Mental Disorders

"ED's have a higher SES background and live in more privileged socio-demographic areas than CONT. ED's have lower social status, have more separations, and are more often single than CONT."

"These data demonstrate a connection between high socio-economic and demographic data, low social status and eating disorder patients compared to normal controls."

"Interest in all forms of eating disorder in children, adolescents and adults continues to grow steadily across the world. The number of publications grows from day to day but, despite the increasing body of knowledge, the causes and origins of eating disorders are as abffling and obscure as ever. Death from anorexia nervosa (AN) was recorded by both Lasegue (1873a,b) and Gull (1874), who first described it. In 1895, both Stephens and Marshall published postmortem finding in the Lancet for a 16-year-old and an 11-year-old patient respectively. In the last five decades there have been several reports of cases of AN with fatal outcomes and subsequent ausopsies (Siebenmann, 1955; Martin, 1955, 1958; Hack, 1959; Mosli, 1967; Chikasue et al., 1988). Gradually work began to be published which covered long observation periods and produced yet more mortality figures. In 1988 in Britain, Patton presented a study of a group of 460 consecutive patients with eating disorders covering the years from 1971-1981. These were divided into two groups for AN and bulimia nervosa (BN) with resulting crude mortality rates of 3.3 percent for the former and 3.1 percent for tha latter. He also carried out a critical evaluation of the methodological problems and the results obtained from earlier studies. Hsu et al. (1979) reported that more than 2 percent had died during an average follow-up period of 5.9 years; Isafer et al. (1985) gave a crude mortality rate of 8.2 percent with an average follow-up period of 12.5 years; and Theander (1985) a crude morality rate of 18 percent over 33 years. Even allowing for the differences in these data, it is clear that AN has the highest mortality rate of all the psychiatric illnesses (Licht et al., 1993). However these differences in crude mortality rates are unsatisfactory from a methodological point of view for a number of reasons. These include the way cases were selected and the differing lengths of the observation periods."

"The severity and type of eating disorder symptoms have been shown to affect comorbidity. The DSM-IV should not be used by laypersons to diagnose themselves even when used by professionals there has been considerable controversy over the diagnostic criteria used for various diagnoses, including eating disorders."

"The speculation about whether there may be a positive association between sexual abuse in childhood and the later development of clinical eating disorder has been widely considered over the past 15 years. It has sometimes been accepted uncritically as established truth. It is certainly plausible. After all, bulimia and anorexia nervosa differentially affect girls and seem to involve complex feelings about the body which might well have originated in adverse early sexual experience. Furthermore, many patients disclose such experiences in the clinic. The evidence from early research studies, however, does not consistently support all of the clinical speculation. More than one review reached broadly negative conclusions.1,2 The study by Wonderlich et al systematically re-examines publications up to the end of 1994. The authors of this review had to grapple with studies employing a wide variety of methods and samples. They used predetermined criteria of quality but not meta-analysis to sort out which studies could contribute to their conclusions. They were appropriately strict in applying their criteria. This review supports the position of clinicians who consider that a history of childhood sexual abuse is worth seeking and may be an important consideration in their patients with eating disorders, but no more important than in many other patients. It may be especially relevant for those who have bulimia nervosa with comorbidity. Patients with such complex problems require careful thought. Finding a background of sexual abuse may prove to be important but should not lead to the conclusion that “all is now explained”. Furthermore, most studies show that only a minority of patients with eating disorders report abuse and inferring past abuse from the fact of present eating disorder is unjustified."

"There is good evidence that children of parents with psychological disorders are themselves at increased risk of disturbances in their development. Although there has been considerable research on a variety of disorders such as depression and alcohol, research on the children of parents with eating disorders has been relatively recent. This paper aims to review the evidence and covers a number of areas, including genetic factors, pregnancy, the perinatal and postpartum period, infancy, and the early years of life, focusing on feeding and mealtimes, general parenting functions, and growth. This is followed by a consideration of psychopathology in the children, parental attitudes to children's weight and shape, and adolescence. What is clear is that although there are numerous case reports and case series, the number of systematic controlled studies is relatively small, and almost nothing has been written about the children of fathers with eating disorders. What is evident from the available evidence is that children of mothers with eating disorders are at increased risk of disturbance, but that the risk depends on a variety of factors, and that difficulties in the children are far from invariable. The paper concludes by summarizing five broad categories of putative mechanisms, based on the evidence to date, by which eating disturbance in parents can influence child development."

"This study explored friendship variables in relation to body image, dietary restraint, extreme weight-loss behaviors (EWEBs), and binge eating in adolescent girls. From 523 girls, 79 friendship cliques were identified using social network analysis. Participants completed questionnaires that assessed body image concerns, eating, friendship relations, and psychological family, and media variables. Similarity was greater for within than for between friendship cliques for body image concerns, dietary restraint, and EWLBs, but not for binge eating. Cliques high in body image concerns and dieting manifested these concerns in ways consistent with a high weight/shape-preoccupied subculture. Friendship attitudes contributed significantly to the prediction of individual body image concern and eating behaviors. Use of EWLBs by friends predicted an individual's own level of use."

"While historically, eating disorders were conceptualized as primarily afflicting Caucasian adolescent or young adult women within high-income, industrialized Western Europe and North America, eating disorders are increasingly documented in diverse countries and cultures worldwide. This study highlights recent trends that reflect the changing landscape of culture and eating disorders: stabilization of the incidence of anorexia nervosa and possibly lower incidence rates of bulimia nervosa in Caucasian North American and Northern European groups; increasing rates of eating disorders in Asia; increasing rates of eating disorders in the Arab region; and increasing rates of binge eating and bulimia nervosa in Hispanic and Black American minority groups in North America."

"The purpose of this study was to assess the relative contribution of personality and emotional experience to self-reported eating attitudes in a group of patients with clinically diagnosed eating disorders, a weight-reduction training group (Weight Watchers), and a control group without body weight problems. Participants in this study (N = 114) completed Estonian versions of the Eating Disorder Inventory-2 (EDI-2; Garner, 1991), NEO Personality Inventory (Costa & McCrae, 1989), and Positive Affect and Negative Affect Schedule, Expanded Form (Watson & Clark, 1994). Data demonstrated validity of the Estonian version of EDI-2 in its ability to identify problems on a continuum of disordered eating behavior. Among the Big Five personality dimensions, Neuroticism made the largest contribution to EDI-2 subscales. Two other dimensions, Openness to Experience and Conscientiousness, also predispose individuals to eating problems. Personality traits made a larger contribution to the self-reported eating pathology than the self-rated effects experienced during the last few weeks. It was argued that personality dispositions have a larger relevancy in the etiology of eating disorders than emotional state."

"Some contributory factors appear to be necessary for the appearance of eating disorders, but none is sufficient. Eating disorders may represent a way of coping with problems of identity and personal control."

"Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions."

"The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a huge body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders, but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed."

"It has been hypothesized that eating disorders have multiple and often shared etiologies including biological, psychological, developmental, and sociocultural. A tightly woven network of causes, symptoms, and outcomes of eating disorders makes the study of etiology of these disorders very challenging. Some suggested risk factors for eating disorders require to be defined as either integral parts of eating disorders syndrome such as body dissatisfaction, and perfectionism or outcome of prolonged disordered eating such as functional alterations in serotonin, and some mood disturbances. Researchers should structure their thought processes around this concept that some of currently well-known risk factors for eating disorders are concurrent symptoms of eating disorders. Hence paying special attention to the new and evolved concepts is highly recommended while studying the etiology of eating disorders."

"Studies have reported that the oral health status is jeopardized in patients with eating disorders. The aim was to review the oro-facial manifestations in patients with eating disorders. The address the focused question was "What is the oro-dental health status in patients with eating disorders?" MEDLINE/PubMed and Google Scholar databases were searched from 1948 to March 2012 using the following terms in various combinations: "Anorexia nervosa", "bulimia nervosa", "eating disorders", "dental", "oral health status". Letters to the editor, unpublished data and articles published in languages other than English were excluded. Dry lips, burning tongue and parotid gland swelling are common manifestations in patients with eating disorders as compared to medically healthy controls. The association of dental caries and periodontal disease in patients with eating disorders remains debatable. Temporomandibular disorders have also been reported to be more prevalent in patients with eating disorders as compared to healthy controls. A critical oral-dental examination during routine dental check-ups may reveal valuable information regarding the presence or absence of eating disorders in routine dental patients. This may be important information, updating the medical history, supporting the role of the physician."

"Comorbid personality disorders in eating disordered patients may seriously affect the treatment and course of their illness. Several studies show such a comorbidity, though with inconsistent findings. Qualitative reviews attribute this to methodological shortcomings, but the qualitative method may itself create new shortcomings. To circumvent this, the present, more extensive review applies a meta-analytic approach. Using the databases MEDLINE and PSYCHLIT, the 28 articles published between 1983 and 1998 that presented empirical evidence for an eating disorder and personality disorder comorbidity suitable for meta-analysis were included. We found a higher proportion of eating disordered patients with any personality disorder (average proportion = 0.58) related to comparison groups (average proportion = 0.28). Compared with anorexia nervosa patients, a higher proportion of patients with bulimia nervosa had a concurrent cluster B personality (average proportion = 0.44) and a borderline personality disorder (average proportion = 0.31). However, no differences between anorexia nervosa and bulimia nervosa patients in proportions of cluster C were found (average proportion = 0.45 and 0.44 respectively). Patients with eating disorders and patients with bulimia nervosa in particular, should be routinely assessed for a concurrent personality disorder using structured clinical interviews. In future research, more stringent assessment procedures are highly recommended to address the question of causality between eating disorders and personality disorders, and how eating disorder symptoms and personality disorder symptoms are related to treatment effects."

"The cognitive model of eating disorders (EDs) states that the processing of external and internal stimuli might be biased in mental disorders. These biases, or cognitive errors, systematically distort the individual's experiences and, in that way, maintains the eating disorder. This chapter presents an updated literature review of experimental studies investigating these cognitive biases. Results indicate that ED patients show biases in attention, interpretation, and memory when it comes to the processing of food-, weight-, and body shape-related cues. Some recent studies show that they also demonstrate errors in general cognitive abilities such as set shifting, central coherence, and decision making. A future challenge is whether cognitive biases and processes can be manipulated. Few preliminary studies suggest that an attention retraining and training in the cognitive modulation of food reward processing might be effective strategies to change body satisfaction, food cravings, and eating behavior."

"An individual who is a first degree relative of someone who has had or currently has an eating disorder is seven to twelve times more likely to have an eating disorder themselves. Twin studies also show that at least a portion of the vulnerability to develop eating disorders can be inherited, and there is evidence to show that there is a genetic locus that shows susceptibility for developing anorexia nervosa."

"Of the empirical studies undertaken, few investigated a cultural group's eating pathology in both its country of origin and a Western country using the same methodology. To date, the research findings are mixed and it is still unclear if the presentation of an eating disorder differs across cultures. Acculturation has not been consistently taken into consideration and psychological control has not been examined in relation to eating disturbances in non‐Western groups."

"Patients with eating disorders (ED) frequently exhibit additional psychiatric disorders. This study aimed to examine whether psychiatric comorbidity in ED patients is associated with increased severity of ED symptoms in a sample of 277 women with a current ED (84 anorexia nervosa, 152 bulimia nervosa, 41 eating disorders not otherwise specified). Psychiatric comorbidity of Axes I and II was determined using the Structured Clinical Interview (SCID) for DSM-IV. Severity of ED-related symptoms was assessed using interviewer-rated scales from the Structured Interview for Anorexia and Bulimia Nervosa (SIAB). Affective and anxiety-related disorders of both axes were linked with increased intensity of weight- and appearance-related fears and concerns. Frequency of binge-eating and frequency of purging both were associated with Axis I anxiety disorders, substance-related disorders, and Cluster B personality disorders. Frequency of dieting was related to anxiety disorders on both axes. Multivariate analyses revealed that Axis I anxiety disorders were more closely linked with severity of ED symptoms than affective or substance-related disorders. The results showed that psychiatric comorbidity of both axes is linked with increased severity of ED symptoms and that there are associations between specific ED symptoms and specific forms of comorbidity."

"Eating disorders, such as anorexia, bulimia, and binge eating disorder, commonly involve a dysregulation of behavior (e.g., a lack or excess of inhibition and impulsive eating patterns) that is suggestive of prefrontal dysfunction. Functional neuro-imaging studies show that prefrontal-subcortical systems play a role in eating behavior and appetite in healthy individuals, and that people with eating disorders have altered activity in these systems. Eating behavior is often disturbed by illnesses and injuries that impinge upon prefrontal-subcortical systems. This study examined relationships between executive functioning and eating behavior in healthy individuals using validated behavioral rating scales (Frontal Systems Behavior Scale and Eating Inventory). Correlations demonstrated that increased dysexecutive traits were associated with disinhibited eating and greater food cravings. There was also a positive association with cognitive restraint of eating, suggesting that increased compensatory behaviors follow disinhibited eating. These psychometric findings reinforce those of other methodologies, supporting a role for prefrontal systems in eating."

"Eating disorders are significant causes of morbidity and mortality in adolescent females and young women. They are associated with severe medical and psychological consequences, including death, osteoporosis, growth delay and developmental delay. Dermatologic symptoms are almost always detectable in patients with severe anorexia nervosa (AN) and bulimia nervosa (BN), and awareness of these may help in the early diagnosis of hidden AN or BN."

"Of the empirical studies undertaken, it is clear that anxiety disorders are significantly more frequent in subjects with eating disorders than the general community. Researchers have shown that often anxiety disorders pre-date eating disorders, leading to a suggestion that early onset anxiety may predispose individuals to developing an eating disorder. To date however, the research presents strikingly inconsistent findings, thus complicating our understanding of eating disorder and anxiety co-morbidity. Furthermore, despite indications that eating disorder prevalence amongst individuals presenting for anxiety treatment may be high, there is a distinct lack of research in this area."

"Substance abuse has been shown to predict poor outcome in eating disorder (ED) samples, and prior cross-sectional data on personality subtypes of EDs suggest that substance abuse is associated with dysregulated and possibly avoidant-insecure subtypes."

"The present review focused on the personality profiles of patients with eating disorders. Studies using the Structured Clinical Interview for DSM-III-R Personality Disorder showed high rates of diagnostic co-occurrence between eating disorders and personality disorders. The most commonly observed were histrionic, obsessive-compulsive, avoidant, dependent and borderline personality disorders. Studies using the Cloninger's personality theory suggested that high Harm Avoidance might be relevant to the pathology of anorexia nervosa and high Novelty Seeking and Harm Avoidance to bulimia nervosa. Moreover, high Self-Directedness was suggested to be associated with favorable outcome in bulimia nervosa. The assessment of personality in a cross-sectional study, however, might be influenced by the various states of the illness. Therefore, a sophisticated longitudinal study will be required to advance this area of research."

"One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase."

"Patients with schizophrenia demonstrate abnormalities in early visual encoding of facial features that precedes the ERP response typically associated with facial affect recognition. This suggests that affect recognition deficits, at least for happy and sad discrimination, are secondary to faulty structural encoding of faces. The association of abnormal face encoding with delusions may denote the physiological basis for clinical misidentification syndromes."

"Impaired emotional functioning is a core feature of schizophrenia described by Eugen Bleuler (1911)nearly 100 years ago. Emotional abnormalities in schizophrenia are now receiving more attention by clinicians and investigators and include a variety of symptoms such as flat or constricted affect, inappropriate affect, and depression (Kohler et al., 2000a). In addition to negative symptoms' influence on the experience and expression of emotions, there is evidence that schizophrenia patients are impaired in recognizing and discriminating facial emotions (Morrison et al., 1988; Mandal et al., 1998; Edwards et al., 2001; Kohler et al., 2003). It is unclear whether emotion recognition deficits represent a specific or generalized form of cognitive impairment in schizophrenia (Kerr and Neale, 1993; Whittaker et al., 2001), yet recent studies show that emotion processing deficits are uniquely related to clinical symptoms (Kohler et al., 2000b; Silver et al., 2002; Sachs et al., 2004)."

"Unfortunately, at the same time that Western mental-health professionals have been convincing the world to think and talk about mental illnesses in biomedical terms, we have been simultaneously losing the war against stigma at home and abroad. Studies of attitudes in the United States from 1950 to 1996 have shown that the perception of dangerousness surrounding people with schizophrenia has steadily increased over this time. Similarly, a study in Germany found that the public’s desire to maintain distance from those with a diagnosis of schizophrenia increased from 1990 to 2001."

"Our own definition of childhood schizophrenia has been a clinical entity, occurring in childhood before the age of eleven years, which "reveals pathology in behavior at every level and in every area of integration or patterning within the functioning of the central nervous system, be it vegetative, motor, perceptual, intellectual, emotional, or social. Further more, this behavior pathology disturbs the patterns of every functioning field in a characteristic way. The pathology cannot therefore be thought of as a focal in the architecture of the central nervous system, but rather as striking at the substratum of integrative functioning or biologically patterned behavior" (1) At present the only concept we have of this pathology is in terms of field forces in which temporal rather than spatial factors are emphasized. Within the concept of field forces, one can accept some idea of a focal disorder, since no one integrated function is ever completely lost or inhibited, and since there are different degrees of severity of disturbance in the life history of any child and between two different children. This also differs with the period of onset. The diagnostic criteria for the 100 schizophrenic children which make up this study have been rigid. In each child it has been possible to demonstrate characteristic disturbances in every patterned functioning field of behavior. Every schizophrenic child reacts to the psychosis in a way determined by his own total personality including the infantile experiences and the level of maturation of the personality. This reaction is usually a neurotic]] one determined by the anxiety stirred up by the disturbing phenomena in the vaspvegetative, motility, perceptual, and psychological fields. Interferences in normal developmental patterns and regressive phenomena with resulting primitive reactions are related to both the essential psychosis and the reaction of the anxiety-ridden personality. There are. of course, children in whom the differential diagnosis is very difficult. Those with some form of diffuse encephalopathy or diffuse developmental deviations in which the normally strong urges for normal development push the child into frustration and reactive anxiety may present many schizphrenic features in the motility disturbances, intellectual interferences, and psychological reactions."

"All schizophrenia patients are mad, and none are sane. Their behaviour is incomprehensible. It tells us nothing about what they do in the rest of their lives, gives no insight into the human condition and has no lesson for sane people except how sane they are. There's nothing profound about it. Schizophrenics aren't clever or wise or witty — they may make some very odd remarks but that's because they're mad, and there's nothing to be got out of what they say. When they laugh at things the rest of us don't think are funny, like the death of a parent, they're not being penetrating, and on other occasions they're not wryly amused at at the simplicity and stupidity of the psychiatrist, however well justified that might be in many cases. They're laughing because they're mad, too mad to be able to tell what's funny any more. The rewards for being sane may not be very many but knowing what's funny is one of them."

"NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations. This was the startling result of three large international studies carried out by the World Health Organization over the course of 30 years, starting in the early 1970s. The research showed that patients outside the United States and Europe had significantly lower relapse rates — as much as two-thirds lower in one follow-up study. These findings have been widely discussed and debated in part because of their obvious incongruity: the regions of the world with the most resources to devote to the illness — the best technology, the cutting-edge medicines and the best-financed academic and private-research institutions — had the most troubled and socially marginalized patients."

"The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia. Collectively referred to as “high expressed emotion,” these reactions include criticism, hostility and emotional over involvement (like overprotectiveness or constant intrusiveness in the patient’s life). In one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE.” (Among British families, 48 percent were high EE; among Mexican families the figure was 41 percent and for Indian families 23 percent.) Does this high level of “expressed emotion” in the United States mean that we lack sympathy or the desire to care for our mentally ill? Quite the opposite. Relatives who were “high EE” were simply expressing a particularly American view of the self. They tended to believe that individuals are the captains of their own destiny and should be able to overcome their problems by force of personal will. Their critical comments to the mentally ill person didn’t mean that these family members were cruel or uncaring; they were simply applying the same assumptions about human nature that they applied to themselves. They were reflecting an “approach to the world that is active, resourceful and that emphasizes personal accountability,” Prof. Jill M. Hooley of Harvard University concluded. “Far from high criticism reflecting something negative about the family members of patients with schizophrenia, high criticism (and hence high EE) was associated with a characteristic that is widely regarded as positive.”"

"If you talk to God, you are praying;"

"There is no such "condition" as "schizophrenia," but the label is a social fact and the social fact a political event."

"The schizophrenic has had their window kicked in, the magician has got a body of law – probably most of it bollocks, it doesn’t matter. The magician’s got a system into which the alien information that will be pouring into him or her will be fitted. They’ve got a filing cabinet, like the Qabalah, which is a filing cabinet for ideas. It divides the whole universe up into ten drawers. Any experience can be passed into one of the drawers. The schizophrenic is probably having exactly the same experience as the magician but has no context in which to understand it. … The schizophrenics I have known, the most evident thing about it is the interconnectedness of everything. That’s standard lunacy, it’s also standard magic. But with one of them, it is uncontrollable, you are lost in a world in which everything is obviously connected by symbolic threads. That is what the magician is seeking, to see these threads that connect things up. If you’ve got a system – even if it’s a completely made-up bogus system – then you’ve at least got a filing cabinet to sort this stuff into, you don’t have to get crushed under it."

"The high prevalence and chronic evolution of schizophrenia are responsible for a major social cost. The adverse consequences of such psychiatric disorders for relatives have been studied since the early 1950s, when psychiatric institutions began discharging patients into the community. According to Treudley (1946) "burden on the family" refers to the consequences for those in close contact with a severely disturbed psychiatric patient. Grad and Sainsbury (1963) and Hoenig and Hamilton (1966) developed the first burden scales for caregivers of severely mentally ill patients, and a number of authors further developed instruments trying to distinguish between "objective" and "subjective" burden. Objective burden concerns the patient's symptoms, behaviour and socio-demographic characteristics, but also the changes in household routine, family or social relations, work, leisure time, physical health.... Subjective burden is the mental health and subjective distress among family members. While the first authors referred to those problems which are deemed to be related to, or caused by the patient, Platt et al. (1983) tried to distinguish between the occurrence of a problem, its alleged aetiology, and the perceived distress, when developing the SBAS questionnaire. These authors also proposed separate evaluations of behavioral disturbance and social performance by relatives, and a report of extra-disease stressors in family life. The SBAS is actually the most complete, but also complex instrument for evaluating burden in caregivers. Since 1967 Pasamanick and others proposed questionnaires for burden evaluation in relatives of schizophrenic patients. Relatives may be included in specific psychoeducational programs, but few of these programs have been evaluated in terms of caregiver burden."

"Psychiatrists look for twisted molecules and defective genes as the causes of schizophrenia, because schizophrenia is the name of a disease. If Christianity or Communism were called diseases, would they then look for the chemical and genetic “causes” of these “conditions”?"

"Rationale for Treatment with LSD and UML Our interest in these drugs was due in part to their psychotomimetic effect, hoping thereby that the autistic defenses of schizophrenic children might be broken down. Of equal interest, on a theoretical basis, is the serotonin inhibiting effect and of greater interest is their effect on the autonomic and central nervous system. Brodie has described the effects of LSD and other hallucinogenic agents as "arousal and increased responsiveness to sensory stimuli, preponderance of sympathetic activity and increased skeletal muscle tone and activity." Of particular interest is their tonic effect on the vascular bed especially of the brain, as has been shown with UML in vascular headaches. The known effects of these drugs on perception further increases¬ their interest in the treatment of schizophrenia. Such drugs were of interest to us for the treatment of childhood schizophrenia since our definition of this condition is a disorder in maturation characterized by an embryonic primitive plasticity in all areas of integrative brain functioning from which behavior subsequently arises. This includes all autonomic functions, perception, emotion, intelligence. It was hoped that 'these drugs might prove some-what specific in modifying the basic process as well as the secondary symptoms. Autism is seen as a withdrawal or denial defense against disturbing sensations arising from disturbed autonomic function and perceptual function and anxiety in the young child with lagging and atypical maturation. It was hoped that this autism might be disrupted and that more normal autonomic functions in the vascular bed, brain, intestines, skin and other organs as well as in perception would permit more normal development."

"Anger has been found to contribute to a range of difficulties among individuals with PTSD, including aggressive behavior, interpersonal conflict and most recently suicide risk. For example, recent research with military soldiers found that risk of aggression was elevated among soldiers with PTSD and high levels of anger, but not among those with low anger (Wilk et al., 2015). Furthermore, anger appears to play a mediating role in the relationship between PTSD and various presentations of aggression. For example, trait anger has been shown to contribute to the relationship between PTSD and verbal and physical aggression (Bhardwaj, 2019). Additionally, research has provided evidence that combat exposure is associated with aggression and violent behavior, with various studies finding that violent combat experience predicts risk-taking behaviors, criminal behavior, and physical aggression with a significant other (MacManus et al., 2015). Most recently, research has examined anger as an emotional risk factor for suicide (Hawkins et al., 2014; Wilks et al., 2019)."

"I'll be fine if we'd just move on, sir." "I assure you, these are things you do not just move on from."

"The impact of relativity was especially powerful because it virtually coincided with the public reception of Freudianism. By the time Eddington verified Einstein's General Theory, Sigmund Freud was already in his mid-fifties. Most of his really original work had been done by the turn of the century. The Interpretation of Dreams had been published as long ago as 1900. He was a well-known and controversial figure in specialized medical and psychiatric circles, had already founded his own school and enacted a spectacular theological dispute with his leading disciple, Carl Jung, before the Great War broke out. But it was only at the end of the war that his ideas began to circulate as common currency. The reason for this was the attention the prolonged trench-fighting focused on cases of mental disturbance caused by stress: 'shell-shock' was the popular term. Well-born scions of military families, who had volunteered for service, fought with conspicuous gallantry and been repeatedly decorated, suddenly broke. They could not be cowards, they were not madmen. Freud had long offered, in psychoanalysis, what seemed to be a sophisticated alternative to the 'heroic' methods of curing mental illness, such as drugs, bullying or electric-shock therapy. Such methods had been abundantly used, in ever-growing doses, as the war dragged on, and as 'cures' became progressively short-lived. When the electric current was increased, men died under treatment, or committed suicide rather than face more, like victims of the Inquisition. The post-war fury of relatives at the cruelties inflicted in military hospitals, especially the psychiatric division of the Vienna General Hospital, led the Austrian government in 1920 to set up a commission of inquiry, which called in Freud. The resulting controversy, though inconclusive, gave Freud the world-wide publicity he needed. Professionally, 1920 was the year of breakthrough for him, when the first psychiatric polyclinic was opened in Berlin, and his pupil and future biographer, Ernest Jones, launched the International Journal of Psycho-Analysis. ij"

"Pavlov’s findings were confirmed in the most distressing manner, and on a very large scale, during the two World Wars. As the result of a single catastrophic experience, or of a succession of terrors less appalling but frequently repeated, soldiers develop a number of disabling psycho-physical symptoms. Temporary unconsciousness, extreme agitation, lethargy, functional blindness or paralysis, completely unrealistic responses to the challenge of events, strange reversals of life-long patterns of behaviour—all the symptoms, which Pavlov observed in his dogs, re-appeared among the victims of what in the First World War was called ‘shell shock’, in the Second, ‘battle fatigue’. Every man, like every dog, has his own individual limit of endurance. Most men reach their limit after about thirty days of more or less continuous stress under the conditions of modern combat. The more than averagely susceptible succumb in only fifteen days. The more than averagely tough can resist for forty-five or even fifty days. Strong or weak, in the long run all of them break down. All, that is to say, of those who are initially sane. For, ironically enough, the only people who can hold up indefinitely under the stress of modern war are psychotics. Individual insanity is immune to the consequences of collective insanity."

"It was out of all these moments that the idea for Modern Warriors rose. While politicians and media can whitewash a conflict, the legacy always remains for those who fought there. The warriors who left their families, friends, and comfort to do the dirty work of their country. We need to tell those stories. And then veterans come home, with hopes and dreams- and scars of war. They struggle to transition to civilian life; many are wounded (seen and unseen); many wrestle with post-traumatic stress; suicide was taking more lives than the battlefield ever did. We cannot allow ourselves to look away, to shrug, and say that's just the way it is."

"Normally, when someone [with PTSD] would be instructed to relive the traumatic experience, they would be overwhelmed with fear, anxiety, and despair. But while under the influence of the MDMA, it's as if they can navigate the experience more safely."

"Previous studies have shown that exposure to traumatic events that put one’s life at risk may affect processing of facial expressions. Thus, for example, individuals suffering from PTSD have difficulties in differentiating between fearful and neutral faces (e.g., Felmingham, Bryant, & Gordon, 2003)."

"The new, re-thought hero that would help open a path to healing for this torn nation is the hero who stops trying to argue that our debacles of war were patriotic necessities rather than tragic stepping-stones for further cycles of vengeance and violence. It’s true, we need to better respect and honor our wounded veterans; but we also need to understand that “the wild” brought back by multi-tour combat vets from the “edge of the human circle” is not constructive for community or for civilization itself."

"Psychologists are re-thinking Post Traumatic Stress and other combat-related issues applied to multi-tour combat soldiers. According to [[The New York Times|[New York] Times]] writer Benedict Carey, the challenge these days is less emotional healing than how to unlearn the hyper-vigilance and shoot-first, ask-questions-later violence necessary for survival in a combat zone. That is... can experienced warriors be adjusted from a wild, adrenaline-fueled state of barbarism to one emphasizing community and civilization? This is a politically tricky matter, since this sort of question inevitably leads to areas critical of US war policy. It’s notable that the research cited by the May 30 Times story is being conducted in civilian universities...not by the military or the Veterans Administration, federal government agencies naturally reluctant to wade into anything that might be critical of US war policy."

"In recent clinical trials, 61 percent of 107 participants no longer had PTSD symptoms two months after MDMA-assisted psychotherapy. Sixty-eight percent were still PTSD-free a year later. In light of findings like these, the FDA recently deemed MDMA a "breakthrough therapy," putting it on the fast track for approval."

"For years I have agitated against the diagnostic jargon, Post-Traumatic Stress Disorder (PTSD), because transparently we are dealing with an injury, not an illness, malady, disease, sickness, or disorder. My insistence comes from awareness that within military forces it is entirely honorable to be injured, and that if one is injured and recovers well enough to be fit for duty, there is no real limit to one's accomplishments, even if a prosthesis is employed. Witness the honored career of General Eric Shinseki, who lost a foot in Vietnam, and eventually retired from the U.S. Army as chief of staff. We do not describe him as suffering "Missing Foot Disorder.""

"There is another symptom of acute trauma that can be easily missed if you are not on the lookout for it that strongly predicts the development of later PTSD. In layman's parlance, we might call it "being spaced out." More technically, we call it dissociation. When people dissociate, things come apart in a variety of ways. Often they feel separated from themselves, as if they are watching themselves from some outside vantage point. Frequently they feel that there is some type of invisible wall between themselves and the rest of the world. Sometimes they will feel that everything in the world, including themselves, is somehow unreal. I've heard patients describe this experience as being like looking at the world through the wrong end of a telescope, so that everything seems smaller and distorted. In extreme instances, people so thoroughly lose track of things that they develop amnesia."