[spiritual_emergency]

Note: I shifted this response to Sky in the Schizophrenia and Metaphor thread to a new thread because the red x wasn't showing up in the thread title.

<hr width=100% size=2>

Sky: However, now I see another questionable statement. Where in the DSM IV does it have that schizophrenia is a dissociative disorder? I believe it is considered a psychotic disorder.

Were you not aware Sky, that psychosis can be a component of PTSD?

See also: <a href ="http://spiritualemergency.blogspot.com/2006/01/psychosis-ego-collapse.html">Psychosis and Ego Collapse</a>

I have noted that trauma played a significant role in my breakdown. The experience of psychosis itself can be quite traumatic! As a result, individuals who have gone through an episode of psychosis -- whether it's determined they have schizophrenia or not -- can find it helpful to investigate trauma resources. Likewise, individuals with PTSD who have experienced psychosis can find it beneficial to investigate psychosis resources.

In addition, were you aware that childhood trauma is being investigated as a potential "cause" of schizophrenia?

<blockquote>The fact that some two-thirds of people diagnosed as schizophrenic have suffered physical or sexual abuse is shown to be a major, if not the major, cause of the illness. Proving the connection between the symptoms of post-traumatic stress disorder and schizophrenia, Read shows that many schizophrenic symptoms are directly caused by trauma.

The cornerstone of Read's tectonic plate-shifting evidence is the 40 studies that reveal childhood or adulthood sexual or physical abuse in the history of the majority of psychiatric patients (see, also, Read's book, Models of Madness). A review of 13 studies of schizophrenics found rates varying from 51% at the lowest to 97% at the highest. Crucially, psychiatric patients or schizophrenics who report abuse are much more likely to experience hallucinations. The content of these often relate directly to the trauma suffered. At their simplest, they involve flashbacks to abusive events which have become generalised to the whole of their experience. For example, an incest survivor believed that her body was covered with ejaculate. The visual hallucinations or voices often tyrannise and belittle the patients, just as their tormentors did in reality, creating a paranoid universe in which intimates cannot be trusted.

Source: Think Again</blockquote>
Those who wish more information may be interested in Dr. Read's book: Models of Madness

[(JD)]

Hmmm No, what I am aware of is some ppl have both PTSD AND psychosis, but psychosis isn't a component of PTSD that I know of.

I won't argue that your trauma as a child may have contributed to your schizophrenia. I'm sorry that you suffered so.

[spiritual_emergency]

Sky psychosis isn't a component of PTSD that I know of.

Someone should let the Mayo Clinic know.

won't argue that your trauma as a child may have contributed to your schizophrenia. I'm sorry that you suffered so.

I'm sorry that anyone has to suffer so, but quite honestly, I think in my own case, I weathered those storms quite well. At minimum, I had a mother who loved her children very much and did what she could to protect them. She left my birth father the night he tried to kill us.

Those events were common family knowledge and because we spoke openly of them, I thought I had dealt with them. Many years later, my mother -- the protector -- would die, and I -- of my own free will -- would walk into a situtation that shared a number of key similarities with the events of my earlier childhood. By the time it was all over, a number of people were dead and I was about as "crazy" as they come.

Still... I had that mother and some people don't have that at all. Love is powerful medicine. Later, when I did go crazy, through a strange series of twists and turns, Kali would come into that space with me.<blockquote><font color=191970>Within that altered space, characters came into play: gods, devils, a kindly and compassionate mentor, a fierce warrior goddess – the real life people I had lost, been with, or been up against, transformed into larger-than-life characters by Story.

Source: PTSD, Psychosis and Story as a Vehicle of Healing

[spiritual_emergency]

Continuing in the theme of trauma and schizophrenia... The following is an excerpt of an interview with Dr. Loren Mosher.

Dr. Mosher was the first Chief of the Center for Studies of Schizophrenia at the National Institute of Mental Health. He founded the Schizophrenia Bulletin and for ten years he was its Editor-in-Chief. <blockquote>Mosher points out that the kind of therapy dispensed at Soteria House differed profoundly from the work that went on at the famous Chestnut Lodge psychiatric hospital in the '50s and '60s. There psychiatrists had tried to cure patients with traditional Freudian-style psychotherapy. "I'm fond of saying psychosis does not fit the 50-minute hour -- because it goes on 24 hours," Mosher says. "So you ought to conform your treatment to fit the problem." Rather than scheduling specific sessions with their charges, the Soteria staff members made a commitment to be available every moment of the schizophrenic residents' waking hours. Mosher says the overall feeling had much in common with the "moral treatment" asylums that appeared in America in the first half of the 1800s. Small, humane, and pleasant environments, these institutions promoted the concept that many lunatics could recover their sanity if treated with decency, gentility, and respect. As peculiar as that notion might appear today, Whitaker in Mad in America writes that "Moral treatment appeared to produce remarkably good results." He cites records from five moral-treatment asylums showing that between 50 to 91 percent of their patients were able to return to normal lives in their communities. Such outcomes led one asylum superintendent to declare in 1843 that insanity "is more curable than any other disease of equal severity.…"

Like this man, the staff at Soteria embraced the notion that "recovery from psychosis was not only possible but probable and to be expected," Mosher asserts, adding, "You start there, and you're way ahead of the game right away." And Mosher went further. By the time the Soteria project got rolling, he had come to believe that rather than being an unfathomable mystery, psychosis was an understandable coping mechanism.

He claims that in this way it resembles shell shock. "Men would be in combat and their entire platoons would be killed, and they would survive and be covered with blood and guts. And they would go out of their minds." What such individuals look like as they're ranting and raving "is really no different than what acute psychosis is like," Mosher says. "Except that the [shell-shock victim's] trauma -- the overwhelming experience -- is very readily identifiable. It's right there, easy to see."

In contrast, he says the trauma that drives schizophrenics over the edge "is not often so readily identifiable, and it is more often cumulative, rather than a single event."

Source: Still Crazy After All These Years</blockquote>

It's worth noting that my own therapist -- the mentor who appeared and guided me through that experience -- served as my constant companion for those several weeks. He was available to me 24 hours a day, as required. The setting was also very homelike, very comforting. Do I think that had something to do with my recovery? Yes, I do.

I had not heard of the work of Loren Mosher or John Weir Perry previous to that experience; I wouldn't stumble across the name of Perry for more than another year, and Mosher, some time after, but somehow I intuitively knew to create that kind of healing environment for myself.

[spiritual_emergency]

Additional resources as related to PTSD and psychosis for those who are so inclined:
[*] Linking Posttraumatic Stress Disorder and Psychosis: A Look at Epidemiology, Phenomenology, and Treatment
[*] Posttraumatic Spectrum Disorder: A Radical Revision
[*] Post Traumatic Stress Disorder With Psychotic Features

[(JD)]

Yes, someone with PTSD can also have psychosis, or someone who is psychotic can also suffer with PTSD. This does not mean that everyone with PTSD is also psychotic, they just aren't linked like that.

[spiritual_emergency]

<blockquote>
Hello once more Sky. I didn't respond to this post earlier because there was nothing to add to it. You are quite correct in noting that not everyone with PTSD will have psychotic features -- although a "flashback" can appear to be a break with reality it should be understood that it is a temporary trauma response to a triggering event.

However, as noted by the clinicians cited above, psychosis can be a part of PTSD for some individuals just as trauma can play a significant role for some individuals who experience psychosis. In my own experience, I have found that among the "schizophrenics" I have spoken with, a triggering event served as a precurser to their experience of psychosis in every instance. Somewhere there has been a loss, a betrayal, the shaking of a belief system that challenged them to the core. That's anecdotal evidence, of course -- reinforced to a large degree by research in the field. Nonetheless, the model of ego collapse is one that I identify with strongly.

In spite of the above, it cannot be stated as a given that trauma will play a role in every individual who undergoes the experience of psychosis and/or schizophrenia. The actual cause of schizophrenia has still not been determined and the field is fraught with controversy. Individuals must develop a treatment approach that addresses the uniqueness of their personal history.

In terms of my own recovery, I have found the trauma model to be helpful. In particular, I found the book Trauma and Recovery by Judith Herman to be highly relevant.</blockquote>

[(JD)]

Yes, that is well said. But with that said, it makes me wonder why different treatments for schizophrenics are not forthcoming? Ok, trauma changes a person physically-brain chemical-wise. Then it should be workable? PTSD is a bear of a disorder. If schizophrenia is caused (perhaps?) by a more severe response to trauma, then it would be more of a bear, but doable!

I think 1 in 100 is huge and demanding of attention. Perhaps the powers that be have swept it under the rug in general, but certainly researchers are working on this?

[spiritual_emergency]

<blockquote>
Sky: Yes, that is well said. But with that said, it makes me wonder why different treatments for schizophrenics are not forthcoming?

I think they are but there's a great deal of resistance from many quarters. No doubt, this is due in part to the fact that schizophrenia has consistently been portrayed as an incurable condition; current theory largely revolves around genetic and biomedical markers. Schizophrenic experiences are also frequently invalidated or dismissed as unimportant -- talking about the experience of psychosis itself is seen as a means of "feeding the delusions". As a result, no one really talks to these people. Although it is acknowledged that stress can often serve as a triggering factor, few admitting personnel and even fewer psychiatrists invest the time in compiling an individual's history. And why would they? They've been taught that schizophrenia is a genetic, neurological disorder that can be treated with a pill. Assertions that the experience is caused by anything other can be written off as "paranoid delusions", in part because of the manner in which they are presented -- schizophrenics speak metaphor; psychiatry does not.

One would think that there might be some hope to be found within the field of psychology with its emphasis on relationship and talk therapy but many psychologists have been taught the same as many psychiatrists -- schizophrenia is an incurable condition that requires treatment with medication. Most psychologists don't have prescribing privileges so they leave the "schizophrenics" to psychiatry.

The adoption of the medical model was supposed to remove some of the stigma associated with the experience by removing the burden of shame -- those with schizophrenia were no longer to be considered lesser, weaker, human beings, instead they were simply genetically flawed... from birth. Given the history of treatment of the schizophrenic, it can be said that this is a grand improvement [Cautionary note: That link may make you weep, particularly if you have any insights into the psyche of the traumatized human being] yet it's still not the improvement that is regularly enjoyed by "schizophrenics" in other cultures where far more of them recover completely.

Ok, trauma changes a person physically-brain chemical-wise. Then it should be workable? PTSD is a bear of a disorder. If schizophrenia is caused (perhaps?) by a more severe response to trauma, then it would be more of a bear, but doable!

I think that's a good attitude. It is a burden, particularly so for those who are younger when their experience occurs. I was in my mid-thirties when I went through those events. I had a long history of healthy function before me, I had more experience as a human being to draw from in my recovery. In spite of that, it was the most difficult thing I've ever done and I had to lean very heavily on others for a time. Younger people don't have the benefit of more life experience which is why the support structure is even more crucial. We do them a mass disservice when we tell them they can't get well, that it's all in their genes, that they will have to set aside the hopes they had for their future; that the medication many of them hate to take (even if they do find it helpful) is their only hope.

I think 1 in 100 is huge and demanding of attention. Perhaps the powers that be have swept it under the rug in general, but certainly researchers are working on this?

They are, i.e. Paul Hammersley and Dr. John Read</blockquote>

[(JD)]

That schizophrenia is thought to only occur in the twenty's and thirty's means that there is some chemical situation at that time of growth of the body that allows the mix up to happen...coupled with the trauma or such response.

You know, and I don't mean to trounce on anyone's feelings here... but I also think that another disorder Tourette's has similar basis. Why else would most all of the ppl with that disorder yell out obscenities rather than anything else?

There is a new mental health parity act (of 2007) that we really need ppl to tell their senators to vote for...maybe once we have everyone in the "system" they will realize the similarities and also the need for proper research!

[Smilie]

wow! Thanks for the link. Its very interesting and educational

Smile

[findebsoon]

I have a brother that became quite messedup because of
his years in the armed forces. He had some delusions and was
depressed and was given some of the same meds once given to me
and his experience gave him opportunity to know what is was like. He's alright now, so I hope that may shed some light on
your previous debate. yo.

[spiritual_emergency]

Yes, findebsoon, it doesn't surprise me in the least that those in the military might emerge from those events a bit "messed up". It's encouraging to hear that your brother is doing better now and that you too have found some peace and stability for yourself.

[spiritual_emergency]

A possible resource for those with trauma in their background.

</font><blockquote><div id="quote"><font class="small">Quote:</font>

Donald E. Kalsched, Ph.D. is a clinical psychologist and Jungian analyst with a private practice in Katonah, N.Y. He is a faculty member and supervisor at the C.G. Jung Institute in New York City and with the Inter-Regional Society of Jungian Analysts. Currently he is Dean of Jungian Studies specialty at the Westchester Institute for Training in Psychoanalysis and Psychotherapy in Bedford Hills, N.Y. He is the author of The Inner World of Trauma: Archetypal Defenses of the Personal Spirit (Routledge, 1996), now in its fourth printing. He has lectured and led workshops on this topic in the US, Europe, and South Africa and is known as an engaging speaker and inspiring teacher.

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<font size=4>From Bewitchment to Enchantment: Transformational Process in the Psychoanalysis of Trauma</font>

Patients who have suffered severe early trauma often find themselves bewitched by dark tyrannical voices assaulting them from within, leading to intense anxiety and depression. In dream work with such patients, the dark inner voices reveal themselves as both archaic and typical--hence archetypal--personifications whose inner purpose seems to be the defense of a vulnerable core of selfhood to make sure it is never violated again. However, in defending the true self against further trauma, the archetypal defenses also persecute and demoralize it, cutting off all hope for life-in-relationship to others. Under these conditions, the positive side of the Self cannot constellate and the individuation process cannot get started. In successful depth psychotherapy, these archetypal defenses slowly lose their power as their daimonic energy slowly becomes humanized in the transference and is transmuted into a mature capacity for love and creative living (enchantment).

In this workshop, clinical material as well as the Grimm's fairy tale Fitcher's Bird will be utilized to illustrate this process. Attendees are asked to read the tale before the workshop.

A version of the story can be found online at D.L. Ashliman's web site : Fitcher's Bird

Source: From Bewitchment to Enchantment: Transformational Process in the Psychoanalysis of Trauma


</div></font></blockquote><font class="post">

</font><blockquote><div id="quote"><font class="small">Quote:</font>

<font size=4>The Inner World of Trauma: Archetypal Defenses of the Personal Spirit</font>

... If we study the impact of trauma on the psyche with one eye on traumatic outer events and one eye on dreams and other spontaneous fantasy-products that occur in response to outer trauma, we discover the remarkable mythopoetic imagery that makes up the "inner world of trauma" and that proved to be so exciting to both Freud and Jung. And yet neither Freud's nor Jung's interpretations of this imagery have proven entirely satisfactory to many clinicians today, including the present author. For this reason, a new interpretation of trauma-linked fantasy follows in the ensuing pages -- one that combines elements from both Freud and Jung. This "new" interpretation relies a great deal on dreams that immediately follow some traumatic moments in the patient's life. Careful study of such dreams in the clinical situation leads to our main hypothesis that the archaic defenses associated with trauma are personified as archetypal daimonic images. In other words, trauma-linked dream imagery represents the psyche's self-portrait of its own archaic defensive operations.

In the clinical material to follow we will find examples of this imagery in the dreams of contemporary patients, all of whom have struggled with the devastating impact of trauma on their lives. We will see how, at certain critical times in the working through of trauma, dreams give us a spontaneous picture of the psyche's "second line of defenses" against the annihilation of the personal spirit. In providing these "self-portraits" of the psyche's own defensive operations, dreams aid in the healing process by symbolizing affects and fragments of personal experience that have been heretofore unrepresentable to consciousness. The idea that dreams should be capable, in this way, of representing the psyche's dissociative activities and holding its fragmented pieces together in one dramatic story is a kind of miracle of psychological life which we may too easily take for granted. Usually, when dreams do this, no one is listening. In depth psychotherapy, we try to listen.

What dreams reveal and what recent clinical research has shown are that when trauma strikes the developing psyche of a child, a fragmentation of consciousness occurs in which the different "pieces" (Jung called the splinter-psyches or complexes) organize themselves according to certain archaic and typical (archetypal) patterns, most commonly dyads or syzygies made up of personified "beings." Typically, one part of the ego regresses to the infantile period, and another part progresses, i.e., grows up too fast and becomes precociously adapted to the outer world, often as a "false self." The progressed part of the personality then caretakes the regressed part. This dyadic structure has been independently discovered by clinicians of many different theoretical persuasions -- a fact that indirectly supports its archetypal basis. We explore the writings of these clinicians in more detail in Chapters 5 and 6.

In dreams, the regressed part of the personality is usually represented as a vulnerable, young, innocent (often feminine) child- or animal-self who remains shamefully hidden. Occasionally it appears as a special animal -- a favorite pet, a kitten, puppy, or bird. Whatever its particular incarnation, this "innocent" remainder of the whole self seems to represent a core of the individual's imperishable personal spirit -- what the ancient Egyptians called the "Ba-soul," or Alchemy, the winged animating spirit of the transformation process, i.e., Hermes/Mercuries. This spirit has always been a mystery -- an essence of selfhood never to be fully comprehended. It is the imperishable essence of the personality -- that which Winnicott referred to as the "True Self" and which Jung, seeking a construct that would honor its transpersonal origins, called the Self. The violation of this inner core of the personality is unthinkable. When other defenses fail, archetypal defenses will go to any length to protect the Self -- even to the point of killing the host personality in which this personal spirit is housed (suicide).

Meanwhile, the progressed part of the personality is represented in dreams by a powerful benevolent or malevolent great being who protects or persecutes its vulnerable partner, sometimes keeping it imprisoned within. Occasionally, in its protective guise, the benevolent/malevolent being appears as an angel or a miraculous wild animal such as a special horse or a dolphin. More often the "caretaking" figure is daimonic and terrifying to the dream-ego. In the clinical material of Chapters 1 and 2 we will explore cases in which it presents itself as a diabolical axeman, a murderer with a shotgun, a mad doctor, a menacing "cloud," a seductive "food demon," or as the Devil himself. Sometimes the malevolent inner tormenter turns another face and presents a more benevolent aspect, thereby identifying himself as a "duplex" figure, a protector and persecutor in one. Examples of this are found in Chapter 2.

Together, the "mythologized" images of the "progressed vs. regressed" parts of the self make up what I call the psyche's archetypal self-care system. The "system" is archetypal because it is both archaic and typical of the psyche's self-preservative operations, and because it is developmentally earlier and more primitive than normal ego-defenses. Because these defenses seem to be "coordinated" by a deeper center in the personality than the ego, they have been referred to as "defenses of the Self." We will see that this is an apt theoretical designation because it underscores the "numinous" awesome character of this "mythopoetic" structure and because the malevolent figure in the self-care system presents a compelling image of what Jung called the dark side of the ambivalent Self. In exploring this imagery in dream, transference, and myth, we will see that Jung's original idea of the Self as the central regulatory and ordering principle of the unconscious psyche requires revision under conditions of severe trauma.

The self-care system performs the self-regulatory and inner/outer mediational functions that, under normal conditions, are performed by the person's functioning ego. Here is where a problem arises. Once the trauma defense is organized, all relations with the outer world are "screened" by the self-care system. What was intended to be a defense against further trauma becomes a major resistance to all unguarded spontaneous expressions of self in the world The person survives but cannot live creatively. Psychotherapy becomes necessary.

Source: The Inner World of Trauma

See also: An Interview With Donald Kalsched

</quote>

[spiritual_emergency]

Another resource...

</font><blockquote><div id="quote"><font class="small">Quote:</font>

Bertram P. Karon, Ph.D., is a Professor of Clinical Psychology at Michigan State University. Dr. Karon received his A.B.from Harvard, his M.A. and Ph.D. from Princeton. He is a former President of the Division of Psychoanalysis of the American Psychological Association, and has over 150 publications. He was selected by the Washington School of Psychiatry as the 2001 Fromm-Reichmann memorial lecturer, by the US chapter of the International Society for the Psychological treatment of Schizophrenia and other psychoses as their 2002 Award for "profound contributions to our psychoanalytic understanding and humane treatment of patients with severe mental illness."

<hr width=100% size=2>

Psych Truth Radio: Welcome Dr. Karon

Bertram Karon: It's a real pleasure to be your guest. And so, shall we talk about the important issues?

PTR: Yes. What do you think causes schziophrenia?

BK: It's really, if you look at all the data we have and all the case studies... schizophrenics are very sick human beings. What it really is, is primarily, a chronic terror syndrome. We're supposed to feel terrified for a minute, maybe for half an hour when there's a danger but if you feel you are in danger of being destroyed and you have to live that way for days, weeks, months, or years... the toll on you is terrible. All of the symptoms of schizophrenia are either aspects of the terror syndrome or defenses against it. And that includes, the catatonic state where people become rigid which we've demonstated in animals occurs when they seem they are on the verge of dying. The hallucinations and delusions which all human beings are capable of doing but most of us will never have to do...

The best evidence of this goes back to WWII. There was a situation in WWII where every solder who went through it -- and they were always sent for treatment -- looked like the sickest, most chronic schizophrenics. And the situation was very simple: people were out there shooting at you, trying to kill you. And so you dug a foxhole as quick as you could and you could barely get into it, and as soon as you could barely get into it, you got into it, so you wouldn't die. And they kept shooting at you trying to kill you, so you didn't move... when your food ran out you stopped eating... if you had to urinate or defecate you did it on yourself. And if this went on for more than three days and nights, every single soldier looked like the most chronic, sickest schizophrenic. The strange thing was however, if they were reasonably healthy people beforehand, when brought to a place of security and safety and just given rest, they got better spontaneously.

<blockquote>
<font size=4><font color=red>There is no such thing as a spontaneous anxiety or an endogenous depression. If a patient is anxious, there is something to be scared of. If a patient is depressed, there is something to be depressed about. If it is not in consciousness, then it is unconscious. If it is not in the present, then it is in the past and something in the present symbolizes it.</font></font>

</blockquote>
At the time, people said it couldn't be schizophrenia because we know that it doesn't get better. The long term studies however ... done in 12 different countries now indicate that irrespective of treatment, 30% of schizophrenics completely recover within 25 years. There have been studies from Switzerland, Italy, Scandinavia, the United States, Germany... they all find the same thing. Unfortunately, the best of the American studies -- that of Courtney Harding, which studied patients from Vermont -- found that the patients got better in 20 years but the patients who stayed on their medication as long as their doctors told them to, none of them ever recovered. 50% of the patients eventually stopped taking their medication against medical advise and all of the patients who had a full recovery were in that group.

PTR: So what you're saying Dr. Karon is first of all that schizophrenia is really an experience, an experience of terror ...

BK: Right.

PTR: And secondly, if someone continues to take the medication as prescribed by psychiatrists and doctors, that the odds are that they won't improve and get better. They're better off stopping the medication.

BK: Taking the medication may make them easier to manage but it gets in the way of full recovery.

PTR: Can you tell us a little bit about your ground-breaking Michigan study which was on the treatment of schizophrenics with psychotherapy versus the usual psychiatric approach?

BK: Yes. This was a study that was done on a NIMH grant using center city Detroit patients. What we did was take clearly schizophrenic patients ... Diagnosis was made by the regular hospital staff and then reviewed by the research staff to ensure they were really schizophrenic. And if anything, they were the very sickest of the schizophrenics.

They were assigned randomly to one of three treatments: psychoanalytic therapy with no medication; psychoanalytic therapy and medication combined or, medication and support as given by a good group of psychiatrists in a good hospital. The evidence that they really were good psychiatrists is the group that did worse in our study -- the medication only group -- did as well as the medication only group in some of the studies ... which claimed to find that therapy didn't help.

The problem is that what they called therapy was done by residents who had no training in psychotherapy, supervised by supervisors who had no training in doing psychotherapy with schizophrenics. In our study, the supervisors had at least ten years experience in doing psychoanalytic therapy with schizophrenics and were considered by their colleagues to be "good therapists". Furthermore, the inexperienced therapists -- because we were interested in whether you could teach this sort of thing -- were psychiatric residents or graduate students in clinical psychology and were given training and supervision, very carefully.

Now here's what we found: the best outcome occurred in those people who got psychoanalytic therapy without medication at all. We used psychological tests, we used a clinical status interview conducted by a very experience psychiatrist who did not know what kind of treatment the patient received. The patients were examined before treatment, after six months, after 12 months and after 20 months of treatment. And then we did a follow up for medication after two years. The best results were obtained with those people who got just psychoanalytic therapy.

The next best results, which were nearly as good, was where medication was used as an adjunct but it was withdrawn as rapidly as the patient could tolerate. The experienced therapist who combined medication with therapy was honest. He told the patients, 'The medication doesn't cure anything. It makes things tolerable so we can talk. But the only thing that will cure you is your understanding.' And he withdrew the medication as quickly as the patients could tolerate and that turned out to be a good way to work.

Therapists who treated their patients with medication as well as psychotherapy but maintained the dosage level of the medication and never withdrew the patients from their medication, this was not nearly as good as just using psychoanalytic therapy or psychoanalytic therapy with medication when the medication was withdrawn as rapidly as the patients could tolerate.

<hr width=100% size=2>

The above excerpt covers the first eight minutes of the interview. You can listen to the rest of the fifteen minute interview here: Mental Health Radio [Requires Real Player]

See also: The Effects of Medicating or Not Medicating on the Treatment Process


</div></font></blockquote><font class="post">

[pachyderm]

"There is no such thing as a spontaneous anxiety or an endogenous depression. If a patient is anxious, there is something to be scared of. If a patient is depressed, there is something to be depressed about. If it is not in consciousness, then it is unconscious. If it is not in the present, then it is in the past and something in the present symbolizes it."

Thank you.

[spiritual_emergency]

<blockquote>
Bumped for the benefit of new member, whispers.

Whispers, there may be additional information here that will be helpful to you in your own journey to recovery.

Continued best wishes.

[whisperslf]

WOW!!!!.........just..........WOW!!!

[(JD)]

Schizophrenia and PTSD have often been misdiagnosed as the other. PTSD is an anxiety disorder.
</font><blockquote><div id="quote"><font class="small">Quote:</font>
There is no such thing as a spontaneous anxiety or an endogenous depression.

</div></font></blockquote><font class="post">
http://www.anxietycentre.com/anxiety...disorder.shtml

Anxiety conditions, for the most part, can be divided into two main categories:

* Circumstantial anxiety – this type of anxiety condition is characterized by symptoms that appear because of an acute stressful event(s), circumstance(s) or emotion(s). Examples include a relationship difficulty (fighting within or the break-up of an important relationship), career challenge (job loss or important job promotion), illness or death of a loved one, or educational stress (intense workload).

Because stress often is the precursor to an anxiety condition, most early stress conditions fall within this category. Once the event, circumstance or emotion has passed, with sufficient self-help materials, rest and time, most anxiety conditions in this category will resolve on their own.

* Chronic anxiety – this type of anxiety condition is characterized by symptoms that come and go over an extended period of time (from a few months to a year, or from a few months to many years). Examples include an individual who has symptoms come and go at different stages of their life (as early as 4 years of age), remain as an ongoing backdrop to their life, or have been on and off of medication throughout their life.

Chronic anxiety also has a deep-seated fear component. Many feel that they live in fear whenever their “episodes of illness” appear. Others may have it as a constant companion as they journey through life. Episodes can last a few weeks to many years. Some can remain constant throughout their life. Conditions that last for an extended period of time can also be referred to as “entrenched” anxiety.

Within these categories, there are four types of anxiety:

<font color="blue"> * Spontaneous anxiety or panic – anxiety or panic that occurs regardless of where a person is.</font>
* Situational or Phobic anxiety or panic – anxiety or panic that occurs because of a particular situation or location.
* Anticipatory anxiety or panic – anxiety or panic that occurs because of a thought that something “might” happen or a situation that “might” occur.
* Involuntary anxiety or panic – anxiety or panic that occurs involuntarily, by itself, or “out of the blue” that hasn’t been preceded by spontaneous, situational, or anticipatory anxiety.

There are also degrees of anxiety conditions. They can be categorized as:

* Early-stage or onset anxiety – symptoms have just started to appear, and while they may be annoying and mildly distressing, they aren’t a reason for over concern. Often one trip to the doctor is reassuring enough that nothing more serious is going on.

This is the best stage to address stress or anxiety, since the more entrenched the condition becomes, the more complex it becomes and the longer it will take to resolve. However, properly addressing an anxiety condition at any stage can bring about full recovery. Bibliotherapy (reading self-help materials) is most often sufficient for full recovery.

* Mild severity – symptoms may be intermittent or persistent. However, their negative impact on an individual’s lifestyle is minimal. While the symptoms may be annoying and mildly distressing, they aren’t too restricting. Individuals at this stage may start to become fearful of their condition or their condition’s implications. The individual may make a few trips to the doctor in hopes of finding a solution.

Addressing a condition at this stage also produces expedient results. Bibliotherapy is most often sufficient for full recovery.

* Moderate severity – symptoms may be more complex, and may be more severe and impacting. Often they will be more persistent, more concerning and worrisome. There is moderate lifestyle impairment. While the individual may be able to force themselves to do mandatory tasks, many activities are restricted. Fear of their condition is becoming more predominant. There may be repeated trips to the doctor in hopes of finding a resolution.

Doctors often prescribe medications at this stage to help reduce symptoms and the negative impact they have on the individual’s lifestyle. Unfortunately, medication alone at this stage often only masks the underlying condition. This masking effect often enables the condition and its effects to continue to resurface time after time unless the underlying condition is properly addressed. Fortunately, more and more doctors are now recognizing the value of a comprehensive approach such as personal coaching, counseling, cognitive therapy and bibliotherapy. While bibliotherapy can produce positive results, working with a personal anxiety coach (someone with extensive experience, and preferably, someone who has experienced anxiety themselves) can produce significantly more effective and lasting results.

* High anxiety – symptoms are dramatic, persistent and entrenched. Lifestyle is significantly impaired. Repeated trips to the doctor prove fruitless. Many at this stage are already on medication, yet their symptoms persist to varying degrees. They have a high level of fear about their condition and where it might lead. Many feel their condition is out of control.

Recommended treatment at this stage should involve personal coaching in conjunction with good self-help materials. Self-help materials alone will most likely not produce full recovery or lasting healing.

As mentioned earlier, recovery can be attained at any stage, however, the road to recovery may be longer and more complex the longer a condition remains entrenched. Nevertheless, successful and lasting results make the recovery journey more than worthwhile.

* Very high anxiety – intense and entrenched symptoms. Dramatic to full lifestyle impairment. This level of severity is more complex and often more difficult to address. It is highly recommend that the help of a personal anxiety coach, counselor, or mental health professional be involved at this stage. While self-help materials will play an important role in the recovery process, one-on-one assistance is most often required before normal and lasting health can be attained when severity has reached this level.

Further, we highly recommend that you work with someone who has personally experienced anxiety at this degree of severity in their own life. Their personal experience and insight will be of great value and comfort to you during your recovery process.

Anxiety disorders are classified into the following categories and descriptions:

There are several categories associated with anxiety disorder, each having their own specific causes and characteristics. While some of the symptoms associated with each category may be unique, the majority of symptoms are common to all types.

The National Institute of Mental Health lists the six main categories of anxiety disorder as:

Panic disorder
Panic disorder is described as a sudden attack of terror, intense fear, or feelings of impending doom that strike without warning and for no apparent reason. This can be immediately followed by a number of symptoms including pounding heart, rapid heart rate, nausea, hot or cold flashes, chest pain, hands and feet may feel numb, you may be lightheaded or woozy, irrational thoughts, fear of losing control and a number of other symptoms. The peak of an attack can range anywhere between 5 to 30 minutes, but the symptoms can last much longer.

While many people have at least one panic attack in the course of their lifetime, panic disorder affects approximately 3% of the population. Panic disorder often begins in adolescence or early adulthood, and as is reportedly more likely to develop in women than in men. However, the statistics may be misleading because men are more reluctant to seek professional help.

If diagnosed early, panic disorder can be treated successfully. But if left untreated, it can develop into a more complex and lengthy condition. However, with today’s treatments the success rate can be very high. Treatments include Cognitive Behavior Therapy (CBT), Behavior Therapy (BT), and medication.

Panic disorder often co-occurs with other disorders such as depression and GAD.

Generalized anxiety disorder
Most people experience anxiety on and off throughout the course of their life, but those who suffer with GAD do so on a day to day basis. Their anxiety becomes chronic and fills their life with exaggerated worry and tension, even though the subject they are worrying about doesn’t warrant it. Individuals with this disorder are always anticipating doom, disaster, and ‘the worst’. They often worry about their health, money, family, work, and the world in general. Often their reason for worry is hard to pinpoint. Even the thought of getting through another day can bring on anxiety.

Individuals with GAD feel that they can’t stop worrying, even though they know the subject they are worrying about isn’t that serious. They can also experience accompanying symptoms such as fatigue, headaches, muscle tension, aches and pains, difficulty swallowing or as having something stuck in their throat, trembling, twitching, irritability, hot and cold flashes, profuse sweating for no reason, and often feel lightheaded or ‘dizzy’. They may also feel nauseated or that they have to go to the washroom frequently.

Individuals with GAD feel that they can’t relax and startle more easily than others. They may also have difficulty in concentrating or that they feel joyless and frustrated. Often their sleep patterns are disrupted with their inability to sleep becoming yet another reason to worry or be anxious.

People with GAD often appear just fine and can go about their day seemingly normal. However, it’s their thought and internal life that undergoes the turmoil.

GAD affects about 6% of the population and affects twice as many women as it does men. The disorder usually comes on gradually and can begin at any age, though it is more frequent between childhood and middle age. Those who experience incessant worry for six months or more are typically diagnosed as having GAD.

GAD often co-occurs with other disorders such as depression, or substance abuse.

Obsessive-compulsive disorder
OCD involves anxious thoughts or rituals the individual feels they must do or can’t control. Individuals with OCD may be plagued by persistent, unwelcome thoughts or images, or by the urgent need to engage in certain rituals like repeatedly washing their hands, repeatedly checking things, counting things, organizing things, and so on.

They may have relentless thoughts of violence or a fear that they may hurt someone they love or are close to. They may have a continual desire to touch things, to symmetrically organize things, repeated thoughts of sexual acts that are repugnant to them, or maybe troubled by thoughts that are against their religious beliefs.

These disturbing thoughts or images are called obsessions, and the rituals that are performed to try to get rid of them are called compulsions. There is no pleasure in doing the rituals, but only temporary relief from the anxiety that builds when they don’t perform them.

A lot of healthy people can identify with some OCD symptoms, such as checking to make sure the door is locked when going to bed or leaving home, or double and often triple checking to make sure the iron is off. However, individuals with OCD spend hours doing this, and are very distressed because it interferes with their daily life.

Most individuals with this condition recognize that what they are doing is senseless, but they feel they can’t stop themselves. However, some people don’t recognize that their behavior is out of the ordinary.

OCD affects approximately 4% of the population and it equally affects both men and women. One third of adults with OCD report having experienced their first symptoms as children. OCD can come and go over time, as well as it can ease or grow worse with age.

Depression and other anxiety disorders most often co-occur with OCD. Like other anxiety disorders, OCD can be successfully treated.

Social phobia (or social anxiety disorder)
Social phobia, also called Social Anxiety Disorder (SAD), is a condition whereby the individual feels overwhelming anxiety and excessive self-consciousness in everyday social situations. In a sense, the individual becomes extremely self-conscious in social environments. People with SAD have a persistent, intense, and chronic fear of being watched and judged by others and being embarrassed or humiliated by their own actions. This fear may be so severe that it interferes with work, school, or any other ordinary activities.

While many people with SAD recognize that their fear of being around people is unusually excessive, they are unable to overcome it. And often, they worry for days or weeks prior to a social situation.

SAD can be a limited to one type of situation, like speaking in public, or it can be as severe as to encompass many or all social situations.

Symptoms can include any of the symptoms associated with anxiety disorder, and can often contribute to the anxiety of a social situation because of the fear associated with the symptoms coming at an ‘inopportune time’ or visible enough for others to notice.

SAD affects approximately 7% of the population and equally affects women and men. This disorder usually begins in childhood or early adolescence. SAD often co-occurs with other anxiety disorders such as depression, substance abuse and panic disorder.

SAD can be successfully treated.

Phobias (including specific phobias)
A specific phobia is an intense fear of something that poses little or no actual danger. Examples include closed in spaces, heights, escalators, elevators, tunnels, driving, flying, spiders, snakes, and so on. In addition, these phobias aren’t just extreme fears but include irrational fears such as being able to skydive but can’t use an elevator. While the individual understands that these fears are irrational, they can’t do anything to change how they feel, and often just the thought of facing their feared object is enough to bring on intense anxiety and even panic attacks.

It is estimated that 6% of the population is affected by specific phobias while it is twice as common in women as it is in men. These phobias generally first appear during childhood or early adolescence.

If the object of their fear is easy to avoid, most often the individual won’t seek treatment. Unfortunately, this usually influences the individual when making important life decisions such as not taking an important career advancement because of having to use an elevator.

Specific phobias can be successfully treated.

Post-traumatic stress disorder
Post Traumatic Stress Disorder (PSTD) is a condition that can develop following a terrifying event. Often, individuals with PSTD have persistent thoughts and memories of this event and feel emotionally numb, especially with people they were once close to. PSTD can result from a number of traumatic incidents such as violent attacks, mugging, rape, torture, terrorism, being held captive, child abuse, serious accidents and natural disasters. The trigger event can be something that threatened the person’s life or the life of someone very close to them, or it could be something they had witnessed, such as a death and destruction from a plane crash, bombing or building devastation.

Some individuals with PSTD repeatedly relive their trauma through dreams, nightmares and disturbing memories throughout the day. They may also experience sleep problems, feel alienated from reality, or easily startled. Other behaviors they may experience include the inability to show affection, have difficulty maintaining an interest in things they used to enjoy, they may feel irritable, more aggressive, and even violent.

Memories of the trauma can be very distressing for them, and can lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often difficult as well.
PTSD affects approximately 6% of the population, and women are more likely than men to develop this condition. It can occur at anytime, including childhood.

PTSD often co-occurs with depression, substance abuse and panic disorder.

PTSD is diagnosed only if the symptoms last for more than a month. For those who develop PTSD, symptoms usually begin within three months of the event, and the course of illness varies from individual to individual. Occasionally, this condition doesn’t show up until years after the event.

PTSD can be successfully treated.
FACTORS ASSOCIATED WITH ANXIETY DISORDERS:

There is much left to discover about the many causes of anxiety disorder. It’s thought that any individual, given the right circumstances, can develop it. The following represents what is presently known.

Genetics
Research has shown that there is a genetic link to anxiety disorder. If someone in your family experiences anxiety disorder, there is a 25% chance that someone else in the family already does or will experience it as well.

This doesn’t mean that you should expect it to be the case. However, if there are two or more people in the family experiencing anxiety disorder, this is common.

Another consideration is that many people either don’t know that anxiety disorder is causing their symptoms, or that they won’t admit that it is a condition that THEY have.

Typically, women are more forthcoming about their condition, whereas men are more reluctant. If you are trying to determine if someone in your family has had or has anxiety disorder, you may have to do some investigative work to truly find out.

Environment/Upbringing
The environment you grew up in, or presently live in, play a role in anxiety disorders. If you grew up with a parent or live with a spouse that worries a lot, chances are you may pick up that habit as well. I call it a habit because worrying or being anxious about situations can become a learned approach to how you look at everyday life and the future.

Another factor is whether you grew up in, or are presently in a stressful environment or situation. Since stress can increase your anxiety level, being in a stressful circumstance for an extended period of time can lead to an anxiety disorder. Examples include being in a family where one or both parents are often threatening or abusive, if you have been sexually assaulted or violated, if you’ve been held captive, live or work in a threatening or unusually noisy environment, have a high stress job, and so on.

If the body is continually under stress without the opportunity to properly rest, the effects of sustained stress can bring on anxiety disorder.

Early trauma has also been shown to bring on anxiety disorder later in life. Research has found that those who experienced a traumatic event early in life were more prone to develop anxiety disorder as they grow older. Some believe that once the brain’s “panic circuitry” is opened, it is accessed more easily. Others believe that it’s the brain’s ability to remember an earlier traumatic event that leads the individual to respond in a hypervigilant manner.

Biochemistry
Ongoing research continues to bring forward new theories on how the various body systems and chemistries work together, and how their individual and combined actions can impact the health of the body’s biological and psychological make up.

Studies have shown that certain behavioral traits and symptoms are related to a ‘chemical imbalance’ in the body. For example, hormonal swings can cause heightened feelings of anxiety. Many women notice an increase in their anxiety and the frequency of panic attacks in sync with their menstrual cycle.

Stress also plays a key role in the onset and aggravation of anxiety disorder. Stress causes certain hormone levels to increase in the body. It’s been shown that heightened levels of stress hormones cause increased feelings of anxiety and even panic.

Diet can also impact anxiety disorder. Since the body constantly monitors and adjusts its internal chemical balance automatically, radical blood sugar or stimulant levels can also produce anxiety and even panic attacks. For example, when the body senses it has unusually low blood sugar the brain sounds a warning that it needs to produce more blood sugar and does so by stimulating (among others) a hormone called adrenaline. Adrenaline stimulates the body to produce blood sugar. Unfortunately, adrenaline is also a stress hormone and an increase in this hormone causes anxiety and even panic as a side affect. Similarly, stimulants like caffeine can also produce the same affect. The member's area of our web site has a wealth of information about diet and nutritional factors.

Sleep also plays a role. Lack of sleep has been shown to increase the body’s stress hormone levels. Did you know that a person will die quicker from a lack of sleep than from a lack of food? Good sleep habits are vital for good health. The member's area of our web site has a complete section dedicated to sleep.

Underlying health conditions such as Pituitary Dysfunction, Thyroid disorders, Multiple Sclerosis and heart disease (to name a few) can also produce anxiety and anxiety-like symptoms. That’s why it’s vital to have a complete medical evaluation done in order to rule out other ‘causes’ of anxiety conditions.

Part One of this web site provides in-depth information about the body’s biological and psychological make up and the role they play in anxiety disorder.

While there is a lot known about anxiety disorder, there is much more to learn. Fortunately, ongoing research continues with new strides being made everyday.

Personality characteristics
Research indicates that there is an identifiable ‘anxiety disorder’ personality. People with this personality type are more prone to develop anxiety disorder.

Anxiety disorder personality traits include:
• A perfectionist approach to life – things must be done to the best of their ability.
• Often things have to be done THEIR way.
• They want things done NOW.
• Everything has to be in place or done BEFORE they can rest.
• Relaxation is very low on their priority list.
• They almost always have too much to do and not enough time to do it.
• They like to be in control and have all the angles figured out.
• They have many interests.
• They have high expectations and expect others to meet THEIR expectations as well.
• They are analytical thinkers, and often worry about the ‘what ifs’.
• They like to be liked and accepted by others.
• They have a martyr complex – do as much as they can to please others and often overload their plate with “Sure I can do that for you. No problem.”
• Tend to be more animated and have a tendency to over-react.

For more information about the ‘anxiety personality’, there is a full section on it in the Member's Area. Click here to become a member to read this, and a wealth of other information about anxiety including a natural recovery strategy.

While the characteristics in themselves aren’t harmful, it’s the effect they have on the lifestyle and nervous system of the individual that can cause anxiety disorder to appear.

Medication and drug abuse
Another consideration includes the effects of medication (both prescription and over-the-counter). Since each body is unique, medications will affect everyone differently. What is effective for one person may be ineffective for another. As well, what is harmless for one may be harmful to another.

Similarly, a common or popular medication may produce no lingering side effects for one person, yet may be very problematic for another.

It’s known that adverse side affects can sometimes increase anxiety and even produce panic attacks, with the anxious condition persisting beyond the use of the medication.
Also, prescription and over-the-counter medications, even though tested before market release, have the potential to negatively affect the body especially when taken in combination, or in multiples (two or more prescription medications combined with one or more over-the-counter medications). It’s important to discuss EVERY medication with your doctor AND your pharmacist before taking them (including herbal remedies).

Recreational drugs can also lead to anxiety disorder. It’s common for those using recreational drugs to experience heightened levels of euphoria, excitement, paranoia and fear. These heightened feelings and emotions can sometimes produce panic attacks which can lead to sustained anxiety disorder and even more attacks long after the recreational drug has left the body.

Unfortunately, this factor is becoming more common and is associated with both recreational drugs and alcohol. Because many of the recreational drugs affect the same parts of the brain and body chemistry that anxiety disorder does, there exists a fine line between remaining healthy and inviting illness whenever they are induced.

Lastly, prescription anti-anxiety, anti-depressant and mood altering medications hold the potential for lasting problems. This is because these medications directly affect the brain and body to degrees that aren’t yet fully understood. While these types of medications can help reduce anxiety disorder symptoms, they also have the potential to pose a long-term health risk. I hope more will become known about this as research continues. In my experience, the majority of people I have talked with over the last ten years have had their condition complicated and extended solely because of the medication they were prescribed.

I experienced the same type of complication. I was prescribed a number of medications only to later discover severe difficulty in dealing with their long term negative affects. Only after being off of medication and fully away from their residual affects was I able to see the significant difference.

Unfortunately, many front line medical professionals often recommend these medications as their “first and only line of treatment” rather than providing a more comprehensive approach. I recommend seeking the help of a professional anxiety disorder specialist even though your doctor believes he or she knows how to manage an anxiety disorder condition. The help of a professional anxiety disorder specialist is your best bet for a full and lasting treatment.

With today’s proliferation and promotion of new ‘designer’ and ‘social’ drugs, it’s vital that you be fully engaged in managing your personal health. Seek the best professional help, then, work closely with them.
http://www.anxietycentre.com/anxiety...disorder.shtml

<font color="blue">Endogenous depression we could call it biochemical depression. It tends to run in families, as in genetic factors, and is generated by brain chemistry and imbalances of serotonin (its one of the "feel good" hormones that helps us to sleep) or other neurotransmitters. Most of anti-depressant medications prescribed currently are chemicals that maintain or improve serotonin levels. Even the natural approach that utilizes diet,herbs, and amino acids is geared toward raising serotonin levels.

Often though, with endogenous depression, the sufferer has difficulty controlling depressive thoughts and as such, in this situation a very specific form of counselling, CBT or Cognitive Behavioural Therapy, is also indicated.
http://www.depression-doctor.com/end...depression.htm

</font>

[whisperslf]

Sky / SE
Please feel my gratitude in your giving me back something that was taken long ago. Power... the knowledge to arm myself in taking back control of my recovery and destiny. I have never felt so positive and driven. I do hope some of the other new members are taking advantage of this as well.

Sleep well.
And peace of mind to all of you reading these posts.

[spiritual_emergency]

*bump*

This topic seems to have come up a few times over the past few days so I thought I would bump this thread. Please note it was initially begun before the site changed over to new software. As a result, some of the earlier posts show some of the editing options (i.e. font adjustments). Unfortunately, there's nothing that can be done about that.

~ Namaste