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PubMed1994

Catharsis and abreaction in the history of psychological healing.

With roots in ancient religious practices of purification and cleansing and in ancient medicine's purgings, Plato evolved a verbal catharsis for diseases of the soul, and Aristotle developed a catharsis of the passions through tragic drama. Through the centuries, most cultures have had recognized contexts in which emotions were evoked, heightened in intensity, and ultimately released or discharged; and cathartic procedures can be detected in many cultures' healing practices. The late decades of the nineteenth century saw the emergence of numerous psychological healings with a cathartic basis. Catharsis came to mean the lively remembering of a traumatic experience in addition to the emotional release; and the term abreaction frequently was used to refer to the emotional release. Subsequently, the notion that the recovered traumatic memories needed to be integrated with the rest of the patient's mental life became a third significant element. The significance of these three factors has been debated vigorously; but, whether it has been some combination of them or merely the emotional discharge, there has been a cathartic element in many twentieth-century approaches to psychological healing.

Abreaction↗

PubMed1994

The history of trauma in psychiatry.

The accidental separation of PTSD and the dissociative disorders, based on the unfortunate fact that the PTSD and the dissociative disorder workgroups of the DSM-III never met to compare data, and the lack of knowledge within the workgroups of existing research connecting these disorders, will continue in the DSM-IV. That separation, however, is slowly being eroded by a solid body of research that shows that these conditions rarely occur independently. Thus, contemporary research is beginning to show that the original concept of "hysteria," formulated 150 years ago to capture a group of patients who have complex psychological and somatic problems and whose problems often elude intervention from the medical and psychological professions, is alive and well among patients on the verge of the twenty-first century. Although the DSM process has attempted to create cleaner diagnostic categories, 100 years of research on traumatized patients consistently shows that these patients defy easy classification, and that they seem to have symptoms that represent somatic, social, symbolic, and intrapsychic adaptations to having experienced overwhelming terror. Thus, what the DSM split when it abolished hysteria as a diagnosis, has once again been found to constitute a syndrome, a conglomeration of symptoms, first defined by Briquet and Janet more than 100 years ago, which is the result of severe and prolonged interpersonal abuse, usually starting in childhood. One hundred years of research has shown us that patients often cannot remember and, instead, re-enact their dramas. The professions ministering to these patients have had similar problems with remembering the past, and thrice in this century have forgotten the hard-earned lessons from our patients. It is not likely that these amnesias and dissociations will be a thing of the past; they are likely to continue as long as physicians and psychologists are faced, helplessly, with man's inhumanity to man.

Combat Disorders↗

PubMed1994

[The myth of the good savage].

The conquest of the New World gave way to the myth of the Good Savage. For the Renaissance intellectuals, the ancient ideas about the Golden Age (an ideal society promising an unending bliss) seemed to be brought back to life at last. Sharply contrasting with the European exacerbated unrest of the time, America stood for a redeeming hope, a symbol of a better future. The myth of the Good Savage assumes people to be naturally good, but civilization has led them into the realm of violence, hatred, and cruelty. Besides being naturally good, nice-minded people, "good savages" were also useful, obedient people, most likely to be easily exploited by Europeans--a source for the historical drama to come. On the verge of freeing itself from the Spanish rule, Latin America--fighting its way toward independence, had three enlightened mentors: Voltaire, Rousseau, and Montesquieu. There, again, another deep contrast arose between the abstract characteristics of Latin American aims to perfection, and people's actual behaviors. The former "good savage" became the modern "Latin American" embodying an utopia as well as a hope in his eagerness for setting up a plural, and humanized culture. The myth of the Good Savage represents a deep longing for an objectivation of the ego-ideal: it has been used, so to speak, in collective mobilizations as well as dogmatic crystallizations, to escape from ignominous realities or to project alternatives for a better socially-shared life.

History, 15th Century↗

PubMed1993

[Breast cancer: the unspeakable].

The drama with the language is that "putting in words" creates an uncrossable chasm between the felt and the expressed. There are moments where the impossibility to communicate cuts the links between doctor and patient. And this often happens in a consultation after the breast cancer has been announced. The unspeakable then, stands between the two protagonists, as the spectral appearance of death. For the patients, the medical revelation then becomes an anathema. The doctor who says the word, becomes the one who overturns a destiny for ever. One knows from greek mythology that confronted to the tragic of his destiny, man hears the ineluctability of the oracle but cannot accepts it. It is the role of the psyche to divert the prophecy so as to have space for hope, for a project of live. To tell, not to tell, how to tell: there is no rule. The misunderstanding is inexorable: it sighs the discordance between the medical reality of the breast cancer, the subject desire and the implication of the doctor who is wedged between the one and the other.

Breast Neoplasms↗

PubMedDate not supplied

[Experiences in community participation to promote nutritional education].

This paper presents several experiences obtained in the Rural Research Center of the Solís Valley in relation to community participation programs. The main objective of these projects was to improve the nutritional practices of children in the rural areas of highland Mexico. As first experience, small groups were formed with mothers, fathers, married couples and teenagers. Each of these groups started a project oriented to promote nutritional self-sufficiency. One group of mothers was successful in assuring the provision of government subsidized milk in their community. A second group of mothers started a chicken-raising farm, but the project failed because all the chicken died in an epidemic. The group of fathers started a sheep-raising project as the first step to get a milk-producing cow. The sheep-raising was successful, but when the sheep were sold each man in the group kept the revenue to himself and the group disappeared. The married couples were successful both in a home-gardening project and in a chicken-raising farm. The teenagers were also successful with their home-gardening project and acted as "injection groups" to spread the project in other communities. As a second experience in community participation, community health workers taught mothers how to use locally available food to improve their diets, preparing culturally acceptable food recipes. This intervention was successful in increasing mother's awareness of a balanced diet. A second intervention combined the presentation of a drama ("peasant's theater") in order to increase mother's participation in these projects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1976

Recent advances in the treatment of postischemic encephalopathy. A review.

Irreversible brain damage after a short period of cerebral ischemia is a clinical drama. Not neuronal dead in se, but a hemodynamic event, described as no reflow phenomenon (NRF) seems to be the primary pathogenetic factor towards fatal outcome. A combination of four flow promoting therapeutic measures (heparinisation, hemodilution, systemic arterial hypertension and brainflushing with dextran 40) greatly improves recovery of the brain function after 12 min. of cardiac arrest in dogs. Short acting barbiturates provide remarkable amelioration of postischemic encephalopathy in the monkey.

Animals↗

PubMed1993

Women at risk of family violence.

Presented here are the basic, core picture and pathognomonic features of spouse (or partner) violence, stripped of obscuring traditional, often male-dominated misinformation. Spouse abuse, like other forms of intentional injury or violence, should no longer be considered tolerable or "normal." It represents a form of psychopathology, corrupting the family emotional setting, provoking human anguish and even death. It often perpetuates itself into the next generation. Assault or murder by an abusive male or lover must be recognized as an all too common, preventable, public health issue. Health care and legal professionals, as well as the public at large, must be informed to recognize the features of this tragic family drama. State laws and welfare agencies have started to accommodate this problem, directing victims to appropriate counseling, support and protection. Reluctant or passive police, attorneys and judges may present considerable frustration to those trying to assist these families.

Female↗

PubMed1995

Love and the heritage of the past.

In this paper, the author explores the difficulties in developing the capacity to fall and remain in love, as shown in a case study of a Holocaust survivor's daughter whose mother lived through the Holocaust as a child. These difficulties arose from the inability of the daughter to go through the mourning processes necessary for the separation from her bereaved mother, as well as from the daughter's fixation on the mother's interminable, unresolved mourning. The daughter exploited her relationships with the love objects in her life to play the role of the victim/persecutor. She thus enacted the drama of facing death and being rescued through flight or promiscuity, elements which were dominant in her fantasies relating to her mother's past. The working through of the transference relationship helped her become aware of the unconscious meaning embedded in her actions and eventually lessened her need to live her mother's past in her own life.

Adult↗

PubMed1995

Conflict resolution with end of life decisions in critical care settings.

This demonstration will present the key modules from an innovative videodisc-based program that was designed as an educational tool for health care professionals. It provides a resource for learning to deal with patients and families regarding the increasing problematic area of end-of-life-decisions. Tough Choices: Ethics, the Elderly, and Life-Sustaining Technologies is an interactive program that combines abstract ethical approaches with the realistic drama of a critical care setting. The format integrates scientific facts about the patient with value questions regarding the utilization of life-sustaining technologies. The unique program provides health care personnel with strategies on how to guide family decision-making as well as examples of the various interventions. This interactive multimedia program opens up an opportunity for health care providers to participate in a clinical case in which life and death decisions are made. Learners can explore various perspectives and treatment options within the framework of the dramatic case presentation without the usual time constraints or worries about causing harm to patients. The program involves learners in a variety of ethical and legal dilemmas that centers around a patient, her family, and a variety of health care professionals. Dramatic advances in the development of life-sustaining medical technologies have given hope to many people whose conditions would have meant certain death only a few years ago. As access to the technologies has expanded, concern for their appropriate utilization has become an issue worthy of increasing attention. Questions about the benefits of life-sustaining treatments are being raised in many quarters, particularly when the technology is viewed as a modern means of postponing death and prolonging suffering. Tough Choices brings to life the story of Irene Sullivan, an elderly widow who has an unexpected heart attack. Suddenly, her very existence depends on the life-support provided by mechanical ventilation and cardiopulmonary resuscitation (CPR). This is a growing area of concern since more than half of the patients who receive CPR and tube feedings and one third of the people receiving mechanical ventilation are 65 or over. Mrs. Sullivan's health care team is forced to deal with the opposing viewpoints of several close family members regarding the utilization of advanced medical technology. The interactive program invites viewers to explore the complex ethical and legal dilemmas involved in making life-and-death decisions about her care. It also permits immediate access to supportive resources in three areas: the clinical chart, abstracts of relevant research studies on life-sustaining technologies, and information from the professional literature on advance directives. The program incorporates practical steps involved in implementing the Patient Self-Determination Act as it follows the patient from the time of hospitalization through a series of life-threatening crises. Two very different aspects of the role of the health care professionals were explored: a crisis mode which covers the steps in managing a full-blown crisis situation, and a prevention mode which analyzes steps that could have been followed to keep an ethical crisis from occurring. The strong role models for practice display many of the characteristics that the helping professions need to foster in an atmosphere of healthcare reform.

Advance Directives↗

PubMed1996

Annual update of how each state stands on legislative issues affecting advanced nursing practice.

The change from a free-for-service system to a system run by managed-care organizations has caused dramatic shifts in where and how health care is delivered. Within the managed-care systems, administrators need to show a good bottom line. Rapid restructuring of the system and the need for profit create many potential consequences (e.g., APNs squeezed out of participation on some provider panels; previously unattractive poor patients are now attractive because they can provide an ongoing revenue base; the use of more unlicensed personnel to provide patient services). Private businesses and the federal government like managed-care health care systems as an answer to the out-of-control escalating costs of health care. Managed care is likely to stay with us for a long while. Because political force comes from money and there is plenty of that in health care insurance corporations, managed care is likely to be with us for a long time. Regulations and control of these managed-care systems will probably be difficult. However, though big business has the money, APNs have the feet, hands and patience to seek further regulation of these huge corporations (e.g., antidiscrimination language to prevent exclusion from provider panels). With the reality of managed care, MDs are no longer in control of the health care system. The AMA's recent attempt to control other providers is tantamount to one ship officer attempting to control another on the Titanic's (i.e., fee-for-service system's) last evening. In a few states, fee-for-service is still predominant, but the majority of states are rapidly moving into megaconglomerate, finance-driven managed care run by business administrators. Things are getting so complex in today's world of corporate takeovers, managed-care megaconglomerates, and power-brokering politics that it is easy to understand why millions of Americans drown themselves in relatively simplistic good-versus-evil entertainment dramas. Huge changes in how the system operates have happened this year while the nation was busy following the Simpson trial. But NPs and other APNs must be very vigilant. We must ensure a place in this new system. Our patients and the nation need us!

Drug Prescriptions↗

PubMedDate not supplied

How the Burford reflective model boosts care standards.

Reflective practice is grounded in the practitioner's everyday experiences. This is why this second part of an examination of reflective models of nursing considers the experiences of two nurses who used the Burford reflective model to inform and refine the care they offer. One reflects on a routine series of community visits, the other focuses on the drama and distress surrounding a terminal illness.

Community Health Nursing↗

PubMedDate not supplied

How the Burford reflective model boosts care standards.

Aged↗

PubMed1996

Suicide: a multidimensional malaise.

No one really knows why human beings commit suicide. The goal of this paper is to provide a psychological point of view on the topic, among the many other perspectives that are needed. It addresses the question by providing a theory of suicide, arguing that it is theory that allows us to sort out the booming buzzing mess of experience (Wm. James). Suicide is a multi-dimensional malaise. Metaphorically speaking, it is an intrapsychic drama on an interpersonal stage. As sound theory must be empirically observable, the theory is next applied to research of suicide notes, studying such factors as age, sex, and method of suicide, cross-culture and cross-time. Next, because all theory must have clinical applicability, a clinical case study of Goethe's Werther is provided. Overall, it is concluded that we need to continue to develop models to understand the suicidal mind.

Adaptation, Psychological↗

PubMedDate not supplied

[Murder of the mother by the daughter--family dynamics and mythology].

The comprehensive casuistry, which is based on the forensic examination by the author illustrates a family-drama, in which a 19-year-old girl killed her alcohol and tablet dependent mother in multiple ways and later, with the help of the three years younger sister plastered the body in a sarcophagus inside the apartment. The paper will delineate the life-circumstances, the family- and the psychodynamic of the criminal act. Beside a review of the literature concerning matricide by the daughter, the dynamic aspect of the matricide will be discussed on the basis of the greek tragedies Elektra (Sophokles) and Medea (Euripides). The victim is compared with the part of Medea, the fate of the daughter with the fate of Elektra.

Adult↗

PubMed1996

[Psychiatric emergencies].

Psychiatric emergencies must not just be seen as catastrophies. They invariably represent the nadir of a development which has not been given enough attention while it arose. In contrast to a typical medical emergency situation the doctor is usually not particularly welcome by the disturbed psychiatric patient and his family. This may represent some hardship for the good doctor. When arriving at the scene of a psychiatric emergency, an accurate differential diagnosis will be of primary importance. Suicidality, disturbances of consciousness, states of excitement, dyskinesias and affective crises are the most frequent findings. In contrast to a somatic crisis where rapid intervention may be life-saving, it is advisable, to take your time and make sure you took everything into account, before making a decision. Sometimes the use of medication can dramatically change the scene from drama to dialogue. Basically, one has to determine if a hospitalization is necessary or not. Two primary concerns have to be looked into here: suicidal risk and dangerousness to others. It is good to be aware of those situations and diagnoses well known for their high suicidal potential. The question which - if any - compulsive measures have to be taken has to be answered and acted upon. Unpopular as they may be, they can resolve an extremely difficult situation within minutes. Unnecessary hesitation is not asked here for the sake of the patient as well as his family. The best way to deal with psychiatric emergencies is to avoid them. Looking out for signs and symptoms of a beginning psychotic development or suicidal ideation and acting upon it, for instance with medication and/or intensifying contacts with the patient are the primary means to prevent a crisis. Stopping medication, by patient or doctor, is one of the main reasons for psychiatric emergencies. After a psychiatric emergency has evolved, it pays out, to carefully analyse its development, the way it was handled and how it finally ended. Thus a crisis may, like the Chinese symbol for it with its double meaning, evolve to a chance for the patient.

Acute Disease↗

PubMed1977

Notes on Ibsen's Peer Gynt.

A short account of the verse drama Peer Gynt is given, showing its setting in Ibsen's life and work, and its content. The paper relates what the poem tells us about Ibsen to what I know of him from elsewhere, specifically to certain conflicts and the search for his "true self." It also relates the poem to the experience of psychoanalysts and psychiatrists (illustrating this with clinical material), and finally, to aspects of the world today.

Humans↗

PubMed1997

Play in the treatment of adolescents.

I propose a view of the treatment process with adolescents which places interactive play at the center. The adolescent plays by creating a highly charged interpersonal drama with the analyst to work out specific developmental conflicts. These conflicts involve struggles for greater autonomy and the formation of a solid sense of identity in the face of regressive pulls. The analyst unwittingly is taken up in the play and uses his or her sense of involvement as material for interpretation to further the play or resolve periods of strain when play falters.

Adolescent↗

PubMedDate not supplied

[Oedipus tragedy].

Taking into account Paul Ricoeur's theories, two possible hermeneutical positions in front of Oedipus' drama are considered. One is to view it as a fatalistic destiny, bred into the darkest incestuous trends any infant is fighting against, and leading to unavoidable stigmata of everlasting nature. The other is to conceive it as the response to present naked truth, resulting from deep reflexion in order to attain real consciousness of oneself. The former is the "backwards conception", having its own limitations, in its very being buried into the past. The latter, having its projections forward, centers on anguish and anxiety aroused by consciousness of oneself, seeked by the alert responsible mind, able to afford reality and truth with all their thorough implications. The author's existential position embraces the secon conception which had been already exposed by Sophocles in Oedipus in Colonna. The dialectics are set between seeing and knowing. Tiresias is blind, but he can see, because he can afford truth, and its consequence, guilt. Oedipus must fight to attain the possibility of knowing, and must go into the ordeal of losing his eyes, as the only way to reach true self realization, through facing truth and bearing anguish.

Humans↗