Confinia psychiatrica. Borderland of psychiatry. Grenzgebiete der Psychiatrie. Les Confins de la psychiatrie最新文献

9 young borderline schizophrenics who developed an acute paradoxical behavioral toxicity as a reaction to the initiation of antipsychotic medication are described. The dynamics, the psychological issues as well as some possible psychopharmacological interactions are discussed. The risk of behavioral toxicity should not be overlooked or underestimated and the occurrence of this reaction must be carefully differentiated from other drug-induced reactions.

The listener often perceives a similarity between humorous comments by schizophrenic patients and linguistic word plays, especially puns. A structural analysis of specific examples illustrates the basic difference. In 'good' as well as 'bad' word plays the humorous effect stems from the surprising similarity of word pairs (homonyms and homophones), while the seemingly humorous comments of the schizophrenic patient are rooted in an alteration of the semantic field of the word(s) employed. In spite of certain similarities in superficial structure there is a basic and specific difference in the semantic structure of these two forms of word play.

Fyodor Dostoevsky has continued to grow in stature and influence among modern writers. His modernity is based, among other things, upon his psychological penetration of character and motive. Suicide received considerable attention and analysis in his novels and stories. Although dynamic psychiatry has always held Dostoevsky in high regard, practically all psychiatrists have tended to ignore Dostoevsky's valuable insights into the subject of suicide. This paper offers a total view of the author's contributions to suicidology, through a study of suicidal behavior in his fiction, journalism and in his own life experiences. Dostoevsky's writings are testimony to the continuous and brilliant interrelations between his fictional and journalistic narratives, his understanding of individual, family and group dynamics, his intellectual search for the roots of ideology, and the authentic experience and spiritual quest of his life.

Existential analysis has made us face the paradoxes, if not antinomies, in psychotherapy that we did not seem to be aware of. Existential philosophy is a highly elaborate, technical and linguisticly difficult field. In psychiatry, existential analysis of turned out to be just a set of hallowed commonplaces. As philosophy, its intent is the discovery of the grounds for our existence and in this way it seems to approach theology. In some instances it may turn into atheistic arrogance. With the stern zeal of philosophy and the pessimistic theology of existentialism, one hardly knows where to begin with psychotherapy. Often it fascinates the mediators, the writers who seem to offer us patterns helpful in our daily work. The effort, to take a radical stand to try to rewrite psychiatry, seems to be justified. And, if existential analysis hardly succeeds in bringing back into 'existence' (Dasein) some of our disturbed patients, it has aroused a review of our stale and abused terms and concepts. Psychiatry cannot exist, disciplined and sensible, without the enlightenment which philosophy offers. Some new departures could be attempted again. But if philosophy is not a way of talking and teaching but a way of living, is the psys goal. If he failed, his work remains a lighthouse in our time, warning us on our voyage.

In discussing 2 patients, the authors point out that a study of spontaneous drawings by psychotics can be of considerable diagnostic importance in clinical practice. The clear structure of the drawings threw doubt on the diagnosis of schizophrenia in the case of the first patient who could be classified in the schizophenia spectrum on the basis of the formal symptoms. In the case of the second patient, where th clinical picture suggested different diagnosis, the drawings represent the 'ossified' essence of the experience and behavior symptoms and thus provided an objective basis for nosological classification. In addition, a characteristic feature of the difference between the creativity of the schizophrenic and the creative artist could be seen from a comparison with medieval Gothic art.

After a brief description of the popular beliefs on the causation of illness held in Sir Lanka, eight illustrative case histories are presented. Although the incidence of religious-supernatural contents of mental disorders has been decreasing in the West it is by no means rare. It does, however, occur mostly in psychotic illness, whereas in Sri Lanka it occurs with great frequency in both psychotic and neurotic conditions. The indigenous exorcistic methods of treatment will be more effective in some cases than in others and a careful diagnosis will provide indications as to the choice of treatment.

Considering the sociological and historical relativeness of 'objective' guilt and the relativeness of guilt feelings in the light of 'objective guilt' the authors delve into the problem of whether there exists such a thing as 'objective guilt'. This is particularly relevant after considering recent American investigations by Kohlberg et al. on children's development. They show the importance of guilt feelings that are aroused quite independently of the moral status of a society or a supposed 'super-ego'. Such feelings are the individual's response to some sort of interactional annihilation of communication. Highly dependent and variable, because of their dispositional and situative connections, guilt feelings seem to represent an anthropological, universally existing factor acting as an individual response to the destruction of communication but not necessarily being related to any kind of 'objective' guilt.

A report is given on the catamnesis of a 43-year-old, previously obsessed female person whose case history was in detail described and discussed in this journal [14: 203-225 (1971)]. Following the attempt of an interpretation of this clinically rare case, testified in its time, the phenomenon of the obsession was discussed in the light of psychiatry and theology at the present time, when man is haunted by fear for his existence and obviously has recourse again to exorcism.

This paper describes a self-portrait scoring system and compares the self-portraits of two groups of adults. The scoring system effectively differentiated between the two groups of subjects which were known to differ on several observable behavioral characteristics. It correlated well with the ratings obtained from counselors but not with a self-report inventory of anxiety. A self-portrait is a single manifestation of an individual's self-concept. It presents only a fraction of the hypothetical universe of one's behavioral manifestations. In addition, every single observation is affected by the place, time, and the presence of the observer. However, if these isolated observations can be studied systematically, they can contribute to a reliable and a valid index of the self-concept. This paper presents one means of achieving that end.

Modern Western Culture regards death as a threatening enemy, whereas the ancients, as is the case in eastern philosophy, recognized both the fight with, and the releasing surrender to death. Dying is quite often a serene voyage, be it through old age, sickness, was or even suicide. Attentive listening to those who face the termination of incurable disease reveals the voice of enlightenment: 'euthanasia' also means 'clarified dying'. An attitude like this alleviates our recoil and assists in a supportive approach to the dying human.