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The Live Memory of Annihilation as a Hindrance to Existence: A Proposal for the “A” Criterion in PTSD Psychosocial Interventions
Abstract
Introduction: The continuing violence in endemic foci has been one of the greatest challenges to contemporary
society. This article is based on a survey of patients who have experienced violence and developed Posttraumatic
Stress Disorder (PTSD). Our fundamental idea was to analyze how these individuals narrate their trauma story and
how they perceive its psychological repercussions. We chose Charles Sanders Peirce’s semiotics as our theoretical
framework for its recognized role in semantic analysis.
Method: The methodology chosen was qualitative. We interviewed 20 individuals who suffered urban violence,
considered as good informants, determined by saturation sampling, according to Patton’s concept. We build
the categorical classification deriving from the sample using the grounded theory approach. Of the 20 selected
individuals, 16 had PTSD, determined by the CAPS scale. Four patients who had experienced violence but not
developed PTSD were also interviewed.
Results: The qualitative categories that we found in the present research concentrated in the semantic fields
of hate, fear and trauma. The concept of trauma was found to be an experience of disruption and paralysis of the
psyche, a forced cessation in the history of life and of the experience of time. The narrative of PTSD respondents
reflected a state of permanent fear arising from an action triggered by hate.
Conclusions: The conceptual categories found in this study illuminate the A criterion required for the diagnosis
of PTSD. Besides the experience of horror due to the danger of death, our patients experienced trauma as a time
paralysis caused by the memory of the event. The trauma narrative leading to PTSD displays the mark of the horror
of the individual undergoing the experience of barbaric violence. The psychosocial intervention proposal entails
approaching the trauma through a continuity project.
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O poder é mau por natureza? Está sempre em mãos erradas? Não. Essa é a resposta dada pelos clássicos da política moderna, Nicolau Maquiavel e Thomas Hobbes. Maquiavel desconfia das promessas antigas do bom regime e da virtude humana. Ele baseia o poder político na produtividade do mal. Apesar de compartilhar o profundo pessimismo antropológico de Maquiavel, Hobbes baseia-se na virtude do soberano: o Leviatã suprime a guerra perpétua. No século XX a apologia filosófica pelo poder assume uma forma diferente. Hannah Arendt separa a violência instrumental do poder comunicativo, transformando a ágora num lugar mágico do poder. Contrariamente, Michel Foucault nega a existência de qualquer lugar privilegiado para ocorrência do poder. Para ele, o poder torna-se uma rede de relações sociais combinando sujeição e criatividade de forma ambígua.
This article scrutinizes Norbert Elias’s figurational sociology by focusing on its ontological foundations. The analytical spotlight is on the inherent tension between Elias’s stance of normative neutrality and detachment, his naturalistic ontology, and an unyielding commitment to directional development. We show how Elias’s social theory does not stand apart, as an external observer, from the figurations it seeks to explain. On the contrary, it constitutes its own outside, and this has consequences when it comes to explaining the ‘dark sides’ of the present, and in particular the social sources of organized violence in modernity. It is our contention that Elias’s ontology incorrectly posits violence as the absolute Other of civilization, so that his theory of the ‘Civilising Process’ fails to adequately account for the persistence and proliferation of warfare in the modern age.
Posttraumatic stress disorder (PTSD) has been identified in survivors of traumatic brain injury (TBI), sustained from road traffic ac-cidents, assaults, or industrial accidents. This article reviews the small literature on this population, which is predominantly charac-terized by integrations of cognitive neuropsychology and cognitive behavior therapy. While these perspectives have been applied to identify etiological processes and treatment options, one insufficiently specified domain in this literature is the role of interpersonal relationships. This includes interpersonal etiological mechanisms and social outcomes, but also therapeutic process for PTSD after TBI. In response, object-relations psychoanalytic concepts of symbolizing (Segal, 1957) and containing–contained (Bion, 1962) mechanisms are applied. These concepts are used to consider the aforementioned factors while permitting close conceptual links to neurological and cognitive vulnerabilities for this clinical group. This article finishes with a therapeutic application of these concepts, from the perspective of a neurorehabilitation team.
We conducted a systematic review of the literature to explore the longitudinal course of PTSD in DSM-5-defined trauma exposed populations to identify the course of illness and recovery for individuals and populations experiencing PTSD.
We reviewed the published literature from January 1, 1998 to December 31, 2010 for longitudinal studies of directly exposed trauma populations in order to: (1) review rates of PTSD in the first year after a traumatic event; (2) examine potential types of proposed DSM-5 direct trauma exposure (intentional and non-intentional); and (3) identify the clinical course of PTSD (early onset, later onset, chronicity, remission, and resilience). Of the 2537 identified articles, 58 articles representing 35 unique subject populations met the proposed DSM-5 criteria for experiencing a traumatic event, and assessed PTSD at two or more time points within 12 months of the traumatic event.
The mean prevalence of PTSD across all studies decreases from 28.8% (range = 3.1-87.5%) at 1 month to 17.0% (range = 0.6-43.8%) at 12 months. However, when traumatic events are classified into intentional and non-intentional, the median prevalences trend down for the non-intentional trauma exposed populations, while the median prevalences in the intentional trauma category steadily increase from 11.8% to 23.3%. Across five studies with sufficient data, 37.1% of those exposed to intentional trauma develop PTSD. Among those with PTSD, about one third (34.8%) remit after 3 months. Nearly 40% of those with PTSD (39.1%) have a chronic course, and only a very small fraction (3.5%) of new PTSD cases appears after three months.
Understanding the trajectories of PTSD over time, and how it may vary by type of traumatic event (intentional vs. non-intentional) will assist public health planning and treatment.
Results of a preliminary effectiveness evaluation of a school-based postwar program for war-exposed Bosnian adolescents are described. The evaluation centered on a manualized trauma/grief-focused group psychotherapy protocol for war-traumatized adolescents based on 5 therapeutic foci: traumatic experiences, trauma and loss reminders, postwar adversities, bereavement and the interplay of trauma and grief, and developmental impact. Fifty-five secondary school students (81% girls; age range = 15–19 years, M = 16.81) from 10 Bosnian schools participated in the evaluation. Students completed pregroup and postgroup self-report measures of posttraumatic stress, depression, and grief symptoms and postgroup measures of psychosocial adaptation and group satisfaction. The evaluation yielded preliminary but promising results, including reduced psychological distress and positive associations between distress reduction and psychosocial adaptation. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This meta-analysis addressed the question of how effective grief therapy is and for whom, using B. J. Becker's (1988) techniques for analyzing standardized mean-change scores. Analyses were based on 35 studies (
N = 2,284), with a weighted mean effect size (ES) of δ
+ = 0.43 (95% confidence interval = 0.33 to 0.52). Clients in no-treatment control groups showed little improvement (
d= = 0.06), possibly because of the relatively long delay between loss and treatment in most studies (mean delay = 27 months). Moderators of treatment efficacy included time since loss and relationship to the deceased. Client selection procedures, a methodological factor not originally coded in this meta-analysis, appeared to contribute strongly to variability in ESs: a small number of studies involving self-selected clients produced relatively large ESs, whereas the majority of studies involving clients recruited by the investigators produced ESs in the small to moderate range. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
67 individuals (aged 18–73 yrs) diagnosed with posttraumatic stress disorder (PTSD) were randomly assigned to either Eye Movement Desensitization and Reprocessing (EMDR) treatment or Standard Care (SC) treatment. Participants were assessed pretreatment, after 3 sessions, and at the completion of treatment using the SCL-90, Beck Depression Inventory, Impact of Event Scale (M. Horowitz et al, 1979), modified PTSD Symptom Scale (S. A. Falsetti et al, 1993), State Trait Anxiety Inventory, and other measures. In addition, an independent evaluator assessed participants using Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) criteria for PTSD including Global Assessment of Functioning at the 3 data points. Ss in the EMDR treatment group showed significantly greater improvement with greater rapidity than those in the SC treatment group on measures of PTSD, depression, anxiety, and general symptoms. Ss who received EMDR treatment used fewer medication appointments for their psychological symptoms and needed fewer psychotherapy appointments. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Background
Over the past five decades, clinicians and researchers have debated the impact of the Holocaust on the children of its survivors. The transgenerational transmission of trauma has been explored in more than 500 articles, which have failed to reach reliable conclusions that could be generalized. The psychiatric literature shows mixed findings regarding this subject: many clinical studies reported psychopathological findings related to transgenerational transmission of trauma and some empirical research has found no evidence of this phenomenon in offspring of Holocaust survivors.
Method
This qualitative study aims to detect how the second generation perceives transgenerational transmission of their parents' experiences in the Holocaust. In-depth individual interviews were conducted with fifteen offspring of Holocaust survivors and sought to analyze experiences, meanings and subjective processes of the participants. A Grounded Theory approach was employed, and constant comparative method was used for analysis of textual data.
Results
The development of conceptual categories led to the emergence of distinct patterns of communication from parents to their descendants. The qualitative methodology also allowed systematization of the different ways in which offspring can deal with parental trauma, which determine the development of specific mechanisms of traumatic experience or resilience in the second generation.
Conclusions
The conceptual categories constructed by the Grounded Theory approach were used to present a possible model of the transgenerational transmission of trauma, showing that not only traumatic experiences, but also resilience patterns can be transmitted to and developed by the second generation. As in all qualitative studies, these conclusions cannot be generalized, but the findings can be tested in other contexts.
Complex posttraumatic stress disorder (CPTSD) has been proposed as a diagnosis for capturing the diverse clusters of symptoms observed in survivors of prolonged trauma that are outside the current definition of PTSD. Introducing a new diagnosis requires a high standard of evidence, including a clear definition of the disorder, reliable and valid assessment measures, support for convergent and discriminant validity, and incremental validity with respect to implications for treatment planning and outcome. In this article, the extant literature on CPTSD is reviewed within the framework of construct validity to evaluate the proposed diagnosis on these criteria. Although the efforts in support of CPTSD have brought much needed attention to limitations in the trauma literature, we conclude that available evidence does not support a new diagnostic category at this time. Some directions for future research are suggested.
Several terms in the scientific literature about posttraumatic stress disorder are used with different meanings in studies conducted by different authors. Words such as trauma, violence, catastrophe, disaster and barbarism are often used vaguely or confusingly, and their meanings change in different articles. The lack of conceptual references for these expressions complicates the organization of literature. Furthermore, the absence of clear concepts may be an obstacle to clinical treatment because the use of these words by the patients does not necessarily point to a diagnosis of posttraumatic stress disorder.
A critical review of scientific literature showed that stress can be divided in stages to facilitate specific terminological adjustments to the event itself, to the subject-event interaction and to psychological responses. Moreover, it demonstrated that the varying concept of trauma expands into fundamental psychotherapeutic definitions and that the meanings of violence associated with barbarism are an obstacle to resilience. Therefore, this study updates the etymological origins and applications of these words, connects them to the expansions of meanings that can be operated in the clinical care of patients with posttraumatic stress disorder, and analyzes them critically according to the criterion A of DSM-IV and ICD-10.
The terminology in the literature about posttraumatic stress disorder includes a plethora of terms whose meanings are not fully understood, and that, therefore, limit this terminology. The analysis of these terms suggested that the transformation of the concept of trauma led to a broader understanding of this phenomenon in its psychic dimensions, that a barbarian type of violence constitutes an obstacle to resilience, and that the criterion A of the DSM-IV and ICD-10 shows imprecision and conceptual fragilities.
To develop this debate article, a current specialized literature review was achieved by searching and retrieving the key terms from two major databases: PubMed and PsycINFO. The key terms included "disaster", "catastrophe", "barbarism", "terrorism", "trauma", "psychic trauma" and "violence", also in combination with the terms "PTSD", "concept" and "conceptual aspects". The data were captured specially from review articles. The included studies were those mostly identified by the authors as relevant by the presence of a conceptual approach in any part of the paper. Researches that relied solely on empirical indicators, like psychopathological, neurobiological or pharmacological aspects, were excluded. The focus here was in conceptual aspects, even when some few empirical studies were included. As it was noted a paucity of medical references related to conceptual aspects of these terms, a wider literature needed to be included, including chapters, books and articles proceeded from the Humanities areas. "Interdisciplinary research is needed in this area to include perspectives from a range of different disciplines" once that "to promote public health (...) new dimensions of such interactions and the implications thereof should be pursued in collaboration with researchers from broader areas" 1.
Conventional approaches to understanding consciousness are generally concerned with the contribution of specific brain areas or groups of neurons. By contrast, it is considered here what kinds of neural processes can account for key properties of conscious experience. Applying measures of neural integration and complexity, together with an analysis of extensive neurological data, leads to a testable proposal-the dynamic core hypothesis-about the properties of the neural substrate of consciousness.
The adult nervous system is not static, but instead can change, can be reshaped by experience. Such plasticity has been demonstrated from the most reductive to the most integrated levels, and understanding the bases of this plasticity is a major challenge. It is apparent that stress can alter plasticity in the nervous system, particularly in the limbic system. This paper reviews that subject, concentrating on: a) the ability of severe and/or prolonged stress to impair hippocampal-dependent explicit learning and the plasticity that underlies it; b) the ability of mild and transient stress to facilitate such plasticity; c) the ability of a range of stressors to enhance implicit fear conditioning, and to enhance the amygdaloid plasticity that underlies it.
To foster a more in-depth understanding of the psychological processes leading to terrorism, the author conceptualizes the terrorist act as the final step on a narrowing staircase. Although the vast majority of people, even when feeling deprived and unfairly treated, remain on the ground floor, some individuals climb up and are eventually recruited into terrorist organizations. These individuals believe they have no effective voice in society, are encouraged by leaders to displace aggression onto out-groups, and become socialized to see terrorist organizations as legitimate and out-group members as evil. The current policy of focusing on individuals already at the top of the staircase brings only short-term gains. The best long-term policy against terrorism is prevention, which is made possible by nourishing contextualized democracy on the ground floor.
Psychotherapy is used commonly to treat a variety of mental illnesses, yet surprisingly little is known about its biological mechanisms especially in comparison with pharmacotherapy. In this review we survey the current knowledge about changes in brain function following psychotherapeutic intervention that are detectable with current neuroimaging techniques. We also consider the possible role for neuroimaging in refining clinical diagnoses and predicting treatment outcome, which would benefit both clinical decision-making and the cognitive neuroscience of psychotherapy.
Few studies have examined treatments for complicated grief--a debilitating condition that can develop after the loss of a loved one. This study compared the effectiveness of cognitive-behavioral therapy with a nonspecific treatment with supportive counseling (SC). Using a minimization method, 54 mourners with clinically significant levels of complicated grief were allocated to 1 of 3 treatment conditions: (a) a condition of 6 sessions of cognitive restructuring (CR) and 6 sessions of exposure therapy (ET; CR + ET), (b) a condition in which these interventions were applied in reversed order (ET + CR), and (c) 12 sessions of SC. Outcomes showed that the 2 cognitive-behavioral therapy conditions produced more improvement in complicated grief and general psychopathology than SC in the completers and intention-to-treat groups. Comparison of the cognitive-behavioral conditions showed that "pure" exposure was more effective than "pure" cognitive restructuring, that adding ET to CR led to more additional improvement than adding CR to ET, and that ET + CR was more efficacious than CR + ET. Effect sizes of ET + CR were encouraging and compare favorably with those found in earlier bereavement intervention studies.
Although most people will gradually recover from the psychological effects of a traumatic event, PTSD will develop in a substantial proportion. PTSD appears to represent a failure to recover from a nearly universal set of emotions and reactions and is typically manifested as distressing memories or nightmares related to the traumatic event, attempts to avoid reminders of the trauma, and a heightened state of physiological arousal. Studies of the biologic mechanisms of PTSD have delineated circumscribed alterations in brain regions, such as the amygdala and hippocampus, that are associated with fear and memory, as well as changes in hormonal, neurochemical, and physiological systems involved in coordinating the body's response to stress. The treatment of PTSD involves educating the patient about the nature of the disorder, providing a safe and supportive environment for discussing traumatic events and their impact, and relieving the distress associated with memories and reminders of the event. A variety of approaches, such as exposure therapy, cognitive therapy, and pharmacotherapy, have been found to be effective in the treatment of PTSD.
A Brief Nosological History of PTSD
The modern conceptualization of what we now call posttraumatic stress disorder (PTSD) originated with the European neurologists Jean-Martin Charcot and Hermann Oppenheim, who treated victims of railroad and industrial accident in the late nineteenth century. Both Charcot and Oppenheim regarded the disorder as stemming from an acute fright or emotional shock. Charcot used the term “traumatic hysteria” to describe a condition of the mind that occurred in mentally defective individuals and stemmed not from the physical effects of the traumatic accident but rather from the idea his patients had formed of it. Oppenheim rejected the hysterical nature of the condition but rather considered that the acute emotional shock induced by the traumatic event injured the nervous system. Both DSM-I and DSM-II failed to recognize these earlier insights, and they did not dignify the condition with a diagnosis.
The book under discussion here, John Deely's Four ages of understanding, has a threefold objective. First, to fill in the gap of the standard modern histories between Ockham and Descartes and them to draw a clear and positive boundary between what is modern and truly postmodern in philosophy. Second, to use this redrawn historical map as the basis for a proper "introduction" to philosophy today. And third, to show that the systematization of semiotic as the positive essence of postmodernity is the florescence precisely of seeds planted in the Latin Age, especially in the "lost" period which culminated in the work of John Poinsot - heretofore all but unknown in the standard histories of philosophy - contemporary with Descartes. My own essay attempts to come to terms principally with this third objective, precisely in order to center further discussion on the nature and role of metaphysics with its doctrine of esse in relation to this newly emergent "doctrine of signs."
This article discusses major new developments in psychoanalytic and psychodynamic psychotherapy during the 21st Century. New developments are set in the context of the ‘crisis of psychoanalysis’ that occurred in the 1990s and are seen as a direct response to this crisis. The responses are categorized as an engagement in evidence-based medicine, the emergence of neuropsychoanalysis, and new therapy models adapted from traditional techniques of psychoanalytic psychotherapy. A description is given of the problems that evidence-based medicine poses for psychotherapy before a critique of this paradigm is outlined. New evidence and alternatives to narrow definitions of evidence-based medicine are then elaborated. New findings in functional neuroscience are discussed, particularly their relevance to psychoanalytic psychotherapy. These new findings demonstrate the neuroscientific basis for many of the theoretical proposals of the psychoanalytic model of the mind. The third area of development is of adaptations in psychotherapy that take account of these neurological findings. Five recent therapy developments are compared and contrasted and the evidence for each is discussed. Some conceptual developments in psychoanalytic psychotherapy are described. Finally, two adaptations of psychoanalytic psychotherapy for the treatment of post-traumatic stress disorder and panic disorder are described.
This is the first of three papers that examine the relationship between the psychopathological phenomenology of Karl Jaspers, the early philosophical phenomenology of Edmund Husserl (papers 1 and 2), and the role of phenomenology in the philosophy of Immanuel Kant (paper 3).
The first paper examines the perceived debt of Jaspers's phenomenology to that of Husserl. This debt has entered the folklore of psychopathology, not least because it was assumed by Jaspers himself. Jaspers acknowledged his debt to what he saw as Husserl's "descriptive psychology" in Logical Investigations (1900 and 1901), in the papers that preceded the first edition of General Psychopathology (1913), in all editions of General Psychopathology, in his 1955 epilogue to the reissue of his Philosophy (1932), and in his Philosophical Autobiography (1957). In all of these he consistently saw the early Husserl as a descriptive psychologist. The paper examines the brief personal relations between Jaspers and Husserl.
The paper traces the development of Husserl's phenomenology from his earliest work in the philosophy of mathematics (1891) to the beginning of his transcendental phenomenology (1913), with a strong emphasis on Logical Investigations—the only work of any concern to Jaspers. Jaspers's view was that Husserl changed from an early interest in phenomenology as an empirical "descriptive psychology" to phenomenology as an "intuition of essences" (Wesensschau) and as a philosophical "rigorous science" (strenge Wissenschaft). Both were anathema to Jaspers. The paper argues that, contrary to Jaspers's understanding, Logical Investigations was committed to both of these propositions. The implication is that Husserl's phenomenology was never the phenomenology as "descriptive psychology" seen by Jaspers. Jaspers had admitted to Husserl in 1913 that he "failed to understand what phenomenology really was." The second paper examines this failure of understanding.
In 1971, Heinz Kohut, trained in neurology and then psychoanalysis, published The Analysis of the Self, a detailed exposition of the central role of the self in human existence. This classic volume of both twentieth century psychoanalysis and psychology was more than a collection of various clinical observationsrather it represented an overarching integrated theory of the development, structuralization, psychopathogenesis, and psychotherapy of disorders of the self. Although some of these ideas were elaborations of previous psychoanalytic principles, a large number of his concepts, including an emphasis on self rather than ego, signified an innovative departure from mainstream psychoanalysis and yet a truly creative addition to Freuds theory.
"MAN HAS GENERALLY CHOSEN TO KNOW LITTLE OF THE HOLOCAUST THAT BEFELL EUROPEAN JEWRY AT THE HANDS OF THE NAZIS. . . .THE HOLOCAUST OF THE CHOSEN JEW REPRESENTS 1 MORE EPISODE IN MAN'S LARGELY UNRECOGNIZED HISTORY AS A STILL PRIMITIVELY-EVOLVED ANIMAL WHO IS GIVEN TO WANTON MURDER OF HIS OWN KIND. IN TEACHING THE HOLOCAUST WE ARE OFFERED AN OPPORTUNITY TO MOVE CLOSER TOWARD CONTENDING WITH THIS AWESOME TRUTH ABOUT OURSELVES. . . . THE REAL SOLUTION MUST BE FOR MAN TO LIVE TO DIGNIFY LIFE, NEITHER TO KILL (OTHERS) OR TO BE KILLED (HIMSELF); THAT HE LEARN TO SPEAK OF HIS ANGRY FEELINGS IN HIS EVERYDAY RELATIONSHIPS, WATCHING CAREFULLY THAT HE IS NOT CARRIED TO EXCESSES, AND CERTAINLY THAT HE NEVER ENGAGES IN OVERT ACTS OF VIOLENCE AGAINST ANOTHER PERSON. . . ." (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Integrates findings from the fields of cognitive science, child development, and trauma to address basic questions about posttraumatic stress disorder (PTSD). Mechanisms of divided attention and emotional flooding during traumatic experiences may explain classic memory (ME) findings in PTSD: psychogenic amnesia in the setting of hyperarousal, startle response, intrusive images, and avoidance behaviors. Cognitive research shows that blocked focal attention leads to impaired explicit processing but intact implicit recall. The hippocampal formation is crucial for explicit ME processing, involving a subsequent consolidation process that is postulated to make MEs permanent in the cortex. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Presents a model for brief dynamic psychotherapy of posttraumatic stress disorder (PTSD) that helps the patient who has been derailed from a normal psychological recovery process to return to an adaptive working-through during and after brief therapy. Brief therapy is most applicable for individuals who present with PTSD several years after traumatic stress events. The success of brief therapy depends on the ability of the patient and therapist to enter quickly into a collaborative working process. The impact of a traumatic event on the PTSD patient's self-concept serves as an organizer for treatment. Working through problematic weak and strong self-concepts and countertransference responses to traumatized patients are discussed, along with termination. Case examples illustrate these issues. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Since its publication, Eichmann in Jerusalem has provoked a storm of controversy. With a few exceptions, critics reacted to the substance of Arendt's thesis with considerable bitterness and hostility. This article argues that her detractors badly misunderstood Arendt because they were insufficiently conversant with, or unaware of, her political theory. Fundamental to this theory, articulated at length in her The Human Condition , is the crucial distinction between the public and the private. None of her critics, including those who sympathized with Arendt, have understood that her critical analysis of Eichmann's conduct and of the response of the Jewish leadership to the tragic fate that befell their people makes sense on the peculiar terrain of her political theory and particularly in terms of the public-private distinction which lies at the core of this theory.
Two distinct doctrines of the will operate in Nietzsche. On one, each person has a will that grows out of their engagement with life. This view can be the basis for a feminist epistemology. On the other, the will must be stimulated through the creation of unattainable goals and games of seduction. This view of the will is misogynist, as it posits a self that must constitute for itself a dominated and silenced other.
This chapter summarizes a theory of consciousness based on brain structure and dynamics. The theory centers around the notion of reentry—ongoing recursive signaling across multiple reciprocally connected brain regions present mainly in the thalamocortical system. It recognized the fundamental beginnings provided by the complementary efforts of Ramon y Cajal and William James.
This article reviews historic, clinical, therapeutic, and research work regarding psychopathological responses to massive emotional stress. From these emerge the suggestion that post-traumatic stress disorder represents a physioneurosis. Psychophysiological and neuroendocrine investigations of the last decade are summarized, as well as the neuropsychological hypothesis the author has derived therefrom about the etiologic development of post-traumatic stress disorders. Lines of future research are suggested.
The brains of higher mammals are extraordinary integrative devices. Signals from large numbers of functionally specialized groups of neurons distributed over many brain regions are integrated to generate a coherent, multimodal scene. Signals from the environment are integrated with ongoing, patterned neural activity that provides them with a meaningful context. We review recent advances in neurophysiology and neuroimaging that are beginning to reveal the neural mechanisms of integration. In addition, we discuss concepts and measures derived from information theory that lend a theoretical basis to the notion of complexity as integration of information and suggest new experimental tests of these concepts.
A theoretical framework for grounding language is introduced that provides a computational path from sensing and motor action to words and speech acts. The approach combines concepts from semiotics and schema theory to develop a holistic approach to linguistic meaning. Schemas serve as structured beliefs that are grounded in an agent's physical environment through a causal-predictive cycle of action and perception. Words and basic speech acts are interpreted in terms of grounded schemas. The framework reflects lessons learned from implementations of several language processing robots. It provides a basis for the analysis and design of situated, multimodal communication systems that straddle symbolic and non-symbolic realms.
Posttraumatic stress disorder (PTSD) as a response to trauma is repeatedly found to be more common among women than men. This article explores prevalence rates and gender differences. Explanations for this gender bias and examined and the literature on trauma types and resulting PTSD is reviewed. Other disorders that may result from trauma that also have gender biases are considered as a potential way to understand this difference. Risk and resilience can perhaps more appropriately be considered specific to symptom picture rather than merely development of pathology.
The electronic version of this book has been prepared by scanning TIFF 400 dpi color and greyscale images of the pages of the text. Original source: Democracy in America / by Alexis de Tocqueville ; translated by Henry Reeve ; with an original preface and notes, by John C. Spencer.; Tocqueville, Alexis de, 1805-1859.; xvi, 455 p. ; 24 cm.; New York :; This electronic text file was created by Optical Character Recognition (OCR). No corrections have been made to the OCR-ed text and no editing has been done to the content of the original document. Encoding has been done through an automated process using the recommendations for Level 2 of the TEI in Libraries Guidelines. Digital page images are linked to the text file.
Metadata only There has been considerable discussion in recent years over the application of interpretive methodologies such as phenomenology, hermeneutics, and semiotics within the field of marketing research, particularly consumer behaviour. However, while these approaches have inspired a wealth of publications, scant attention has been paid to the potential of grounded theory. This is attributed largely to misconceptions regarding both the principles of the method and the two distinct approaches associated with the original authors, Glaser and Strauss (1967). The paper outlines the development of the method and explicates the philosophy underpinning its procedures. Finally, it suggests that grounded theory if applied in its true sense has scope and potential for the study of consumer behaviour and consumption experiences given its emphasis on context, theoretical emergence, and the social construction of realities.
Epidemiologic studies have reported that the majority of community residents in the United States have experienced posttraumatic stress disorder (PTSD)-level traumatic events, as defined in the DSM-IV. Only a small subset of trauma victims develops PTSD (<10%). Increased incidence of other disorders following trauma exposure occurs primarily among trauma victims with PTSD. Female victims of traumatic events are at higher risk for PTSD than male victims are. Direct evidence on the causes of the sex difference in the conditional risk of PTSD is unavailable. The available evidence suggests that the sex difference is not due to (a) the higher occurrence of sexual assault among females, (b) prior traumatic experiences, (c) preexisting depression or anxiety disorder, or (d) sex-related bias in reporting. Observed sex differences in anxiety, neuroticism, and depression, inducing effects of stressful experiences, might provide a theoretical context for further inquiry into the greater vulnerability of females to PTSD.
Two parallel sets of selective networks composed of intercommunicating neuron-like elements have been connected to produce a new kind of automaton capable of limited recognition of two-dimensional patterns. Salient features of this automaton are (i) preestablished unchanging connectivity, (ii) preassigned connection strengths that are selectively altered according to experience, (iii) local feature detection in one network with simultaneous global feature correlation in the other, and (iv) reentrant interactions between the two networks to generate a new function, associative memory. No forced learning, explicit semantic rules, or a priori instructions are used.
Most forms of psychotherapy have been proposed as treatments for post-traumatic stress disorder (PTSD), even though there is an absence of sophisticated outcome literature and few validated conclusions. The Koach project suggests that patients, therapists, and objective outcome measures differ significantly in their assessments of the usefulness of therapy. Clearly, entrenched PTSD is very resistant to psychotherapy and many patients remain symptomatic in spite of the best efforts of their therapists. Just talking about the trauma does not seem to be sufficient, yet current outcome studies suggest that exposure and the cognitive reworking of PTSD memories are the critical elements to treatment. Moreover, the personal characteristics of some individuals make them particularly responsive to treatment.
Violent behavior among individuals with severe mental illness has become an important focus in community-based care. This study examines the joint effect of substance abuse and medication noncompliance on the greater risk of serious violence among persons with severe mental illness.
Involuntarily admitted inpatients with severe mental illness who were awaiting a period of outpatient commitment were enrolled in a longitudinal outcome study. At baseline, 331 subjects underwent an extensive face-to-face interview. Complementary data were gathered by a review of hospital records and a telephone interview with a family member or other informant. These data included subjects' sociodemographic characteristics, illness history, clinical status, medication adherence, substance abuse, insight into illness, and violent behavior during the 4 months that preceded hospitalization. Associations between serious violent acts and a range of individual characteristics and problems were analyzed by using multivariable logistic regression.
The combination of medication noncompliance and alcohol or substance abuse problems was significantly associated with serious violent acts in the community, after sociodemographic and clinical characteristics were controlled.
Alcohol or other drug abuse problems combined with poor adherence to medication may signal a higher risk of violent behavior among persons with severe mental illness. Reduction of such risk may require carefully targeted community interventions, including integrated mental health and substance abuse treatment.
We examine potential sources of the sex differences in post-traumatic stress disorder (PTSD) in the community.
Data were obtained from a representative sample of 2181 persons aged 18-45 years in the Detroit primary metropolitan statistical area, which is a six-county area containing more than four million residents. A random digit dialling method was used to select the sample and a computer-assisted telephone interview was used to obtain the data. DSM-IV PTSD was assessed with respect to a randomly selected trauma from the list of qualifying traumas reported by each respondent.
The lifetime prevalence of exposure and the mean number of traumas were lower in females than males. The overall conditional risk of PTSD (i.e. the probability of PTSD among those exposed to a trauma) was approximately twofold higher in females than males, adjusting for the sex difference in the distribution of trauma types. The sex difference was due primarily to females' greater risk following assaultive violence. The sex difference in the avoidance and numbing symptom group following assaultive violence exceeded the sex differences in other symptom groups.
Future research should focus on sex differences in the response to assaultive violence, including potential explanations for females' greater probability to experience avoidance and numbing.
Little is known about the total population prevalence and societal costs of posttraumatic stress disorder (PTSD); this report reviews relevant literature on these topics.
A literature search of computerized databases for published reports on trauma and PTSD was conducted. This literature was reviewed to find data on general population exposure to trauma, conditional risk of PTSD among those exposed to trauma both in focused samples of trauma victims and in general population samples, and the adverse consequences of PTSD.
PTSD was found to be a commonly occurring disorder that often has a duration of many years and is frequently associated with exposure to multiple traumas. The impairment associated with PTSD in U.S. samples, where the majority of research on these consequences has been carried out, is comparable to, or greater than, that of other seriously impairing mental disorders. Risk of suicide attempts is particularly high among people with PTSD. Available evidence suggests that the prevalence of PTSD and the adverse emotional and psychological consequences of PTSD are much greater in the many countries around the world that are in the midst of armed conflicts involving political, racial, or ethnic violence.
PTSD is a highly prevalent and impairing condition. Only a minority of people with PTSD obtain treatment. Early and aggressive outreach to treat people with PTSD could help reduce the enormous societal costs of this disorder.
We used a randomized clinical trial to investigate the interaction of two patient personality characteristics (quality of object relations [QOR] and psychological mindedness [PM]) with two forms of time-limited, short-term group therapy (interpretive and supportive) for 139 psychiatric outpatients with complicated grief. Findings differed depending on the outcome variable (e.g., grief symptoms, general symptoms) and the statistical criterion (e.g., statistical significance, clinical significance, magnitude of effect). Patients in both therapies improved. For grief symptoms, a significant interaction effect was found for QOR. High-QOR patients improved more in interpretive therapy and low-QOR patients improved more in supportive therapy. A main effect was found for PM. High-PM patients improved more in both therapies. For general symptoms, clinical significance favored interpretive therapy over supportive therapy. Clinical implications concerning patient-treatment matching are discussed.
Symptom exacerbation (i.e., treatment side effects) has often been neglected in the psychotherapy literature. Although prolonged exposure has gained empirical support for the treatment of chronic posttraumatic stress disorder (PTSD), some have expressed concem that imaginal exposure, a component of this therapy, may cause symptom exacerbation, leading to inferior outcome or dropout. In the present study, symptom exacerbation was examined in 76 women with chronic PTSD. To define a "reliable" exacerbation, we used a method incorporating the standard deviation and test-retest reliability of each outcome measure. Only a minority of participants exhibited reliable symptom exacerbation. Individuals who reported symptom exacerbation benefited comparably from treatment. Further, symptom exacerbation was unrelated to dropout. Thus, although a minority of individuals experienced a temporary symptom exacerbation, this exacerbation was unrelated to outcome.
The authors present a multidimensional meta-analysis of studies published between 1980 and 2003 on psychotherapy for PTSD.
Data on variables not previously meta-analyzed such as inclusion and exclusion criteria and rates, recovery and improvement rates, and follow-up data were examined.
Results suggest that psychotherapy for PTSD leads to a large initial improvement from baseline. More than half of patients who complete treatment with various forms of cognitive behavior therapy or eye movement desensitization and reprocessing improve. Reporting of metrics other than effect size provides a somewhat more nuanced account of outcome and generalizability.
The majority of patients treated with psychotherapy for PTSD in randomized trials recover or improve, rendering these approaches some of the most effective psychosocial treatments devised to date. Several caveats, however, are important in applying these findings to patients treated in the community. Exclusion criteria and failure to address polysymptomatic presentations render generalizability to the population of PTSD patients indeterminate. The majority of patients posttreatment continue to have substantial residual symptoms, and follow-up data beyond very brief intervals have been largely absent. Future research intended to generalize to patients in practice should avoid exclusion criteria other than those a sensible clinician would impose in practice (e.g., schizophrenia), should avoid wait-list and other relatively inert control conditions, and should follow patients through at least 2 years.