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A Psychologist's Thoughts on Clinical Practice, Behavior, and Life

Preventing Imminent Suicide

Though suicide is never an acceptable alternative to living, it can seem so in an experienced world of continuous unbearable anxiety and hopelessness. One may also choose suicide to communicate how intolerable their life had become. During this struggle between life and death a relationship with a compassionate friend or psychotherapist, from whom to draw strength, can enable time for ego strength and self-esteem to recover with the powers focused on life and not ending it. Freed from the self-imposed punishment of death to use their abilities and resolve important life issues.

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Coping With Work or Marriage Conflict Through Triangulation

Triangulation is the commonly occurring reduction of anxiety in a problematic relationship by introducing a third element into the situation. At work this can be a person or corporate directive depicted as "crazy" and in a marriage a child being termed "impossible." Though reducing anxiety, this unconscious maneuver is destructive since it doesn't resolve the problem. To accomplish this a third party, a management consultant or a psychotherapist, must reframe communication so the real issues are confronted. But here triangulation can also occur if the consultant identifies with the worker or the psychotherapist with the patient(s). As I never tire of repeating, the unconscious is very powerful and one must respect its power.

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Psychogenic ("Voodoo") Death

Though widely believed to be merely a folklore belief of primitive societies, psychogenic death or "voodoo death," a physically healthy person's demise solely because of their belief, has been well documented. In these cases people found themselves in an impossible situation, unable to struggle, to flee or to fight. This giving-up is often complemented by a rejection of their critically important nurturing figures. During psychotherapy this can be an ending of the intense emotional attachment of patient to therapist, resurrecting the early childhood fear of rejection by their mother, akin to cutting the umbilical cord too soon. But this belief of inescapable death may be reversed, stopping the person's deterioration by introducing a powerful figure, a family member (particularly their mother) or a more flexible therapist.

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Early Child-Parenting Experiences In The Development of Psychopathology

A child's mind grows by sharing and borrowing aspects of themselves as they develop their unique life experiences which become woven into their view of the world. While many aspects of their "story," their philosophy of life, are accurate, the child's immaturity inevitably creates errors of belief that lead to difficulties in relating to themselves and others. If deprecated by their parents they may feel worthless and unlovable, which is an apparently valid conclusion since their parents, who seem as Gods, think little of them. But with different experiences, feelings of confidence and optimism are inculcated.
The development of an organized sense of who one, what psychologists term the "sense of self," begins at birth through the interactions and play between infant and caretaker, who need not be their biological parent. Often, when only one of the many children in an abusive family becomes a successful independent adult, it is because of an outsider's (often a grandparent's) different, powerful, early-life influence, with the child's mind having "fed" on this mind-saving infusion as does an ill person's body their healing medication.

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Potential Personality Change Following Military Combat

Violence can cause personality change and military combat is among the most intense. One pesonality change, called the "heart of darkness" syndrome, transforms a previously normal person into an enjoyer of killing, exceeding the normal reactions to prolonged combat though having revealed no antisocial behavior earlier and having a close, caring relationship with their comrades. The personality change from "normal" to "happy killer" occurred after witnessing their comrades' deaths.


Yet this reaction to combat trauma is extreme since soldiers with brief combat experience need not make such a personality adjustment to how they relate to reality in order to psychologically survive, having adjusted to it with controllable fear during their potentially fatal experiences. But continuous combat tends to produce a sense of denial despite the close-by death of comrades, causing a persistant blunting of feelings that can affect relationships long after military service has ended.

Three possibilities exist within the combat continuum of personality change: (1) none, where the ex-soldier remembers and re-experiences past events without denial or the blunting of feelings or becoming a lover of killing; (2) the soldier develops a warrior mentality but functions under orders and kills only for military purposes, retaining a sense of ethics; (3) the soldier has come to love killing, feeling invulnerable and lacking empathy for those whom they kill.

But this continuum of human personality change cannot be so clearly separated since courage, heroism, self-control, and intense comradeship exist in all.

Reference: "Combat and Personality Change" by Samuel L.Bradshaw, M.D., Carroll D. Ohlde, Ph.D., and James B. Horne, M.D. - Bulletin of the Menninger Clinic, Fall, 1993, pp. 466-47

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The Police Officer, The Doctor, And The Annual Medical Exam

While apparently dissimilar, the work of the police officer and the doctor share an essential characteristic since both must wait for the undesired event to occur before intervening: the police officer for the crime and the doctor for the symptom, both of which may be long in development. No law or medical guideline allows personal rights to be violated regardless of potential benefit to society or the individual.
Following the medical model of treatment bars intervention until an illness is apparent, a corollary principle being that no illness should be ignored. To resolve this conflict demands an uncommon level of practice, the ability to note subtlety of words and tone and behavior within the framework of psychological knowledge.Thus does the ritualized annual health check-up have minimal effect on critical issues for it ignores the early stages of psychological stress from internalized childhood psychological development issues and family and work that can lead to organic illness. 

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Of Adult Anxieties and Lingering Childhood Fears

Consideration of anxiety has a long illustrious history. Pascal, the French seventeenth century child prodigy, mathematician, and physicist, suffered from anxiety and wrote "all of the misfortunes of men derive from one single thing which is their their inability to sit still in a room." Anxiety is today's most frequent mental health diagnosis, having as a common complaint the inability to sit still.
Yet were humans unable to experience anxiety its species could not have endured since it is a critical survival mechanism: a reptilian instinct that mortal danger approaches and warning the need to prepare. Now, these dangers are rarely lethal, referring instead to job or relationship difficulty. While these anxieties are readily interpreted, the inexplicable frighten most since they erupt from the bedrock of personality created during early life: the struggle for autonomy and conflicts about self-assertion and intimacy, fragments of which persist to do battle.
Once, during my successful treatment of a young child, her mother shared her own troubled childhood. I remarked that her mother "had issues." She instantly retorted, "My mother was a perfect mother," stormed from my office and removed her daughter from my treatment.
A woman in her eighties, the recipient of numerous national awards, said after receiving her latest, "I wish my mother could have seen this."

Childhood emotions linger throughout life, to be expressed in artistic creations, self-defeating behaviors, and fears.

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The Unconscious Factors Underlying Some Learning Difficulties

Psychology has long known of the association between unconscious emotional attitudes and academic failure, or with a subject that is considered disagreeable from association with a parent's occupation. Reading difficulty can result from the angry feelings it arouses or a frightening experience of self, and school failure from the unconscious desire for criticism and punishment. A child's problems with their mother, the most important figure in their early development, can extend to their relationship with their teacher.
An overly narcissistic mother, or one who views their child as defective, will hinder their child's ability to adapt to reality, particularly when speech is used to gain praise rather than communicate. Underachievement, a failure to learn, can reflect hostility, an indirect passive attack on parents and society. Clearly, for some children, the powerful, genetically endowed hunger to learn has been throttled.

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The Borderline Personality Disorder Continuum

Like all mental health disorders, those suffering from Borderline Personality Disorder exhibit symptoms of varying severity depending on their capacity for relationships. Those closest to a psychotic disorder are openly angry, having given up their desire for relationships. Less severe are those that vacillate between moving toward and away from others. The next group lack a secure "sense of self" or sense of who they are, and mold their behavior according to what others expect; while the least disturbed group continually seek a symbiotic relationship with a mothering figure, having lacked a "good-enough" parenting figure early in life. This continuum of pathology reflects the deficient ability to tolerate intimacy, a contining modulation of closeness by moving toward and away from others.

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The Curative Factors in Psychotherapy

Several factors are now considered to comprise the healing elements of individual psychotherapy, both classic psychoanalytic treatment, which is uncommon today and suited for few, and the frequent psychodynamically oriented treatment. Gaining insight into one's behavior has far less effect than has been promulgated by movies since a patient who gains great insight may achieve little life change. A second factor is the patient's attachment to their therapist, the theapeutic relationship, within which a more benign and thoughtful orientation toward themselves is adopted. During this corrective emotional experience the patient comes to view themselves and others differently, and long-held, unconscious terrors are extinguished.

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