Category: Mental Health

What is Liaison Psychiatry?

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Introduction

Liaison psychiatry, also known as consultative psychiatry or consultation-liaison psychiatry is the branch of psychiatry that specialises in the interface between general medicine/paediatrics and psychiatry, usually taking place in a hospital or medical setting.

The role of the consultation-liaison psychiatrist is to see patients with comorbid medical conditions at the request of the treating medical or surgical consultant or team. Consultation-liaison psychiatry has areas of overlap with other disciplines including psychosomatic medicine, health psychology and neuropsychiatry.

Brief History

The history of liaison psychiatry is partly a history of psychiatry and medicine. Galen was highly influential for over 1500 years in medicine particularly advocating the use of experimentation to advance knowledge. The polymath physician Avicenna produced many insights into medicine but only became influential in Western medicine when William Harvey’s elucidation of the circulatory system forced a re-evaluation of Galen’s work. The French philosopher René Descartes began the dualistic debate on the division between mind and body. Johann Christian August Heinroth is credited with the origination of the term psychosomatic illness. At the beginning of the 19th century Johann Christian Reil created the term psychiatry whilst the polymath Benjamin Rush wrote Diseases of the Mind. The philosopher Spinoza’s concept of conatus, Mesmer’s development of hypnosis together with Charcot’s refinement of this technique influenced Sigmund Freud whose development of psychoanalytic theory was to have a profound impact on the development of liaison psychiatry. Under the guidance of Alan Gregg, psychoanalysis impacted on hospital medicine through figures such as Franz Alexander, Stanley Cobb and Felix Deutsch.

Edward Billings first coined the term “liaison psychiatry.” The publishing of two texts A Handbook of Elementary Psychobiology and Psychiatry, by Billings, and Psychosomatic Medicine, by Edward Weiss and O. Spurgeon English, outlined the theoretical foundations for the developing field. George L. Engel is considered to have been one of the most important figures in the development of liaison psychiatry and coined the term “Biopsychosocial Model” which overcame divisions created by Cartesian Dualism and was to have wider repercussions on psychiatric practice.

United Kingdom

The Faculty of Liaison Psychiatry was established within the Royal College of Psychiatrists in 1997. The European Association for Consultation Liaison Psychiatry and Psychosomatics also produced a set of guidelines for training in Liaison Psychiatry.

A survey for NHS England in 2015 found 133 out of 179 A&E departments could not deliver the minimum core standard for 24/7 liaison psychiatry. 11 hospitals had no liaison psychiatry service, and only 35 delivered at or above the minimum standards. Collectively there was a shortage of 1,270 trained nurses and 230 trained consultants.

United States

The American Psychiatric Association formally recognised C-L psychiatry as a subspecialty in 2004, with its own sub-specialty board exam. The profession debated about the best term for this specialty, finally settling on “Psychosomatic Medicine”.

Scope

Liaison psychiatry usually provides a service to patients in a general medical hospital, either inpatients, outpatients or attenders at the Emergency Department. Referrals are made when the treating medical team has questions about a patient’s mental health, or how that patient’s mental health is affecting their care and treatment. Typical issues include:

  • Patients with medical conditions that cause/exacerbate psychiatric or behavioural problems, such as delirium.
  • Supporting the management of patients with mental disorders who have been admitted for the treatment of medical problems.
  • Assisting with assessment of the capacity of a patient to consent to treatment.
  • Patients who may report physical symptoms as a result of a mental disorder, or patients with medically unexplained physical symptoms.
  • Patients who may not have a psychiatric disorder but are experiencing distress related to their medical problems.
  • Patients who have attempted suicide or self-harm.
  • Assisting with the diagnosis, treatment and functional assessment of people with dementia, including advice on discharge planning or the need for long-term care.

The psychiatric team “liaises” with many other services, including the treating medical team, other mental health services, social services, and community services. There is increasing interest on extending liaison psychiatry to primary care, for the management of long-term medical conditions such as diabetes mellitus.

Effectiveness of Liaison Psychiatry

Consultation-liaison psychiatry helps improve patients’ coping mechanisms, treatment adherence, school/work re-integration and quality of life. An evaluation of the Rapid Assessment, Interface and Discharge (RAID) model of liaison psychiatry – employed at City Hospital, Birmingham – estimated that the service saved between 43 and 64 beds per day through reduced lengths of stay and prevention of readmission. In 2011 the Centre for Mental Health published an economic evaluation of the service, estimating savings of around £3.5 million. This was followed in 2012 by the publication of a report recommending that every NHS hospital should have a liaison psychiatry service as standard.

What is a Mental Health Nurse?

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Introduction

A Mental Health Nurse (MHN), sometimes referred to as a psychiatric nurse, is someone who specialises in the care of patients with mental health issues.

Background

In 2015, MHNs comprised approximately 12% of the total NHS Nursing workforce (Addicott et al., 2015). In order to qualify as a MHN in the UK, a Nursing & Midwifery Council (NMC) accredited nursing degree or diploma is required. Registration must be renewed every three years, for which 450 hours of registered practice and 35 hours of study must have been completed in the past three years. The total number of registered mental health nurses in the UK was 48,130 in 2010, however, since then there has been a slight decrease, as some nurses have transferred over to voluntary and independent providers. MHNs typically work within community or hospital settings, as part of Crisis Assessment and Treatment, inpatient environments and/or community mental health teams.

Roles of a Mental Health Nurse

MHNs act to bridge the gap between mental health services and general practice for patients suffering from acute to chronic mental illnesses. The role of an MHN has gradually transitioned over the years, to encompass a greater level of involvement in patient care e.g. nurses now have authority to prescribe medication. The main responsibilities of a MHN can be subdivided into six broad categories with a certain degree of overlap:

  1. Case management:
    • This consists of tailoring care to the specific needs of an individual.
    • It involves providing interventions in the form of psychotherapy or familial support; arranging other services when required; establishing networks with community agencies; overseeing changes in medication; community integration and actively seeking out people who drop out of services.
  2. Psychosocial interventions:
    • A holistic approach to patient care is required, by which the MHN should build rapport with patients to encourage trust, while listening to and interpreting their needs and concerns.
    • If a patient is having social/financial problems, the MHN may offer advice and interventions e.g. by arranging social events in the community, in order to develop patients’ socials skills and combat feelings of isolation.
    • They may also work with patients’ families and carers, helping to educate them about the burden of mental illness.
  3. Physical health:
    • Long-term mental illness sufferers may have substantial cardiometabolic/ respiratory illnesses.
    • Furthermore, this population is at considerable risk of contracting infections, such as HIV and AIDS.
    • The MHN will prepare and maintain comprehensive patient records, whilst also producing care plans and risk assessments.
    • They must also monitor weight, blood pressure and provide health education and interventions in areas such as diet, smoking and sexual behaviour.
  4. Medication management:
    1. MHN must ensure correct administration of medication, including injections, and monitoring the results of treatment.
  5. Working with dual diagnosis patients, and promoting a ‘recovery’ based approach to care.
  6. Behavioural therapy:
    • Providing evidence-based individual therapy e.g. cognitive behavioural therapy for depression and anxiety.
    • Empathising with distressed patients and applying ‘de-escalation’ techniques to help patients manage their emotions and behaviour better.
    • Encourage patients to take part in therapeutic hobbies such as art or drama.

Reference

Addicott, R., Maguirre, D., Honeyman, M. & Jabbal, J. (2015) Workforce Planning in the NHS. Available from World Wide Web: https://www.kingsfund.org.uk/sites/default/files/field/field_publication_file/Workforce-planning-NHS-Kings-Fund-Apr-15.pdf. [Accessed: 30 May, 2021].

What is a Mental Health Counsellor?

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Introduction

A mental health counsellor (MHC), or counsellor, is a person who works with individuals and groups to promote optimum mental and emotional health.

Such persons may help individuals deal with issues associated with addiction and substance abuse; family, parenting, and marital problems; stress management; self-esteem; and ageing. The United States Bureau of Labour Statistics distinguishes “Mental Health Counsellors” from “Social Workers”, “Psychiatrists“, and “Psychologists“.

Duties

The legal definition of a counsellor, and hence the legal scope of practice, varies with jurisdiction. In some jurisdictions across the US, counsellors, marriage and family therapists, and psychologists have virtually identical definitions: evaluating and treating mental and behavioural disorders. In spite of such definitions, many mental health professionals reject the medical model (which assumes that clients are “disordered”) in favour of broader viewpoints, such as those that emerged from systems psychology.

Service Users

MHCs work with individuals, couples, families, and groups to address and treat emotional and mental disorders and to promote mental health. Most mental health counsellors in the US work in outpatient and residential care centres, individual and family services, and local governments. They are trained in a variety of therapeutic techniques used to address issues, including depression, anxiety, addiction and substance abuse, suicidal impulses, stress, problems with self-esteem, and grief. They also help with job and career concerns, educational decisions, issues related to mental and emotional health, and family, parenting, marital, or other relationship problems. Some career concerns include helping employees who have mental health conditions to manage their health condition whilst adhering to organisational demands to demonstrate performance and commitment to their work. MHCs also continue to play a growing role in the military mental health crisis, helping military personnel and their families deal with issues such as PTSD. MHCs often work closely with other mental health specialists, such as psychiatrists, psychologists, clinical social workers, psychiatric nurses, and school counsellors. Many mental health counsellors look to help their clients have a concise whole body treatment plan that addresses all the needs of the client. In the United States, MHCs diagnose as well as treat mental illness, though the scope of practice for mental health practitioners varies from state to state.

Regulation

United States

Licensing requirements can vary depending on which state a mental health counsellor practices in. Across the United States, mental health counselling licensure is required to independently practice, but can be practiced without a license if under close supervision of a licensed practitioner. Licensing titles for mental health counsellors vary from state to state: Licensed Mental Health Counsellor (LMHC), Licensed Professional Counsellor (LPC), Licensed Professional Clinical Counsellor (LPCC), and various forms of these titles may list differently per state statues. The title “Mental Health Counsellor” (or variation thereof) is often a protected title and thus it may be a violation of state law for persons to hold themselves as such without a proper credential.

A licensed mental health counsellor holds a minimum of a master’s degree in counselling or another closely related field in mental health care. After obtaining a master’s degree, mental health counsellors complete two to three years (depending on various state statutes) of clinical work under the supervision of a licensed or certified mental health professional. The qualifications for licensure are similar to those for marriage and family therapists and for clinical social workers. Becoming a counsellor and using it in daily life to help others to learn more about themselves is not a reason for someone to pursue a degree within this field. Ethics within this profession require the counsellor to remain professional to be able to adequately treat patients. Remaining detached as the witness to a client’s thought, feelings, and emotions can be a hard thing to do, but will ultimately reassure a patient that there are no judgement to what they will share. Guiding a patient to understand themselves and their choices is also another aspect of this profession.

Wellbeing & Productivity

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“Addressing wellbeing at work increases productivity by as much as 12%.” (Mental Health Foundation, 2021).

Reference

Mental Health Foundation. (2021) How to Support Mental Health at Work. Available from World Wide Web: https://www.mentalhealth.org.uk/publications/how-support-mental-health-work. [Accessed: 30 May, 2021].

What is Neurosis?

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Introduction

Neurosis is a class of functional mental disorders involving chronic distress, but neither delusions nor hallucinations. The term is no longer used by the professional psychiatric community in the United States, having been eliminated from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1980 with the publication of DSM III. However, it is still used in the ICD-10 Chapter V F40-48.

Neurosis should not be mistaken for psychosis, which refers to a loss of touch with reality. Nor should it be mistaken for neuroticism, a fundamental personality trait proposed in the Big Five personality traits theory.

Etymology

The term is derived from the Greek word neuron (νεῦρον, ‘nerve’) and the suffix -osis (-ωσις, ‘diseased’ or ‘abnormal condition’).

The term neurosis was coined by Scottish doctor William Cullen in 1769 to refer to “disorders of sense and motion” caused by a “general affection of the nervous system.” Cullen used the term to describe various nervous disorders and symptoms that could not be explained physiologically. Physical features, however, were almost inevitably present, and physical diagnostic tests, such as exaggerated knee-jerks, loss of the gag reflex and dermatographia, were used into the 20th century. The meaning of the term was redefined by Carl Jung and Sigmund Freud over the early and middle 20th century, and has continued to be used in psychology and philosophy.

The DSM eliminated the neurosis category in 1980, because of a decision by its editors to provide descriptions of behaviour rather than descriptions of hidden psychological mechanisms. This change has been controversial. Likewise, according to the American Heritage Medical Dictionary, neurosis is “no longer used in psychiatric diagnosis.”

Symptoms and Causes

Neurosis may be defined simply as a “poor ability to adapt to one’s environment, an inability to change one’s life patterns, and the inability to develop a richer, more complex, more satisfying personality.” There are many different neuroses, including:

According to C. George Boeree, professor emeritus at Shippensburg University, the symptoms of neurosis may involve:

… anxiety, sadness or depression, anger, irritability, mental confusion, low sense of self-worth, etc., behavioral symptoms such as phobic avoidance, vigilance, impulsive and compulsive acts, lethargy, etc., cognitive problems such as unpleasant or disturbing thoughts, repetition of thoughts and obsession, habitual fantasizing, negativity and cynicism, etc. Interpersonally, neurosis involves dependency, aggressiveness, perfectionism, schizoid isolation, socio-culturally inappropriate behaviors, etc.

Jungian Theory

Carl Jung found his approach particularly effective for patients who are well adjusted by social standards but are troubled by existential questions. Jung claims to have “frequently seen people become neurotic when they content themselves with inadequate or wrong answers to the questions of life”. Accordingly, the majority of his patients “consisted not of believers but of those who had lost their faith”. Contemporary man, according to Jung,

…is blind to the fact that, with all his rationality and efficiency, he is possessed by ‘powers’ that are beyond his control. His gods and demons have not disappeared at all; they have merely got new names. They keep him on the run with restlessness, vague apprehensions, psychological complications, an insatiable need for pills, alcohol, tobacco, food — and, above all, a large array of neuroses.

Jung found that the unconscious finds expression primarily through an individual’s inferior psychological function, whether it is thinking, feeling, sensation, or intuition. The characteristic effects of a neurosis on the dominant and inferior functions are discussed in his Psychological Types. Jung also found collective neuroses in politics: “Our world is, so to speak, dissociated like a neurotic.”

Psychoanalytic Theory

According to psychoanalytic theory, neuroses may be rooted in ego defence mechanisms, though the two concepts are not synonymous. Defence mechanisms are a normal way of developing and maintaining a consistent sense of self (i.e. an ego). However, only those thoughts and behaviours that produce difficulties in one’s life should be called neuroses.

A neurotic person experiences emotional distress and unconscious conflict, which are manifested in various physical or mental illnesses; the definitive symptom being anxiety. Neurotic tendencies are common and may manifest themselves as acute or chronic anxiety, depression, an obsessive compulsive disorder, a phobia, or a personality disorder.

Horney’s Theory

In her final book, Neurosis and Human Growth, Karen Horney lays out a complete theory of the origin and dynamics of neurosis. In her theory, neurosis is a distorted way of looking at the world and at oneself, which is determined by compulsive needs rather than by a genuine interest in the world as it is. Horney proposes that neurosis is transmitted to a child from his or her early environment and that there are many ways in which this can occur:

When summarized, they all boil down to the fact that the people in the environment are too wrapped up in their own neuroses to be able to love the child, or even to conceive of him as the particular individual he is; their attitudes toward him are determined by their own neurotic needs and responses.

The child’s initial reality is then distorted by his or her parents’ needs and pretences. Growing up with neurotic caretakers, the child quickly becomes insecure and develops basic anxiety. To deal with this anxiety, the child’s imagination creates an idealised self-image:

Each person builds up his personal idealized image from the materials of his own special experiences, his earlier fantasies, his particular needs, and also his given faculties. If it were not for the personal character of the image, he would not attain a feeling of identity and unity. He idealizes, to begin with, his particular “solution” of his basic conflict: compliance becomes goodness, love, saintliness; aggressiveness becomes strength, leadership, heroism, omnipotence; aloofness becomes wisdom, self-sufficiency, independence. What—according to his particular solution—appear as shortcomings or flaws are always dimmed out or retouched.

Once he identifies himself with his idealised image, a number of effects follow. He will make claims on others and on life based on the prestige he feels entitled to because of his idealised self-image. He will impose a rigorous set of standards upon himself in order to try to measure up to that image. He will cultivate pride, and with that will come the vulnerabilities associated with pride that lacks any foundation. Finally, he will despise himself for all his limitations. Vicious circles will operate to strengthen all of these effects.

Eventually, as he grows to adulthood, a particular “solution” to all the inner conflicts and vulnerabilities will solidify. He will be either:

  • Expansive, displaying symptoms of narcissism, perfectionism, or vindictiveness;
  • Self-effacing and compulsively compliant, displaying symptoms of neediness or codependence; or
  • Resigned, displaying schizoid tendencies.

In Horney’s view, mild anxiety disorders and full-blown personality disorders all fall under her basic scheme of neurosis as variations in the degree of severity and in the individual dynamics. The opposite of neurosis is a condition Horney calls self-realisation, a state of being in which the person responds to the world with the full depth of his or her spontaneous feelings, rather than with anxiety-driven compulsion. Thus the person grows to actualize his or her inborn potentialities. Horney compares this process to an acorn that grows and becomes a tree: the acorn has had the potential for a tree inside it all along.

What is Neuropsychoanalysis?

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Introduction

Neuropsychoanalysis integrates both neuroscience and psychoanalysis, to create a balanced and equal study of the human mind.

This overarching approach began as advances in neuroscience lead to breakthroughs which held pertinent information for the field of psychoanalysis. Despite advantages for these fields to interconnect, there is some concern that too much emphasis on neurobiological physiology of the brain will undermine the importance of dialogue and exploration that is foundational to the field of psychoanalysis. Critics will also point to the qualitative and subjective nature of the field of psychoanalysis, claiming it cannot be fully reconciled with the quantitative and objective nature of neuroscientific research.

However, despite this critique, proponents of the field of neuropsychoanalysis remind critics that the father of psychoanalysis, Sigmund Freud himself, began his career as a neuroanatomist, further arguing that research in this category proves that the psychodynamic effects of the mind are inextricably linked to neural activity in the brain. Indeed, neuroscientific progress has created a shared study of many of the same cognitive phenomenon, and proponents for a distinct field under the heading of neuropsychoanalysis point to the ability for observation of both the subjective mind and empirical evidence in neurobiology to provide greater understanding and greater curative methods.

Therefore, neurospsychoanalysis aims to bring a field, often viewed as belonging more to the humanities than the sciences, into the scientific realm and under the umbrella of neuroscience, distinct from psychoanalysis, and yet adding to the plethora of insight garnered from it.

Brief History

Neuropsychoanalysis as a discipline can be traced as far back as Sigmund Freud’s manuscript, “Project for a Scientific Psychology”. Written in 1895, but only published posthumously, Freud developed his theories of the neurobiological function of the storage of memory in this work. His statement, based on his theory that memory is biologically stored in the brain by, “a permanent alteration following an event”, had a prophetic insight into the empirical discoveries that would corroborate these theories close to 100 years later. Freud speculated that psychodynamics and neurobiology would eventually reunite as one field of study. While time would eventually prove him correct to some degree, the latter half of the 20th century only saw a very gradual movement in this direction with only a few individuals championing this line of thought.

Significant advances in neuroscience throughout the 20th century created a clearer understanding of the functionality of the brain, which have vastly enhanced the way we view the mind. This began in the 1930s with the invention of electroencephalography, which enabled imaging of the brain as never seen before. A decade later the use of dynamic localisation, or the lesion method, further shed light onto the interaction of systems in the brain. Computerised tomography (CT) lead to even greater understanding of the interaction within the brain, and finally the invention of multiple scan technologies in the 1990s, the functional magnetic resonance imaging (fMRI), positron emission tomography (PET), and the single photon emission computed tomography (SPECT) gave researchers empirical evidence of neurobiological processes.

It was in 1999, just before the turn of the century, that the term “neuropsychoanalysis” was used in a new journal entitled with the same name. This term once was hyphenated to indicate that the conjoining of the two fields of study did not suggest that they had been fully integrated, but rather that this new line of scientific inquiry was interdisciplinary. With repeated use, the hyphen was lost, and the name appears as we see it today.

Theoretical Base

Dual-Aspect Monism

Neuropsychoanalysis is best described as a marriage between neuroscience and psychoanalysis. However, its relationship to the broader field of neuropsychology – which relates the biological brain to psychological functions and behaviour – cannot be denied. Indeed, neuropsychoanalysis further seeks to remedy classical neurology’s exclusion of the subjective mind.

The subjective mind, that is, sensations, thoughts, feelings and consciousness, can seem antithetical to the cellular matter that makes up the neurobiology of the brain. Indeed, while Freud is most often credited with being the seminal creator of the study of the mind in modern terms, it was Descartes who concluded that mind and brain were two entirely different kinds of stuff. Accordingly, he invented the “dualism” of the mind, the mind-body dichotomy. Body is one kind of thing, and mind (or spirit or soul) is another. But since this second kind of stuff does not lend itself to scientific inquiry, many of today’s psychologists and neuroscientists have seemingly rejected Cartesian dualism.

Neuropsychoanalysis meets this challenge via dual-aspect monism, sometimes referred to as perspectivism. That is, we are monistic. Our brains, including mind, are made of one kind of stuff, cells, but we perceive this stuff in two different ways.

Psychoanalysis as a Foundation

Perhaps because Freud himself began his career as a neurologist, psychoanalysis has given the field of neuroscience the platform upon which many of its scientific hypotheses were founded. With the field of psychoanalysis suffering from what many see as a decline in innovation and popularity, a call for new approaches and a more scientific methodology is long overdue. The history of neuropsychoanalysis therefore, goes some way in explaining why some consider it the logical conclusion, and representative of an evolution that psychoanalysis was in need of. Since the mind itself is viewed as purely ontological, our appreciation of reality is dependent on neurobiological functions of the brain, which we can use to observe “subjectively,” from inside, how we feel and what we think. Freud refined this kind of observation into free association. He claimed and that this is the best technique that we have for perceiving complex mental functions that simple introspection will not reveal. Through psychoanalysis, we can discover mind’s unconscious functioning.

Neuroscience as a Foundation

Due to the very nature of neuropsychoanalysis, those working in this burgeoning field have been able to draw useful insights from a number of distinguished neuroscientists, indeed many of these now serve on the editorial board of the journal Neuropsychoanalysis. Some of these more notable names foundational to the development of neuropsychoanalysis include:

  • Antonio Damasio.
  • Eric Kandel.
  • Joseph LeDoux.
  • Helen Mayberg.
  • Jaak Panksepp.
  • VS Ramachandran.
  • Oliver Sacks.
  • Mark Solms.

Neuroscientists, often studying the same cognitive functions of the brain as psychoanalysts, do so in quantitative methods such as dissection post mortem, small lesions administered to create certain curative effects, or with the visual and objective aid of brain imaging, all of which enable researchers to trace neurochemical pathways and build a more accurate understanding of the physical functioning of the brain. Another branch of neuroscience also observes the “mind” from outside, that is, by means of neurological examination. This is often done in the form of physical tests, such as questionnaires, the Boston Naming test or Wisconsin Sorting, creating bisecting lines, acting out how one performs daily tasks such as a screwdriver, just to name a few. Neurologists can compare the changes in psychological function that the neurological examination shows with the associated changes in the brain, either post mortem or by means of modern imaging technology. Much of neuroscience aims to break down and tease out the cognitive and biological functions behind both conscious and unconscious actions within the brain. In this way it is no different than psychoanalysis, which has had similar goals since its inception. Therefore, to ignore the additional insight neuroscience can offer psychoanalysis would be to limit a huge source of knowledge that can only enhance psychoanalysis as a whole.

Models of Pathologies

Depression

Heinz Böker and Rainer Krähenman proposed a model depression as dysregulation of the relationship between the self and the other. This psychodynamic model, is related to the neurobiological model of the default mode network, DMN, and the executive network, EN, of the brain, noting experimentally the DMN seemed to be more active in depressed patients. The psychological construct of rumination is conceptualised which is experimentally more common in depressed patients, is viewed as equivalent to the cognitive processing of the self, and therefore the activation of the DMN. Similarly, experimentally measurable constructs of attribution bias are viewed as being related to this “cognitive processing of self”. It has been shown that forms of psychodynamic therapy for depression have effects on the activation of several areas of the brain.

Research Directions

Neuropsychoanalytic relate unconscious (and sometimes conscious) functioning discovered through the techniques of psychoanalysis or experimental psychology to underlying brain processes. Among the ideas explored in recent research are the following:

  • “Consciousness” is limited (5-9 bits of information) compared to emotional and unconscious thinking based in the limbic system.
    • Note: Solm’s book showed as reference in the footnote does not provide such an information.
    • It may be confused with the capacity of short-term memory.
  • Secondary-process, reality-oriented thinking can be understood as frontal lobe executive control systems.
  • Dreams, confabulations, and other expressions of primary-process thinking are meaningful, wish-fulfilling manifestations of the loss of frontal executive control of mesocortical and mesolimbic “seeking” systems.
  • Freud’s “libido” corresponds to a dopaminergic seeking system.
  • Drives can be understood as a series of basic emotions (prompts to action) anchored in pontine regions, specifically the periaqueductal gray, and projecting to cortex: play; seeking; caring; fear; anger; sadness. Seeking is constantly active; the others seek appropriate consummations (corresponding to Freud’s “dynamic” unconscious).
  • Seemingly rational and conscious decisions are driven from the limbic system by emotions which are unconscious.
  • Infantile amnesia (the absence of memory for the first years of life) occurs because the verbal left hemisphere becomes activated later, in the second or third year of life, after the non-verbal right hemisphere.
    • But infants can and do have procedural and emotional memories.
  • Infants’ first-year experiences of attachment and second-year (approximately) experiences of disapproval lay down pathways that regulate emotions and profoundly affect adult personality.
  • Oedipal behaviors (observable in primates) can be understood as the effort to integrate lust systems (testosterone-driven), romantic love (dopamine-driven), and attachment (oxytocin-driven) in relation to key persons in the environment.
  • Differences between the sexes are more biologically-based and less environmentally-driven than Freud believed.

What is Neuropsychiatry?

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Introduction

Neuropsychiatry or Organic Psychiatry is a branch of medicine that deals with mental disorders attributable to diseases of the nervous system.

It preceded the current disciplines of psychiatry and neurology, which had common training, however, psychiatry and neurology have subsequently split apart and are typically practiced separately. Nevertheless, neuropsychiatry has become a growing subspecialty of psychiatry and it is also closely related to the fields of neuropsychology and behavioural neurology.

The Case for the Rapprochement of Neurology and Psychiatry

Given the considerable overlap between these subspecialities, there has been a resurgence of interest and debate relating to neuropsychiatry in academia over the last decade. Most of this work argues for a rapprochement of neurology and psychiatry, forming a specialty above and beyond a subspecialty of psychiatry. For example, Professor Joseph B. Martin, former Dean of Harvard Medical School and a neurologist by training, has summarized the argument for reunion: “the separation of the two categories is arbitrary, often influenced by beliefs rather than proven scientific observations. And the fact that the brain and mind are one makes the separation artificial anyway.” These points and some of the other major arguments are detailed below.

Mind/brain Monism

Neurologists have focused objectively on organic nervous system pathology, especially of the brain, whereas psychiatrists have laid claim to illnesses of the mind. This antipodal distinction between brain and mind as two different entities has characterised many of the differences between the two specialties. However, it has been argued that this division is fictional; evidence from the last century of research has shown that our mental life has its roots in the brain. Brain and mind have been argued not to be discrete entities but just different ways of looking at the same system (Marr, 1982). It has been argued that embracing this mind/brain monism may be useful for several reasons. First, rejecting dualism implies that all mentation is biological, which provides a common research framework in which understanding and treatment of mental disorders can be advanced. Second, it mitigates widespread confusion about the legitimacy of mental illness by suggesting that all disorders should have a footprint in the brain.

In sum, a reason for the division between psychiatry and neurology was the distinction between mind or first-person experience and the brain. That this difference is taken to be artificial by proponents of mind/brain monism supports a merge between these specialties.

Causal Pluralism

One of the reasons for the divide is that neurology traditionally looks at the causes of disorders from an “inside-the-skin” perspective (neuropathology, genetics) whereas psychiatry looks at “outside-the-skin” causation (personal, interpersonal, cultural). This dichotomy is argued not to be instructive and authors have argued that it is better conceptualized as two ends of a causal continuum. The benefits of this position are: firstly, understanding of aetiology will be enriched, in particular between brain and environment. One example is eating disorders, which have been found to have some neuropathology (Uher and Treasure, 2005) but also show increased incidence in rural Fijian school girls after exposure to television (Becker, 2004). Another example is schizophrenia, the risk for which may be considerably reduced in a healthy family environment (Tienari et al., 2004).

It is also argued that this augmented understanding of aetiology will lead to better remediation and rehabilitation strategies through an understanding of the different levels in the causal process where one can intervene. It may be that non-organic interventions, like cognitive behavioural therapy (CBT), better attenuate disorders alone or in conjunction with drugs. Linden’s (2006) demonstration of how psychotherapy has neurobiological commonalities with pharmacotherapy is a pertinent example of this and is encouraging from a patient perspective as the potentiality for pernicious side effects is decreased while self-efficacy is increased.

In sum, the argument is that an understanding of the mental disorders must not only have a specific knowledge of brain constituents and genetics (inside-the-skin) but also the context (outside-the-skin) in which these parts operate (Koch and Laurent, 1999). Only by joining neurology and psychiatry, it is argued, can this nexus be used to reduce human suffering.

Organic Basis

To further sketch psychiatry’s history shows a departure from structural neuropathology, relying more upon ideology (Sabshin, 1990). A good example of this is Tourette syndrome, which Ferenczi (1921), although never having seen a patient with Tourette syndrome, suggested was the symbolic expression of masturbation caused by sexual repression. However, starting with the efficacy of neuroleptic drugs in attenuating symptoms (Shapiro, Shapiro and Wayne, 1973) the syndrome has gained pathophysiological support (e.g. Singer, 1997) and is hypothesized to have a genetic basis too, based on its high inheritability (Robertson, 2000). This trend can be seen for many hitherto traditionally psychiatric disorders (see table) and is argued to support reuniting neurology and psychiatry because both are dealing with disorders of the same system.

Table: Linking Traditional Psychiatric Symptoms or Disorders to Brain Structures and Genetic Abnormalities.

Psychiatric SymptomsPsychodynamic ExplanationNeural CorrelatesSource
DepressionAnger turned inwardLimbic-cortical dysregulation, monoamine imbalanceMayberg (1997)
Bipolar Disorder (Mania)NarcissisticPrefrontal cortex and hippocampus, anterior cingulate, amygdalaBarrett et al. (2003), Vawter, Freed, & Kleinman (2000)
SchizophreniaNarcissistic/escapismNMDA receptor activation in the human prefrontal cortexRoss et al. (2006)
Visual HallucinationProjection, cold distant mother causing a weak egoRetinogeniculocalcarine tract, ascending brainstem modulatory structuresMocellin, Walterfang, Velakoulis, (2006)
Auditory HallucinationProjection, cold distant mother causing a weak egoFrontotemporal functional connectivityShergill et al., 2000
Obsessive Compulsive DisorderHarsh parenting leading to love-hate conflictFrontal-subcortical circuitry, right caudate activitySaxena et al. (1998), Gamazo-Garran, Soutullo and Ortuno (2002)
Eating DisorderAttempted control of internal anxietyAtypical serotonin system, right frontal and temporal lobe dysfunction, changes to mesolimbic dopamine pathwaysKaye et al. (2005), Uher and Treasure (2005), Olsen (2011), Slochower (1987)

This table is in not exhaustive but provides some neurological bases to psychiatric symptoms.

Improved Patient Care

Further, it is argued that this nexus will allow a more refined nosology of mental illness to emerge thus helping to improve remediation and rehabilitation strategies beyond current ones that lump together ranges of symptoms. However, it cuts both ways: traditionally neurological disorders, like Parkinson’s disease, are being recognized for their high incidence of traditionally psychiatric symptoms, like psychosis and depression (Lerner and Whitehouse, 2002). These symptoms, which are largely ignored in neurology, can be addressed by neuropsychiatry and lead to improved patient care. In sum, it is argued that patients from both traditional psychiatry and neurology departments will see their care improved following a reuniting of the specialties.

Better Management Model

Schiffer et al. (2004) argue that there are good management and financial reasons for rapprochement.

US Institutions

Behavioural Neurology & Neuropsychiatry fellowships are accredited by the United Council for Neurologic Subspecialties (UCNS; http://www.ucns.org), in a manner analogous to the accreditation of psychiatry and neurology residencies in the United States by the American Board of Psychiatry and Neurology (ABPN).

The American Neuropsychiatric Association (ANPA) was established in 1988 and is the American medical subspecialty society for neuropsychiatrists. ANPA holds an annual meeting and offers other forums for education and professional networking amongst subspecialists in behavioural neurology & neuropsychiatry as well as clinicians, scientists, and educators in related fields. American Psychiatric Publishing, Inc. publishes the peer-reviewed Journal of Neuropsychiatry and Clinical Neurosciences, which is the official journal of ANPA.

International Organisations

The International Neuropsychiatric Association was established in 1996. INA holds congresses biennially in countries around the world and partners with regional neuropsychiatric associations around the world to support regional neuropsychiatric conferences and to facilitate the development of neuropsychiatry in the countries/regions where those conferences are held.

The British NeuroPsychiatry Association (BNPA) was founded in 1987 and is the leading academic and professional body for medical practitioners and professionals allied to medicine in the UK working at the interface of the clinical and cognitive neurosciences and psychiatry.

Recently, a new non-profit professional society named Neuropsychiatric Forum (NPF) was founded. NPF aims to support effective communication and interdisciplinary collaboration, develop education schemes and research projects, organise neuropsychiatric conferences and seminars.

What is a Psychiatric Hospital?

Published on by Andrew Marshall35 Comments

Introduction

Psychiatric hospitals, also known as mental health units or behavioural health units, are hospitals or wards specialising in the treatment of serious mental disorders, such as major depressive disorder, schizophrenia and bipolar disorder.

Psychiatric hospitals vary widely in their size and grading. Some hospitals may specialise only in short-term or outpatient therapy for low-risk patients. Others may specialise in the temporary or permanent containment of patients who need routine assistance, treatment, or a specialised and controlled environment due to a psychological disorder. Patients often choose voluntary commitment, but those whom psychiatrists believe to pose significant danger to themselves or others may be subject to involuntary commitment and involuntary treatment.

Psychiatric hospitals may also be called psychiatric wards/units (or “psych” wards/units) when they are a subunit of a regular hospital.

The modern psychiatric hospital evolved from and eventually replaced the older lunatic asylum. The treatment of inmates in early lunatic asylums was sometimes brutal and focused on containment and restraint. With successive waves of reform, and the introduction of effective evidence-based treatments, most modern psychiatric hospitals emphasize treatment, and attempt where possible to help patients control their lives in the outside world, with the use of a combination of psychiatric drugs and psychotherapy. Exceptions include Japan, where many psychiatric hospitals still use physical restraints on patients, tying them to their beds for days or even months at a time, and India, where the use of restraint and seclusion is endemic.

Brief History

Modern psychiatric hospitals evolved from, and eventually replaced, the older lunatic asylum. Their development also entails the rise of organised institutional psychiatry.

Hospitals known as bimaristans were built in Persia (old name of Iran) beginning around the early 9th century, with the first in Baghdad under the leadership of the Abbasid Caliph Harun al-Rashid. While not devoted solely to patients with psychiatric disorders, they often contained wards for patients exhibiting mania or other psychological distress. Because of cultural taboos against refusing to care for one’s family members, mentally ill patients would be surrendered to a bimaristan only if the patient demonstrated violence, incurable chronic illness, or some other extremely debilitating ailment. Psychological wards were typically enclosed by iron bars owing to the aggression of some of the patients.

Western Europe would later adopt these views with the advances of physicians like Philippe Pinel at the Bicêtre Hospital in France and William Tuke at the York Retreat in England. They advocated the viewing of mental illness as a disorder that required compassionate treatment that would aid in the rehabilitation of the victim. In the Western world, the arrival of institutionalisation as a solution to the problem of madness was very much an advent of the nineteenth century. The first public mental asylums were established in Britain; the passing of the County Asylums Act 1808 empowered magistrates to build rate-supported asylums in every county to house the many ‘pauper lunatics’. Nine counties first applied, the first public asylum opening in 1812 in Nottinghamshire. In 1828, the newly appointed Commissioners in Lunacy were empowered to license and supervise private asylums. The Lunacy Act 1845 made the construction of asylums in every county compulsory with regular inspections on behalf of the Home Secretary, and required asylums to have written regulations and a resident physician.

At the beginning of the nineteenth century there were a few thousand “sick people” housed in a variety of disparate institutions throughout England, but by 1900 that figure had grown to about 100,000. This growth coincided with the growth of alienism, later known as psychiatry, as a medical specialism. The treatment of inmates in early lunatic asylums was sometimes very brutal and focused on containment and restraint.

In the late 19th and early 20th centuries, terms such as “madness”, “lunacy” or “insanity” – all of which assumed a unitary psychosis – were split into numerous “mental diseases”, of which catatonia, melancholia and dementia praecox (modern day schizophrenia) were the most common in psychiatric institutions.

In 1961 sociologist Erving Goffman described a theory of the “total institution” and the process by which it takes efforts to maintain predictable and regular behaviour on the part of both “guard” and “captor”, suggesting that many of the features of such institutions serve the ritual function of ensuring that both classes of people know their function and social role, in other words of “institutionalising” them. Asylums was a key text in the development of deinstitutionalisation.

With successive waves of reform and the introduction of effective evidence-based treatments, modern psychiatric hospitals provide a primary emphasis on treatment; and further, they attempt – where possible – to help patients control their own lives in the outside world with the use of a combination of psychiatric drugs and psychotherapy. These treatments can be involuntary. Involuntary treatments are among the many psychiatric practices which are questioned by the mental patient liberation movement. Most psychiatric hospitals now restrict internet access and any device that can take photos. In the US state of Connecticut, involuntary patients must be examined annually by a court-appointed psychiatrist. Patients may also apply for release at any time and receive a full hearing on the application.

Types

There are a number of different types of modern psychiatric hospitals, but all of them house people with mental illnesses of widely variable severity. In the United Kingdom, both crisis admissions and medium-term care are usually provided on acute admissions wards. Juvenile or youth wards in psychiatric hospitals or psychiatric wards are set aside for children or youth with mental illness. Long-term care facilities have the goal of treatment and rehabilitation within a short time-frame (two or three years). Another institution for the mentally ill is a community-based halfway house.

Crisis Stabilisation

The crisis stabilisation unit is effectively an emergency department for psychiatry, often treating suicidal, violent, or otherwise critical individuals.

Open Units

Open psychiatric units are not as secure as crisis stabilisation units. They are not used for acutely suicidal persons; instead, the focus in these units is to make life as normal as possible for patients while continuing treatment to the point where they can be discharged. However, patients are usually still not allowed to hold their own medications in their rooms because of the risk of an impulsive overdose. While some open units are physically unlocked, other open units still use locked entrances and exits, depending on the type of patients admitted.

Medium Term

Another type of psychiatric hospital is medium term, which provides care lasting several weeks. Most drugs used for psychiatric purposes take several weeks to take effect, and the main purpose of these hospitals is to monitor the patient for the first few weeks of therapy to ensure the treatment is effective.

Juvenile Wards

Juvenile wards are sections of psychiatric hospitals or psychiatric wards set aside for children or adolescents with mental illness. However, there are a number of institutions specialising only in the treatment of juveniles, particularly when dealing with drug abuse, self-harm, eating disorders, anxiety, depression or other mental illness.

Long-Term Care Facilities

In the UK, long-term care facilities are now being replaced with smaller secure units (some within the hospitals listed above). Modern buildings, modern security, and being locally situated to help with reintegration into society once medication has stabilised the condition are often features of such units. Examples of this include the Three Bridges Unit, in the grounds of St Bernard’s Hospital in West London and the John Munroe Hospital in Staffordshire. However, these modern units have the goal of treatment and rehabilitation to allow for transition back into society within a short time-frame (two or three years). However, not all patients’ treatment can meet this criterion, so the large hospitals mentioned above often retain this role.

These hospitals provide stabilisation and rehabilitation for those who are actively experiencing uncontrolled symptoms of mental disorders such as depression, bipolar disorders, eating disorders, and so on.

Halfway Houses

One type of institution for the mentally ill is a community-based halfway house. These facilities provide assisted living for an extended period of time for patients with mental illnesses, and they often aid in the transition to self-sufficiency. These institutions are considered to be one of the most important parts of a mental health system by many psychiatrists, although some localities lack sufficient funding.

Political Imprisonment

In some countries, the mental institution may be used for the incarceration of political prisoners as a form of punishment. A notable historical example was the use of punitive psychiatry in the Soviet Union and China.

Secure Units

In the UK, criminal courts or the Home Secretary can, under various sections of the Mental Health Act, order the admission of offenders for detainment in a psychiatric hospital, but the term “criminally insane” is no longer legally or medically recognised. Secure psychiatric units exist in all regions of the UK for this purpose; in addition, there are a few specialist hospitals which offer treatment with high levels of security. These facilities are divided into three main categories: High, Medium and Low Secure. Although the phrase “Maximum Secure” is often used in the media, there is no such classification. “Local Secure” is a common misnomer for Low Secure units, as patients are often detained there by local criminal courts for psychiatric assessment before sentencing.

Run by the National Health Service, these facilities which provide psychiatric assessments can also provide treatment and accommodation in a safe hospital environment which prevents absconding. Thus there is far less risk of patients harming themselves or others. The Central Mental Hospital in Dublin performs a similar function

Community Hospital Utilisation

Community hospitals across the United States regularly see mental health discharges. A study of community hospital discharge data from 2003-2011 showed that mental health hospitalisations were increasing for both children (patients aged 0-17 years) and adults (patients aged 18-64). Compared to other hospital utilisation, mental health discharges for children were the lowest while the most rapidly increasing hospitalisations were for adults under 64. Some units have been opened to provide “Therapeutically Enhanced Treatment” and so form a subcategory to the three main unit types.

The general public in the UK are familiar with the names of the High Secure Hospitals due to the frequency that they are mentioned in the news reports about the people who are sent there. Those in the UK include Ashworth Hospital in Merseyside, Broadmoor Hospital in Crowthorne, Berkshire, Rampton Secure Hospital in Retford, Nottinghamshire, and Scotland’s The State Hospital in Carstairs. Northern Ireland and the Isle of Man have their own Medium and Low Secure units but use the mainland facilities for High Secure, to which smaller Channel Islands also transfer their patients as Out of Area (Off-Island Placements) Referrals under the Mental Health Act 1983. Of the three unit types, Medium Secure is most prevalent throughout the UK. As of 2009, there were 27 women-only units in England alone. Irish units include those at prisons in Portlaise, Castelrea and Cork.

Criticism

Hungarian-born psychiatrist Thomas Szasz argued that psychiatric hospitals are like prisons unlike other kinds of hospitals, and that psychiatrists who coerce people (into treatment or involuntary commitment) function as judges and jailers, not physicians. Historian Michel Foucault is widely known for his comprehensive critique of the use and abuse of the mental hospital system in Madness and Civilisation. He argued that Tuke and Pinel’s asylum was a symbolic recreation of the condition of a child under a bourgeois family. It was a microcosm symbolizing the massive structures of bourgeois society and its values: relations of Family-Children (paternal authority), Fault–Punishment (immediate justice), Madness-Disorder (social and moral order).

Erving Goffman coined the term “Total Institution” for mental hospitals and similar places which took over and confined a person’s whole life. Goffman placed psychiatric hospitals in the same category as concentration camps, prisons, military organisations, orphanages, and monasteries. In his book Asylums Goffman describes how the institutionalisation process socialises people into the role of a good patient, someone “dull, harmless and inconspicuous”; in turn, it reinforces notions of chronicity in severe mental illness. The Rosenhan experiment of 1973 demonstrated the difficulty of distinguishing sane patients from insane patients.

Franco Basaglia, a leading psychiatrist who inspired and planned the psychiatric reform in Italy, also defined the mental hospital as an oppressive, locked and total institution in which prison-like, punitive rules are applied, in order to gradually eliminate its own contents. Patients, doctors and nurses are all subjected (at different levels) to the same process of institutionalism. American psychiatrist Loren Mosher noticed that the psychiatric institution itself gave him master classes in the art of the “total institution”: labelling, unnecessary dependency, the induction and perpetuation of powerlessness, the degradation ceremony, authoritarianism, and the primacy of institutional needs over those of the persons whom it was ostensibly there to serve: the patients.

The anti-psychiatry movement coming to the fore in the 1960s has opposed many of the practices, conditions, or existence of mental hospitals; due to the extreme conditions in them. The psychiatric consumer/survivor movement has often objected to or campaigned against conditions in mental hospitals or their use, voluntarily or involuntarily. The mental patient liberation movement emphatically opposes involuntary treatment but it generally does not object to any psychiatric treatments that are consensual, provided that both parties can withdraw consent at any time.

What is Negative Affectivity?

Published on by Andrew Marshall3 Comments

Introduction

Negative affectivity (NA), or negative affect, is a personality variable that involves the experience of negative emotions and poor self-concept.

Refer to Positive Affectivity.

Negative affectivity subsumes a variety of negative emotions, including anger, contempt, disgust, guilt, fear, and nervousness. Low negative affectivity is characterised by frequent states of calmness and serenity, along with states of confidence, activeness, and great enthusiasm.

Individuals differ in negative emotional reactivity. Trait negative affectivity roughly corresponds to the dominant personality factor of anxiety/neuroticism that is found within the Big Five personality traits as emotional stability. The Big Five are characterised as openness, conscientiousness, extraversion, agreeableness, and neuroticism. Neuroticism can plague an individual with severe mood swings, frequent sadness, worry, and being easily disturbed, and predicts the development and onset of all “common” mental disorders. Research shows that negative affectivity relates to different classes of variables: Self-reported stress and (poor) coping skills, health complaints, and frequency of unpleasant events. Weight gain and mental health complaints are often experienced as well.

People who express high negative affectivity view themselves and a variety of aspects of the world around them in generally negative terms. Negative affectivity is strongly related to life satisfaction. Individuals high in negative affect will exhibit, on average, higher levels of distress, anxiety, and dissatisfaction, and tend to focus on the unpleasant aspects of themselves, the world, the future, and other people, and also evoke more negative life events. The similarities between these affective traits and life satisfaction have led some researchers to view both positive and negative affect with life satisfaction as specific indicators of the broader construct of subjective well-being.

Negative affect arousal mechanisms can induce negative affective states as evidenced by a study conducted by Stanley S. Seidner on negative arousal and white noise. The study quantified reactions from Mexican and Puerto Rican participants in response to the devaluation of speakers from other ethnic origins.

Measurement

There are many instruments that can be used to measure negative affectivity, including measures of related concepts, such as neuroticism and trait anxiety. Two frequently used are:

  • PANAS – The Positive and Negative Affect Schedule incorporates a 10-item negative affect scale.
    • The PANAS-X is an expanded version of PANAS that incorporates negative affect subscales for Fear, Sadness, Guilt, Hostility, and Shyness.
  • I-PANAS-SF – The International Positive and Negative Affect Schedule Short Form is an extensively validated brief, cross-culturally reliable 10-item version of the PANAS.
    • Negative Affect items are Afraid, Ashamed, Hostile, Nervous and Upset.
    • Internal consistency reliabilities between .72 and .76 are reported.
    • The I-PANAS-SF was developed to eliminate redundant and ambiguous items and thereby derive an efficient measure for general use in research situations where either time or space are limited, or where international populations are of interest but where English may not be the mother tongue.

Benefits

Studies have indicated that negative affect has important, beneficial impacts on cognition and behaviour. These developments were a departure from earlier psychological research, which was characterised by a unilateral emphasis on the benefits of positive affect. Both states of affect influence mental processes and behaviour.

Benefits of negative affect are present in areas of cognition including perception, judgement, memory and interpersonal personal relations. Since negative affect relies more on cautious processing than pre-existing knowledge, people with negative affect tend to perform better in instances involving deception, manipulation, impression formation, and stereotyping. Negative affectivity’s analytical and detailed processing of information leads to fewer reconstructive-memory errors, whereas positive mood relies on broader schematic to thematic information that ignores detail. Thus, information processing in negative moods reduces the misinformation effect and increases overall accuracy of details. People also exhibit less interfering responses to stimuli when given descriptions or performing any cognitive task.

Judgement

People are notoriously susceptible to forming inaccurate judgments based on biases and limited information. Evolutionary theories propose that negative affective states tend to increase scepticism and decrease reliance on pre-existing knowledge. Consequently, judgemental accuracy is improved in areas such as impression formation, reducing fundamental attribution error, stereotyping, and gullibility. While sadness is normally associated with the hippocampus, it does not produce the same side effects that would be associated with feelings of pleasure or excitement. Sadness correlates with feeling blue or the creation of tears, while excitement may cause a spike in blood pressure and one’s pulse. As far as judgement goes, most people think about how they themselves feel about a certain situation. They will jump right to their current mood when asked a question. However, some mistake this process when using their current mood to justify a reaction to a stimulus. If you are sad, yet only a little bit, chances are your reactions and input will be negative as a whole.

Impression Formation

First impressions are one of the most basic forms of judgments people make on a daily basis; yet judgment formation is a complex and fallible process. Negative affect is shown to decrease errors in forming impressions based on presuppositions. One common judgment error is the halo effect, or the tendency to form unfounded impressions of people based on known but irrelevant information. For instance, more attractive people are often attributed with more positive qualities. Research demonstrates that positive affect tends to increase the halo effect, whereas negative affect decreases it.

A study involving undergraduate students demonstrated a halo effect in identifying a middle-aged man as more likely to be a philosopher than an unconventional, young woman. These halo effects were nearly eliminated when participants were in a negative affective state. In the study, researchers sorted participants into either happy or sad groups using an autobiographical mood induction task in which participants reminisced on sad or happy memories. Then, participants read a philosophical essay by a fake academic who was identified as either a middle-aged, bespectacled man or as a young, unorthodox-looking woman. The fake writer was evaluated on intelligence and competence. The positive affect group exhibited a strong halo effect, rating the male writer significantly higher than the female writer in competence. The negative affect group exhibited almost no halo effects rating the two equally. Researchers concluded that impression formation is improved by negative affect. Their findings support theories that negative affect results in more elaborate processing based upon external, available information.

Fundamental Attribution Error

The systematic, attentive approach caused by negative affect reduces fundamental attribution error, the tendency to inaccurately attribute behaviour to a person’s internal character without taking external, situational factors into account. The fundamental attribution error (FAE) is connected with positive affect since it occurs when people use top-down cognitive processing based on inferences. Negative affect stimulates bottom-up, systematic analysis that reduces fundamental attribution error.

This effect is documented in FAE research in which students evaluated a fake debater on attitude and likability based on an essay the “debater” wrote. After being sorted into positive or negative affect groups, participants read one of two possible essays arguing for one side or another on a highly controversial topic. Participants were informed that the debater was assigned a stance to take in the essay that did not necessarily reflect his views. Still, the positive affect groups rated debaters who argued unpopular views as holding the same attitude expressed in the essay. They were also rated as unlikeable compared to debaters with popular stances, thus, demonstrating FAE. In contrast, the data for the negative affect group displayed no significant difference in ratings for debaters with popular stance and debaters with unpopular stances. These results indicate that positive affect assimilation styles promote fundamental attribution error, and negative affect accommodation styles minimise the error in respect to judging people.

Stereotyping

Negative affect benefits judgement in diminishing the implicit use of stereotypes by promoting closer attention to stimuli. In one study, participants were less likely to discriminate against targets that appeared Muslim when in a negative affective state. After organising participants into positive and negative affect groups, researchers had them play a computer game. Participants had to make rapid decisions to shoot only at targets carrying a gun. Some of the targets wore turbans making them appear Muslim. As expected, there was a significant bias against Muslim targets resulting in a tendency to shoot at them. However, this tendency decreased with subjects in negative affective states. Positive affect groups developed more aggressive tendencies toward Muslims. Researchers concluded that negative affect leads to less reliance on internal stereotypes, thus decreasing judgemental bias.

Gullibility

Multiple studies have shown that negative affectivity has a beneficial role in increasing scepticism and decreasing gullibility. Because negative affective states increase external analysis and attention to details, people in negative states are better able to detect deception.

Researchers have presented findings in which students in negative affective states had improved lie detection compared to students in positive affective states. In a study, students watched video clips of everyday people either lying or telling the truth. First, music was used to induce positive, negative, or neutral affect in participants. Then, experimenters played 14 video messages that had to be identified by participants as true or false. As expected, the negative affect group performed better in veracity judgments than the positive affect group who performed no better than chance. Researchers believe that the negative affect groups detected deception more successfully because they attended to stimulus details and systematically built inferences from those details.

Memory

Memory has been found to have many failures that affect the accuracy of recalled memories. This has been especially pragmatic in criminal settings as eyewitness memories have been found to be less reliable than one would hope. However, the externally focused and accommodative processing of negative affect has a positive effect on the overall improvement of memory. This is evidenced by reduction of the misinformation effect, and the number of false memories reported. The knowledge implies that negative affect can be used to enhance eyewitness memory; however, additional research suggests that the extent to which memory is improved by negative affect does not sufficiently improve eyewitness testimonies to significantly reduce its error.

Misinformation Effect

Negative affect has been shown to decrease susceptibility of incorporating misleading information, which is related to the misinformation effect. The misinformation effect refers to the finding that misleading information presented between the encoding of an event and its subsequent recall influences a witness’s memory. This corresponds to two types of memory failure:

  • Suggestibility:
    • When recollections are influenced by the prodding or expectations of others creating false memories.
  • Misattribution:
    • When a witness gets confused and misattributes the misinformation to the original event.
    • Also defined as the retroactive interference: When later information interferes with the ability to retain previously encoded information.

In Witness of Events

Negative mood is shown to decrease suggestibility error. This is seen through reduced amounts of incorporation of false memories when misleading information is present. On the other hand, positive affect has shown to increase susceptibility to misleading information. An experiment with undergraduate students supported these results. Participants began the study in a lecture hall and witnessed what they thought was an unexpected five-minute belligerent encounter between an intruder and the lecturer. A week later, these participants watched a 10-minute-long video that generated either a positive, negative or neutral mood. They then completed a brief questionnaire about the previous incident between the intruder and lecturer that they witnessed the week earlier. In this questionnaire half of the participants received questions with misleading information and the other half received questions without any misleading information. This manipulation was used to determine if participants were susceptible to suggestibility failure. After 45 minutes of unrelated distractors participants were given a set of true or false questions which tested for false memories. Participants experiencing negative moods reported fewer numbers of false memories, whereas those experiencing positive moods reported a greater amount of false memories. This implies that positive affect promotes integration of misleading details and negative affect reduces the misinformation effect.

In Recall of Past Public Events

People who experience negative affectivity following an event report fewer reconstructive false memories. This was evidenced by two studies conducted around public events. The first surrounded the events of the televised O.J. Simpson trial. Participants were asked to fill out questionnaires three times: one week, two months and a year after the televised verdict. These questionnaires measured participant emotion towards the verdict and the accuracy of their recalled memory of what occurred during the trial. Overall the study found that although participant response to the event outcome did not affect the quantity of remembered information, it did influence the likelihood of false memory. Participants who were pleased with the verdict of the O.J. Simpson trial were more likely to falsely believe something occurred during the trial than those who were displeased with the verdict. Another experiment found the same findings with Red Sox fans and Yankees fans in their overall memory of events that occurred in the final game of a 2004 playoff series in which the Red Sox defeated the Yankees. The study found that the Yankees fans had better memory of events that occurred than the Red Sox fans. The results from both of these experiments are consistent with the findings that negative emotion can lead to fewer memory errors and thus increased memory accuracy of events.

Degree of Enhanced Memory

Although negative affect has been shown to decrease the misinformation effect, the degree to which memory is improved is not enough to make a significant effect on witness testimony. In fact, emotions, including negative affect, are shown to reduce accuracy in identifying perpetrators from photographic line-ups. Researchers demonstrated this effect in an experiment in which participants watched a video that induced either negative emotion or a neutral mood. The two videos were deliberately similar except for the action of interest, which was either a mugging (negative emotion) or a conversation (neutral emotion). After watching one of the two videos participants are shown perpetrator line-ups, which either contained the target perpetrator from the video or a foil, a person that looked similar to the target. The results revealed that the participants who watched the emotion-induced video were more likely to incorrectly identify the innocent foil than to correctly identify the perpetrator. Neutral participants were more likely to correctly identify the perpetrator in comparison to their emotional counterparts. This demonstrates that emotional affect in forensic settings decreases accuracy of eyewitness memory. These findings are consistent with prior knowledge that stress and emotion greatly impair eyewitness ability to recognitive perpetrators.

Interpersonal Benefits

Negative affectivity can produce several interpersonal benefits. It can cause subjects to be more polite and considerate with others. Unlike positive mood, which causes less assertive approaches, negative affectivity can, in many ways, cause a person to be more polite and elaborate when making requests.

Negative affectivity increases the accuracy of social perceptions and inferences. Specifically, high negative-affectivity people have more negative, but accurate, perceptions of the impression they make to others. People with low negative affectivity form overly-positive, potentially inaccurate impression of others that can lead to misplaced trust.

Intergroup Discrimination

A research conducted by Forgas J.P studied how affectivity can influence intergroup discrimination. He measured affectivity by how people allocate rewards to in-group and out-group members. In the procedure, participants had to describe their interpretations after looking at patterns of judgments about people. Afterwards, participants were exposed to a mood induction process, where they had to watch videotapes designed to elicit negative or positive affectivity. Results showed that participants with positive affectivity were more negative and discriminated more than participants with negative affectivity. Also, happy participants were more likely to discriminate between in-group and out-group members than sad participants. Negative affect is often associated with team selection. It is viewed as a trait that could make selecting individuals for a team irrelevant, thus preventing knowledge from becoming known or predicted for current issues that may arise.

Communication

Negative affectivity subconsciously signals a challenging social environment. Negative mood may increase a tendency to conform to social norms.

In a study, college students were exposed to a mood induction process. After the mood induction process, participants were required to watch a show with positive and negative elements. After watching the show, they were asked to engage on a hypothetical conversation in which they “describe the episode (they) just observed to a friend”. Their speech was recorded and transcribed during this task. Results showed that speakers in a negative mood had a better quality descriptions and greater amount of information and details. These results show that negative mood can improve people’s communication skills.

A negative mood is closely linked to better conversation because it makes use of the hippocampus and different regions of the brain. When someone is upset, that individual may see or hear things differently than an individual who is very upbeat and happy all the time. The small details the negative individual picks up may be something completely overlooked before. Anxiety disorders are often associated with over-thinking and ruminating on topics that would seem irrelevant and pointless to an individual without a disorder. Obsessive compulsive disorder (OCD) is one common anxiety trait that allows the affected individual a different insight on how things may appear to be. An individual that makes use of their negative affect has a different view of the world and what goes on in it, thus making their conversations different and interesting to others.

Self-Disclosure

Results of one study show that participants with negative affectivity were more careful with the information they shared with others, being more cautious with who they could trust or not. Researchers found that negative mood not only decreases intimacy levels but also increases caution in placing trust in others.

Enhanced Ability to Experience Feelings

Negative affect is regularly recognised as a “stable, heritable trait tendency to experience a broad range of negative feelings, such as worry, anxiety, self-criticisms, and a negative self-view”. This allows one to feel every type of emotion, which is regarded as a normal part of life and human nature. So, while the emotions themselves are viewed as negative, the individual experiencing them should not be classified as a negative person or depressed. They are going through a normal process and are feeling something that many individuals may not be able to feel or process due to differing problems.

Fit with Evolutionary Psychology

These findings complement evolutionary psychology theories that affective states serve adaptive functions in promoting suitable cognitive strategies to deal with environmental challenges. Positive affect is associated with assimilative, top-down processing used in response to familiar, benign environments. Negative affect is connected with accommodative, bottom-up processing in response to unfamiliar, or problematic environments. Thus, positive affectivity promotes simplistic heuristic approaches that rely on pre-existing knowledge and assumptions. Conversely, negative affectivity promotes controlled, analytic approaches that rely on externally drawn information.

What is Positive Affectivity?

Published on by Andrew Marshall7 Comments

Introduction

Positive affectivity (PA) is a human characteristic that describes how much people experience positive affects (sensations, emotions, sentiments); and as a consequence how they interact with others and with their surroundings.

People with high positive affectivity are typically enthusiastic, energetic, confident, active, and alert. Research has linked positive affectivity with an increase in longevity, better sleep, and a decrease in stress hormones. People with a high positive affectivity have healthier coping styles, more positive self-qualities, and are more goal oriented. Positive affectivity also promotes an open-minded attitude, sociability, and helpfulness.

Those having low levels of positive affectivity (and high levels of negative affectivity) are characterised by sadness, lethargy, distress, and un-pleasurable engagement (see negative affectivity). Low levels of positive affect are correlated with social anxiety and depression, due to decreased levels of dopamine.

Research and Findings

Studies are finding there is a relationship between dopamine release and positive affect in cognitive abilities. For instance, when dopamine levels are low, positive affect can stimulate the release of more dopamine, temporarily increasing cognitive, motor, and emotional processing. Stimulating dopamine release influences several cognitive functions. First, an increase in dopamine in the nigrostriatal system can temporarily relieve motor or cognitive dysfunction, due to Parkinson’s.

An increase in dopamine release also influences the mesocorticolimbic system, via ventral tegmental area (VTA) cells, increasing mood and open mindedness in older adults. Positive affect also stimulates dopamine production in the prefrontal cortex and the anterior cingulate facilities, which help with processing working memory and executive attention. Lastly, PA indirectly improves memory consolidation in the hippocampus, by increasing acetylcholine release from an increase in dopamine.

Overall, positive affect results in a more positive outlook, increases problem solving skills, increases social skills, increases activity and projects, and can play a role in motor function.

Relationship with Negative Affectivity

Refer to Negative Affectivity.

Positive affectivity (PA) and negative affectivity (NA) are nearly independent of each other; it is possible for a person to be high in both PA and NA, high in one and low in the other, or low in both. Affectivity has been found to be moderately stable over time and across situations (such as working versus relaxing). Positive affectivity may influence an individual’s choices in general, particularly their responses to questionnaires.

Relationship with Happiness, Self-Esteem and Extraversion

Happiness, a feeling of well-being, and high levels of self-esteem are often associated with high levels of positive affectivity, but they are each influenced by negative affectivity as well. Trait PA roughly corresponds to the dominant personality factors of extraversion; however, this construct is also influenced by interpersonal components.

Testing

Because there is not a hard-and-fast rule for defining certain levels of positive affectivity, different self-reported assessments use different scales of measure. Several prominent tests are listed below; in each of these, the respondent determines the degree to which a given adjective or phrase accurately characterizes him or her.

  • Differential Emotions Scale (DES): A PA scale that assesses enjoyment (happy or joyful feelings) and interest (excitement, alertness, curiosity).
  • Multiple Affect Adjective Checklist – Revised (MAACL-R): Measures PA according to the DES scale and to an additional scale assessing thrill-seeking behaviour (i.e. how daring or adventurous the person is).
  • Profile of Mood States (POMS): Uses vigour scale to assess the domain of PA.
  • Expanded Form of the Positives and Negative Affect Schedule (PANAS-X): This test uses three main scales:
    • Joviality (how cheerful, happy, or lively);
    • Self-assurance (how confident and strong); and
    • Attentiveness (alertness and concentration).
  • International Positive and Negative Affect Schedule Short-Form (I-PANAS-SF): This is a brief, 10-item version of the PANAS that has been developed and extensively validated for use in English with both native and non-native English speakers.
    • Internal consistency reliability for the 5-item PA scale is reported to range between .72 and .78.

In Business Management

Positive affectivity is a managerial and organisational behaviour tool used to create positive environments in the workplace. Through the use of PA, the manager can induce a positive employee experience and culture. “Since affectivity is related to the employee experiences, we expect the employees with high PA to feel considerable organizational support. Their optimism and confidence also helps them discuss their views in a manner characterised by constructive controversy with their supervisor, so that problems are solved and their positive feelings confirmed”. Positive Affectivity allows creative problem solving to flourish in an environment where employees are not intimidated to approach managers, therefore employees believe they are playing a key role in the organisation in coming forward with solutions. The goal is to maximise PA and minimise any negative affectivity circulating in the business. Negative emotions, such as fear, anger, stress, hostility, sadness, and guilt, increase the predictability of workplace deviance, and therefore reduce the productivity of the business.

Effects

Positive affectivity is an integral part of everyday life. PA helps individuals to process emotional information accurately and efficiently, to solve problems, to make plans, and to earn achievements. The broaden-and-build theory of PA suggests that PA broadens people’s momentary thought-action repertoires and builds their enduring personal resources.

Research shows that PA relates to different classes of variables, such as social activity and the frequency of pleasant events. PA also strongly relates to life satisfaction. The high energy and engagement, optimism, and social interest characteristic of high-PA individuals suggest that they are more likely to be satisfied with their lives. In fact, the content similarities between these affective traits and life satisfaction have led some researchers to view both PA, NA, and life satisfaction as specific indicators of the broader construct of subjective well-being.

PA may influence the relationships between variables in organizational research. PA increases attentional focus and behavioural repertoire, and these enhanced personal resources can help to overcome or deal with distressing situations. These resources are physical (e.g. better health), social (e.g. social support networks), and intellectual and psychological (e.g. resilience, optimism, and creativity).

PA provides a psychological break or respite from stress, supporting continued efforts to replenish resources depleted by stress. Its buffering functions provide a useful antidote to the problems associated with negative emotions and ill health due to stress, as PA reduces allostatic load. Likewise, happy people are better at coping. McCrae and Costa concluded that PA was associated with more mature coping efforts.