Tag: Neurologist

On This Day … 06 February [2023]

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People (Births)

  • 1839 – Eduard Hitzig, German neurologist and psychiatrist (d. 1907)
  • 1852 – C. Lloyd Morgan, English zoologist and psychologist (d. 1936)

People (Deaths)

  • 2012 – David Rosenhan, American psychologist and academic (b. 1929)

Eduard Hitzig

Eduard Hitzig (6 February 1838 to 20 August 1907) was a German neurologist and neuropsychiatrist of Jewish ancestry born in Berlin.

He studied medicine at the Universities of Berlin and Würzburg under the instruction of famous men such as Emil Du Bois-Reymond (1818–1896), Rudolf Virchow (1821–1902), Moritz Heinrich Romberg (1795–1873), and Karl Friedrich Otto Westphal (1833–1890). He received his doctorate in 1862 and subsequently worked in Berlin and Würzburg. In 1875, he became director of the Burghölzli asylum, as well as professor of psychiatry at the University of Zurich. In 1885, Hitzig became a professor at the University of Halle where he remained until his retirement in 1903.

Hitzig is remembered for his work concerning the interaction between electric current and the brain. In 1870, Hitzig, assisted by anatomist Gustav Fritsch (1837–1927), applied electricity via a thin probe to the exposed cerebral cortex of a dog without anaesthesia. They performed these studies at the home of Fritsch because the University of Berlin would not allow such experimentation in their laboratories. What Hitzig and Fritsch had discovered is that electrical stimulation of different areas of the cerebrum caused involuntary muscular contractions of specific parts of the dog’s body. They identified the brain’s “motor strip”, a vertical strip of brain tissue on the cerebrum in the back of the frontal lobe, which controls different muscles in the body. In 1870, Hitzig published his findings in an essay called Ueber die elektrische Erregbarkeit des Grosshirns (On the Electrical Excitability of the Cerebrum). This experimentation was considered the first time anyone had done any localised study regarding the brain and electric current.

However this was not the first time Hitzig had experienced the interaction between the brain and electricity; earlier in his career as a physician working with the Prussian Army, he experimented on wounded soldiers whose skulls were fractured by bullets. Hitzig noticed that applying a small electric current to the brains of these soldiers caused involuntary muscular movement.

Hitzig and Fritsch’s work opened the door to further localised testing of the brain by many others including Scottish neurologist, David Ferrier.

C. Lloyd Morgan

Conwy Lloyd Morgan, FRS (06 February 1852 to 06 March 1936) was a British ethologist and psychologist. He is remembered for his theory of emergent evolution, and for the experimental approach to animal psychology now known as Morgan’s Canon, a principle that played a major role in behaviourism, insisting that higher mental faculties should only be considered as explanations if lower faculties could not explain a behaviour.

David Rosenhan

David L. Rosenhan (22 November 1929 to 06 February 2012) was an American psychologist. He is best known for the Rosenhan experiment, a study challenging the validity of psychiatry diagnoses.

On This Day … 24 September [2022]

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People (Births)

  • 1901 – Alexandra Adler, Austrian neurologist and psychologist (d.2001).

People (Deaths)

  • 2013 – Boris Karvasarsky, Ukrainian-Russian psychiatrist and author (b. 1931).

Alexandra Adler

Alexandra Adler (24 September 1901 to 04 January 2001) was an Austrian neurologist and the daughter of psychoanalyst Alfred Adler.

She has been described as one of the “leading systematizers and interpreters” of Adlerian psychology. Her sister was Socialist activist Valentine Adler. Alexandra Adler’s husband was Halfdan Gregersen.

Boris Karvasarksy

Boris Dmitrievich Karvasarsky (Russian: Борис Дмитриевич Карвасарский; 03 February 1931 to 24 September 2013) was a Russian psychiatrist, a disciple of V.N. Myasishchev.

Karvasarsky headed the Department of Neuroses and Psychotherapy in the Bekhterev Research Institute from 1961 until his death. During the period of 1982 until 1993 he also held the chair of Child-Adolescent Psychotherapy in Leningrad Institute for Postgraduate Medical Education. In 1986, he became Head of the Republican Centre for Scientific and Methodic Coordination in Psychotherapy.

On This Day … 23 September [2022]

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People (Deaths)

  • 1939 – Sigmund Freud, Austrian neurologist and psychiatrist (b. 1856).

Sigmund Freud

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for evaluating and treating pathologies in the psyche through dialogue between a patient and a psychoanalyst.

Freud was born to Galician Jewish parents in the Moravian town of Freiberg, in the Austrian Empire. He qualified as a doctor of medicine in 1881 at the University of Vienna. Upon completing his habilitation in 1885, he was appointed a docent in neuropathology and became an affiliated professor in 1902. Freud lived and worked in Vienna, having set up his clinical practice there in 1886. In 1938, Freud left Austria to escape Nazi persecution. He died in exile in the United Kingdom in 1939.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis, Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression, and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Though in overall decline as a diagnostic and clinical practice, psychoanalysis remains influential within psychology, psychiatry, and psychotherapy, and across the humanities. It thus continues to generate extensive and highly contested debate concerning its therapeutic efficacy, its scientific status, and whether it advances or hinders the feminist cause. Nonetheless, Freud’s work has suffused contemporary Western thought and popular culture. W.H. Auden’s 1940 poetic tribute to Freud describes him as having created “a whole climate of opinion / under whom we conduct our different lives”.

On This Day … 20 April [2022]

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People (Births)

  • 1745 – Philippe Pinel, French physician and psychiatrist (d. 1826).
  • 1915 – Joseph Wolpe, South African psychotherapist and physician (d. 1997).
  • 1920 – Frances Ames, South African neurologist, psychiatrist, and human rights activist (d. 2002).

Philippe Pinel

Philippe Pinel (20 April 1745 to 25 October 1826) was a French physician, precursor of psychiatry and incidentally a zoologist. He was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy. He worked for the abolition of the shackling of mental patients by chains and, more generally, for the humanisation of their treatment. He also made notable contributions to the classification of mental disorders and has been described by some as “the father of modern psychiatry”.

After the French Revolution, Dr. Pinel changed the way we look at the crazy (or “aliénés”, “alienated” in English) by claiming that they can be understood and cured. An 1809 description of a case that Pinel recorded in the second edition of his textbook on insanity is regarded by some as the earliest evidence for the existence of the form of mental disorder later known as dementia praecox or schizophrenia, although Emil Kraepelin is generally accredited with its first conceptualisation.

“Father of modern psychiatry”, he was credited with the first classification of mental illnesses. He had a great influence on psychiatry and the treatment of the alienated in Europe and the United States.

Joseph Wolpe

Joseph Wolpe (20 April 1915 to 04 December 1997) was a South African psychiatrist and one of the most influential figures in behaviour therapy.

Wolpe grew up in South Africa, attending Parktown Boys’ High School and obtaining his MD from the University of the Witwatersrand.

In 1956, Wolpe was awarded a Ford Fellowship and spent a year at Stanford University in the Centre for Behavioral Sciences, subsequently returning to South Africa but permanently moving to the United States in 1960 when he accepted a position at the University of Virginia.

In 1965, Wolpe accepted a position at Temple University.

One of the most influential experiences in Wolpe’s life was when he enlisted in the South African army as a medical officer. Wolpe was entrusted to treat soldiers who were diagnosed with what was then called “war neurosis” but today is known as post traumatic stress disorder. The mainstream treatment of the time for soldiers was based on psychoanalytic theory, and involved exploring the trauma while taking a hypnotic agent – so-called narcotherapy. It was believed that having the soldiers talk about their repressed experiences openly would effectively cure their neurosis. However, this was not the case. It was this lack of successful treatment outcomes that forced Wolpe, once a dedicated follower of Freud, to question psychoanalytic therapy and search for more effective treatment options. Wolpe is most well known for his reciprocal inhibition techniques, particularly systematic desensitisation, which revolutionised behavioural therapy. A Review of General Psychology survey, published in 2002, ranked Wolpe as the 53rd most cited psychologist of the 20th century, an impressive accomplishment accentuated by the fact that Wolpe was a psychiatrist.

Frances Ames

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody. When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalization for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.

Who was Frances Ames?

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Introduction

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody.

When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalization for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.

Early Life

Ames was born at Voortrekkerhoogte in Pretoria, South Africa, on 20 April 1920, to Frank and Georgina Ames, the second of three daughters. Her mother, who was raised in a Boer concentration camp by Ames’ grandmother, a nurse in the Second Boer War, was also a nurse. Ames never knew her father, who left her mother alone to raise three daughters in poverty. With her mother unable to care for her family, Ames spent part of her childhood in a Catholic orphanage where she was stricken with typhoid fever. Her mother later rejoined the family and moved them to Cape Town, where Ames attended the Rustenburg School for Girls. She enrolled at the University of Cape Town (UCT) medical school where she received her MBChB degree in 1942.

Medical Career

In Cape Town, Ames interned at Groote Schuur Hospital; she also worked in the Transkei region as a general practitioner. She earned her MD degree in 1964 from UCT, the first woman to do so. Ames became head of the neurology department at Groote Schuur Hospital in 1976. She was made an associate professor in 1978. Ames retired in 1985, but continued to work part-time at both Valkenberg and Alexandra Hospital as a lecturer in the UCT Psychiatry and Mental Health departments. In 1997, UCT made Ames an associate professor emeritus of neurology; she received an honorary doctorate in medicine from UCT in 2001. According to Pat Sidley of the British Medical Journal, Ames “was never made a full professor, and believed that this was because she was a woman.”

Biko Affair

South African anti-apartheid activist Steve Biko, who had formerly studied medicine at the University of Natal Medical School, was detained by Port Elizabeth security police on 18 August 1977 and held for 20 days. Sometime between 06 and 07 September, Biko was beaten and tortured into a coma. According to allegations by Ames and others, surgeon Ivor Lang, along with chief district surgeon Benjamin Tucker, collaborated with the police and covered up the abuse, leading to Biko’s death from his injuries on 12 September. According to Benatar & Benatar 2012, “there were clear ethical breaches on the part of the doctors who were responsible” for Biko.

When the South African Medical and Dental Council (SAMDC) along with the support of the Medical Association of South Africa (MASA), declined to discipline the district surgeons in Biko’s death, two groups of physicians filed separate formal complaints with the SAMDC regarding the lack of professionalism shown by Biko’s doctors. Both cases made their way to the South African Supreme Court in an attempt to force the SAMDC to conduct a formal inquiry into the medical ethics of Lang and Tucker. One case was filed by Ames, along with Trefor Jenkins and Phillip Tobias of the University of the Witwatersrand; a second case was filed by Dumisani Mzana, Yosuf Veriava of Coronationville Hospital, and Tim Wilson of Alexandra Health Centre.

As Ames and the small group of physicians pursued an inquiry into members of their own profession, Ames was called a whistleblower. Her position at the university was threatened by her superiors and her colleagues asked her to drop the case. By pursuing the case against the Biko doctors, Ames received personal threats and risked her safety. Baldwin-Ragaven et al. note that the medical association “closed ranks in support of colleagues who colluded with the security police in the torture and death of detainees [and] also attempted to silence and discredit those doctors who stood up for human rights and who demanded disciplinary action against their colleagues.”

After eight years, Ames won the case in 1985 when the South African Supreme Court ruled in her favour. With Ames’ help, the case forced the medical regulatory body to reverse their decision. The two doctors who treated Biko were finally disciplined and major medical reforms followed. According to Benatar & Benatar 2012, the case “played an important role in sensitising the medical profession to medical ethical issues in South Africa.”

Cannabis Research

Ames studied the effects of cannabis in 1958, publishing her work in The British Journal of Psychiatry as “A clinical and metabolic study of acute intoxication with Cannabis sativa and its role in the model psychoses”. Her work is cited extensively throughout the cannabis literature. She opposed the War on Drugs and was a proponent of the therapeutic benefits of cannabis, particularly for people with multiple sclerosis (MS). Ames observed first-hand how cannabis (known as dagga in South Africa) relieved spasm in MS patients and helped paraplegics in the spinal injuries ward of her hospital. She continued to study the effects of cannabis in the 1990s, publishing several articles about cannabis-induced euphoria and the effects of cannabis on the brain.

Personal Life

Ames was married to editorial writer David Castle of the Cape Times and they had four sons. She was 47 years old when her husband died unexpectedly in 1967. After her husband’s death, Ames’s housekeeper Rosalina helped raise the family. Ames wrote about the experience in her memoir, Mothering in an Apartheid Society (2002).

Death

Ames struggled with leukaemia for some time. Before her death, she told an interviewer, “I shall go on until I drop.” She continued to work for UCT as a part-time lecturer at Valkenberg Hospital until six weeks before she died at home in Rondebosch on 11 November 2002. Representing UCT’s psychiatry department, Greg McCarthy gave the eulogy at the funeral. Ames was cremated, and according to her wishes, her ashes were combined with hemp seed and dispersed outside of Valkenberg Hospital where her memorial service was held.

Legacy

South African neurosurgeon Colin Froman referred to Ames as the “great and unorthodox protagonist for the medical use of marijuana many years before the current interest in its use as a therapeutic drug”. J.P. van Niekerk of the South African Medical Journal notes that “Frances Ames led by conviction and example” and history eventually justified her action in the Biko affair.

Ames’s work on the Biko affair led to major medical reforms in South Africa, including the disbanding and replacement of the old apartheid-era medical organisations which failed to uphold the medical standards of the profession. According to van Niekerk, “the most enduring lesson for South African medicine was the clarification of the roles of medical practitioners when there is a question of dual responsibilities. This is now embodied inter alia in the SAMA Code of Conduct and in legal interpretations of doctors’ responsibilities”.

Ames testified during the medical hearings at the Truth and Reconciliation Commission in 1997. Archbishop Desmond Tutu honoured Ames as “one of the handful of doctors who stood up to the apartheid regime and brought to book those doctors who had colluded with human rights abuse.” In acknowledgement of her work on behalf of human rights in South Africa, Nelson Mandela awarded Ames the Order of the Star of South Africa in 1999, the highest civilian award in the country.

What is Logotherapy?

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Introduction

Logotherapy was developed by neurologist and psychiatrist Viktor Frankl, on a concept based on the premise that the primary motivational force of an individual is to find a meaning in life.

Frankl describes it as “the Third Viennese School of Psychotherapy” along with Freud’s psychoanalysis and Adler’s individual psychology. Logotherapy is based on an existential analysis focusing on Kierkegaard’s will to meaning as opposed to Alfred Adler’s Nietzschean doctrine of will to power or Freud’s will to pleasure. Rather than power or pleasure, logotherapy is founded upon the belief that striving to find meaning in life is the primary, most powerful motivating and driving force in humans.

A short introduction to this system is given in Frankl’s most famous book, Man’s Search for Meaning, in which he outlines how his theories helped him to survive his Holocaust experience and how that experience further developed and reinforced his theories. Presently, there are a number of logotherapy institutes around the world.

Basic Principles

The notion of Logotherapy was created with the Greek word logos (“reason”). Frankl’s concept is based on the premise that the primary motivational force of an individual is to find a meaning in life. The following list of tenets represents basic principles of logotherapy:

  • Life has meaning under all circumstances, even the most miserable ones.
  • Our main motivation for living is our will to find meaning in life.
  • We have freedom to find meaning in what we do, and what we experience, or at least in the stance we take when faced with a situation of unchangeable suffering.

The human spirit is referred to in several of the assumptions of logotherapy, but the use of the term spirit is not “spiritual” or “religious”. In Frankl’s view, the spirit is the will of the human being. The emphasis, therefore, is on the search for meaning, which is not necessarily the search for God or any other supernatural being. Frankl also noted the barriers to humanity’s quest for meaning in life. He warns against “…affluence, hedonism, [and] materialism…” in the search for meaning.

Purpose in life and meaning in life constructs appeared in Frankl’s logotherapy writings with relation to existential vacuum and will to meaning, as well as others who have theorised about and defined positive psychological functioning. Frankl observed that it may be psychologically damaging when a person’s search for meaning is blocked. Positive life purpose and meaning was associated with strong religious beliefs, membership in groups, dedication to a cause, life values, and clear goals. Adult development and maturity theories include the purpose in life concept. Maturity emphasizes a clear comprehension of life’s purpose, directedness, and intentionality which contributes to the feeling that life is meaningful.

Frankl’s ideas were operationalized by Crumbaugh and Maholick’s Purpose in Life (PIL) test, which measures an individual’s meaning and purpose in life. With the test, investigators found that meaning in life mediated the relationships between religiosity and well-being; uncontrollable stress and substance use; depression and self-derogation. Crumbaugh found that the Seeking of Noetic Goals Test (SONG) is a complementary measure of the PIL. While the PIL measures the presence of meaning, the SONG measures orientation towards meaning. A low score in the PIL but a high score in the SONG, would predict a better outcome in the application of Logotherapy.

Discovering Meaning

According to Frankl, “We can discover this meaning in life in three different ways: (1) by creating a work or doing a deed; (2) by experiencing something or encountering someone; and (3) by the attitude we take toward unavoidable suffering” and that “everything can be taken from a man but one thing: the last of the human freedoms – to choose one’s attitude in any given set of circumstances”. On the meaning of suffering, Frankl gives the following example:

“Once, an elderly general practitioner consulted me because of his severe depression. He could not overcome the loss of his wife who had died two years before and whom he had loved above all else. Now how could I help him? What should I tell him? I refrained from telling him anything, but instead confronted him with a question, “What would have happened, Doctor, if you had died first, and your wife would have had to survive without you?:” “Oh,” he said, “for her this would have been terrible; how she would have suffered!” Whereupon I replied, “You see, Doctor, such a suffering has been spared her, and it is you who have spared her this suffering; but now, you have to pay for it by surviving and mourning her.” He said no word but shook my hand and calmly left the office.

Frankl emphasized that realising the value of suffering is meaningful only when the first two creative possibilities are not available (for example, in a concentration camp) and only when such suffering is inevitable – he was not proposing that people suffer unnecessarily.

Philosophical Basis of Logotherapy

Frankl described the meta-clinical implications of logotherapy in his book The Will to Meaning: Foundations and Applications of Logotherapy. He believed that there is no psychotherapy apart from the theory of the individual. As an existential psychologist, he inherently disagreed with the “machine model” or “rat model”, as it undermines the human quality of humans. As a neurologist and psychiatrist, Frankl developed a unique view of determinism to coexist with the three basic pillars of logotherapy (the freedom of will). Though Frankl admitted that a person can never be free from every condition, such as, biological, sociological, or psychological determinants; based on his experience during his life in the Nazi concentration camps, he believed that a person is “capable of resisting and braving even the worst conditions”. In doing such, a person can detach from situations and themselves, choose an attitude about themselves, and determine their own determinants, thus shaping their own character and becoming responsible for themselves.

Logotherapeutic Views and Treatment

Overcoming Anxiety

By recognising the purpose of our circumstances, one can master anxiety. Anecdotes about this use of logotherapy are given by New York Times writer Tim Sanders, who explained how he uses its concept to relieve the stress of fellow airline travellers by asking them the purpose of their journey. When he does this, no matter how miserable they are, their whole demeanour changes, and they remain happy throughout the flight. Overall, Frankl believed that the anxious individual does not understand that their anxiety is the result of dealing with a sense of “unfulfilled responsibility” and ultimately a lack of meaning.

Treatment of Neurosis

Frankl cites two neurotic pathogens: hyper-intention, a forced intention toward some end which makes that end unattainable; and hyper-reflection, an excessive attention to oneself which stifles attempts to avoid the neurosis to which one thinks oneself predisposed. Frankl identified anticipatory anxiety, a fear of a given outcome which makes that outcome more likely. To relieve the anticipatory anxiety and treat the resulting neuroses, logotherapy offers paradoxical intention, wherein the patient intends to do the opposite of their hyper-intended goal.

A person, then, who fears (i.e. experiences anticipatory anxiety over) not getting a good night’s sleep may try too hard (that is, hyper-intend) to fall asleep, and this would hinder their ability to do so. A logotherapist would recommend, then, that the person go to bed and intentionally try not to fall asleep. This would relieve the anticipatory anxiety which kept the person awake in the first place, thus allowing them to fall asleep in an acceptable amount of time.

Depression

Viktor Frankl believed depression occurred at the psychological, physiological, and spiritual levels. At the psychological level, he believed that feelings of inadequacy stem from undertaking tasks beyond our abilities. At the physiological level, he recognised a “vital low”, which he defined as a “diminishment of physical energy”. Finally, Frankl believed that at the spiritual level, the depressed individual faces tension between who they actually are in relation to what they should be. Frankl refers to this as the gaping abyss. Finally Frankl suggests that if goals seem unreachable, an individual loses a sense of future and thus meaning resulting in depression. Thus logotherapy aims “to change the patient’s attitude toward their disease as well as toward their life as a task”.

Obsessive-Compulsive Disorder

Frankl believed that those suffering from obsessive-compulsive disorder lack the sense of completion that most other individuals possess. Instead of fighting the tendencies to repeat thoughts or actions, or focusing on changing the individual symptoms of the disease, the therapist should focus on “transform[ing] the neurotic’s attitude toward their neurosis”. Therefore, it is important to recognise that the patient is “not responsible for his obsessional ideas”, but that “he is certainly responsible for his attitude toward these ideas”. Frankl suggested that it is important for the patient to recognise their inclinations toward perfection as fate, and therefore, must learn to accept some degrees of uncertainty. Ultimately, following the premise of logotherapy, the patient must eventually ignore their obsessional thoughts and find meaning in their life despite such thoughts.

Schizophrenia

Though logotherapy was not intended to deal with severe disorders, Frankl believed that logotherapy could benefit even those suffering from schizophrenia. He recognised the roots of schizophrenia in physiological dysfunction. In this dysfunction, the person with schizophrenia “experiences himself as an object” rather than as a subject. Frankl suggested that a person with schizophrenia could be helped by logotherapy by first being taught to ignore voices and to end persistent self-observation. Then, during this same period, the person with schizophrenia must be led toward meaningful activity, as “even for the schizophrenic there remains that residue of freedom toward fate and toward the disease which man always possesses, no matter how ill he may be, in all situations and at every moment of life, to the very last”.

Terminally Ill Patients

In 1977, Terry Zuehlke and John Watkins conducted a study analysing the effectiveness of logotherapy in treating terminally ill patients. The study’s design used 20 male Veterans Administration volunteers who were randomly assigned to one of two possible treatments – (1) group that received 8 45-minute sessions over a 2-week period and (2) group used as control that received delayed treatment. Each group was tested on 5 scales – the MMPI K Scale, MMPI L Scale, Death Anxiety Scale, Brief Psychiatric Rating Scale, and the Purpose of Life Test. The results showed an overall significant difference between the control and treatment groups. While the univariate analyses showed that there were significant group differences in 3/5 of the dependent measures. These results confirm the idea that terminally ill patients can benefit from logotherapy in coping with death.

Forms of Treatment

Ecce Homo is a method used in logotherapy. It requires of the therapist to note the innate strengths that people have and how they have dealt with adversity and suffering in life. Despite everything a person may have gone through, they made the best of their suffering! Hence, Ecce Homo – Behold the Man!

Controversy

Authoritarianism

In 1969 Rollo May argued that logotherapy is, in essence, authoritarian. He suggested that Frankl’s therapy presents a plain solution to all of life’s problems, an assertion that would seem to undermine the complexity of human life itself. May contended that if a patient could not find their own meaning, Frankl would provide a goal for his patient. In effect, this would negate the patient’s personal responsibility, thus “diminish[ing] the patient as a person”. Frankl explicitly replied to May’s arguments through a written dialogue, sparked by Rabbi Reuven Bulka’s article “Is Logotherapy Authoritarian?”. Frankl responded that he combined the prescription of medication, if necessary, with logotherapy, to deal with the person’s psychological and emotional reaction to the illness, and highlighted areas of freedom and responsibility, where the person is free to search and to find meaning.

Religiousness

Critical views of the life of logotherapy’s founder and his work assume that Frankl’s religious background and experience of suffering guided his conception of meaning within the boundaries of the person and therefore that logotherapy is founded on Viktor Frankl’s worldview. Many researchers argue that logotherapy is not a “scientific” psychotherapeutic school in the traditional sense but a philosophy of life, a system of values, a secular religion which is not fully coherent and is based on questionable metaphysical premises.

Frankl openly spoke and wrote on religion and psychiatry, throughout his life, and specifically in his last book, Man’s Search for Ultimate Meaning (1997). He asserted that every person has a spiritual unconscious, independently of religious views or beliefs, yet Frankl’s conception of the spiritual unconscious does not necessarily entail religiosity. In Frankl’s words: “It is true, Logotherapy, deals with the Logos; it deals with Meaning. Specifically, I see Logotherapy in helping others to see meaning in life. But we cannot “give” meaning to the life of others. And if this is true of meaning per se, how much does it hold for Ultimate Meaning?” The American Psychiatric Association awarded Viktor Frankl the 1985 Oskar Pfister Award (for important contributions to religion and psychiatry).

Recent Developments

Since the 1990s, the number of institutes providing education and training in logotherapy continues to increase worldwide. Numerous logotherapeutic concepts have been integrated and applied in different fields, such as cognitive behavioural therapy (CBT), acceptance and commitment therapy (ACT), and burnout prevention. The logotherapeutic concepts of noogenic neurosis and existential crisis were added to the ICD 11 under the name demoralisation crisis, i.e. a construct that features hopelessness, meaninglessness, and existential distress as first described by Frankl in the 1950s. Logotherapy has also been associated with psychosomatic and physiological health benefits. Besides Logotherapy, other meaning-centred psychotherapeutic approaches such as positive psychology and meaning therapy have emerged. Paul Wong’s meaning therapy attempts to translate logotherapy into psychological mechanisms, integrating CBT, positive psychotherapy and the positive psychology research on meaning. Logotherapy is also being applied in the field of oncology and palliative care (William Breitbart). These recent developments introduce Viktor Frankl’s logotherapy to a new generation and extend its impact to new areas of research.

On This Day … 06 May

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Events

  • 1757 – English poet Christopher Smart is admitted into St Luke’s Hospital for Lunatics in London, beginning his six-year confinement to mental asylums.

People (Births)

  • 1856 – Sigmund Freud, Austrian neurologist and psychoanalyst (d. 1939).
  • 1922 – Camille Laurin, Canadian psychiatrist and politician, 7th Deputy Premier of Quebec (d. 1999).

People (Deaths)

2012 – Jean Laplanche, French psychoanalyst and author (b. 1924).

Christopher Smart

The English poet Christopher Smart (1722-1771) was confined to mental asylums from May 1757 until January 1763. Smart was admitted into St Luke’s Hospital for Lunatics, Upper Moorfields, London, on 06 May 1757. He was taken there by his father-in-law, John Newbery, although he may have been confined in a private madhouse before then. While in St Luke’s he wrote Jubilate Agno and A Song to David, the poems considered to be his greatest works. Although many of his contemporaries agreed that Smart was “mad”, accounts of his condition and its ramifications varied, and some felt that he had been committed unfairly.

Smart was diagnosed as “incurable” while at St Luke’s, and when they ran out of funds for his care he was moved to Mr. Potter’s asylum, Bethnal Green. All that is known of his years of confinement is that he wrote poetry. Smart’s isolation led him to abandon the poetic genres of the 18th century that had marked his earlier work and to write religious poetry such as Jubilate Agno (“Rejoice in the Lamb”). His asylum poetry reveals a desire for “unmediated revelation”, and it is possible that the self-evaluation found in his poetry represents an expression of evangelical Christianity.

Late 18th-century critics felt that Smart’s madness justified them in ignoring his A Song to David, but during the following century Robert Browning and his contemporaries considered his condition to be the source of his genius. It was not until the 20th century, with the rediscovery of Jubilate Agno (not published until 1939), that critics reconsidered Smart’s case and began to see him as a revolutionary poet, the possible target of a plot by his father-in-law, a publisher, to silence him.

Sigmund Freud

Sigmund Freud (born Sigismund Schlomo Freud; 06 May 1856 to 23 September 1939) was an Austrian neurologist and the founder of psychoanalysis, a clinical method for treating psychopathology through dialogue between a patient and a psychoanalyst.

Freud was born to Galician Jewish parents in the Moravian town of Freiberg, in the Austrian Empire. He qualified as a doctor of medicine in 1881 at the University of Vienna. Upon completing his habilitation in 1885, he was appointed a docent in neuropathology and became an affiliated professor in 1902. Freud lived and worked in Vienna, having set up his clinical practice there in 1886. In 1938, Freud left Austria to escape Nazi persecution. He died in exile in the United Kingdom in 1939.

In founding psychoanalysis, Freud developed therapeutic techniques such as the use of free association and discovered transference, establishing its central role in the analytic process. Freud’s redefinition of sexuality to include its infantile forms led him to formulate the Oedipus complex as the central tenet of psychoanalytical theory. His analysis of dreams as wish-fulfilments provided him with models for the clinical analysis of symptom formation and the underlying mechanisms of repression. On this basis Freud elaborated his theory of the unconscious and went on to develop a model of psychic structure comprising id, ego and super-ego. Freud postulated the existence of libido, a sexualised energy with which mental processes and structures are invested and which generates erotic attachments, and a death drive, the source of compulsive repetition, hate, aggression and neurotic guilt. In his later works, Freud developed a wide-ranging interpretation and critique of religion and culture.

Though in overall decline as a diagnostic and clinical practice, psychoanalysis remains influential within psychology, psychiatry, and psychotherapy, and across the humanities. It thus continues to generate extensive and highly contested debate with regard to its therapeutic efficacy, its scientific status, and whether it advances or hinders the feminist cause. Nonetheless, Freud’s work has suffused contemporary Western thought and popular culture. W.H. Auden’s 1940 poetic tribute to Freud describes him as having created “a whole climate of opinion / under whom we conduct our different lives.”

Camille Laurin

Camille Laurin (06 May 1922 to 11 March 1999) was a psychiatrist and Parti Québécois (PQ) politician in the province of Quebec, Canada. MNA member for the riding of Bourget, he is considered the father of Quebec’s language law known informally as “Bill 101”.

Born in Charlemagne, Quebec, Laurin obtained a degree in psychiatry from the Université de Montréal where he came under the influence of the Roman Catholic priest, Lionel Groulx. After earning his degree, Laurin went to Boston, Massachusetts, where he worked at the Boston State Hospital. Following a stint in Paris, France, in 1957, he returned to practice in Quebec. In 1961, he authored the preface of the book Les fous crient au secours, which described the conditions of psychiatric hospitals of the time.

He was one of the early founders of the Quebec sovereignty movement. As a senior cabinet minister in the first PQ government elected in the 1976 Quebec election, he was the guiding force behind Bill 101, the legislation that placed restrictions on the use of English on public signs and in the workplace of large companies, and strengthened the position of French as the only official language in Quebec.

Laurin resigned from his cabinet position on 26 November 1984 because of a disagreement with Lévesque on the future of the sovereignty movement. He resigned from his seat in the National Assembly on 25 January 1985. He was elected once again to the Assembly on 12 September 1994 but did not run in the 1998 election for health reasons.

He died after a long battle with cancer.

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.

On This Day … 20 April

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People (Births)

  • 1745 – Philippe Pinel, French physician and psychiatrist (d. 1826).
  • 1915 – Joseph Wolpe, South African psychotherapist and physician (d. 1997).
  • 1920 – Frances Ames, South African neurologist, psychiatrist, and human rights activist (d. 2002).

Philippe Pinel

Philippe Pinel (20 April 1745 to 25 October 1826) was a French physician who was instrumental in the development of a more humane psychological approach to the custody and care of psychiatric patients, referred to today as moral therapy. He also made notable contributions to the classification of mental disorders and has been described by some as “the father of modern psychiatry”.

An 1809 description of a case that Pinel recorded in the second edition of his textbook on insanity is regarded by some as the earliest evidence for the existence of the form of mental disorder later known as dementia praecox or schizophrenia, although Emil Kraepelin is generally accredited with its first conceptualisation.

Joseph Wolpe

Joseph Wolpe (20 April 1915 to 04 December 1997 in Los Angeles) was a South African psychiatrist and one of the most influential figures in behaviour therapy.

Wolpe grew up in South Africa, attending Parktown Boys’ High School and obtaining his MD from the University of the Witwatersrand.

In 1956 Wolpe was awarded a Ford Fellowship and spent a year at Stanford University in the Center for Behavioral Sciences, subsequently returning to South Africa but permanently moving to the United States in 1960 when he accepted a position at the University of Virginia.

In 1965 Wolpe accepted a position at Temple University.

One of the most influential experiences in Wolpe’s life was when he enlisted in the South African army as a medical officer. Wolpe was entrusted to treat soldiers who were diagnosed with what was then called “war neurosis” but today is known as post traumatic stress disorder. The mainstream treatment of the time for soldiers was based on psychoanalytic theory, and involved exploring the trauma while taking a hypnotic agent – so-called narcotherapy. It was believed that having the soldiers talk about their repressed experiences openly would effectively cure their neurosis. However, this was not the case. It was this lack of successful treatment outcomes that forced Wolpe, once a dedicated follower of Freud, to question psychoanalytic therapy and search for more effective treatment options. Wolpe is most well known for his reciprocal inhibition techniques, particularly systematic desensitisation, which revolutionised behavioural therapy.

A Review of General Psychology survey, published in 2002, ranked Wolpe as the 53rd most cited psychologist of the 20th century, an impressive accomplishment accentuated by the fact that Wolpe was a psychiatrist.

Frances Ames

Frances Rix Ames (20 April 1920 to 11 November 2002) was a South African neurologist, psychiatrist, and human rights activist, best known for leading the medical ethics inquiry into the death of anti-apartheid activist Steve Biko, who died from medical neglect after being tortured in police custody. When the South African Medical and Dental Council (SAMDC) declined to discipline the chief district surgeon and his assistant who treated Biko, Ames and a group of five academics and physicians raised funds and fought an eight-year legal battle against the medical establishment. Ames risked her personal safety and academic career in her pursuit of justice, taking the dispute to the South African Supreme Court, where she eventually won the case in 1985.

Born in Pretoria and raised in poverty in Cape Town, Ames became the first woman to receive a Doctor of Medicine degree from the University of Cape Town in 1964. Ames studied the effects of cannabis on the brain and published several articles on the subject. Seeing the therapeutic benefits of cannabis on patients in her own hospital, she became an early proponent of legalisation for medicinal use. She headed the neurology department at Groote Schuur Hospital before retiring in 1985, but continued to lecture at Valkenberg and Alexandra Hospital. After apartheid was dismantled in 1994, Ames testified at the Truth and Reconciliation Commission about her work on the “Biko doctors” medical ethics inquiry. In 1999, Nelson Mandela awarded Ames the Star of South Africa, the country’s highest civilian award, in recognition of her work on behalf of human rights.

On This Day … 26 March

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People (Births)

  • 1905 – Viktor Frankl, Austrian neurologist and psychiatrist (d. 1997).

People (Deaths)

  • 2014 – Roger Birkman, American psychologist and author (b. 1919).
  • 2015 – Tomas Tranströmer, Swedish poet, translator, and psychologist Nobel Prize laureate (b. 1931).

Viktor Frankl

Viktor Emil Frankl (26 March 1905 to 02 September 1997) was an Austrian neurologist, psychiatrist, philosopher, author, and Holocaust survivor.

He was the founder of logotherapy, a school of psychotherapy which describes a search for a life meaning as the central human motivational force. Logotherapy is part of existential and humanistic psychology theories.

Frankl published 39 books. The autobiographical Man’s Search for Meaning, a best-selling book, is based on his experiences in various Nazi concentration camps.

Roger Birkman

Roger Winfred Birkman (01 February 1919 to 26 March 2014) was an American organisational psychologist. He was the creator of The Birkman Method, a workplace psychological assessment. Birkman received his Ph.D. in psychology in 1961 from the University of Texas at Austin. He was the founder and chairman of the board of Birkman International, Inc.

The Birkman Method

The Birkman Method is an online personality, social perception, and occupational interest assessment consisting of ten scales describing occupational preferences (Interests), 11 scales describing “effective behaviours” (Usual behaviours) and 11 scales describing interpersonal and environmental expectations (Needs or Expectations). A corresponding set of 11 scale values was derived to describe “less than effective” behaviours (Stress behaviours). Occupational profiling consists of 22 job families with more than 200 corresponding job titles all connected to O*Net.

The construction and comparative analysis of the Birkman Method is designed to provide insight into what specifically drives a person’s behaviour, with the goal of creating greater choice and more self-responsibility. It attempts to measure social behaviours, underlying expectations of interpersonal and task actions, potential stress reactions to unmet expectations, occupational preferences and organisational strengths. It is empirically supported by reliability and validity studies, including studies using classical test theory (CTT) and item response theory (IRT). The Birkman Method has 3 different types of assessments available.

Tomas Tranströmer

Tomas Gösta Tranströmer 15 April 1931 to 26 March 2015) was a Swedish poet, psychologist and translator. His poems captured the long Swedish winters, the rhythm of the seasons and the palpable, atmospheric beauty of nature. Tranströmer’s work is also characterised by a sense of mystery and wonder underlying the routine of everyday life, a quality which often gives his poems a religious dimension. He has been described as a Christian poet.

Tranströmer is acclaimed as one of the most important Scandinavian writers since the Second World War. Critics praised his poetry for its accessibility, even in translation. His poetry has been translated into over 60 languages. He was the recipient of the 1990 Neustadt International Prize for Literature and the 2011 Nobel Prize in Literature.

On This Day … 11 March

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People (Births)

  • 1915 – J.C.R. Licklider, American computer scientist and psychologist (d. 1990).

People (Deaths)

  • 1999 – Herbert Jasper, Canadian psychologist, anatomist, and neurologist (b. 1906).
  • 1999 – Camille Laurin, Canadian psychiatrist and politician (b. 1922).

J.C.R. Licklider

Joseph Carl Robnett Licklider (11 March 1915 to 26 June 1990), known simply as J.C.R. or “Lick”, was an American psychologist and computer scientist who is considered among prominent figures in computer science development and general computing history.

He is particularly remembered for being one of the first to foresee modern-style interactive computing and its application to all manner of activities; and also as an Internet pioneer with an early vision of a worldwide computer network long before it was built. He did much to initiate this by funding research which led to much of it, including today’s canonical graphical user interface, and the ARPANET, the direct predecessor to the Internet.

He has been called “computing’s Johnny Appleseed”, for planting the seeds of computing in the digital age; Robert Taylor, founder of Xerox PARC’s Computer Science Laboratory and Digital Equipment Corporation’s Systems Research Center, noted that “most of the significant advances in computer technology—including the work that my group did at Xerox PARC—were simply extrapolations of Lick’s vision. They were not really new visions of their own. So he was really the father of it all”.

Herbert Jasper

Herbert Henri Jasper, OC GOQ FRSC (27 July 1906 to 11 March 1999) was a Canadian psychologist, physiologist, neurologist, and epileptologist.

Born in La Grande, Oregon, he attended Reed College in Portland, Oregon and received his PhD in psychology from the University of Iowa in 1931 and earned a Doctor of Science degree from the University of Paris for research in neurobiology.

From 1946 to 1964 he was Professor of Experimental Neurology at the Montreal Neurological Institute, McGill University and then from 1965 to 1976 he was Professor of Neurophysiology, Université de Montréal. He did his most important research with Wilder Penfield at McGill University. He was a member of the American Academy of Neurology and the American Association for the Advancement of Science. He was also a member of the Canadian Neurological Society and the Royal Society of Medicine. He wrote more than 350 scientific publications.

Camille Laurin

Camille Laurin (06 May 1922 to 11 March 1999) was a psychiatrist and Parti Québécois (PQ) politician in the province of Quebec, Canada. MNA member for the riding of Bourget, he is considered the father of Quebec’s language law known informally as “Bill 101”.

Born in Charlemagne, Quebec, Laurin obtained a degree in psychiatry from the Université de Montréal where he came under the influence of the Roman Catholic priest, Lionel Groulx. After earning his degree, Laurin went to Boston, Massachusetts, where he worked at the Boston State Hospital. Following a stint in Paris, France, in 1957, he returned to practice in Quebec. In 1961, he authored the preface of the book Les fous crient au secours, which described the conditions of psychiatric hospitals of the time.

He was one of the early founders of the Quebec sovereignty movement. As a senior cabinet minister in the first PQ government elected in the 1976 Quebec election, he was the guiding force behind Bill 101, the legislation that placed restrictions on the use of English on public signs and in the workplace of large companies, and strengthened the position of French as the only official language in Quebec.

Laurin resigned from his cabinet position on 26 November 1984 because of a disagreement with Lévesque on the future of the sovereignty movement. He resigned from his seat in the National Assembly on 25 January 1985. He was elected once again to the Assembly on 12 September 1994 but did not run in the 1998 election for health reasons.

He died after a long battle with cancer.