What is Parataxic Distortion?

Introduction

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

Refer to Parataxical Integration.

Background

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

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

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

Etymology

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

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

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

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

Interpersonal Relationships and Emotions

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

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

Attachment Theory

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

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

Negative Effects

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

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

Defence Mechanism

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

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

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

The Nurse-Patient Relationship: Aggressive Behaviour in a Mental Health Setting

Research Paper Title

Aggressive Behaviour: Nurse-Patient Relationship in Mental Health Setting.

Background

Mental disorder is known to be as a loss of existential paradigm; individual’s functioning is lacking in all areas. Therefore, it is difficult to point out what the patients exactly need because their needs are set on a broad range of a difficult boundary.

The level of care that follows will be complex and multifactorial because nursing will challenge the interaction with the individual as a whole: behaviours and relations with family members.

At this stage exploring interpersonal conflicts, with past and present aggression behaviours will be crucial.

Methods

The aim of this paper is to investigate the professional experience in a work context where the patient’s clinical condition poses a daily challenge from a physical and emotional perspective.

Narrative investigation is performed here in order to explore the psychological load of the professional’s psychological experience and its implication in facing aggressive situations.

Moreover, this investigation highlights the importance of some professional and personal resources that can be made available to the operator.

Results

These tools could improve the understanding of the subjective experience of acute events guiding the individual through an exploration of the phenomenology of what happened decreasing the intimate stress load.

Conclusions

A constant updating, the knowledge of de-escalation techniques and sharing the experience in dedicated settings could be important allies in the management of risk events.

Reference

Moriconi, S., Balducci, P.M. & Tortorella, A. (2020) Aggressive Behavior: Nurse-Patient Relationship in Mental Health Setting. Pyschiatria Danubina. 32(Suppl 1), pp.207-209.

Is It Important that Health Promotion be a Focus that Permeates the Entire Organisation of Mental Health Care?

Research Paper Title

Mental health nurses’ experience of physical health care and health promotion initiatives for people with severe mental illness.

Background

Health care for people with severe mental illness is often divided into physical health care and mental health care despite the importance of a holistic approach to caring for the whole person.

Mental health nurses have an important role not only in preventing ill health, but also in promoting health, to improve the overall health among people with severe mental illness and to develop a more person-centred, integrated physical and mental health care.

Thus, the aim of this study was to describe mental health nurses’ experiences of facilitating aspects that promote physical health and support a healthy lifestyle for people with severe mental illness.

Methods

Interviews were conducted with mental health nurses (n = 15), and a qualitative content analysis was used to capture the nurse’s experiences.

Results

Analysis of the interviews generated three categories:

  • To have a health promotion focus in every encounter;
  • To support with each person’s unique prerequisites in mind; and
  • To take responsibility for health promotion in every level of the organisation.

Conclusions

The results show the importance of a health promotion focus that permeates the entire organisation of mental health care.

Shared responsibility for health and health promotion activities should exist at all levels:

  • In the person-centred care in the relation with the patient;
  • Embedded in a joint vision within the working unit; and
  • In decisions at management level.

Reference

Lundstrom, S., Jormfeldt, H., Ahlstrom, B.H. & Skarsater, I. (2020) Mental health nurses’ experience of physical health care and health promotion initiatives for people with severe mental illness. International Journal of Mental Health Nursing. 29(2), pp.244-253. doi: 10.1111/inm.12669. Epub 2019 Oct 29.

Should Service Users be Involved in Co-Designing Surveys they will Use?

Research Paper Title

Validation of a Comprehensive Patient Experience Survey for Addiction and Mental Health that was Co-designed with Service Users.

Background

A rigorous survey development process was undertaken to design and test a novel, comprehensive patient experience measure that can be used across the full continuum of addiction and mental health programs.

Service users were involved in all aspects of the measure’s development, including the selection of items, pre-testing, naming of the scales, and interpretation of the results.

Methods

Survey data was collected from 1222 patients in treatment in a variety of service settings across Alberta, Canada (89% outpatients; 60% female).

Results

An exploratory factor analysis identified five subscales-patient-centred care, treatment effectiveness, staff behaviour, availability and coordination of care, and communication.

The subscales had high internal reliability (Cronbach’s alpha = 0.77 to 0.85) and test-retest reliability ranged from 0.53 to 0.82 across the five scales.

Conclusions

Scores on the new instrument were correlated with treatment outcomes.

The assessment of patient experience should be integrated into a continuous, sustainable quality improvement process to be truly effective.

Reference

Currie, S.R., Liu, P., Adamyk-Simpson, J. & Stanich, J. (2020) Validation of a Comprehensive Patient Experience Survey for Addiction and Mental Health that was Co-designed with Service Users. Community Mental Health Journal. 56(4), pp.735-743. doi: 10.1007/s10597-019-00534-1. Epub 2020 Jan 1.

MedSupport: Patient Perceptions & Perceived Support

Research Paper Title

Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport.

Background

This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting.

The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.

Methods

A cross-sectional study was performed. The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire.

Diagnosis and treatment information were obtained at the clinical visits and from patient records.

Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study.

Results

The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables.

The MedSupport mean score was 3.8 (standard deviation.9, median 3.8).

Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support.

Patients diagnosed with behavioural and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.

Conclusions

The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication.

Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

Reference

Drivenes, K., Vederhus, J.K., Haaland, V.Ø., Ruud, T., Hauge, Y.L., Regevik, H., Falk, R.S. & Tanum, L. (2020) Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine (Baltimore). 99(1):e18635. doi: 10.1097/MD.0000000000018635.

Do We Need to be Aware of Differences in Patients’ Perceptions of Medication Support?

Research Paper Title

Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport.

Background

This cross sectional study examined patients’ perceptions of professional support regarding use of psychotropic medication in a specialist mental health care setting.

The aims were to evaluate reliability and validity of the MedSupport inventory, and investigate possible associations between MedSupport scores and patient characteristics.

Methods

A cross-sectional study was performed.

The patients completed the MedSupport, a newly developed self-reported 6 item questionnaire on a Likert scale ranged 1 to 5 (1 = strongly disagree to 5 = strongly agree), and the Beliefs about Medicines Questionnaire.

Diagnosis and treatment information were obtained at the clinical visits and from patient records.

Among the 992 patients recruited, 567 patients (57%) used psychotropic medications, and 514 (91%) of these completed the MedSupport and were included in the study.

Results

The MedSupport showed an adequate internal consistency (Cronbach alpha.87; 95% CI.86-89) and a convergent validity toward the available variables.

The MedSupport mean score was 3.8 (standard deviation.9, median 3.8).

Increasing age and the experience of stronger needs for psychotropic medication were associated with perception of more support to cope with medication, whereas higher concern toward use of psychotropic medication was associated with perception of less support.

Patients diagnosed with behavioural and emotional disorders, onset in childhood and adolescence perceived more support than patients with Mood disorders.

Conclusions

The MedSupport inventory was suitable for assessing the patients’ perceived support from health care service regarding their medication.

Awareness of differences in patients’ perceptions might enable the service to provide special measures for patients who perceive insufficient medication support.

Reference

Drivenes, K., Vederhus, J.K., Haaland, V.Ø., Ruud, T., Hauge, Y.L., Regevik, H., Falk, R.S. & Tanum, L. (2020) Enabling patients to cope with psychotropic medication in mental health care: Evaluation and reports of the new inventory MedSupport. Medicine (Baltimore). 99(1):e18635. doi: 10.1097/MD.0000000000018635.