other disorders (SCD) can: be contingent on the picture of another acute, easily recognisable mental disorder; or, on the other hand, be highly reactional and transient; or constitute the "somatic presentation" of an anxious disorder, the panic attack, well known in somatic emergencies. Management is based on diagnostic considerations and by the difficulties of the patient to accept a psychic cause of the symptoms whereas he is experiencing an organic disorder. The possibilities of discussing such psychogenesis in the context of the emergency department are slight, and the best course is often to adopt a pragmatic and prudent medical approach. An essential point is respect of the patient and his ideas. The legal provision, which already exists, for the presence of psychiatrists in emergency departments should lead to physician-psychiatrist cooperation that would be beneficial for these patients.

Adult↗
PubMed1981

Dissociative states with abnormal temporal lobe EEG. Multiple personality and the illusion of possession.

Twelve patients with clinical and EEG manifestations reminiscent of temporal lobe epilepsy reported symptoms of dissociative states. In seven of these patients, the clinical picture was consistent with multiple personality, whereas the other five had the illusion of supernatural possession. These cases suggest that in selected instances dissociative states may constitute complex behavioral manifestations of chronic limbic epilepsy.

Adult↗
PubMed2007

Multiplicity of selves and others: cognitive analytic therapy.

In cognitive analytic therapy (CAT), multiplicity is understood in terms of a range of self-other patterns (reciprocal role relationships) originating in childhood. These alternate in determining experience and action according to the situation (contextual multiplicity). They may be restricted by adverse childhood experiences (diminished multiplicity), and severe deprivation or abuse may result in a structural dissociation of self-processes ( pathological multiplicity). Therapeutic interventions, to be effective, must be based on an understanding of the structure of the individual patient's self-processes. In CAT practice, descriptions of dysfunctional relationship patterns and of transitions between them are worked out by therapist and patient at the start of therapy and are used by both throughout its course. This approach is illustrated by an account of the treatment of a depressed and anxious 70-year-old man who alternated between two main patterns.

Cognitive Behavioral Therapy↗
PubMed1994

Spirit possession in South Asia, dissociation or hysteria? Part 1: Theoretical background.

Psychoanalytic theory appears flawed in its notions of universal oedipal conflict and repression, and unsuitable for the study of pathological spirit possession in South Asia. The biological theory of contemporary psychiatry is no more effective in this analysis because mental illnesses are constituted within culture-bound categories of experience. Dissociation theory offers a better theoretical tool for this type of research. A summary of the history of paradigm shifts in psychiatric theory relevant to spirit possession is presented.

Anthropology, Cultural↗
PubMed1990

Dissociation and displacement: where goes the "ouch?".

Hypnosis is widely used to relieve pain. Current theory emphasizes its dissociative features. Multiple personality patients can eliminate pain in the primary personality by displacing it into underlying alters. The Hilgards demonstrated that normal hypnotized subjects can similarly dissociate pain into a covert cognitive structural system which they called the "hidden observer." The Watkins discovered that "hidden observers" appeared to be the same phenomenon as "ego states." "Ego-state theory" assumes that human personality develops through integration and differentiation. At one end of the continuum, "differentiation" is adaptive. Ego states possess relatively permeable boundaries as in normal moods. At the other end ego-state boundaries become less permeable. Normal "differentiation" becomes maladaptive "dissociation" and multiple personalities may be created. In the intermediate range of the differentiation/dissociation continuum, "covert" ego states can be found in many normal subjects who volunteer for hypnotic laboratory experiments. Normal individuals, like multiple personalities and "hidden observer" subjects, can displace (dissociate) pain into "covert" ego states. The pain is not eliminated. This suggests that when we remove pain by hypnosis we may not be getting away "scot-free."

Dissociative Disorders↗
PubMed1992

The interface between multiple personality, spirit mediumship, and hypnosis.

In this paper I draw parallels between multiple personality, spirit mediumship, and hypnosis from historical, anthropological, and clinical perspectives. I emphasize Milton H. Erickson's view of multiple personalities as not necessarily pathological but as potential resources. He employed hypnosis to gain access to personalities and to transform their behavior from involuntary to voluntary actions. I discuss similarities between this view and the use of spirits as a resource with mediums. Natural trance therapies in other cultures offer a new perspective for viewing the normalcy or pathology of "other selves."

Dissociative Disorders↗
PubMed1993

Ego-state therapy: an overview.

Ego-state therapy is a psychodynamic approach in which techniques of group and family therapy are employed to resolve conflicts between the various "ego states" that constitute a "family of self" within a single individual. Although covert ego states do not normally become overt except in true multiple personality, they are hypnotically activated and made accessible for contact and communication with the therapist. Any of the behavioral, cognitive, analytic, or humanistic techniques may then be employed in a kind of internal diplomacy. Some 20 years experience with this approach has demonstrated that complex psychodynamic problems can often be resolved in a relatively short time compared to more traditional analytic therapies.

Dissociative Disorders↗
PubMed2001

Generalized dissociative amnesia: episodic, semantic and procedural memories lost and found.

OBJECTIVE: This review tests Ribot's classic twofold categorization of generalized amnesia (GA) into Type I, total loss of episodic memory, and Type II, additional more or less extensive loss of semantic and/or procedural memory. It also explores his law of regression, according to which, cast in modern terms, recovery of lost procedural and semantic memories precedes recovery of episodic memory, as well as reported aetiological factors. METHOD: Clinically and formally assessed cases of GA, published since 1845, were surveyed and further analysed. RESULTS: Over and above authentic episodic memory loss, cases differed widely in the extent of impairment of semantic and procedural memory. Recovery of semantic and procedural memory often preceded recovery of episodic memory. This particularly applied to authenticated trauma memories. To an extent, lost memories affected current functioning, and in some cases were associated with alternating dissociative personalities. Severe memory distortions upon memory recovery were not reported. Most cases were trauma or stress related, while in some cases the aetiology remained unknown. CONCLUSIONS: Contrary to the view expressed in DSM-IV, which states that dissociative amnesia pertains to an inability to recall personal information, GA may also involve loss and recovery of semantic and procedural memories. Since the loss of various memory types in GA is dimensional rather than categorical, Ribot's typological distinction does not hold. Some of the reviewed cases suggest a trauma-related aetiology. Generalized amnesia of varying degrees of severity can involve delayed retrieval of trauma memories, as well as the loss and delayed retrieval of the premorbid personality.

Amnesia↗
PubMed2004

Establishing and running a trauma and dissociation unit: a contemporary experience.

OBJECTIVE: To evaluate the functioning of a trauma and dissociation unit that has run for the past 8 years in a private hospital, with particular regard to operating philosophy, operating parameters, challenges encountered, research and educational initiatives, and the applicability of the treatment model to other settings. CONCLUSIONS: Despite the challenges associated with significant difficulties in the corporate management of a private health-care system, it has been possible to operate an inpatient and day hospital programme tailored to the needs of patients in the dissociative spectrum, and the lessons learnt from this experience are valid considerations in the future planning of mental health services overall.

Cooperative Behavior↗