Counteranalysis via Freud

In psychology, the term was first employed by Sigmund Freud‘s colleague Josef Breuer (1842–1925), who developed a “cathartic” treatment using hypnosis for persons suffering from extensive hysteria. While under hypnosis, Breuer’s patients were able to recall traumatic experiences, and through the process of expressing the original emotions that had been repressed and forgotten, they were relieved of their hysteric symptoms. Catharsis was also central to Freud’s concept ofpsychoanalysis, but he replaced hypnosis with free association.[16]

The term catharsis has also been adopted by modern psychotherapy, particularly Freudian psychoanalysis, to describe the act of expressing, or more accurately,experiencing the deep emotions often associated with events in the individual’s past which had originally been repressed or ignored, and had never been adequately addressed or experienced.

There has been much debate about the use of catharsis in the reduction of anger. Some scholars believe that “blowing off steam” may reduce physiological stress in the short term, but this reduction may act as a reward mechanism, reinforcing the behavior and promoting future outbursts.[17][18][19][20] However, other studies have suggested that using violent media may decrease hostility under periods of stress.[21] Legal scholars have linked “catharsis” to “closure”[22] (an individual’s desire for a firm answer to a question and an aversion toward ambiguity) and “satisfaction” which can be applied to affective strategies as diverse as retribution, on one hand, and forgiveness on the other.[23] Interestingly, there’s no “one size fits all” definition of “catharsis”,[24] and this doesn’t allow a clear definition of its use in therapeutic terms.

COUNTERANALYSIS
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Medical Students Don’t Learn About Death

The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.

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Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.

I have never been sure whether to consider myself lucky or unlucky. Is that a morbid way to think about it? That maybe I was lucky (and my patients were lucky) that they didn’t die on my watch? That maybe I was lucky that I hadn’t had to experience those awful and heartbreaking conversations with a patient’s family. In the Russian roulette game of hospital care and medical education, I felt spared.

At the same time – and I feel almost selfish for saying this – I considered myself unlucky. I had never been around a dying patient. I had never known what it meant to take care of someone in their final days. I had never had the opportunity to learn and grow as a person and a physician from those difficult moments.

My first clinical experience with death was during my sub-internship, with a woman with end-stage ovarian cancer. I had scrubbed in on her most recent debulking surgery, and I had followed her post-operatively. Though her overall prognosis was poor, she was progressing well after this most recent operation. Her pain and abdominal bloating were slightly improved. She was even about ready to go to a rehab facility; all the arrangements had been made for transfer.

But then she started failing – started not being able to get out of bed. Started being more confused about herself and her surroundings. Started sleeping more of the day. She was physically and mentally breaking down. The cancer burden was overwhelming her body, and she was not able to hold up.

This experience was undoubtedly sad, but the experience for me was compounded by the suddenness and relative unexpectedness of it all. “She was not dying when I met her!” I naively believed.

She did have terminal cancer, after all.

The emotional impact was heightened for me because of the fact that only one of her family members was with her until the end. I felt bad that nobody she knew from outside the hospital was there for; yet I hope our medical team was able to be a somewhat second family to her in her final days. I visited in on her, spoke with her relative, did everything non-medical I thought to try to make her comfortable (I didn’t know much).

When she passed, I imagined the briefest moment of stillness amongst the chaos, but the hospital quickly moved on. There was no closure, no reflection, almost no conversation. When the other team members who had helped take care of her found out the news, there was a general statement of sadness, but then it was back to work as usual. There was more work to be done, other patients to take care of.

I heard that the nursing and floor teams held a small commemoration for our patient later that week (as they do for any patient on the cancer floor who dies). I wasn’t aware it was happening, and I’m positive none of the medical team was present.

Do doctors not mourn, too? Don’t we all need a moment to breathe, to reflect on our relationship with that patient, and to acknowledge our emotions about their passing?

Why don’t they prepare us for this?

markmdmph

The following is part 1 in a series about death and dying in the medical context. This reflection was written by me earlier this year, before I sought out a Palliative Medicine elective. Part 2 will follow soon.

death_and_dying-300x239

Until the last week of my sub-internship, I had never had a patient die on my watch. To be sure, I had patients on the cusp of dying – and some who did die, of course, when I was already on another rotation. I have been around dying patients who were on our team but were being taken care of by the other resident/medical student. But never a patient of my own, until my final year of medical school.

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FBI To Formally Open New South Florida HQ

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The FBI’s new South Florida field office in Miramar. (Source: CBS4)

MIAMI (CBSMiami) – There will be a ribbon cutting and dedication ceremony Friday for the FBI’s new South Florida field office in Miramar.

FBI Director James Comey and U.S. Rep. Frederica Wilson are scheduled to officially open the building which is named for agents Benjamin P. Grogan and Jerry L. Dove, who were killed in a gun battle with bank robbers in South Miami-Dade on Friday, April 11, 1986. The firefight is still considered the bloodiest in the history of the FBI. Agent Grogan was a 25 year veteran of the Bureau. Agent Dove had been with the FBI for four years.

“The naming ceremony and dedication is a fitting tribute to Special Agents Benjamin P. Grogan and Jerry L. Dove. These brave men answered the call of duty and gave their lives to keep our streets, communities and country safe. We owe them and their families a debt of gratitude that can never be repaid,” said Wilson in a statement.

The new $194 million office building contains 330,000 square feet and sits on a 20-acre site adjacent to Interstate 75.

For 28 years, the FBI’s South Florida headquarters was located in North Miami Beach. The field office has jurisdiction over federal cases along Florida’s southeast coast from Vero Beach to Key West.

(TM and © Copyright 2015 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2015 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)

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Psychologists in focus; Kevin Dutton: Psychopath Studies

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Video: PSYCHOLOGISTS IN FOCUS; KEVIN DUTTON

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Dutton takes the view that we often miss what should be the obvious anomaly sidelined by the charm – But is it all smoke and fingers?

Kevin Dutton is a postdoctoral researcher at the University of Oxford.  He is specialises in the study of Psychopaths, but rather than the traditional forensic route Dutton takes interest how the ‘symptoms’ of psychopathy can have an advantage in a modern world that is fraught with stressors.  The psychopath often described as  having a selection of specific traits such as cunning and manipulativeness, lack of remorse or guilt, callousness and lack of empathy, charm, grandiose estimation of self, need for stimulation and pathological lying.  Not the best characteristics to put on a C.V.  It is included in the DSM under the classification of Antisocial Personality Disorder.   However in his book The Wisdom of Psychopaths Dutton discusses how these traits are rewarded in society particularly as resistance to stress where others feel the pressure, psychopaths are able to thrive. Self doubt and fear can impair decision making, the psychopath is arguably resistant to this –but would you want one as your boss?  Dutton is clear that this is far from the glorification of violent psychopaths (stating only a small minority of psychopaths are violent) rather acknowledging that the ‘spectrum of psychopathy‘ which all people can be measured and the right characteristics in the right circumstances can be a force for good – hence his term ‘the good psychopath‘.

Here is a quote from Dutton’s book the Wisdom of  Psychopaths, from James Geraghty cited as one of the UK’s leading neurosurgeons.

I have no compassion for those whom I operate on. That is a luxury I simply cannot afford. In the theatre I am reborn: as a cold, heartless machine, totally at one with scalpel, drill and saw. When you’re cutting loose and cheating death high above the snowline of the brain, feelings aren’t fit for purpose. Emotion is entropy, and seriously bad for business. I’ve hunted it down to extinction over the years.”

Do we need people like this in such high stakes roles where emotion maybe a hindrance rather than a help?  Or is compassion an essential characteristic that allows a surgeon to consider the long term impact of their work?

In fact jobs that Psychopaths are believed to flourish in are;

Kevin Dutton

1. CEO
2. Lawyer
3. Media (Television/Radio)
4. Salesperson
5. Surgeon
6. Journalist
7. Police officer
8. Clergy person
9. Chef
10. Civil servant

here’s the list of occupations with the lowest rates of psychopathy:

1. Carer
2. Nurse
3. Therapist
4. Craftsperson
5. Beautician/Stylist
6. Charity worker
7. Teacher
8. Creative artist
9. Doctor
10. Accountant

Could you spot a Psychopath?  Take the test here.

An online study with over 2 1/2 million British participants found the following results relating to psychopathic tendencies.

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Dutton discusses how Psychopaths process ethical dilemmas differently.

Follow Kevin Dutton on twitter

Psychlite

FullSizeRender Dutton takes the view that we often miss what should be the obvious anomaly sidelined by the charm – But is it all smoke and fingers?

Kevin Dutton is a postdoctoral researcher at the University of Oxford.  He is specialises in the study of Psychopaths, but rather than the traditional forensic route Dutton takes interest how the ‘symptoms’ of psychopathy can have an advantage in a modern world that is fraught with stressors.  The psychopath often described as  having a selection of specific traits such as cunning and manipulativeness, lack of remorse or guilt, callousness and lack of empathy, charm, grandiose estimation of self, need for stimulation and pathological lying.  Not the best characteristics to put on a C.V.  It is included in the DSM under the classification of Antisocial Personality Disorder.   However in his book The Wisdom of Psychopaths Dutton discusses how these traits are rewarded in society…

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