Throughout my career, I've been privileged to explore the intricate tapestry of the human mind, encountering many concepts that have not only shaped my professional outlook but have also offered profound insights into the essence of human nature.
Psychiatry has always been a field of endless discovery. Each patient brings a unique story, each case a unique challenge, and each I've learned has unlocked new dimensions of understanding. Here, I share some of the key concepts and developments that have been pivotal in my work, critical in unlocking human potential - and even revolutionary in my practice.
Nature vs. Nurture
From the outset, the realm of psychological treatment has, to a greater or lesser degree, acknowledged the inter-relationship of nature and nurture. Nature refers to inborn traits stemming from our genetic constitution - the structure and functioning of the brain. While nurture refers to the environmental factors that operate and change us throughout our lives.
Nothing is static. Nothing stays the same, Even the hardest rock changes in the continuous process of wearing away as in erosion and the accumulation of detritus in the process of aggregation. Such is the case with our nature as it is shaped by the different experiences we encounter throughout our lives.
Freudian Psychoanalysis
Psychoanalysis was the predominant approach to the psyche/psychological treatment from the 1940s to the1960s.
This method focused on the individual and their past with a study of dreams, memories and defense mechanisms (defenses are like ship stabilizers that maintain our equilibrium, to help us function in the real world and prevent us from reeling off course).
Anna Freud, a prominent psychoanalyst and daughter of Sigmund, worked in the early to mid-20th century and identified the common defense mechanisms.
*DEFENSE MECHANISMS include:
1. Denial, the refusal to acknowledge or accept a concept of reality that causes distress. (For example, an older person may deny the loss of intellectual and/ or physical faculties that occur in the aging process.)
2. Repression operates to keep painful or distressing memories out of our consciousness or awareness.
3. Projection operates when an individual attributes their unacceptable thoughts or feelings or impulses to another person.
4. Displacement describes what happens when an individual re-directs their emotions or impulses from their original source to a less threatening target.
5. Rationalization is a thought process that operates to find a logical or socially acceptable explanation for unacceptable behaviors, feelings or thoughts.
(Becoming a psychotherapist to work out one’s persnal conflicts.)
6. Sublimation channels negative or unacceptable impulses into socially acceptable activities or behaviors. (Becoming a nutritionist to combat one’s
impulsive eating habits).
7.Regression: reverting to earlier, less mature behaviors in response to stress or conflict. (E.g. a depressed person who withdraws from social interactions.)
8.Reaction formation: expressing the opposite of one’s true feelings or impulses to cope with anxiety.
9.Intellectualization: Avoiding emotional distress by focusing on a logical or intellectual explanation for a situation.
(For example, to regard one’s abnormal EKG as an interesting study of heart functioning).
10. Undoing: Engaging in behaviors to try to “undo” or make up for unacceptable thoughts, feelings, or actions.
Shakespeare’s Lady Macbeth is a classic literary example. She repeatedly washes her hands after engineering a murder.
Recognizing defense mechanisms can remove obstacles to progress.
The process of analyzing the unconscious and the mechanism of defense could last for years.
Following the Freudians, the Neo-Freudians broadened the array of psychological techniques available. Austrian psychoanalyst Heinz Kohut (1913-1981) contributed significantly to this expansion with his introduction of concepts such as empathy, mirroring, and confrontation. These ideas enhanced our comprehension psychology. Kohut's theoretical frameworks provided psychotherapists with new tools to address the needs of individuals with personality disorders, particularly those who had suffered psychological or physical trauma in their early lives.
Stigma
In the past, personality disorders were often viewed with significant stigma and posed challenges in treatment. Nowadays, some clients actively inquire if their issues are related to such disorders. Unlike several decades ago, when being diagnosed with a personality disorder was a shameful label, many young people today find comfort in knowing that their symptoms are part of a recognized diagnostic category and can be treated effectively.
Diagnosis
A diagnosis is crucial for providing the right treatment, yet it should be approached with flexibility and openness to change. It's wise to remain prepared for unforeseen developments, as diagnoses can sometimes shift unexpectedly.
For instance, some years ago I was surprised to learn that Mr. C, whom I had treated for depression for decades, overnight developed manic symptoms. This rapid shift of mood suggested that his depression was one aspect of a bipolar disorder with the potential for moods to fluctuate rapidly from a depressed state to a state of pathological euphoria.
Since the 1960s, various approaches have been developed to expedite the journey towards better mental health. These approaches focus on elements such as interpersonal relationships, the integration of mind, body and emotions as well as Eastern meditation practices.
The range of techniques introduced included behavioral, cognitive, humanistic and integrative-holistic therapies. Additionally, therapies specifically aimed at treating trauma, such as EDMR (Eye Movement Desensitization and Reprocessing), have been designed to target symptoms of Post Traumatic Stress Disorder directly.
The object relationships school addresses the problem of "splitting", in which a person or a situation is viewed as "all good" or "all bad", a relatively common problem with far-reaching consequences in the realm of personal, interpersonal and world events.
If you perceive the world as toxic, you end up shaping a hostile environment. In truth, the world both nurtures and deprives, and it is the individual's task to discern reality in the present moment and manage to integrate both aspects. Typically, the ability to see objects (people, places and things) as neither wholly good nor wholly bad develops in the brain around the age of twelve. However, some individuals, particularly those who have experienced trauma - be it psychological or physical - struggle to perceive and reconcile these dual aspects of reality.
Any form of psychotherapy can address this dichotomy, which can cause discord with and individual, (intrapersonal or within oneself), in interpersonal relationships (our connections with others) and in the broader world.
Curiosity
While scientists have yet to pinpoint the exact area of the brain responsible for curiosity, it remains a crucial trait for adapting to our constantly changing world and for a deeper understanding of ourselves.
Summary
Attempting to categorize humans into strictly defined boxes - without acknowledging the fluidity and openness needed in ongoing dialogues - is not only limiting but potentially harmful.
The field neuropsychology has become increasingly complex, enhancing our understanding of the brain and mind. As a species, we continue to evolve in a dynamic world. Keeping this in mind reinforces the value of maintaining an openness to change.
Paradoxically, while we often crave stability, a rarity in its true form, real life presents us with turbulence, akin to ocean currents or the shifting of tectonic plates at the Earth's core
