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psychiatry  QUOTES

2 " The first inkling of this notion had come to him the Christmas before, at his daughter's place in Vermont. On Christmas Eve, as indifferent evening took hold in the blue squares of the windows, he sat alone in the crepuscular kitchen, imbued with a profound sense of the identity of winter and twilight, of twilight and time, of time and memory, of his childhood and that church which on this night waited to celebrate the second greatest of its feasts. For a moment or an hour as he sat, become one with the blue of the snow and the silence, a congruity of star, cradle, winter, sacrament, self, it was as though he listened to a voice that had long been trying to catch his attention, to tell him, Yes, this was the subject long withheld from him, which he now knew, and must eventually act on.He had managed, though, to avoid it. He only brought it out now to please his editor, at the same time aware that it wasn't what she had in mind at all. But he couldn't do better; he had really only the one subject, if subject was the word for it, this idea of a notion or a holy thing growing clear in the stream of time, being made manifest in unexpected ways to an assortment of people: the revelation itself wasn't important, it could be anything, almost. Beyond that he had only one interest, the seasons, which he could describe endlessly and with all the passion of a country-bred boy grown old in the city. He was beginning to doubt (he said) whether these were sufficient to make any more novels out of, though he knew that writers of genius had made great ones out of less. He supposed really (he didn't say) that he wasn't a novelist at all, but a failed poet, like a failed priest, one who had perceived that in fact he had no vocation, had renounced his vows, and yet had found nothing at all else in the world worth doing when measured by the calling he didn't have, and went on through life fatally attracted to whatever of the sacerdotal he could find or invent in whatever occupation he fell into, plumbing or psychiatry or tending bar. (" Novelty" ) "

10 " I began to see that the stronger a therapy emphasized feelings, self-esteem, and self-confidence, the more dependent the therapist was upon his providing for the patient ongoing, unconditional, positive regard. The more self-esteem was the end, the more the means, in the form of the patient’s efforts, had to appear blameless in the face of failure. In this paradigm, accuracy and comparison must continually be sacrificed to acceptance and compassion; which often results in the escalation of bizarre behavior and bizarre diagnoses.The bizarre behavior results from us taking credit for everything that is positive and assigning blame elsewhere for anything negative. Because of this skewed positive-feedback loop between our judged actions and our beliefs, we systematically become more and more adapted to ourselves, our feelings, and our inaccurate solitary thinking; and less and less adapted to the environment that we share with our fellows. The resultant behavior, such as crying, depression, displays of temper, high-risk behavior, or romantic ventures, or abandonment of personal responsibilities, which seem either compulsory, necessary, or intelligent to us, will begin to appear more and more irrational to others.The bizarre diagnoses occur because, in some cases, if a ‘cause disease’ (excuse from blame) does not exist, it has to be 'discovered’ (invented). Psychiatry has expanded its diagnoses of mental disease every year to include 'illnesses’ like kleptomania and frotteurism [now frotteuristic disorder in the DSM-V]. (Do you know what frotteurism is? It is a mental disorder that causes people, usually men, to surreptitiously fondle women’s breasts or genitals in crowded situations such as elevators and subways.)The problem with the escalation of these kinds of diagnoses is that either we can become so adapted to our thinking and feelings instead of our environment that we will become dissociated from the whole idea that we have a problem at all; or at least, the more we become blameless, the more we become helpless in the face of our problems, thinking our problems need to be 'fixed’ by outside help before we can move forward on our own.For 2,000 years of Western culture our problems existed in the human power struggle constantly being waged between our principles and our primal impulses. In the last fifty years we have unprincipled ourselves and become what I call 'psychologized.’ Now the power struggle is between the 'expert’ and the 'disorder.’ Since the rise of psychiatry and psychology as the moral compass, we don’t talk about moral imperatives anymore, we talk about coping mechanisms. We are not living our lives by principles so much as we are living our lives by mental health diagnoses. This is not working because it very subtly undermines our solid sense of self. "

14 " Gadgetry will continue to relieve mankind of tedious jobs. Kitchen units will be devised that will prepare ‘automeals,’ heating water and converting it to coffee; toasting bread; frying, poaching or scrambling eggs, grilling bacon, and so on. Breakfasts will be ‘ordered’ the night before to be ready by a specified hour the next morning. Communications will become sight-sound and you will see as well as hear the person you telephone. The screen can be used not only to see the people you call but also for studying documents and photographs and reading passages from books. Synchronous satellites, hovering in space will make it possible for you to direct-dial any spot on earth, including the weather stations in Antarctica. [M]en will continue to withdraw from nature in order to create an environment that will suit them better. By 2014, electroluminescent panels will be in common use. Ceilings and walls will glow softly, and in a variety of colors that will change at the touch of a push button. Robots will neither be common nor very good in 2014, but they will be in existence. The appliances of 2014 will have no electric cords, of course, for they will be powered by long- lived batteries running on radioisotopes.“[H]ighways … in the more advanced sections of the world will have passed their peak in 2014; there will be increasing emphasis on transportation that makes the least possible contact with the surface. There will be aircraft, of course, but even ground travel will increasingly take to the air a foot or two off the ground. [V]ehicles with ‘Robot-brains’ … can be set for particular destinations … that will then proceed there without interference by the slow reflexes of a human driver. [W]all screens will have replaced the ordinary set; but transparent cubes will be making their appearance in which three-dimensional viewing will be possible. [T]he world population will be 6,500,000,000 and the population of the United States will be 350,000,000. All earth will be a single choked Manhattan by A.D. 2450 and society will collapse long before that!There will, therefore, be a worldwide propaganda drive in favor of birth control by rational and humane methods and, by 2014, it will undoubtedly have taken serious effect. Ordinary agriculture will keep up with great difficulty and there will be ‘farms’ turning to the more efficient micro-organisms. Processed yeast and algae products will be available in a variety of flavors. The world of A.D. 2014 will have few routine jobs that cannot be done better by some machine than by any human being. Mankind will therefore have become largely a race of machine tenders. Schools will have to be oriented in this direction…. All the high-school students will be taught the fundamentals of computer technology will become proficient in binary arithmetic and will be trained to perfection in the use of the computer languages that will have developed out of those like the contemporary “Fortran" . [M]ankind will suffer badly from the disease of boredom, a disease spreading more widely each year and growing in intensity. This will have serious mental, emotional and sociological consequences, and I dare say that psychiatry will be far and away the most important medical specialty in 2014. [T]he most glorious single word in the vocabulary will have become work! in our a society of enforced leisure. "

19 " The case of a patient with dissociative identity disorder follows:Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis.Cindy had been well until 3 years before admission, when she developed depression, " voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen.Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life.Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged.At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters. "