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History

The Wisdom of Silvano Arieti, Pioneer in Schizophrenia

Silvano Arieti's classic book Interpretation of Schizophrenia was awarded the 1975 U.S. National Book Award in the Science category. More than forty years later, it remains the most thorough and extensive psychological examination of the most complex condition to afflict mankind—schizophrenia. Given the current state of psychiatry, both mental health professionals and their patients would be wise to review Arieti's vast contributions to the field.


Medicalization

The Hidden Language of Conversion Disorder

"… for all the shortcomings in the concepts proposed by Freud and Breuer in Studies [on Hysteria], the 21st century has brought no great advances to a better understanding of the mechanisms for this disorder." – Dr. Suzanne O'Sullivan, It's All in Your Head (2015) Conversion disorder represents perhaps the most inherently fascinating of all psychiatric conditions. A seemingly healthy individual, often in the prime of his life, is struck down by debilitating neurological symptoms—rendering him unable to walk, talk, or move a body part. After a thorough medical and neurological workup, no organic cause can be detected. The problem is not with the body, it is with the mind.


Philosophy

Nonsexual Boundary Violations in Psychotherapy: A Primer

Sexual boundary violations reflect the most egregious of boundary violations in psychotherapy, yet they comprise the minority of all such abuses of the privileged therapy relationship. Trainees in psychiatry and psychotherapy are quick to identify sexual relations with patients as a major ethical and legal transgression. As described elsewhere, many mental health professionals who engage in such behavior have severe narcissistic or masochistic characterological pathology (Gabbard, 2005). Yet, many therapists fail to recognize that some other types of boundary violations exist, are detrimental to the healing process of psychotherapy, and can lead to future violations of a sexual nature. Some uninformed or psychologically unfit therapists attempt to justify their actions as being therapeutic in their intent or result. Others recognize them as inappropriate conduct but engage in them nevertheless. From my experience as a psychotherapist, these types of violations are more prevalent than commonly believed.


Medicalization

Jays and Sparrows: The Limitations of Psychiatric Diagnosis

"The moment a little boy is concerned with which is a jay and which is a sparrow, he can no longer see the birds or hear them sing." – Eric Berne, M.D., Games People Play (1964) In modern psychiatric and psychotherapeutic education, diagnosis is one of the first things a trainee is taught to do. In clinical practice, it is a requirement for reimbursement by the insurance companies and a process thought to help structure and guide the treatment. But it wasn't long ago that psychiatric diagnosis didn't count for much; prior to the publication DSM-III, many psychiatrists and therapists never formally conferred a diagnosis. Categories were limited to "neurotic" and "psychotic," with little attention paid to any further delineation.


Medicalization

Creeping Schizophrenia and the Psychiatrization of Political Dissent

As an arm of the state, psychiatry has long been used for political purposes as an instrument of state-sanctioned social control. This is well-recognized by historians of psychiatry and those who study the sociology of psychiatry through a critical but inquiring lens. Though cast by the modern biopsychiatrists as an inherently medical specialty along the same lines as cardiology and ophthalmology, psychiatry (and its diagnosis) has always carried with it a great social weight that distinguishes it from these former disciplines. What is different about psychiatry is that it deals assuredly with behavior, the classification of which as disease or disorder is a purely social determination. I have written about this elsewhere (see Ruffalo, 2015).


Medicalization

Trump, Narcissism, and Responsibility

My colleague and ally in the fight against psychiatric medicalization, Allen Frances, has written elsewhere about the consequences of pathologizing narcissistic behavior, particularly as it relates to the presidency of Donald Trump. He has a new book on the psychology of the Trump revolution, Twilight of American Sanity, published last year. Frances was chairman of the American Psychiatric Association's DSM-IV Task Force and is professor emeritus of psychiatry at the Duke University School of Medicine.


Cognitive Behavioral Therapy

The Problem with Manualized Psychotherapy

"We are what we are because we have been what we have been, and what is needed for solving the problems of human life and motives is not moral estimates but more knowledge." – Sigmund Freud Robotics has already been introduced in the field of surgery. It is surmisable that in the not-so-distant future, a robot alone might complete an operation. But could you imagine a robot in the field of psychiatry or psychotherapy? In many ways, being robotic is the opposite of what makes for good therapy.