Category: Mental Health

What is Rationalisation (Psychology)?

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Introduction

Rationalisation is a defence mechanism (ego defence) in which apparent logical reasons are given to justify behaviour that is motivated by unconscious instinctual impulses.

It is an attempt to find reasons for behaviours, especially ones own. Rationalisations are used to defend against feelings of guilt, maintain self-respect, and protect oneself from criticism.

Rationalisation happens in two steps:

  • A decision, action, judgement is made for a given reason, or no (known) reason at all.
  • A rationalisation is performed, constructing a seemingly good or logical reason, as an attempt to justify the act after the fact (for oneself or others).

Rationalisation encourages irrational or unacceptable behaviour, motives, or feelings and often involves ad hoc hypothesizing. This process ranges from fully conscious (e.g. to present an external defence against ridicule from others) to mostly unconscious (e.g. to create a block against internal feelings of guilt or shame). People rationalise for various reasons – sometimes when we think we know ourselves better than we do. Rationalisation may differentiate the original deterministic explanation of the behaviour or feeling in question.

Many conclusions individuals come to do not fall under the definition of rationalisation as the term is denoted above.

Brief History

Quintilian and classical rhetoric used the term colour for the presenting of an action in the most favourable possible perspective. Laurence Sterne in the eighteenth century took up the point, arguing that, were a man to consider his actions, “he will soon find, that such of them, as strong inclination and custom have prompted him to commit, are generally dressed out and painted with all the false beauties [colour] which, a soft and flattering hand can give them”.

DSM Definition

According to the DSM-IV, rationalisation occurs:

“when the individual deals with emotional conflict or internal or external stressors by concealing the true motivations for their own thoughts, actions, or feelings through the elaboration of reassuring or self serving but incorrect explanations”.

Examples

Individual

  • Rationalisation can be used to avoid admitting disappointment: “I didn’t get the job that I applied for, but I really didn’t want it in the first place.”

Egregious rationalisations intended to deflect blame can also take the form of ad hominem attacks or DARVO.

  • Ad hominem refers to several types of arguments, some but not all of which are fallacious.
  • DARVO is an acronym for deny, attack, and reverse victim and offender – a common manipulation strategy of psychological abusers.

Some rationalisations take the form of a comparison. Commonly, this is done to lessen the perception of an action’s negative effects, to justify an action, or to excuse culpability:

  • “At least [what occurred] is not as bad as [a worse outcome].”
  • In response to an accusation: “At least I didn’t [worse action than accused action].”
  • As a form of false choice: “Doing [undesirable action] is a lot better than [a worse action].”
  • In response to unfair or abusive behaviour: “I must have done something wrong if they treat me like this.”

Based on anecdotal and survey evidence, John Banja states that the medical field features a disproportionate amount of rationalisation invoked in the “covering up” of mistakes. Common excuses made are:

  • “Why disclose the error? The patient was going to die anyway.”
  • “Telling the family about the error will only make them feel worse.”
  • “It was the patient’s fault. If he wasn’t so (sick, etc.), this error wouldn’t have caused so much harm.”
  • “Well, we did our best. These things happen.”
  • “If we’re not totally and absolutely certain the error caused the harm, we don’t have to tell.”
  • “They’re dead anyway, so there’s no point in blaming anyone.”

In 2018 Muel Kaptein and Martien van Helvoort developed a model, called the Amoralisations Alarm Clock, that covers all existing amoralisations in a logical way. Amoralisations, also called neutralisations, or rationalisations, are defined as justifications and excuses for deviant behaviour. Amoralisations are important explanations for the rise and persistence of deviant behaviour. There exist many different and overlapping techniques of amoralisations.

Collective

  • Collective rationalisations are regularly constructed for acts of aggression, based on exaltation of the in-group and demonisation of the opposite side: as Fritz Perls put it, “Our own soldiers take care of the poor families; the enemy rapes them”.
  • Celebrity culture can be seen as rationalising the gap between rich and poor, powerful and powerless, by offering participation to both dominant and subaltern views of reality.

Criticism

Some scientists criticise the notion that brains are wired to rationalise irrational decisions, arguing that evolution would select against spending more nutrients at mental processes that do not contribute to the improvement of decisions such as rationalisation of decisions that would have been taken anyway. These scientists argue that learning from mistakes would be decreased rather than increased by rationalisation, and criticise the hypothesis that rationalisation evolved as a means of social manipulation by noting that if rational arguments were deceptive there would be no evolutionary chance for breeding individuals that responded to the arguments and therefore making them ineffective and not capable of being selected for by evolution.

Psychoanalysis

Ernest Jones introduced the term “rationalisation” to psychoanalysis in 1908, defining it as “the inventing of a reason for an attitude or action the motive of which is not recognized” – an explanation which (though false) could seem plausible. The term (Rationalisierung in German) was taken up almost immediately by Sigmund Freud to account for the explanations offered by patients for their own neurotic symptoms.

As psychoanalysts continued to explore the glossed of unconscious motives, Otto Fenichel distinguished different sorts of rationalisation – both the justifying of irrational instinctive actions on the grounds that they were reasonable or normatively validated and the rationalising of defensive structures, whose purpose is unknown on the grounds that they have some quite different but somehow logical meaning.

Later psychoanalysts are divided between a positive view of rationalisation as a stepping-stone on the way to maturity, and a more destructive view of it as splitting feeling from thought, and so undermining the powers of reason.

Cognitive Dissonance

Leon Festinger highlighted in 1957 the discomfort caused to people by awareness of their inconsistent thought. Rationalisation can reduce such discomfort by explaining away the discrepancy in question, as when people who take up smoking after previously quitting decide that the evidence for it being harmful is less than they previously thought.

What is Delusional Misidentification Syndrome?

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Introduction

Delusional misidentification syndrome is an umbrella term, introduced by Christodoulou (in his book The Delusional Misidentification Syndromes, Karger, Basel, 1986) for a group of delusional disorders that occur in the context of mental and neurological illness.

They all involve a belief that the identity of a person, object, or place has somehow changed or has been altered. As these delusions typically only concern one particular topic, they also fall under the category called monothematic delusions.

Background

This psychopathological syndrome is usually considered to include four main variants:

  • The Capgras delusion is the belief that (usually) a close relative or spouse has been replaced by an identical-looking impostor.
  • The Fregoli delusion is the belief that various people the believer meets are actually the same person in disguise.
  • Intermetamorphosis is the belief that an individual has the ability to take the form of another person in both external appearance and internal personality.
  • Subjective doubles, described by Christodoulou in 1978 (American Journal of Psychiatry 135, 249, 1978), is the belief that there is a doppelgänger or double of themselves carrying out independent actions.

However, similar delusional beliefs, often singularly or more rarely reported, are sometimes also considered to be part of the delusional misidentification syndrome. For example:

  • Mirrored-self misidentification is the belief that one’s reflection in a mirror is some other person.
  • Reduplicative paramnesia is the belief that a familiar person, place, object, or body part has been duplicated. For example, a person may believe that they are in fact not in the hospital to which they were admitted, but an identical-looking hospital in a different part of the country, despite this being obviously false.
  • Cotard’s syndrome is a rare disorder in which people hold a delusional belief that they are dead (either figuratively or literally), do not exist, are putrefying, or have lost their blood or internal organs. In rare instances, it can include delusions of immortality.
  • Syndrome of delusional companions is the belief that objects (such as soft toys) are sentient beings.
  • Clonal pluralisation of the self, where a person believes there are multiple copies of themselves, identical both physically and psychologically, but physically separate and distinct.
  • Clinical lycanthropy is the belief that one is turning or has turned into an animal.

There is considerable evidence that disorders such as the Capgras or Fregoli syndromes are associated with disorders of face perception and recognition. However, it has been suggested that all misidentification problems exist on a continuum of anomalies of familiarity, from déjà vu at one end to the formation of delusional beliefs at the other.

What is Decompensation (Psychology)?

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Introduction

In medicine, decompensation is the functional deterioration of a structure or system that had been previously working with the help of allostatic compensation.

Background

Decompensation may occur due to fatigue, stress, illness, or old age. When a system is “compensated,” it is able to function despite stressors or defects. Decompensation describes an inability to compensate for these deficiencies. It is a general term commonly used in medicine to describe a variety of situations.

Physiology

For example, cardiac decompensation may refer to the failure of the heart to maintain adequate blood circulation, after long-standing (previously compensated) vascular disease (see heart failure). Short-term treatment of cardiac decompensation can be achieved through administration of dobutamine, resulting in an increase in heart contractility via an inotropic effect.

Kidney failure can also occur following a slow degradation of kidney function due to an underlying untreated illness; the symptoms of the latter can then become much more severe due to the lack of efficient compensation by the kidney.

Psychology

In psychology, the term refers to an individual’s loss of healthy defence mechanisms in response to stress, resulting in personality disturbance or psychological imbalance. Some who suffer from narcissistic personality disorder or borderline personality disorder may decompensate into persecutory delusions to defend against a troubling reality.

What are Grandiose Delusions?

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Introduction

Grandiose delusions (GD) – also known as delusions of grandeur or expansive delusions – are a subtype of delusion that occur in patients suffering from a wide range of psychiatric diseases, including two-thirds of patients in manic state of bipolar disorder, half of those with schizophrenia, patients with the grandiose subtype of delusional disorder, and a substantial portion of those with substance abuse disorders.

GDs are characterised by fantastical beliefs that one is famous, omnipotent, wealthy, or otherwise very powerful. The delusions are generally fantastic and typically have a religious, science fictional, or supernatural theme. There is a relative lack of research into GD, in contrast to persecutory delusions and auditory hallucinations. About 10% of healthy people experience grandiose thoughts but do not meet full criteria for a diagnosis of GD.

Signs and Symptoms

According to the DSM-IV-TR diagnostic criteria for delusional disorders, grandiose-type symptoms include exaggerated beliefs of:

  • Self-worth.
  • Power.
  • Knowledge.
  • Identity.
  • Exceptional relationship to a deity or famous person.

For example, a patient who has fictitious beliefs about his or her power or authority may believe himself or herself to be a ruling monarch who deserves to be treated like royalty. There are substantial differences in the degree of grandiosity linked with grandiose delusions in different patients. Some patients believe they are God, the Queen of the United Kingdom, a president’s son, a famous rock star, and some other examples. Others are not as expansive and think they are skilled athletes or great inventors.

Expansive delusions may be maintained by auditory hallucinations, which advise the patient that they are significant, or confabulations, when, for example, the patient gives a thorough description of their coronation or marriage to the king. Grandiose and expansive delusions may also be part of fantastic hallucinosis in which all forms of hallucinations occur.

Positive Functions

Grandiose delusions frequently serve a very positive function by sustaining or increasing their self-esteem. As a result, it is essential to consider the consequences of removing the grandiose delusion on self-esteem when trying to modify the grandiose delusion in therapy. In many instances of grandiosity, it is suitable to go for a fractional rather than a total modification, which permits those elements of the delusion that are central for self-esteem to be preserved. For example, a person who believes they are a senior secret service agent gains a great sense of self-esteem and purpose from this belief, thus until this sense of self-esteem can be provided from elsewhere, it is best not to attempt modification.

Comorbidity

Schizophrenia

Schizophrenia is a mental disorder distinguished by a loss of contact with reality and the occurrence of psychotic behaviours, including hallucinations and delusions (unreal beliefs which endure even when there is contrary evidence). Delusions may include the false and constant idea that the person is being followed or poisoned, or that the person’s thoughts are being broadcast for others to listen to. Delusions in schizophrenia often develop as a response to the individual attempting to explain their hallucinations. Patients who experience recurrent auditory hallucinations can develop the delusion that other people are scheming against them and are dishonest when they say they do not hear the voices that the delusional person believes that he or she hears.

Specifically, grandiose delusions are frequently found in paranoid schizophrenia, in which a person has an extremely exaggerated sense of his or her significance, personality, knowledge, or authority. For example, the person may declare to own a major corporation and kindly offer to write a hospital staff member a check for $5 million if only help them escape from the hospital. Other common grandiose delusions in schizophrenia include religious delusions such as the belief that one is Jesus Christ.

Bipolar Disorder

Refer to Bipolar Disorder.

Bipolar I disorder can lead to severe affective dysregulation, or mood states that sway from exceedingly low (depression) to exceptionally high (mania). In hypomania or mania, some bipolar patients can suffer grandiose delusions. In its most severe manifestation, days without sleep, auditory and other hallucinations, or uncontrollable racing thoughts can reinforce these delusions. In mania, this illness affects emotions and can also lead to impulsivity and disorganised thinking, which can be harnessed to increase their sense of grandiosity. Protecting this delusion can also lead to extreme irritability, paranoia, and fear. Sometimes their anxiety can be so over-blown that they believe others are jealous of them and, thus, undermine their “extraordinary abilities,” persecuting them or even scheming to seize what they already have.

The vast majority of bipolar patients rarely experience delusions. Typically, when experiencing or displaying a stage of heightened excitability called mania, they can experience joy, rage, and other intense emotions that can cycle out of control, along with thoughts or beliefs that are grandiose. Some of these grandiose thoughts can be expressed as strong beliefs that the patient is very rich or famous or has super-human abilities, or can even lead to severe suicidal ideations. In the most severe form, in what was formerly labelled as megalomania, the bipolar patient may hear voices that support these grandiose beliefs. In their delusions, they can believe that they are, for example, a king, a creative genius, or can even exterminate the world’s poverty because of their extreme generosity.

Cause(s)

There are two alternative causes for developing grandiose delusions:

  1. Delusion-as-defence: Defence of the mind against lower self-esteem and depression.
  2. Emotion-consistent: Result of exaggerated emotions.

Anatomical Aspects

Grandiose delusions may be related to lesions of the frontal lobe. Temporal lobe lesions have been mainly reported in patients with delusions of persecution and of guilt, while frontal and frontotemporal involvement have been described in patients with grandiose delusions, Cotard’s syndrome, and delusional misidentification syndrome.

Diagnosis

Patients with a wide range of mental disorders which disturb brain function experience different kinds of delusions, including grandiose delusions. Grandiose delusions usually occur in patients with syndromes associated with secondary mania, such as Huntington’s disease, Parkinson’s disease, and Wilson’s disease. Secondary mania has also been caused by substances such as L-DOPA and isoniazid which modify the monoaminergic neurotransmitter function. Vitamin B12 deficiency, uraemia, hyperthyroidism as well as the carcinoid syndrome have been found to cause secondary mania, and thus grandiose delusions.

In diagnosing delusions, the MacArthur-Maudsley Assessment of Delusions Schedule is used to assess the patient

Treatment

In patients suffering from schizophrenia, grandiose and religious delusions are found to be the least susceptible to cognitive behavioural interventions. Cognitive behavioural intervention is a form of psychological therapy, initially used for depression, but currently used for a variety of different mental disorders, in hope of providing relief from distress and disability. During therapy, grandiose delusions were linked to patients’ underlying beliefs by using inference chaining. Some examples of interventions performed to improve the patient’s state were focus on specific themes, clarification of patient’s neologisms, and thought linkage. During thought linkage, the patient is asked repeatedly by the therapist to explain their jumps in thought from one subject to a completely different one.

Patients suffering from mental disorders that experience grandiose delusions have been found to have a lower risk of having suicidal thoughts and attempts.

Epidemiology

In researching over 1000 individuals of a vast range of backgrounds, Stompe and colleagues (2006) found that grandiosity remains as the second most common delusion after persecutory delusions. A variation in the occurrence of grandiosity delusions in schizophrenic patients across cultures has also been observed. In research done by Appelbaum et al. it has been found that GDs appeared more commonly in patients with bipolar disorder (59%) than in patients with schizophrenia (49%), followed by presence in substance misuse disorder patients (30%) and depressed patients (21%).

A relationship has been claimed between the age of onset of bipolar disorder and the occurrence of GDs. According to Carlson et al. (2000), grandiose delusions appeared in 74% of the patients who were 21 or younger at the time of the onset, while they occurred only in 40% of individuals 30 years or older at the time of the onset.

Prevalence

Research suggests that the severity of the delusions of grandeur is directly related to a higher self-esteem in individuals and inversely related to any individual’s severity of depression and negative self-evaluations. Lucas et al. (1962) found that there is no significant gender difference in the establishment of grandiose delusion. However, there is a claim that ‘the particular content of Grandiose delusions’ may be variable across both genders. Also, it has been noted that the presence of GDs in people with at least grammar or high school education was greater than lesser educated persons. Similarly, the presence of grandiose delusions in individuals who are the eldest is greater than in individuals who are the youngest of their siblings.

What is Parataxical Integration?

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Introduction

First used by Irish-American psychoanalytic psychiatrist Harry Stack Sullivan in the 1940s, Parataxical Integration (a combination of terms) refers to the mutual condition of parataxic distortions (another concept of Sullivan’s).

Parataxical integration exists when two people, usually intimate with each other (i.e. parents and children, spouses, romantic partners, business associates), are reciprocally reactive to each other’s seductions, judgemental inaccuracies, hostile comments, and manipulations or other “triggering” behaviours. One says or does something causing the other to react, setting off a cyclical “ping-pong”, “tit-for-tat”, “you-get-me-and-I-get-you-back” oscillation of verbal and/or behavioural reactions.

Development

The concept first appeared in Sullivan’s The Interpersonal Theory of Psychiatry, published in 1953. It was developed further by his protégé, Lorna Smith Benjamin, in her Interpersonal Diagnosis and Treatment of Personality Disorders (1996). Benjamin saw parataxical integration as typical in the interpersonal behaviour of couples with unresolved autonomy (i.e. separation, boundary) and identity issues. Erik Erikson had himself described the unconscious, reciprocal reactivation (without using Sullivan’s terms) in his essay, “The Problem of Ego Identity,” and in Identity and Anxiety, by Stein et al. (1960).

Usage

Though the term itself is not used in much of the professional peer-reviewed literature, the interpersonal manifestation to which it refers appears regularly in the case study literature of the “family systems” school of psychologists, including Don D. Jackson, Jay Haley, Gregory Bateson, Virginia Satir, and Salvador Minuchin. Parataxical integrations are also presented in similar studies reported by Ronald D. Laing, Aaron Esterson, and anthropologist Jules Henry, largely during the 1950s and 1960s. Harold Searles and Charles McCormack describe manifestations of parataxical integration in their works on borderline personality disorders in the 1980s and 2000s.

Paul Watzlawick et al. describes the concept in his book, Change, noting, “… the circularity of their interaction makes it undecidable … whether a given action is the cause or effect of an action by the other party … either party sees its actions as determined and provoked by the other’s actions …”.

Rodger Garrett also employs the concept in his millennial-era work on borderline personality disorder and family of origin aetiology, typically using the term “reciprocal reactivity” along with it.

Reciprocal reactivity was studied by Gary Sperduto et al. in the 1970s, and it is clear from the abstract of his paper (see below) that his definitional terminology equated to that of Sullivan.

Numerous mass-market psychology authors, many writing about the topic of “co-dependence,” including Melody Beattie, Pia Mellody, Anne Wilson Schaef, and Barry & Janae Weinhold, describe the interpersonal manifestation without using Sullivan’s term per se. Co-dependence expert Pia Mellody describes the behavioural manifestations of parataxical integration at length in an audio presentation available online.

What is Parataxic Distortion?

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Introduction

Parataxic distortion is a psychiatric term first used by Harry S. Sullivan to describe the inclination to skew perceptions of others based on fantasy.

Refer to Parataxical Integration.

Background

The “distortion” is a faulty perception of others, based not on actual experience with the other individual, but on a projected fantasy personality attributed to the individual. For example, when one falls in love, an image of another person as the “perfect match” or “soul mate” can be created when in reality, the other person may not live up to these expectations or embody the imagined traits at all.

The fantasy personality is created in part from past experiences and from expectations as to how the person ‘should be’, and is formulated in response to emotional stress. This stress can originate from the formation of a new relationship, or from cognitive dissonance required to maintain an existing relationship. Parataxic distortion serves as an immature cognitive defence mechanism against this psychological stress and is similar to Transference.

Parataxic distortion is difficult to avoid because of the nature of human learning and interaction. Stereotyping of individuals based on social cues and the classification of people into groups is a commonplace cognitive function of the human mind. Such pigeonholing allows for a person to gain a quick, though possibly inaccurate, assessment of an interaction. The cognitive processes employed, however, can have a distorting effect on the clear understanding of individuals. In essence, one can lose the ability to ‘hear the other’ through one’s own projected beliefs of what the other person is saying.

Etymology

From the Greek παράταξις, “placement side by side”.

Para – A Greek prefix which came to designate objects or activities auxiliary to or derivative of that denoted by the base word ( parody; paronomasia, paranoia) and hence abnormal or defective.

Taxic – indicating movement towards or away from a specified stimulus.

In this sense, Parataxic distortion, is a shift in perception away from reality.

Interpersonal Relationships and Emotions

Distorting one’s perception of others can often interfere with interpersonal relationships. In many cases, however, it may be beneficial to do so. Humans are constantly and subconsciously stereotyping. According to Paul Martin Lester, “our brains naturally classify what we see, we can’t help but notice the differences in physical attributes between one person and another.” Parataxic distortion runs parallel to stereotyping while it remains in the subconscious. As we make quick judgements, we are drawing from previous experiences stored in our memory.

Parataxic distortion can be a beneficial defence mechanism for the individual, allowing the individual to maintain relationships with others with whom he or she would otherwise be unable to interact or allowing the individual to endure difficult periods in relationships. A self-imposed blindness to certain personality traits can keep a relationship healthy, or it can also prove destructive. For instance, parataxic distortion can keep one in denial of the abusive nature of a spouse.

Attachment Theory

Parataxic distortion can begin in the early stages of development in infants. A mother’s nurturing personality and emotional warmth might be projected onto a lover later in life. This could initially generate stronger feelings for the woman than are warranted by her behaviour and character alone. This example of attachment theory correlates with parataxic distortion.

Attachment theory would have it that the fantasy selves projected onto others in parataxic distortion are informed by our long-term attachment patterns. Not only are these imagined traits the resultant of our earliest bonds and unresolved emotional issues from past relationships, but they are recreated in these fantasy selves for the purpose of recreating that past attachment in the present.

Negative Effects

Dealing with current situations or people that relate to a past event, or remind someone of a person from the past, can have negative effects on a human from an emotional standpoint. If the person from the past was a negative figure or the past event had a negative influence on a person, the person may create a self-sense of identity for the new individual they met. The negative emotional response happens when the individual realises that they have been creating a fake identity for the new individual.

Parataxic distortion is most effective in the realm of interpersonal communication. Parataxic distortion is typically used to avoid coping with past events. For example, if a child is mistreated by his or her father, the child may not only attach the fear and anger towards the father but will also relate this fear and anger to other men that look, talk or act like the father. The human mind keeps track of situations that we have encountered in the past to help us deal with future situations. The unconscious memory, without our knowing, helps us understand and deal with situations in the present that we have dealt with in the past. Parataxic distortion and our unconscious mind make us act the same way in current situations as we did in the past, even without realising it.

Defence Mechanism

As a defence mechanism, parataxic distortion protects one from the emotional consequences of a past event. A person may not remember a certain event, or be acting on it consciously, but will act a certain way to protect themselves from an outcome with the use of parataxic distortion. This behaviour is a pathological attempt to cope with reality by using unreality.

Parataxic distortion is a commonly used psychological defence mechanism. It is not an illness or a disease, but a part of everyday, normal human psychology that can become maladaptive in certain situations. The cognitive abilities used to generate internal models of others are useful in interaction. As we can never truly internalise the full reality of another, we must interact with a shorthand version of them. It is only when we believe that the shorthand version is their reality that this ability can become maladaptive. One may also attempt to coerce or force another to ‘fit the mould’ and act more according to expectations, more like the idealised version they dream the other as being. This is also pathological.

However, all humans engage in parataxic distortion to one extent or another, in one realm or another. It may be to manage emotions within their family, to facilitate communication between them and their spouse, or to imagine a relationship between them and their nation-state.

What is Persecutory Delusion?

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Introduction

Persecutory delusions are a set of delusional conditions in which the affected persons believe they are being persecuted, despite a lack of evidence.

Background

Specifically, they have been defined as containing two central elements:

  • The individual thinks that harm is occurring, or is going to occur.
  • The individual thinks that the perceived persecutor has the intention to cause harm.

According to the DSM-IV-TR, persecutory delusions are the most common form of delusions in paranoid schizophrenia, where the person believes “he or she is being tormented, followed, tricked, spied on, or ridiculed”, or that their food is being poisoned. They are also often seen in schizoaffective disorder and, as recognised by DSM-IV-TR, constitute the cardinal feature of the persecutory subtype of delusional disorder, by far the most common.

Delusions of persecution may also appear in manic and mixed episodes of bipolar disorder, polysubstance abuse, and severe depressive episodes with psychotic features, particularly when associated with bipolar illness.

Prevalence

A 2020 study by Sheridan and colleagues gave figures for lifetime prevalence of perceived stalking by groups, a common form of persecutory delusion, at 0.66% for adult women and 0.17% for adult men.

When the focus is to remedy some injustice by legal action, persecutory delusions are sometimes termed “querulous paranoia”.

In cases where reporters of stalking behaviour have been judged to be making false reports, a majority of them were judged to be delusional.

Treatment

Medications for schizophrenia are often used, especially when positive symptoms are present. Both first-generation antipsychotics and second-generation antipsychotics may be useful. Cognitive behavioural therapy (CBT) has also been used.

What is the Menninger Foundation?

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Introduction

The Menninger Foundation was founded in 1919 by the Menninger family in Topeka, Kansas.

The Menninger Clock Tower in Topeka, Kansas (2013).

The Menninger Foundation, known locally as Menninger’s, consists of a clinic, a sanatorium, and a school of psychiatry, all of which bear the Menninger name. Menninger’s consisted of a campus at 5800 S.W. 6th Avenue in Topeka, KS which included a pool as well as the other aforementioned buildings.

In 2003, the Menninger Clinic moved to Houston. The foundation was started in 1919 by Dr. Charles F. Menninger and his sons, Drs. Karl and William Menninger. It represented the first group psychiatry practice. “We had a vision,” Dr. C. F. Menninger said, “of a better kind of medicine and a better kind of world.”

Brief History

The Menninger Clinic, also known as the C. F. Menninger Memorial Hospital, was founded in the 1920s in Topeka, Kansas. The Menninger Sanitarium was founded in 1925. The Menninger Clinic established the Southard School for children in 1926. The school fostered treatment programmes for children and adolescents that were recognised worldwide. In the 1930s the Menningers expanded training programmes for psychiatrists, psychologists, and other mental health professionals.

The Menninger Foundation was established in 1941. The Menninger School of Psychiatry was established in 1946. It quickly became the largest training centre in the country, driven by the country’s demand for psychiatrists to treat military veterans.

Menninger announced its affiliation with Baylor College of Medicine and The Methodist Hospital in December 2002. The concept was that Menninger would perform treatment while Baylor would oversee research and education.

Moves

The Menninger Clinic moved in June 2003 from Topeka, Kansas to its present location in Houston, Texas. The Menninger Clinic again moved to its new location at 12301 S. Main St., Houston, Texas, 77035 in May 2012.

Current Facilities

As of May 2012, The Menninger Clinic offers the following inpatient programmes and services: Adolescent Treatment Programme, a Professionals in Crisis Programme (PIC), the Compass Programme for Young Adults, the Comprehensive Psychiatric Assessment & Stabilisation Programme, an Assessments Service and the Hope Programme for Adults.

Revolution in Psychiatric Education

The Menninger School of Psychiatry and the local Veterans Administration Hospital represented the centre of a psychiatric education revolution. The Clinic and the School became the hub for training professionals in the bio-psycho-social approach. This approach integrated the foundations of medical, psychodynamic, developmental, and family systems to focus on the overall health of patients. For patients, this way of treatment attended to their physical, emotional, and social needs.

Dr. Otto Fleischmann, head of the psychoanalytic institute from 1956 to 1963, was doing psychotherapy behind a one-way vision screen, in full view of all the students.

In 1960 Otto Kernberg joined the Clinic and later become its director until 1965.

Karl Menninger

Dr. Karl Menninger’s first book, The Human Mind (1930), became a bestseller and familiarized the American public with human behaviour. Many Americans also read his subsequent books, including The Vital Balance, Man Against Himself and Love Against Hate.

Will Menninger

Dr. Will Menninger made a major contribution to the field of psychiatry when he developed a system of hospital treatment known as milieu therapy. This approach involved a patient’s total environment in treatment. Dr. Menninger served as Chief of the Army Medical Corps’ Psychiatric Division during World War II. Under his leadership, the Army reduced losses in personnel due to psychological impairment. In 1945, the Army promoted Dr. Menninger to brigadier general. After the war, Dr. Menninger led a national revolution to reform state sanitariums. In 1948, Time magazine featured Dr. Menninger on its cover, lauding him as “psychiatry’s U.S. sales manager.”

Activities

At the Menninger Clinic, staff proceeded to launch new treatment approaches and open specialty programmes. The Menninger Foundation gained a reputation for intensive, individualised treatment, particularly for patients with complex or long-standing symptoms. The treatment approach was multidimensional, addressing a patient’s medical, psychological, and social needs. Numerous independent organisations recognised the Menninger Foundation as a world leader in psychiatric and behavioural health treatment.

US News & World Report listed Houston’s Menninger Clinic #5 in Psychiatry on their annual list of best hospitals. The rankings are based on performance in meeting certain criteria, and are given a grade in each section and an overall scorecard. The eligibility requirements to participate are such that only 165 hospitals were considered for evaluation.

The Menninger Clinic remains one of the primary North American settings supporting psychodynamically informed research on clinical diagnosis, assessment, and treatment. Recently, efforts have been organised around the construct of mentalising, a concept integrating research activities related to attachment, theory of mind, internal representations, and neuroscience.

In the 1960s the Menninger Clinic studied Swami Rama, a noted yogi, specifically investigating his ability to exercise voluntary control of bodily processes (such as heartbeat) which are normally considered non-voluntary (autonomous) as well as Yoga Nidra. It was part of Gardner Murphy’s research programme into creativity and the paranormal, funded by Ittleson Family Foundation.

What is the JED Foundation?

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Introduction

The Jed Foundation (JED) is a non-profit organisation that protects emotional health and prevents suicide for teens and young adults in the United States.

JED partners with high schools and colleges to strengthen their mental health, substance misuse and suicide prevention programmes and systems. They equip teens and young adults with the skills and knowledge to help themselves and each other. They encourage community awareness, understanding and action for young adult mental health.

Brief History

In 1998, we lost our youngest son Jed to suicide. Since then, we have worked to understand this unendurable tragedy. Although suicide was and continues to be a leading cause of death among young adults, schools had no uniform model for preventing suicide on campus. Communities struggled to overcome the shame and secrecy that prevented honest discussion of mental health. Campus prevention programs were limited in scope and priority. In 2000, we founded The Jed Foundation (JED) to surmount these hurdles and launch a blueprint for prevention. Today, JED is the nation’s leading organization dedicated to young adult mental health.

We thank our friends, partners and supporters for making this possible. We thank all of you who have accompanied us on this journey from loss to hope. Your commitment to protecting the lives of young people is transforming the conversation around mental health and mobilizing communities to action. Together we are helping students navigate the emotional challenges of college, prepare for adulthood, and thrive. Donna & Phil Satow.

The JED Foundation is rated 4-stars by Charity Navigator, their highest rating.

Campaigns

JED’s Mental Health Resource Centre

The JED website provides information about common emotional health issues and provides guidance for those concerned about themselves or others.

JED Campus

A nationwide initiative designed to help colleges and universities develop campus-wide systems, programs and policies to support mental health and prevent substance abuse and suicide. Following JED’s Comprehensive Approach, JED Campuses embark on a multi-year strategic partnership with JED to build a safety net for their students. The JED Campus program involves nearly 170 campuses.

Set to Go

A new programme that guides students, families and high school educators through the social, emotional and mental health challenges related to the transition out of high school to college and adulthood. Set to Go currently features a Transition of Care Guide, Right Fit Worksheet and other tools for students and families.

ULifeline

A mental health resource centre for college students that provides information about emotional health issues and the resources available on their campus. It also offers a confidential mental health self-screening tool. Over 1,600 colleges and universities are registered on ULifeline.

Half of Us

An award-winning programme from JED & MTV featuring a library of free-for-use videos including PSAs, celebrities and students talking about their personal experiences with mental health and substance use. Half of Us helps young people feel less alone and encourages them to reach out for help.

Love is Louder

A community-oriented site offering advice, support, and information on well-being and self-care. Co-founded by actress and singer Brittany Snow.

JED also partners with a number of organizations on educational and awareness campaigns and projects and creates guides and tools for professionals, parents and students.

Seize The Awkward

A national campaign in partnership with Ad Council and American Foundation for Suicide Prevention that encourages teens and young adults to “seize the awkward” by reaching out to a friend who may be struggling with mental health problems.

What is an Identified Patient?

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Introduction

Identified patient (IP) is a clinical term often heard in family therapy discussion.

It describes one family member in a dysfunctional family who expresses the family’s authentic inner conflicts. Usually, the “designated patient” expresses their physical symptoms unconsciously, unaware they are making overt dysfunctional family dynamics that have been covert and which no one can talk about at home. Occasionally, the identified patient is partly conscious of why and how they have become the focus of concern in the family system.

As a family systems dynamic, the overt symptoms of identified patient draw attention away from the “elephants in the living room no one can talk about” which need to be discussed, such as a pending separation or divorce. If covert abuse occurs between family members, the overt symptoms can draw attention away from the perpetrator(s).

The identified patient is a kind of diversion and a kind of scapegoat. Often a child, this is “the split-off false carrier of a breakdown in the entire family system,” which may be a transgenerational disturbance or trauma.

In Organisational Management

The term is also used in analysing dysfunction in businesses where an individual becomes the carrier of a group problem.

Origins and Characteristics

The term emerged from the work of the Bateson Project on family homeostasis, as a way of identifying a largely unconscious pattern of behaviour whereby an excess of painful feelings in a family lead to one member being identified as the cause of all the difficulties – a scapegoating of the IP.

The IP – also called the “symptom-bearer” or “presenting problem” – may display unexplainable emotional or physical symptoms, and is often the first person to seek help, perhaps at the request of the family. However, while family members will typically express concern over the IP’s problems, they may instinctively react to any improvement on the IP’s part by attempting to reinstate the status quo.

Virginia Satir the wellspring of family systems theory, who knew Bateson, viewed the identified patient as a way of both concealing and revealing a family’s secret agendas. Conjoint family therapy stressed accordingly the importance in group therapy of bringing not only the identified patient but the extended family in which their problems arose into the therapy – with the ultimate goal of relieving the IP of the broader family feelings he or she has been carrying. In such circumstances, not only the IP but their siblings as well may end up feeling the benefits.

R.D. Laing saw the IP as a function of the family nexus: “the person who gets diagnosed is part of a wider network of extremely disturbed and disturbing patterns of communication.” Later formulations suggest that the patient may be an “emissary” of sorts from the family to the wider world, in an implicit familial call for help, as with the reading of juvenile delinquency as a coded cry for help by a child on his parents’ behalf. There may then be an element of altruism in the IP’s behaviour – ‘playing’ sick to prevent worse things happening in the family, such as a total family breakdown.

Examples

  • In a family where the parents need to assert themselves as powerful figures and caretakers, often due to their own insecurities, they may designate one or more of their children as being inadequate, unconsciously assigning to the child the role of someone who cannot cope by themselves. For example, the child may exhibit some irrational problem requiring the constant care and attention of the parents.
  • In Dibs, an account of a child therapy, Virginia Axline considered that perhaps the parents, “quite unconsciously…chose to see Dibs as a mental defective rather than as an intensified personification of their own emotional and social inadequacy”.
  • Gregory Bateson considered sometimes “the identified patient sacrifices himself to maintain the sacred illusion that what the parent says makes sense”, and that “the identified patient exhibits behaviour which is almost a caricature of that loss of identity which is characteristic of all the family members.”

Criticism

Extending the original concept of the identified patient, the anti-psychiatry movement went on to argue it is the family who is chiefly mad, rather than the individual the family identifies as ‘sick’ – positing also that the latter might in fact be the least disturbed member of the family nexus.

Literary and Biographical

  • In the play The Family Reunion, T.S. Eliot writes of the protagonist: “It is possible You are the consciousness of your unhappy family, Its bird sent flying through the purgatorial flame”.
  • Carl Jung, who viewed individual neurosis as often deriving from whole family or social groups, considered himself a case in point: “I feel very strongly I am under the influence of things or questions left incomplete and unanswered by my parents and grandparents and more distant ancestors…an impersonal karma within a family, which is passed on from parents to children”.