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On This Day … 11 February

Published on by Andrew MarshallLeave a comment

People (Births)

  • 1925 – Virginia E. Johnson, American psychologist and academic (d. 2013).

People (Deaths)

  • 1958 – Ernest Jones, Welsh neurologist and psychoanalyst (b. 1879).

Virginia E. Johnson

Virginia E. Johnson, born Mary Virginia Eshelman (11 February 1925 to 24 July 2013), was an American sexologist, best known as a member of the Masters and Johnson sexuality research team. Along with her partner, William H. Masters, she pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual dysfunctions and disorders from 1957 until the 1990s.

Early Life

Virginia Johnson was born in Springfield, Missouri, the daughter of Edna (née Evans) and Hershel “Harry” Eshelman, a farmer. Her paternal grandparents were members of the LDS Church, and her father had Hessian ancestry. When she was five, her family moved to Palo Alto, California, where her father worked as a groundskeeper for a hospital. The family later returned to Missouri and farming. Virginia enrolled at her hometown’s Drury College at age 16, but dropped out and spent four years working in the Missouri state insurance office. She eventually returned to school, studying at the University of Missouri and the Kansas City Conservatory of Music, and during World War II began a music career as a band singer. She sang country music for radio station KWTO in Springfield, where she adopted the stage name Virginia Gibson.

Johnson moved to St. Louis, Missouri, where she became a business writer for the St. Louis Daily Record. Eschewing a singing career, Johnson enrolled at Washington University in St. Louis, intending to earn a degree in sociology but never attaining one.

Sexological Works

Johnson met William H. Masters in 1957 when he hired her as a research assistant at the Department of Obstetrics and Gynecology at Washington University in St. Louis. Masters trained her in medical terminology, therapy, and research during the years she worked as his assistant. Together they developed polygraph-like instruments that were designed to measure sexual arousal in humans. Using these tools, Masters and Johnson observed and measured about 700 men and women who agreed to engage in sexual activity with other participants or masturbate in Masters’ laboratory. By observing these subjects, Johnson helped Masters identify the four stages of sexual response. This came to be known as the human sexual response cycle. The cycle consists of the excitement phase, plateau phase, orgasmic phase, and resolution phase. In 1964, Masters and Johnson established their own independent non-profit research institution in St. Louis called the Reproductive Biology Research Foundation. The centre was renamed the Masters and Johnson Institute in 1978.

In April 2009, Thomas Maier reported in Scientific American that Johnson had serious reservations about the Masters and Johnson Institute’s programme to convert homosexuals into heterosexuals, a programme which ran from 1968 to 1977.

Personal Life

By her early 20s, Johnson had married a Missouri politician; the marriage lasted two days. She then married a much older attorney, whom she also divorced. In 1950, Johnson married bandleader George Johnson, with whom she had a boy and a girl, before divorcing in 1956. In 1971, Johnson married William Masters after he divorced his first wife. They were divorced in 1993, though they continued to collaborate professionally. Johnson died in July 2013 “of complications from several illnesses”.

Masters, who married again after his divorce from Johnson, died in 2001.

In Popular Culture

The American cable network Showtime debuted Masters of Sex, a dramatic television series based on the 2009 biography of the same name, on September 29, 2013. The series stars Lizzy Caplan as Johnson.

Ernest Jones

Alfred Ernest Jones FRCP MRCS (01 January 1879 to 11 February 1958) was a Welsh neurologist and psychoanalyst. A lifelong friend and colleague of Sigmund Freud from their first meeting in 1908, he became his official biographer. Jones was the first English-speaking practitioner of psychoanalysis and became its leading exponent in the English-speaking world. As President of both the International Psychoanalytical Association and the British Psycho-Analytical Society in the 1920s and 1930s, Jones exercised a formative influence in the establishment of their organisations, institutions and publications.

Early Career

After obtaining his medical degrees, Jones specialised in neurology and took a number of posts in London hospitals. It was through his association with the surgeon Wilfred Trotter that Jones first heard of Freud’s work. Having worked together as surgeons at University College Hospital, he and Trotter became close friends, with Trotter taking the role of mentor and confidant to his younger colleague. They had in common a wide-ranging interest in philosophy and literature, as well as a growing interest in Continental psychiatric literature and the new forms of clinical therapy it surveyed. By 1905 they were sharing accommodation above Harley Street consulting rooms with Jones’s sister, Elizabeth, installed as housekeeper. Trotter and Elizabeth Jones later married. Appalled by the treatment of the mentally ill in institutions, Jones began experimenting with hypnotic techniques in his clinical work.

Jones first encountered Freud’s writings directly in 1905, in a German psychiatric journal in which Freud published the famous Dora case-history. It was thus he formed “the deep impression of there being a man in Vienna who actually listened with attention to every word his patients said to him…a revolutionary difference from the attitude of previous physicians…”

Jones’s early attempts to combine his interest in Freud’s ideas with his clinical work with children resulted in adverse effects on his career. In 1906 he was arrested and charged with two counts of indecent assault on two adolescent girls whom he had interviewed in his capacity as an inspector of schools for “mentally defective” children. At the court hearing Jones maintained his innocence, claiming the girls were fantasising about any inappropriate actions by him. The magistrate concluded that no jury would believe the testimony of such children and Jones was acquitted. In 1908, employed as a pathologist at a London hospital, Jones accepted a colleague’s challenge to demonstrate the repressed sexual memory underlying the hysterical paralysis of a young girl’s arm. Jones duly obliged but, before conducting the interview, he omitted to inform the girl’s consultant or arrange for a chaperone. Subsequently, he faced complaints from the girl’s parents over the nature of the interview and he was forced to resign his hospital post.

Psychoanalytical Career

Whilst attending a congress of neurologists in Amsterdam in 1907, Jones met Carl Jung, from whom he received a first-hand account of the work of Freud and his circle in Vienna. Confirmed in his judgement of the importance of Freud’s work, Jones joined Jung in Zurich to plan the inaugural Psychoanalytical Congress. This was held in 1908 in Salzburg, where Jones met Freud for the first time. Jones travelled to Vienna for further discussions with Freud and introductions to the members of the Vienna Psychoanalytic Society. Thus began a personal and professional relationship which, to the acknowledged benefit of both, would survive the many dissensions and rivalries which marked the first decades of the psychoanalytic movement, and would last until Freud’s death in 1939.

With his career prospects in Britain in serious difficulty, Jones sought refuge in Canada in 1908. He took up teaching duties in the Department of Psychiatry of the University of Toronto (from 1911, as Associate Professor of Psychiatry). In addition to building a private psychoanalytic practice, he worked as pathologist to the Toronto Asylum and Director of its psychiatric outpatient clinic. Following further meetings with Freud in 1909 at Clark University in Worcester, Massachusetts, where Freud gave a series of lectures on psychoanalysis, and in the Netherlands the following year, Jones set about forging strong working relationships with the nascent American psychoanalytic movement. He gave some 20 papers or addresses to American professional societies at venues ranging from Boston, to Washington and Chicago. In 1910 he co-founded the American Psychopathological Association and the following year the American Psychoanalytic Association, serving as its first Secretary until 1913.

Jones undertook an intensive programme of writing and research, which produced the first of what were to be many significant contributions to psychoanalytic literature, notably monographs on Hamlet and On the Nightmare. A number of these were published in German in the main psychoanalytic periodicals published in Vienna; these secured his status in Freud’s inner circle during the period of the latter’s increasing estrangement from Jung. In this context in 1912 Jones initiated, with Freud’s agreement, the formation of a Committee of loyalists charged with safeguarding the theoretical and institutional legacy of the psychoanalytic movement. This development also served the more immediate purpose of isolating Jung and, with Jones in strategic control, eventually manoeuvring him out of the Presidency of the International Psychoanalytical Association, a post he had held since its inception. When Jung’s resignation came in 1914, it was only the outbreak of the Great War that prevented Jones from taking his place.

Returning to London in 1913, Jones set up in practice as a psychoanalyst, founded the London Psychoanalytic Society, and continued to write and lecture on psychoanalytic theory. A collection of his papers was published as Papers on Psychoanalysis, the first account of psychoanalytic theory and practice by a practising analyst in the English language.

By 1919, the year he founded the British Psychoanalytical Society, Jones could report proudly to Freud that psychoanalysis in Britain “stands in the forefront of medical, literary and psychological interest” (letter 27 January 1919 (Paskauskas 1993)). As President of the Society – a post he would hold until 1944 – Jones secured funding for and supervised the establishment in London of a Clinic offering subsidised fees, and an Institute of Psychoanalysis, which provided administrative, publishing and training facilities for the growing network of professional psychoanalysts.

Jones went on to serve two periods as President of the International Psychoanalytic Association from 1920 to 1924 and 1932 to 1949, where he had significant influence. In 1920 he founded the International Journal of Psychoanalysis, serving as its editor until 1939. The following year he established the International Psychoanalytic Library, which published some 50 books under his editorship. Jones soon obtained from Freud rights to the English translation of his work. In 1924 the first two volumes of Freud’s Collected Papers was published in translations edited by Jones and supervised by Joan Riviere, his former analysand and, at one stage, ardent suitor. After a period in analysis with Freud, Riviere worked with Jones as the translation editor of the International Journal of Psychoanalysis. She then was part of a working group Jones set up to plan and deliver James Strachey’s translations for the standard edition of Freud’s work. Largely through Jones’ energetic advocacy, the British Medical Association officially recognised psychoanalysis in 1929. The BBC subsequently removed him from a list of speakers declared to be dangerous to public morality. In the 1930s Jones and his colleagues made a series of radio broadcasts on psychoanalysis.

After Adolf Hitler took power in Germany, Jones helped many displaced and endangered Jewish analysts to resettle in England and other countries. Following the Anschluss of March 1938, Jones flew into Vienna at considerable personal risk to play a crucial role in negotiating and organising the emigration of Freud and his circle to London.

The Jones-Freud Controversy

Jones’s early published work on psychoanalysis had been devoted to expositions of the fundamentals of Freudian theory, an elaboration of its theory of symbolism, and its application to the analysis of religion, mythology, folklore and literary and artistic works. Under the influence of Melanie Klein, Jones’ work took a new direction.

Klein had made an impact in Berlin in the new field of child analysis and had impressed Jones in 1925 when he attended her series of lectures to the British Society in London. At Jones’s invitation she moved to London the following year; she soon acquired a number of devoted and influential followers. Her work had a dramatic effect on the British Society, polarising its members into rival factions as it became clear that her approach to child analysis was seriously at odds with that of Anna Freud, as set out in her 1927 book An Introduction to the Technique of Child Analysis. The disagreement centred around the clinical approach to the pre-Oedipal child; Klein argued for play as an equivalent to free association in adult analyses. Anna Freud opposed any such equivalence, proposing an educative intervention with the child until an appropriate level of ego development was reached at the Oedipal stage. Klein held this to be a collusive inhibition of analytical work with the child.

Influenced by Klein, and initiating what became known as the Jones-Freud controversy, Jones set out to explore a range of interlinked topics in the theory of early psychic development. These included the structure and genesis of the superego and the nature of the feminine castration complex. He coined the term phallocentrism in a critique of Freud’s account of sexual difference. He argued together with Klein and her Berlin colleague, Karen Horney, for a primary femininity, saying that penis envy arose as a defensive formation rather than arising from the fact, or “injury”, of biological asymmetry. In a corresponding reformulation of the castration complex, Jones introduced the concept of “aphanisis” to refer to the fear of “the permanent extinction of the capacity (including opportunity) for sexual enjoyment”.

These departures from orthodoxy were noted in Vienna and were topics that were featured in the regular Freud-Jones correspondence, the tone of which became increasingly fractious. Faced with accusations from Freud of orchestrating a campaign against him and his daughter, Jones sought to allay Freud’s concerns without abandoning his new critical standpoint. Eventually, following a series of exchange lectures between the Vienna and London societies, which Jones arranged with Anna Freud, Freud and Jones resumed their usual cordial exchanges.

With the arrival in Britain of refugee German and Viennese analysts in the 1930s, including Anna Freud in 1938, the hostility between the orthodox Freudians and Kleinians in the British Society grew more intense. Jones chaired a number of “extraordinary business meetings” with the aim of defusing the conflict, and these continued into the war years. The meetings, which became known as the controversial discussions, were established on a more regular basis from 1942. By that time, Jones had removed himself from direct participation, owing to ill health and the difficulties of war-time travel from his home in Elsted, West Sussex. He resigned from the presidency of the British Society in 1944, the year in which, under the presidency of Sylvia Payne, there finally emerged a compromise agreement which established parallel training courses providing options to satisfy the concerns of the rival groups that had formed: followers of Anna Freud, followers of Melanie Klein and a non-aligned group of Middle or Independent Group analysts. It was agreed further that all the key policy making committees of the BPS should have representatives from the three groups.

Later Life

After the end of the war, Jones gradually relinquished his many official posts whilst continuing his psychoanalytic practice, writings and lecturing. The major undertaking of his final years was his monumental account of Freud’s life and work, published to widespread acclaim in three volumes between 1953 and 1957. In this he was ably assisted by his German-speaking wife, who translated much of Freud’s early correspondence and other archive documentation made available by Anna Freud. His uncompleted autobiography, Free Associations, was published posthumously in 1959.

Jones was made a Fellow of the Royal College of Physicians (FRCP) in 1942, Honorary President of the International Psychoanalytical Association in 1949, and was awarded an Honorary Doctor of Science degree at Swansea University (Wales) in 1954.

Jones died in London on 11 February 1958, and was cremated at Golders Green Crematorium. His ashes were buried in the grave of the oldest of his four children in the churchyard of St Cadoc’s Cheriton on the Gower Peninsula.

What is Orthorexia Nervosa?

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Orthorexia nervosa (also known as orthorexia) is a proposed eating disorder characterised by an excessive preoccupation with eating healthy food.

The term was introduced in 1997 by American physician Steven Bratman, M.D. He suggested that some people’s dietary restrictions intended to promote health may paradoxically lead to unhealthy consequences, such as social isolation, anxiety, loss of ability to eat in a natural, intuitive manner, reduced interest in the full range of other healthy human activities, and, in rare cases, severe malnutrition or even death.

In 2009, Ursula Philpot, chair of the British Dietetic Association and senior lecturer at Leeds Metropolitan University, described people with orthorexia nervosa as being “solely concerned with the quality of the food they put in their bodies, refining and restricting their diets according to their personal understanding of which foods are truly ‘pure’.” This differs from other eating disorders, such as anorexia nervosa and bulimia nervosa, where those affected focus on the quantity of food eaten.

Orthorexia nervosa also differs from anorexia nervosa in that it does not disproportionally affect one gender. Studies have found that orthorexia nervosa is equally found in both men and women with no significant gender differences at all. Furthermore, research has found significant positive correlations between ON and both narcissism and perfectionism, but no significant correlation between ON and self esteem. This shows that high-ON individuals likely take pride over their healthy eating habits over others and that is the driving force behind their orthorexia as opposed to body image like anorexia.

Orthorexia nervosa is not recognised as an eating disorder by the American Psychiatric Association, and so is not mentioned as an official diagnosis in the widely used Diagnostic and Statistical Manual of Mental Disorders (DSM).

Brief History

In a 1997 article in the magazine Yoga Journal, the American physician Steven Bratman coined the term “orthorexia nervosa” from the Greek ορθο- (ortho, “right” or “correct”), and όρεξις (orexis, “appetite”), literally meaning ‘correct appetite’, but in practice meaning ‘correct diet’. The term is modelled on anorexia, literally meaning “without appetite”, as used in the definition of the condition anorexia nervosa. (In both terms, “nervosa” indicates an unhealthy psychological state.) Bratman described orthorexia as an unhealthy fixation with what the individual considers to be healthy eating. Beliefs about what constitutes healthy eating commonly originate in one or another dietary theory such as raw foods veganism or macrobiotics, but are then taken to extremes, leading to disordered eating patterns and psychological and/or physical impairment. Bratman based this proposed condition on his personal experiences in the 1970s, as well as behaviours he observed among his patients in the 1990s. In 2000, Bratman, with David Knight, authored the book Health Food Junkies, which further expanded on the subject.

Following the publication of the book, in 2004 a team of Italian researchers from La Sapienza University of Rome, published the first empirical study attempting to develop a tool to measure the prevalence of orthorexia, known as the ORTO-15.

In 2015, responding to news articles in which the term orthorexia is applied to people who merely follow a non-mainstream theory of healthy eating, Bratman specified the following: “A theory may be conventional or unconventional, extreme or lax, sensible or totally wacky, but, regardless of the details, followers of the theory do not necessarily have orthorexia. They are simply adherents of a dietary theory. The term ‘orthorexia’ only applies when an eating disorder develops around that theory.” Bratman elsewhere clarifies that with a few exceptions, most common theories of healthy eating are followed safely by the majority of their adherents; however, “for some people, going down the path of a restrictive diet in search of health may escalate into dietary perfectionism.” Karin Kratina, PhD, writing for the National Eating Disorders Association, summarises this process as follows: “Eventually food choices become so restrictive, in both variety and calories, that health suffers – an ironic twist for a person so completely dedicated to healthy eating.”

Although orthorexia is not recognised as a mental disorder by the American Psychiatric Association, and it is not listed in the DSM-5, as of January 2016, four case reports and more than 40 other articles on the subject have been published in a variety of peer-reviewed journals internationally. According to a study published in 2011, two-thirds of a sample of 111 Dutch-speaking eating disorder specialists felt they had observed the syndrome in their clinical practice.

According to the Macmillan English Dictionary, the word is entering the English lexicon. The concept of orthorexia as a newly developing eating disorder has attracted significant media attention in the 21st century.

Signs and Symptoms

Symptoms of orthorexia nervosa include “obsessive focus on food choice, planning, purchase, preparation, and consumption; food regarded primarily as source of health rather than pleasure; distress or disgust when in proximity to prohibited foods; exaggerated faith that inclusion or elimination of particular kinds of food can prevent or cure disease or affect daily well-being; periodic shifts in dietary beliefs while other processes persist unchanged; moral judgment of others based on dietary choices; body image distortion around sense of physical “impurity” rather than weight; persistent belief that dietary practices are health-promoting despite evidence of malnutrition.”

Cause(s)

There has been no investigation into whether there may be a biological cause specific to orthorexia nervosa. It may be a food-centred manifestation of obsessive-compulsive disorder (OCD), which has a lot to do with control.

Diagnosis

In 2016, formal criteria for orthorexia were proposed in the peer-reviewed journal Eating Behaviours by Thom Dunn and Steven Bratman. These criteria are as follows:

  • Criterion A:
    • Obsessive focus on “healthy” eating, as defined by a dietary theory or set of beliefs whose specific details may vary; marked by exaggerated emotional distress in relationship to food choices perceived as unhealthy; weight loss may ensue, but this is conceptualised as an aspect of ideal health rather than as the primary goal.
    • As evidenced by the following:
      1. Compulsive behaviour and/or mental preoccupation regarding affirmative and restrictive dietary practices believed by the individual to promote optimum health. (Footnotes to this criteria add: Dietary practices may include use of concentrated “food supplements.” Exercise performance and/or fit body image may be regarded as an aspect or indicator of health.)
      2. Violation of self-imposed dietary rules causes exaggerated fear of disease, sense of personal impurity and/or negative physical sensations, accompanied by anxiety and shame.
      3. Dietary restrictions escalate over time, and may come to include elimination of entire food groups and involve progressively more frequent and/or severe “cleanses” (partial fasts) regarded as purifying or detoxifying. This escalation commonly leads to weight loss, but the desire to lose weight is absent, hidden or subordinated to ideation about healthy food.
  • Criterion B:
    • The compulsive behaviour and mental preoccupation becomes clinically impairing by any of the following:
      1. Malnutrition, severe weight loss or other medical complications from restricted diet.
      2. Intrapersonal distress or impairment of social, academic or vocational functioning secondary to beliefs or behaviours about healthy diet.
      3. Positive body image, self-worth, identity and/or satisfaction excessively dependent on compliance with self-defined “healthy” eating behaviour.

A diagnostic questionnaire has been developed for orthorexia sufferers, similar to questionnaires for other eating disorders, named the ORTO-15. However, Dunn and Bratman critique this survey tool as lacking appropriate internal and external validation.

Epidemiology

Results across scientific findings have yet to find a definitive conclusion to support whether nutrition students and professionals are at higher risk than other population subgroups, due to differing results in the research literature. There are only a few notable scientific works that, in an attempt to explore the breadth and depth of the still vaguely-understood illness, have tried to identify which groups in society are most vulnerable to its onset. This includes a 2008 German study, which based its research on the widespread suspicion that the most nutritionally-informed, such as university nutrition students, are a potential high-risk group for eating disorders, due to a substantial accumulation of knowledge on food and its relationship to health; the idea being that the more one knows about health, the more likely an unhealthy fixation about being healthy can develop. This study also inferred that orthorexic tendencies may even fuel a desire to study the science, indicating that many within this field might suffer from the disorder before commencing the course. However the results found that the students in the study, upon initial embarkation of their degree, did not have higher orthorexic values than other non-nutrition university students, and thus the report concluded that further research is needed to clarify the relationship between food-education and the onset of ON.

Similarly, in a Portuguese study on nutrition tertiary students, the participants’ orthorexic scores (according to the ORTO-15 diagnostic questionnaire) actually decreased as they progressed through their course, as well as the overall risk of developing an eating disorder being low at 4.2%. The participants also answered questionnaires to provide insight into their eating behaviours and attitudes, and despite this study finding that nutrition and health-science students tend to have more restrictive eating behaviours, these studies however found no evidence to support that these students have “more disturbed or disordered eating patterns than other students” These two aforementioned studies conclude that the more understanding of food one has is not necessarily a risk factor for ON, explaining that the data gathered suggests dietetics professionals are not at significant risk of it.

However, these epidemiologic studies have been critiqued as using a fundamentally flawed survey tool that inflates prevalence rates. Scholars have questioned both the reliability and validity of the ORTO-15.

Most scientific findings tend to agree, however, young adults and adolescents are extremely susceptible to developing eating disorders. One study found that there was no relationship between BOT score and college major, which may indicate the prevalence of mental health issues and eating disorders on college campuses and that health and science majors are no longer the only ones affected More studies have also been conducted on the link between increased Instagram use and Orthorexia nervosa. The social media based healthy community has recently grown in popularity especially on platforms such as Instagram. The hashtag #food is one of the top 25 most popular hashtags on Instagram. A study that investigated this relationship found that increased use of Instagram correlated between symptoms of ON with no other social media platform having the same effect. With young adults and adolescents making up the majority of social media users, exposure to this type of content can lead to developing unhealthy behaviour.

Book: Parenting Children with Mental Health Challenges

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Book Title:

Parenting Children with Mental Health Challenges: A Guide to Life with Emotionally Complex Kids.

Author(s): Deborah Vlock.

Year: 2018.

Edition: First (1st).

Publisher: Rowman & Littlefield Publishers, Illustrated Edition.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Parenting Children with Mental Health Challenges: A Guide to Life with Emotionally Complex Kids offers overwhelmed readers guidance, solidarity, and hope. The author, a “mental-health mom” who’s survived indignity, exhaustion, and the heartbreak of loving a child with multiple mental-health disorders, writes with frankness and occasional humour about the hardest parenting job on earth.

Drawing on her own experiences and those of other parents, plus tips from mental health professionals, Vlock suggests ways of parenting smarter, partnering better, and living more fully and less fearfully in the shadow of childhood psychiatric illness.

Addressing the many hurdles children and families must face, including life on the home front, school, friendships and relationships, and more, the book shows readers that they are not alone-and they are stronger than they think. With its combination of easily digestible, to-the-point suggestions, clear action items, and first-person parent/kid stories, its aim is to make mental-health parents feel stronger and better, while actively seeking positive outcomes for their kids and families.

With rates of mental health diagnoses among youth on the rise, this invaluable resource will help parents through the trying times with support, understanding, and guidance.

Book: Orthorexia – When Healthy Eating Goes Bad

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Book Title:

Orthorexia – When Healthy Eating Goes Bad.

Author(s): Renee McGregor.

Year: 2017.

Edition: First (1st).

Publisher: Nourish Books.

Type(s): Paperback and Kindle.

Synopsis:

Can healthy eating become a dangerous obsession?

Orthorexia is an eating disorder that is hard to see. It is not about purging or cutting calories. But by excluding foods in pursuit of a “clean” or ideal diet, it can quickly turn into a compulsion with serious consequences for mental and physical health.

For the first time, dietician, nutritionist and eating disorder campaigner Renee McGregor reveals the true messages behind these dangerous diets. Packed with first-hand experiences and analysis, it provides the tools to guide sufferers back to a balanced, truly healthy way of eating.

Book: Mindfulness Workbook for Stress Relief

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Book Title:

Mindfulness Workbook for Stress Relief: Reduce Stress through Meditation, Non-Judgement, Mind-Body Awareness, and Self-Inquiry.

Author(s): April Snow (LMFT).

Year: 2020.

Edition: First (1st).

Publisher: Rockridge Press.

Type(s): Kindle.

Synopsis:

Mindfulness is a powerful and proven method for reducing stress and its negative health effects. The Mindfulness Workbook for Stress Relief shows you how to relieve tension and find calm using soothing, restorative techniques like meditation, non-judgement, self-inquiry, and mind-body awareness.

Featuring helpful exercises and simple meditations, this hands-on stress management workbook delivers a wide variety of effective mindfulness tools that you can add to your self-care toolbox like breath awareness, body scans, mindful walking, and more.

The Mindfulness Workbook for Stress Relief includes:

  • Practical & actionable: This book has a beginner-friendly focus that covers a spectrum of everyday situations and science-based solutions.
  • Evidence-based approach: Explore engaging mindfulness-based exercises that are proven to help relieve stress, anxiety, chronic pain, and sleep issues.
  • Situational success: Learn how to address stress triggers in many areas of daily life like relationships, at work, and beyond.

Take a deep breath and begin your practice today with this evidence-based mindfulness workbook.

Book: Assessment Procedures for Counsellors and Helping Professionals

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Book Title:

Assessment Procedures for Counsellors and Helping Professionals.

Author(s): Carl Sheperis, Robert Drummond, and Karyn Jones.

Year: 2019.

Edition: Ninth (9th).

Publisher: Pearson.

Type(s): Paperback.

Synopsis:

A classic textbook for aspiring counsellors, now updated and expanded to improve its usefulness and relevance for practicing counsellors.

Since its first publication in 1988, Assessment Procedures for Counsellors and Helping Professionals has become a classic among assessment textbooks designed specifically for aspiring counsellors. Now in its 9th Edition, the text includes extensive changes to content and updating throughout, while maintaining its popular, easy-to-read format and continuing emphasis on assessment information that is most useful and relevant for school counsellors, marriage and family therapists, mental health counsellors, and other helping professionals. Throughout the text, readers get invaluable information and examples about widely used assessment instruments in order to become familiar with these well-known tests.

NOTE:

Before purchasing, check with your instructor to ensure you select the correct ISBN. Several versions of the MyLab(TM) and Mastering(TM) platforms exist for each title, and registrations are not transferable. To register for and use MyLab or Mastering, you may also need a Course ID, which your instructor will provide.

Used books, rentals, and purchases made outside of Pearson

If purchasing or renting from companies other than Pearson, the access codes for the MyLab or Mastering platform may not be included, may be incorrect, or may be previously redeemed. Check with the seller before completing your purchase.

Book: The Mindfulness and Acceptance Workbook for Self-Esteem

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Book Title:

The Mindfulness and Acceptance Workbook for Self-Esteem.

Author(s): Joe Oliver.

Year: 2020.

Edition: First (1st).

Publisher: New Harbinger, Workbook Edition.

Type(s): Paperback and Kindle.

Synopsis:

We all have stories we have created about ourselves-some of them positive and some of them negative. If you suffer from low self-esteem, your story may include these types of narratives: “I’m a failure,” “I’ll never be able to do that,” or “If only I were smarter or more attractive, I could be happy.” Ironically, at the end of the day, these narratives are your biggest roadblocks to achieving happiness and living the life you deserve. So, how can you break free from these stories-once and for all?

Grounded in evidence-based acceptance and commitment therapy (ACT), this workbook offers a step-by-step programme to help you break free from self-doubt, learn to accept yourself and your faults, identify and cultivate your strengths, and reach your full potential. You will also discover ways to take action and move toward the life you truly want, even when these actions trigger self-doubt. Finally, you’ll learn to see yourself in all your complexity, with kindness and compassion.

What are Tricyclic Antidepressants?

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Introduction

Tricyclic antidepressants (TCAs) are a class of medications that are used primarily as antidepressants. TCAs were discovered in the early 1950s and were marketed later in the decade. They are named after their chemical structure, which contains three rings of atoms. Tetracyclic antidepressants (TeCAs), which contain four rings of atoms, are a closely related group of antidepressant compounds.

Although TCAs are sometimes prescribed for depressive disorders, they have been largely replaced in clinical use in most parts of the world by newer antidepressants such as

  • Selective serotonin reuptake inhibitors (SSRIs);
  • Serotonin-norepinephrine reuptake inhibitors (SNRIs); and
  • Norepinephrine reuptake inhibitors (NRIs).

Adverse effects have been found to be of a similar level between TCAs and SSRIs.

Brief History

The TCAs were developed amid the “explosive birth” of psychopharmacology in the early 1950s. The story begins with the synthesis of chlorpromazine in December 1950 by Rhône-Poulenc’s chief chemist, Paul Charpentier, from synthetic antihistamines developed by Rhône-Poulenc in the 1940s. Its psychiatric effects were first noticed at a hospital in Paris in 1952. The first widely used psychiatric drug, by 1955 it was already generating significant revenue as an antipsychotic. Research chemists quickly began to explore other derivatives of chlorpromazine.

The first TCA reported for the treatment of depression was imipramine, a dibenzazepine analogue of chlorpromazine code-named G22355. It was not originally targeted for the treatment of depression. The drug’s tendency to induce manic effects was “later described as ‘in some patients, quite disastrous'”. The paradoxical observation of a sedative inducing mania led to testing with depressed patients. The first trial of imipramine took place in 1955 and the first report of antidepressant effects was published by Swiss psychiatrist Roland Kuhn in 1957. Some testing of Geigy’s imipramine, then known as Tofranil, took place at the Münsterlingen Hospital near Konstanz. Geigy later became Ciba-Geigy and eventually Novartis.

Dibenzazepine derivatives are described in US patent 3,074,931 issued 1963-01-22 by assignment to Smith Kline & French Laboratories. The compounds described share a tricyclic backbone different from the backbone of the TCA amitriptyline.

Merck introduced the second member of the TCA family, amitriptyline (Elavil), in 1961. This compound has a different three-ring structure than imipramine.

Medical Uses

The TCAs are used primarily in the clinical treatment of mood disorders such as major depressive disorder (MDD), dysthymia, and treatment-resistant variants. They are also used in the treatment of a number of other medical disorders, including anxiety disorders such as:

Clinical Depression

For many years the TCAs were the first choice for pharmacological treatment of clinical depression. Although they are still considered to be highly effective, they have been increasingly replaced by antidepressants with an improved safety and side effect profile, such as the SSRIs and other newer antidepressants such as the novel reversible MAOI (monoamine oxidase inhibitors) moclobemide. However, tricyclic antidepressants are possibly more effective in treating melancholic depression than other antidepressant drug classes. Newer antidepressants are thought to have fewer and less severe side effects and are also thought to be less likely to result in injury or death if used in a suicide attempt, as the doses required for clinical treatment and potentially lethal overdose are far wider in comparison.

Nonetheless, the TCAs are commonly prescribed for treatment-resistant depression that has failed to respond to therapy with newer antidepressants, they also tend to have fewer emotional blunting and sexual side effects than SSRI antidepressants. They are not considered addictive and are somewhat preferable to the MAOIs. The side effects of the TCAs usually come to prominence before the therapeutic benefits against depression and/or anxiety do, and for this reason, they may potentially be somewhat dangerous, as volition can be increased, possibly giving the patient a greater desire to attempt or commit suicide.

ADHD

The TCAs were used in the past in the clinical treatment of ADHD, though they are not typically used anymore, having been replaced by more effective agents with fewer side effects such as atomoxetine (Strattera, Tomoxetin) and stimulants like methylphenidate (Ritalin, Focalin, Concerta), and amphetamine (Adderall, Attentin, Dexedrine, Vyvanse). ADHD is thought to be caused by an insufficiency of dopamine and norepinephrine activity in the prefrontal cortex of the brain. Most of the TCAs inhibit the reuptake of norepinephrine, though not dopamine, and as a result, they show some efficacy in remedying the disorder. Notably, the TCAs are more effective in treating the behavioural aspects of ADHD than the cognitive deficits, as they help limit hyperactivity and impulsivity, but have little to no benefits on attention.

Chronic Pain

The TCAs show efficacy in the clinical treatment of a number of different types of chronic pain, notably neuralgia or neuropathic pain and fibromyalgia. The precise mechanism of action in explanation of their analgesic efficacy is unclear, but it is thought that they indirectly modulate the opioid system in the brain downstream via serotonergic and noradrenergic neuromodulation, among other properties. They are also effective in migraine prophylaxis, though not in the instant relief of an acute migraine attack. They may also be effective to prevent chronic tension headaches.

Side Effects

Many side effects may be related to the antimuscarinic properties of the TCAs. Such side effects are relatively common and may include dry mouth, dry nose, blurry vision, lowered gastrointestinal motility or constipation, urinary retention, cognitive and/or memory impairment, and increased body temperature.

Other side effects may include drowsiness, anxiety, emotional blunting (apathy/anhedonia), confusion, restlessness, dizziness, akathisia, hypersensitivity, changes in appetite and weight, sweating, muscle twitches, weakness, nausea and vomiting, hypotension, tachycardia, and rarely, irregular heart rhythms. Twitching, hallucinations, delirium and coma are also some of the toxic effects caused by overdose. Rhabdomyolysis or muscle breakdown has been rarely reported with this class of drugs as well.

Tolerance to these adverse effects of these drugs often develops if treatment is continued. Side effects may also be less troublesome if treatment is initiated with low doses and then gradually increased, although this may also delay the beneficial effects.

TCAs can behave like class 1A antiarrhythmics, as such, they can theoretically terminate ventricular fibrillation, decrease cardiac contractility and increase collateral blood circulation to ischemic heart muscle. Naturally, in overdose, they can be cardiotoxic, prolonging heart rhythms and increasing myocardial irritability.

New research has also revealed compelling evidence of a link between long-term use of anticholinergic medications like TCAs and dementia. Although many studies have investigated this link, this was the first study to use a long-term approach (over seven years) to find that dementias associated with anticholinergics may not be reversible even years after drug use stops. Anticholinergic drugs block the action of acetylcholine, which transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory.

Discontinuation

Antidepressants in general may produce withdrawal. However, since the term “withdrawal” has been linked to addiction to recreational drugs like opioids, the medical profession and pharmaceutical public relations prefer that a different term be used, hence “discontinuation syndrome.” Discontinuation symptoms can be managed by a gradual reduction in dosage over a period of weeks or months to minimise symptoms. In tricyclics, discontinuation syndrome symptoms include anxiety, insomnia, headache, nausea, malaise, or motor disturbance.

Overdose

Refer to Tricyclic Antidepressant Overdose.

TCA overdose is a significant cause of fatal drug poisoning. The severe morbidity and mortality associated with these drugs is well documented due to their cardiovascular and neurological toxicity. Additionally, it is a serious problem in the paediatric population due to their inherent toxicity and the availability of these in the home when prescribed for bed-wetting and depression. In the event of a known or suspected overdose, medical assistance should be sought immediately.

A number of treatments are effective in a TCA overdose.

An overdose on TCA is especially fatal as it is rapidly absorbed from the GI tract in the alkaline conditions of the small intestines. As a result, toxicity often becomes apparent in the first hour after an overdose. However, symptoms may take several hours to appear if a mixed overdose has caused delayed gastric emptying.

Many of the initial signs are those associated to the anticholinergic effects of TCAs such as dry mouth, blurred vision, urinary retention, constipation, dizziness, and emesis (or vomiting). Due to the location of norepinephrine receptors all over the body, many physical signs are also associated with a TCA overdose:

  • Anticholinergic effects: Altered mental status (e.g., agitation, confusion, lethargy, etc.), resting sinus tachycardia, dry mouth, mydriasis (pupil dilation), and fever.
  • Cardiac effects: Hypertension (early and transient, should not be treated), tachycardia, orthostasis and hypotension, arrhythmias (including ventricular tachycardia and ventricular fibrillation, most serious consequence) / ECG changes (prolonged QRS, QT, and PR intervals).
  • CNS effects: Syncope, seizure, coma, myoclonus, hyperreflexia.
  • Pulmonary effects: Hypoventilation resulting from CNS depression.
  • Gastrointestinal effects: Decreased or absent bowel sounds.

Treatment of TCA overdose depends on severity of symptoms:

Initially, gastric decontamination of the patient is achieved by administering, either orally or via a nasogastric tube, activated charcoal pre-mixed with water, which adsorbs the drug in the gastrointestinal tract (most useful if given within 2 hours of drug ingestion). Other decontamination methods such as stomach pumps, gastric lavage, whole bowel irrigation, or (ipecac induced) emesis, are not recommended in TCA poisoning.

If there is metabolic acidosis, intravenous infusion of sodium bicarbonate is recommended by Toxbase.org, the UK and Ireland poisons advice database (TCAs are protein bound and become less bound in more acidic conditions, so by reversing the acidosis, protein binding increases and bioavailability thus decreases – the sodium load may also help to reverse the Na+ channel blocking effects of the TCA).

Interactions

The TCAs are highly metabolised by the cytochrome P450 (CYP) hepatic enzymes. Drugs that inhibit cytochrome P450 (for example cimetidine, methylphenidate, fluoxetine, antipsychotics, and calcium channel blockers) may produce decreases in the TCAs’ metabolism, leading to increases in their blood concentrations and accompanying toxicity. The major factor that distinguishes SSRI’s amongst one another is the inhibition of select CYP enzymes. Drugs that prolong the QT interval including antiarrhythmics such as quinidine, the antihistamines astemizole and terfenadine, and some antipsychotics may increase the chance of ventricular dysrhythmias. TCAs may enhance the response to alcohol and the effects of barbiturates and other CNS depressants. Side effects may also be enhanced by other drugs that have antimuscarinic properties.

Pharmacology

The majority of the TCAs act primarily as SNRIs by blocking the serotonin transporter (SERT) and the norepinephrine transporter (NET), which results in an elevation of the synaptic concentrations of these neurotransmitters, and therefore an enhancement of neurotransmission. Notably, with the sole exception of amineptine, the TCAs have negligible affinity for the dopamine transporter (DAT), and therefore have no efficacy as dopamine reuptake inhibitors (DRIs). Both serotonin and norepinephrine have been highly implicated in depression and anxiety, and it has been shown that facilitation of their activity has beneficial effects on these mental disorders.

In addition to their reuptake inhibition, many TCAs also have high affinity as antagonists at the 5-HT2 (5-HT2A and 5-HT2C), 5-HT6, 5-HT7, α1-adrenergic, and NMDA receptors, and as agonists at the sigma receptors (σ1 and σ2), some of which may contribute to their therapeutic efficacy, as well as their side effects. The TCAs also have varying but typically high affinity for antagonising the H1 and H2 histamine receptors, as well as the muscarinic acetylcholine receptors. As a result, they also act as potent antihistamines and anticholinergics. These properties are often beneficial in antidepressants, especially with comorbid anxiety, as it provides a sedative effect.

Most, if not all, of the TCAs also potently inhibit sodium channels and L-type calcium channels, and therefore act as sodium channel blockers and calcium channel blockers, respectively. The former property is responsible for the high mortality rate upon overdose seen with the TCAs via cardiotoxicity. It may also be involved in their efficacy as analgesics, however.

In summary, tricyclic antidepressants can act through NMDA antagonism, opioidergic effects, sodium, potassium and calcium channel blocking, through interfering with the reuptake of serotonin and acting as antagonists to SHAM (serotonin, histamine, alpha, muscarinic) receptors. Thus their dangerous side effect profile limits their use in daily practice.

Chemistry

There are two major groups of TCAs in terms of chemical structure, which most, but not all, TCAs fall into. The groupings are based on the tricyclic ring system. They are the dibenzazepines (imipramine, desipramine, clomipramine, trimipramine, lofepramine) and the dibenzocycloheptadienes (amitriptyline, nortriptyline, protriptyline, butriptyline). Minor TCA groups based on ring system include the dibenzoxepins (doxepin), the dibenzothiepines (dosulepin), and the dibenzoxazepines (amoxapine). In addition to classification based on the ring system, TCAs can also be usefully grouped based on the number of substitutions of the side chain amine. These groups include the tertiary amines (imipramine, clomipramine, trimipramine, amitriptyline, butriptyline, doxepin, dosulepin) and the secondary amines (desipramine, nortriptyline, protriptyline). Lofepramine is technically a tertiary amine, but acts largely as a prodrug of desipramine, a secondary amine, and hence is more similar in profile to the secondary amines than to the tertiary amines. Amoxapine does not have the TCA side chain and hence is neither a tertiary nor secondary amine, although it is often grouped with the secondary amines due to sharing more in common with them.

Society and Culture

Recreational Use

A very small number of cases involving non-medical use of antidepressants have been reported over the past 30 years. According to the US government classification of psychiatric medications, TCAs are “non-abusable” and generally have low abuse potential. Nonetheless due to their atypical MOA, amineptine and tianeptine (dopamine reuptake inhibition and μ-opioid receptor agonism, respectively) are the two TCAs with the highest addiction and abuse potential. Despite tianeptine’s recreational value, many people use it as a nootropic and follow other countries’ usage guidelines, such as France, as a way to treat their depression if other antidepressants do not work. Their prescription guidelines are 12.5 mg three times a day, and not to exceed 50 mg in one day. Tianeptine has no recreational value when taken at that dosage and kept under 50 mg a day. Many people report that tianeptine has treated their depression when SSRI’s or SNRI’s have not. Several cases of the misuse of amitriptyline alone or together with methadone or in other drug dependent patients and of dosulepin with alcohol or in methadone patients have been reported.

List of TCAs

Those that preferentially inhibit the reuptake of serotonin (by at least 10-fold over norepinephrine) include:

  • Butriptyline† (Evadyne) (relatively weak serotonin reuptake inhibitor).
  • Clomipramine (Anafranil).
  • Imipramine (Tofranil, Janimine, Praminil).
  • Trimipramine (Surmontil) (relatively weak serotonin reuptake inhibitor).

Those that preferentially inhibit the reuptake of norepinephrine (by at least 10-fold over serotonin) include:

  • Desipramine (Norpramin, Pertofrane).
  • Dibenzepin‡ (Noveril, Victoril).
  • Lofepramine§ (Lomont, Gamanil).
  • Maprotiline (Ludiomil) – can be classed with the TCAs though more frequently classed with the TeCAs.
  • Nortriptyline (Pamelor, Aventyl, Norpress).
  • Protriptyline (Vivactil).

Whereas either fairly balanced reuptake inhibitors of serotonin and norepinephrine or unspecified inhibitors include:

  • Amitriptyline (Elavil, Endep).
  • Amitriptylinoxide (Amioxid, Ambivalon, Equilibrin).
  • Amoxapine (Asendin) – can be classed with the TeCAs but more frequently classed with the TCAs.
  • Demexiptiline† (Deparon, Tinoran).
  • Dimetacrine† (Istonil, Istonyl, Miroistonil).
  • Dosulepin§ (Prothiaden).
  • Doxepin (Adapin, Sinequan).
  • Fluacizine† (Phtorazisin).
  • Imipraminoxide† (Imiprex, Elepsin).
  • Melitracen§ (Deanxit, Dixeran, Melixeran, Trausabun).
  • Metapramine† (Timaxel).
  • Nitroxazepine‡ (Sintamil).
  • Noxiptiline‡ (Agedal, Elronon, Nogedal).
  • Pipofezine‡ (Azafen/Azaphen).
  • Propizepine† (Depressin, Vagran).
  • Quinupramine† (Kevopril, Kinupril, Adeprim, Quinuprine).

And the following are TCAs that act via main mechanisms other than serotonin or norepinephrine reuptake inhibition:

  • Amineptine‡ (Survector, Maneon, Directim) – norepinephrine–dopamine reuptake inhibitor.
  • Iprindole† (Prondol, Galatur, Tetran) – 5-HT2 receptor antagonist.
  • Opipramol‡ (Insidon, Pramolan, Ensidon, Oprimol) – σ receptor agonist.
  • Tianeptine § (Stablon, Coaxil, Tatinol) – atypical μ-opioid receptor agonist.

Legend:

  • † indicates products which have been withdrawn from the market worldwide.
  • ‡ indicates products which are not available in any country in which English is an official language.
  • § indicates products which are not available in the United States, but are available in other English-speaking countries such as Australia, Canada, United Kingdom, etc.
  • Bolded names indicates products which are available in at least three countries in which English is an official language.

Are There Sex Differences in Comorbidity Between Substance Use & Mental Health in Adolescents?

Published on by Andrew MarshallLeave a comment

Research Paper Title

Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin.

Background

This study aims to evaluate sex differences in alcohol and cannabis use and mental health disorders (MHD) in adolescents, and to evaluate the predictive role of mental health disorders for alcohol and cannabis use disorders (AUD and CUD respectively).

Method

A sample of 863 adolescents from the general population (53.7% girls, Mage = 16.62, SD = 0.85) completed a computerised battery including questions on substance use frequency, the Brief Symptom Inventory, the Cannabis Problems Questionnaire for Adolescents – Short version, the Rutgers Alcohol Problem Index and the DSM-IV-TR criteria for AUD and CUD. Bivariate analyses and binary logistic regressions were performed.

Results

Girls presented significantly more mental health problems and a higher prevalence of comorbidity between SUD and MHD. Obsessive-compulsive symptoms and phobic anxiety indicated a higher risk of AUD, whereas depression and interaction between hostility and obsessive-compulsive disorder indicated a higher risk of CUD.

Conclusions

Comorbidity between SUD and MHD is high among adolescents, and significantly higher among girls.

Reference

Fernandez-Artamendi, S. Martinez-Loredo, V. & Lopez-Nunez, C. (2021) Sex Differences in Comorbidity Between Substance Use and Mental Health in Adolescents: Two Sides of the Same Coin. Psicotherma. 33(1), pp.36-43. doi: 10.7334/psicothema2020.297.

Book: On Being Normal and Other Disorders

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Book Title:

On Being Normal and Other Disorders – A Manual for Clinical Psychodiagnostics.

Author(s): Paul Verhaeghe.

Year: 2019.

Edition: First (1st).

Publisher: Routledge.

Type(s): Hardcover, Paperback, and Kindle.

Synopsis:

Winner of the 2005 Goethe Award in Psychoanalytic Scholarship.

The central argument of On Being Normal and Other Disorders is that psychic identity is acquired through one’s primary intersubjective relationships. Thus, the diagnosis of potential pathologies must also be founded on this relation. Given that the efficacy of all forms of treatment depends upon the therapeutic relation, a diagnostic of this sort has wide-ranging applications.

Paul Verhaeghe’s critical evaluation of the contemporary DSM-diagnostic shows that the lack of reference to an updated governing metapsychology impinges on the therapeutic value of the DSM categories. In response to this problem, the author sketches out the foundations of such a metapsychology by combining a Freudo-Lacanian approach with contemporary empirical research. Close attention is paid to the processes of identity acquisition to show how the self and the Other are not two separate entities. Rather, subject formation is seen as a process in which both the subject’s and the Other’s identity, as well as the relationship between them, comes into being.

By engaging this new theoretical approach in a constant dialogue with the findings of contemporary research, this book provides a compass for the practical applications of such a differential diagnostic. Post-modern categories of anxiety disorders, personality disorders, and post-traumatic stress disorders are approached both through the well-known neurotic, psychotic, and perverse structures, as well as through the less familiar distinction between an actual pathology and a psychopathology. These two outlooks, which involve the role of language and the subject’s relation to the Other, are spelled out to show their implications for treatment at every turn.