Brain Blogger » Psychology & Psychiatry Health and Science Blog Covering Brain Topics Sun, 28 Dec 2014 00:07:23 +0000 en-US hourly 1 Are We Superhuman? Part 2 – Precognition Mon, 22 Dec 2014 12:00:41 +0000 Could your brain have the potential to predict what will happen in the future?

In the first installment of the series, Part 1 – Feeling the Future, we touched upon the easier to swallow concept of predictive anticipatory activity (PAA), known to the psychic community as presentiment.

It almost seems logical, even expected, that a system that potentially employs quantum principles- your brain – would be capitalizing on phenomena that could aid your survival. But if I said to you that your brain may have the potential to make accurate predictions about what will happen in the future, as opposed to the generalized physiological PAA premonitions indicating something will happen, you might think this is taking things a step too far. No?

Well, it’s not too far for some scientists, who are boldly exploring waters teaming with shrewd scientific sharks ready to chew up and spit out their work. In 2011, one of the most notorious scientific supporters of precognitive phenomena, Cornell University’s Professor Daryl J. Bem, urged researchers to attempt to replicate his time-reversed experimental findings, in order to create a database that as it grows, will increasingly allow for a more scrupulous analysis of precognition research.

Now, in 2014, Bem and colleagues have published a meta-analysis based on this database that included 90 experiments from 33 laboratories across 14 different countries involving 12,406 participants. The analysis yielded an overall positive Hedges’ effect size, albeit relatively small, in favor of the theory that a persons’ cognitive and affective response in the present can be influenced by events in the future that are yet to occur. This was coupled with pretty strong statistical significance (p=1.3×10-11) indicating that the experimental results are not due to chance. But are they due to precognitive thought? Now, that is the real question.

Let’s take a look at the experiments themselves, which were of ten main types, all aimed to test for the existence of the time-reversal of four well-established psychological effects:

  1. Approach/avoidance experiments: The first set of experiments were, in essence, standard presentiment studies, with a cognitive twist. Instead of simply detecting whether a randomly presented image is emotionally and physiologically arousing, in this case sexually arousing, before it is revealed, test subjects had to guess which of two curtains the picture was behind. A time-reversed effect was considered present when the subject was able to correctly identify the location of the image more often than chance, with the effect only observed for emotionally arousing images.
  2. Affective priming: Traditional priming experiments involve using a briefly flashed positive or negative word, e.g. beautiful or ugly, prior to viewing an image and asking subjects to judge as quickly as they can whether a picture is pleasant or unpleasant. When the image and the word are of the same valence (both positive or both negative), we make a correct choice quicker, than if one is negative and the other positive. To time-reverse the experiment, the priming word was shown after the participant made their choice. As priming effects are associated with specific changes in brain activity, extending this experiment to include fMRI analysis would prove very enlightening.
  3. Habituation: This involves repeated exposure to an emotionally arousing stimulus, be it an image, word or sound, resulting in subjects having a dampened emotional response to the stimulus (habituation). To time-reverse the experiment, the session comprising of stimulus familiarization by repeated exposure was performed after the level of arousal was measured from seeing the stimulus for the first time in a single exposure session.
  4. Facilitation of recall: Put simply, random words are displayed which have to later be recalled. Half of the words are repeated (e.g. typed out) in a practice session. In standard experiments the practice session occurs before the recall session, and in time-reversed experiments the practice session occurs after the recall session.

If we put any methodological and interpretational caveats aside and we take the results for face value, all experiments tested for time-reversed psychological capacities. However, most of the experiments were fast-thinking experiments, with the only slow-thinking experiments being of the facilitation of recall type. All of the fast-thinking experiments are quite easily explained by the more palatable PAA phenomenon. Slow-thinking experiments on the other hand, that involve specific details of future events, are clearly more in-line with the concept of precognition.

Interestingly, while the meta-analysis presented a strong effect size for fast-thinking experiments, the slow-thinking experiments achieved a negligible effect size, failing to achieve even a conventional level of statistical significance. Notably, of the 29 slow-thinking experiments included in the analysis, analyzing the 15 that were exact replications of Bem’s experiments (i.e. with minor if any modifications) resulted in a statistically significant effect size comparable with fast-thinking experiments.

All in all, the measured effect does NOT definitively correlate with precognitive slow-thinking. Instead, the results support theories of fast and instinctive retrocausal thinking far more readily, and quite easily aligns with PAA theory. Even meta-analysis of Bem’s results performed by other researchers lead to the conclusion that people may be able to feel the future with strongly valenced emotional stimuli, i.e. presentiment, but did not go so far as to consider precognition.

And even if we consider that all of the modified facilitation of recall experiments had negatively skewed results, remembering one or two words slightly better than expected is nowhere near as grand as psychics’ claims of conjuring up visions and precognitive dreams. So don’t go running for your crystal balls just yet.

Alone, these experiments might not have us believing we have the psychic powers of Professor Xavier, but collectively they certainly warrant further investigation. We may find that all of the experiments suffer from the same fatal flaw, producing false positive results, as some skeptics propose. Further developments in experimental design are undoubtedly needed for theories to be more widely acknowledged, or indeed debunked.

Nonetheless, the progression of research into time-reversed psychological phenomena thus far is impressive, especially with such overwhelming opposition in the scientific community. It is not unrealistic to assume that with a few more years of avid research we shall finally reach a paradigm shift, and enter a world where psychic capabilities like precognition get a modern makeover, or are left for tricksters, dreamers, the gullible and fairy tales.

Whatever holds true, as Lewis Carroll’s Queen in Alice in Wonderland quite aptly put it: “It’s a poor sort of memory that only works backwards”.


Bem, D., Tressoldi, P., Rabeyron, T., & Duggan, M. (2014). Feeling the Future: A Meta-Analysis of 90 Experiments on the Anomalous Anticipation of Random Future Events SSRN Electronic Journal DOI: 10.2139/ssrn.2423692

Bem DJ (2011). Feeling the future: experimental evidence for anomalous retroactive influences on cognition and affect. Journal of personality and social psychology, 100 (3), 407-25 PMID: 21280961

Rabeyron T (2014). Retro-priming, priming, and double testing: psi and replication in a test-retest design. Frontiers in human neuroscience, 8 PMID: 24672466

Rouder JN, & Morey RD (2011). A Bayes factor meta-analysis of Bem’s ESP claim. Psychonomic bulletin & review, 18 (4), 682-9 PMID: 21573926

Schwarzkopf DS (2014). We should have seen this coming. Frontiers in human neuroscience, 8 PMID: 24904372

Image via Nikkytok / Shutterstock.

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Mental Context – A Delicate Subject Wed, 10 Dec 2014 12:00:43 +0000 Differentiating psychotic experience from religious experience is a delicate matter. The discussion that follows is not intended to validate psychotic experience or denigrate religious experience. Rather, it is meant to address the questions of whether hallucinations and delusions can be distinguished from religious experience.

M. Pierre, a noted researcher, wrote an article entitled “Faith or delusion? At the crossroads of religion and psychosis”. In this article, he evaluates clinical psychiatric or psychological practice concluding that, “in clinical practice, no clear guidelines exist to distinguish between ‘normal’ religious beliefs and ‘pathological’ religious delusions.” Clearly, differentiating psychotic experience and religious experience represents a difficult conundrum.

It should be noted that both psychotic experience and religious experience largely rely on events in the mental realm. Scientists who attempt to empirically evaluate and validate religious experience often overlook the fact that facts emerge from and in the material world, and religious faith is generated from mental experience perhaps in synchronicity with material experience. As such, religious experience is subjective instead of being objective. However, this does not mean that it is invalid.

Synchronicity is a concept that can explain religious experience. Synchronicity is defined as the simultaneous appearance of events which appear significantly related but have no discernable causal connection. Religious experience relies on the reality that there are no discernable causal connections regarding the synchronicity of parallel events in the material and the mental realms. Synchronicity may be characteristic of religious experience, and it is the lack of a causal connection that forms a basis for individuals to understand this experience as miraculous. Causal realities are thought to rely on chance events. When experience appears to be meaningful but strongly improbable, it is thought not to be based upon chance events.

The psychotic individual may experience synchronicity of chance events, but in terms of this experience, synchronicity generates delusions instead of faith in religious ideas, including miracles.

Psychotic ideation and religion may be differentiated, and the key to this differentiation may be based on the context in which they occur. Religious ideas usually occur in the context of benevolence, perhaps that of God, as well as a positive view of the world in terms of non-normative experience. Psychotic ideation occurs in the context of a punitive and deceptive state of mind and the world. Religious experience is sought in the mental and the material worlds, while psychotic hallucinations and delusions result in the psychotic individual cringing in both the mental and the material worlds. It should be noted, however, that what is defined by religious experience can be negative, as well. However, it may be meaningful to the individual whether it is positive or negative, while psychosis tends to be dismissed by the non-psychotic as not meaningful.

I’ve suggested in previous articles that the mind is whatever we imagine it to be. This is a simple and perhaps dubious statement, but it is not entirely dissimilar to and incompatible with the idea that the mind is Skinner’s “black box”. The appearance of what constitutes experience outside of what can be considered causally explicated may be understood as relying on the mental context of this experience.

While religious individuals may welcome “miracles” nonjudgmentally, paranoid psychotic individuals go to extremes of thought in order to make sense of them or avoid them. The psychotic individual may not be able to make sense of “religious experience” because, to them, the only rational and logical ways of understanding psychosis rely on metacognition instead of faith. If psychotic individuals could exercise faith that hallucinations are just that – hallucinations – then they would function in a more positive way.

It is the case that psychosis is ego-dystonic, incompatible with the self-conception and the- definition of the psychotic individual. This may be the result of stigma that accompanies the self-denigration by the psychotic individual or the possible insidious, but relentless, auditory hallucinations that may clamor within the mental experience of the psychotic individual. What clinicians treating the mentally do not seem to realize is that, while the psychotic should accept psychosis, psychosis may be unacceptable.

Overall, it seems to be the context of religious and psychotic experience that differentiates them. The specific religious context of this perceived experience may determine whether this experience is positive or negative. Even though religious experience can have positive or negative connotations, it is still regarded as more meaningful than psychotic experience, and it is responded to with faith. Faith implicates a tendency on the part of the religious person to accept with little evaluation the perceived meaning of experience. Faith, like self-confidence, may elicit faith or trust in religious experience as defined by the individual, and this faith or trust may frame experience in a way that is compatible with a perceived unification with God. If the mind is whatever we each imagine it to be in terms of projection onto the mental realm, then religious experience will have an appearance of validity simply because this validity is expected.

Psychotic experience remains more problematic to the individual dealing with hallucinations and delusions. Often, psychotic individuals imagine their minds to be punitive arenas that present as deceptive. Because they imagine their experience to be irrational, as is told to them by clinicians, their experience of their minds and even their material environments are confusing and painful.

While a perceived experience of God or the identification as experience emanating from God within the mental realms of the religious person, one is forgiven, loved and trusting. God is represented as faithful in doing what is best for the individual, even when the experience of what seems to be God’s will can be painful. When the imagined mental context represents God as trustworthy, good thoughts and feelings will emanate from this experience. Conversely, the experience of the psychotic mind is painful. Due to the difference in the way mental experience is framed in terms of religion and psychosis, the subjective realities of the mind’s presentation will conform to divergent representations of reality in both the mental and the material realms.

This discussion is not meant to imply that religious experience is invalid or that psychotic experience should be considered valid. The essential idea that is proposed in this article is that the mind is whatever it is imagined to be by the individual experiencing it. Although this idea may be identified as a weak explanation of the mind, this understanding of the mind implicates projection onto the mental world of what the mind is believed to be by the individual. What the mind is believed to be then generates a context of the mental realm, and the appearance of psychosis and religious views of the mind rely on context.


Pierre JM (2001). Faith or delusion? At the crossroads of religion and psychosis. Journal of psychiatric practice, 7 (3), 163-72 PMID: 15990520

Image via umbertoleporini / Shutterstock.

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Is Anxiety Really a Gift? Sun, 07 Dec 2014 12:00:07 +0000 Anxiety is most known as a “thinking” disorder which can be evidenced through symptoms such as chronic worrying. Science now shows that human beings have on average between 60,000 and 70,000 thoughts per day and according to author Joe Dispenza, roughly “70% of those thoughts are negative in nature.” Negative thoughts create negative emotions which over time neurologically create redundant behaviors such as rushing, nervousness, preoccupation with the future as well as the past. How is it then, that anxiety could be a gift?

The truth is the actual symptoms itself may not be a gift, however the experience of the symptoms are. It turns out thoughts and emotions are made up of energy. They are simply molecules and atoms in motion. These send off a vibrational frequency. When the frequency is low (has little movement) this corresponds to low level emotions such as fear, insecurity and guilt. When the frequency is high (more movement) this corresponds to higher emotions such as courage, love and appreciation. This information has been scientifically tested and validated by scientists and clinicians such as Dr. David Hawkins.

This information allows us to approach, interpret and treat the symptoms of anxiety in a new way. Rather than attempt to beat, cure, prevent or control the symptoms the focus becomes on learning how to convert lower vibrational emotions into higher ones. This creates quite a shift in the field of psychology not only in the role of a therapist but also for the client. When applied consistently techniques such as visualization, mindfulness, and breathing have proven to transform emotions such as fear and worry into faith. As this occurs, new interpretations and insights develop. Similar to receiving clues in a board game symptoms become assets rather than barriers. For example, an emotion such as shame when released from the body has the capacity to uncover the gift of empathy.

Transforming emotions such as guilt into courage can be quite rewarding however, as stated in The Four Gifts of Anxiety “a life with your gifts does not mean a life without challenges, vulnerability or pain. Instead, a life with your gifts allows you to become empowered by the very same symptoms you once believed disempowered you.” The symptoms of anxiety when viewed in this light become a guidepost rather than a barrier. Rather than being a signal for what is wrong, think of a symptom such as increased heart rate as a marking of a buried treasure (in this case a buried emotion) waiting to be discovered.

Through skill development and awareness one can begin to surrender the stigmas and stereotypes anxiety has formally attached to. Some of these include subconscious beliefs that you have anxiety rather than a reflection of your current experience (I am experiencing worry). It is not until each and every one of us breaks the habit of becoming our symptoms, instead choosing to pay attention to how they may in fact be our greatest ally, as they often point out exactly which emotions are looking to be acknowledged and cleared so we may open up the pathway to our gifts.


Dispenza, Joe Ph.D. (2014) You Are the Placebo. Hay House, Inc. pp 45.

Hawkins, David R. M.D., Ph.D. (1995, 1998, 2004, 2012.) Power vs. Force. Hay House, Inc.

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Psychosis – A Dream-Like State Of Mind? Sat, 06 Dec 2014 12:00:18 +0000 Have you ever thought of psychosis as a dream-like state of mind? Dreaming does actually bear strong similarities with the psychotic state of mental illnesses such as schizophrenia. Psychotic states are characterized by hallucinations, loosening of associations, incongruity of personal experience, and a loss of self-reflective capacity. Dreams can also be seen as a kind of delusional thought during which there is a complete lack of insight into one’s true state of consciousness. Both the psychotic patient and the dreamer are in a state of acceptance of nonsensical experiences as real.

That dreaming may be a model for psychosis is a long-standing idea that has now been supported by recent studies on dream phenomenology. There are extensive similarities in measures of cognitive bizarreness between the waking thoughts of psychotic patients and dream reports of both psychotic patients and healthy controls. But whereas healthy subjects shut down those hallucinations while awake, psychotic patients continuously experience such dream-like mental activity.

One of the key aspects of the dreaming-psychosis model is the issue of insight, i.e. awareness of the mental state. Lack of insight into the dream state is a hallmark of the dream experience; likewise, 50-80% of schizophrenia patients have poor insight into their illness.

However, in contrast to normal dreaming, there is a special kind of dreaming in which the sleeping subject becomes fully aware of the mental state: lucid dreaming. In lucid dreams, the dreamer is aware that he is dreaming and is frequently able to control the ongoing dream. During normal rapid eye movement (REM) sleep, when the most vivid dreams occur, there is an increased activity in higher visual and motor areas, reflecting the occurrence of visuomotor hallucinations, the hallmark of typical dreaming.

In contrast, areas associated with willingness and critical thinking show decreased activity. During lucid REM sleep, on the other hand, there is increased activation of regions involved in attention and in higher cognitive processes like intelligence or working memory. Nevertheless, lucid REM sleep still includes all classic dream features such as visuomotor hallucinations, but the lucid dreamer can recognize dreams as such.

Lucidity during dreaming represents what patients during psychosis lack: insight into the delusional nature of their state of consciousness. Given these characteristics, it has been suggested that lucidity during dreaming may be a good model for insight in the dreaming-psychosis model. This model hypothesizes that the neural processes of lucid dreaming extensively overlap with those of insight into the psychotic state, and that the means to achieve lucidity during normal dreaming may also increase insight into the pathological state in psychotic patients.

Actually, for all brain regions associated with lucid dreaming there has been at least one study demonstrating the involvement of that region also in psychotic insight deficits; likewise, brain regions linked to insight problems in psychosis have shown remarkable overlap with brain regions in which activation increases during lucid dreaming, which strongly supports the theoretical idea that dreaming may indeed serve as a model of psychosis.

Interventions to promote insight are thought to be a promising alternative for schizophrenia therapy. Lucid dreaming can be trained, which makes this phenomenon an interesting tool and research topic, even though it occurs rarely in untrained subjects. Insight deficits in psychosis have been targeted with different interventions, but without noteworthy success.

Lucidity training has already been applied to other clinical settings such as nightmare therapy. If it proves to be successful in enhancing insight capabilities during psychosis, lucidity training may allow the psychotic patient to become aware of his state and, hopefully, even control it.


Dresler M, Wehrle R, Spoormaker VI, Steiger A, Holsboer F, Czisch M, & Hobson JA (2014). Neural correlates of insight in dreaming and psychosis. Sleep medicine reviews PMID: 25092021

Kahn D, & Gover T (2010). Consciousness in dreams. International review of neurobiology, 92, 181-95 PMID: 20870068

Limosani I, D’Agostino A, Manzone ML, & Scarone S (2011). The dreaming brain/mind, consciousness and psychosis. Consciousness and cognition, 20 (4), 987-92 PMID: 21288741

Stumbrys T, Erlacher D, Schädlich M, & Schredl M (2012). Induction of lucid dreams: a systematic review of evidence. Consciousness and cognition, 21 (3), 1456-75 PMID: 22841958

Image via Bruniewska / Shutterstock.

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The Hollywood Medical Reporter – Big Eyes and Delusional Disorder Wed, 03 Dec 2014 12:00:15 +0000 Simultaneously grotesque yet tender material is director Tim Burton’s specialty. Burton was therefore the perfect choice for a film about Margaret Keane’s art, which was mostly recognizable by children with strange – but sweet – over-sized eyes. Big Eyes is easily among my personal favorite Tim Burton films.

Left to Right: Tim Burton, Christoph Waltz and Amy Adams

Left to Right: Tim Burton, Christoph Waltz and Amy Adams

I recently had the pleasure of attending the Film Independent at LACMA screening series for the world premiere of Big Eyes, which will open Christmas Day. Burton and stars Amy Adams and Christoph Waltz, after watching it for the first time themselves, participated in a panel discussion moderated by Film Independent curator, Elvis Mitchell.

Big Eyes tells the story of Margaret and Walter Keane in the 1950s and 1960s. The Keanes’ marriage ends after years of Walter defrauding the world, and perhaps even himself, into thinking that his wife’s paintings of wide-eyed children were his own creation.

The film begins with Margaret (Amy Adams) packing her things and driving off with her daughter (Delaney Raye), just having left husband number one. She moves to San Francisco, where she soon meets Walter Keane (Christoph Waltz) at an outdoor art fair where they both have set up shop.

You can instantly see why Burton was the right director for this story. The over-sized, pastel teal car, driving along a bright and symmetrical suburban street of 1950s San Francisco is iconic of his work. A voice-over narration, used throughout the film, adds to the storybook feel.

However, this storybook suburbia is real. While the aesthetics of the time and place fit right in with Burton’s taste, the larger than life character of Walter Keane truly seems to have lived for the sole purpose of providing Tim Burton with an ideal subject for a film.

The moment Margaret and the audience meet Walter we both fall in love. Who wouldn’t? He is the definition of charming and charismatic, with a mouth so smooth and fast it deserves its own Olympic category. At first, the worst we may think is that he is a delightfully manipulative scoundrel. However, we soon understand that Walter’s ability to manipulate the truth is out of control, and a symptom of deeper issues. In 1986, 20 years after Margaret leaves Walter, she decides to sue him for slander to finally set the record straight on who the true artist of the family is. During the case, a court psychologist diagnoses Walter as having delusional disorder.

Delusional disorder, according to the DSM-IV, is characterized by the presence of either bizarre or non-bizarre delusions (or a fixed, false belief that is resistant to any reason or opposition with genuine fact), which perseveres for at least one month. The inclusion of bizarre delusions was a fairly recent addition, updated in the latest edition of the DSM 5.

A bizarre delusion is one that is clearly implausible and not understandably derived from ordinary life experiences. For example, if a person claimed that someone took out his or her organs and replaced them with someone else’s organs without leaving any scars or physical evidence of any kind, this belief would be deemed “bizarre.”

Non-bizarre delusions typically are about something occurring in a person’s life that is not out of the realm of possibility. Some examples include when a person believes: their significant other is cheating on them; a close friend is about to die; a friend is really a secret government agent; and so on. All of these examples are situations that technically could be true, or at least could be labeled as a possibility, but when checked by a third-party, proves not to be.

People like Walter Keane, who had delusional disorder, by and large do not show a noticeable impairment in their daily life. Their outward behaviors cannot generally be labeled as objectively out-of-the-ordinary or show clear signs of alarm.

Much of diagnosing delusional disorder can be categorized as being one of exclusion: the delusion in question cannot be better diagnosed as schizophrenia, a mood disorder or any other clear and strong potential diagnostic alternative.

Even without knowing the specifics, the average viewers could easily walk away from the film having made the diagnosis about Walter Keane for themselves. Even more convincing than his threats to “whack” his wife if she speaks the truth, are the wide smiles and fantastical justifications Waltz makes while calmly explaining his way out of whatever hole he happens to have been caught in. For example, years into their marriage (and lie) Margaret is taken aback by a surprising stepdaughter Walter never bothered to tell her about. While it is obvious to you, me and of course Margaret, Walter, through a clenched but convincing smile tells Margaret that he was sure he told her, and that it must just be a simple misunderstanding, not worthy of another thought. This character clearly does not deal with reality well.

The film is a far cry from perfect, or even greatness. No one could delude themselves into thinking Big Eyes is a masterpiece worthy of Keane’s own ego. There are many narrative threads it left unresolved, such as the surprise daughter. It seems as if Burton may have been a bit overwhelmed by the details of this story, unable to resist including each one, since they were all so awesomely perfect for the screen. Unlike some other films by the director (such as Alice in Wonderland, where the convoluted exploitation of the narrative may have been caused by overreaching), in Big Eyes, the filmmaker curbs his enthusiasm: he is firmly in control of his subject.

Nevertheless, the Burton touch is very much alive and all the more effective for its restraint. It maintains the fairytale feel while at the same time being both real and realistic.

The depiction of Walter Keane’s delusional disorder is 100% realistic. While the film never actually uses the phrase, “delusional disorder” it knows it could not deny this fact about the character. But more importantly, it wouldn’t want to. This character’s condition defines what happens in the film.

For example, the court sequence draws the viewer in with the fantastically absurd actions of Walter. While serving as his own lawyer, he questions himself, literally scurrying back and forth from the witness stand to behind the examiner’s table. After the judge orders both Margaret and Walter to paint in order to prove who is telling the truth, Walter still does not, and perhaps cannot, admit the truth. Rather, he clutches his arm in pain and claims to be suffering from an injury that renders him incapable of painting. Such actions, while not obviously irrational, are far more deluded than your average lie.

In the end, Big Eyes depicts the disorder accurately and exploits it with integrity. Without the disorder, there would be no conflict. Some films sacrifice accuracy (of such disorders) for the sake of heightening the drama. That is not the case here: the disorder underlies the conflict of the film without sacrificing authenticity.

Image via Ramon Espelt Photography / Shutterstock.

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Stigma and Schizophrenia – A Predetermination of Failure Fri, 28 Nov 2014 12:00:26 +0000 Stigma surrounding schizophrenia is a circumstance of mental illness that the newly diagnosed schizophrenic may not initially perceive or anticipate. To my knowledge, many schizophrenics initially speak of their mental illnesses publicly to strangers, not really expecting that this will cause others to view them as extremely peculiar or exactly what they are: mentally ill.

Newly diagnosed schizophrenics may seek reflection of their internal states, attempting to understand themselves as mentally ill. It is then that they encounter stigmatization.

As a matter of course, stigma tends to exacerbate the condition of schizophrenia because it leads to interpersonal alienation and a withdrawal into the mental realm. This culminates in greater involvement in psychotic ideation and perhaps greater interaction with one’s hallucinations, as this is understood by the schizophrenic. Stigmatization is damaging to the schizophrenic. It leads to engulfment in mental illness, given that stigma, in a cyclic way, culminates in deeper psychopathology, and deeper psychopathology leads to increased stigmatization by others.

There was a person of my acquaintance, diagnosed with schizophrenia and early in the process of her mental illness, but newly aware of stigmatization. She asked her clinician how she would be able to combat stigma. The clinician replied: “Get a job.” This was good advice.

Vocational activity in the form of employment or scholastic endeavor can help to ameliorate stigma. Such activity may normalize the self-concept of the schizophrenic individual, and it will lead to a greater sense of self-worth. If a schizophrenic can obtain vocational activity prior to the emergence of damage to her sense of self as a result of stigma, she may have more success in vocational spheres. She may gain self-confidence in spite of her mental illness.  

The fact that the newly diagnosed schizophrenic may be particularly responsive to intervention at the initial stage of dealing with her illness stems from the reality she has not really accepted stigma as an aspect of her self-definition. Healthy and normative activity can be enacted by this individual at this stage specifically prior to assumption of the damaging effects of stigma in terms of her self-concept. Stretching the newly diagnosed person’s belief in terms of what she is capable of in the vocational and educational realms will benefit that schizophrenic individual.

One clinician, a psychotherapist, engaged in treatment with a schizophrenic individual of my acquaintance. The schizophrenic individual expressed her desire to attend graduate school. The clinician stated: “You will never go to graduate school. Look at the statistics on people like you.” This therapist’s statement was contraindicated by the facts regarding appropriate treatment for mental illness. The psychotherapist stigmatized the client. The client, however, did not accept the stigmatization that the clinician projected onto her. The client went on to achieve a doctorate in psychology.

This client was an anomaly. Most schizophrenics may have believed the therapist’s statement, whether it did or did not accurately reflect their level of ability. There is no way of estimating how many schizophrenics’ life goals have been destroyed by the way others have stigmatized them. Perhaps the mental illness, schizophrenia, is only partially the culprit in the failure of people with schizophrenia to achieve vocational and educational success.

Clearly, another culprit may be the damaging and stigmatizing ways that others view schizophrenics. These views, communicated to the schizophrenic, become prophetic specifically because the schizophrenic believes them, incorporates them into his self-definition, and lives by them.

Early in the course of the illness of an individual diagnosed with schizophrenia represents the ideal time to intervene and even halt the progress and the process of emerging psychopathology. The fact that the newly diagnosed schizophrenic does not readily perceive the stigma associated with mental illness can actually benefit her. If the newly diagnosed schizophrenic is assisted in engaging in activities that will strengthen her self-concept, she may be better equipped to cope with stigma and its implications.

Encouraging vocational and educational activity is an important aspect of treatment for schizophrenia. However, stigmatization may be a substantial reason for failure in these areas. As a result, the schizophrenic individual may reside in secrecy regarding her mental illness, as a way of deflecting the effects of stigmatization. Note, as well, that alienation is one effect of stigma, and alienation bolsters mental illness. Failure, alienation and a sense of personal diminishment and defeat accompany stigma. It is essential that schizophrenics are reached early in their illnesses, before the effects of stigma have virtually predetermined failure.

Image via Sinseeho / Shutterstock.

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Facebook – Are We Over-Connected? Mon, 24 Nov 2014 16:58:50 +0000 The evolution of the human brain is deeply intertwined with our experience as social beings, and the ability we have to bond with others through co-operative activities. According to Dunbar’s study of human brain size and complexity in relation to those other species, humans can manage at most around 150 people as part of their personal network (including family members, acquaintances and friends), while maintaining active and stable relationships through co-operation with them.

Just a few years ago, in 2009, it was suggested that the average number of contacts on a Facebook profile varied between 120 and 144. This finding was consistent with Dunbar’s figures. However, this number has rapidly grown beyond such limits. Until January 2010, Facebook offered a maximum limit of 5,000 friends per profile, so that people could ‘add real friends only’. Amongst the first to reach these limits were of course celebrities, but also everyday users started to approach the 5,000 limit, especially those using their profile as a platform for self-promotion or business promotion.

The longer an active user stays on a social networking service (SNS), the greater number of friends he or she is likely to accumulate. Now, 144 contacts is regarded by many users as a very limited number. A large majority of users’ contacts are simply casual acquaintances and not people with whom they have significant relationships. As SNS users add more contacts to their lists, they face the need to negotiate the sharing of information with a variety of social circles such as family, old friends, new acquaintances and work colleagues.

These circles may have different social demands and pressures associated with them. This may result in users restricting who may view information using their privacy settings, although most users probably don’t keep up to date on the frequently changing controls for such settings in Facebook.

Fred Stutzman, a professor at UNC’s School of Information and Library Science, carried out a pilot study based on a quantitative analysis into ‘identity-sharing information’, comparing information shared over different SNSs with information shared in a physical directory produced for student use. He considered the opinions of participants about disclosing personal information across each medium. He suggested that data such as photos, political views and sexual orientation are new types of information currently only widely shared by students through SNSs, access to which may prove ‘potentially invasive’.

A large majority of users are becoming increasingly selective when adding contacts to their profiles. Many manage their personal networks relatively strictly, by limiting their network to close friends and family, however their networks keep on growing. Therefore, as Cain points out, ‘the ability to define the audience through privacy features is an important component of Facebook’.

Many users seem to be more reflective now about whom it is that they wish to add to their networks and for which purposes. It may be that this enhanced selectivity will continue to increase as users continue to adapt to these sites.

As the number of contacts on SNS personal networks keeps growing, so will the need to study how this increase in social connections affects how people are using their profiles, and what choices they are making in sharing self-representations and personal information through multimedia shared over these sites.


Cain J (2008). Online social networking issues within academia and pharmacy education. American journal of pharmaceutical education, 72 (1) PMID: 18322572

Dunbar, R. (2010). ‘How Many Friends Does One Person Need?’, London: Faber and Faber.

Nessi, L. (2011) ‘Constructing Online Identities on Social Networking Sites: Social, Economic and Cultural Distinctions Made by Privileged Mexican Users’, (a thesis submitted in partial fulfilment of the requirements of Nottingham Trent University for the degree of Doctor of Philosophy), Nottingham, United Kingdom.

Stutzman, F. (2006) ‘An evaluation of identity-sharing behaviour in social network communities‘, Proceedings of the 2006 iDMAa and IMS Code Conference, Oxford, Ohio.

Image via TijanaM / Shutterstock.

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Psychotherapy for Paranoid Schizophrenia Mon, 27 Oct 2014 11:00:04 +0000 Often psychotherapy is not considered to be effective with individuals dealing with schizophrenia spectrum disorders. But a cognitive-relational psychotherapy approach helps form a warm, trusting and detached relationship, conveys an understanding and concern for one’s client, and involves the therapist telling that individual their own empathic views about what that individual is dealing with.

Often clinicians assume that psychotherapy does not work well with persons manifesting what are called “thought disorders” – conceived to be irrational, unrealistic and factually inaccurate. Again, clinicians fail to understand, empathically, the circumstances of the psychotic individual. It should be noted that schizophrenics deal with non-normative experience that, in terms of hallucinations, is visceral in nature. This experience entrenches them in delusions based on hallucinations that are highly convincing.

One idea that may help schizophrenics is reflected in this line from a poem I wrote: “May you walk beyond the empty sudden blindness of existence.” To schizophrenics in crisis and even those not in crisis, the future may seem to be extremely uncertain and perhaps treacherous. They may perceive both the mental and the material worlds as incredibly dangerous. And in many ways, they are dangerous, due to the amount of suffering experienced by the paranoid schizophrenic that seems to her to be inflicted on her by these worlds.

No knowledge about knowledge

A non-epistemological stance regarding no knowledge about knowledge may help a schizophrenic replace her delusions. Essentially, the non-epistemological view represents deconstruction of knowledge with an assertion that relies on the fact that all “knowledge” is subjective. While schizophrenics have subjective views regarding their own knowledge, and although this may be communicated to them, they may be able to understand, in a similar sense, that nobody really has any kind of certain knowledge.

In terms of non-epistemology, it may not be possible to live in the world on these terms. Moreover, it may not be possible to tolerate an awareness that anything may happen to us at any time that will catapult us into crisis. The sudden death of a loved one may be an example of this.

Typically, we reside in faith that things will go normally and as planned, and they generally do so. However, the schizophrenic lacks such faith. If the therapist can communicate to the schizophrenic that she should try to get as comfortable as possible with simply “not knowing,” this may help the schizophrenic. There is a basis for “not knowing” that corresponds to everyone’s subjective experiences of the world, and this is reflected in all individuals’ perspectives on the mental and the material worlds. Realistically, it might be more threatening to the schizophrenic to “not know”, as opposed to clasping her delusional beliefs.

In terms of addressing the idea of “not knowing” with the paranoid schizophrenic, the psychotherapist may say the following: “Nobody knows what the future may bring. If you buy a lottery ticket, even if the chances are small, you may win the lottery. If you have sex, even with birth control, you may become a parent. Most events in are life happen by chance. You don’t really know what will happen, even if you fear with certainty that bad things will happen to you. Your condition of schizophrenia really causes you to suffer mostly because of your fear of bad things happening to you, rather than these things actually happening to you. Maybe the thing you should fear in your life is the fear itself. By realizing that you do not know what the future will bring, you may feel safer.”

Context matters?

Another aspect of dealing with schizophrenia is encompassed in the idea, stated by Ralph Ellison in The Invisible Man: “If you don’t know where you are, you don’t know who you are.”

This statement implies that one needs to know her context in order to know her self and her identity. Often schizophrenics fail to know their contexts. They have confused and distorted ideas about context, based on the fact that their contexts, in their minds as well as in the material world, may reflect delusions and hallucinations. This leads to ambiguity as perceived by the schizophrenic in her mental and material environments as threatening, simply because the schizophrenic may be dealing with non-normative experience.

The clinician may convey to the schizophrenic the idea of not knowing her context by stating: “It’s hard to know what you think of yourself when you don’t really know what you are dealing with in the world. This may be what causes you to be afraid of the world. And this means that you are afraid of both your voices in your mind, (for example), and the people outside in the world.”

The schizophrenic may adhere to her delusional beliefs due to the fact that she, as well as virtually everyone else in the world, thinks that knowing one’s context allows them to be safer than they would be if they did not “know what they know”, even when “knowing what they know” may be delusional. Again, the assertion that the client does not really know what her worlds signify can replace delusional ideas.

One way of communicating this idea to a paranoid schizophrenic would be constituted by saying: “You might think that being a schizophrenic makes people prejudiced towards you, and it may, but also the world we live in makes you into a schizophrenic. Your context in the world – and how the world views you – may be determined by the situation that you are in. You may believe that this is false, that you really know more than other people about the world, but you still do not know what you are in the world, perhaps because believing you are schizophrenic may be unacceptable and may not make sense to you. Nevertheless, you do not know for certain what the world is. That is why it is scary. And you don’t know who and what you really are, because you may believe one thing and others believe differently.”

Treating life as normal

Another idea for dealing with hallucinations and delusions stems from a novel by Carrie Fisher, Postcards from the Edge, which states the idea that: “Perhaps if we treat life as normal, a sense of normalcy will follow.”

This idea is highly salient to dealing with one’s hallucinations and delusions. The schizophrenic may be perhaps traumatized by her experience, but treating life as normal may lead to a gradually acquired feeling of safety.

The idea embedded in this statement from Fisher reflects the advantages of the act of challenging the delusions of a schizophrenic by the schizophrenic. Living one’s life normally in terms of habits and faith in the normative view of reality may allow the schizophrenic to experience the decay of her fears, her paranoia and her delusions. Not obsessing about one’s hallucinations and delusions, by trusting life to proceed normally, combats the punitive experience of schizophrenia and paranoid schizophrenia, in particular.

It should be noted that the ideas contained within this article represent an intellectualized framework of how the clinician or the psychotherapist may approach therapy with a paranoid schizophrenic. They may also be applicable to those who are high functioning, but may be suffering to an extreme extent.

A belief in the scientific bases for the effectiveness of psychiatric medications may be a belief that can be cultivated or even spontaneously adhered to by the schizophrenic. Nevertheless, non-normative experience may lead to non-normative thought, and the deep communication by an empathic therapist who is able to accurately imagine and recapitulate to the schizophrenic what she is dealing with may be in some sense curative.

I have applied these ideas to psychotherapy with paranoid schizophrenics with some success. One client, a paranoid schizophrenic, was struck by the idea that “if you don’t know where you are, you don’t know who you are.” She asked for a restatement of that idea based upon the connection she had established with it. Another schizophrenic stated humorously that he wanted to write a book entitled, The Fallacy of Truth.” He was able to understand a non-epistemological stance. Lastly, one client tried diligently to treat her life as normal and routine even though she was hyper-vigilant and paranoid. The trauma that she experienced precluded her from entirely benefiting from this perspective, but she became extremely high functioning.

Overall, these ideas for psychotherapy, from a cognitive relational perspective, may be of some help to some people, especially paranoid schizophrenics. However, it should be noted that the different types of schizophrenia may correspond with different interventions and treatment.

Image via Diez Artwork / Shutterstock.

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Comparing the 5 Theories of Emotion Wed, 22 Oct 2014 11:00:19 +0000 Emotions seem to dominate many aspects of our lives. But what exactly are emotions?

The word first appears in our language in the mid-16th century, adapted from the French word émouvoir, which literally means, “to stir up”. However, one can find precursors to the word emotion dating back to the earliest known recordings of language. When searching for a definition, Hockenbury describes an emotion as “a complex psychological state that involves three distinct components: a subjective experience, a physiological response, and an expressive response.”

Researchers have long studied how and why people experience emotion and a number of theories have been proposed. In order to compare and contrast these theories of emotion it is helpful to first explain them in terms of the interactions between their components: an emotion-arousing stimulus, a response of physiological arousal, a response of cognitive appraisal, and the subjective experience of emotion.

According to the James-Lange theory, initially proposed by James and around the same time also by Lange, the stimulus leads to the arousal that leads to the emotion. The sound of a gun shot, for example, leads to the physiological responses like rapid heart rate and trembling that lead to the subjective experience of fear. On the other hand, according to the Cannon-Bard theory, proposed first by Cannon and later extended by Bard, the stimulus leads to both the arousal and the emotion. The sound of a gun shot, for example, leads both to the physiological responses like rapid heart rate and trembling and to the subjective experience of fear.

The two most well-known cognitive theories are the two-factor and the cognitive-mediational theories of emotion. According to the two-factor theory, proposed by Schachter and Singer, the stimulus leads to the arousal that is labelled using the cognition that leads to the emotion. The sound of a gunshot, for example, leads to the physiological responses like rapid heart rate and trembling that are interpreted as fear and lead to the subjective experience of fear.

According to the cognitive-mediational theory, proposed by Lazarus, the stimulus leads to the personal meaning arrived at using cognition that leads to both the arousal and the emotion. The sound of a gunshot, for example, is interpreted as something potentially dangerous and leads to both the physiological responses like a rapid heart rate and trembling and the subjective experience of fear.

Finally, according to the facial feedback theory, emotion is the experience of changes in our facial muscles. In other words, when we smile, we then experience pleasure, or happiness. When we frown, we then experience sadness. It is the changes in our facial muscles that cue our brains and provide the basis of our emotions. Just as there are an unlimited number of muscle configurations in our face, so to are there a seemingly unlimited number of emotions. The sound of a gunshot, for example causes your eyes to widen, your teeth clench and your brain interprets these facial changes as the expression of fear. Therefore, you experience the emotion of fear.

By breaking them down in this way, one can already notice the differences and similarities between the different theories, as one can clearly identify the components that exist in each theory and the order in which they occur. As can be seem from the above, the James-Lange and Cannon-Bard theories are fundamentally similar in that they both involve the same three components but different in how they handle the timing of when arousal and emotion occur. They differ from the two cognitive theories in that both of them do not explicitly acknowledge any role of cognition.

Regarding the similarities, the sequence of the three components in both the James-Lange and two-factor theories and in both the Cannon-Bard and cognitive-mediational theories is the same, the fundamental difference between the two theories comprising each pair being the addition of a cognition component at some point in the sequence in the cognitive theories.


Hockenbury & Hockenbury (2007). Discovering Psychology: Fourth Edition. New York: Worth Publishers, Inc.

JAMES, W. (1884). II.—WHAT IS AN EMOTION ? Mind, os-IX (34), 188-205 DOI: 10.1093/mind/os-IX.34.188

Lazarus, R. S. (1991). Emotion and adaptation. New York: Oxford University Press.

Myers, D. G. (2004). Theories of Emotion. Psychology: Seventh Edition, New York, NY: Worth Publishers.

Image via Elnur / Shutterstock.

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Poor Social Judgment – An Aspect of Schizophrenia Sun, 12 Oct 2014 11:00:40 +0000 There are three components that generally typify an individual emerging with schizophrenia: alienation, introversion and divergent thinking. Together, these characteristics diminish the schizophrenic individual’s capacity for exercising good judgment in social situations.


People with emerging schizophrenia are generally socially impaired and isolated. As stated by Burns (2006), “premorbid developmental and social impairments have been well documented in adult schizophrenia.” People with schizophrenia tend to be unpopular and uninvolved in primary and secondary school, and they may also be more introverted than their peers.

The mentally ill are possibly the most alienated members of our society. Research suggests that social isolation (i.e. limited social interaction with other children) and poor or disrupted interpersonal relations during childhood, teen and early adult years appear to increase an individual’s risk for future development of schizophrenia-spectrum disorders. It is quite possible that social isolation is causally implicated in the presentation of schizophrenia, instead of simply being correlated with psychosis as a separate characteristic. It is obvious that social isolation is a consequence of schizophrenia.


Introversion may also accompany psychosis, and it too may be inexorably intertwined with alienation and psychosis. Divergent thinking has been noted to be descriptive of individuals that may be more self-involved, at least in terms of their thinking processes. Jung noted that introverts solve their problems in their own minds, as opposed to extroverts who rely on the external world and interaction with other people in solving problems.

As stated by Rugu (2013), “one is predominantly introverted if his interest and attention generally turn inward, toward his own thoughts and feelings; if his interest and attention are generally directed outward, toward other people and external stimuli, he is predominantly extroverted.” Clearly, however, there exists a continuum between introversion and extraversion, with most individuals falling between the two extremes. Nevertheless, most schizophrenics are probably more introverted than they are extroverted, and the social isolation that may accompany their introversion may be extreme.

Divergent thinking

In previous articles, I’ve suggested that schizophrenic individuals tend to be divergent thinkers. Divergent thinking has been noted to rely on perceiving more details in the in the mental and the material worlds than what might emerge from what may be called dogmatic thinking, and it should be understood that there exists worlds that are constituted by the material and the non-material.

While people with schizophrenia may be more imaginative than non-mentally ill individuals, the creativity implicit in their thought processes may not be productive in a positive sense, specifically because they may lack the quality of convergent thinking, involving analytic reasoning and logic. Schizophrenics may have more details at their disposal with which to construct their world-views, but they may not be able to construct their world-views in a meaningful way. Divergent thinking characterizes perhaps all forms of schizophrenia. It may be most obvious in the paranoid schizophrenic, but the results of this type of thinking, when convergent thinking is lacking in the individual, can be seen disorganized schizophrenic individuals.

Divergent thinking accompanies social isolation due to the fact that this type of thinking leads to unique ideas, whether these are good ideas or bad ideas, and whether these ideas are practically applicable to problems in the material and mental worlds. Because divergent thinking is a quality that characterizes schizophrenic individuals as well, it might be said, again, that divergent thinking is a correlate of schizophrenia and it may result in alienation. Alienation, divergent thinking, and introversion all may be amalgamated as causes of the psychotic presentation. In combination, these characteristics allow for the synergy between isolation and introversion, compounded by the influence of divergent thinking, perhaps without the convergent thinking which would permit solutions to problems related to social interaction.

The synergy between alienation, introversion and divergent thinking may all equally form part of the personality of the schizophrenic individual. This personality will be dysfunctional in meeting the interpersonal needs of the schizophrenic individual, due to the nature of intrapersonal self-involvement reflected in alienation, introversion and divergent thinking.

Social judgment

Ultimately, it is social judgment that is compromised by these three characteristics. The schizophrenic’s essential and paramount battle may be to ameliorate the effects of stigma, a consequence of implicit societal attitudes that are a reaction to the schizophrenic’s hapless and unintended nonconformity.

Without social judgment, the schizophrenic may have no means of negotiating social relationships, she may be unable to understand how others view her, and she may lose contact with others in the material world. This loss of real world social contact, then, exacerbates the condition of schizophrenia.

Schizophrenia can be viewed as a vicious cycle caused by alienation, introversion and divergent thinking. Social skills training would be an intervention that might serve to assist schizophrenics in dealing with stigma. This type of training might allow them to approach new acquaintances with knowledge of appropriate disclosure of their condition – disclosure that may demonstrate a social awareness of how their illness is viewed by others. Equipped with an understanding, however limited, of the role of stigma in terms of their interactions with others, people with schizophrenia may be better able to interact in the material world.


Burns J (2006). The social brain hypothesis of schizophrenia. World psychiatry : official journal of the World Psychiatric Association (WPA), 5 (2), 77-81 PMID: 16946939

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Treating Children and Teens Diagnosed with Schizophrenia Wed, 24 Sep 2014 11:00:11 +0000 In this article, I will focus on treatment considerations regarding the diagnosis of schizophrenia in children and adolescents. This article on assessment of schizophrenia concerns the nature of psychological tests that evaluate the prevalence of schizophrenic symptoms in an individual child or adolescent. These specific tests, which rely on interview and self-report, are described as potentially useful in formulating a diagnosis of schizophrenia by a qualified clinician.

There are several treatment strategies for helping one’s child or adolescent cope with a diagnosis of schizophrenia. These avenues to treatment may include psychiatric medication, individual therapy, behavioral intervention, such as a token economy, and family therapy.

Medications for psychotic illnesses have revolutionized the treatment for schizophrenia and psychotic disorders of all types. While some parents may be reluctant to medicate their child for very good reasons, medication nevertheless may be an extremely important piece of a configuration of treatment strategies. The fact is that medication has evolved since the times when medication was viewed by some as “psychiatric straight jacket”. 

While past antipsychotics have been termed “major sedatives”, newer, atypical antipsychotics increase cognitive organization, and, in conjunction with other medications, such as appropriately prescribed antidepressant and mood stabilizing medication, these medications may help the child or adolescent. For this reason, the use of medication should be considered as treatment for children and adolescents who manifest schizophrenic symptoms. It might make them feel better, and it might increase their subjective well-being.

While medication seems to be the treatment of choice for psychotic disorders, other interventions bear scrutiny. Sometimes clinicians underestimate the value of psychotherapy in treating schizophrenia. The reality exists that even the most well-intended parents will have difficulty dealing with their schizophrenic child. However, if a child therapist treats a child, she may have more success in diminishing the overt symptoms of schizophrenia in a child, precisely because she is not one of the child’s parents.

A therapist can be warm and detached, simultaneously. While these two characteristics may seem dichotomous, they can be combined by a therapist so that she does not forfeit her objectivity, but nevertheless nurtures the child. The element of emotional detachment in a therapist is crucial for both parties. One can see that parents and their youths may lack detachment from each other to an extent that creates negative feelings in both the parents and their children. This is why bringing the child in for individual therapy may be crucial to the child’s or the adolescent’s well-being. If nothing else, the therapist might serve as a trusted and caring adult or role model. This type of relationship clearly will benefit the child or adolescent who becomes involved in individual therapy. It should be noted that therapy of any modality, relational, behavioral or eco-systemic, will likely benefit the child or adolescent.

One intervention that relies on the principles of behaviorism is the token economy. A token economy can be described as a system of positive and negative reinforcement by which a child may earn and lose privileges as a result of his behavior. This means that the child essentially enters into a contract with the facilitator of the token economy, who would likely be his parent. The contract between the child and his parent would specify what the child may gain or lose privileges, contingent on whether he did his chores or his homework, as examples. As such, the child may earn one hour of playing video games, as an example, in return for completing his homework.

If the rewards are meaningful to the child, and the system of the token economy seems fair to the child, the token economy will work to change maladaptive behavior. Note, also, that the rules of the token economy may be determined before it is implemented, and the child’s or adolescent’s feelings, as well as his parents’ feelings, should not enter into what and when rewards will be forthcoming. This allows for some detachment, on the part of both the child and the parent, which will assist the process entailed by the token economy, overall.

Family therapy is efficacious in treating the schizophrenic child or adolescent for several reasons. Clearly, by means of family therapy, the schizophrenic child or adolescent will feel supported by her parents in terms of the concern that they demonstrate in gathering together in an effort to help the client, who is the identified patient. Moreover, the family can be guided and monitored by the therapist in such a way that the family members can express their feelings about the issues surrounding the impact of the diagnosis on the family without angering other family members. Lastly, the therapist will be able to normalize the experience of family members, thus clarifying their expectations about living with the diagnosis of the child or adolescent.

Overwhelmingly, however, it is the support of the schizophrenic individual by her family members as evidenced by the choice to engage in family therapy that will have the greatest positive therapeutic effect on that individual. He will know that his family cares about him.

The diagnosis of schizophrenia regarding a child or adolescent is incredibly difficult for the entire family to endure. However, this may be the case largely because the parents do not know how to negotiate the process of beginning with observation of odd behavior in their child, then seeking an assessment for a schizophrenic diagnosis, and culminating in treatment for all family members to help them deal with the situation.

No one expects to have a schizophrenic child. The anger, sadness and grief associated with this diagnosis are extreme. However, parents should note that their child may feel this anger and sadness and grief more poignantly than they do. The odd, confusing and inappropriate behavior of their child or adolescent may be compounded simply because he has received this diagnosis, and he is likely to be treated differently by family members as a result of this diagnosis.

The appropriate behavior of the schizophrenic individual’s family members is crucial to dealing well with this diagnosis. Perhaps the discussion by this writer has in some way illuminated the path for the families of schizophrenic children and adolescents so that they will be able to cope effectively with this diagnosis that need not equate with tragedy.

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The Relationship Between Depression and Arthritis Fri, 08 Aug 2014 11:00:35 +0000 Both arthritis and depression are common in the United States, with age and obesity trends likely to increase the number of people who suffer from both conditions simultaneously.

Studies have repeatedly demonstrated an association between arthritis symptoms and major depression. Of concern, research has shown that among patients with both conditions, the result is not merely the sum of the suffering and disability associated with each independent illness; when depression coincides with arthritis, studies have found that the conditions are multiplicative rather than additive, amplifying each other.

Arthritis and depression are but one example of the increasingly frequent overlap between medical and behavioral health, and evidence suggests that treating depression reduces arthritis-related healthcare expenditures, increases compliance with arthritis treatment plans, and alleviates physical symptoms.

The Arthritis Problem
According to the CDC’s 2013 Morbidity and Mortality Weekly Report, one in five adults in the United States has physician-diagnosed arthritis. For the past 15 years, arthritis has been the most common cause of disability among U.S. adults. Ten years ago, just under 10 percent of U.S. adults, approximately 19 million people, said their activities of daily living were limited by this chronic condition. The number is projected to reach 25 million by 2030.

In older populations, arthritis is widespread: by age 65, at least a third of people in the U.S. have osteoarthritis, and the majority, approximately 80 percent, experience degenerative changes or joint disease. The costs associated with this are enormous: The American Academy of Orthopedic Surgeons (AAOS) reported an estimated annual cost for medical care to treat arthritis and joint pain of $281.5 billion in 2004. Prescription drugs accounted for 23 percent of the expenditures.

The Depression Problem
The Morbidity and Mortality Weekly Report also notes that depression is more common among people with chronic diseases such as diabetes, asthma, cancer, and arthritis. Citing the Behavioral Risk Factor Surveillance System (BRFSS) survey conducted from 2006 to 2008, 9 percent of U.S. adults, of any health status, met the criteria for depression.

Depressive symptoms have been identified as an independent risk factor for all-cause mortality. A study by Wells et al. found an association between depression and disability where the effects of depression were comparable to several major medical conditions.

When Arthritis and Depression Overlap
When arthritis and depression overlap, studies have shown a synergism resulting in worse suffering and disability than that which would be associated with each condition independently. A 1998 study found that osteoarthritis-related knee pain was associated with depression. Other studies demonstrate worse outcomes, lack of adherence to treatment plans, and increased cost of care in patients suffering from both illnesses.

In addition to increased use of pain medication, a bidirectional relationship exists between the two conditions: Yohannes and Canton describe how the fatigue that accompanies depression results in activity avoidance, which decreases muscle conditioning, resulting in increasing arthritis pain while also leading to social isolation, thereby perpetuating depression. They also note that “a previous history of depression is a better predictor of utilizing healthcare than the severity of osteoarthritis symptoms,” which implies that the financial burdens of arthritis could be mitigated to some extent by addressing coinciding depression.

While osteoarthritis is the most common form of arthritis, another form, rheumatoid arthritis, shows an even more significant link with depression. The National Institute of Mental Health (NIMH) Catchment Area program reports that the lifetime prevalence of psychiatric disorders among patients with rheumatoid arthritis is 63 percent. “Indeed,” state the researchers, “approximately 20 percent of patients with RA are found to have current major depression with potential impact on RA symptoms.”

Devellis and Devellis summarize the implications of these studies, stating that “helping arthritis patients obtain relief from their depression promises both to mitigate the added risk associated with depression and to enable the patient and physician to manage the arthritis itself more effectively. A first step to optimal treatment may simply be an awareness of the role that depression can play in the course of arthritis and its treatment.” Primary care physicians could screen arthritis patients for depression and refer them for treatment.

The long term effects of medication, as well as interactions between medications, should be cause for concern among patients afflicted with multiple conditions. Non-steroidal anti-inflammatory and other drugs for arthritis are associated with gastrointestinal issues, renal toxicity, and other side effects.

Breedveld notes that among American adults over the age of 35 with osteoarthritis, 41 percent were also receiving pharmacotherapy for hypertension. As other chronic diseases join the mix of arthritis and depression, the potential for activity-limiting, undesirable medication side effects increases. According to the CDC, 57 percent of those with heart disease also have arthritis, and 52 percent of diabetics have arthritis.

The CDC’s Arthritis Program recommends self-management education and physical activity programs, noting that some of the barriers to self-management through physical activity include lack of time, competing responsibilities, lack of motivation, difficulty finding an enjoyable activity, and fear of exacerbating pain or further damaging joints. Barriers to treating depression often include cost of drugs, side effects, stigma, and the patient-provider relationship.

Studies have shown that older people with osteoarthritis could benefit from combination therapy utilizing medication and cognitive behavioral therapy, however copays are frequently a barrier to treatment for elderly patients on a fixed income. Consistent with the CDC’s recommendations, Yohannes and Canton concluded that self management techniques, medical information, assistance with pain coping skills, and exercise would be beneficial. Cognitive behavioral therapy has been used to cultivate the belief that the patient is equipped to effectively cope with the condition, resulting in increased activity and improvement in depressive symptoms. Aerobic exercise programs have decreased depression in adults with arthritis.

Depression exacerbates the manifestations of joint disease. Recognition of this relationship by family members and providers can lead to better support for the increasing number of people suffering from overlapping medical and behavioral health issues. Counseling, education, and exercise programs have shown the potential to mitigate symptoms and reduce health care spending while improving quality of life and daily functioning.


Agarwal P, Pan X, & Sambamoorthi U (2013). Depression treatment patterns among individuals with osteoarthritis: a cross sectional study. BMC psychiatry, 13 (1) PMID: 23607696

Behnam, B. (2013). The Frequency and Major Determinants of Depression in Patients with Rheumatoid Arthritis Turkish Journal of Rheumatology, 28 (1), 32-37 DOI: 10.5606/tjr.2013.2599

Breedveld, F. (2004). Osteoarthritis–the impact of a serious disease Rheumatology, 43 (90001), 4-8 DOI: 10.1093/rheumatology/keh102

Current Depression Among Adults, 2006-2008. (2010). Morbidity and Mortality Weekly Report

Parmelee PA, Harralson TL, McPherron JA, & Schumacher HR (2013). The structure of affective symptomatology in older adults with osteoarthritis. International journal of geriatric psychiatry, 28 (4), 393-401 PMID: 22653754

Prevalence of Doctor-Diagnosed Arthritis and Arthritis-Attributable Activity Limitation – United States, 2007-2009. Morbidity and Mortality Weekly Review, 59(139).

Yohannes AM, & Caton S (2010). Management of depression in older people with osteoarthritis: A systematic review. Aging & mental health, 14 (6), 637-51 PMID: 20686976

Image via Image Point Fr / Shutterstock.

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Reading Your Psychotherapist’s Mind Sun, 27 Jul 2014 11:00:20 +0000 I am a clinical social worker and faculty member in psychology and community counseling. I came across a provocative article in the New York Times, Wellness section, entitled “What the Therapist Thinks About You”. I am sharing my clinical experience of sharing my notes with the clients I treat.

Mental health patients do not have the ready access to office visit notes that, increasingly, other patients enjoy. But as discussed in the article, Mr. Baldwin is among about 700 patients at Beth Israel Deaconess Medical Center who are participating in a novel experiment.

Within days of a session, they can read their therapists’ notes on their computers or smartphones. The hope is that this transparency will improve therapeutic trust and communication.

The Department of Veterans Affairs, which began making medical and mental health records available online last year, is only just beginning to study the effect of this on mental health patients.

The Beth Israel project grew out of OpenNotes, a program by Dr. Delbanco and his colleagues that made physicians’ notes accessible to 22,000 patients at three institutions. A 2011 study showed that patients responded positively and became more involved in their care.

Mindful of any pitfalls, the Beth Israel psychiatrists have offered notes initially to only 10 percent of patients.

I have been sharing my clinical notes with clients for years now, with no discernible negative effects. However, I do so only at the next session as a review of our last session. I never post them in any electronic format, so as to preserve respect, confidentiality and privacy. I do not trust the safety of electronic information.

I have been doing this for a number of reasons, some I will discuss here.

For one, I believe that all healthcare recipients are entitled to an accurate recording of their care. Secondly, I believe that this approach also solidifies the therapeutic alliance, which is critical to effective care. Thirdly, it reinforces therapeutic momentum and keeps the client and clinician focused on the objectives and goals of the treatment.

So in my experience, the benefits outnumber the liabilities. I’m certain that some clinicians will disagree with the essential premise of this article; and I welcome robust discussion.


J. Hoffman (2014). What The Therapist Thinks About You. New York Times, July 7.

Leveille SG, Walker J, Ralston JD, Ross SE, Elmore JG, & Delbanco T (2012). Evaluating the impact of patients’ online access to doctors’ visit notes: designing and executing the OpenNotes project. BMC medical informatics and decision making, 12 PMID: 22500560

Image via Pressmaster / Shutterstock.

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Self-Help for Schizophrenics Fri, 18 Jul 2014 11:00:22 +0000 In spite of the existence of stigma, the first crucial step in dealing with schizophrenia is acceptance by that individual that he or she has a mental illness.

This acceptance will allow him to deal more effectively with his life and move on with a lifestyle that is perhaps different from that of an ordinary person. Acceptance of one’s mental illness and the life task modifications that are involved in existing as a schizophrenic in the world are essential to dealing with schizophrenia with a modicum of success. Noteworthy is the fact that denial of having a mental illness is likely to be a significant step toward delusional thinking, and acceptance of having a mental illness is a step toward sanity.

At this point, it’s worth addressing the fact that there has been a fair amount of criticism directed at me for labeling and pathologizing those who have perceptual differences in the articles I’ve written so far for this website. Much of this criticism has described my articles as “reductionistic” and “stigmatizing”. By no means do I intend to denigrate schizophrenics or those with perceptual differences. Rather, these articles represent efforts to illuminate schizophrenia, and they have been intended to help the individuals suffering from the condition of schizophrenia.

Many of the suggested treatments for mental illness have reflected traditional approaches. But I believe in the importance of self-help. This article is intended to offer helpful advice, not only to schizophrenics, but to their treatment providers, as well.

Although not usually construed as a self-help related behavior, taking one’s prescribed medication is also an important aspect of self-help. Medication has been empirically studied from the perspective of science, amounting to predicting and controlling behavior by means of medication. There are a multitude of very reliable studies that have been done, equating with the efficacy of medication in treating schizophrenia and myriad other diagnosed conditions, such as depressive, anxiety and bipolar disorders.

Often schizophrenics wax delusional in that they feel that taking medication makes them mentally ill, or that stopping their medication will make them sane, or that taking medication is synonymous with being mentally ill, and they should throw their pills away. They may discontinue taking their prescribed medications as a direct result of their delusional stance, or they may discontinue their medication use simply because they do not like the side-effects of medications.

Accepting psychiatric treatment by taking prescribed medications and attending appointments with one’s psychiatrist are perhaps the single most important aspects of self-help that a person with schizophrenia can enact. The use of medication to treat diagnosed psychiatric conditions may be reductionistic, but taking medication might also lead to subjective well-being on the part of the mentally ill individual.

Mental illness, and schizophrenia in particular, entails social isolation. Stigma to a great extent causes this type of alienation, and combating alienation from others is essential in dealing with mental illness. This can be achieved by attending group therapy or support groups. Speaking to other schizophrenics about one’s symptoms and participating in dialogue about mental illness aids one in seeing one’s own problems in the experience of others.

For example, revealing to other mentally ill people one’s delusional ideation, and then asking others how they think it feels to think these thoughts, is a way of reaching for a union with others. Even though they may or may not agree with one’s expression of one’s delusional framework, group therapy or support groups may allow one to feel less isolated. Moreover, the realities of dealing with poverty or childcare, experienced by the mentally ill, may allow one to feel less alienated, as well. Just talking to others and getting out of one’s internal ruminations about one’s psychosis is helpful to the mentally ill individual. As a consequence, seeking interpersonal activity is an extremely important aspect of self-help regarding mental illness and schizophrenia.

In addition to relational activity, vocational activity – whether this involves paid or voluntary employment – is extremely helpful to those dealing with mental illness. Freud said that happiness resides in love and work. In addition to meaningful relationships, work is essential in providing an individual with feelings of self-worth. Many individuals who suffer from serious mental illness are currently engaging in vocational activities, more so than in past decades. These include peer support specialists, who are consumers of mental health services who work in the mental health system, often assisting other consumers with their positive treatment related activities. Even filling the roles of greeters at large stores can help some mentally ill individuals by providing with both relational and vocational activity.

One should remember that it is often not the status entailed by a particular job that is important to job success. Success in vocational activities relies on whether the individual, in this case, one with schizophrenia, fits the niche of that job. Often, the atmosphere of one’s workplace and how the individual feels while he is working will determine her success or her failure. For example, the atmosphere of a fast food restaurant may be too fast-paced for a mentally ill person. This type of stress may lead to failure for the schizophrenic almost inevitably.

The individual schizophrenic should perhaps start slowly by first volunteering at a work venue, where he feels comfortable, for a minimal period of time each week. Then, as he gains confidence, gradually works toward a goal of what he seeks in terms of vocational success. One should realize, however, that a schizophrenic should not exaggerate or minimize what one foresees as his ability in this regard. One must proceed at a slow pace and a exercise a trial and error approach to succeeding in work.

Overall, there are many avenues to better psychological health regarding schizophrenia. These include but are not limited to the use of psychiatric medication. Discovering these avenues may be approached sensibly in terms of understanding the needs that all people have in their lives, and, as mentally ill individuals, trying to modify their approach to fulfilling needs that are universal.

“Love” and “work” are concepts that represent needs for all people. We all need relational and vocational activity in order to combat interpersonal alienation and proceed in activity that gives us a sense of purpose. We all need vocational activity in order to feel worthwhile. We all need relationships with others who perceive us as we are.

Often, the mentally ill stray from the productive avenues of life, due to the fact that no one thinks that they can participate in love and work. Perhaps their symptoms cause a lack of fulfillment of these fundamental needs, even while this lack of need fulfillment may cause their symptoms. The purposes of love and work should be sought with persistence and faith in one’s own ability to fulfill needs in this regard. But first, the mentally ill individual should accept her mental illnesses and accept her use of psychiatric medication.

Lastly, the mentally ill should not embrace or reject the label of schizophrenia without reservation. The danger of stigma and usefulness of this diagnosis should be navigated using good judgment and self-awareness. No one can define what a mentally ill individual may be able to accomplish, and the diagnostic label of “schizophrenia” is not a self-fulfilling prophecy. Ultimately, it is largely to the schizophrenic’s lack of self-esteem, entailed by stigma that is accepted, ambivalently or not so, that determines whether stigma has any power.

One should not allow the terms for mental illness to define them. Stigmatizing labels may make one angry, defensive and degraded, but the word “schizophrenia” has no power. Labels can amount to name-calling by people who have the psychological sophistication of children. Perhaps that is why this author will not acknowledge stigma even to the extent of not using these labels that clearly seem reductionistic.

The choice to be stigmatized by a label is a decision made by the individual who is mentally ill, and the choice to be limited by a diagnosis may be their choice, as well.

Image via Image Point Fr / Shutterstock.

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Psychosis – The Brain’s Inner Conflict Mon, 30 Jun 2014 15:08:26 +0000 Sensation is a function of the five senses: taste, smell, touch, vision and sound. Sensory organs convert stimulation into experiences that can be described as meaningful by means of neural receptors that send sensory information to the brain. Thus, the brain interprets sensory information as experience as meaningful. The human brain experiences the absorption of energy as meaningful in terms of the senses involving taste, smell, touch, sight and hearing.

Perception is different. It is the process by which the brain organizes and interprets sensory information, shaped by learning, expectation and attention. Perception also affects how we understand sensory information and give it meaning by using memory and emotion. Although sensation and perception work together to create meaningful human experience, they are separate processes, implicating separate functions.

Perception results in consciousness of the material world. Although sensory perception allows us to maintain information about the world gathered by the five senses, intellectual perception allows one to comprehend information. This differs from ordinary perception. Intellectual perception allows one to extrapolate from sensory experience and reason about it analytically and abstractly.

Thinking about sensory experience involves Piaget’s conceptualized abilities of assimilation and accommodation. Assimilation involves fitting objects or concepts into categories. For example, we might place an “apple” and an “orange” into the category of “fruit”. An example of accommodation involves the creation of a new category that cannot be assimilated into the category of “fruit” by creating a category for “vegetables” when one is first introduced to a vegetable, such as “cabbage”. The concepts of assimilation and accommodation are the basic tools by which knowledge is created and comprehended.

It is obvious that the processes of thought and knowledge about the world are much more complex than is signified by these examples. Sensory stimulation, sensory experience, sensory perception and categorization of concepts, intellectual perception, and meta-cognition or thinking about thinking are amalgamated except perhaps by philosophy’s attempts to disseminate such knowledge in a rational way. It is obvious in an intuitive way that thought processes rely on various ways of thinking, feeling and sensing.

A baby is born with sensory perception. She responds with emotion to pain and pleasure. Emotion represents a form of perception. Some of our emotions are virtually instinctive and innate. Other emotions depend on memory and learning that combine with sensory and intellectual perception to create the various ways we feel about and experience the world. In short, we construct our understanding of the world.

People, generally, do not create consistent worldviews, and it is blatantly clear that cognitive errors are rampant in the minds of virtually all individuals. Even speaking of consciousness, a state that all people know by experience, may baffle most people. Cognitive error can be comprehended as afflicting all individuals who do not have belief systems that are interconnected logically and consistently. It may not be possible to achieve a belief system that is logically consistent in terms of a worldview.

Cognitive dissonance — the mental stress experienced by someone who holds more than one contradictory, conflicting idea in their minds — stems from cognitive error that is skewed by emotion to create views that an individual, when made aware of this dissonance and corresponding error, attempts to modify by changing his views or reinterpreting his experience.

For example, the “just-world hypothesis” is a cognitive bias that is comprised of the view that an individual’s actions always result in ethically fair consequences, such that good deeds are rewarded and bad actions are punished. When information contrary to this assumption is revealed to an individual, the individual may change his views to make them compatible with his assumption of the just-world hypothesis, such that he may maintain that the individual who is punished for good deeds in fact deserved his punishment.

It should be noted that paranoid psychotic individuals have views that represent amalgamations of experience involving sensation, perception, emotion and thought or thought about thought. Psychotic individuals have the misfortune of enduring pseudo-sensory experience in the form of hallucinations. This experience is as visceral and real to them as is the experience of the five senses that most people endure. Hallucinated experience cannot simply be dismissed as “white noise” because it is said to be unreal — it persists in the mind of the schizophrenic, and, especially in terms of auditory hallucinations, it has immediate meaning in that the schizophrenic “hears” verbal material in what should be the safe sanctuary of her own mind.

Nevertheless, we distinguish between the mentally ill and the non-mentally ill with either/or mentalities, such that it is assumed that a person is either mentally ill or not so, when in fact all people make cognitive errors. While cognitive dissonance is experienced by all people who misinterpret sensory and perceptual experience, the mentally ill are punished for such misinterpretation. If there exists any reason to challenge the attributions of the mentally ill that are entailed by stigma, this should be the most salient one. The ideation of the psychotic mentally ill is comprehensible, and, if it is viewed as such, the stigma regarding mental illness may be diminished. In fact, a lack of stigmatization of the mentally ill might paradoxically allow them to release over-valued ideas.

It is the paranoia of the psychotic mentally ill person that creates a vigilance by which that individual responds to hallucinations and delusions, and vigilance creates a sensitivity to reinforcement of delusional material. Paranoia fuels psychotic ideation because it implicates an intolerance for ambiguity that corresponds with fear. Clearly, if the psychotic individual does feel safe or safer, she may express less of a need to speculate, perhaps endlessly, about the world-view that is unwillingly owned by her.

Image via lolloj / Shutterstock.

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