Posts tagged knafo
Posts tagged knafo
Psychoanalysis for Serious Mental Illness? YES!
By Danielle Knafo, Ph.D., professor, Clinical psychologist and psychoanalyst; and creator of SeriousMentalIllness.net
Some people believe that psychoanalysis, a theory and therapy created over a century ago by Sigmund Freud, is not a treatment of choice for serious mental illness. I strongly disagree with this view. Here are ten reasons why:
1. Psychoanalysis is known for client-centered care. The client is considered the authority on him or herself and the psychoanalyst is attuned to listening to the client who, most often, takes the lead in the treatment. Unlike other therapies, here the client is at its center and the therapy takes place with a great emphasis on the client’s own experiences and expressions. Thus, importantly, there is a balance in power and responsibility. Unlike many forms of mental health treatment, which take authoritarian stands with clients, psychoanalysis is a collaborative process with each participant’s involvement forming a crucial part of the whole.
2. At the root of psychoanalytic treatment is the need to understand how and why people become the way they do. What circumstances in their lives caused them pain or trauma? Today we know that trauma is a leading precipitating factor in many forms of mental illness, including personality disorders and psychoses. Identifying the trauma, giving it a name, creating a narrative for it, and finding meaning in it all help people to heal and grow from disruptive and overwhelming forces in their lives. Key to psychoanalytic treatment is attention to the individual. Psychoanalysts know that every individual is different, and they listen to each person’s story to create with that person a treatment plan. It is the only treatment approach that begins with a questioning attitude rather than a knowing attitude.
3. Psychoanalytic treatment is the only therapy that takes into account both conscious and unconscious forces. Most of the time, people do not know why they behave the way they do. This is because a large part of our knowledge is unconscious. When struggling with mental illness, it is important to help the patient surface the unconscious elements so as to understand the reasons for unusual, painful or uncontrollable behaviors.
4. Psychoanalytic methods pay attention to a person’s defense mechanisms. We all use defense mechanisms. This is part of being human. Yet some defenses are healthier than others and help us better adapt to and cope with the world. Psychoanalytic work aims at identifying harmful defenses and replacing them with healthier, more adaptive mechanisms. For example, a person might deny reality by refusing to believe that he was fired from his job. Imagine the problems this defense might cause. Such a person might return to the place of employment, develop a delusion about his boss and coworkers, or even believe God wants him to exact revenge. Psychodynamic therapists would help this person acknowledge the pain and helplessness he feels and replace the denial with constructive reality adapting defenses.
5. Attention to symptoms is another feature that psychoanalysts hold dear. Most doctors and therapists working in the field of mental health pay attention to symptoms, but many of them do so to construct a diagnosis and/or eliminate the symptoms. Psychoanalysts do not rush to eliminate symptoms because they know that symptoms are meaningful, and one does not take away a person’s meaning without offering them something else in its place. Rather than cure someone, eliminating symptoms can deepen the illness and even cause a breakdown.
6. Many people with serious mental illness are highly sensitive. Some of them feel too much and are overwhelmed by the world. They have trouble knowing, understanding and regulating their emotions. Psychoanalysts are experts at helping people identify and regulate what they feel. Patients learn to tolerate difficult emotions and to bear what is felt to be unbearable.
7. Many people who have serious mental illness go through states of regression. They stop taking care of themselves and become dependent on others. Unfortunately, many hospitals infantilize the mentally ill and treat them like children, which does not foster growth and independence. Yet, sometimes it is important to avert regressed states, and other times regression can bring us back to a place we need to know. Regression in a safe space and in a trusted relationship can at times be an extremely curative experience. British psychoanalyst and pediatrician, D.W. Winnicott spoke about the healing aspects of regression. Sometimes it is important to go back to move forward. Psychoanalysts are keen to this process because they have strong theories of development. They know what a child needs at different stages of development and what can happen if the child does not get its needs met. Psychoanalytic treatment has been called a “corrective emotional experience.”
8. Psychoanalysts explore a client’s problems as well as her strengths. Since Freud, we know that no one is only sick, pathological or engages in maladaptive behavior. Everyone has what Buddhist psychoanalyst, Edward Podvoll called “islands of clarity.” Analysts are well trained to identify and work with their client’s talents because it is these talents and skills that will help overcome the problems.
9. Most importantly, psychoanalysis recognizes the value of relationships. The therapeutic relationship is a central component of the treatment and psychoanalysts allow themselves to be “used” in different ways in the therapeutic relationship. Persons who have had disorganized attachments or abusive or neglectful early relationships with their primary caretakers often develop mistrust in their relationships, or they repeat the abusive patterns they grew up with. This repetition also takes place in the therapy relationship and psychoanalysts are trained to recognize relational blueprints and not take things personally but, rather, to use the relationship to create new ways of relating. Sometimes clients feel they can trust for the very first time. This sense gets generalized to other relationships in their lives.
10. Finally, psychoanalysis is not a rushed treatment. Some people make fun of the time it takes. In this age of short-term treatments and brief hospitalizations, psychoanalysis stands out as perhaps the only treatment that recognizes the time it takes to change life-long patterns. Psychoanalysts know that it takes time to uncover the roots of problems and to alter maladaptive behavior. They are prepared to invest the time it takes.
For all these reasons, and more, psychoanalysis can be highly beneficial to those who suffer from serious mental illness. Prolific author and psychoanalyst, Christopher Bollas, in his most recent book titled Catch Them Before They Fall: Psychoanalysis of Breakdown, claims that psychoanalysis is the treatment of choice for psychosis. Not all psychoanalysts specialize in serious mental illness, but some do. For those who cannot afford private treatment, they can go to local psychoanalytic institutes or mental health clinics that offer low-fee services. Psychoanalytic treatment is conducted with or without medication, depending on what the therapist and client decide. If you are interested in finding a psychoanalytic therapist in your area, the following sites can be of help.
It’s been two years since I decided to create this blog on serious mental illness, and we now have over 10,000 followers! Initially, a blog meant to be a resource center for LIU graduate students in the Serious Mental Illness concentration, the post now attracts the attention of many educated lay people who find the study of the troubled mind an important concern for a variety of reasons. Many thanks go to Tristan Barsky, my research assistant who does an outstanding job of managing the blog! Without him none of this would have been possible. In addition to updating the archival sections, we’ve begun writing original articles. We would love to hear feedback to know what you most like about the blog and what topics you’d like us to cover in the future.
Many people think mental illness is rare. Nothing could be further from the truth. Over a quarter of Americans 18 or older suffer from a diagnosable mental illness in any given year. Whereas Post Traumatic Stress Disorder claims 3.5% annually, this number is deceptive. Many disorders besides PTSD have serious trauma at their base. Some of these include Dissociative Disorders, Borderline Personality Disorder, Psychoses, Addictions, Eating Disorders, Perversions, Antisocial Personality Disorder, and more. Twenty million people suffer from mood disorders (6.7% Major Depression and 2.6% Bipolar Disorder). Approximately 30,000 Americans take their lives each year. The number is 22 per day among US veterans.
We’re talking about a great many people. The simple truth is that no one is far away from mental illness—either themselves or in someone they know. Sadly, many of these people don’t get the help they need. Since my decades in the profession, I’ve seen a progressive decrease in mental health professionals who specialize in the care of SMI. It seems they’ve left suffering minds to psychiatry and pharmacology, two professions that focus primarily on illness and symptoms rather than strengths and recovery. These professionals now speak of “broken brains” instead of people facing hardships. They believe that if the brain is broken then the treatment must be biological. I have nothing against medication, but I lament the reduction of the person to a diagnosis solely treated with chemicals as well as the widespread and facile use of drugs. This practice has led to the unquestioned assumption that people often need to be medicated for life. Human and relational components of the treatment have unfortunately taken a back seat to medications, and that’s if they are included at all.
As a psychoanalyst, I’ve dedicated a good part of my career to the education and treatment of serious mental illness. I believe it is critical to educate the heart, not merely the mind because I have seen that too many people labeled with broken brains in fact have broken hearts, and what they need more than anything is a compassionate relationship with someone who understands how people can lose their way. Time and again, I have watched how the therapeutic relationship, which offers patience, understanding and meaning-making, helps people come through the most difficult travails.
I’ve also encouraged engagement in the arts for those living in extreme states. I’ve no doubt based on my experience that many creative individuals suffer from mental illness of some kind. Artists often have heightened sensibilities and perceptions that facilitate an original perspective on life. Creative work facilitates communication of what they see and what they are going through. Art making serves to release intense emotion and helps people know themselves better through it. This is why I created our second blog, Art from the Edge (again, thank you Tristan Barsky!) to offer a virtual gallery to all those who’d like to share artwork created in edge states. I encourage those who suffer extreme states to create and to express their experiences through literature, visual art and music. As well as being highly therapeutic, putting one’s experiences into art becomes a gift to others who seek expression for what they are going through.
My vision for this blog is to better educate people about mental illness. Here we create a venue for those who struggle to speak out and share their experiences in their own words. The blog is a place where people can go to read about recent research or to find an opinion piece on any aspect relating to serious mental illness or its care. Most of all, this blog is meant to encourage a humane, compassionate and nonjudgmental understanding of serious mental illness.
The Uncanny Valley and the Medical Model
By Danielle Knafo, Ph.D., Creator of SeriousMentalIllness.net
Professor and chair of the Serious Mental Illness Concentration at LIU’s Clinical Psychology Doctoral Program
Sigmund Freud popularized the concept of the uncanny in 1919 to refer to our discomfort (unheimliche) with things that are familiar yet seem alien. Examples he used are dolls (humanlike yet nonhuman) and the dead (of the human yet no longer human). These examples, he claimed, create a discomforting effect in people because they are recognizable and strange at one and the same time.
In 1970, Japanese robotics professor, Masahiro Mori, expanded on Freud’s examination of the uncanny by applying it to robotics and animation. It appears that people are attracted to robots that resemble humans until the machine looks a little too much like a human while retaining the appearance and movement qualities that signal artifice; the reaction then becomes imbued with revulsion. As the robot continues to become increasingly humanlike, the response returns to attraction. The point of revulsion is referred to as the “uncanny valley” because it marks the area in between the almost human and the fully human. This area of perception is where we cannot clearly distinguish the idea of what is real from what is not.
Clearly, we are uncomfortable with finding ourselves in a state where objects and their meanings are not clear and where reality is not cleanly distinguished from fantasy. Yet, I believe that it might sometimes benefit us to place ourselves precisely in a situation that elicits uncanny responses. Allow me to explain.
I’ve been thinking about this term and how it might apply to the ways mental health professionals conceptualize and teach mental illness. As a clinician and professor, I have always been struck by the tendency to pathologize people with psychological problems, a tendency that creates an “us vs. them” mentality. Freud himself was against such thinking. For him, psychopathology always existed along a continuum. We all have elements of the normal and the abnormal—it’s simply a matter of degree. For example, we are all psychotic (in our dreams); we are all perverts (in infancy); we all engage in magical thinking (superstitions and beliefs); we all somatize (get headaches or stomach aches or catch colds) at critical times; we all experience anxiety (separation and loss) and we all live with fears, some of them quite serious and justified (mortality).
Unfortunately, the medical model does not adhere to such thinking. The DSM, a diagnostic manual for categorizing mental illness, focuses on symptoms as signs of illness. A person is easily reduced to a collection of symptoms rather than regarded as a whole person with healthy and unhealthy parts, with strengths as well as weaknesses, with talents and skills as well as defensive embodiments. I believe that one purpose of categorizing people according to their symptoms, pathology, and brain malfunctioning is to render them case studies rather than complex human beings who have many sides to them and to whom many things have happened. The result is to distinguish them from “us.” They are the ill ones. They are the crazies. They have broken brains. Not us. No way. Not us!
I have taught psychopathology and trained students in the treatment of serious mental illness for years. One of the ways I do this is to have them step into the shoes of the “patient.” My tests include items that require students not to describe but, rather, to embody all of the disorders they learn about. They become the borderline, the narcissist, the paranoid schizophrenic, the addict and the bulimic. Naturally, this creates an uncanny feeling in them–– which is exactly the point! My aim is to make it more difficult for them to fall into the comfort of binaries. We seek to intentionally blur the boundaries so adamantly held onto by the medical model which reduces the “patient” to a diagnosis or disease; not a living subject but an object of study.
Perhaps we should all swallow hard, face our fears, and enter the uncanny valley that challenges separations among people. Perhaps once we endure the discomforting emotions, we can develop a more empathic and less stigmatizing approach to all humans, especially those who suffer the most extreme existential conditions and who live on the edge of human experience.
Children who have lots of bad dreams and nightmares are at a greater risk of suffering psychosis, a study has shown.
Research showed that for 12-year-olds, nightmares more than tripled the occurrence of psychotic symptoms such as hallucinations and delusions.
And children aged between two and nine who were most plagued by bad dreams were 56 per cent more likely to experience later episodes of psychosis than those whose sleep was undisturbed.
However, scientists have moved to reassure parents that nightmares are common in young children, and that they usually grow out of them.
Lead researcher Professor Dieter Wolke, from the University of Warwick, said: ‘We certainly don’t want to worry parents with this news; three in every four children experience nightmares at this young age.
'However, nightmares over a prolonged period or bouts of night terrors that persist into adolescence can be an early indicator of something more significant in later life.'
The study, part of a wide-ranging health investigation called the Avon Longitudinal Study of Parents and Children (Alspac), recruited more than 6,700 children.
By the age of 12, around a quarter of the group reported having nightmares in the previous six months.
Fewer than one in 10 experienced night terrors, which are often signified by a loud scream and the individual sitting upright in a panicked state, though unaware of any of the involuntary action.
Nightmares and night terrors are often confused but very different forms of sleep disturbance.
The former tend to occur during the shallower REM (rapid eye movement) part of the sleep cycle, when most dreaming takes place.
Night terrors happen during deep sleep, causing the unaware sleeper to sit bolt upright in a panicked state, thrash about or scream.
The children were assessed six times between the ages of two and nine. Higher rates of nightmares during this period were found to increase the likelihood of psychosis.
Children who reported persistent nightmares at only one of the assessment time points were 16 per cent more likely to experience adolescent psychotic episodes than those who had no nightmares.
Three or more nightmare periods were associated with a 56 per cent increased risk.
At 12 years of age the risk of psychosis was more than tripled by having nightmares and almost doubled by night terrors.
Lucie Russell, from the charity YoungMinds, which campaigns to improve the mental health of children and young people, said: ‘This is a very important study because anything that we can do to promote early identification of signs of mental illness is vital to help the thousands of children that suffer.
'Early intervention is crucial to help avoid children suffering entrenched mental illness when they reach adulthood.'
For more mental health news, Click Here to access the Serious Mental Illness Blog
Fact vs. fiction: Ending the stigma of mental illness
By Bonnie Weber-Richardson
Many times we think we understand something well, but we may just not have all the facts. When it comes to mental illnesses, there is a misunderstanding on what it is, and most importantly what it isn’t. If you are considering treatment for yourself or someone you love, it is crucial to differentiate between fact and fiction. Here’s some help to know the truth.
FICTION: Only “crazy” people get mental health treatment.
FACT: Mental illness can happen to anyone. You are not alone. The National Alliance of Mental Illness (NAMH) states that “one in four adults, approximately 61.5 million Americans, experience mental illness in a given year and approximately 20% of youth ages 13 to 18 experience some kind of mental disorder in a given year.”
FICTION: Mental illness is a sign of weakness.
FACT: Mental illness is not caused by personal weakness. It is a disease like any other and cannot be easily cured by positive thinking or willpower. Mental illness is not related to a person’s character or intelligence. It falls along a continuum of severity. Some people require proper treatment.
FICTION: People will think it is my fault and that I’m a bad person.
FACT: Like most diseases of the body, mental illness has many causes (genetics, biological, environmental, social/cultural). Consequently, it is not caused by one single factor. Mental illness usually strikes individuals in the prime of their lives, often during adolescence and young adulthood. All ages, genders and races are susceptible.
FICTION: Children are not diagnosed with mental illness.
FACT: National Institute of Mental Health (NIMH) states that “Four million children in this country suffer from a serious mental disorder that causes significant functional impairments at home, at school and with peers. Half of all lifetime cases of mental disorders begin by age 14. Despite effective treatments, there are long delays, sometimes decades, between the first onset of symptoms and when people seek and receive treatment.”
FICTION: Men do not need to seek mental health treatment.
FACT: According to the NIMH, in America alone, more than 6 million men have depression each year. This does not include other types of mental illness prevalent among men such as anxiety disorder, post- traumatic stress disorder (PTSD), anger management, and alcohol and substance abuse, among others.
FICTION: People with a mental illness will never get better.
FACT: The best treatments for serious mental illnesses today are highly effective. The NIMH reports that “between 70 and 90 percent of individuals have significant reduction of symptoms and improved quality of life with a combination of pharmacological and psychosocial treatments and supports.” With appropriate effective medication and treatment, most people who live with serious mental illnesses can significantly reduce the impact of their illness and find a satisfying measure of achievement and independence.
Early identification and treatment is of vital importance.
For more mental health news, Click Here to access the Serious Mental Illness Blog