Tag: psychiatry

Posted in Psychology & Medicine

The Three Christs Of Ypsilanti

Posted on by Jinavie

On July 1, 1959, a social psychologist named Milton Rokeach began an experiment in Ypsilanti State Hospital in Michigan to explore the nature of delusions. He gathered three paranoid schizophrenics who each believed they were Jesus Christ and put them in one room. Technically, there can only be one Jesus Christ. So how did the three schizophrenics respond to each other’s claims that they were Jesus?

The experiment ran for two years, with the three patients meeting regularly with Rokeach (under the guise that it was a support group). The initial meetings were far from peaceful. One “Christ” would yell out that the other two were fakes, while another would decry that he would not worship the other Christ as he was the real Jesus. The third reasoned that there cannot be more than one Jesus, and that he was the Good Lord. The arguments escalated to the point of physical violence in many cases. No one would budge and accept that the other person could be Jesus, as they themselves were Jesus. It was the ultimate paradox and cognitive dissonance, as there can be only one Jesus.

Rokeach hoped that the patients would soon see the error of their delusions. He even went as far as sending each of them fake letters from the patient’s “wife” and “the hospital boss” to see if they would alter their routine as the letter advised. But instead of breaking down and accepting that they were deluded, the three patients each found an explanation to resolve the cognitive dissonance.

One patient declared that his fellow patients were actually dead but being controlled by “machines”, thus their arguments were not credible. The other two explained that the other patients were “crazy” people with mental health issues, thus they should not be believed.

This is not a surprising ending to the story, as the definition of a delusion is that it is a “fixed, false belief not amenable to reason”. By definition, a delusion cannot be “reasoned” or broken with logic. Even if you blatantly show the patient proof that their delusion is not real, the patient will not yield. Instead, they will find creative ways to work around the inconvenient truth. Ergo, no matter what evidence you put forward, those three patients would always, in their mind, be the one and only Jesus Christ.

Now let us assume that you met a doppelgänger who states that they are the real “you”, challenging your identity. How would you respond? Challenging one’s identity is the most vicious attack possible, as no person is secure enough with their own identity to be unaffected by the attack. Because people define themselves with a set identity, changing even a small portion of their identity causes extreme confusion and panic. To avoid such emotional turmoil, the brain does everything in its power to protect the identity it believes in. This is why people will respond with fury and anger when their identity is challenged.

People say that “I know myself the best”. But if we construct our identities around flimsy, false foundations, we would still cling to the idea that that is our true identity. If people were to suggest that we are not who we think we are, our brain would defend its identity at all costs. In that case, are our identities delusional? How do we know whether our identity is the real us, or a delusion our brain is clinging to?

Better yet, imagine that everyone around you claimed that you are a duck. Even though you know for sure that you are not a duck, everyone else sees you as a duck and defines you as a duck. An interesting thing about delusions is that the definition includes the phrase: “…and not in keeping with that person’s subculture”. This means that if everyone in your subculture were to say that your belief and your identity were wrong, you could be labelled “delusional”. In that case, are you crazy or is everyone else crazy?

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Posted in Psychology & Medicine

Five Stages Of Grief

Posted on by Jinavie

Dr. Elisabeth Kübler-Ross was a psychiatrist who was greatly interested in the field of death and dying. She believed that medical students and doctors should be aware of how important the topic was. One of her major contributions to the field of medicine was a theory inspired by her work with terminally ill patients. Dr. Kübler-Ross discovered that patients who were given bad news often reacted in a rather predictable pattern of five “stages”. She also found that these theoretical stages of coping with dying also applied to other grieving processes, such as a child going through a divorce or grieving a break-up. It is important to note that these stages are not absolutely complete or chronological, but only a general theory of how people react to grief.

  1. Denial: A person’s initial response to any bad news or trauma is usually denial. Denial is a hardwired defence mechanism of the brain to protect the mind from trauma. However, it may hinder the process of coping, with some people being perpetually stuck in this stage while never fully coping with their grief. An example thought during this stage is “This can’t be happening to me”.
  2. Anger: Once the person overcomes their denial and recognises reality, they respond with anger. This is an externalisation response where the mind tries to deal with the bad news by lashing out. It can be seen as the mind’s response to the confusion that arises from receiving the bad news, which may be caused by cognitive dissonance arising from the conflict between denial and reality. Because people at this stage often lash out with rage and verbal abuse (sometimes even physical), they may be difficult to deal with. Thus, it is important to recognise that this is a natural response to grief and try to support them even though they are acting abusive. An example thought during this stage is “It’s unfair that this is happening to me”.
  3. Bargaining: When the anger settles down, a person attempts to deal with the grief with logic instead of emotions. They will try to negotiate with a higher power to delay their death, such as through praying. This stage shows how desperate and vulnerable the person is while trying to deal with the bad news. They will try to do anything to make the grief go away, or at least reduce it. However, this stage rarely produces any viable solutions. An example thought during this stage is “If I can have a few more years, I will do anything”.
  4. Depression: With both emotions and logic failing to protect them from the grief, the person will fall into a state of depression. Hope is lost and the person understands that resistance is futile (an example of learned helplessness). By this stage, the person has become quiet and withdrawn, often detaching themselves from family and friends. Ironically, trying to cheer a person up during this stage is ill-advised. It is more beneficial if the person can pull through the depression and process it to make it to the last stage of grief. An example thought during this stage is “Why bother, I’m going to die anyway”.
  5. Acceptance: The last stage of grief is not only accepting that death is unavoidable, but also recognising that there is still time before that. The person reaches a state of clarity and comes to term with the grief, achieving some inner peace. The time taken to reach this state varies and some people may never reach it at all. It is also important to note that just because the person receiving the bad news has accepted it, others around them may not have processed the grief. An example thought during this stage is “Everything is going to be okay”.
Posted in Psychology & Medicine

Laughter Epidemic

Posted on by Jinavie

It is said that laughter is infectious. In 1962, an extreme case of “laughter infection” happened in village in Tanzania. The phenomenon originated in a boarding school for girls. On January 30, three girls spontaneously burst out in laughter and could not stop themselves from laughing. Soon after, the whole class was suffering from fits of uncontrollable laughter. The “infection” then spread throughout the school, claiming 95 of the 159 students over a stretch of two months. This strange symptom of uncontrollable laughter lasted anywhere from a few hours to 16 days. Interestingly, teachers were not affected and only girls between the ages of 12 to 18 were affected. By March 18, the school was forced to close down due to students not being able to focus during class.

The laughter epidemic was not localised to the school. After the school shut down and the girls returned home, fellow villagers were afflicted by the laughing disease, resulting in 217 villagers being “infected” by May (mostly children and teenagers). By June, the laughing epidemic spread to another nearby school, affecting 48 girls. The epidemic then went on to claim two more schools, forcing them to close down. By the time the epidemic died down (6 to 18 months after “patient zero”), it had affected over a 1000 people and shut down 14 schools.

So what was this strange disease? Was it some new viral infection causing neurological symptoms? Was it a toxin in the water supply? The answer was even simpler: mass psychogenic illness, also known as mass hysteria. Mass hysteria is a psychological phenomenon that occurs in groups placed in high-tension situations, such as within an airplane. This setting is perfect for triggering a mass delusion, causing the person to believe they are suffering from a physical disease. The trigger is usually another “patient” and the hysteria spreads like wildfire, usually by people seeing affected victims. Although the above case makes mass hysteria look like a harmless, amusing phenomenon, psychosomatism (when the mind tricks the body into thinking it is sick) can cause symptoms such rashes, fevers, vomiting and even paralysis. In fact, all of these symptoms were also reported during the Tanganyika laughter epidemic.

Posted in Psychology & Medicine

Parent

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Parents only have one duty: to bring up their children with love. The problem is that so many parents do not know this fact, or have a twisted understanding of the concept of “love”. Some never even hug their child, some abandon their child for their own lives and some even abuse their child. However, that does not mean one should obsess with their child either. Always teaching the child that “they are the best” is not love. Also, trapping a child and preventing them from leaving you is obsession, not love. Some parents tell their children that studying will lead to a happy, successful future, and compare them to other children who get better grades. This is a crucial mistake, as the children will probably live out an unhappy life with a deep wound in their heart for the rest of their lives. This is because the parents’ role is not to secure a successful future and instructing them how to get there, but to allow the child to independently plan their future, taste failure and develop their own values and philosophy, only supporting them from the side. A parent is not a leader who leads a child along a predestined path of life, but an assistant who supports a child while they pave their own path of life and walk down it. To support and respect a child’s decisions, dreams, talents and potential; to teach the wisdom and skills the child will need to follow their dreams; that is true love.

Of course, that is not to say that one should neglect and leave a child without any interventions. If a child clearly makes an objective error or misbehaves, it is a parent’s role to correct it. This kind of home education is not interference like obsessing about the child’s studies, but supportive intervention that helps the child follow their dreams and not be lost on the way. Home education is a very important form of love that imbues a child with skills such as social skills, ethics, morality, philosophy and love that will allow them to lead a happy and wholesome life.

Why is parental love so important to a child? Childhood is a critical period when the child’s brain is rapidly developing and when the child begins to form his or her personality and view of the world. Almost every mental illness (especially personality disorders) can be traced back to a childhood trauma, or at least be affected by it. For example, a child whose parents did not care for them will grow up lacking love and attachment, leading to constantly seeking love and attention from others, which may develop into dependent personality disorder. If a child has to live up to the parents’ great expectations, they will not receive sympathy and fail to develop a self identity. To fill this void, the child will continuously float from one person to another to seek this sympathy. A child with obsessive parents being led to believe that they are the best could develop narcissistic personality disorder, who becomes violent and enraged when someone points out a mistake they made. As one can see, parental love is a crucial nutrient that fosters a healthy personality in a child, helping them become a wholesome, independent “person”.

No matter how poor the parents are, a child who was raised on love is able to construct a plentiful, happy life. Then, when the child becomes a parent, they will know how to raise their own children with love as well. The best parents are those who respect the child’s decisions and allow them to be free when they set out on their pursuit of happiness. All you need is love.

Posted in Psychology & Medicine

Learned Helplessness

Posted on by Jinavie

The following is an incidental finding from an experiment studying conditioning in dogs. In stage 1, a dog was tied on a leash in a room with electrified floors to prevent it from running away and was shocked for a day. Next, the dog from stage 1 and another dog were left in the same room without any leashes, leaving the door opened so that they could run away when they were shocked. Although the dog that did not pass stage 1 (fresh dog) immediately ran to the next room, the dog from stage 1 just helplessly lay down on the floor, receiving the electric shock. In stage 3, the same dog from stage 1 was taught that going to the next room prevents it from getting shocked. However, even after learning this, the dog refused to move and stayed in the room and accepted the shock. It had learned helplessness.

Everyone has depressing moments in their lives, but when these repeat over time it can cause you to feel that life is an inescapable pit of despair. You will learn a sense of helplessness that no matter what you do, the result will be failure and disappointment. But the moment you accept this helplessness, the nightmarish fate that you loathe so much becomes reality. There is no such thing as fate or destiny. If you do not like the fate given to you, free yourself the restraints of life, break away from the fetters and pioneer a new future for yourself. 

Posted in Psychology & Medicine

Trepanation

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When and what was the first surgery performed by mankind? Many would believe it to be a simple procedure such as suturing a wound. But would you believe that the earliest surgical procedure was brain surgery in 6500BC? Surprisingly, this is true.

Archaeologists have found a large amount of skulls with a large, round hole in them. Some of the oldest skulls with holes were found in France, where 40 skulls from the Neolithic era were excavated. Archaeologists believed these holes to be from a battle leading to a dent in the skull. However, these holes were actually the results of a surgery (signs of bone recovery can be seen around the edges of the hole, suggesting the patients were alive for some time even after the operation). These skulls all belonged to trepanation patients.

Trepanation is the surgical opening of the skull by drilling a hole in it. This is an ancient surgery that can be found throughout history. Hippocrates and Galen from ancient Greece both recorded detailed instructions on trepanation, ancient Incans performed the surgery and it was also common during the Middle Ages and the Renaissance in Europe. These surgeries were most likely indicated for skull fractures where fragments were embedded in the brain. During the Middle Ages when it was better known that the brain was the seat of the soul, trepanation was used for psychiatric treatments too. For example, in 15th century Netherlands, trepanation was used to excise a so-called stone of madness that was supposedly the cause of insanity. Like this, it was believed that trepanation could release the demons and insanity trapped in the skull.

Although this operation sounds hilariously misled, it is still used in modern medicine. Of course, it is not known to treat insanity, but rather to treat brain bleeds. Extradural and subdural haemorrhages occur when a rupture of an artery in the brain causes a collection of blood in the skull, compressing the brain. This is a dangerous situation which can lead to a stroke or even death. One treatment of this condition is trepanation, or a burr hole, where a small hole is drilled in the skull to relieve the pressure, lowering intracranial pressure and stabilising the patient. Trepanation is an excellent example of how we can learn from the past and how medical knowledge from ancient times is sometimes still valid.

Posted in Psychology & Medicine

The Desire Of Others

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This world endlessly tells us to live for the desires and wants of others. We live every day to fulfil the desire of our parents, our teachers, our friends and our lovers. But to live for other people’s desired, you must first fulfil your own desires. For our weak “self” identity to survive and develop, we cannot allow other people’s desires dominate us.

There is a mental illness called delusional disorder where the patient is obsessed about a “false belief” and is completely convinced that it is the truth. The word “delusion” brings to mind strange cases such as “I was abducted by aliens” and “the government is monitoring my phone calls”, but these delusions are more common with conditions such as schizophrenia. Instead, delusional disorder presents with delusions such as Othello syndrome (believing your spouse is having an affair) or hypochondria that are not too strange and allows for a relatively normal day-to-day life, making delusional disorder very hard to detect. Furthermore, the patients form these delusions in a very logical and highly structured manner, causing the patient to become easily obsessed with it and make the delusions more believable.

Delusional disorder can be categorised into six types:

  • Erotomanic type: delusion that someone is in love with you
  • Grandiose type: delusion that you are godlike and possess greater value, strength, intelligence or identity than others
  • Jealous type: delusion that your lover is unfaithful
  • Persecutory type: delusion that someone is acting malevolently or trying to harm you
  • Somatic type: delusion that you have a medical condition or physical defect
  • Mixed type: delusion showing characteristics of more than one of the above types, with no one type being prominent

As these patients are so attached to their delusions, treatment is extremely difficult. As soon as a psychiatrist or psychologist attempts treatment or even a close friend denies the delusion, they instantly become an “enemy”. The patient automatically incorporates those people into their delusion and antagonise them to worsen the situation. This is why the key principle of treating delusion is “do not touch the delusion”. For example, if the patient believes they are someone else, instead of negating that delusion you should give them a chance to be that person. A treatment called “psychodrama” uses impromptu acting to bypass the delusion and tries to reach the patient’s subconscious, or their “self”. Through this, one can approach the patient’s “self” via affirming their delusions, allowing the psychiatrist or psychologist to ask what the patient’s “self” wants and discover the source of the delusion. The important point is that this treatment is not an instant cure for the delusions (it takes a while for the patient to rid themselves of the delusions completely).

Delusional disorder is a phenomenon which is not uncommon in people who live for the desires of others. A perfect example would be young celebrities. If young teenagers begin life in the entertainment sector and live for the audience before they develop their own “self”, they may not be able to find answers to questions such as “who am I” and “what do I want”, ultimately causing a weakening of their identity. As the “self” is highly capable of tricking itself, it creates a delusion that can rationalise this situation and works to create a different identity.

Thus, the most important tool for surviving in this world is not money, power, wisdom or love: it is your identity and “self”. If you do not know what you truly want, then life cannot give you happiness and success.

Posted in Psychology & Medicine

Pica

Posted on by Jinavie

Occasionally, there are news stories about a man who eats steel or a girl who likes to eat plastic. Such a condition where the person develops an appetite for a non-food substance is called pica. Pica is more common than one would think. The most common cases are those of dirt, clay and chalk, with the disorder being much more prevalent in children or pregnant women. Although pica is officially a mental disorder (possibly related to OCD), it is possible that it is a neurological mechanism to cure a certain mineral deficiency. For example, patients with coeliac diseases or hookworm infections tend to be iron-deficient and the substances they eat tend to contain iron. It is unclear how the brain knows what “food” to eat to cure a disease, but there are many cases where people subconsciously consume foods that would improve their health. According to a study, between 8% and 65% of people have had a sudden urge for a very strange appetite. However, as substances commonly involved in pica (such as dirt and ice) are solids, they can damage the oesophagus and the digestive tract. Also, they may contain toxic chemicals which can cause poisonings, making pica a potentially dangerous condition.

Posted in Psychology & Medicine

Fugue State

Posted on by Jinavie

Any computer user would have had an (unfortunate) experience where their computer crashed and all the information there was destroyed in a second. You may still be able to format it and use it without problems, but the data you had on the computer and any customisation you made would be lost. But what if this exact thing could happen to a human being?

There are many types of amnesia, with causes ranging from neurobiological (where trauma to the brain, a drug or some other pathology causes memory loss) to psychogenic (where there is no apparent biological cause for the amnesia). With psychogenic amnesia, one only experiences retrograde amnesia, where they cannot recall memories from the past. However, anterograde amnesia, where you cannot form new memories and keep forgetting what happened, is absent in psychogenic amnesia. Psychogenic amnesia is often caused by extreme stress or a traumatic event. One type of psychogenic amnesia is situation-specific amnesia, as seen in post-traumatic stress disorder (PTSD) that occurs after a severely stressful experience such as war, rape, child abuse or witnessing a brutal death. In this case, the patient tends to only lose memories regarding the event, as if the brain is trying to protect the person from the hurtful memories.

A more interesting and much rarer type of amnesia is global psychogenic amnesia, also known as a fugue state or dissociative fugue. Unlike situation-specific amnesia, patients in fugue states have absolutely no memory of their original identity and personality. Simply put, they (usually) retain all their functions such as speaking and social interactions, but their persona has been wiped out like a formatted computer. Fugue states often develop after severe stress and can happen to anyone. Similar to situation-specific amnesia, the brain blocks all memories of the past in an attempt to protect the person’s psyche. Due to the “deletion” of the previous persona, patients in fugue states often generate new identities and begin wandering (sometimes even travelling to another country) away from the place they lost their memories. This is most likely the brain attempting to leave the environment to avoid the stressor that caused the event. 

Fugue states are often short-lived, lasting from days to months. However, very rarely they can last for years. Once out of a fugue state, the patient recovers all of their past memories but have no recollection of what happened during the fugue state. This creates a hole in their memory. For obvious reasons, this usually causes intense confusion and distress in the patient and treatment is often based around helping the person come to an understanding about the episode and cope with the stressor that caused it.

Posted in Psychology & Medicine

Munchausen’s Syndrome

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Some people are known to overreact regarding their health, such as a hypochondriac thinking that she has kidney failure because her urine looks slightly frothier. However, some people far surpass the level of hypochondrias to the level of psychiatric disease.
Münchausen’s syndrome patients are known to exaggerate or create symptoms so that the doctor would pay attention to them. When the doctor investigates, treats and sympathises with the patient they gain satisfaction from all the attention they are receiving.
Although this may sound like hypochondrias, Münchausen’s is far more serious.

A Münchausen’s patients are known to cause symptoms just to get attention from others. For example, a common manoeuvre used is the injection of insulin to induce a hypoglycaemic seizure. When their symptoms are “treated”, the patient will most likely invent another factitious disease to be treated for a longer time. They will also seek out many different doctors when the attending doctor catches on to their act. In fact, a Münchausen’s patient will do almost anything to prolong medical care, even accepting unnecessary and risky procedures such as surgeries.

The key difference between Münchausen’s syndrome and hypochondriasis is that the patient is aware that they are not actually sick (hypochondriacs actually believe they are sick). The fundamental basis for Münchausen’s syndrome is the desire for attention. Thus, the main risk factor for developing Münchausen’s is childhood experience of seeing someone close (typically a family member) suffering a debilitating disease. For example, if a girl sees her sister suffering from leukaemia and receiving all the attention of everyone around her, she may develop feelings of jealousy and later try to duplicate the scenario. As a patient, the person feels safe and comfortable and this feeds their addiction to medical care.

As Münchausen’s patients are very proficient liars and act completely like an actual patient, doctors must rule out any diseases before suspecting that their patients have a psychiatric problem. However, some signs such as the patient being overly keen on receiving procedures such as biopsies or continuously developing random symptoms may indicate Münchausen’s.

Interestingly, a similar condition called Münchausen’s syndrome by proxy also exists, where a caregiver (e.g. mother) convinces a doctor that the person they are caring for (e.g. child) are sick. Unfortunately, as these patients actually cause illness in the child, it is considered a form of child abuse. Common “symptoms” include: growth problems, asthma, allergies, vomiting, diarrhoea, seizures and infections. This may lead to the child developing Münchausen’s syndrome in the future.