Something to bright up you day...!

Before you play this video, please roll down your mouse, until you find a virtual ipod on the right hand side. Click on the sign // on the bottom of the wheel, that will make the background music stop, so you will be able to watch the video with no interference.Thank you!

Now, this video is about more than 200 dancers performing their version of "Do-Re-Mi", in the Central Station of Antwerp, with just 2 rehearsals they created this amazing stunt! Those 4 fantastic minutes started the 23 of march 2009, 08:00 AM. ...

Don't you just wish life would always have this magic?

Enjoy!

AO

On compassion...

"All major religious traditions carry basically the same message, that is love, compassion and forgiveness. The important thing is, that they should be part of our daily lives." Thus spoke the Dalai Lama.
Opposed to some schools of therapy that proclaim a very technical, "purified" and adjust to a specific 1, 2, 3 step manual, I state, that there is no cure without kindness and compassion. And because compassion is something that all the patients that come to our clinic need to feel about themselves, I believe that we should become a first mirror. Not an empty mirror, but a mirror of empathy and validation of the experience.
Whether towards a patient that suffers depression, or when confronted with all kind of different other pathologies, to show compassion and acceptance is an absolute basic, and the first step toward healing.

A.O.J.

"Who am I?"

That, who I am...

Many times we try to define ourselves. We do it on the positive and on the negative. And by doing so, we build; we put one more brick to the description of ourselves. By the end of our lives, may be we lived long enough as to believe in the castle we made out of sand... may be, we are already living there.
But who are we? We do not really have one answer for this multi dimensional question, it depends from what angle we look, and even then, we will still be left without words...But one thing is for sure, whatever "we are", involves a process of transformation. Constant transformations, as we grow, learn and interact with the environment.
And amidst all these component of the cosmos of our personal existence, are emotions...
They project onto areas in our brain that make them addictive...Do you know anyone addicted to their emotions? Sure you do.

Even though we are not our emotions, they can shape us, build us, even change our neurological system, our synapses in the brain, our neurotransmitters...There is enough evidence for that already...
We'd been through life, since we were children...taking advantage of them, getting angry to get what we wanted, sulking, but also laughing and feeling high...
Emotions are, what promote changes in our lives...there is no change without emotion...and also they can make us freeze and powerless and despaired...
Emotions, are conditioned answers to a way in which, information -of what we perceive- is processed. It is also a mixture of chemicals in our bodies, that sometimes scatter for no apparent reason...norepinephrine, dopamine, glucocorticoids...sending signals out of place.
Sometimes is the environment, the "magnetic campus" of the other'subconsciousness...
We get used to associate some chemical shots in our blood stream with an emotion, and to identify with it...to name it. We actually name a chemical effect in our body!...and we make a possession of all of these, as if they were simply "Me"..."I am..." But...are you?
And think what happens when you name...you say things like "I am..." but the fact is that "you are" not...

An emotion is happening to you. You do not have to feel fully identified with it. Even if a part of you does, another part of you can observe...and as you observe...emotions calm down...

Think of how many times you exploded to let someone know...to be acknowledged...to be heard...
A good exercise, is to stand up in front of the mirror...and claim to yourself what you are claiming from the other...Do it lovingly...
Sometimes it is us that need to hear ourselves, to aknowledge...to know... to pay attention to us.

That, is a core there...deep down the waters of your waving sea...

...

A.O

Casos Clinicos: Capgras

El Síndrome de Capgras fue descrito en 1923 por Jean Marie Capgras y J. Reboul-Lachaux. He aqui un caso clinico, desgraciadamente un poco plagado de interpretaciones psicoanaliticas (mal invitablemente epidemico de muchos psiquiatras Argentinos). Lo mas interesante son las explicaciones neuro-psiquiatricas y la descripcion del caso, asi que no se distraigan por palabras tales como "perdida de objeto", etc.- teorias sin fundamento y poco cientificas-:

Capgras

(click on the link)

Giandomenico Tiepolo

I am afraid I might become like my mother...!

When we think of someone who is strong and independent, what we admire is her strong sense of self, that vital part of the personality that allows her to have a positive self-image, to identify her own wishes and maintain her self-esteem by asserting herself with other people.

The lack of this inner development is the key to borderline problems, which occur when a young child fails to separate her own self-image from that of her mother (1). This happens roughly between the ages of two and three, often because of a parent’s own emotional problems.
A mother’s encouragement of a child’s self-assertion is vital. When the mother suffers from low self-esteem, dependency or feelings of abandonment, she has difficulty encouraging her child’s emerging self, and to introduce an exploring vision of the world, which includes a space for the other as an other, and not a mere reflection of her own fears of rejection for example.
The child experiences this absence as a loss of self, creating also feelings of abandonment that lead to depression sooner or later in the child.
To deal with the depression, the child gives up efforts to support her emerging self and instead, she relies on her mother’s approval to maintain the esteem of a "false self." All these efforts, are to achieve proximity to her.

• Be like him or her.
• Act as she or he is still there and in control.
• Treat yourself as she or he treated you.

These are part of a copy or modeling process. And it is maintained by the wish that the the important persons -and over all, their mental representations- will: forgive, forget, apologize, wake up,listen, make restitution, etc. Or make it possible for there to be rapprochement and reunion. These semi-unconscious wishes could be called "the gifts of love"...

Some kind of "living testimony" for the mother's rules and values...so that they, in the imaginary, will become more loving, affirming and nurturing.

In their relationships, they become more concerned with the parental internalization than they are with what is actually happening...

It is because of these patterns of regressive "loyalty", that it is so difficult for them to change...because they have to decide to let go of these wishes, grieve the loss of what never was, never can be or cannot "again" be, so that he or she might be more adequately present in the here and now, bringing more suitable answers rather than the care giver's.

Alex Olivera, Lorna Smith.

(1) When we talk about mother, we mean the person that is most significant and spends more time with the child, fulfilling this function.

Remember that everyone models their parents, this pattern in not about simply modeling but a big replacement of the self, by that of the mothers.

Terapias para las personas que no responden a terapia.

La Terapia Interpersonal Reconstructiva IRT (Benjamin 2003) forma parte de un grupo de métodos, para ayudar a aquellas personas que normalmente no responden a otras terapias. Dentro de este grupo no se incluyen personas que tienen comprometida su capacidad de apender, por lo que no es apropiada para aquellos cuyas habilidades cognitivas son limitadas.

Funciona muy bien con sujetos que padecen trastornos del Axis II ( Trastornos de Personalidad) y para los estados co-morbidos del Axis I -tan común al Axis II- tales como depresión, ansiedad, distorsion del pensamiento y pseudo-alucinaciones (las que están en el espacio interior o subjetivo, no en el espacio exterior, y tienen existencia subjetiva y constituyen una realidad evidente para el sujeto).

Es un método de intervención basado fuertemente en la teoría del rol del apego en Bowlby (1969-1977) y en las investigaciones de Cassidy & Shaver en 1999.

La intención de este modelo es la de transformar ciertos "modelos" internos, que fueron hechos propios por fenómenos como la internalizacion, recapitulacion, e introyeccion, y permite al paciente ir ganando libertad e independencia de ellos, para poder actuar en un modo mas deseable y propio.

Esta terapia -así como la Terapia Cognitiva entre otras- me resulta interesante como "modos de intervención" mas que como terapias en si mismas. Proviniendo de una base "psicoanalitica" ha tenido el tino de acercarse al paciente y trabajar desde otro lugar, mas claro y cognitivo.

Fotografía de Christophe Bouffil

AOJ

Susanne Boyle

Not long time ago I posted a video of the famous British singers contest Britain's got talent. In that occasion we heard and saw Paul Potts. Well...this contest keeps on bringing surprises.
In this occasion I would like to introduce you to Susan Boyle. Unfortunately I cannot post the video directly, so you will have to click on the link and look it up. A window of Youtube will open with the video ready to be watch. I hope that this will be a soul trip for you as it is for me every time I hear it.

This are the lyrics of the song "I had a dream" from Les Miserables, song that Susanne will interpret.

"There was a time when men were kind
When their voices were soft
And their words inviting
There was a time when love was blind
And the world was a song
And the song was exciting
There was a time
Then it all went wrong

I dreamed a dream in time gone by
When hope was high
And life worth living
I dreamed that love would never die
I dreamed that God would be forgiving
Then I was young and unafraid
And dreams were made and used and wasted
There was no ransom to be paid
No song unsung, no wine untasted

But the tigers come at night
With their voices soft as thunder
As they tear your hope apart
And they turn your dream to shame

He slept a summer by my side
He filled my days with endless wonder
He took my childhood in his stride
But he was gone when autumn came

And still I dream he'll come to me
That we will live the years together
But there are dreams that cannot be
And there are storms we cannot weather

I had a dream my life would be
So different from this hell I'm living
So different now from what it seemed
Now life has killed the dream I dreamed."

Enjoy and have a great week end.

http://www.youtube.com/watch?v=9lp0IWv8QZY

A.O.J.

The world...

...will never be reflected exactly as it is, in the configuration of your mind, but your mind will be reflected into the world that you percieve...

Painting Ramiro F. Saus

Our dependency makes slaves out of us, especially because it will always be related to our self-esteem. If you need encouragement, praise, pats on the back from everybody, then you make everybody your judge.

A.O.

Compassion...

The path to authentic compassion arises from within, beginning with a deep acceptance and love of oneself.

Language

Language is an agreement on words. Most of words are old, but language and words still evolve. And they do evolve because the experience grows, and changes, and we need new words. Since the out-coming of cybernetics we talk about "processing"..."she is still processing" we say...may be before we used words like "brewing"? "She is still brewing" This seemed to come from the English tea culture, doesn' t it? That is what you do in teapots, you "brew" and while you brew the tea, you have to wait. Or "chewing" or "ruminating".
We keep on introducing words to our baggage of lenguage in order to be closer to what we want to express.
Because they are symbols, words can only point at the experience, can never with hold it, they are in place of the experience. So because most of our thoughts are in words, the more words the more the reduction of the experience they can contain. They tend to hide much more than they can express.
The Japanese zen poets knew about this.
So poets like Basho (1644 – 1694) wrote what are called "Haiku". Haiku is a particular style in poetry, a minimalistic style. Like the touch of a feather. Only pointing at, never too much engage into describing...and then just the silence...
It was funny because when I went to Japan last year I commented on a Haiku and they all looked at me expecting that I would go on. They were sure I did not know the whole "poem" but in fact I did...
A Hiku gives you a soft push, in order for you to go alone...

The noise in your mind...

If you try to stop the noise in your mind, you will never be able to. The more the noise gets attention the louder it will get. Just let it be there. Put more attention in what is behind the noise, your breath...while you are fighting in yourself to get yourself, over-impossing and wanting to be right...life goes on...
You are here.
Surrender to your existence...

Broadening of consciousness: the vibrant stillness

Because therapy is a way to broaden consciousness, sooner or later you come to reach some kind of a spiritual level. When I mean spiritual I do not mean religious. I mean a level of transcendence, transcendence of the impact of certain events, that are in the configuration of our lives.
It is in the "here and now", when you are completely inspired by nature, and you observe around, that you see everything moving, everything changing...and it changes over a stillness, as if it slides on some kind of warm sleeping animal, which is still and breathing... and then you come to realize, that what you are perceiving, is no more, no less, than your own self..with-holding events. Here and now.

When we cling to events, it is in a way because we need them. We need to identify with them. We need them to make them part of our identity, whether they are past or present events....something inside does not let go... it is struggling. But around this struggling there is "something" observing the struggle...
Somehow...when you reach to feel the stillness within you..., this pure life energy, which no words can hold...you realize that you do not identify with those events...that, even if they are there, they are like clouds in the sky...

A.O.J.

Mesa sobre la que escribia, "literalmente", la poetiza Alejandra Pizarnik.

Ampliacion de la conciencia

La ampliación del campo de la conciencia, se produce por medio de rupturas epistemologicas. Es como si habitáramos en el centro de una muñeca rusa, de esas que van una dentro de la otra. Este proceso va sucediendo de adentro hacia afuera. Nos deja con la sensacion de que tenemos un metro mas para respirar alrededor nuestro.
Esta ampliación de la conciencia ocurre en terapia a medida que nos va "cayendo la ficha" con respecto a determinadas cosas. Pero tambien, obviamente, ocurre en la vida! En la vida, salvo que algo muy significativo ocurra, suele no poderse apurar este proceso por que los seres humanos tenemos una zona proximal de desarrollo como bien decía Vigotsky -aunque el se refería al aprendizaje solamente-. Creo que por fuera de la zona Vigotskiana, hay otra zona -las muñecas rusas- que esta en relación al conocimiento que hemos adquirido a través de la información y la experiencia -información practica-
Para Vigotsky lo que habilitaba esta zona proximal era la madurez que nos permite acceder a, por ejemplo planos mas y mas abstractos de la información - un niño de cinco anos no puede aprender álgebra (al menos que sea un fenómeno).
Madurez mas información, conducen a un nivel de aprendizaje, que nos permite la ampliación de la conciencia, uno de los grados mas sutiles y mas poderosos del terreno en donde se mueve el conocimiento.
En terapia la informacion circula mas rapidamente, porque ademas los terapeutas podemos, o al menos se supone que deberiamos poder, tener una mirada diferente, mas holistica sobre las cuestiones que nos plantean nuestros pacientes. Aveces con pequenos "bocadillos" en momentos oportunos, logramos ese "click" que hace la diferencia para poder seguir creciendo.
Entramos en una suerte de retroalimentación antipoética de aprendizaje- ampliación del campo de la conciencia-aprendizaje, a donde el limite para la explorcion puede extenderse indefinidamente

Esta pequeña frase...

...recuerdan?
"...serenidad para aceptar las cosas que no puedo cambiar. Valor para cambiar las que si puedo. Y sabiduría para poder diferenciarlas."
Yo creo que quien creo esta oración ya poseía las tres cosas. No?

Jump the wall!

...do not bump into it...
...do not try to pull it down...
Your life is much greater than the wall...

Una subjetividad que se inventa

Como terapeuta se que tengo que poner mi propia historia sobre la mesa porque de alguna forma, esto hace que el otro, se anime a cambiar. La gente mas terriblemente sola del planeta, aquellos que han sido mortalmente rechazados, aquellos seres de lo que llamamos "allá afuera" necesitan mirarse en un espejo que le permita construir de alguna forma un camino...una esperanza.
Por otro lado una diría

Existe mi historia para el otro? cuando necesita tanto ver su propia historia...para no caer en la tentación de engancharse con la mía..?
Hay puntos en que las dos son relevantes, pero del arte profundo que surge, casi como el duende del flamenco...se encuentra en la inter-subjetividad...Allí donde tu y yo son uno en el racconto. Donde me he perdido de mi y estoy profundamente en tus caminos y puedo ver el mundo con tus ojos, y revisar a donde fue que la solución que intentaste aplicar a aquello que tanto te dolía, empeoro notablemente las cosas...
Y darnos cuenta de repente...como la subjetividad, se inventa entre nosotros... ...

A.O.J.

The condition of the mind is always doubt...

A doubting mind will always be a doubting mind. You will have to move away from giving answers...your answers will never answer enough...

A.O.J.

Art work by Maggie Taylor

Mirror neurons

Vittorio Gallese is professor of human physiology at the University of Parma, Italy with appointments in the departments of neuroscience, psychiatry and psychology. He is an expert in neurophysiology, neuroscience, social neuroscience, and philosophy of mind. Gallese is one of the discoverer of mirror neurons.

His research attempts to elucidate the functional organization of brain mechanisms underlying social cognition, including action understanding, empathy, and theory of mind.

Vittorio Gallese studied medicine at the University of Parma, Parma, Italy, and was awarded an M.D, in Neurology in 1990. He is a Full Professor of physiology in the Department of Neuroscience of the University of Parma. As a cognitive neuroscientist, his research focuses on the relationship between the sensory-motor system and cognition, both in non-human primates and humans using a variety of neurophysiological and functional neuroimaging techniques. Among his major contributions is the discovery, together with the colleagues of Parma, of mirror neurons, and the elaboration of a theoretical model of basic aspects of social cognition. He is actively developing an interdisciplinary approach to the understanding of intersubjectivity and social cognition in collaboration with psychologists, psycholinguists and philosophers.

Gallese has been doing research at the University of Lausanne, Switzerland, and at the Nihon University, Tokyo, Japan. He has been George Miller visiting professor at the University of California at Berkeley. In 2007 he received together with Giacomo Rizzolatti and Leonardo Fogassi the Grawemeyer Award for Psychology, for the discovery of mirror neurons.
Stephanie Preston and Frans de Waal,Jean Decety and Vittorio Gallese have independently argued that the mirror neuron system is involved in empathy. A large number of experiments using functional MRI, electroencephalography and magnetoencephalography have shown that certain brain regions (in particular the anterior insula, anterior cingulate cortex, and inferior frontal cortex) are active when a person experiences an emotion (disgust, happiness, pain, etc.) and when he sees another person experiencing an emotion.However, these brain regions are not quite the same as the ones which mirror hand actions, and mirror neurons for emotional states or empathy have not yet been described in monkeys. More recently, Christian Keysers at the Social Brain Lab and colleagues have shown that people that are more empathic according to self-report questionnaires have stronger activations both in the mirror system for hand actions and the mirror system for emotions, providing more direct support to the idea that the mirror system is linked to empathy.

But I dare to go further. I dare to think that the concept of "Darshana" in India is very much related to this. According to Wikipedia, Darśana (Darshan, Sanskrit: दर्शन) is a Sanskrit term meaning "sight" (in the sense of an instance of seeing or beholding; from a root dṛś "to see"), vision, apparition, or glimpse. It is most commonly used for "visions of the divine," i.e. of a god or a very holy person or artifact. One could "receive darshana" of the deity in the temple, or from a great saintly person, such as a great guru.
In the sense "to see with reverence and devotion," the term translates to hierophany, and could refer either to a vision of the divine or to being in the presence of a highly revered person. In this sense it may assume a meaning closer to audience. "By doing darshan properly a devotee develops affection for God, and God develops affection for that devotee".

The psychoanalysts discovered something called the "inconscience's field". According to this theory people that live together enter into some kind of "magnetic field". It comes to me the analogy of a home that has many computers and share "media" for example. I had a patient whose son used to dream things that were more according to the process of my patient than his own processes...

The cognitive behaviorists call it "modeling". Modeling is something you do not have to be aware of in order to do it effectively.

Gallese has published over 100 papers in international peer-reviewed journals and edited books.

...and always remember...

Stanley Milgram

The story
If someone told you to press a button to deliver a 450-volt electrical shock to an innocent person in the next room, would you do it?

Common sense may say no, but decades of research suggests otherwise.

In the early 1960s, a young psychologist at Yale, kown as Stanley Milgram, began what became one of the most widely recognized experiments in his field. In the first series, he found that about two-thirds of subjects were willing to inflict what they believed were increasingly painful shocks on an innocent person when the experimenter told them to do so, even when the victim screamed and pleaded...read full article

"He who does not at some stage, with definite determination consent to the terribleness of life, or even exalts in it, never takes possession of the inexpressible fullness of the power of our existence."

"Selected Letters" from Rainer Maria Rilke

Beware of the clincal/family doctor.

In the health field there seem to be a constant trespassing of limits.
It is not strange to see family doctors, or general doctors prescribe psychiatric medication such as Benzodiazepines (check for these (some of them I have not heard about for a long time now..): alprazolam (Xanax), clorazepate (Tranxene), diazepam (Valium), lorazepam (Ativan), oxazepam (Serax), Clonazepan -a favourite-(Klonopin in the United States and Rivotril, Ravotril or Rivatril in Europe, South America, North America Canada and Mexico, India and Australia and prazepam (Centrax)). Some of these drugs are also given by practitioners on occasional basis- not regular- as pre anesthetics or for endoscopies. But this is very different than to prescribe them.

We know not just few cases where someone goes to the doctor and sais "Dr. I cannot sleep". It is so easy for the doctor then, to prescribe sleeping pills. The clinician is not prepared to understand all the possible causes for insomnia. He will make his own limited reading.

These things make me go goose pimpled.

Do these guys have an idea of what they are doing?

Did they ever heard of the long term collateral effects of certain psychiatric drugs?

Were they trained to understand that to a certain population you just DO NOT prescribe sleeping pills?

There is not one psychiatrist that I know, that would favour this behavior. They are asking the clinicians to keep out of that field and derive patients for a consultation. But it is just useless. Narcissism in the medical community tends to be quite paroxystic.

They might think that it is very reasonable, that if someone is undergoing anxiety, to medicate with anxiolytics!

I do believe, that the license that doctors have to prescribe should be discreet. Should be discriminated. Of course the labs will incentivate the opposite. Labs make trillions of dollars by it.

Some collateral effects of certain psychoactive drugs they are IRREVERSABLE (for many reasons, which will not be discussed here) One of them is loss of short term memory.

I knew this woman that was for seventeen years under Benzos, prescribed by her family Dr. He said to her as he kept on writing prescriptions: " What can you do, now days with the stress we live under...I have been taken them for twenty years myself, and here I am!"

Another woman used to regulate herself the intake of anti-depressants as if they were aspirins for headache! "Oh, I feel low today, I shall take an anti-depressant!" Who gives her the prescriptions? Do you believe this? It is surrealistic, but better believe it. And she is not atypical!... unfortunately.

We are living in a light culture of psycho-drugs, and not in a culture of light but of darkness and ignorance. This kind of thing is what we see around coming from people that should be health educators! I am not including every one, but whoever the shoe fits...but there are far to many Cinderellas out there.

Terror movie?

No. Reality show.

So what the population can do, is to think that if it takes so long to choose a hairdresser because you do not want someone to mess with the outside of your head, should take time to go to the right guy that will take care of what goes on inside your head...Isn't that right?

If you think you are having some kind of emotional disturbance, ask for a psychological consultation. Under no means let your family dr. to prescribe you with tranquilizers or any kind of psychoactive drugs .

Honor your life. You just got one life to live.

A.O.J.

Disorganized attachment and the disorganization of the self: the alien self.

Because of their constitution, infants are primed to expect to find a version of their internal states mirrored by their caregivers. These mirroring responses are necessary to help them learn to represent their internal sates, both to themselves, both to others. If a small child does not have access to an adult that has this ability to recognize and respond, he will find it very difficult to make his own experience meaningful. I put emphasis in their, because it is not about the internal state of the caregiver we are talking about. That is why caregivers with psychological burdens are not the ideal at all to do the job...
If the adults mirroring reaction do not reflect the infants experience accurately, the infant is nevertheless forced to use this incongruent reflections to assist in organizing internal states. As these adults do not map sufficiently well on the child's experience, the self will be prone to disorganization, that is, incoherence and fragmentation. This forces the child, once again to internalize representations of the parents state, rather than his own experience. This creates an alien experience within the self. Subjective experience that correspond to this may be a sense of having feelings and ideas that are known as ones own ideas but do not feel like one's own.
All of us have non integrated parts of the self to a certain degree. States of mind that are not felt to fit coherently into the self structure, are nevertheless integrated into it by the capacity of symbolization.
In children whose attachment history, is one of disorganization because of hostile, frightening or fearful behaviour of their caregivers, the capacity of mentalizing is compromised. The discontinuity of the self will be more and more evident more the time. Making eclosion at the adolescence, when the boy or the girl is restructuring himself in search of an identity.

Adolescence is an enough confusional time because it is when the personality takes shape. this starts around 14 years of age, so you can imagine when the search of a sense of identity is in play -deeper crisis than it would naturally occur-

Adolescence is a key point for the outburst of some long cooking history that started when infants. Now, this is very importan, because most of the people are traying to search in the adolescence the causes of something that is just emerging in the adolescence but was always there.
Because parents, whos own state of mind work as a TV closed circuit, will continue to do what they have always done, will always tend annulate the perception of the child in favour of their own perception. Simple example:

-What flavour of ice cream do you want?
-Vanilla, please.
-No. You think you want vanilla but what you really want is chocolate.
-No, no, I want vanilla
-No. You want chocolate, because chocolate is what we have.
-O.K. I want chocolate.


You can understand the difficulties that children that are systematically treated in this way will have to connect to their own feelings and perceptions...Why would they trust their perceptions?

Someone that "knows" better to deal with the world, knows that they think they want vanilla but what they really want is chocloate! So when they think they want vanilla ice cream they will ask for chocolate, or wait until someone tells them what they want. Does it sound familiar to you?
It is the typical case of wanting to go to the right and ending in the left!
Or "Everything was going alright, but I do not know what happened..." The devil did put the tail in!
These incoherence, according to Linehan, Fogany and Bateman, are theoretical bases for development of Borderline Personality Disorders. But of course not all. On top of this will be a special vulnerability to disorganization, and will be genetics playing a role. It is not the same to have antecedents of Bipolar Disorders or Affective Disorders such as Depression in the family, that not to have them.

A.O.J.

Psychopaths

Some people used to ask me if it was not scary to work in a Psychiatric Hospital, I answer that the scary part has to do more with some of the psychopathic population that runs and works at the Mental Hospitals than the patients themselves.

There is a huge percentage of mentally ill "outside", and most of them in powerful governmental, political, financial, educational, economical positions. Now, THAT IS spooky.
According to a friend, "the world has only one problem: Psychopaths. Social or Anti-Social ones." But they all end up been anti social ones, dont they? They know quite well how to hide "Under the mask of sanity"...

Learn more...

Family violence and attachment

I have seen some confusion among some colleagues, toward situations of maltreatment in couples. Example violent husbands.
Many studies show that people that come from violent homes, tend to repeat the story. The reading some make about these evidences is that people model a way to function. This is what they saw, this is what it is about for them. I believe this is a little shortsighted interpreting of the situation, even though there is NO doubt how strong culture is.

I also heard about Masochist tendencies in the victim. Heard of narcissistic projections. And even worse I heard some saying "they stay because they like it".
Most of the women I met under these circumstances did not like it.
They also knew that there was better somewhere, even if that was not their case.
Did not hear too much into the academic means about the way the brain works, and that fact, turns many of these into shallow theories.
Even though all of them have certain truth to it, there is still something that goes a bit beyond.
Within us there is an area of our brain related with the attachment system.

Secure attachment is fundamental for a healthy development. Yet, being in an attachment relationship activates the attachment system, and this makes the people less acutly aware and judgmental about the mental state of the other.

When the person es so unlucky to have parents that for some reason they maltreat their children, the child tends to search for proximity, even though. The more gets attached the more it is mistreated, and the more it will seek for protection. For survival reason this attachment area gets very stimulated but it is not able to discriminate who will be a safe figure to turn to, specially if there are not many around...You see, this mechanism is so deep inside, and so related with emotion, that cannot work discrimination. It is like "hunger is hunger". Then you eat the salad? or you eat the chips, bacon and the fried egg? Whatever is available! Hunger is hunger. Not talking of appetite.
This over attachment will go on in life for as long as the person lives. Will be even worse if the process of introjection of a caregiver figure was sensed as an alien to himself, which will produce in the best of cases a constant sense of void and need to check on the availability of a body because has problems with symbolizing in absentia. This happens to Borderline Personality Disorders.
Most psychopaths who are most charming people, "smell" needy like "pork smells truffles", also men with narcissistic personalities will search for someone dependant..and the rest is all history.

Naivity and need to be right: the best ground for psychopaths

Psychologist Robert Hare cites a famous case where a psychopath was "Man of the Year" and president of the Chamber of Commerce in his small town. (Remember that John Wayne Gacy was running for Jaycee President at the very time of his first murder conviction?) The man in question had claimed to have a Ph.D. from Berkeley. He ran for a position on the school board which he then planned to parlay into a position on the county commission which paid more.

At some point, a local reporter suddenly had the idea to check up on the guy - to see if his credentials were real. What the reporter found out was that the only thing that was true about this up and coming politician's "faked bio" was the place and date of birth. Everything else was fictitious. Not only was the man a complete impostor, he had a long history of antisocial behavior, fraud, impersonation, and imprisonment. His only contact with a university was a series of extension courses by mail that he took while in Leavenworth Federal Penitentiary. What is even more amazing is the fact that before he was a con-man, he was a "con-boy." For two decades he had dodged his way across America one step ahead of those he had hoodwinked. Along the way he had married three women and had four children, and he didn't even know what had happened to them. And now, he was on a roll! But darn that pesky reporter!

When he was exposed, he was completely unconcerned. "These trusting people will stand behind me. A good liar is a good judge of people," he said. Amazingly, he was right. Far from being outraged at the fact that they had all been completely deceived and lied to from top to bottom, the local community he had conned so completely to accrue benefits and honors to himself that he had not earned, rushed to his support!

I kid you not! And it wasn't just "token support." The local Republican party chairman wrote about him: "I assess his genuineness, integrity, and devotion to duty to rank right alongside of President Abraham Lincoln." As Hare dryly notes, this dimwit was easily swayed by words, and was blind to deeds.

What kind of psychological weaknesses drive people to prefer lies over truth?
This may have something to do with what is called Cognitive Dissonance. Leon Festinger developed the theory of Cognitive Dissonance in the 50's when he apparently stumbled onto a UFO cult in the Midwest. They were prophesying a coming world cataclysm and "alien rapture."
When no one was raptured and no cataclysm he studied the believers response, and detailed it in his book "When Prophecy Fails." Festinger observed:

"A man with a conviction is a hard man to change. Tell him you disagree and he turns away. Show him facts or figures and he questions your sources. Appeal to logic and he fails to see your point."

We have all experienced the futility of trying to change a strong conviction, especially if the convinced person has some investment in his belief. We are familiar with the variety of ingenious defenses with which people protect their convictions, managing to keep them unscathed through the most devastating attacks.

But man's resourcefulness goes beyond simply protecting a belief. Suppose an individual believes something with his whole heart; suppose further that he has a commitment to this belief, that he has taken irrevocable actions because of it; finally, suppose that he is presented with evidence, unequivocal and undeniable evidence, that his belief is wrong: what will happen? The individual will frequently emerge, not only unshaken, but even more convinced of the truth of his beliefs than ever before. Indeed, he may even show a new fervor about convincing and converting other people to his view.

It seems that part of the problem has to do with ego and the need to be "right." People with a high "need to be right" or "perfect" seem to be unable to acknowledge that they have been conned.

From Cassiopea.com

Disguised in lenguage...

Before we are told, before we are born, we are already "said". Expectations upon us will start building who we will become, even, before our head appears into this world. The Symbolic formations always precede us.
The construction that we will make of the world and its "reality", will depend in the first instance on how we, and the world are "said", by the Other. Our perceptions will be from the first moment, dependent on the recognition of the Other who embodies "the legitimacy of the code". The truth of our experience will lie forever outside ourselves, rather than being somewhere deep within us. We cannot look into our selves and find out who we truly are, because who we truly are is always elsewhere.

A.O.J.

On the subject...subject to who... subject to what?

"The subject has not substantial positive being in itself, being caught between 'not yet' and 'no longer'. The subject never is, it will have been - either it is not yet here or it is no longer here, since there is only a trace of its absence".

Slavoj Zizek

Mentalizing and Otherwise

In an attempt to respond to a philosophical discussion with some colleagues, about the apparent similarities of mental reading Vs. mentalizing.

Mentalizing, is a process that implies a focus on mental states in oneself/others, particularly related to explanations of behavior. Mental states, among other things, influence behaviour. They are a mix of believes, wishes, feelings and thoughts, inside or outside our awareness. Determine what we do or not do with what we "have".

Mentalizing, requires to be thought, both as a process that can be studied in normal healthy subjects, interacting in a combination of socio/bio/psycho issues, as in mentally or emotionally disturbed subjects into the same interactions. There is a lot still to learn about this fascinating field.

A focus on mind, leads to far more uncertain conclusions, as Bateman & Fogany say, than to do so on physical circumstances.

Now: even though, they (B&F) say, that mentalization belongs to the realm of imagination, because it is a about imagining what other people might be thinking or feeling (each person will be lead by their own capacity of imagining, personal history, and mental state in a particular moment) a simple gesture might be interpreted real wrong, getting the person to a biased conclusion. We do that sometimes. Right? " I thought he did not like it because he did not say anything..."

Now, if it would be about imagination basically we would be talking about "Mirror Stage" which is about the "concrete"and not the symbolic - that goes to my Lacanean colleges-So I believe is not exactly imagination what they are talking about. If it was so, this would be no longer interpreting at all, but projecting. Here is where IMGO would be on play, would not it? So I believe they are unintentionally mixing two concepts: one for mentalizing, other for failing on mentalizing. This makes a basic difference.

The ability to understand what might be going through peoples mind is not a new concept, it is called "Theory of the mind".The Symbolic Order is what substitutes for the loss of the immediacy of the world and it is where the void of the subject is filled in by the process of subjectivization. The latter is where the subject is given an identity and where that identity is altered by the Self.
Discontinuity of the organization of Self is included in this level of concreteness, that goes from "abduction" to softer levels such as that "other" people think wrong of them, want to harm them, criticize them, with no reality base -that kind of egosintonic speech such as "I am perfect, THEY have a problem", typical of Personality Disorders-.

Why is it so very difficult to appeal and make them understand that they are not perceiving the reality too well, that it is their own projection in play there. Because there is a failure in the process of mentalizing, and they cannot really differentiate inside/outside. No matter what you say, they will always find a reason to suspect your bad intentions.

This is clearly delusional. It is clearly projective. It is, as you well know, a very primitive defence mechanism, to keep away from themselves their own cruelty and aggression and it is what infants, form birth to six months of age do, in order to not annihilate themselves. Melanie Klein describes this very well, in the paranoid-schizoid position - even though she was half crazy, as J.Lacan always used to say, M.K. still made some genial discoveries-.

So projection is much rather to think that the other will think and know what I do think and know. Mentalizing would be like an updating this knowledge in order to reach the skill to recognize that others might not think or know as we do.

People with disorders in this field, lost the capability of mentalizing. It is all about THEM and not about THE OTHER.

Does it exist such thing? Yes! in an informal way it is called "closed TV circuit".(Read to the end Didi. They are very clear here! ).

(You know, that is the problem when you, psychiatrists, put yourselves to work on therapy. You do not have one bit of theoretical background! Get out of the field!...with all due respect ; / ).

A.O.J.

The Watcher I

The Watcher II

Sometimes diagnosis is difficult.

We have to remember that manuals and books on psychopathology and also in all kind of medical science literature were based on clinical experience, which can be real enormous, but will never cover the spectrum of every human being.
On top of this, problems appear when you have pictures that evolved in such ways that the patient has a lot of "everything". And the professional is trying to interpret it as one picture, instead of separating and prevailing.
Sometimes only two situations together can mess a frame. But why this happens?
Because we are physical, spiritual, mental, social and contextual creatures, and we are a multiple One functioning at many levels. What affects a part of our functions will necessarily affect other, therefore, it is very important to extricate the tangle.

There are primary and secondary symptoms as a principal, but there can be even quaternary ones.
It is important to remember for example, that things like viruses and flue tend to produce depressive symptoms even in a newly gold medal Olympic guy. Situations like this do not have to be confused by Freudian theories, like the one of "those that fail when they succeed"!

Now days we see a lot of depression going on in psychiatric consultation.

Depressions are sometimes tricky and difficult to diagnose because they can "hide", under symptoms like muscular pain and fatigue.

It is very possible that you will find patients with some chronic, achy muscle or ligament pain, stiffness, or weakness, feeling "low", anxious, poor tolerance to stress or headaches. Perhaps also some digestive complaints, problems with sleep quality or lacked mental focus. And then you might say Bingo! It is obvious that this person has a Generalized Anxiety Disorder.

But the selective serotonin re uptake inhibitor (SSRI) does not seem to alleviate the symptoms.

Antidepressants dont change the picture significantly neither.

So you could start thinking of Fibromyalgia.

Fibromyalgia, also called non-articular rheumatism, and myofascial pain syndrome, occurs in 1 out of 30 people, and seems to be on the rise. Some suggest it has no identifiable cause (or cure,) most patients, treated with a comprehensive approach, enjoy complete resolution of symptoms.

Since patients with Fibromyalgia, almost always have a sleep disorder, sleep aids can help. Antidepressants are often effective because they increase blood serotonin, which can improve sleep. However, antidepressants can sometimes aggravate the sleep disorder that accompanies Fibromyalgia. Preliminary reports on guaifenesin seem promising, although it’s ineffective in many cases. Drugs such as pain killers (NSAIDS) are also used, and although provide relief for some, must be used long term, which causing gastrointestinal bleeding & ulcers.

Learn about Fibromyalgia in this link, from the Journal of Clinical Psychiatry.

A.O.J.

The way we use to express ourselves..

...most of times makes the difference between getting or missing the objective.

Even though expression is an art that can be studied in publicity and oratory, every each one of us, have more or less the capacity to improve our communication with the other.
If you think otherwise, just have a look at this clip.

Just imagine if the second sign would have been recriminating and demanding...he would probably get even less, than the little he was already getting...

A.O.J.

Thanks Maria Jose.

Life as a dialectic process

The strife that many people have in life is located between a sense of independence and expansion, and the sense of belonging and self surrender to someone. These are basic motives in every human life.

Sometimes, for many people it is difficult to interweave them together and they may be experienced as opposites.

The fact is that most people seem to be happier when they can make them work together.

In order to do so some amount of emotional maturity is needed, not only individually but as into the relationship with the significant other. When I mean maturity, I am meaning clearence of some past battles, wheather with dependency weather with rebelness, selfdefensiveness etc., that can keep people attached to some kind of moovie from the past, most of it related to primary relationships with the family or parents for example.

When this is not possible the strife can feel very accentuated because it is thought from a solo point of view. In extreme cases you can see that it goes from feeling invaded to feeling abandoned.

The possibility of real sharing is not contemplated, because it can be threatening, both ways.

On one hand the capacity of the significant other to allow space to grow can only be done from a loving place, where it can be felt beyond threat, and so if even apart, they are with holding one another. This apparent dialectics can grow toward a synthesis where life quality is gained.

But some kind of leap is needed, and it can be done through confronting ones believes and statements, but not only.

Correcting of the emotional experiences is also very important, because no one will convince anyone against their own personal experience!

But then? Then what can be re-thought is the experience itself under different light, the way you tell the story can change the way you feel about the experience...

Every story have a personal motive behind it, and a ceertain epic. When you are able to discover your own one, life can be a little more easy.

My love for books and libraries, will never be enough as to take me away from their natural source: the marvel of human existence...
A.O.J.

The Theoretical framework of Self-Narratives

The work of Hermans and Hermans Jansen, has a theoretical framework, valuation theory, which is rooted in the metaphor of the person as a motivated story teller, as someone who has a story to tell about his or her own life. In telling the story the person gives special significance to particular or group events, which function as units of meaning, or as valuations, which mean that the person attributes, positive, negative or ambivalent value, to the event, past, present and future.The various valuations are arranged into a system that will depend on the nature of the person-situation interaction, and reorganized within the course of time. Basic motives influence this valuation system, but two are particularly salient: striving for self-enhancement (protection, maintenance, expansion) and longing for contact, and union for something or someone else.
The organization and re-organization of the valuation system, reflecting the telling and retelling of of one self narrative is systematically investigated in the confrontation method, which focuses not only in the content but in the latent motivational basis, which are made explicit and used in such a way that a smooth transition between assessment and change is realized. The concept of Prof.Dr.Hermans challenges the idea of a definite sense Self by understanding the Self as an organized process of meaning construction.
To expand your knowledge and information about Professor Dr. Hubert J.M. Hermans, please click this link.

Some people in different parts of the world, like in Peru or Bolivia, Brazil as well as in Indonesia and India, have developed a kind of "partnership" with their gods. They understand that life can suddenly make a bad turn -in kechua they call it Pachacuti- so they feed and take care of their gods, they are careful with the omens and they do not dare challenge the costumes because that would expose them to dangers: there are certain procedures that have to be watched upon.
This kind of approach is very earthly, gods and people act in every day life as something concrete and not something somewhere else.
In this double stream of gods and rituals, what made people move from this pantheistic concrete form of worship to abstract ones?
I believe it has to do with symbolic representation development.
Offerings to the gods still go on but in a "subtler" way. There are transactions. "I do this You do that, if I get this you get that.
Nevertheless, I think that together with this capacity of moving to more abstracs means, somewhere inside of us still lives like in an archaeological site, an area of total primitiveness, and that for some reason sometimes it gets ignited. We are like trapped in this twilight which also help us to deal with certain apects of a reality that goes beyond of what we see.

Psychotherapy is a process that involves change and consciousness broadering...

With all my love to my friend and teacher H.F.A.

DID in Japan, lecture by Prof. Dr. Totaro Ichimaru

It was very surprising on the last day of the 5th Congress of Psychotherapy in Beijing, China, the lecture of Prof. Dr. Ichimaru, one of the few representatives of Japan in the Congress. Dr. Ichimaru made a small recount of the history of DID in Japan, then he started talking about the etiology, according to his investigations.
He sais that he reckons two types of DID, one of a hysterical type and one related to tiredness that goes away after some sleep. This first approach makes me think that he is not using the instruments available in the world nowadays to make a proper diagnosis.
What can occur if a person is extremely tired is a depersonalization, but not DID.

The name "hysterical-type" of DID seems to me as a flash back to the Salpêtrière in its "Meiji" period. He relates this type to "the loss of object".
Another point that he remarked was that there is little sexual abuse in Japan. It is interesting as a woman from the public commented that in Japan fondling of a child is not considered sexual abuse. May be this fact is part of the culture, therefore accepted not as sexual abuse.
The fact is that it is very clear what sexual abuse means (click here for some links) at an international level, as much as there is a clear notion about human rights and this involves even tribes in Ghana.
So it would be interesting to dimensionalized this variable in Japan, because we do not know what is the limit. On top of this we have to realize that the majority of cases are not denounced, which on top of the regular reasons for not doing so, this must be due to a kind of "normalization" of certain acts. As also the fact that many patients with DID suffer from dissociative amnesia about the traumatic events.

He referred to the Japanese use of the "I" and the "you" which is so multiple depending on the relationship and the context that helps to deal with a"healthy" dissociation that lenguage already promotes. While in the West the construction of the I tends to be more solid, therefore more inflexible. Save me from qualifying this speculation, which is only philosophical.
In general terms I saw a salad of criteria also related to symptoms and Axis.
He attributed the number of DID cases in USA to a iatrogenic cause, when it has been studied, deeply researched and concluded, that even if you can create alters under hypnosis, there are certain characteristics that make it evident that it is iatrogenic and not real DID.
But what it is MORE than clear is that DID is a development of a complex PTSD, mostly related to sexual abuse during childhood.

I believe that it is very brave if not darey on behalf of Dr. Ichimaru to present such information.

I respect the fact that he was a pioneer on the field and working hard, and I respect his good will.

I also believe that he can understand that cultural and anthropological roots still do not justify such poor approaches not to science not to the presentation of a salad of theory, in fields that are so delicate and vulnerable as child abuse.

DID is not something to be re invented based on Freudian theories plus some other local and personal speculation, by doing so, Dr.Ichimaru pushes it back indirectly to the era of obscurity, which, we so much fought to get it out from.

We came a long way and it was not easy for us. I also was a pioneer in my own country dealing with DID patients when they were taken for schizophrenics. We keep on researching and sharpening our knowledge, and there is a lot to be done still.

DID as other mental disturbances, as for example Schizophrenia, is delimited and concise. The only variations are the cultural representations of the patient, and may be some unusual case here and there, and of course the personal characteristics of the patient himself, his own narrative.

It is more than about time to present our work under this light, unless, these patients are not suffering from DID but from something completely different, unknown to the West.

In the anthropological section of the Kaplan you have described illnesses such as "Koro" for example, even if today we can see it as a part of a spectrum of may be OCD... So in these kind of cases we could be thinking from an inter-anthropological point of view, if you want: Local illnesses under local views... This, is very different than presenting a lecture on DID.

A.O.J.

Yesterday I had the opportunity to go to the Beijing Traditional Chinese Medicine Hospital.
Many of us got an immersion in TCM but never had the opportunity to see it working in a place like a hospital.
The system in the hospital works similar to the Western. The person has to register and then is able to consult, be taken into emergency and get the medicines, all through government care.
There are also areas of specialization like "allergies" for instance.
Other areas contemplate issues like "bone massage" and "massage" in general. As many people familiarized with TCM know, Tui-Na is an essential part of it.
I was able to see the pharmacy with bulky packs of herbs. Herbs and specific diet to control the harmony between Ying and Yang are a basic part of TCM.
The area of Emergencies was divided into small rooms of three to four beds, and these were eventually the observation rooms.

BEIJING HOSPITAL OF TRADITIONAL CHINESE MEDICINE

Address: 23 Meishuguanhou Street

Zip: 100010

Phone: 010-64040791

I understand that there are some kind of tours for the TCM practitioners which might be fascinating, and much more extended than my little trip. For that may be you search in the net.

Good luck!

Looking into the future...

The Congress of Psychotherapy in Beijing

It is very important this step for the Chinese society. I would say that most of this Congress, if not all of it, it is dedicated to the Chinese people to start getting acquainted with what is going on in the West.
The themes proposed by the Chinese exposures are more or less related to the state of the art in China, which is as I wrote before, that of the somatic affections. Other than that we can see the importance of the old Taoist philosophy, art or calligraphy and work therapy.
As in any therapy that the West opens to the East, it is basic not to forget the conceptions of the world and its avatars that the East has. It is a mill that has to go through, as for instance the fact of lack of individualism: the principals of the construction of the self is collective.
Once again, as I many times express in my own clinical practice, it is very important to work in an holistic manner. We learn from the Chinese to treat the side effects of the drugs used for example in schizophrenic patients. I did not have the opportunity yet to get into the Beijing Hospital of TCM but hopefully I will.
Besides that there is not much new under the sun here except for an amazing pollution.

But this not really new...

It will be never enough to insist...

...to be cautious with "recipes". Nor a diagnosis, nor a therapy style have to lack of flexibility. If flexibility is what we want to work upon our patients, we have to be the first ones in practising it.
Each person is unique no matter how steryotyped you will find your case in the Manuals of Psychopathology. Never loose sight of this. It is most important.
The same goes for therapy. Follow the protocols, because they are designed to function on that specific way, but be sensitive, to when you have to stop for awhile, or take a roundabout.
Psychotherapy is not about technicians, it is about artists...like anything else in life...you need to learn the technique in order to be free...

Over that persisting vocation for trapping the Infinite...

....we are destined to go about essays...

A.O.J.

"As if "...: The false Self

In 1934, and again in 1942, Helene Deutsch described what she called the "As if" (als ob) personality type. She was referring to individuals who leave other people with an impression of inauthenticity. Even though they seem to enjoy "normal" relations with those around them and even though they complain of no disorder.They appear perfectly well adjusted, and are even capable of a certain warmth, but in a number of circumstances they betray a lack of emotional depth.

This phenomenon does not correspond to a type of repression but rather to a "real loss of object cathexis". The apparently normal relationship to the world corresponds to a child's imitativeness and is the expression of identification with the environment, a mimicry which results in an ostensibly good adaptation to the world of reality despite the absence of object cathexis" (1942, p. 304). Their creations are, on observation, "a spasmodic, if skilled, repetition of a prototype without the slightest trace of originality" (p. 303). "Another characteristic of the 'as if' personality is that aggressive tendencies are almost completely masked by passivity, lending an air of negative goodness, of mild amiability which, however, is readily convertible to evil" (p. 305).

In the course of psychoanalytic treatment their behavior may seem to indicate excellent cooperation and a certain progress, until the analyst realizes that nothing is actually happening, that the patients have changed nothing in their lives. Although "a strong identification with the analyst can be used as an active and constructive influence" (ibid.), these patients often develop a "vocation" to become psychoanalysts themselves.

Deutsch classified such personalities as "depersonalized" and associated them with schizoid-type behavior, insisting that there was a schizoid psychotic core behind their pseudo-normality. They were later classed as "borderline states" presenting "narcissistic disorders" or, according to Heinz Kohut, "disorders of the Self." Links have also been established between "As if" personalities and the notion of a "false Self" developed by Donald W. Winnicott (1962/1965), or Phyllis Greenacre's studies of "the imposter" (1958). Masud Khan related the etiology of "as if" personalities to the failure of the superego or the absence of a personal ideal ego, suggesting that although these subjects give the impression of being psychopathic or immoral "they have a very highly organized ego-ideal and all their attempts are to approximate to its demands" (1960, p. 435).

In any event, Deutsch's initial description corresponds to a reality that continues to be confirmed in clinical experience as in everyday life. The decription fits very well what today is considered a Schizoid Personality Disorder according to Theodor Millon, but clearly matches a central aspecto of the Border Personality Disorder functioning in the "pretend mode"and the lack of sense of Self, that they describe as a pervasive feeling of "void".

. Deutsch, Helene. (1934).Über einen Typus der Pseudoaffektivität ("Als ob"). Internationale Zeitschrift für Psychoanalyse, 20.
. Winnicott, .Donald W. (1965). Ego distortion in terms of true and false Self. In The maturational processes and the facilitating environment (pp. 140-152). London: Hogarth and the Institute for Psycho-Analysis. (Original work published 1962)

"Rest, does not come from sleeping but from awakening"

A.O.J.

Hospitalize: double blade tool

Two rules usually govern over the difficult decission of placing someone in a psychiatric hospital: immediate threat to harm themselves, or to harm other people. The same applies for patients with recurrent suicidal behavour.

Sometimes it can be really hard to decide for these reasons:

• In some places the Hospital situation is so bad, that you might find yourself working not only on the patients original trauma but on a secondary trauma due to hospital conditions.

Therefore, it is better to decide on 24hs home-care, providing the family has the means, -emotional and financial- and day-care hospital, where they can receive psychosocial rehabilitation.

It is very important to keep them busy while at home, to give them some small missions, so that they can feel useful. When they are ready, they can go out with some caregiver. Never to press them. Sometimes they blow at a minimal crisis during these transitional period. This does not mean that they will be allowed to do whatever. The family will have to become real good at negotiating. Sometimes even over the amount of food they have to eat.

There is another fact that has to be considered, and that is when

• the patient is insisting on been taken into the MHCH, because they feel that they are less exposed to all what it means to start re adapting, which is not easy, and they might feel vulnerable, so the MHCH tend to became a place that most patients refuse to leave after awhile. Some tend to take it as a "retirement", a place for reflection. The psychiatric hospital is very deteriorating environment because the patients slowly start to loose the ability to cope with the outside world, which outcome is a clear tendency to become "chronified".

So to the denial of the practitioner to confine them, some might even go into actings such as slashing or severely cutting or taking overdoses (medication has always to be out of reach!) in order to press the professional . Even though these actings are not suicidal attempts, we have to realize that an accident may happen.

These actings tend to have some weird kind of erotic charge. They are not really directed onto themselves but onto us.

When this happens and we realize a clear manipulation, we refuse to see them while hospitalized, no matter how much they claim for us. We make this message clear through the nurses: we will see them only after they are out again. This always has to be done in a nonjudgmental, patient, sensitive and compassionate way.

.
They have to deal with another practitioner that they will not like so much. It is not easy to do so, because we also tend to love our patients, and it is the strength of the relationship what keeps them into therapy, and we believe, that this is a necessary limit for them.
So far this proved to be an effective technique that reduced actings.
We want to bring them back home as soon as the imminent danger passed, and have them with 24 hour vigilant care. All our efforts are centred in promoting a normalization of their routine and life. We believe that we do not have to treat people with mental problems as if they are mentally ill. We only have to be aware of dangers and difficulties to try and prevent them as much as possible.

For sometime now there has been a movement to try to stop chronic hospitalization and bring the patients back into the society and into their families. These actions brought good results and bad results. There is not one universal recipe and a clinical criteria should apply for every each one case.

But most of all, whatever the outcome, one thing is for certain: the conditions of psychiatric hospitals should be much more better in order to fulfil their Foundational Contract.

A.O.J.

The nature of the psychological problems...

...are mostly due to inflexibility. Inflexibility obviously produces limitation of the perception. The person is convinced that there are no possible options: that is it.
So when confronted with a situation they will have a very limited set of tools that they will use. This limitation will obviously create more limitations about the operativity, accentuating the limits of their perception. I mean how far can you get peeling and orange with a banana? People in this condition will tend to blame the orange! This set of tools will become automatic and generalized after awhile, producing a great lose of freedom..."just look what the oranges, and not only the oranges but all the fruits, do to me!"
People try to fix the problem but no matter how hard they try it seems impossible.
Now, these efforts, mainly, do reinforce the attitude to the problem as "the enemy". They tend to think that once the problem is defeated, everything will be fine.
This encourages rumiation over the problem, creating a situation from which they will want to escape, thus, creating self invalidation.

Complex situation, isnt it?
For all these non wanted actions, people will tend, on top of it, to blame themselves. This can be going on for ever.

In order to make people see what seems to be obvious, I cannot be obvious in the obviousness. I can neither think that the person is blind.

What I may think is that the problem is in front of her very eyes, and because of the way she is bound to perceive things, she is not able to realize the outcome.

Between her and the obvious, she has constructed a wall. She has constructed her world with those limits, therefore she has become impoverished in her vision of the world.

The problem ends up been about the struggle with the problem.
The problem and the solution go together, they are like the sides of a same coin.I cannot assist her in solving her problem insisting in the tool that she have been using for not solving it.
Only the experience will convince you and make you change the structure of that portion of the world. An experience that would necessarily defy your previous experiences, an experience that causes that the scaffolds to where you are holding to fall, and break through to your perception of reality.
An experience,is by far, better than one explanation. Life itself does that. Just puts you through where you have to be, sometimes with a kick in the "touches". Life is one of the best teachers you could hope for...but some people cannot wait that long, and also sometimes people are so entangled that they are just bound to miss the lessons of life...
Some of these limitations will be when people is convinced that "the others", "the world", "life" is the problem, and they will learn this role of victim and that is what they will always get: a self fulfilled prophecy.

Information is very important to understand the way we function, it can be very relieving and make us realize that there are many others in the same situation that we are, and that we are not an "avis rara", but information it is not enough because it does not enter an existential realm, until it is related to emotion, and the emotion is necessary for the change. There is no change without emotion.

Pain, sadness, depression, rage, as any other nominalization is not an object to get rid of.

It is a process... a process can be feed ed-back eternally and continue its inertia...but it will only get worse. Remember: it reinforces itself.

We all learn something from a bad experience, something of the experience will be lightening our heart when we are able to re-signify it. And the best way to re-signify it is to become the owner of that pain.. It does not matter if it was caused from outside by some leading circumstance and I was victim, or if I created it, I allowed it, or I caused it.

The result is that this is mine now and I will have to be me who will embrace this.
To become involved, to stop putting it outside as if it was a parcel belonging to someone else. Now, that, it is the first passage towards healing.

A.O.J.

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. . Maggie Taylor

Milton Erikson

Milton Erikson gave many examples about the way on which suggetions should be introduced during the hypnotic trance. It becomes quite clear in this correspondance between father and son:

Dear Dad,

$chool i$ really great. I am making lot$ of friend$ and $tudying very hard. With al my $tuff, I $imply can't think of anything I need, $o if you would like, you can ju$t $end me a card, a$ I would love to hear from you.

Love, Your $on.

Answer of the father...

Dear Son,

I kNOw that astroNOmy, ecoNOmics, and oceaNOgraphy are eNOugh to keep even an hoNOr student busy. Do NOt forget that the pursuit of kNOwledge is a NOble task, and you can never study eNOugh.

Love, Dad

Get it?

Society for Psychotherapy Research

The Society for Psychotherapy Research organises a regular programme of International, European and UK conferences.

Comments

You may leave your comment at the end of each article. Please, just where there is a little envelope =

Alex will be back to you as soon as she can. Thank you.

Dissociative Identity Disorder

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Trastorno Disociativo de Identidad: hecho o artificio?

A bibliographical research by Alex Olivera Johananoff

Historical review, actualization of the research and evidence on the Dissociative Identity Disorder (in Spanish). Click above (in gray "Trastorno Disociativo de Identidad...").
By Alex Olivera Johananoff

There is almost no material what so ever in Spanish about this terrible disorder

In many countries DID is still considered for many reasons a kind of invention, therefore it is hardly studied in the University by the future psychiatrists.
This fact misleads very gravely the health practitioners at the time to diagnose and decide over treatment, even to the point of confusing it with Schizophrenia, or Border Personality Disorder.
I thought it fundamental to produce fresh information about what are the advances in neuroscience about this malady, so that the professional interested can always go into deeper research himself.

A.O.J.

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"Song for the Night Journey"

by A.O.J.

When cronical becomes terminal...

There are many ways of dying.

Dying is not only what happens to our ephimerous physical body...dying is also when we stopped having a name and we became an "F20.0x". Dying is when we are swept out of the possibility to be looked into the eyes, and be seen...

…”ojos que no se cierran y hacen señas
y vagan de la lámpara a mis ojos,
fija mirada que se abraza a otra,
ajena, que se asfixia en el abrazo
y al final se suelta y ve desde la orilla
como se hunde y pierde cuerpo el alma
y no encuentra unos ojos a que asirse
¿y me invito a morir esa mirada?
Quizá morimos sólo por que nadie quiere morirse con nosotros
Nadie
Quiere mirarnos a los ojos.”

Octavio Paz

Mindfulness, reincarnated

Meditation is recognized as a component of almost all religions, and has been practiced for over 5,000 years.
It originated from Vedic Hinduism which is the oldest religion that professes meditation as a spiritual and religious practice.
Meditation has been central to Buddhism and considered a key tool in spiritual development. Most forms of Buddhism distinguish between two classes of meditation practices, Shamatha and Vipassana, both of which are necessary for attaining enlightenment. The former consists of practices aimed at developing the ability to focus the attention single-pointedly; the latter includes practices aimed at developing insight and wisdom through seeing the true nature of reality. Enlightment, Satori, Nirvana, liberation from Ego states... meditation is what helps people to cope with emotional turbulence, inducing detachment. Some information you can find here, but basically the idea is to

seat

breath

observed

as if thoughts were clouds in the sky.

This method is one of the pillars of Regulation of Emotions, and has the effect of a Meta Cognitive action.

Many therapies are incorporating now techniques of Self Monitoring and Self Observing within the context of acceptance. This it is now called Mindfulness...

We think that his technique should obviously not be used alone as instead of therapy, but in a therapeutical context of learning abilities, self monitoring, etc., case DBT (Marsha Linehan) -up to now, the only therapy with a long term proven data for treating Borderline Personality Disorders-. and it also seem to have produced interesting, but still young data, in treatment of GAD (Generalized Anxiety Disorder). All of them Behavioural.

The inclusion of spirituality, meditation, they are considered as the Third Wave in CB Therapies. It makes sense, because it includes aspects of the human development that cannot be left out. So far is bringing sustainable results.

A.O.J.

Buddhist Pilgrim Kesa

Resilience

Resilience is the process of adapting well in the face of adversity, trauma, tragedy, threats, or even significant sources of stress -- such as family and relationship problems, serious health problems, or workplace and financial stressors. It means "bouncing back" from difficult experiences.
Being resilient does not mean that a person doesn't experience difficulty or distress. Emotional pain and sadness are common in people who have suffered major adversity or trauma in their lives. In fact, the road to resilience is likely to involve considerable emotional distress.

Resilience is not a trait that people either have or do not have. It involves behaviors, thoughts, and actions that can be learned and developed in anyone.
Some little keys from APA Help Center from the American Psychological Association

10 Ways to Build Resilience

Make connections. Good relationships with close family members, friends, or others are important. Accepting help and support from those who care about you and will listen to you strengthens resilience. Some people find that being active in civic groups, faith-based organizations, or other local groups provides social support and can help with reclaiming hope. Assisting others in their time of need also can benefit the helper.

Avoid seeing crises as insurmountable problems. You can't change the fact that highly stressful events happen, but you can change how you interpret and respond to these events. Try looking beyond the present to how future circumstances may be a little better. Note any subtle ways in which you might already feel somewhat better as you deal with difficult situations.

Accept that change is a part of living. Certain goals may no longer be attainable as a result of adverse situations. Accepting circumstances that cannot be changed can help you focus on circumstances that you can alter.

Move toward your goals. Develop some realistic goals. Do something regularly -- even if it seems like a small accomplishment -- that enables you to move toward your goals. Instead of focusing on tasks that seem unachievable, ask yourself, "What's one thing I know I can accomplish today that helps me move in the direction I want to go?"

Take decisive actions. Act on adverse situations as much as you can. Take decisive actions, rather than detaching completely from problems and stresses and wishing they would just go away.

Look for opportunities for self-discovery. People often learn something about themselves and may find that they have grown in some respect as a result of their struggle with loss. Many people who have experienced tragedies and hardship have reported better relationships, greater sense of strength even while feeling vulnerable, increased sense of self-worth, a more developed spirituality, and heightened appreciation for life.

Nurture a positive view of yourself. Developing confidence in your ability to solve problems and trusting your instincts helps build resilience.

Keep things in perspective. Even when facing very painful events, try to consider the stressful situation in a broader context and keep a long-term perspective. Avoid blowing the event out of proportion.

Maintain a hopeful outlook. An optimistic outlook enables you to expect that good things will happen in your life. Try visualizing what you want, rather than worrying about what you fear.

Take care of yourself. Pay attention to your own needs and feelings. Engage in activities that you enjoy and find relaxing. Exercise regularly. Taking care of yourself helps to keep your mind and body primed to deal with situations that require resilience.

Additional ways of strengthening resilience may be helpful. For example, some people write about their deepest thoughts and feelings related to trauma or other stressful events in their life. Meditation and spiritual practices help some people build connections and restore hope.

The key is to identify ways that are likely to work well for you as part of your own personal strategy for fostering resilience.

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Post Traumatic Growth Inventory

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Peng Wei

Theodor Millon

Theodore Millon, Ph.D., D. Sc., (born 1928) is an American psychologist, founding editor of the Journal of Personality Disorders and the inaugural president of the International Society for the Study of Personality Disorders and a full professor at Harvard Medical School and the University of Miami. A leading researcher and theorist.

His award-winning evolutionary theory of personality structure and development has guided the development of seven relatively brief Millon Inventories, among them the MCMI-III, MBMD, MACI, MIPS and most recently, the M-PACI and MCCI, each focused on a different clinical population, e.g., adults, adolescents, medical patients. Furthermore, the Parents' Preference Test (PPT) is based on his personality model, adapted to the interpersonal perspective. As a key member of the DSM-III and IV, his theory is closely correlated with the official classification system, increasing the utility of his associated diagnostic instruments.

A prolific author, he has written or edited more than thirty books, including Disorders of Personality, and The Millon Inventories: A Practitioner’s Guide to Personalized Clinical Assessment, published in 2008.

Winner of numerous lifetime awards, Professor Millon was also the 2003 recipient of the American Psychological Association's Distinguished Contributor to Applied Research award. The APA and American Psychological Foundation have established the Theodore Millon Award for mid-career scholars in personality psychology. His former students and colleagues published a Festschrift honoring his lifetime achievements in Stephen Strack's 2005 Handbook of Personology and Psychopathology (Wiley). Professor Millon now serves as Dean and Scientific Director of the Institute for Advanced Studies in Personology and Psychopathology.
You may click here to access to his wonderful site.

"He who does not at some stage, with definite determination consent to the terribleness of life, or even exalts in it, never takes possession of the inexpressible fullness of the power of our existence."
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"Selected Letters "of Rainer Maria Rilke

I love my job.
But I specially like to work with women,
I feel that when two women get together to work in therapy, the space becomes a cooking pot where alchemy is performed. It feels to me as an encountering of two sorcerers, a "Concilium"...
Whatever power of amazing uteral creation moves there I do not know...
but makes me understand, why men fear us sometimes the way they do...we a strong creatures...

Alex
Painting by A.O.J

The good and the bad...

The Judeo-Christian culture, has a deep Descartean way to see the existence: what they consider to be bad in people is something that has to be suppressed. Man have to be "good", follow what it is written. These two statements I heard many times on and on.
Human beings have to be "good", but they do not know how to be "good" no matter how much they read, people sometimes cannot help the way they are. To try to suppress the "bad", is the best way to make that grow.

Many people, some of which I treated as patients, believe that may be there is a kind of devil inside of them. I use this opportunity to turn this into a metaphor.

I ask them about the story of Lucifer, most of them know that Lucifer was a fallen angel...

And this is where the story starts.

There are many reasons why a person could feel that there is something really wrong about them, most of the time there is an equation that works quite prescise: the hardest their past was, the most related to have been abused, the more this feeling of been bad.

Sometimes there is an undergoing dissociation that does not arrive to the point of DID but it is in the neighbourhoods.

I explain to them, that what they percieve as a "bad" part, much rather as a kind of fallen angel...a part of them in the exile...in need of love and acceptance.

That bad part, stands there to be embraced, in that embracing, the patient will have the opportunity to become more whole.

A.O.J.

Letters to a young practitioner

Dear Jean Paul,

In your previous letter you are asking about my conclusions (first four hundred hours) of working in a mental hospital, and what kind of advice I could give to you.
As you can imagine there are so many instances in the practice, that I find myself trying to make almost an existential synthesis...: difficult task.
The mental hospitals in (...) can be really the frontier of the unheimlich. As I see you are feeling like I did, the need to push to the limit, beyond what is "known" and familiar and submerge yourself into the unknown, thrilling or even terrifying, as Erlich described it.

My first suggestion is that you come with a "map". At the beginning a map will protect you as a "transitional object"...
The encounter face to face with the "otherness" of the other, in its most obscure and unknown aspects it is always something frightening, as it is frightening to discover that, in oneself, independently from wether the other comes unwashed, with the hair in a revolt, or if it has a way to compensate himself by delusions and hallucinations.
So remember your map, even if it is a rough one, because you will be experiencing in three dimensions what you learned in one. And at a point you will get thrilled by this passage, which is not just any passage...Suddenly you will be able to impair your perceptions with what you learned and that is a feeling that I cannot explain to you, but you will experience by yourself.

Second suggestion. May be you will percieve the urge that sometimes many professionals around you will have to establish a diagnosis even though when the picture is confusing. A diagnosis takes time, and they have to write something down as a conclusion as soon as the patients are hospitalized. Sometimes this "urge" will push to serious and grave mistakes. Once the diagnosis is made, it is hard for the professional to re think about it. The patient comes in, and what they will tend to see is more the diagnosis than the person. Alas! with this...always remember the conclusions of Wittgenstein in his Tractatus Lógico-Philosophicus. Once you came up the stairs through the ladder!
The diagnosis is something to be bordering about...to surround...something provisory. The practice of clinic is about the particularities. Remember always this.

Third suggestion. You are not invulnerable. Have a friend in the mental care system that will be able to deal with your existential nausea, because it will come...you will hate the system, you might feel like Rambo at a certain point.

The forth suggestion is, in time... to let go of the map. Your best teachers will be the patients. Ask yourself "what if...", that will leave the door open...don't close the door...

Suddenly you might find yourself looking from inside out, just the other way round as you came in. May be you will realize, like I did, that your staying in a mental asylum brought you back to a kind of sanity...that you recovered something of a human dimension.... That somewhere, further away from trauma, there is a place that words cannot touch, another aby: beauty.

And finally, my dear Jean Paul...you know...may be all of us, the ones that have chosen this profession, are also a bit lunatic, late nighter poets, and definitely lovers of a certain vocation for labyrinths. We work day and night to find something that would aproach a truth effect, still knowing that there is no more than that...but that "that", will nevertheless make us free enough, as to be able to open the dimension of "what there is not", so that this time, we will be able to cross through its anguish.

With love and affection,

Alex

"If you are not prepared to be wrong, you will never come up with anything original. By the time children become adults, they become frightened of being wrong."

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Ken Robinson

Paul Ricouer: L'éternité, ce déborde une catégorie de présent.

Paul Ricoeur

(1913-2005)

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Quint Buchholz

Reminder...

Maggie Taylor

No matter how faithfully adjust to the protocols your therapy will be... don't forget what it means the Infinite presence of the Other...
...Technical aspects alone, will never be deep enough as to reach a human soul ...

A.O.J.

The process of changing...

For many people "change" has an unhappy connotation. Because through a period of their life change meant the undergoing of instability, this impairment tends to make people develop a special aversion to changes.
It is almost certain that this attitude will make the person go right away into mechanisms of avoidance, which will tend to reinforce with time. At the beginning they might get the wrong idea that if they don't move they will be able to keep as much control as to provide stability.We all know that change is not avoidable. The fact is that change is the only permanent issue.
Because the need to avoid change, people with this characteristics seldom took risks. If they ever did and went wrong,they got kind of discouraged "forever".
It is because failure is egosintonic , it is isomorphic with the idea that they have of themselves, the result will be, in the long run, the incapability to deal with new circumstances because now they will be lacking in the necessary abilities to do so, since they never allowed exposure.

This characteristics can be found in many a different groups in the world of mental health care, but they all have one thing in common when they turn to therapy: they are looking for change.
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In the process of helping our patients to change, we find a two-fold action: on one hand acceptance, of their condition, of the responses they give as the best they know and learned and on the other hand, the need to change. So we have to work out through these dialectics.

The whole idea is to try to introduce flexibility. As when in training in gymnastics you have to go step by step, and practice on and on. Flexibility provides a campus were failing and falling every now and then will be a part of non judgemental learning for the patient.

The interventions with this kind of patients will have to be, as to produce in the them, as minimum change as needed. You do not want to make a whole deconstruction of the patient's personality to heal a phobia.

-It is better to move towards small changes that are sustainable, where the patient still feels comfortable, - nevertheless the patient will most surely feel "strange" at the beginning-than to try and produce a big "change event", that most probable will make the patient feel scared and go back to base-line if not underneath base-line.
Therapy when well applied has a Domino Rally effect, one thing moves the other. A lot goes on when the patient leaves the clinic. Therapy continues in their heads during the week working at many levels.

-Relapses may occur. In therapy patients go up and down even though the line tends to go up. It is important that they will know this, to avoid the frustration and disappointment when a relapse takes place. This hopefully will be happening less and lighter, each time.

-Always keep present what they learned from a relapse and make sure they register how they came out!

-Last but not least. Trust their capability to stand the failure and move forward.

A.O.J.

EMDR

EMDR is a psychotherapeutic approach that was developed by Shapiro (1989, 2001) to resolve symptoms resulting from disturbing and unresolved life experiences.
It is based on a theoretical information processing model, which posits that symptoms arise when events are inadequately processed and may be eradicated when the memories are fully processed and integrated.
Shapiro further maintains that a negative sense of self, inappropriate emotional responses, and self-destructive behaviors are also manifestations of inadequately processed material, and that processing the etiological experiences underlying these current dysfunctions will transform them, allowing newself-perceptions, emotions, and behaviors to emerge.
In addition, new experiences are targeted, processed,and incorporated into memory in order to overcome developmental and skills defi cits.
EMDR is an integrative therapy, synthesizing elements of many traditional psychological orientations, such as psychodynamic, cognitive behavioral, experiential, physiological, and interpersonal therapies (Shapiro, 2001, 2002; Shapiro & Maxfi eld, 2002).
Currently, EMDR is rated in the highest categoryof effectiveness and research support in the PTSD practice guidelines of both the American Psychiatric
Association (2004) and the U.S. Department of Veterans Affairs and Department of Defense (2004).

Journal of EMDR Practice and Research, Volume 1, Number 1, 2007

The Journal of EMDR Practice and Research

(Free First Issue; July 2007. Don't dispair, takes a little while to download...)

Nico Garstman

"Salvation"

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Dalia Johananoff

Salvation seems to me, like an inclusive long term solution. If you were to fill up this bottle, what would you put in?

Bodily inscriptions

Somatization of mental-emotional complaints in China

In the year 1740, during the Qing dynasty, an order was incorporated to the Qing Code, that would place the insane under house arrest or in prison, turning them from mentally ill, into "criminal deviants". According to Flaws & Lake (2007) this kept on going on during the Communist regime. During the Cultural Revolution, all mental illness, including the most notable depression was called into question by the Maoists a "wrong political thinking".Therefore, dysphoric emotion, has been regarded as shameful to self and family and not shared outside the household doors, including health care providers, except only in somatic terms. Kleinman & Kleinman (1985).

The tendency towards somatization is reinforced by Chinese medical theory itself. Knowing that extreme emotions damage health, Chinese patients tend to emphasize somatic complaints when presenting their cases to avoid loose face.

Psychiatric complaints enter a category called "internal medicine"(nei ke) and is treated with somatic based treatments, such as acupuncture and herbs. This once again reinforces the process of somatization. Flaws & Lake (2007).

Even though a common diagnosis today is still "neurasthenia" and involves a long list of mental dysfunctions and illnesses, information permeating China from the rest of the world, provided a shift toward the adoption of Western psychiatric diagnosis, with the DSM IV...so they seem to be undergoing their "fifties" now, and we hope, that a free distribution of "schizophrenia" labels will not start circulating, like they did, in our hospitals in the West, during that period.

A.O.J.

Zhang Huan

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It is not by keeping it

to yourself

but

through shearing it

that your light will grow.

A.O.J.

Quint Buchholz

Navegatio ad infinitum...

Even though all the efforts to define and to label, our patients will always remain an oltremare landscape...a complete and definite Other...

We venture with them into their territories with a rough navigation chart...and where we go, it is beyond the coordinates of the DSM or the ICD...beyond scores and research and principles of valid inference and demonstration ..

We venture...with them...

... meaning that at certain point, we will be detaching from the "problem" and facing the ontological mystery, as defined by Gabriel Marcel. Therefore, we will necessarily get into the syndrome of the end of the map...

It sais in the "Tractatus Lógico-Philosophicus"; "He who understands my propositions recognizes them as senseless. (He must so to speak throw away the ladder, after he has climbed up it)". Wittgenstein, L.; 1921.
A.O.J

Quint Buchholz

Conclusions for an imaginary psycoanalitic thriller:

"Under these hermeneutics of suspicion, interpreting could be the murderer... "

A.O.J.

Virginia Satir

(26 June 1916 - 10 September 1988)

In Memoriam

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"The problem is not the problem. The problem is how you cope with the issue; that is what creates the problem"

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Maggie Taylor

I hold therapy...

...as an experience of a middle ground between the self and the world. The therapist as a facilitator of tools that will enable him/her to exercise as much as possible, within the "proximal zone of development", a buffering area that it is about symbolic capacity.
The limit of the language -assumed not only as speech, but the capacity to represent-will mean the limit of our world.
A.O.J.

Paul Potts, a lesson to be learned.

It is easy to understand the difficulties that Paul had with his confidence when we watch the pre-judice of the judges, made evident by their looks and comments, before and after. That makes you think so much about the affirmation of Paul when he sais "Confidence is always been difficult for me...", we start realizing that his difficulty was the other people's difficulty in the first place...

Since I posted this link, the Embedding has been disabled by request, so please go to the link of Youtube.
http://www.youtube.com/watch?v=bEo5bjnJViA

Power within...

‘My Declaration of Self-Esteem’

I AM ME

In all the world there is no-one else exactly like me. Everything that comes out of me is authentically mine because I alone chose it.

I own everything about me; my body, my feelings, my mouth, my voice, all my actions, whether they be to others or to myself - I own all my triumphs and successes, all my failures and mistakes, because I own all of me.

I can become intimately acquainted with me. By so doing I can love me and be friendly with me in all my parts. I know there are aspects about myself that puzzle me and other aspects that I do not know, but as long as I am friendly and loving to myself, I can courageously and hopefully look for solutions to the puzzles and for ways to find out more about me.

However I look and sound, whatever I say and do, and whatever I think and feel at a given moment in time is authentically me. If later some parts of how I looked, sounded, thought and felt turn out to be unfitting, I can discard that which is unfitting, keep the rest, and invent something new for that which I discarded. I can see, hear, feel, think, say and do - I have the tools to survive, to be close to others, to be productive, and to make sense and order out of the world of people and things outside of me

I own me, and therefore I can engineer me - I am me and

I AM OKAY

Virginia Satir

Never give up. No matter what is going on, there will be always something that you will be able to improve. There will be always a way that will make you feel better.

I heard once a quote by B.Burton that went: "Nothing great has ever been achieved, except by those who dared to believe, that something inside of them, was superior to the circumstances."

You have that "something" even if you did not realized it yet. I can assure you.

A.O.J.

方式我們是 or the way we are...

Graphic explanations of the Chinese Public Health to show us why we are only machines.
To enlarge, and therefore understand, please click on the image.

Body and soul

Janet (1859-1947) was one of the luminaries that integrated the mind to the body, discovering that there was a condition -in some of his patients that were suffering from astasia abasia- that referred non neurological illness.
Babinsky (1857-1932) also contributed to this discovery, producing or failing to produce, his famous reflex in the arch of their feet.

Since then a lot has been done to overcome Descartes -we have not managed much, though-. But whole range of psychosomatic illnesses, have a well established place now in Journals and Academies, like the APM of Berlin, etc.
But in the field of non division body-mind, there is nothing like the Chinese. The fact is that they see it the other way round.

Does it have to do with the position of the earth, or the position of the subject?: In China, phobias belong in general to the territory of the kidneys. Several agents can cause a kidney essence insufficiency -such as addiction to hot peppery food, drinking alcohol, faulty diet, liver depression transforming heat and so on -.
The diagnosis, like in the rest of T.C.M. is done by pattern discrimination (call it semiology) that could include something like "aversion to wind", "pale tong with thin fur" or "profuse dreams", for example.

Until now I have personally seen case histories, but I cannot account for having read about any case research, with control group etc. It seems that it goes like: "why should you take three months to research what it is already known since before the times of Yellow Emperor?"
Anyway, the next Congress in China will be far interesting to try and find out what kind of data was produced, about this particular way of exercising mental health.
So may be next time we have to deal with a Social Phobia, we'll bring out the needles and the herbs?

A.O.J.

Ilustration from Yingyanghouse

Seminar V (Lacan)

Trees of hope...

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.Robert & Shana Parke Harrison

Analogies

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It seems that within the inner journey, we discover and bring to light what was always there... even though it was not, until we saw it... Somehow, it reminds me of quantic physics and the poor old Schrodinger's cat...

A.O.J.

"What lingers from the parent's individual past, unresolved or incomplete, often becomes part of her or his irrational parenting."

Virginia Satir

Safety area

I believe that it is important, at beginning of the treatments to establish a "Safety Area". This area it is an imaginary place that every each patient creates in his own mind. It is a kind of sanctuary where he/she would feel protected.
You can use one session to establish it. It has the function to anchor feelings of warmth and security, which many times will be needed during the treatment of trauma.
It is also from this place that the patient can look at traumatic scenarios and be able to work on them in a dissociated way, which saves unnecessary stress, until he/she is able to cope with the affection at a bearable rate.
Many safety places at the beginning are rudimentary, some do not have windows or doors...with time they tend to warm up, and be more inviting. Suddenly a door or a window appears. I interpret this changes as a sign that the patient is becoming more confident, and more committed to the therapeutic work.

A.O.J.

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and always remember...
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"The hardness of the butter is proportional to the softness of the bread."
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Boswell D. Rabbitsmith

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Tales of Molla Nasraddin

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Once, Nasreddin was invited to deliver a khutba. When he got on the minbar (pulpit), he asked: "Do you know what I am going to say?" The audience replied "NO", so he announced "I have no desire to speak to people who don't even know what I will be talking about" and he left.

The people felt embarrassed and called him back again the next day. This time when he asked the same question, the people replied "YES". So Nasreddin said, "Well, since you already know what I am going to say, I won't waste any more of your time" and he left.

Now the people were really perplexed. They decided to try one more time and once again invited the Mullah to speak the following week. Once again he asked the same question - "Do you know what I am going to say?" Now the people were prepared and so half of them answered "YES" while the other half replied "NO". So Nasreddin said "The half who know what I am going to say, tell it to the other half" and he left!

Pablo:...Life goes on grinding up glass, wearing out clothes, making fragments breaking down forms and what lasts through time is like an island on a ship in the sea, perishable surrounded by dangerous fragility by merciless waters and threats....

Pablo Neruda

Alex:...and as I live and look arround, I realise, that nothing is built on stone; all is built on sand... but we must build as if the sand were stone...

A.O.J.

Photograph by Zou Wen Dou

5th World Congress for Psychotherapy in Beijing

• Agenda

October 12-15, 2008 in Beijing, China. For information about the event, please click on the title.

.
"The words that we attach to our experience,

became our experience"

Ethnobotanics and Ethnopsychopharmachology

m

Luigi Serafini

Ethnobotanics, as a scientific discipline, studies and interprets the history of plants in the ancient and current societies, devoting itself to the recovery of the knowledge, that ethnias and cultures from all over the world have, of their properties and utilization, in all the areas of life.

This area, is of course, very much related to spiritual healing. It is the one that would come closer to the exercise of psychiatry.

When we are confronted with the term etnopsychopharmacology we face at least two criteria:

• The art of the usage of substances in different cultures with the purposes of healing or prevention of diseases, generally manipulated by the shaman or medical wizard.
  


• The science of research, for the sake of genetic individualities of identified groups, which could spot certain vulnerabilities; that there will be necessary to have in mind, at the moment of prescribing a psychoactive drug.

Both of them crossed by a triple communication slope that implies messages of chemical, inter-relational and social type.
Cultural or psychosocial facts, such as attitudes and believes of an ethnic group, can affect the efficacy of, or the adhesion to, a therapy that involves medication. For example, some non occidental groups would have difficulty to understand chronical treatment, because in their mental representation, medicines are to be taken for a short period for the purpose of alleviating symptoms, and then the y should finish the treatment. Some others would feel afraid that the drugs will inhibited them to be aware of an environment which might be dangerous and unknown like a big metropolis.

Asiatic groups might interpret a dry mouth or muscle stiffness, side effect of certain drugs, like symptoms described in Chinese medicine of an illness itself.

The poliurea, one of the side effects of Lithium, will be seen as something positive by them (Lee A.:1993)

Aspects related to the daily life like the impact of emotions and tension, sexual considerations, usage of herbs, physical exercise, smoking habits, consumption of coffee, dieting habits like the intake of black pepper, common in Indian population, that inhibits the CYP1A2 causing a diminishing of the metabolization of Benzodiazepines, Tricyclics and IRSS.

From the genetic point of view you have cases like the Ashkenazy Jews in the United States, with a tendency to develop agranulocytosis up to a 10 to 12 %, while in the western population is common up to 1%, due to a specific haplotype.

The field of the medical anthropology, genetics and cultural psychiatry have arisen to study these questions, starting to produce intensive research over "identified ethnic" groups, with determined vulnerabilities, that will have to be taken in account when dealing with psychiatric drugs.

A.O.J.

This is a very short summary which you can extend if you wish, by consulting the following references;

References

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´ Escobar, J.I.; Tuason VB, (1980) , Antidepressant agents: A cross cultural study, Psychopharmacological Bullettin, 16, 49-52.
´ Falloon, I.R.H.; Liberman RP (1983). Interactions between drug and psychosocial therapy in schizophrenia. Schizophrenia Bullettin, 9,543-554.
´ Ferrali, J.C. (2004)Psicofarmacología para el equipo de Salud Mental. Hojas clínicas de Salud Mental. Año 1. Número 1, 1.
´ Goldberg, S.C. et al. (1966). Sex and race differences in response to drug treatment among schizophrenics., Psychopharmacologia (Berlin) 9, 31-47.
´ Kalow, W. (Ed.). (1992). Pharmacogenetics of Drug Metabolism. New York: Pergamon Press.
´ Turbay, D.; Lieberman, J.; Alper, C.A.; et al. Tumor necrosis factor constellation polymorphism and clozapine-induced agranulocytosis in two different ethnic groups. Blood: 1997; 89:4167
´ Lee, S. (1993), Side effects of chronic lithium therapy in Hong Kong Chinese, Culture, Medicine and Psychiatry, 17, 301-20
´ Lin, K.M.; Poland-RE; Anderson-D (1995), Psychopharmacology, Ethnicity and Culture, Transcultural Psychiatric Research Review, 32, 3-41