:: wikimiki.org ::

Dissociation

Dissociation

: This article is about dissociation in psychology and psychiatry. For dissociation of molecules and salts in chemistry see dissociation (chemistry). Dissociation is a psychological state or condition in which certain thoughts, emotions, sensations, or memories are separated from the rest of the psyche. An example is the experience of being engrossed in a book or movie. The French psychiatrist Pierre Janet (1859-1947) coined the term in his book L'Automatisme psychologique; he emphasized its role as a defensive maneuver in response to psychological trauma. While he considered dissociation an initially effective defense mechanism that withdraws the individual psychologically from the impact of overwhelming traumatic events, a habitual tendency to dissociate would, however, promote psychopathology. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition considers symptoms such as depersonalization, derealization, and psychogenic amnesia as core features of dissociative disorders. However, in the normal population mild dissociative experiences are highly prevalent, with 80% to 90% of the respondents indicating that they experience dissociative experiences at least some of the time. Attention to dissociation as a clinical feature is growing in recent years as a concommitant to knowledge of post-traumatic stress disorder, and as brain imaging research and population studies show its relevance. Dissociation most often makes the news with regards to soldiers' responses to wartime stress, rape victims with amnesia for details, and in occasional criminal trials where the question is if a person with Dissociative Identity Disorder (DID) can be responsible for his or her actions. The most talked about form of dissociative disorder is DID, formerly known as Multiple Personality Disorder (MPD). Dissociation has a storied role in murder trials, or at least in movies about murder, where it is occasionally given as a reason for a "not guilty by reason of insanity" verdict. Formal study of dissociation and dissociative disorders is advanced by the International Society for the Study of Dissociation (http://www.issd.org).

Useful resources

- [http://www.dpselfhelp.com Depersonalization Community - Depersonalization Support Site]- Support site for those suffering from depersonalization and derealization.
- [http://www.dreamchild.net DreamChild - Living with chronic depersonalization]- Personal page of experiences and advice by one sufferer of chronic depersonalization disorder.

Molecule

A molecule is the smallest particle of a pure chemical substance that still retains its chemical composition and properties. The science of molecules is called molecular chemistry or molecular physics, depending on the focus. Molecular chemistry deals with the laws governing the interaction between molecules that results in the formation and breakage of chemical bonds, while molecular physics deals with the laws governing their structure and properties. In practice, however, this distinction is vague. According to the strict definition, molecules can consist of one atom (as in noble gases) or more atoms bonded together. The concept of monatomic (single-atom) molecule is used almost exclusively in the kinetic theory of gases. In molecular sciences, a molecule consists of a stable system (bound state) comprising two or more atoms. The term unstable molecule is used for very reactive species, i.e., short-lived assemblies (resonances) of electrons and nuclei, such as radicals, molecular ions, Rydberg molecules, transition states, Van der Waals complexes, or systems of colliding atoms as in Bose-Einstein condensates. A peculiar use of the term molecular is as a synonym to covalent, which arises from the fact that, unlike molecular covalent compounds, ionic compounds do not yield well-defined smallest particles that would be consistent with the definition above. No typical "smallest particle" can be defined for covalent crystals, or network solids, which are composed of repeating unit cells that extend indefinitely either in a plane (such as in graphite) or three-dimensionally (such as in diamond). Although the concept of molecules was first introduced in 1811 by Avogadro, and was accepted by many chemists as a result of Dalton's laws of Definite and Multiple Proportions (1803-1808), with notable exceptions (Boltzmann, Maxwell, Gibbs), the existence of molecules as anything other than convenient mathematical constructs was still an open debate in the physics community until the work of Perrin (1911), and was strenuously resisted by early positvists such as Mach. The modern theory of molecules makes great use of the many numerical techniques offered by computational chemistry. Dozens of molecules have now been identified in interstellar space by microwave spectroscopy. microwave spectroscopy (right) representations of the terpenoid, atisane. In the 3D model on the left, carbon atoms are represented by gray spheres; white spheres represent the hydrogen atoms and the cylinders represent the bonds. The model is enveloped in a "mesh" representation of the molecular surface, colored by areas of positive (red) and negative (blue) electric charge. In the 3D model (center), the light-blue spheres represent carbon atoms, the white spheres are hydrogen atoms, and the cylinders in between the atoms correspond to single bonds.]]

Chemical bond

:See main article chemical bond In a molecule, the atoms are joined by shared pairs of electrons in a chemical bond. It may consist of atoms of the same chemical element, as with oxygen (O₂), or of different elements, as with water (H₂O).

Size

Most molecules are much too small to be seen with the naked eye, but there are exceptions. DNA, a macromolecule, can reach macroscopic sizes. The smallest molecule is the hydrogen molecule. The interatomic distance is 0.15 nanometres (1.5 Å). But the size of its electron cloud is difficult to define precisely. Under standard conditions molecules have a dimension of a few to a few dozen Å.

Empirical formula

:See main article empirical formula The empirical formula of a molecule is the simplest integer ratio of the chemical elements that constitute the compound. For example, in their pure forms, water is always composed of a 2:1 ratio of hydrogen to oxygen, and ethyl alcohol or ethanol is always composed of carbon, hydrogen, and oxygen in a 2:6:1 ratio. However, this does not determine the kind of molecule uniquely - dimethyl ether has the same ratio as ethanol, for instance. Molecules with the same atoms in different arrangements are called isomers. The empirical formula is often the same as the molecular formula but not always. For example the molecule acetylene has molecular formula C2H2, but the simplest integer ratio of elements is CH.

Chemical formula

:See main article chemical formula The chemical formula reflects the exact number of atoms that compose a molecule. The molecular mass can be calculated from the chemical formula and is expressed in conventional units equal to 1/12 from the mass of a ¹²C isotope atom. For network solids, the term formula unit is used in stoichiometric calculations.

Molecular geometry

:See main article molecular geometry Molecules have fixed equilibrium geometries—bond lengths and angles—. A pure substance is composed of molecules with the same geometrical structure. The chemical formula and the structure of a molecule are the two important factors that determine its properties, particularly its reactivity. Isomers share a chemical formula but normally have very different properties because of their different structures. Stereoisomers, a particular type of isomers, may have very similar physico-chemical properties and at the same time very different biochemical activities.

Molecular spectroscopy

:See main article spectroscopy Molecular spectroscopy is the study of the response (spectrum) of a molecule to a signal of known energy (or frequency, according to Planck's formula). This signal is usually an electromagnetic wave or a beam of electrons, but new molecular spectroscopies, such as the positron spectroscopy, are under development. The molecular response can be signal absorption (absorption spectroscopy), emission of another signal (emission spectroscopy), fragmentation, or a change in its chemical nature. Spectroscopy is recognized as the most powerful tool in the investigation of the microscopic properties of molecules, and, in particular, their energy levels. Nowadays, in order to extract the maximum microscopic information from the experimental results, spectroscopical studies are very often coupled with computational chemical investigations. The theoretical background of spectroscopy is the scattering theory.

Salt

: This article is about the general chemical term salt. For the everyday meaning, see edible salt or its main ingredient, sodium chloride. For other meanings of the word salt, see salt (disambiguation). In chemistry, salt is a term used for ionic compounds composed of positively charged cations and negatively charged anions, so that the product is neutral and without a net charge. These ions can be inorganic (Cl^-) as well as organic (CH₃-COO^-) and monoatomic (F^-) as well as polyatomic ions (SO₄^2-). Solutions of salts in water are called electrolytes. Electrolytes as well as molten salts conduct electricity. Zwitterions are salts that contain an anionic center and a cationic center in the same molecule, examples are the amino acids, many metabolites, peptides, and proteins. Mixtures of many different ions in solution like in the cytoplasm of cells, in blood, urine, plant saps, and mineral waters usually do not form defined salts after evaporation of the water. Therefore their salt content is given for the respective ions. Impure salt is a name for salt which has lost its saltiness. It can also refer to natron.

Appearance

Consistency

Salts are usually solid crystals with a relatively high melting point. However, there exist salts that are liquid at room temperature, so-called ionic liquids. Inorganic salts usually have a low hardness and a low compressibility, similar to edible salt.

Color

Salts can be clear and transparent (sodium chloride), opaque (titanium dioxide), and even metallic and lustrous (iron disulfide). Salts exist in all different colors, e.g. yellow (sodium chromate), orange (sodium dichromate), red (mercury sulfide), mauve (cobalt dichloride hexahydrate), blue (copper sulfate pentahydrate, ferric hexacyanoferrate), green (nickel oxide), colorless (magnesium sulfate), white (titanium dioxide), and black (manganese dioxide). Most minerals and inorganic pigments as well as many synthetic organic dyes are salts.

Taste

Different salts can elicit all five basic tastes, i.e. salty (sodium chloride), sweet (lead diacetate), sour (potassium bitartrate), bitter (magnesium sulfate), and umami or savory (monosodium glutamate).

Odor

Pure salts are odorless, while impure salts may smell after the acid (e.g. acetates like acetic acid (vinegar), cyanides like hydrogen cyanide (almonds)) or the base (e.g. ammonium salts like ammonia).

Nomenclature

The name of a salt starts with the name of the cation (e.g. sodium or ammonium) followed by the name of the anion (e.g. chloride or acetate). Salts are often referred to only by the name of the cation (e.g. sodium salt or ammonium salt) or by the name of the anion (e.g. chloride or acetate). Common salt-forming cations are:
- ammonium NH₄⁺
- calcium Ca²⁺
- iron Fe²⁺ and Fe³⁺
- magnesium Mg²⁺
- potassium K⁺
- pyridinium C₅H₅NH⁺
- quaternary ammonium NR₄⁺
- sodium Na⁺ Common salt-forming anions (and the name of the parent acids in parentheses) are:
- acetate CH₃-COO^- (acetic acid)
- carbonate CO₃^2- (carbonic acid)
- chloride Cl^- (hydrochloric acid)
- citrate HO-C(COO^-)(CH₂-COO^-)₂ (citric acid)
- cyanide C≡N^- (hydrogen cyanide)
- hydroxide OH^- (water)
- nitrate NO₃^- (nitric acid)
- nitrite NO₂^- (nitrous acid)
- oxide O^2- (water)
- phosphate PO₄^3- (phosphoric acid)
- sulfate SO₄^2- (sulfuric acid)

Formation

Salts are formed by a chemical reaction between:
- a base and an acid, e.g. NH₃ + HCl → NH_{4_Cl}
- a metal and an acid, e.g. Mg + H₂SO₄ → MgSO₄ + H₂ Salts can also form if solutions of different salts are mixed, their ions recombine, and the new salt is insoluble and precipitates (see: Solubility equilibrium).

References

- Kurlansky, Mark (2002). Salt: A World History. Walker Publishing Company. ISBN: 0142001619
- silting is the natural deposit of salt from sea water

Dissociation (chemistry)

Dissociation in chemistry and biochemistry is a general process in which complexes, molecules, or salts separate or split into smaller molecules, ions, or radicals, usually in a reversible manner. Dissociation is the opposite of association and recombination.

Dissociation constant

For reversible dissociations in a chemical_equilibrium : AB <=> A + B the dissociation constant K_d is the ratio of dissociated to undissociated compound :

K_d = \frac

Salts

The dissociation of salts by solvation in a solvent like water means the separation of the anions and cations. The salt can be recovered by evaporation of the solvent. See also: Solubility equilibrium

Acids

The dissociation of acids in a solution means the split-off of a proton H⁺, see Acid-base reaction theories. This is an equilibrium process, meaning that dissociation and recombination takes place at the same time. The acid dissociation constant K_a is an indicator of the acid strength: stronger acids have a higher K_a value (and a lower pK_a value).

Fragmentation

Fragmentation of a molecule can take place by a process of heterolysis or homolysis.

Absorption

Receptors

Receptors are proteins that bind small ligands. The dissociation constant K_d is used as indicator of the affinity of the ligand to the receptor. The higher the affinity of the ligand for the receptor the lower the K_d value (and the higher the pK_d value). category:chemical processes

Thought

Thought or thinking is a mental process which allows beings to model the world, and so to deal with it effectively according to their goals, plans, ends and desires. Concepts in our language, which are akin to thought are cognition, sentience, consciousness, idea, and imagination. As of yet, the english language has not coined more specific words for the exact experiences and endeavors people do in their minds on a daily basis. Thinking involves manipulation of information, as when we form concepts, engage in problem solving, reason and make decisions. Thinking is a higher cognitive function and the analysis of thinking processes is part of cognitive psychology. The basic mechanics of the human mind reflect a process of pattern matching. In a Moment of Reflection, new situations and new experiences are judged against recalled ones and judgements are made. In order to make these judgements the intellect maintains present experience and sorts relevant past experience. It does this while keeping present and past experience distinct and seperate. Animals can't do that, so they can't make those judgements. They depend on instincts. The intellect can mix, match, merge, sift and sort concepts, perceptions and experience. This process is called reasoning. Logic is the science of reasoning. The awareness of this process of reasoning is access consciousness ( see philosopher Ned Block). The imagination performs a different function. It combines the reasoning intellect with your feelings, intuitions and emotions. This is magical or irrational thinking, depending on your point of view. Thinking can be modelled by a field ( like a mathematical representation of an electro-magnetic field, but with each point in the field a point of consciousness) . Paterns are formed and judgements are made within the field. Some philosophers ( panpsychists/ panexperientialists- see wikibook on consciousness) believe the entire field is conscious in and of itself, a consciousness field. They say consciousness creates thinking, thinking and other brain processes do not create consciousness. Other scientist (for ex. Bernard Baars ) think of it as a workspace. No scientist claims to understand how we are conscious. Other philosophers ( ex. Thomas Nagel) have said they do not have a clue as to how we are aware of our thinking.

Aids/pitfalls to thinking

#Use of models, symbols, diagrams and pictures #Use of abstraction to simplify the effort of thinking #Use of metasyntactic variables to simplify the effort of naming #Use of iteration and recursion to converge on a concept #Limitation of attention to aid concentration and focus on a concept. Use of peace and quiet to aid concentration. #Goal setting and goal revision. Simply letting the concept percolate in the subconscious, and waiting for the concept to re-surface. #Talking with like-minded people. Resorting to communication with others, if this is allowed. #Working backward from the goal. #Fashion of thinking. #Desire for learning.

Reference

- Eric Baum, What is Thought MIT Press 2004 ISBN 0-262-02548-5 - Chapter Two: The Mind is a Computer Program Category:Cognition ja:思考

Sensation

In psychology, sensation is the first stage in the chain of biochemical and neurologic events that begins with the impinging of a stimulus upon the receptor cells of a sensory organ, which then leads to perception, the mental state that is reflected in statements like "I see a uniformly blue wall." A sensation that might lead to that statement could include the excitation of cone cells in the retina, spatially varying in the proportion of "blue" and "green" cone excitation due to portions of the wall receiving different proportions of yellowish artificial and bluish sky-light; it is common for these variations to be compensated for, within the brain, so that the non-uniform sensation yields a perception of uniform color. In the West, the human body's senses are divided into seven: visual, auditory, gustatory, olfactory, cutaneous, kinesthetic, vestibular, organic. The ways in which these senses are divided from one another in concept, and combined in varying ratios in perceiving the world, differs based on individual physiology, social and cultural context, and physical surroundings. The whole sensory system, including both physical sensation and interpretation (or cognition) of information from the senses, is referred to as a sensorium.

Visual sense

Light enters to the eyes through cornea. It then passes through the pupil, and then refracted by the crystalline lens of the eyes. Light is then channeled through the vitreous humour and then on to the retina. In the retina, there are two kinds of cells, rods and cones. Rods see black-and-white colors, and is dominant in the night (because, as Physics state, there are no colors in the night, because what we see is the colors reflected from the atmosphere). Cones then, see colored structures. Cones are exceptionally abundant in the fovea. Cones are reactive to the three colors of red, blue, and green. Other colours are sensed as combinations of these.

Auditory sense

Sound is received by the ear via the pinna, the outer ear structure, which then leads the sound inside through the external auditory meatus. After the sound passes through the meatus, it goes to the eardrum, or tympanus, then vibrates its way through the tiny ossicles, the hammer (malleus), anvil (incus), and stirrup (stapes), then to the cochlea. The cochlea converts vibration into electical impulses which are transmitted to the brain.

Gustatory sense

Taste, or gustation, is the ability to detect sensory changes in the tongue, through the use of taste buds, situated deep into the papillae. Intriguingly, the sense called gustation is if fact comprised of varying ratios of multiple sensory systems, shifting in importance and attention as food is chewed, tasted and swallowed. These include the taste buds, the sense of touch in the structures of the mouth and digestive system, chemical sensation of irritation in the trigeminal nerve system, and unique receptors for sensing the properties of water located at the rear of the oral cavity.

Olfactory sense

Smell, or olfaction, is received by the olfactory bulb and the connected to the brain by the olfactory nerve, the 1st cranial nerve of the brain, just after the nasal turbinates of the nose warms strain and filter the air.

Cutaneous Sense

Please see the skin article for more details.

Kinesthetic Sense

The kinesthetic sense is the sense of posture and movement. It is also referred to as proprioception.

Vestibular Sense

The vestibular sense is the sense of balance. It is mediated by the action of the fluid inside the Semicircular canals in the ear.

Organic Sense

The organic sense, per se, refers only to sensation from the internal organs, or viscera, but can, however, be expanded to include certain physiological processes, such as hunger, thirst, and drowsiness. Category:perception

Psyche (psychology)

Psyche (Greek ψυχή breathe, blow) used in classic Greek as a synonym for the word soul. Since our culture and mind grew more sophisticated it became necessary to separate the two concepts. Today psyche is the object psychology is dealing with. It is one of the four parts that makes the sum total of the non-physical aspects of a human being; the others are consciousness, mind and soul. Whilst psyche only exists in the body and is connected to the body, soul refers to the part that is unfading.

Functions of psyche

Psyche has two main functions. It is both a non-material "hard disk" that stores memories and a non-material digestion organ that masters fear. Psyche can be of different complexity and can in this respect be compared with a mirror globe that has more or less reflectors on its surface. A globe with less mirrors gives a simple image of reality whilst a globe with many mirrors gives a highly complex image of reality. It is obvious that a highly complexe psyche is able to represent reality more sophisticated but on the other hand is more prone to picture distorted images of reality. A strong distortion of reality can lead to a state in which the basic function of psyche temporarily is no longer functioning and fear will no longer be digested correctly. A pathologically working pysche will not only sustain distortions of reality but also intensify them, so that help from outside is necessary (psychoanalysis) to re-enable psyche to sanely digest fear again. As a consequence of this help distortion of reality (that always happens because of fear) can be abolished little by little.

Psyche and mind

The word mind relates to the mental abilities of a human, the will, intellect, wit, power of judgement, cogitation separating capability, experiences, education, the ability to discover coherences and the communicative aspects of the human being, like language. Basically mind and psyche work together. Psyche can be accessed by the mind and mind can uncover the distortions of reality that psyche adapted to. Very seldomly psyche is in rude health. A healthy psyche knows the fear but doesn't allow fear to control it.

Psyche and consciousness

Superficially it seems paradoxical that psyche is constructed in a way to primarily store distorted images of reality, but it is only under these conditions that consciousness is needed develop. Growing consciousness is capable of discovering discrepancies between memories and reality and capable of correcting the distortions of reality with the help of the mind. In this respect psyche is a most precious growth subsidiary for the development of consciousness.

Horizontal and vertical intermediary

By being a non-physical storage organ that is dependent on the supply of the physis, psyche gives a connective link between the physical (body) and the spiritual aspects (mind, soul) of the human being as well as a bridge between the separated bodies of all the many humans being alive at the same time.

Acknowledgement

Many thanks to the authors of the book "Welten der Seele" (Worlds of the soul) that provided these utterly new, clear and penetrative borderlines between the different parts the human being consists of. This article is mainly based on these insights.

References

- Hasselmann, Varda and Frank Schmolke: Welten der Seele (Worlds of the soul). Munich, 1993. Pages 31-45 (till now only available in German, Nov. 2005) ja:プシュケ

Psychiatrist

Psychiatry is the branch of medicine that studies, diagnoses and treats mental illness and behavioral disorders. While all physicians will encounter patients with mental illnesses and any of them may treat it, psychiatrists specialize in these areas. They are more extensively trained in the differential diagnosis (the distinguishing of various forms) and treatment of mental illness and are required to keep up to date on the newest developments in the field of mental illness. Psychologists, nurse practitioners and social workers may also provide mental healthcare, though of these none may prescribe medication in the UK and only nurse practitioners may prescribe medication in the United States.

Practice of psychiatry

Psychiatry has proven to be a malleable term, meaning that it is associated with the diagnosis, treatment and prevention of mental, emotional and behavioral disorders such as major depression, schizophrenia and anxiety disorders. Psychiatry uses laboratory and imaging studies, medication and psychotherapy in diagnosing and treating psychiatric conditions. The field of psychiatry itself can be divided into various subspecialities. These include:
- Child and Adolescent Psychiatry
- Geriatric Psychiatry
- Consultation-Liaison Psychiatry
- Emergency Psychiatry
- Addiction Psychiatry
- Forensic Psychiatry Other areas of focus include mood disorders, neuropsychiatry and various forms of psychotherapy such as Psychodynamic Therapy and Cognitive Behavioral Therapy. Individuals with mental illness, typically referred to as patients or, sometimes when privately treated, clients, may come under the care of a psychiatrist or other psychiatric practitioners through various processes. This may be by self-referral or referral by a primary care physician (the two most common methods in the United States) or by hospital medical staff; or by court order, involuntary commitment or, in the UK, by sectioning under the Mental Health Act. In all circumstances the psychiatrist assesses the patient's mental and somatic (general medical) condition through interviewing the patient and/or by obtaining information from relatives, associates, carers, law enforcement personnel, nursing staff or other healthcare professionals. Physical examination is usually performed to establish or exclude other illnesses or identify any signs of self-harm. Blood tests and medical imaging may be also performed and their associated medical specialists consulted. Mental and behavioral conditions are treated with various forms of medication, therapy and counseling. Psychotherapy may be used for many conditions, either exclusively or in combination with medication. Commencing treatment with medication requires the patient to agree to this treatment (although in many countries the law provides overriding circumstances) and that they will follow the dosage prescribed. Many psychiatric medications can produce side-effects in patients and hence they may need ongoing therapeutic drug monitoring, for instance full blood counts or, for patients taking lithium salts, serum levels of lithium. Electroconvulsive therapy, a controversial practice despite claims for its efficacy, is sometimes administered for serious and disabling conditions, especially those unresponsive to medication. Psychiatric patients may be either inpatients and outpatients. Psychiatric outpatients periodically visit their psychiatrist for consultation in his or her office, usually for an appointment lasting thirty to sixty minutes. These consultations normally involve the psychiatrist interviewing the patient to update their assessment of the patient's condition and management of any medication. The psychiatrist may also provide psychotherapy. The frequency with which a psychiatrist sees patients varies widely, from days to months, depending on the type, severity and stability of each patient's condition. Inpatients are admitted to a hospital to receive psychiatric care. In the majority of cases this admission is voluntary, but it can be involuntary if the patient is in immediate danger of harming others or themselves. In a hospital setting, patients can be more carefully monitored, treated more rapidly and better protected from self-harm or harming others. Hospitalized patients are increasingly being managed in a multidisciplinary fashion, where nursing staff, occupational therapists, psychotherapists, social workers and other healthcare professionals all may contribute to a patient's care. Historically, particularly before the advent of psychiatric medication, hospital stays averaged six months or more, with a significant number of cases requiring hospitalization for many years. Today the average hospital stay is around two to three weeks, with only a small number of cases requiring long term hospitalization. On being discharged from hospital, inpatients typically become outpatients.

The DSM system

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a system of psychaitric diagnoses overseen and revised by the American Psychiatric Association and is presently (2005) in its fourth revised edition (IV-TR, published 2000). It is based on five axes:
- Axis I: Psychiatric disorders
- Axis II: Personality disorders / Mental retardation
- Axis III: General medical condition
- Axis IV: Social functioning and impact of symptoms
- Axis V: Global Assessment of Functioning (on a scale from 100 to 0) Common axis I disorders include substance dependence and abuse (e.g. alcohol dependence); mood disorders (e.g. depression, bipolar disorder); psychotic disorders (e.g. schizophrenia, schizoaffective disorder); and anxiety disorders (e.g. post-traumatic stress disorder, obsessive-compulsive disorder). Common axis II disorders include borderline personality disorder, schizotypal personality disorder, avoidant personality disorder and antisocial personality disorder. The intention is to create a set of diagnoses that are replicable and meaningful, although the categories are broad and many of the symptoms overlap. While the system was originally intended to enhance research into both diagnosis and treatment, the nomenclature is now one of two standards widely used by clinicians, administrators and insurance companies in many countries. The other standard, the ICD-10 (International Classification of Diseases-10), is less specific in its criteria for each illess.

Contrast with psychology

Psychiatry is practised by psychiatrists, who are medical doctors specializing in mental illness and who may prescribe drugs. Psychiatrists evaluate patients from a biopsychosocial perspective before prescribing treatment. In contrast, psychology is the broader study of human behaviour and thought processes, not just in the context of mental health. Clinical psychologists specialize in mental health and have extensive training in psychotherapy and psychological testing. Psychologists are generally not allowed to prescribe medications in the United States (exceptions have been made in the Department of Defense, Guam, New Mexico, and Louisiana, but the psychologist must complete a postdoctoral training program in clinical psychopharmacology and practicum, and pass a licensing examination prior to doing so). The turf battle over prescribing privileges is ongoing in the U.S. A significant subset of psychologists argue that there is an inadequate number of psychiatrists to treat all of the nation's psychiatricaly ill and that focused education in psychopharmacology is adequate to provide expert medication management. The American Psychiatric Association has long argued that psychologists lack the medical training to make the sometimes difficult diagnostic and therapeutic decisions that accompany the pharmacologic treatment of the seriously mentally ill.

Professional requirements

In the United States, psychiatrists are board certified as specialists in their field. After completing four years of medical school, physicians will practise as psychiatry residents for four years. After completing their training, psychiatrists take written and then oral board examinations, each of which has a failure rate that approaches 50%, before becoming board certified. In the United Kingdom, people work as a senior house officer (SHO) in psychiatry for 2-3 years while sitting postgraduate exams, after which they may apply for a specialist registrar post, which may be in any one of several areas of specialisation within psychiatry. In other countries, similar rules usually apply. Some psychiatrists specialize in helping certain age groups; child and adolescent psychiatrists work with children and teenagers in addressing psychological problems. Those who work with the elderly are called geriatric psychiatrists, or in the UK, psychogeriatricians. Those who practise psychiatry in the workplace are called industrial psychiatrists (this is a term used in the US but not the UK); those working in the courtroom and reporting to the judge and jury (in both criminal and civil court cases) are forensic psychiatrists. Forensic psychiatrists also treat mentally disordered offenders and other patients whose condition is such that they have to be treated in secure units. In the United Kingdom there are several different areas of specialisation in which one may train as a specialist registrar (the 3-4 final years of training required before becoming a senior doctor or consultant). They are: general adult psychiatry, child and adolescent psychiatry, psychogeriatrics, forensic psychiatry, psychotherapy, and drugs and alcohol. After this period as a specialist registrar, one has to be approved by the Royal College of Psychiatrists as an approved specialist in the chosen field before going on to apply for a consultant post in that field.

History

Psychiatric illnesses are generally characterised as disorders of the mind rather than the brain, although the distinction is not always obvious. Many conditions have been linked to biological or chemical abnormalities in the brain's psychology, but for most conditions the etiology and pathogenesis are still the subject of intense research. For a long period of history, neurology and psychiatry were a single discipline, and following their division the tremendous advances in neurosciences (especially in genetics and neuroimaging) recently are bringing areas of the two disciplines back together. Indeed, in a 2002 review article in the American Journal of Psychiatry, Professor Joseph B. Martin, Dean of Harvard Medical School and a neurologist by training, wrote that "the separation of the (neurological versus psychiatric disorders) is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway" (Martin 2002). Psychiatry was at first a pragmatic discipline that was part of general medicine, combining medicine and practical psychology. The work of Emil Kraepelin laid the foundations of scientific psychiatry. A neurologist, Sigmund Freud, used these same powers of medically-based observation to develop the field of psychoanalysis. For many years, Freudian theories dominated psychiatric thinking. The discovery of lithium carbonate as a treatment for bipolar disorder (and shortly thereafter after by the development of typical antipsychotics for treatment of schizophrenia), followed by the development of fields such as molecular biology and tools such as brain imaging has led to psychiatry re-discovering its origins in physical and observational medicine without losing sight of its humane dimension.

Opposition to and criticism of psychiatry

Anti-psychiatry

Unlike most other areas of medicine, there is a politicised anti-psychiatry movement opposed to the practices of, and in some cases the existence of, psychiatry. This phenomenon mainly originated in the 1960s and 1970s under the leadership of David Cooper, Thomas Szasz and R. D. Laing. The Church of Scientology opposes psychiatry for various reasons, mainly through its Citizens Commission on Human Rights.

Other criticisms

Others, probably a considerably larger number than those who oppose psychiatry altogether, still have problems with a number of aspects of the profession as practised today. Many believe that psychiatrists have a tendency to over-diagnose mental disorders and to prescribe medication in cases where it is not necessary (or in some cases even when medically contraindicated). Many critics question the current DSM diagnostic labels, finding some or all labels arbitrary, vague, and/or lacking in firm biological basis, leading some to describe them as pseudoscientific. However, it could be argued that many psychiatrists share such concerns, thus helping to guide the profession forward from within. Drug companies spend large amounts of money marketing psychiatric drugs. There is evidence this leads some psychiatrists to prescribe advertised drugs instead of more appropriate, better, or cheaper drugs (or prescribing them when drugs are not needed at all). The training and techniques of psychiatrists can vary substantially, according to critics, and patients often have to switch psychiatrists a few times before they find one they are satisfied with. Critics also contend training is unduly influenced by the drug industry. Misdiagnosis (one common example, unipolar depression instead of bipolar depression) remains a problem in some cases, prolonging the suffering for those patients. Also, as in any medical specialty, different individuals respond differently to a given drug; this can lead to some patients experiencing a prolonged trial-and-error process.

Related terms

- "Alienist" was a somewhat derogatory and now obselete term for a psychiatrist or psychologist.
- "Shrink", taken from "head shrinker", is a slang term for a psychiatrist or psychotherapist, sometimes treated as derogatory or offensive.

External links

- [http://www.psych.org American Psychiatric Association]
- [http://www.aacap.org American Academy of Child and Adolescent Psychiatry]

References

- Martin JB. The integration of neurology, psychiatry and neuroscience in the 21st century. Am J Psychiatry 2002; 159:695-704. [http://ajp.psychiatryonline.org/cgi/content/full/159/5/695 Fulltext]. PMID 11986119. Psychiatry Category:Applied psychology Category:Mental health ja:精神医学

Pierre Janet

Pierre Marie Félix Janet, (May 30 1859 - February 24 1947) was a pioneering French psychiatrist. He studied under Jean-Martin Charcot.

Sources

- [http://www.whonamedit.com/doctor.cfm/2467.html a short biography]
- [http://www.sidran.org/refs/ref12.html bibliographic site] Janet, Pierre Janet, Pierre Janet, Pierre Janet, Pierre Janet, Pierre ja:ピエール・ジャネ

Psychological trauma

The concept of a psychological trauma, or damage to the psyche corresponding in effect or severity to that of physical trauma, has been a part of the disciplines of psychiatry and psychology since the early twentieth century. Trauma can be caused by a wide variety of events, but there are a few common aspects. A traumatic event involves a singular experience or enduring event or events that completely overwhelm the individual's ability to cope or integrate the emotion involved with that experience. It usually involves a complete feeling of helplessness in the face of a real or subjective threat to life, bodily integrity, or sanity. There is frequently a violation of the person's familiar ideas about the world, putting the person in a state of extreme confusion and insecurity. This is seen when people or institutions depended on for survival violate or betray the person in some way. Psychological trauma may accompany physical trauma, or exist independently of it. Typical causes of psychological trauma are abuse, violence, the threat of either, or the witnessing of either, particularly in childhood. Catastropic events such as earthquakes and volcanic eruptions, war or other mass violence can also cause psychological trauma. Long-term exposure to situations such as extreme poverty or milder forms of abuse, such as verbal abuse, can be traumatic (though verbal abuse can also potentially be traumatic as a single event). In some cases, even a person's own actions, such as committing rape, can be traumatic for the offender as well as the victim, especially if the offender feels helpless to control the urge to commit such crimes. It should be noted, however, that different people will react differently to similar events. One person may perceive an event to be traumatic that another may not, and not all people who experience a traumatic event will become psychologically traumatized.

Symptoms of trauma

People who go through traumatic experiences often have certain symptoms and problems afterward. How severe these symptoms are depends on the person, the type of trauma involved, and the emotional support they receive from others. This section is a general listing of possible symptoms, and is not exhaustive. Reactions to and symptoms of trauma can be wide and varied, and differ in severity from person to person. A traumatized individual may experience one or several of them. After a traumatic experience, a person may re-experience the trauma mentally and physically. Because this can be uncomfortable and sometimes painful, survivors tend to avoid reminders of the trauma. They may turn to alcohol and/or drugs to try and escape the feelings. Re-experiencing symptoms are a sign that the body and mind are actively struggling to cope with the traumatic experience. Triggers and cues that are reminders of the trauma can trigger anxiety and other associated emotion. Often, the person can even be completely unaware of what the trigger is. Panic attacks can result from these emotional triggers. Intense feelings of anger may surface frequently, sometimes in very inappropriate or unexpected situations, since danger seems to always be present. Upsetting memories such as images, thoughts, or flashbacks may haunt the person, and nightmares may be frequent. Insomnia may occur as lurking fears and insecurity keep the person vigilant and on the lookout for danger, both day and night. In time, emotional exhaustion may set in, leading to distraction, and clear thinking may be difficult. Emotional detachment, also known as dissociation or "numbing out", can frequently occur. Dissociating from the painful emotion will include normal emotion as well, and the person may seem emotionally flat, preoccupied or distant. The person can become confused in ordinary situations and have memory problems. Some traumatized people may feel permanently damaged when trauma symptoms don't go away and s/he doesn't believe their situation will improve. This can lead to feelings of despair, loss of self-esteem, and frequently depression. If important aspects of the person's self and world understanding have been violated, the person may call his/er own identity into question. These symptoms can lead to stress or anxiety disorders, or even posttraumatic stress disorder, where the person experiences flashbacks and re-experiences the emotion of the trauma as if it is actually happening.

Trauma in psychoanalysis

French neurologist Jean-Martin Charcot argued that psychological trauma was the origin of all instances of the mental illness of hysteria. Charcot's "traumatic hysteria" often manifested as a paralysis that followed a physical trauma, typically years later, after what Charcot described as a period of "incubation" . Sigmund Freud, Charcot's student and the father of psychoanalysis, examined the concept of psychological trauma throughout his career. Jean Laplanche has given a general description of Freud's understanding of trauma, which varied significantly throughout Freud's career: "An event in the subject's life, defined by its intensity, by the subject's incapacity to respond adequately to it and by the upheaval and long-lasting effects that it brings about in the psychical organisation" .

Trauma and stress disorders

In times of war, psychological trauma has been known as shell shock or combat stress reaction (CSR). Psychological trauma may cause acute stress disorder (ASD) which may lead on to posttraumatic stress disorder (PTSD). PTSD can also develop without an antecedent ASD and may come on months or years after the trauma. Both ASD and PTSD are specific disorders in which the traumatized individual may experience nightmares, avoidance of certain situations and places, depression, and other symptoms. PTSD emerged as the label for this condition after the Vietnam War in which many veterans returned to their respective countries demoralized, and sometimes, addicted to drugs. Psychological trauma is treated with therapy and, if indicated, psychotropic medications. Recent studies try to show the effect of trauma on human memory. This kind of study is useful in order to verify the attendibility of eyewitnesses involved in criminal acts. Therapies used in the treatment of psychological trauma include: Cognitive therapy (CBT), Brief therapy, Psychodynamic psychotherapy, Play therapy and EMDR. Following traumatic events, persons involved are often asked to talk about the events soon after, sometimes even immediately after the event occurred in order to start a healing process. This practice may not garner the positive results needed to recover psychologically from a traumatic event. Victims of traumatic occurances who were debriefed immediately after the event in general do fare better than others who received therapy at a later time. Yet, there is one indication that forcing immediate debriefing may even distort the natural psychological healing process .

Growth aspects of trauma

Though the idea of trauma is most frequently thought of in negative terms, it is also often seen to have positive aspects. Many people, such as Christopher Reeves and Rick Hansen, have overcome traumas and moved on to become inspirational figures. This growth, often called called posttraumatic growth, it is often the result of the person's attitude, and it is pointed out that a traumatized person must choose "to embark on the long journey of recovery - to restore shattered assumptions, regain confidence and find healing at physical, emotional, and spiritual levels." According to Richard G. Tedeschi and and Lawrence Calhoun, both professors at the University of North Carolina, trauma experiences can lead to growth, though this is not inevitable. They have found that "reports of growth experiences in the aftermath of traumatic events far outnumber reports of psychiatric disorders." They state that these changes can include

...improved relationships, new possibilities for one's life, a greater appreciation for life, a greater sense of personal strength and spiritual development. There appears to be a basic paradox apprehended by trauma survivors who report these aspects of posttraumatic growth: Their losses have produced valuable gains ...They also may find themselves becoming more comfortable with intimacy and having a greater sense of compassion for others who experience life difficulties.

Still, they add, "posttraumatic growth does not necessarily yield less emotional distress."

...posttraumatic growth occurs in the context of suffering and significant psychological struggle, and a focus on this growth should not come at the expense of empathy for the pain and suffering of trauma survivors. For most trauma survivors, posttraumatic growth and distress will coexist, and the growth emerges from the struggle with coping, not from the trauma itself.

They point out that "there are also a significant number of people who experience little or no growth in their struggle with trauma."

References

- DePrince, A.P. & Freyd, J.J. (2002). "The Harm of Trauma: Pathological fear, shattered assumptions, or betrayal?" In J. Kauffman (Ed.) Loss of the Assumptive World: a theory of traumatic loss. (pp 71-82). New York: Brunner-Routledge. [http://dynamic.uoregon.edu/~jjf/articles/dpf02harm.pdf]
- [http://www.ncptsd.va.gov/facts/general/fs_effects.html Effects of Traumatic Experiences National Center for PTSD] by Eve B. Carlson, Ph.D. and Josef Ruzek, Ph.D.
- [http://students.usask.ca/wellness/info/mentalhealth/trauma/symptoms/ University of Saskatchewan: A list of trauma symptoms]
- [http://www.loyola.edu/campuslife/healthservices/counselingcenter/trauma.html Loyola College in Maryland: Trauma and Post-traumatic Stress Disorder]

External links

- [http://www.helpguide.org/mental/emotional_psychological_trauma.htm Emotional and Psychological Trauma: Causes, Symptoms, Effects, and Treatment]
- [http://www.aacap.org/press_releases/2005/0104.htm Responding to Natural Disaster: Mental health resources for Parents and Families]
- [http://www.childadvocate.net/disaster.htm Disaster help for parents and children]
- [http://www.helpguide.org/mental/coping_disaster_help_recovery.htm Coping with Disasters: Natural, War, Rape and Other Traumas]

Notes

# #ibid p. 465 # [http://dx.doi.org/10.1111/1529-1006.01421 Abstract] # Paul T. P. Wong, PhD. C. Psych. [http://www.meaning.ca/articles/presidents_column/post_traumatic_growth.htm Pathways to posttraumatic growth], International Network of Personal Meaning. # Richard G. Tedeschi, Ph.D., and Lawrence Calhoun, Ph.D. [http://www.psychiatrictimes.com/p040458.html "Posttraumatic Growth: A New Perspective on Psychotraumatology"] Psychiatric Times, April 2004, V. XXI, issue 4. category:psychiatry

Defence mechanism

:The following article is about the psychological aspect of defence mechanism; it is also used in biology. For an article about that specific subject visit Defence mechanism (biology). Defence mechanisms (British spelling; Defense mechanisms in American English) are a set of unconscious ways to protect one's personality from unpleasant thoughts and realities which may otherwise cause anxiety. The notion of defence mechanism is an integral part of the psychoanalytic theory. Although often described as detrimental and negative ways that an individual deals with overwhelming stressors; these mechanisms can also be applied positively when dealing with conflicts. Used sparingly, they help people face difficult life situations. However, a defence mechanism can also lead to a neurosis if it causes a person to adopt ineffectual or inappropriate coping strategies.

Examples

Examples of defence mechanisms include: the examples given here are generally negative applications of the mechanism; although, these mechanism can often be used in healthy fashion to deal with stressors.
- Acting out. Dealing with emotional stressors by actions rather than reflections or feelings. For example, a person facing a small problem responds quickly with intense passion when the situation would not have required it.
- Altruism. Dealing with emotional stressors by dedication to meeting the needs of others. For example, a person putting away her own problems starts to volunteer.
- Anticipation. Dealing with emotional stressors by experiencing emotional reactions in advance of, or anticipating consequences of, possible future events and considering realistic, alternative responses or solutions. For example, after a difficult job interview an unemployed candidate expects that he might not be selected by the employer.
- Avoidance. Dealing with emotional stressors by refusing to encounter situations, objects, or activities because of the fear of failures or difficulties. Often seen in phobias. For example, a worker refuses to confront an employer fearing his or her reactions.
- Compensation. Dealing with emotional stressors by overemphasizing other activities or situations. For example, a physically unattractive adolescent starts weightlifting.
- Denial. Dealing with emotional stressors by failing to recognize obvious implications or consequences of a thought, act, or situation. For example, a disabled person plans to return to former activities although it is evident it is virtually impossible.
- Displacement. Dealing with emotional stressors by redirecting emotion from a 'dangerous' object to a 'safe' object. For example, a worker is angered by his superior but suppresses his anger; later, on return to his home, he punishes one of his children for misbehaviour that would usually be tolerated or ignored.
- Humour. Dealing with emotional stressors by emphasizing the amusing or ironic aspects of the conflict or stressors. For example, a patient is laughing off the fact that physicians are unable to diagnose him with a specific disease.
- Idealization. Dealing with emotional stressors by overestimating the desirable qualities and underestimating the limitations of a desired object. For example, a lover speaks in glowing terms of the beauty of an average-looking woman he has recently dated.
- Intellectualization. Dealing with emotional stressors by excessive use of abstract thinking or complex explanations to control or minimize disturbing feelings. For example, a husband is constructing elaborate logical explanations for his wife's recent paranoid ideas.
- Introjection. Dealing with emotional stressors by internalizing the values or characteristics of another person; usually someone who is significant to the individual in some way. For example, adopting the ideals of a charismatic leader in order to deal with feelings of one's own inadequacy.
- Isolation. Dealing with emotional stressors by splitting-off of the emotional components from a difficult thought. The mechanism of isolation is commonly over utilized by people with obsessive compulsive personalities. For example, a medical student dissects a cadaver without being disturbed by thoughts of death.
- Passive Aggression. Dealing with emotional stressors by indirectly and unassertively expressing aggression toward others. Main article: Passive-aggressive behavior.
- Projection. The opposite of introjection. Attributing one's own emotions or desires to an external object or person. For example, saying others hate you when it is you who hates the others.
- Rationalization. Dealing with emotional stressors by inventing a socially acceptable or logical reason to justify an already taken unconscious emotional action. For example, becoming drunk and then after-the-fact saying that it was needed to 'take the edge off'."
- Reaction formation. Dealing with emotional stressors by converting an uncomfortable feeling into its opposite. For example, a married woman who is disturbed by feeling attracted to another man treats him rudely.
- Regression. Dealing with emotional stressors by returning to a less mature, anxiety reducing behaviour. For example, a high school girl who has had a very traumatic day at school curls up in a blanket and rocks herself to sleep.
- Repression. Moving thoughts unacceptable to the ego into the unconscious, where they cannot be easily accessed.
- Somatization. Dealing with emotional stressors by physical symptoms involving parts of the body innervated by the sympathetic and parasympathetic system. For example, a highly competitive and aggressive person, whose life situation requires that such behaviour be restricted, develops hypertension.
- Splitting. When someone who can't cope with ambivalent feelings about others compartmentalizes those people as all good or all bad. For example, an actor believes that Scientologists are kind, noble, intelligent, and a source of inspiration. Meanwhile, he believes psychiatrists are evil, emotionless, and bent on turning people into zombies.
- Sublimation. Dealing with emotional stressors by using the energy in other, usually constructive activities. For example, playing sports to relieve stress or anger.
- Suppression. Dealing with emotional stressors by deferred dealing with the stressor. For example, a worker finds that he is letting thoughts about a date that evening interfere with his duties; he decides not to think about plans for the evening until he leaves work.
- Undoing. Dealing with emotional stressors by negating a previous act or communication. For example, after having made a derogatory statement to his wife, a husband brings her a gift.
External links

- [http://www.prenticehall.ca/wood/home/tryit/defence.html World of Psychology entry on Defence Mechanisms]
See also

- Neurosis
- Psychoanalysis
- Sigmund Freud Category:Freudian psychology ja:防衛機制 ko:방어기제 th:กลไกการป้องกันตนเอง

Psychopathology

Psychopathology is a term which refers to either # the study of mental illness or mental distress # the manifestation of behaviours and experiences which may be indicative of mental illness or psychological impairment. It is also the name of an academic journal that specialises in the understanding and classification of mental illness in clinical psychiatry.

Psychopathology as the study of mental illness

Many different professions may be involved in studying mental illness or distress. Most notably, psychiatrists and clinical psychologists are particularly interested in this area and may either be involved in clinical treatment of mental illness, or research into the origin, development and manifestations of such states, or often, both. More widely, many different specialties may be involved in the study of psychopathology. For example, a neuroscientist may focus on brain changes related to mental illness. Therefore, someone who is referred to as a psychopathologist, may be one of any number of professions who have specialised in studying this area. Psychiatrists in particular are interested in descriptive psychopathology, which has the aim of describing the symptoms and syndromes of mental illness. This is both for the diagnosis of individual patients (to see whether the patient's experience fits any pre-existing classification), or for the creation of diagnostic systems (such as the Diagnostic and Statistical Manual of Mental Disorders) which define exactly which signs and symptoms should make up a diagnosis, and how experiences and behaviours should be grouped in particular diagnoses (e.g. clinical depression, schizophrenia).

Psychopathology as a descriptive term

The term psychopathology may also be used to denote behaviours or experiences which are indicative of mental illness, even if they do not constitute a formal diagnosis. For example, the presence of an hallucination may be considered as a psychopathological sign, even if there are not enough symptoms present to fulfill the criteria for one of the disorders listed in the DSM. In a more general sense, any behaviour or experience which causes impairment, distress or disability, particularly if it is thought to arise from a functional breakdown in either the cognitive or neurocognitive systems in the brain, may be classified as psychopathology.

The academic journal 'Psychopathology'

Originally founded in 1897 and named Psychiatria Clinica, the journal changed its name to Psychopathology in 1984. It bills itself as the 'International journal of experimental psychopathology, phenomenology and psychiatric diagnosis' and aims to 'elucidate the complex interrelationships of biology, subjective experience, behavior and therapies'.

External links

- [http://content.karger.com/ProdukteDB/produkte.asp?Aktion=JournalHome&ProduktNr=224276 Psychopathology] journal by Karger Publishers category:abnormal psychology

Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association, is the handbook used most often in diagnosing mental disorders in the United States and internationally. The International Statistical Classification of Diseases and Related Health Problems (ICD) is a commonly-used alternative. Some psychologists have stated that they use DSM primarily for completing forms for the government or insurance companies, some of which require a patient to be classified by a diagnosis.

Cautionary Statement

A DSM cautionary statement is required to create balance and perspective for the various diagnoses and criteria used in the Diagnostic and Statistical Manual of Mental Disorders (DSM) published by the American Psychiatric Association. The DSM provides diagnostic categories and criteria for their diagnoses. The proper use of these requires clinical training, knowledge and skills to apply them. Their use by people without this background is likely to lead to an inappropriate application of diagnoses. The various criteria and diagnostic discussions based on the DSM are provided for information. Any reader who believes that they or someone close to them could be diagnosed with one of the conditions mentioned is advised to consult with a specialist in the field (a psychiatrist or psychologist) for further clarification. The criteria that are described in the DSM are meant to be used by clinicians and investigators. They should not be used in a legal setting without considering other aspects which are not specifically mentioned. The criteria and classification system of the DSM are based on the majority opinion of people who represent American mental health specialists. Therefore, the content of the DSM does not reflect all opinions on the subject of psychopathology, nor are there any objective standards to which it can adhere. The criteria, and the way they are applied by individual clinicians are at least to some extent influenced by cultural variables. What is and what is not considered a mental disorder changes over time. For example, several decades ago homosexuality was commonly considered a mental disorder, and it was listed in the DSM as such. Today, homosexuality is seen by most psychologists and psychiatrists as a normal sexual orientation. It is also known that diagnosis of some mental disorders is influenced by gender role expectations. That is, while diagnostic criteria do not mention gender, clinicians diagnose women's and men's behaviour in different ways.¹ The categories do not represent a complete list of all psychiatric disorders or research topics. For instance, the DSM does not categorize mental disorders that are specific to other (i.e. non-American) cultures, such as koro, susto, or taijin kyofusho. The DSM categories do not include many uncommon or rare syndromes although at times they are mentioned in the text.

Brief history

Users should be reminded that the manual is, to an extent, a historical document. The science used to create categories, taxonomies, and diagnoses is based on statistical models. These systems are thus subject to the limitations of the methods used to create them. Deconstructive critics assert that DSM invents illnesses and behaviors. Detractors of DSM argue that patients frequently fail to fit into any particular category or fall into several, that time limits and numbers of clinical characteristics required for a categorisation are arbitrary and that attention directed towards finding a suitable DSM category for a patient would be better spent discussing possible life-history events that precipitated a mental disturbance or monitoring treatment. Since effective treatment is the aim of the psychiatric profession they would argue that it makes more sense to regard ailments on the basis of how they should be treated rather than on deciding what clinically irrelevant differences place them in one category and not another. This would allow for the modular treatment of different sets of symptoms, for instance prescribing antidepressants for a deficit of serotonin and tranquillisers to deal with acute anxiety.
- The first edition (DSM-I) was published in 1952, and had about 60 different disorders.
- DSM-II was published in 1968. :Both of these editions were strongly influenced by the psychodynamic approach, which provides no sharp distinction between normal and abnormal. All disorders are considered reactions to environmental events, with mental disorders existing on a continuum of behavior. In this sense, everyone is more or less abnormal. The people with more severe abnormalities have more severe difficulties with functioning. :The classificatory structure of early editions of the DSM was rooted in a distinction between two poles of mental disorder, psychosis and neurosis. A psychosis is a severe mental disorder characterized by a disconnection from reality. Psychoses typically involve hallucinations, delusions, and illogical thinking. A neurosis, however, is a milder mental disorder characterized by distortions of reality, but not a complete break with reality. Neuroses typically involve anxiety and depression. :Among the most noted examples of controversial diagnoses is the classifying in the DSM-II of homosexuality as a mental disorder, a classification that was removed by vote of the APA in 1973 after three years of various gay activists groups demonstrating at APA meetings (see also homosexuality and psychology).
- In 1980, with DSM-III, the psychodynamic view was abandoned and the biomedical model became the primary approach, introducing a clear distinction between normal and abnormal. The DSM became atheoretical since it had no preferred etiology for mental disorders.
- In 1987 the DSM-III-R appeared as a revision of DSM-III. Many criteria were changed.
- In 1994, it evolved into DSM-IV. This work is currently in its fourth edition.
- The most recent version is the 'Text Revision' of the DSM-IV, also known as the DSM-IV-TR, published in 2000. The vast majority of the criteria for the diagoses were not changed from DSM-IV. The text in between the criteria was updated.
- DSM-V, is tentatively scheduled for publication in 2011, with initial planning having begun in 1999. The APA Division of Research expects to begin forming DSM development workgroups in 2007 [http://www.dsm5.org/].

A Multiaxial Approach

The Diagnostic and Statistical Manual of Mental Disorders, presently in its fourth revised (IV-TR, 2000) edition, systemizes psychiatric diagnosis in five axes:
- Axis I: major mental disorders, developmental disorders and learning disabilities
- Axis II: underlying pervasive or personality conditions, as well as mental retardation
- Axis III: any nonpsychiatric medical condition ("somatic")
- Axis IV: social functioning and impact of symptoms
- Axis V: Global Assessment of Functioning (on a scale from 100 to 0) Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, and schizophrenia. Common Axis II disorders include borderline personality disorder, schizotypal personality disorder, avoidant personality disorder, and antisocial personality disorder. The contents of the DSM are determined by experts whose mandate is to create a set of diagnoses that are replicable and meaningful. While the classification system was originally intended to enhance research into both diagnosis and treatment, the nomenclature is now widely used by both clinicians and insurance companies.

Reference

¹ Ford, M. R. & Widiger, T. A. (1989) Sex bias in the diagnosis of histrionic and antisocial personality disorder. Journal of Consulting and Clinical Psychology, 57, 301-305.

External links

- [http://www.appi.org/dsm.cfx DSM home page at APPI]
- [http://www.behavenet.com/capsules/disorders/dsm4TRclassification.htm DSM-IV-TR online] Category:Medical manuals Category:Mental illness diagnosis by DSM and ISCDRHP ja:精神障害の診断と統計の手引き

Derealization

In psychiatry, depersonalization (or derealization) is the experience of feelings of loss of a sense of reality. A sufferer feels that they have changed and the world has become less real — it is vague, dreamlike, or lacking in significance. A sufferer is divorced from both the world and from their own identity and physicality. Often times the person who has experienced this disorder claims that life "feels like a movie, things seem unreal, or hazy." Also a recognition of self breaks down (hence the name). When a person suffers from the disorder (or the symptoms associated with the same) he or she finds that when he or she looks in the mirror that his or her face is not familiar though logically he or she is completely aware of his or her identity. An alteration in the perception or experience of one's self, so that the self is felt to be unreal, detached from reality or one's own body or mental processes. The condition is usually found in conjunction with other mental disorders, especially depression, post-traumatic stress disorder, panic disorder, certain neuroses, and may be engendered by use of marijuana. If reported together with more serious delusions, depersonalization is a sign of schizophrenia — an indication of the disintegration of personality. A sufferer from depersonalization can be especially susceptible to suicide, undertaking the suicidal process calmly and easily without real awareness. People with this disorder often report that the depersonalization is stronger after waking from a nap. The DSM-IV categorizes depersonalization disorder as a form of dissociative disorder. The symptoms associated with depersonalization have a known connection with psychological trauma. However, if the problem develops into a disorder (persistent and recurring) then it is important to have it treated as it may lead to suicide, depression, lack of meaning, lack of joy, and general apathy. Lt. Col. Dave Grossman, in his book On Killing, suggests that military training artificially creates depersonalization in soldiers, suppressing empathy and making it easier for them to kill other human beings.

Useful Resources

Depersonalization Community - Depersonalization Support Site
Support site for those suffering from depersonalization and derealization.
[http://www.dpselfhelp.com/ http://www.dpselfhelp.com] DreamChild - Living with chronic depersonalization
Personal page of experiences and advice by one sufferer of chronic depersonalization disorder.
[http://www.dreamchild.net/ http://www.dreamchild.net] Depersonalization.info
In-depth explanation of depersonalization, as well as a message board for those suffering from the disorder.
[http://www.depersonalization.info/ http://www.depersonalization.info]

Dissociative identity disorder

In psychiatry, dissociative identity disorder (DID) is the current name of the condition formerly listed in the Diagnostic and Statistical Manual of Mental Disorders as multiple personality disorder (MPD) and multiple personality syndrome. The International Statistical Classification of Diseases and Related Health Problems continues to list it as Multiple Personality Disorder. Multiple Personality Disorder should not be confused with schizophrenia. According to standard American textbooks in clinical psychology, dissociative identity disorder is a psychological condition characterized by the use of dissociation as a primary defense mechanism. A chronic reliance on dissociation as a means of defending against stressors in the environment causes the individual to experience their psyche/identity as disconnected or split into distinct parts. (The concept of defense mechanism is itself controversial; see below for a discussion.)

Controversy

This diagnosis is controversial. The main points of disagreement are: # Whether MPD/DID is a real disorder, or just a fad. # If it is real, is the appearance of multiple personalities real or delusional? # If it is real, should it be defined in psychoanalytic terms? # Whether it can be cured. # Whether it should be cured. # Who should primarily define the experience -- therapists, or those who believe that they are "multiple" (have multiple personalities)? # Whether it is invariably a disorder or simply a way of being. In rough terms, believers in DID or MPD argue that children who are stressed or abused (especially sexually abused), split into several independent personalities or ego states as a defense mechanism. How people with DID/MPD perceive their actions varies, but often only one personality (or "alter") can control the body at any given time. Sometimes alters are co-conscious and share all memories. Sometimes each alter remembers only the times when he/she/it controlled the body, and has amnesia for all other periods. People diagnosed with DID may exhibit erratic alterations of personality and may "lose time". Skeptics claim that people who act as if they have MPD/DID have learned to exhibit the symptoms in return for social reinforcement, either from therapists, from others with DID, from society at large or from any combination thereof. Believers in DID retort that people with the syndrome really do have multiple selves or experience themselves so, really cannot control their behaviors, and should be treated with the same respect and consideration afforded those with other mental disorders. A third view is that it is normal to experience oneself as multiple and that "multiplicity" is not necessarily a disorder, so that it is possible to be multiple without having MPD or DID. The debate over DID and MPD arose in the context of the furor over repressed and later recovered memories of childhood sexual abuse, the child sex abuse panic of the 1980s, and associated stories of Satanic Ritual Abuse. In the U.S. (and to a much lesser extent in other English-speaking countries, like the U.K. and Australia), it was widely believed that sex and Satanic abuse were rampant and that they often caused MPD. More people began to suspect that their psychological problems were caused by childhood abuse and that they had MPD. However, as the stories told by clients grew ever more bizarre, as the number of people claiming MPD spiked, as public prosecutions of daycare workers began to seem to some like Salem witch trials, the public at large grew less accepting and more hostile to stories of recovered memories, ritual abuse, and MPD. However, there are still many mental health workers who would argue that while there was much exaggeration and bad therapy during the 1980s and early 1990s, and a few supposed MPD clients who were merely suggestible, DID is a real disorder, with real victims. It was a disorder before the child abuse hysteria, and it is still a disorder now that much of the child abuse panic has died down. This view is common enough that DID still figures in American diagnostic manuals, and MPD in those of England and Europe. At stake is how we are to treat those experiencing multiple selves. If DID is real, then DID clients may have suffered some form of childhood trauma which is adversely affecting their present lives and which requires treatment. If it is factitious, then the supposed victims are displaying something like histrionic personality disorder: the adoption of a less-than-ideal strategy for controlling others. Given that the stakes are so high and opinions so fundamentally opposed, it is extremely difficult to present information about multiplicity, MPD and DID in a way that all sides will accept. Perhaps the best solution is to give each side a chance to state its case. These sides might be said to be:
- "Believers", who argue that we must trust and believe those who claim to have DID/MPD and to have recovered memories of childhood trauma.
- The critics, who have challenged the believers. Many critics argue that DID is a fad rather than a real disorder.
- Mental health professionals, scientists, and others who believe that DID is a valid diagnosis, while distancing themselves from the perceived excesses of the believers.
- People who believe that it is possible to be multiple and psychologically healthy. Arguments that assume all multiplicity is an illness, whether MPD or DID, do an injustice to healthy multiples. Note that the existence of psychologically healthy multiples does not preclude the existence of MPD/DID as a disorder.

"Believers"

The basic premise of the believers is that child abuse or child sexual abuse are trivialized and under-reported. Some people find it hard to believe that real mothers and fathers would abuse their children or allow them to be hurt; often, the community rejected claims of abuse victims who spoke up. Believers say that we must believe them, even when they say things which upset us. Otherwise, we are protecting the pedophiles who prey on children and who are confident that any children who do complain will not be believed. Not only should we believe the children, we should believe the adult survivors who have struggled to recover repressed memories of childhood abuse. Many believers trust that hypnosis, dream analysis, body memory analysis, and other such techniques are valid ways to uncover the repressed memories. Believers may differ in how far they will accept all details of children's accounts and recovered memories. When survivors report satanic ritual abuse and alien abduction, some people say that we must still believe the survivors. Others would say that while not all details may be accurate, it is still likely that something untoward occurred. Believers are particularly incensed by the False Memory Syndrome Foundation, a support and advocacy group for parents accused of child sexual abuse. By encouraging the public not to believe the victims, they say, the FMSF in effect supports pedophiles. (See note at end of article for a pro and con on this accusation.) Prominent believers:
- Dr. Colin Ross M.D., author of Multiple Personality Disorder: Diagnosis, Clinical Features, and Treatment (1989), Satanic Ritual Abuse: Principles of Treatment (1995). Dr. Ross later reversed his position, declaring multiplicity to be "an elaborate form of pretending" and essentially agreeing with the detractors.
- E. Sue Blume, clinical social worker, author of Secret Survivors (1991).
- Laura Davis and Ellen Bass, authors of The Courage to Heal (1988). Quotes from this book: :::" ... if you are unable to remember any specific instances like the ones mentioned above but still have a feeling that something abusive happened to you, it probably did" (p. 21). :::" ... demands for proof are unreasonable" (p. 137).

Critics

Those skeptical of DI

Dissociation

Useful resources

See also

Molecule

Chemical bond

Size

Empirical formula

Chemical formula

Molecular geometry

Molecular spectroscopy

See also

Related lists

Salt

Appearance

Consistency

Color

Taste

Odor

Nomenclature

Formation

References

See also

Dissociation (chemistry)

Dissociation constant

Salts

Acids

Fragmentation

Absorption

Receptors

Thought

Aids/pitfalls to thinking

See also

Reference

Sensation

Visual sense

Auditory sense

Gustatory sense

Olfactory sense

Cutaneous Sense

Kinesthetic Sense

Vestibular Sense

Organic Sense

Psyche (psychology)

Functions of psyche

Psyche and mind

Psyche and consciousness

Horizontal and vertical intermediary

Acknowledgement

References

Psychiatrist

Practice of psychiatry

The DSM system

Contrast with psychology

Professional requirements

History

Opposition to and criticism of psychiatry

Anti-psychiatry

Other criticisms

Related terms

See also

Lists

External links

References

Pierre Janet

Sources

Psychological trauma

Symptoms of trauma

Trauma in psychoanalysis

Trauma and stress disorders

Growth aspects of trauma

See also

References

Further reading

External links

Notes

Defence mechanism

Examples

External links

See also

Psychopathology