PDF Ebook Madness of Psychiatry
When I was growing up, people got most of their information about psychiatry from cartoons of patients lying on couches talking to a psychoanalyst, usually about sex (Illustration 1.1). After more than a quarter century in the profession, I have never seen a psychoanalyst’s couch. Nor, by the way, have I seen a padded cell or a straight jacket. Either my training and experience are lacking, or there was something wrong with the common stereotypes.
This is not a textbook, but we do need to look briefly at the classification of the mental disorders. The purpose of classification, the putting of apparently related material into boxes or categories, is to simplify and to help us understand large amounts of complicated information.
The current method of classifying mental disorders is frustrating because it depends largely on words. Words will be less important when psychiatry has objective tests. At the moment, the only data the psychiatrist has is the appearance and behaviour of the patient and the words he or she uses to describe thoughts, feelings and other experiences. We have to package these in the best way possible, so that we can communicate with each other as clearly as possible.
Delusions are false beliefs that are sustained despite evidence to the contrary. They are out of keeping with the patient’s social, cultural and educational background. Supporters may be convinced that their football team is better than any other, in spite of arguments to the contrary by the supporters of other teams, and healthy scientists may be slow to accept the results of studies which disprove their pet theory. The term delusion is reserved for use in cases where fixed beliefs are symptoms of mental disorders.
In the previous chapter we looked at the things patients believe. Technically, this is termed the “content of thought”. We will now look at what is called the “form of thought”, that is, the connections between thoughts, when patients are thinking.
The content and the form of thinking are separate matters. A particular patient may have no delusions whatsoever, but still have severe problems in connecting one thought with the next. Patients are generally unaware and do not complain about abnormalities in the form of their thinking. Abnormality in the form of thought is often unrecognised, and may be dismissed as an eccentric style of expression. However, abnormalities in the form of thought are powerful diagnostic pointers.
We are concerned here with hallucinations as they occur in mental disorders. It is important to be aware that similar phenomena may be experienced in the absence of mental disorder. Throughout history, people have heard voices when there has been no one with them, and seen things which, to say the least, were unexpected.
Many of the symptoms of schizophrenia have been described in the chapters dealing with hallucinations, delusions and abnormal form of thought (Illustration 6.1). They have been described separately because each is complex and deserves to be considered in detail, and because each of these symptoms can occur not only in schizophrenia, but also as a feature of other disorders.
In the previous chapters we saw how abnormalities of thought and perception lead to certain clinical pictures or syndromes. In this chapter we will see how abnormalities in mood, both pathological depression and elation, (“path”, from the Greek word for disease) may also present as mental illness.
Some healthy people are uneasy when talking to a psychiatrist. It is as if they are afraid that the psychiatrist might suddenly and inexplicably go crazy him or herself, and lock them up in a cruel place, with no avenue for appeal, forcing them to live among frightening, dangerous mad people for the rest of their lives. Central to such a notion would have to be that psychiatrists are at best ignorant and at worst sadistic, and that they possess unbridled legal powers. Nobody could be so irrational, or could they?
The public gets angry when a criminal act has been performed and a defendant’s lawyer raises the topic of mental disorder. There is a feeling that something unfair is happening, a bad person is cheating, a guilty person is avoiding punishment. The media, knowing what’s good for business, provide comprehensive coverage, and feed the fire.
Contents
Chapter 1
What are we talking about?
Chapter 2
Classifying mental disorders
Madness
Psychotic disorders
Further categories
Non-psychotic disorders
Personality disorders
Closing comment
Chapter 3
Delusions
Case dramatization
Chapter 4
Form of thought
Types of abnormal form of thought
Case dramatization
Case dramatization
Case dramatization
Case dramatization
Chapter 5
Hallucinations
Hallucinations in mental disorders
Case dramatization
Case dramatization
Case dramatization
Chapter 6
Schizophrenia
Case dramatization
Case report
Sane australia
Chapter 7
Mood disorders
Depression
Case dramatization
Bipolar disorder
Case dramatization
Chapter 8
Compulsory admission and treatment
Case dramatization
The review process
Case dramatizations
Chapter 9
Madness in court
Fitness to plead
Criminal responsibility
The insanity defence
Guilty but mentally ill
Diminished responsibility
Alcohol and drugs
Automatism
The german system
Past, present and future
Case report
Case speculation
Chapter 10
Madness in the community
Service problem
Case dramatization
Case dramatization
Conclusion
Chapter 11
Madness and genius
Case report
Summary
Chapter 12
Suicide
Is suicide a form of madness?
High and low risk
Different countries, times and rates
Creeping custodialism
Murder-suicide
Conclusion
Case study
Case study
Case study
Case history
Chapter 13
Stress reactions and treatments
Posttraumatic stress disorder (ptsd)
Case dramatization
Case dramatization
Case dramatization
DebriefingEye movement desensitization and reprocessing (emdr)
Chapter 14
Recovered memories
Recovered memory therapy
Childhood sexual abuse (csa)
False memory syndrome
The nature of memory
Caution
Case report
Case report
Case report
Case report
Alien abduction
Chapter 15
Electroconvulsive therapy (ect) and transcranial magnetic stimulation (tms)
History of ect
The procedure
Electrode placement
Death and ect
Permanent brain damage and ect
Memory and ect
Conditions treated with ect
Case dramatization
Case dramatization
Case dramatization
Transcranial magnetic stimulation
Tms in depression
Conclusion
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PDF Ebook Madness of Psychiatry
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