Mental Health Matters

On This Day … 21 June

Published on 06/21/202106/16/2021 by Andrew MarshallLeave a comment

People (Births)

1880 – Arnold Gesell, American psychologist and paediatrician (d. 1961).
1924 – Jean Laplanche, French psychoanalyst and academic (d. 2012).

Arnold Gesell

Doctor Arnold Lucius Gesell (21 June 1880 to 29 May 1961) was an American clinical psychologist, paediatrician and professor at Yale University known for his research and contributions to the field of child development.

Gesell served as a teacher and high school principal before seeking his psychological doctorate at Clark University, where the university’s president, G. Stanley Hall, had founded a child study movement. Arnold received his PhD from Clark in 1906.

Gessell worked at several educational facilities in New York City and Wisconsin before obtaining a professorship at the Los Angeles State Normal School, now known as The University of California, Los Angeles(UCLA)). There he met fellow teacher Beatrice Chandler who would become his wife. They later had a daughter and a son, Federal District Judge Gerhard Gesell.

Gesell also spent time at schools for the mentally disabled, including the Vineland Training School in New Jersey. Having developed an interest in the causes and treatment of childhood disabilities, Gesell began studying at the University of Wisconsin Medical School to better understand physiology. He later served as an assistant professor at Yale University while continuing to study medicine. He developed the Clinic of Child Development there and received his M.D. in 1915. He was later given a full professorship at Yale.

Gesell also served as the school psychologist for the Connecticut State Board of Education and helped to develop classes to help children with disabilities succeed. This historic appointment made Dr. Gesell the first school psychologist in the US He wrote several books, including The Preschool Child from the Standpoint of Public Hygiene and Education in 1923, The Mental Growth of the Preschool Child in 1925 (which was also published as a film), and An Atlas of Infant Behaviour (chronicling typical milestones for certain ages) in 1934. He co-authored with Frances Ilg two childrearing guides, Infant and Child in the Culture of Today in 1943, and The Child from Five to Ten in 1946.

Gesell made use of the latest technology in his research. He used the newest in video and photography advancements. He also made use of one-way mirrors when observing children, even inventing the Gesell dome, a one-way mirror shaped as a dome, under which children could be observed without being disturbed. In his research he studied many children, including Kamala, the wolf girl. He also did research on young animals, including monkeys.

As a psychologist, Gesell wrote and spoke about the importance of both nature and nurture in child development. He cautioned others not to be quick to attribute mental disabilities to specific causes. He believed that many aspects of human behaviour, such as handedness and temperament were heritable. He explained that children adapted to their parents as well as to one another. He advocated for a nationwide nursery school system in the United States.

Gesell’s popular books spread his ideas beyond academia. His core message, urging parents to “nourish the child’s trustfulness in life”, resonated with child advocates long before Dr. Benjamin Spock became America’s most prominent parental advisor. In The Child from Five to Ten, Gesell wrote, “It is no longer trite to say that children are the one remaining hope of mankind. . . If we could but capture their transparent honesty and sincerities! They still have much to teach us, if we observe closely enough”.

Gesell’s ideas came to be known as Gesell’s Maturational Theory of child development. Based on his theory, he published a series of summaries of child development sequences, called the Gesell Developmental Schedules.

The Gesell Institute of Human Development, named after him, was started by his colleagues from the Clinic of Child Development, Frances Ilg and Louise Bates Ames in 1950, after Gesell retired from the university in 1948. In 2012, the institute was renamed the Gesell Institute of Child Development.

Jean Laplanche

Jean Laplanche (21 June 1924 to 06 May 2012) was a French author, psychoanalyst and winemaker. Laplanche is best known for his work on psychosexual development and Sigmund Freud’s seduction theory, and wrote more than a dozen books on psychoanalytic theory. The journal Radical Philosophy described him as “the most original and philosophically informed psychoanalytic theorist of his day.”

From 1988 to his death, Laplanche was the scientific director of the German to French translation of Freud’s complete works (Oeuvres Complètes de Freud/Psychanalyse – OCF.P) in the Presses Universitaires de France, in association with André Bourguignon, Pierre Cotet and François Robert.

Laplanche attended the École Normale Supérieure in the 1940s, studying philosophy. He was a student of Jean Hyppolite, Gaston Bachelard and Maurice Merleau-Ponty. In 1943, during the Vichy regime, Laplanche joined the French Resistance, and was active in Paris and Bourgogne. In 1946-1947, he visited Harvard University for a year. Instead of joining that university’s philosophy department, he instead studied at the Department of Social Relations, and became interested in psychoanalytic theory. After returning to France, Laplanche began attending lectures and undergoing psychoanalytic treatment under Jacques Lacan. Laplanche, advised by Lacan, began studying medicine, and eventually earned his doctorate and became an analyst himself, joining the International Psychoanalytical Association, of which he remained a member until his death.

On This Day … 20 June

Published on 06/20/202106/15/2021 by Andrew MarshallLeave a comment

People (Births)

1884 – Johannes Heinrich Schultz, German psychiatrist and psychotherapist (d. 1970).

People (Deaths)

1925 – Josef Breuer, Austrian physician and psychologist (b. 1842).

Johannes Heinrich Schultz

Johannes Heinrich Schultz (20 June 1884 to 19 September 1970) was a German psychiatrist and an independent psychotherapist. Schultz became world-famous for the development of a system of self-hypnosis called autogenic training.

Life

He studied medicine in Lausanne, Göttingen (where he met Karl Jaspers) and Breslau. He earned his doctorate from Göttingen in 1907. After receiving his medical license in 1908, he practiced at the polyclinic at the Medical University Clinic at Göttingen until 1911. Afterwards he worked at the Paul-Ehrlich Institute in Frankfurt, at the insane asylum at Chemnitz and finally at the Psychiatric University Clinic at Jena under Otto Binswanger, where he earned his habilitation in 1915.

During the First World War, he served as director of a sanitorium in Belgium. In 1919 he became a professor of Psychiatry and Neuropathology at Jena. In 1920 he became Chief Doctor and scientific leader at Dr. Heinrich Lahmann’s sanatorium Weisser Hirsch in Dresden. In 1924, he established himself as a psychiatrist in Berlin.

From 1925-26 he was a member of the founding committee for the first General Doctors’ Congress for Psychotherapy, board member of the General Medical Society for Psychotherapy (established in 1927). From 1928 he advised the organisation’s newsletter, and after 1930 he co-edited (with Arthur Kronfeld and Rudolf Allers) the journal, now named the Zentralblatt für Psychotherapie. In 1933 he became a board member of the renamed German Medical Society for Psychotherapy under Matthias Heinrich Göring and from 1936 under this vice-director a board member of the German Institute for Psychological Research and Psychotherapy (Deutsches Institut für psychologische Forschung und Psychotherapie) as well as director of the polyclinic.

Nazi Period

In 1933 he began research on his guidebook on sexual education, Geschlecht, Liebe, Ehe, in which he focused on homosexuality and explored the topics of sterilisation and euthanasia. In 1935 he published an essay titled Psychological consequences of sterilisation and castration among men, which supported compulsory sterilization of men in order to eliminate hereditary illnesses. Soon after he was appointed deputy director of the Göring Institute in Berlin, which was the headquarters of the Deutsches Institut für psychologische Forschung und Psychotherapie (German institute for psychological research and psychotherapy).

Through this institute, he had an active role in the extermination of mentally handicapped individuals in the framework of the Aktion T4 programme.

There he began to test many of his theories on homosexuality. Schultz strongly believed that homosexuality generally was not hereditary and that most homosexuals became so through perversion. He stated on numerous occasions that homosexuals displayed “scrubby and stunted forms of personality development”. Consequently, he also believed that homosexuality was curable through intense psychotherapy. During his time at the Göring Institute, 510 homosexuals were recorded to have received numerous psychotherapeutic treatments and 341 were deemed to be cured by the end of the treatments. Most of his subjects were convicted homosexuals brought in from concentration camps. After treating his patients, Schultz tested the treatments’ effectiveness by forcing them to have sex with prostitutes. In a case study he later released, in which he briefly discussed the process of determining whether a young SS soldier, who had been sentenced to death for homosexual acts, was ‘cured’, Schultz stated: “Those who were considered incurable were sent back to the concentration camps, but ‘cured’ homosexuals, such as the previously mentioned SS soldier, were pardoned and released into military service”. In this way Schultz actually saved numerous accused homosexuals from the hellish life of a concentration camp but he stated later that “successfully treated subjects were sent to the front, where they most probably were killed in action”.

After the war, the Göring Institute was disbanded but Schultz faced no repercussions for his more dubious research and methods during the past decade. In fact he released a case study on his work with homosexuals in 1952 titled Organstörungen und Perversionen im Liebesleben, in which he admitted to the inhumanity of some of his experiments but also still supported their results. In fact he continued to support his findings and even continued to advocate paragraph 175 for the rest of his life.

In 1956, he became editor of the journal Psychotherapie, and in 1959 founder of the German Society for Medical Hypnosis (Deutschen Gesellschaft für ärztliche Hypnose).

Josef Breuer

Josef Breuer (15 January 1842 to 20 June 1925) was a distinguished physician who made key discoveries in neurophysiology, and whose work in the 1880s with his patient Bertha Pappenheim, known as Anna O., developed the talking cure (cathartic method) and laid the foundation to psychoanalysis as developed by his protégé Sigmund Freud.

Neurophysiology

Breuer, working under Ewald Hering at the military medical school in Vienna, was the first to demonstrate the role of the vagus nerve in the reflex nature of respiration. This was a departure from previous physiological understanding, and changed the way scientists viewed the relationship of the lungs to the nervous system. The mechanism is now known as the Hering–Breuer reflex.

Independent of each other in 1873, Breuer and the physicist and mathematician Ernst Mach discovered how the sense of balance (i.e. the perception of the head’s imbalance) functions: that it is managed by information the brain receives from the movement of a fluid in the semicircular canals of the inner ear. That the sense of balance depends on the three semicircular canals was discovered in 1870 by the physiologist Friedrich Goltz, but Goltz did not discover how the balance-sensing apparatus functions.

What is Dissaffection?

Published on 06/18/202106/18/2021 by Andrew Marshall1 Comment

Introduction

The term disaffectation was coined by noted French psychoanalyst Joyce McDougall as a strictly psychoanalytic term for alexithymia, a neurological condition characterised by severe lack of emotional awareness.

Background

McDougall felt that alexithymia had become too strongly classified as a neuroanatomical defect and concretised as an intractable illness leaving little room for a purely psychoanalytic explanation for this phenomenon.

In coining the term McDougall hoped to indicate the behaviour of people who had experienced overwhelming emotion that threatened to attack their sense of integrity and identity. Such individuals, unable to repress the ideas linked to emotional pain and equally unable to project these feelings delusively onto representations of other people, simply ejected them from consciousness by “pulverizing all trace of feeling, so that an experience which has caused emotional flooding is not recognized as such and therefore cannot be contemplated”. They were not suffering from an inability to experience or express emotion, but from “an inability to contain and reflect over an excess of affective experience.”

‘Disaffectation’ conveys a deliberate double meaning. The Latin prefix dis-, indicates separation or loss and suggests, metaphorically, that certain people are psychologically separated from their emotions and may have “lost” the capacity to be in touch with interior psychic reality. Also included in this prefix is the secondary meaning from the Greek dys- with its implication of illness.

According to Professor of Psychiatry of the University of Toronto, Graeme Taylor, this psychoanalytic conceptualisation departs from older, less applicable theories which emphasized the role of unconscious neurotic conflicts, and instead facilitates a psychoanalytic model of physical illness and disease based on the operation of primitive pre-neurotic pathology that has failed to achieve psychic representation. Henry Krystal Professor of Psychiatry at Michigan State University agreed, adding that it is useful to separate the consideration of psychotherapy for the “disaffected” individual from that of the classical psychosomatic neuroses. To Krystal this consideration is important because “since these patients may develop serious, even occasionally fatal exacerbations of illness during psychotherapy, treating them with psychotherapy for psychosomatic illness is not indicated”. This distinction has allowed the field of psychoanalysis to contribute constructively to the field of psychosomatic medicine.

What is the Diathesis-Stress Model?

Published on 06/18/202101/13/2023 by Andrew Marshall4 Comments

Introduction

The diathesis-stress model, also known as the vulnerability-stress model, is a psychological theory that attempts to explain a disorder, or its trajectory, as the result of an interaction between a predispositional vulnerability, the diathesis, and a stress caused by life experiences. The term diathesis derives from the Greek term (διάθεσις) for a predisposition, or sensibility. A diathesis can take the form of genetic, psychological, biological, or situational factors. A large range of differences exists among individuals’ vulnerabilities to the development of a disorder.

The diathesis, or predisposition, interacts with the individual’s subsequent stress response. Stress is a life event or series of events that disrupts a person’s psychological equilibrium and may catalyse the development of a disorder. Thus the diathesis-stress model serves to explore how biological or genetic traits (diatheses) interact with environmental influences (stressors) to produce disorders such as depression, anxiety, or schizophrenia. The diathesis-stress model asserts that if the combination of the predisposition and the stress exceeds a threshold, the person will develop a disorder. The use of the term diathesis in medicine and in the specialty of psychiatry dates back to the 1800s; however, the diathesis-stress model was not introduced and used to describe the development of psychopathology until it was applied to explaining schizophrenia in the 1960s by Paul Meehl.

The diathesis-stress model is used in many fields of psychology, specifically for studying the development of psychopathology. It is useful for the purposes of understanding the interplay of nature and nurture in the susceptibility to psychological disorders throughout the lifespan. Diathesis-stress models can also assist in determining who will develop a disorder and who will not. For example, in the context of depression, the diathesis-stress model can help explain why Person A may become depressed while Person B does not, even when exposed to the same stressors. More recently, the diathesis-stress model has been used to explain why some individuals are more at risk for developing a disorder than others. For example, children who have a family history of depression are generally more vulnerable to developing a depressive disorder themselves. A child who has a family history of depression and who has been exposed to a particular stressor, such as exclusion or rejection by his or her peers, would be more likely to develop depression than a child with a family history of depression that has an otherwise positive social network of peers. The diathesis-stress model has also served as useful in explaining other poor (but non-clinical) developmental outcomes.

Protective factors, such as positive social networks or high self-esteem, can counteract the effects of stressors and prevent or curb the effects of disorder. Many psychological disorders have a window of vulnerability, during which time an individual is more likely to develop disorder than others. Diathesis-stress models are often conceptualised as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. The differential susceptibility hypothesis is a recent theory that has stemmed from the diathesis-stress model.

Refer to Differential Susceptibility Hypothesis, Differential Susceptibility, and Vantage Sensitivity.

Diathesis

The term diathesis is synonymous with vulnerability, and variants such as “vulnerability-stress” are common within psychology. A vulnerability makes it more or less likely that an individual will succumb to the development of psychopathology if a certain stress is encountered. Diatheses are considered inherent within the individual and are typically conceptualised as being stable, but not unchangeable, over the lifespan. They are also often considered latent (i.e. dormant), because they are harder to recognise unless provoked by stressors.

Diatheses are understood to include genetic, biological, physiological, cognitive, and personality-related factors. Some examples of diatheses include genetic factors, such as abnormalities in some genes or variations in multiple genes that interact to increase vulnerability. Other diatheses include early life experiences such as the loss of a parent, or high neuroticism. Diatheses can also be conceptualised as situational factors, such as low socio-economic status or having a parent with depression.

Stress

Stress can be conceptualised as a life event that disrupts the equilibrium of a person’s life. For instance, a person may be vulnerable to become depressed, but will not develop depression unless they are exposed to a specific stress, which may trigger a depressive disorder. Stressors can take the form of a discrete event, such the divorce of parents or a death in the family, or can be more chronic factors such as having a long-term illness, or ongoing marital problems. Stresses can also be related to more daily hassles such as school assignment deadlines. This also parallels the popular (and engineering) usage of stress, but note that some literature defines stress as the response to stressors, especially where usage in biology influences neuroscience.

It has been long recognised that psychological stress plays a significant role in understanding how psychopathology develops in individuals. However, psychologists have also identified that not all individuals who are stressed, or go through stressful life events, develop a psychological disorder. To understand this, theorists and researchers explored other factors that affect the development of a disorder and proposed that some individuals under stress develop a disorder and others do not. As such, some individuals are more vulnerable than others to develop a disorder once stress has been introduced. This led to the formulation of the diathesis-stress model.

Genetics

Sensory processing sensitivity (SPS) is a temperamental or personality trait involving “an increased sensitivity of the central nervous system and a deeper cognitive processing of physical, social and emotional stimuli”. The trait is characterised by “a tendency to ‘pause to check’ in novel situations, greater sensitivity to subtle stimuli, and the engagement of deeper cognitive processing strategies for employing coping actions, all of which is driven by heightened emotional reactivity, both positive and negative”.

Sensory processing sensitivity captures sensitivity to environment in a heritable, evolutionary-conserved trait, associated with increased information processing in the brain. Moderating sensitivity to environments in a for-better-and-for-worse fashion. Interaction with negative experiences increases risk for psychopathology. Whereas interaction with positive experiences (including interventions), increases positive outcomes. Mast cells are long-lived tissue-resident cells with an important role in many inflammatory settings including host defence to parasitic infection and in allergic reactions. Stress is known to be a mast cell activator.

There is evidence that children exposed to prenatal stress may experience resilience driven by epigenome-wide interactions.” Early life stress interactions with the epigenome show potential mechanisms driving vulnerability towards psychiatric illness. ancestral stress alters lifetime mental health trajectories via epigenetic regulation.

Carriers of congenital adrenal hyperplasia have a predeposition to stress, due to the unique nature of this gene. True rates of prevalence are not known but common genetic variants of the human Steroid 21-Hydroxylase Gene (CYP21A2) are related to differences in circulating hormone levels in the population.

Psychological distress is a known feature of generalised joint hypermobility (gJHM), as well as of its most common syndromic presentation, namely Ehlers-Danlos syndrome, hypermobility type (a.k.a. joint hypermobility syndrome – JHS/EDS-HT), and significantly contributes to the quality of life of affected individuals. Interestingly, in addition to the confirmation of a tight link between anxiety and gJHM, preliminary connections with depression, attention deficit (and hyperactivity) disorder, autism spectrum disorders, and obsessive-compulsive personality disorder were also found.

Protective Factors

Protective factors, while not an inherent component of the diathesis-stress model, are of importance when considering the interaction of diatheses and stress. Protective factors can mitigate or provide a buffer against the effects of major stressors by providing an individual with developmentally adaptive outlets to deal with stress. Examples of protective factors include a positive parent-child attachment relationship, a supportive peer network, and individual social and emotional competence.

Throughout the Lifespan

Many models of psychopathology generally suggest that all people have some level of vulnerability towards certain mental disorders, but posit a large range of individual differences in the point at which a person will develop a certain disorder. For example, an individual with personality traits that tend to promote relationships such as extroversion and agreeableness may engender strong social support, which may later serve as a protective factor when experiencing stressors or losses that may delay or prevent the development of depression. Conversely, an individual who finds it difficult to develop and maintain supportive relationships may be more vulnerable to developing depression following a job loss because they do not have protective social support. An individual’s threshold is determined by the interaction of diatheses and stress.

Windows of vulnerability for developing specific psychopathologies are believed to exist at different points of the lifespan. Moreover, different diatheses and stressors are implicated in different disorders. For example, breakups and other severe or traumatic life stressors are implicated in the development of depression. Stressful events can also trigger the manic phase of bipolar disorder and stressful events can then prevent recovery and trigger relapse. Having a genetic disposition for becoming addicted and later engaging in binge drinking in college are implicated in the development of alcoholism. A family history of schizophrenia combined with the stressor of being raised in a dysfunctional family raises the risk of developing schizophrenia.

Diathesis-stress models are often conceptualised as multi-causal developmental models, which propose that multiple risk factors over the course of development interact with stressors and protective factors contributing to normal development or psychopathology. For example, a child with a family history of depression likely has a genetic vulnerability to depressive disorder. This child has also been exposed to environmental factors associated with parental depression that increase their vulnerability to developing depression as well. Protective factors, such as strong peer network, involvement in extracurricular activities, and a positive relationship with the non-depressed parent, interact with the child’s vulnerabilities in determining the progression to psychopathology versus normative development.

Some theories have branched from the diathesis-stress model, such as the differential susceptibility hypothesis, which extends the model to include a vulnerability to positive environments as well as negative environments or stress. A person could have a biological vulnerability that when combined with a stressor could lead to psychopathology (diathesis-stress model); but that same person with a biological vulnerability, if exposed to a particularly positive environment, could have better outcomes than a person without the vulnerability.

What is Pharmacotherapy?

Published on 06/18/2021 by Andrew Marshall2 Comments

Introduction

Pharmacotherapy is therapy using pharmaceutical drugs, as distinguished from therapy using surgery (surgical therapy), radiation (radiation therapy), movement (physical therapy), or other modes. Among physicians, sometimes the term medical therapy refers specifically to pharmacotherapy as opposed to surgical or other therapy; for example, in oncology, medical oncology is thus distinguished from surgical oncology. Pharmacists are experts in pharmacotherapy and are responsible for ensuring the safe, appropriate, and economical use of pharmaceutical drugs.

Background

The skills required to function as a pharmacist require knowledge, training and experience in biomedical, pharmaceutical and clinical sciences. Pharmacology is the science that aims to continually improve pharmacotherapy. The pharmaceutical industry and academia use basic science, applied science, and translational science to create new pharmaceutical drugs.

As pharmacotherapy specialists and pharmacists have responsibility for direct patient care, often functioning as a member of a multidisciplinary team, and acting as the primary source of drug-related information for other healthcare professionals. A pharmacotherapy specialist is an individual who is specialised in administering and prescribing medication, and requires extensive academic knowledge in pharmacotherapy.

In the US, a pharmacist can gain Board Certification in the area of pharmacotherapy upon fulfilling eligibility requirements and passing a certification examination.

While pharmacists provide valuable information about medications for patients and healthcare professionals, they are not typically considered covered pharmacotherapy providers by insurance companies.

What is Dissociative Disorder Not Otherwise Specified?

Published on 06/18/2021 by Andrew Marshall2 Comments

Introduction

Dissociative disorder not otherwise specified (DDNOS) is a mental health diagnosis for pathological dissociation that matches the DSM-5 criteria for a dissociative disorder, but does not fit the full criteria for any of the specifically identified subtypes, which include dissociative identity disorder, dissociative amnesia, and depersonalisation/derealisation disorder, and the reasons why the previous diagnoses were not met are specified.

Refer to Depressive Disorder Not Otherwise Specified (DD-NOS).

Background

“Unspecified dissociative disorder” is given when the clinician does not give a reason. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) refers to the diagnosis as “Other dissociative and conversion disorders”.

Examples of DDNOS include chronic and recurrent syndromes of mixed dissociative symptoms, identity disturbance due to prolonged and intense coercive persuasion, disorders similar to dissociative identity disorder, acute dissociative reactions to stressful events, and dissociative trance.

DDNOS is the most common dissociative disorder and is diagnosed in 40% of dissociative disorder cases. It is often co-morbid with other mental illnesses such as complex posttraumatic stress disorder, major depressive disorder, generalised anxiety disorder, personality disorders, substance use disorders, and eating disorders.

What is Depressive Disorder Not Otherwise Specified?

Published on 06/18/202106/18/2021 by Andrew MarshallLeave a comment

Introduction

Depressive Disorder Not Otherwise Specified (DD-NOS) is designated by the code 311 in the DSM-IV for depressive disorders that are impairing but do not fit any of the officially specified diagnoses. According to the DSM-IV, DD-NOS encompasses “any depressive disorder that does not meet the criteria for a specific disorder.” In the DSM-5, it is called unspecified depressive disorder.

Refer to Dissociative Disorder Not Otherwise Specified (DDNOS).

Background

Examples of disorders in this category include those sometimes described as minor depressive disorder and recurrent brief depression.

“Depression” refers to a spectrum of disturbances in mood that vary from mild to severe and from short periods to constant illness. DD-NOS is diagnosed if a patients symptoms fail to meet the criteria more common depressive disorders such as major depressive disorder or dysthymia. Although DD-NOS shares similar symptoms to dysthymia, dysthymia is classified by a period of at least 2 years of constantly recurring depressed mood, where as DD-NOS is classified by much shorter periods of depressed moods.

For most people who suffer the condition, their life will be significantly affected. DD-NOS can make many aspects of a person’s daily life difficult to manage, inhibiting their ability to enjoy the things that used to make them happy. Sufferers of the disorder tend to isolate themselves from their friends and families, lose interest in some activities, and experience behavioural changes and sleeping disorders. Some sufferers also experience suicidal tendencies or suicide attempts. In addition to having these symptoms, a diagnosis of DD-NOS will only be made if the symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning. For the diagnosis to be accurate, a psychiatrist is required to spend extensive time with the patient.

Symptoms of the disorder may arise due to several reasons. These include:

Distress due to medical conditions.
Environmental effects and situations.

However, the effects of drugs or medication or bereavement are not classified under the diagnosis.

A person will not be diagnosed with the condition if they have or have had any of the following: a major depressive episode, manic episode, mixed episode or hypomanic episode.

A diagnosis of the disorder will look like: “Depressive Disorder NOS 311”.

Concerns

Accurately assessing for a specific Depressive Disorder diagnosis requires an expenditure of time that is deemed unreasonable for most primary care physicians. For this reason, physicians often use this code as a proxy for a more thorough diagnosis. There is concern that this may lead to a “wastebasket” mindset for certain disorders. In addition reimbursement through Medicare may be lower for certain non specific diagnosis.

Treatment

It is possible for this disorder to progress over time. A patient suffering from the disorder can improve the condition with treatments. There are several types of therapies that may improve the condition, but depending on a patient’s experience of the disorder or the cause of the disorder, treatments will vary.

Psychotherapy including behaviour therapy, Gestalt therapy, Adlerian therapy, psychoanalytic therapy and existential therapy.
Pharmacotherapy through medications including antidepressants.

On This Day … 18 June

Published on 06/18/202106/15/2021 by Andrew MarshallLeave a comment

People (Births)

1948 – Sherry Turkle, American academic, psychologist, and sociologist.

Sherry Turkle

Sherry Turkle (born 18 June 1948) is the Abby Rockefeller Mauzé Professor of the Social Studies of Science and Technology at the Massachusetts Institute of Technology. She obtained a BA in Social Studies and later a PhD in Sociology and Personality Psychology at Harvard University. She now focuses her research on psychoanalysis and human-technology interaction. She has written several books focusing on the psychology of human relationships with technology, especially in the realm of how people relate to computational objects.

In The Second Self, originally published in 1984, Turkle writes about how computers are not tools as much as they are a part of our social and psychological lives. “‘Technology,’ she writes, ‘catalyzes changes not only in what we do but in how we think.’” She goes on using Jean Piaget’s psychology discourse to discuss how children learn about computers and how this affects their minds. The Second Self was received well by critics and was praised for being “a very thorough and ambitious study.”

In Life on the Screen, Turkle discusses how emerging technology, specifically computers, affect the way we think and see ourselves as humans. She presents to us the different ways in which computers affect us, and how it has led us to the now prevalent use of “cyberspace.” Turkle suggests that assuming different personal identities in a MUD (i.e. computer fantasy game) may be therapeutic. She also considers the problems that arise when using MUDs. Turkle discusses what she calls women’s “non-linear” approach to the technology, calling it “soft mastery” and “bricolage” (as opposed to the “hard mastery” of linear, abstract thinking and computer programming). She discusses problems that arise when children pose as adults online.

Turkle also explores the psychological and societal impact of such “relational artifacts” as social robots, and how these and other technologies are changing attitudes about human life and living things generally. One result may be a devaluation of authentic experience in a relationship. Together with Seymour Papert she wrote the influential paper “Epistemological Pluralism and the Revaluation of the Concrete.” Turkle has written numerous articles on psychoanalysis and culture and on the “subjective side” of people’s relationships with technology, especially computers. She is engaged in active study of robots, digital pets, and simulated creatures, particularly those designed for children and the elderly as well as in a study of mobile cellular technologies. Profiles of Turkle have appeared in such publications as The New York Times, Scientific American, and Wired Magazine. She is a featured media commentator on the effects of technology for CNN, NBC, ABC, and NPR, including appearances on such programs as Nightline and 20/20.

Turkle has begun to assess the adverse effects of rapidly advancing technology on human social behaviour. Alone Together: Why We Expect More from Technology and Less from Each Other was published in 2011 and when discussing the topic she speaks about the need to limit the use of popular technological devices because of these adverse effects.

On This Day … 17 June

Published on 06/17/202106/14/2021 by Andrew MarshallLeave a comment

People (Births)

1919 – William Kaye Estes, American psychologist and academic (d. 2011).

William Kaye Estes

William Kaye Estes (17 June 1919 to 17 August 2011) was an American psychologist.

In order to develop a statistical explanation for the learning phenomena, William Kaye Estes developed the Stimulus Sampling Theory in 1950 which suggested that a stimulus-response association is learned on a single trial; however, the learning process is continuous and consists of the accumulation of distinct stimulus-response pairings.

A Review of General Psychology survey, published in 2002, ranked Estes as the 77th most cited psychologist of the 20th century.