Andrew Marshall

What is Experiential Avoidance?

Published on 10/14/2021 by Andrew Marshall1 Comment

Introduction

Experiential avoidance (EA) has been broadly defined as attempts to avoid thoughts, feelings, memories, physical sensations, and other internal experiences – even when doing so creates harm in the long-run.

The process of EA is thought to be maintained through negative reinforcement – that is, short-term relief of discomfort is achieved through avoidance, thereby increasing the likelihood that the behaviour will persist. Importantly, the current conceptualisation of EA suggests that it is not negative thoughts, emotions, and sensations that are problematic, but how one responds to them that can cause difficulties. In particular, a habitual and persistent unwillingness to experience uncomfortable thoughts and feelings (and the associated avoidance and inhibition of these experiences) is thought to be linked to a wide range of problems.

Background

EA has been popularised by recent third-wave cognitive-behavioural theories such as acceptance and commitment therapy (ACT). However, the general concept has roots in many other theories of psychopathology and intervention.

Psychodynamic

Defence mechanisms were originally conceptualised as ways to avoid unpleasant affect and discomfort that resulted from conflicting motivations. These processes were thought to contribute to the expression of various types of psychopathology. Gradual removal of these defensive processes are thought to be a key aspect of treatment and eventually return to psychological health.

Process-Experiential

Process-experiential therapy merges client-centred, existential, and Gestalt approaches. Gestalt theory outlines the benefits of being fully aware of and open to one’s entire experience. One job of the psychotherapist is to:

“explore and become fully aware of [the patient’s] grounds for avoidance” and to “[lead] the patient back to that which he wishes to avoid”.

Similar ideas are expressed by early humanistic theory:

“Whether the stimulus was the impact of a configuration of form, color, or sound in the environment on the sensory nerves, or a memory trace from the past, or a visceral sensation of fear or pleasure or disgust, the person would be ‘living’ it, would have it completely available to awareness…he is more open to his feelings of fear and discouragement and pain…he is more able fully to live the experiences of his organism rather than shutting them out of awareness.”

Behavioural

Traditional behaviour therapy utilises exposure to habituate the patient to various types of fears and anxieties, eventually resulting in a marked reduction in psychopathology. In this way, exposure can be thought of as “counter-acting” avoidance, in that it involves individuals repeatedly encountering and remaining in contact with that which causes distress and discomfort.

Cognitive

In cognitive theory, avoidance interferes with reappraisals of negative thought patterns and schema, thereby perpetuating distorted beliefs. These distorted beliefs are thought to contribute and maintain many types of psychopathology.

Third-Wave Cognitive-Behavioural

The concept of EA is explicitly described and targeted in more recent CBT modalities including acceptance and commitment therapy (ACT), dialectical behaviour therapy (DBT), functional analytic psychotherapy (FAP), and behavioural activation (BA).

Associated Problems

Distress is an inextricable part of life; therefore, avoidance is often only a temporary solution.
Avoidance reinforces the notion that discomfort, distress and anxiety are bad, or dangerous.
Sustaining avoidance often requires effort and energy.
Avoidance limits one’s focus at the expense of fully experiencing what is going on in the present.
Avoidance may get in the way of other important, valued aspects of life.

Empirical Evidence

Laboratory-based thought suppression studies suggest avoidance is paradoxical, in that concerted attempts at suppression of a particular thought often leads to an increase of that thought.
Studies examining emotional suppression and pain suppression suggest that avoidance is ineffective in the long-run. Conversely, expressing unpleasant emotion results in short-term increases in arousal, but long-term decreases in arousal.
Exposure-based therapy techniques have been shown to be effective in treating a wide range of psychiatric disorders.
Numerous self-report studies have linked EA and related constructs (avoidance coping, thought suppression) to psychopathology and other forms of dysfunction.

Relevance to Psychopathology

Seemingly disparate forms of pathological behaviour can be understood by their common function (i.e., attempts to avoid distress). Some examples can be seen in the Table below.

Diagnosis	Example Behaviours	Target of Avoidance
Major Depressive Disorder	Isolation/suicide	Feelings of sadness, guilt, and/or low self-worth.
PTSD	Avoiding trauma reminders, hypervigilance	Memories, anxiety, concerns of safety.
Social Phobia	Avoiding social situations	Anxiety, concerns of judgement from others.
Panic Disorder	Avoiding situations that might induce panic	Fear, physiological sensations.
Agoraphobia	Restricting travel outside of home or other ‘safe areas’	Anxiety, fear of having symptoms of panic.
Obsessive-Compulsive Disorder	Checking/rituals	Worry of consequences (e.g. contamination).
Substance Use Disorders	Abusing alcohol/drugs	Emotions, memories, withdrawal symptoms
Eating Disorders	Restricting food intake, purging	Worry about becoming ‘overweight’, fear of losing control.
Borderline Personality Disorder	Self-harm (e.g. cutting)	High emotional arousal.

Relevance to Quality of Life

Perhaps the most significant impact of EA is its potential to disrupt and interfere with important, valued aspects of an individual’s life. That is, EA is seen as particularly problematic when it occurs at the expense of a person’s deeply held values. Some examples include:

Putting off an important task because of the discomfort it evokes.
Not taking advantage of an important opportunity due to attempts to avoid worries of failure or disappointment.
Not engaging in physical activity/exercise, meaningful hobbies, or other recreational activities due to the effort they demand.
Avoiding social gatherings or interactions with others because of the anxiety and negative thoughts they evoke.
Not being a full participant in social gatherings due to attempts to regulate anxiety relating to how others are perceiving you.
Being unable to fully engage in meaningful conversations with others because one is scanning for signs of danger in the environment (attempting to avoid feeling “unsafe”).
Inability to “connect” and sustain a close relationship because of attempts to avoid feelings of vulnerability.
Staying in a “bad” relationship to try to avoid discomfort, guilt, and potential feelings of loneliness a break-up might entail.
Losing a marriage or contact with children due to an unwillingness to experience uncomfortable feelings (e.g. achieved through drug or alcohol abuse) or symptoms of withdrawal.
Not attending an important graduation, wedding, funeral, or other family event to try to avoid anxiety or symptoms of panic.
Engaging in self-destructive behaviours in an attempt to avoid feelings of boredom, emptiness, worthlessness.
Not functioning or taking care of basic responsibilities (e.g. personal hygiene, waking up, showing up to work, shopping for food) because of the effort they demand and/or distress they evoke.
Spending so much time attempting to avoid discomfort that one has little time for anyone or anything else in life.

Measurement

Self-Report

The Acceptance and Action Questionnaire (AAQ) was the first self-report measure explicitly designed to measure EA, but has since been re-conceptualised as a measure of “psychological flexibility”. The 62-item Multidimensional Experiential Avoidance Questionnaire (MEAQ) was developed to measure different aspects of EA. The Brief Experiential Avoidance Questionnaire (BEAQ) is a 15-item measure developed using MEAQ items, which has become the most widely used measure of experiential avoidance.

What is Avoidance Coping?

Published on 10/14/202110/14/2021 by Andrew MarshallLeave a comment

Introduction

In psychology, avoidance coping is a coping mechanism and form of experiential avoidance.

It is characterized by a person’s efforts, conscious or unconscious, to avoid dealing with a stressor in order to protect oneself from the difficulties the stressor presents. Avoidance coping can lead to substance abuse, social withdrawal, and other forms of escapism. High levels of avoidance behaviours may lead to a diagnosis of avoidant personality disorder, though not everyone who displays such behaviours meets the definition of having this disorder. Avoidance coping is also a symptom of post-traumatic stress disorder (PTSD) and related to symptoms of depression and anxiety. Additionally, avoidance coping is part of the approach-avoidance conflict theory introduced by psychologist Kurt Lewin.

Literature on coping often classifies coping strategies into two broad categories: approach/active coping and avoidance/passive coping. Approach coping includes behaviours that attempt to reduce stress by alleviating the problem directly, and avoidance coping includes behaviours that reduce stress by distancing oneself from the problem. Traditionally, approach coping has been seen as the healthiest and most beneficial way to reduce stress, while avoidance coping has been associated with negative personality traits, potentially harmful activities, and generally poorer outcomes. However, avoidance coping can reduce stress when nothing can be done to address the stressor.

Measurement

Avoidance coping is measured via a self-reported questionnaire. Initially, the Multidimensional Experiential Avoidance Questionnaire (MEAQ) was used, which is a 62-item questionnaire that assesses experiential avoidance, and thus avoidance coping, by measuring how many avoidant behaviours a person exhibits and how strongly they agree with each statement on a scale of 1-6. Today, the Brief Experiential Avoidance Questionnaire (BEAQ) is used instead, containing 15 of the original 62 items from the MEAQ.

Treatment

Cognitive behavioural and psychoanalytic therapy are used to help those coping by avoidance to acknowledge, comprehend, and express their emotions. Acceptance and commitment therapy, a behavioural therapy that focuses on breaking down avoidance coping and showing it to be an unhealthy method for dealing with traumatic experiences, is also sometimes used.

Both active-cognitive and active-behavioural coping are used as replacement techniques for avoidance coping. Active-cognitive coping includes changing one’s attitude towards a stressful event and looking for any positive impacts. Active-behavioural coping refers taking positive actions after finding out more about the situation.

On This Day … 14 October

Published on 10/14/202110/12/2021 by Andrew MarshallLeave a comment

People (Births)

1936 – Jürg Schubiger, Swiss psychotherapist and author (d. 2014).

Jurg Schubiger

Jürg Schubiger (14 October 1936 to 15 September 2014) was a Swiss psychotherapist and writer of children’s books. He won the Deutscher Jugendliteraturpreis (German Youth Literature Award) in 1996 for Als die Welt noch jung war.

For his “lasting contribution” as a children’s writer Schubiger received the biennial Hans Christian Andersen Medal in 2008. The award conferred by the International Board on Books for Young People is the highest recognition available to a writer or illustrator of children’s books.

What is the Community Mental Health Act of 1963?

Published on 10/13/2021 by Andrew Marshall1 Comment

Introduction

The Community Mental Health Act of 1963 (CMHA) (also known as the Community Mental Health Centres Construction Act, Mental Retardation Facilities and Construction Act, Public Law 88-164, or the Mental Retardation and Community Mental Health Centres Construction Act of 1963) was an act to provide federal funding for community mental health centres and research facilities in the United States.

Background

This legislation was passed as part of John F. Kennedy’s New Frontier. It led to considerable deinstitutionalisation.

In 1955, Congress passed the Mental Health Study Act, leading to the establishment of the Joint Commission on Mental Illness and Mental Health. That Commission issued a report in 1961, which would become the basis of the 1963 Act.

The CMHA provided grants to states for the establishment of local mental health centres, under the overview of the National Institute of Mental Health. The NIH also conducted a study involving adequacy in mental health issues. The purpose of the CMHA was to build mental health centres to provide for community-based care, as an alternative to institutionalisation. At the centres, patients could be treated while working and living at home.

Only half of the proposed centres were ever built; none were fully funded, and the act did not provide money to operate them long-term. Some states saw an opportunity to close expensive state hospitals without spending some of the money on community-based care. Deinstitutionalisation accelerated after the adoption of Medicaid in 1965. During the Reagan administration, the remaining funding for the act was converted into a mental-health block grant for states. Since the CMHA was enacted, 90% of beds have been cut at state hospitals.

The CMHA proved to be a mixed success. Many patients, formerly warehoused in institutions, were released into the community. However, not all communities had the facilities or expertise to deal with them. In many cases, patients wound up in adult homes or with their families, or homeless in large cities, but without the mental health care they needed.

What was Addington vs Texas (1979)?

Published on 10/13/2021 by Andrew MarshallLeave a comment

Introduction

Addington v. Texas, 441 U.S. 418 (1979), was a landmark decision of the US Supreme Court that set the standard for involuntary commitment for treatment by raising the burden of proof required to commit persons for psychiatric treatment from the usual civil burden of proof of “preponderance of the evidence” to “clear and convincing evidence”.

Background

Before Frank Addington was arrested on the misdemeanour charge of “assault threat” against his mother, Addington’s mother filed a petition with the court, in accordance with Texas law, requesting that Addington be indefinitely involuntarily committed to a state psychiatric hospital. Addington had a long history of mental and emotional problems and past psychiatric hospitalisations. The state trial court issued jury instructions that the decision be based on “clear, unequivocal and convincing evidence” that Addington was mentally ill and that hospitalisation was required for his own welfare and the welfare of others. The jury found that Addington was mentally ill and required hospitalisation. Thereupon the trial court ordered his indefinite commitment. He was indefinitely committed to Austin State Hospital.

However, Addington appealed to the Texas Court of Appeals, based on the argument the court should have used the “beyond a reasonable doubt” standard of proof. The appeals court reversed, agreeing with Addington. The Texas Supreme Court then reversed the Court of Appeals’ decision, reinstating the trial court’s orders. It concluded that the standard of proof of the preponderance of the evidence satisfied due process in a civil commitment proceeding.

Addington then appealed to the US Supreme Court on a writ of certiorari (in law, certiorari is a court process to seek judicial review of a lower court of government agency).

Opinion of the Court

The appeal was dismissed and certiorari granted; the lower court’s decision was vacated and remanded. The court said the issue of an individual’s interest in liberty is of such weight and gravity that a higher standard of proof is required than is normal in civil cases brought under state law. Because of the uncertainties of psychiatric diagnosis, the burden of proof does not need to be as high as “beyond a reasonable doubt” in criminal cases, but should be a “clear and convincing” standard of proof as required by the Fourteenth Amendment in such a civil proceeding to commit an individual involuntarily for an indefinite period to a state psychiatric hospital.

Further, the opinion touched on the issue of an involuntary commitment as primarily medical in nature and needing the expertise of mental health experts.

Whether the individual is mentally ill and dangerous to either himself or others and is in need of confined therapy turns on the meaning of the facts which must be interpreted by expert psychiatrists and psychologists.

Subsequent Developments

The court raised the bar for committing someone against their will in a civil commitment proceeding. When the stakes are exceptionally high in civil matters, the burden of proof must be “clear and convincing evidence”. The case raised important issues regarding civil commitment by placing the burden of proof on the petitioner, that is the party seeking the involuntary commitment of a person.

The opinion also suggested that it was not necessarily for the trier of facts to draw the necessary conclusions without the expertise of psychiatrists and psychologists.

The Supreme Court also cited the Addington case in Santosky v. Kramer, which set a clear and convincing evidence standard in termination of parental rights cases.

What is Self Psychology?

Published on 10/12/2021 by Andrew Marshall1 Comment

Introduction

Self psychology, a modern psychoanalytic theory and its clinical applications, was conceived by Heinz Kohut in Chicago in the 1960s, 70s, and 80s, and is still developing as a contemporary form of psychoanalytic treatment.

In self psychology, the effort is made to understand individuals from within their subjective experience via vicarious introspection, basing interpretations on the understanding of the self as the central agency of the human psyche. Essential to understanding self psychology are the concepts of empathy, selfobject, mirroring, idealising, alter ego/twinship and the tripolar self. Though self psychology also recognises certain drives, conflicts, and complexes present in Freudian psychodynamic theory, these are understood within a different framework. Self psychology was seen as a major break from traditional psychoanalysis and is considered the beginnings of the relational approach to psychoanalysis.

Origins

Kohut came to psychoanalysis by way of neurology and psychiatry in the 1940s, but then ’embraced analysis with the fervor of a convert … [and as] “Mr Psychoanalysis”‘ took on an idealising image of Freud and his theories. Subsequently, “in a burst of creativity that began in the mid-1960s … Kohut found his voice and explored narcissism in new ways that led to what he ended up calling a ‘psychology of the self'”.

Major Concepts

Self

Kohut explained, in 1977, that in all he wrote on the psychology of the self, he purposely did not define the self. He explained his reasoning this way: “The self…is, like all reality…not knowable in its essence…We can describe the various cohesive forms in which the self appears, can demonstrate the several constituents that make up the self … and explain their genesis and functions. We can do all that but we will still not know the essence of the self as differentiated from its manifestations.”

Empathy

Kohut maintained that parents’ failures to empathize with their children and the responses of their children to these failures were ‘at the root of almost all psychopathology’. For Kohut, the loss of the other and the other’s self-object (“selfobject”) function (see below) leaves the individual apathetic, lethargic, empty of the feeling of life, and without vitality – in short, depressed.

The infant moving from grandiose to cohesive self and beyond must go through the slow process of disillusionment with phantasies of omnipotence, mediated by the parents: ‘This process of gradual and titrated disenchantment requires that the infant’s caretakers be empathetically attuned to the infant’s needs’.

Correspondingly, to help a patient deal in therapy with earlier failures in the disenchantment process, Kohut the therapist ‘highlights empathy as the tool par excellence, which allows the creation of a relationship between patient and analyst that can offer some hope of mitigating early self pathology’.

In comparison to earlier psychoanalytic approaches, the use of empathy, which Kohut called “vicarious introspection”, allows the therapist to reach conclusions sooner (with less dialogue and interpretation), and to create a stronger bond with the patient, making the patient feel more fundamentally understood. For Kohut, the implicit bond of empathy itself has a curative effect, but he also warned that ‘the psychoanalyst … must also be able to relinquish the empathic attitude’ to maintain intellectual integrity, and that ’empathy, especially when it is surrounded by an attitude of wanting to cure directly … may rest on the therapist’s unresolved omnipotence fantasies’.

The conceptual introduction of empathy was not intended to be a “discovery.” Empathic moments in psychology existed long before Kohut. Instead, Kohut posited that empathy in psychology should be acknowledged as a powerful therapeutic tool, extending beyond “hunches” and vague “assumptions,” and enabling empathy to be described, taught, and used more actively.

Selfobjects

Selfobjects are external objects that function as part of the “self machinery” – ‘i.e. objects which are not experienced as separate and independent from the self’. They are persons, objects or activities that “complete” the self, and which are necessary for normal functioning. ‘Kohut describes early interactions between the infant and his caretakers as involving the infant’s “self” and the infant’s “selfobjects”‘.

Observing the patient’s selfobject connections is a fundamental part of self psychology. For instance, a person’s particular habits, choice of education and work, taste in life partners, may fill a selfobject-function for that particular individual.

Selfobjects are addressed throughout Kohut’s theory, and include everything from the transference phenomenon in therapy, relatives, and items (for instance Linus van Pelt’s security blanket): they ‘thus cover the phenomena which were described by Winnicott as transitional objects. Among “the great variety of selfobject relations that support the cohesion, vigor, and harmony of the adult self … [are] cultural selfobjects (the writers, artists, and political leaders of the group – the nation, for example – to which a person feels he belongs)”.

If psychopathology is explained as an “incomplete” or “defect” self, then the self-objects might be described as a self-prescribed “cure”.

As described by Kohut, the selfobject-function (i.e. what the selfobject does for the self) is taken for granted and seems to take place in a “blindzone”. The function thus usually does not become “visible” until the relation with the selfobject is somehow broken.

When a relationship is established with a new selfobject, the relationship connection can “lock in place” quite powerfully, and the pull of the connection may affect both self and selfobject. Powerful transference, for instance, is an example of this phenomenon.

Optimal Frustration

When a selfobject is needed, but not accessible, this will create a potential problem for the self, referred to as a “frustration” – as with ‘the traumatic frustration of the phase appropriate wish or need for parental acceptance … intense narcissistic frustration’.

The contrast is what Kohut called “optimal frustration”; and he considered that, ‘as holds true for the analogous later milieu of the child, the most important aspect of the earliest mother-infant relationship is the principle of optimal frustration. Tolerable disappointments … lead to the establishment of internal structures which provide the basis for self-soothing.’

In a parallel way, Kohut considered that the ‘skilful analyst will … conduct the analysis according to the principle of optimal frustration’.

Suboptimal frustrations, and maladaptations following them, may be compared to Freud’s trauma concept, or to problem solution in the oedipal phase. However, the scope of optimal (or other) frustration describes shaping every “nook and cranny” of the self, rather than a few dramatic conflicts.

Idealising

Kohut saw idealising as a central aspect of early narcissism. “The therapeutic activation of the omnipotent object (the idealized parent image) … referred to as the idealizing transference, is the revival during psychoanalysis” of the very early need to establish a mutual selfobject connection with an object of idealisation.

In terms of “the Kleinian school … the idealizing transference may cover some of the territory of so-called projective identification”.

For the young child, “idealized selfobjects “provide the experience of merger with the calm, power, wisdom, and goodness of idealized persons””.

Alter Ego/Twinship Needs

Alter ego/twinship needs refer to the desire in early development to feel alikeness to other human beings. Freud had early noted that ‘The idea of the “double” … sprung from the soil of unbounded self-love, from the primary narcissism which holds sway in the mind of the child.’ Lacan highlighted ‘the mirror stage … of a normal transitivism. The child who strikes another says that he has been struck; the child who sees another fall, cries.’ In 1960, ‘Arlow observed, “The existence of another individual who is a reflection of the self brings the experience of twinship in line with the psychology of the double, of the mirror image and of the double”.’

Kohut pointed out that ‘fantasies, referring to a relationship with such an alter ego or twin (or conscious wishes for such a relationship) are frequently encountered in the analysis of narcissistic personalities’, and termed their transference activation ‘the alter-ego transference or the twinship’.

As development continues, so a greater degree of difference from others can be accepted.

The Tripolar Self

The tripolar self is not associated with bipolar disorder, but is the sum of the three “poles” of the body:

“grandiose-exhibitionistic needs”.
“the need for an omnipotent idealized figure”.
“alter-ego needs”..

Kohut argued that ‘reactivation of the grandiose self in analysis occurs in three forms: these relate to specific stages of development … (1) The archaic merger through the extension of the grandiose self; (2) a less archaic form which will be called alter-ego transference or twinship; and (3) a still less archaic form … mirror transference’.

Alternately, self psychologists ‘divide the selfobject transference into three groups: (1) those in which the damaged pole of ambitions attempts to elicit the confirming-approving response of the selfobject (mirror transference); (2) those in which the damaged pole of ideals searches for a selfobject that will accept its idealisation (idealising transference); and those in which the damaged intermediate area of talents and skills seeks … alter ego transference.’

The tripolar self forms as a result of the needs of an individual binding with the interactions of other significant persons within the life of that individual.

Cultural Implications

An interesting application of self psychology has been in the interpretation of the friendship of Freud and Jung, its breakdown, and its aftermath. It has been suggested that at the height of the relationship “Freud was in narcissistic transference, that he saw in Jung an idealised version of himself”, and that conversely in Jung there was a double mix of “idealization of Freud and grandiosity in the self”.

During Jung’s midlife crisis, after his break with Freud, arguably “the focus of the critical years had to be a struggle with narcissism: the loss of an idealized other, grandiosity in the sphere of the self, and resulting periods of narcissistic rage”. Only as he worked through to “a new sense of himself as a person separate from Freud” could Jung emerge as an independent theorist in his own right.

On the assumption that “the western self is embedded in a culture of narcissism … implicated in the shift towards postmodernity”, opportunities for making such applications will probably not decrease in the foreseeable future.

Criticism

Kohut, who was “the center of a fervid cult in Chicago”, aroused at times almost equally fervent criticism and opposition, emanating from at least three other directions: drive theory, Lacanian psychoanalysis, and object relations theory.

From the perspective of drive theory, Kohut appears “as an important contributor to analytic technique and as a misguided theoretician … introduces assumptions that simply clutter up basic theory. The more postulates you make, the less their explanatory power becomes.” Offering no technical advances on standard analytic methods in “his breathtakingly unreadable The Analysis of the Self”, Kohut simply seems to blame parental deficit for all childhood difficulties, disregarding the inherent conflicts of the drives: “Where the orthodox Freudian sees sex everywhere, the Kohutian sees unempathic mothers everywhere – even in sex.”

To the Lacanian, Kohut’s exclusive “concern with the imaginary”, to the exclusion of the Symbolic meant that “not only the patient’s narcissism is in question here, but also the analyst’s narcissism.” The danger in “the concept of the sympathetic or empathic analyst who is led astray towards an ideal of devotion and samaritan helping … [ignoring] its sadistic underpinnings” seemed only too clear.

From an object relations perspective, Kohut “allows no place for internal determinants. The predicate is that a person’s psychopathology is due to unattuned selfobjects, so all the bad is out there and we have a theory with a paranoid basis.” At the same time, “any attempt at “being the better parent” has the effect of deflecting, even seducing, a patient from using the analyst or therapist in a negative transference … the empathic analyst, or “better” parent”.

With the passage of time, and the eclipse of grand narrative, it may now be possible to see the several strands of psychoanalytic theory less as fierce rivals and more “as complementary partners. Drive psychology, ego psychology, object relations psychology and self psychology each have important insights to offer twenty-first-century clinicians.”

On This Day … 12 October

Published on 10/12/202110/11/2021 by Andrew MarshallLeave a comment

Events

1773 – America’s first insane asylum opens (Eastern State Hospital, Virginia).

People (Births)

1925 – Denis Lazure, Canadian psychiatrist and politician (d. 2008).
1929 – Robert Coles, American psychologist, author, and academic.

People (Deaths)

1948 – Susan Sutherland Isaacs, English psychologist and psychoanalyst (b. 1885).

Eastern State Hospital (Virginia)

Eastern State Hospital is a psychiatric hospital in Williamsburg, Virginia. Built in 1773, it was the first public facility in the present-day United States constructed solely for the care and treatment of the mentally ill. The original building had burned but was reconstructed in 1985.

Denis Lazure

Denis Lazure (12 October 1925 to 23 February 2008) was a Canadian psychiatrist and politician. Lazure was a Member of the National Assembly of Quebec (MNA) from 1976 to 1984 and from 1989 to 1996. He is the father of actress Gabrielle Lazure.

Lazure attended Université de Montréal and was a doctorate in medicine. He also attended the University of Pennsylvania in psychiatry as well as the University of Toronto in which he was bachelor in hospital administration.

Lazure was the founder of the infant psychiatry department of Saint-Justine Hospital in 1957. He was also the director of this hospital as well as those of Riviere-des-Prairies and Louis-Hippolyte Lafontaine all in the Montreal region. He would later be the director in 1974 of the first psychiatric hospital in Haiti. He was also a teacher at Université de Montréal and was the President of the Canadian Association of Psychiatrists.

Robert Coles

Robert Coles (born 12 October 1929) is an American author, child psychiatrist, and professor emeritus at Harvard University.

Born Martin Robert Coles in Boston, Massachusetts on 12 October 1929, to Philip Coles, an immigrant from Leeds, England, United Kingdom, and Sandra Young Coles, originally from Sioux City, Iowa. Robert Coles attended Boston Latin School where he played tennis, ran track, and edited the school literary magazine. He entered Harvard College in 1946, where he studied English literature and helped to edit the undergraduate literary magazine, The Harvard Advocate. He graduated magna cum laude and earned Phi Beta Kappa honours in 1950.

Coles originally intended to become a teacher or professor, but as part of his senior honours thesis, he interviewed the poet and physician William Carlos Williams, who promptly persuaded him to go into medicine. He studied medicine at Columbia University College of Physicians and Surgeons, graduating in 1954. After residency training at the University of Chicago in Chicago, Illinois (the University of Chicago Pritzker School of Medicine), Coles moved on to psychiatric residencies at Massachusetts General Hospital in Boston, Massachusetts, and McLean Hospital in Belmont, Massachusetts (the two hospitals are affiliates of Harvard University and the Harvard University Medical School in Cambridge, Massachusetts).

Knowing that he was to be called into the US Armed Forces under the Doctor Draft, Coles joined the Air Force in 1958 and was assigned the rank of captain. His field of specialisation was psychiatry, his intention eventually to sub-specialise in child psychiatry. He served as chief of neuropsychiatric services at Keesler Air Force Base in Biloxi, Mississippi, and was honourably discharged in 1960. He returned to Boston and finished his child psychiatry training at the Children’s Hospital. In July 1960, he was married to Jane Hollowell, and the couple moved to New Orleans.

Susan Sutherland Isaacs

Susan Sutherland Isaacs, CBE (née Fairhurst; 24 May 1885 to 12 October 1948; also known as Ursula Wise) was a Lancashire-born educational psychologist and psychoanalyst. She published studies on the intellectual and social development of children and promoted the nursery school movement. For Isaacs, the best way for children to learn was by developing their independence. She believed that the most effective way to achieve this was through play, and that the role of adults and early educators was to guide children’s play.

In 1907, Isaacs enrolled to train as a teacher of young children (5 to 7-year-olds) at the University of Manchester. Isaacs then transferred to a degree course and graduated in 1912 with a first class degree in Philosophy. She was awarded a scholarship at the Psychological Laboratory in Newnham College, Cambridge and gained a master’s degree in 1913.

Isaacs also trained and practised as a psychoanalyst after analysis by the psychoanalyst John Carl Flugel (1884-1955). She became an associate member of the newly formed British Psychoanalytical Society in 1921, becoming a full member in 1923. She began her own practice that same year. She later underwent brief analysis with Otto Rank and in 1927 she submitted herself to further analysis with Joan Riviere, to get personal experience and understanding of Melanie Klein’s new ideas on infancy. Isaacs also helped popularise the works of Klein, as well as the theories of Jean Piaget and Sigmund Freud. She was initially enthusiastic for Jean Piaget’s theories on the intellectual development of young children, though she later criticised his schemas for stages of cognitive development, which were not based on the observation of the child in their natural environment, unlike her own observations at Malting House School.

Between 1924 and 1927, she was the head of Malting House School in Cambridge, which is an experimental school founded by Geoffrey Pyke. The school fostered the individual development of children. Children were given greater freedom and were supported rather than punished. The teachers were seen as observers of the children who were seen as research workers. Her work had a great influence on early education and made play a central part of a child’s education. Isaacs strongly believed that play was the child’s work.

Between 1929 and 1940, she was an ‘agony aunt’ under the pseudonym of Ursula Wise, replying to readers’ problems in several child care journals, notably The Nursery World and Home and School.

In 1933, she became the first Head of the Child Development Department at the Institute of Education, University of London, where she established an advanced course in child development for teachers of young children. Her department had a great influence on the teaching profession and encouraged the profession to consider psychodynamic theory with developmental psychology.

What is the Eastern State Hospital (Virginia)?

Published on 10/11/2021 by Andrew Marshall1 Comment

Introduction

Francis Fauquier and the Enlightenment

Eastern State Hospital traces its foundation to a speech by Francis Fauquier, Royal Governor of the colony of Virginia, on 06 November 1766. At the House of Burgesses’ first meeting since the Stamp Act and Virginia Resolves, Fauquier primarily discussed the relationship between the Mother Country and these colonists, and expressed optimism for their future. His speech also unexpectedly addressed the mentally ill, as follows:

“It is expedient I should also recommend to your Consideration and Humanity a poor unhappy set of People who are deprived of their senses and wander about the Country, terrifying the Rest of their fellow creatures. A legal Confinement, and proper Provision, ought to be appointed for these miserable Objects, who cannot help themselves. Every civilized Country has an Hospital for these People, where they are confined, maintained and attended by able Physicians, to endeavor to restore to them their lost reason.”

About a year later, on 11 April 1767, Governor Fauquier addressed the same issue before the next House of Burgesses, thus:

“There is a subject which gives me concern, on which I shall particularly address myself to you, as it is your peculiar province to provide means for the subsistence of the poor of any kind. The subject I mean is the case of the poor lunatics. I find on your journals that it was Resolved, That an hospital be erected for the reception of persons who are so unhappy as to be deprived of their reason; And that it was Ordered, that the Committee of Propositions and Grievances do prepare and bring in a bill pursuant to the above resolution. But I do not find that any thing more was done in it. It was a measure which I think could offend no party, and which I was in hopes humanity would have dictated to every man, as soon as he was made acquainted with the call for it. It also concerns me much on another account; for as the case now stands, I am as it were compelled to the daily commission of an illegal act, by confining without my authority, a poor lunatic, who, if set at liberty, would be mischievous to society; and I would choose to be bound by, and observant of, the laws of the country. As I think this is a point of some importance to the ease and comfort of the whole community, as well as a point of charity to the unhappy objects, I shall again recommend it to you at your next meeting; when I hope, after mature reflection, it will be found to be more worth your attention than it has been in this.”

Governor Fauquier’s benevolent and bold expressions did eventually lead to the establishment of the Eastern State Hospital, although he died 03 March 1768, before it was built. His compassion and humanitarian care for those who needed it the most, made it easier for his ideas to be developed and a facility built.

Fauquier’s concern probably rested in Enlightenment principles, which were so widespread throughout the time. The 18th century was a time for rejecting superstitions and religions, and substituting science and logical reasoning. The philosophers David Hume and Voltaire were studying and investigating the worth of human life, which would ultimately alter perceptions of the mentally ill. During this time in London, insane people were viewed and used for as entertainment and comical relief. The Bethlehem Royal Hospital (sometimes called Bedlam) attracted many tourists and even held frequent parades of inmates. Enlightenment attitudes encouraged more sensitivity towards the mentally ill, rather than treating them as outcasts and fools. Some started to believe that being mentally ill was, in fact, an illness of the mind, much like a physical disease or sickness, and that these mental illnesses were also treatable.

Before Governor Fauquier’s speeches, a person who was mentally ill was not diagnosed by a doctor, but rather judged by 12 citizens, much like a jury, to be either a criminal, lunatic or Idiot. Most classified as lunatic were placed in the Public Gaol in Williamsburg. Taxpayers probably appreciated the hospital idea only if they had a family member or close friend who was mentally ill. The only hospital where mentally ill patients were sometimes taken before Eastern State Hospital was built, was the Pennsylvania Hospital, a Quaker institution in Philadelphia. Until a campaign by Benjamin Rush in 1792 to establish a separate treatment wing, mentally ill patients were kept in the basement and out of the way of regular patients who needed medical assistance.

Percival Goodhouse was is thought to be one of the first patients admitted to the Eastern State Hospital after its opening on 12 October 1773.

Civil War and Decline

In 1841, Dr. John Galt was appointed superintendent of the hospital, with roughly 125 patients (then called “inmates”) at the time. Dr. Galt introduced Moral treatment practices, a school of thought which viewed those with mental illness as deserving of respect and dignity rather than punishment for their behaviour. Galt provided his patients with talk therapy and occupational therapy, and argued for in-house research. He decreased the use of physical restraints, even going an entire year without using them, relying instead on calming drugs (including laudanum), and also proposed deinstitutionalizing patients in favour of community-based care, though this proposal was repeatedly rejected. As the head of the hospital, Galt was successful in pressing for admission for enslaved people with mental illness, and taught the enslaved people owned by the hospital to provide talk therapy alongside nurses and aides. Although he claimed to treat patients equally regardless of their race, Galt did not publish racial breakdowns of his patients.

When the Civil War came to Williamsburg, the hospital found itself alternately on one side of the lines and then the other. On 06 May 1862, Union troops captured the asylum. Two weeks later, on 17 or 18 May, Dr. Galt died of an overdose of laudanum, though it is unclear whether this was intentional or accidental. When the hospital was captured, Union soldiers found that the 252 patients had been locked in without food or supplies by the fleeing white employees. Somersett Moore was the only non-African American employee to return following the capture, and he gave the keys to release the patients to the occupying men.

In the following decades, the increasingly crowded hospital saw a regression in methodology as science was increasingly viewed as an ineffective means of dealing with mental illness. During this era of custodial care, the goal became not to cure patients, but to provide a comfortable environment for them, separate from society. On 07 June 1885, the original 1773 hospital burned to the ground due to a fire that had started in the building’s newly added electrical wiring, a consequence of the great expansion of facilities at this time.

Restoration

By 1935 Eastern State Hospital housed some 2,000 patients with no more land for expansion. The restoration of Colonial Williamsburg and development of the Williamsburg Inn resulted in the facility being at the centre of a thriving tourist trade. The hospital’s location and space issues made a move necessary. Between 1937 and 1968, all of Eastern State’s patients were moved to a new facility on the outskirts of Williamsburg, Virginia, where it continues to operate today.

In 1985, the original hospital was reconstructed on its excavated foundations by the Colonial Williamsburg Foundation.

On This Day … 10 October

Published on 10/10/202110/06/2021 by Andrew MarshallLeave a comment

Events

World Mental Health Day.

People (Deaths)

1979 – Christopher Evans, English psychologist, computer scientist, and author (b. 1931).

World Mental Health Day

World Mental Health Day (10 October) is an international day for global mental health education, awareness and advocacy against social stigma.

Christopher Evans

Christopher Riche Evans (29 May 1931 to 10 October 1979) was a British psychologist, computer scientist, and author.

Born in Aberdyfi, Christopher Evans spent his childhood in Wales and was educated at Christ College, Brecon (1941-1949). He spent two years in the RAF (1950-1952), and worked as a science journalist and writer until 1957, when he began a B.A. course in Psychology at University College, London, graduating with honours in 1960.

After a summer fellowship at Duke University in the United States, where he first met his American wife, Nancy Fullmer, he took up a Research Assistant post in the Physics Laboratory, University of Reading, working on eye movements under Professor R. W. Ditchburn. Upon receiving his PhD (the title of his thesis was “Pattern Perception and the Stabilised Retinal Image”), he went to the Division of Computer Science, National Physical Laboratory, Teddington, in 1964, where he remained until his death from cancer in 1979.

He had two children, Christopher Samuel Evans and Victoria Evans-Theiler.

On This Day … 09 October

Published on 10/09/202110/05/2021 by Andrew MarshallLeave a comment

People (Births)

1900 – Joseph Zubin, Lithuanian-American psychologist and academic (d. 1990).
1943 – Douglas Kirby, American psychologist and author (d. 2012).

Joseph Zubin

Joseph Zubin (09 October 1900 to 18 December 1990) was a Lithuanian born American educational psychologist and an authority on schizophrenia who is commemorated by the Joseph Zubin Awards.

Zubin was born 09 October 1900 in Raseiniai, Lithuania, but moved to the US in 1908 and grew up in Baltimore. His first degree was in chemistry at Johns Hopkins University in 1921, and he earned a PhD in educational psychology at Columbia University in 1932. In 1934 he married Winifred Anderson (who survived him) and they had three children (2 sons, David and Jonathan, and a daughter, Winfred). At his death on 18 December 1990, he had seven grandchildren. In addition, his great-grandson is Adam Chapnik, counsellor of the Abbey Unit at Massachusetts Audubon Society’s Wildwood Camp.

Zubin was President of both the American Psychopathological Association (1951-1952) and the American College of Neuropsychopharmacology (1971-1972) and received numerous awards for his work. In 1946 he was elected as a Fellow of the American Statistical Association.

Douglas Kirby

Douglas Bernard Kirby, Ph.D. (09 October 1943 to 22 December 2012) was senior research scientist for ETR Associates in Scotts Valley, California, and one of the world’s leading experts on the effectiveness of school and community programmes in the reduction of adolescent sexual risk-taking behaviours. In recent years he had also undertaken research and analysis on the impact of HIV/AIDS prevention programmes in Uganda under the auspices of the World Health Organization, USAID, and other organisations.

Kirby authored over 100 articles, chapters and monographs on these programmes including the widely acclaimed Emerging Answers 2007: Research Findings on Programmes to Reduce Teen Pregnancy and Sexually Transmitted Diseases which he produced for the National Campaign to Prevent Teen and Unplanned Pregnancy. It is a comprehensive review of 115 programme evaluations to help determine the most effective approaches to preventing teen pregnancy and STDs. It paints a detailed picture of the protective factors associated with adolescent risk taking behaviour and identifies important characteristics of effective sexuality and HIV education programmes. His recent research has shown strong evidence for the effectiveness of comprehensive sex and STD/HIV programs and limited evidence for the effectiveness of sexual abstinence programmes.