Friday, June 15, 2007

Do I love her (part 3)

can we love deliberately?

these are some scientists asnwering the question:

Albert Ellis Ph.D.
usually ... you strongly favor a few traits of your beloved....such as beauty and intelligence...and you firmly convince yourself that your beloved uniquely possesse them and fall in love with that "special" person.

Robert Milardo, Ph.D. president of international association for relationships research
romantic love may feel magical, but we learn to love in a deliberate fashion. can we learn to love just anyone? no, we need shared core beliefs and attitudes, a simplse foundation on which we build...

James Morris Ph.D. presedent of american association for marriage and familly therapy
"we were made for each other" is a romantic falsehood tend to obscure the actual work involved in creating love between two people. this work involves shared commitment, responsibility, fidelity, and mutual would do well to think more in terms of "choosing" and "creating" love together.

can we love deliberately?

Do I Love Her? (part 2)

I will try to make the triangular theory of love more love has three components according to this theory...intimacy, passion, and decision/ mixing these 3 components with defferent strengths ...we will get different types of love....

If a erlation has strong intimacy component but no other component, it will be called Liking... if we mix intimacy with a strong strength of passion, we will get what is called as Romantic Love....and the tringular diagram will tell you what could be when we mix other components...

Consummate Love is when we mix all the components to the sasme strong strength...

for my case it seems that I got a romantic love or infatuation to the lady am dedicating this search in love...can you tell me about your type of love....

Thursday, June 14, 2007

Mosul the old fationed

Mosul is an old fashioned city with many old buildings and even old traditions and culture…people here are still living as if they are living in a 50 years before…..sometimes as if 100 year before with believe in witchcraft and magic…as a psychiatrist I rarely see a patient who came to me asking for help before going to a traditional healer who treated him or her by trying to get the genie (evil soul) out of the body of the patient….well sometimes they beat the patient heavily to a degree that he or she have fractures…and sometimes patient came to tell us that the traditional healer had told them to go to the psychiatrist to receive for example 2 sessions of ECT…some old types of work are still present like the man who walks and sells some juices like this man…

Do I Love Her?

Love…that commonly used term in our daily life….in our public and in our secret life too…used by all of us sometime…maybe it is all the time dormant inside us…just need a trigger and it will come spontaneously from our unconscious hidden memories to our consciousness….we have said "I love you" many times to many persons…but what did that really mean?....what is love is all about?...does it mean the same thing for all of us?....

A chat with an intelligent sensitive person before 2 days made feel in need that I search for theories of love especially from the psychological point of view….and for that person who knows herself I dedicate this summary:

From the many theories about love that varies in their views and almost all of them have no evidence to prove worthy…but I found few to worth mention here….this is not to say that other theories are not nice to read about but I want to give a summary to be stick in our memory and not lost in details…..

Plato said that when we love a person, we love an abstraction or image of the person's best qualities….so we don't love a person for his or her unique qualities….

In 1986, Robert Sternberg comes with his famous triangular theory of love…which states that love has three components:
1. Intimacy (closeness, connectedness, and bondedness)
2. Passion (romance, physical attraction and sexual consummation)
3. Decision / Commitment (in the short term there is the decision to love and in the long term there is the decision to maintain the love).

What was strange to find is that about 13 % of cultures have no word for love (from the book of a natural history of love by Ackerman, Diane in 1994).....

The Chinese character for love is also worth to mention:

It means from top to bottom: that which gives breath (i.e.spirit) to the heart, with graceful motion…

Monday, June 11, 2007

help me to diagnose

The strange stories always come on the afternoon….after the usual headache of the morning….& after a fast fatty lunch….i got dizziness added to the headache due to the shift of blood supply from my brain to my stomach and intestines….
Taking my dizzeness and headache with me…. I went to the ward again to see a newly admitted client..who was very quit and silent in the morning to a degree that we missed taking history from him till afternoon when my colleague had told me that one of us must go back after lunch to take history from him…I volunteered…

He was a clean handsome young man with stylish clothes and clever look in his eyes and very polite and calm and peaceful in behavior…. His story came like this by his own words:

Before one year an explotion occur in the street and some man was injured… I volunteered to take him to the hospital… and then in the hospital I saw many injured people and volunteered to give blood for the sake of anyone…the nurse was fast when taking blood from me…that was not my first volunteer to give blood…but the nurse was very fast because of the stressful situation by then and when he took the needle out of my vein I moved my arm and severe pain occurred at the site of the entry of the needle.....since then I got pain which is COLD…. It is coldness and pain at the same time…going above from my forearm … the left one…. till reaching the left shoulder … then going into my left side of chest then to the abdomen…. This pain prevents me from work….and sometimes from sleep…since one year I have quit working in the market as I used to do as a salesman….i keep going to doctors but they did not cured my pain…before four months I had dreamt of prophet Mohamed telling me that is I amputate my hands I will get better….doctor please I do not need anything from you….. am not psychiatrically ill…but I came to the psychiatry unit because the surgeon I visit told me that he will not do an amputation for me till I visit you…I don't know why he asked me to visit you…but I think you can help me by giving me a paper writing on it that am insightful and having no mental illness… and if you want me to stay so that you examine me psychiatrically it is ok…I will stay… examine me….but I want you to promise me that if you find me insightful and having no mental illness.. promise me that you give me a paper saying that you are agree that I need to amputate my left arm as prophet Mohamed told me…and I think you do not consider yourself more wise than prophet Mohamed…are you?

That was the summary of his story…and it is worthy to say that he did not volunteered to say all that easily…I encouraged him to talk and used many techniques of the psychiatric interview to let him come with these information…the history taking took about an hour but to my surprise it took away my headache and dizziness from me….during his stay in the hospital he was completely normal person…what do u think?

concept of schizophrenia

19th century 2 views

1. Wilhelm Griesinger’s unitary psychosis (einheitpsychose).

he thought that all mental illnesses are the same illness but in different sevirity.

2. Benedict A.Morel in 1852 coined demence precoce (early dementia) to describe a disorder that start in adolescence and leading to withdrawal, odd mannerisms, self neglect and finally to
intellectual deterioration.

Karl Kahlbaum (1863) described the syndrome of catatonia.

Ewald Hecker (1871) described what he called as hebephrenia.

Emil Kraeplin

Division of severe mental disorders into 2: dementia praecox (partial improvement) and manic depressive psychosis (full recovery).

13% of his patients did recover.

3 subtypes: catatonic, hebephrenic, and paranoid.
. Described dementia praecox: “a series of states, the common characteristic of which is a peculiar destruction of the internal connections of the psychic personality”(1919)

Kraepelin believed that dementia praecox was primarily a disease of the brain, and particularly a form of dementia

Coined the name paraphrenia for a condition that start in middle life with no changes in emotions and volition.

Later Bleuler added the 4th as: simple.
Eugen Bleuler, Swiss psychiatrist, coined the term schizophrenia, did not consider delusions, hallucinations, and catatonic symptoms to be necessary for Dx. Leading to the idea that we could Dx. Schizophrenia without the presence of psychotic symptoms (simple schizophrenia).
4As : Association
Ambivalence (apathy)

Bleuler realized the illness was not a dementia (it did not always lead to mental deterioration) and could sometimes occur late as well as early in life and was therefore misnamed.
Bleuler believed that dementia praecox subsumed multiple disorders that differed in etiology and pathogenesis but certain clinical features in common.

Conflict between Kraeplin & Bleuler views reached its peak in 1950s leading to the International Pilot Study of Schizophrenia which showed that USA and URSS got broader concepts of schizophrenia than Colombia, Czechoslovakia, Denmark, India, Nigeria, Taiwan, and the UK “WHO 1973”.
Norwegian psychiatrist Langfeldt differentiate between schizophrenia and schizophreniform psychosis. In that they got different outcome and in that ECT and insulin coma therapy were ineffective in schizophrenia (1960).
DSM-IV term schizophreniform disorder is used in a different way than that meant by Langfeldt. According to modern diagnostic criteria, most of Langfeldt’ schizophreniform stated would be classified as mood disorder (Bergen et al.,1990)
Clinical psychologists in USA developed series of rating scales – the Elgin, Phillips, and Kantor scales- to differentiate between process and non-process schizophrenia mainly on the basis of premorbid personality and psychosexual adjustment
Both Langfeldt and the American psychologists assumed that true process schizophrenia was endogenous and hereditary, and that schizophreniform or non-process (“reactive”) psychosis were psychogenic, but neither succeeded in demonstrating a clear demarcation between the two.

Kurt schneider (1887-1967)
the first rank symptoms.
Pseudoneurotic schizophrenia (Hoch and Polatin 1949):
patient had a wide range of neurotic symptoms, such as phobias, obsessions, and depersonalization, often associated with severe anxiety and attacks of psychotic disturbance lasting days, hours or perhaps only minutes.
Some authorities, like Kleist and Leonard in Germany and Langfeldt in Norway, insisted that the term should be restricted to illnesses resulting in permanent damage to the personality; others used it freely regardless of outcome.
Some insisted on the presence of certain key symptoms; others were prepared to make a confident dx. on the basis of indefinable subjective impressions, the so-called “praecox feeling”.
Leonard distinguished schizophrenia from the cycloid psychosis, a group of non-affective psychosis of good outcome (1957).

Adolf Meyer saw schizophrenia as a reaction to life events. However, he recognized the importance of biological predisposition.

Some authors say that anyone, if had enough of the right stresses, will develop schizophrenia.
DSM-I was heavily influenced by Meyer’s thoughts and referred to schizophrenic reactions.
DSM-II moved toward a disease entity.
DSM-III & IV attempted to be atheoretical.
Presently, the stress-diathesis model for schizophrenia reigns supreme, but as developmental neurobiology evolves, other more sophisticated models may prove useful
In Denmark and Norway, cases of psychosis arising after stressful events have received much attention. The term reactive psychosis, or psychogenic psychosis are commonly applied to conditions which appear to be ppt. by stress and have good prognosis.
In current dx. Schemes such disorders would be classified as brief psychotic disorder or schizophreniform disorder.
Studies examining the diagnosis of schizophrenia have typically shown relatively low, or inconsistent levels of diagnostic reliability. Most famously, David Rosenhan's 1972 study, published as On being sane in insane places, demonstrated that the diagnosis of schizophrenia was (at least at the time) often subjective and unreliable. More recent studies have found agreement between any two psychiatrists when diagnosing schizophrenia tends to reach about 65% at best33. This, and the results of earlier studies of diagnostic reliability (which typically reported even lower levels of agreement) have led some critics to argue that the diagnosis of schizophrenia should be abandoned34.
They pointed to Japan, where the category schizophrenia was replaced with "integrated disorder" in 2004, as a possible model

Thursday, June 07, 2007

Explosions…. Bullets….Again….

I was a nice morning and the psychiatric ward was full of patients and psychiatric staff including me and another colleague and a female senior psychiatrist standing in the main collidor discussing a newly admitted case while we had not yet finished our morning tour… there were some patient standing in the collidor, one of them believes he is a prophet and that he had died 20 times before and came back to life… in the middle of our conversation an explosion shaked the floor below our feet and the all the door shivered together.. especially the locked ones.. making some shaky low pitched (male) noise … and the windows had cried while their glass had broken into small pieces adding a voice of an acute high pitched (female) sound… our prophet laughed strangely in a loud voice and murmured "they disserve it".. while the female senior psychiatrist searched with her wonderful blue bright eyes into eyes for an explanation…. I gave her a long short eye to eye contact then prvert my gaze downward and sigh.. she sighed… then continue our morning tour fastly…

In the evening

I was walking back from the ward to my room at evening to have my dinner.. when I was passing inside the main inside door of the hospital (ibn seena hospital) a heard a sound of crashes of glass and of a metal on the floor… me and a worker in the hospital and a visitor to a patient start to search about the source of those sounds and we found lately a bullet below a chair in the welcoming room.. these are pictures….

A Finnish In Iraq

It was late in that afternoon when Mr.S, the new client in our ward, whom I did not take history till that time from him, came asking for a pencil and a paper. Usually, our clients don't do that. I searched for him and found a paper, give it to him, he said that that paper will not help, because it contains lines on it, he needed a blank one.. I found one for him with difficulty and then gave him my second pen and asked him to give it back to me when he finnish..

Went to lunch… back in the evening… I saw Mr.S had drawn a symmetrical shape looking like a flower in that paper… full of details…I told him it is nice.. he told me if he got colors it will be nicer..

We managed to find coloring pencils and this is a sample of his work…

We went to the room of the resident doctor (me) and start together to collect the history of the psychiatric problem of Mr.S. and it came as this:

In 1991 he was a solder in the Iraqi army his duty was in the borderline between Iraq and Saudi (KSA).. at war a plane came suddenly and through something on them.. he did not know about his 2 fellows, but he also did not know about himself till he woke up in a clean room in a hospital and start to cry… a man came to him and told him in Arabic language that he is in Finland….in a hospital and he was unconscious for 3 months... the man knew our client's name, from the identity card which was with him….but when ask our client about more details of his personal history.. Our client found that he cannot remember personal information about himself... he was told that after that bomb he was found by UN workers unconscious and with dry blood on his ears, nose and mouth… and covered nearly totally with soil… he was taken to KSA then to Finland to receive treatment... on the account of the UN…
He gradually start to become better.. but his memory was very bad regarding his past history and also regarding his everyday life… but that problems in memory become less after 3 months when the medical staff of the hospital he was in (in the city of TORKO) adviced him to stay in hospital in the morning but go at the night to an apartment they helped him to found it… when he did that, he start to feel frightened and start to feel that others may harm him and that maybe a persecution against him and started to hear voices commenting on him…he was advised to stay in the hospital 24 hr/24 hr and start to receive psychiatric treatment…but voices keep following him and finally was advised to draw when hearing voices and when he did that he found it helpful more than all the other drug he took (the finally used drug was LEPONEX)… stayed for one year in TORKO.. then moved to hospital NIVA NEMI in the city of KOPIO where he stayed for 5 years… then move to hospital of LIPAKOTI in the city of KALAKOSKI where he spent more than one year and a half…start to work in LIPAKOTI as a cleaner… took the Finnish Nationality in 1998…he gathered some sum of money in the bank as a retire salary….but he know nothing now about that sum of money because he was sent back to Iraq in 2001 without his agreement where he was imprisoned by the intelligent security forces for few months in Baghdad just because he was treated abroad without the agreement of the government and they took his nationality identity card from him and also his passport… and sense then lost contact with anything in Finland which he belong for it too much and hope that he goes back to it and see again the sea of Balteek…

under this last picture he wrote that: life is a long way full of roses and those who do not know how to enjoy smelling the flowers....will not know how to get away from the thorns.. these were his own words as he said