Cognitive performance in conversion hysteria.

In order to test some neurobiologically based assumptions pertaining to attention and memory dysfunction in conversion hysteria, a series of tasks was given to 17 hospitalized patients with hysterical conversion reaction and to a control group of nonpsychotic patients under conditions of nonstress and stress. The results indicated significant differences in performance between hysteria and control subjects. The former group, in comparison to controls, had heightened suggestibility, greater field dependency, and greater impairment of recent memory and vigilance-attention. A discriminant analysis indicated the feasibility of using such tests as objective diagnostic criteria for hysteria.

'Loss of control' in alcoholics.

This study evaluates the ability of alcoholics to regulate their blood alcohol levels (BAL) within a designated range by relying primarily on interoceptive cues. Forty male alcoholics and 20 control subjects were exposed to an initial training session in which they received sufficient ethanol to maintain them within a designated BAL range over a 2 1/2-hour period. They were then exposed to two experimental sessions, one providing "overfeedback" and one "underfeedback." During each session, subjects had ten drinking decisions to make with respect to regulation of their BAL. The results indicated that alcoholics displayed greater "loss-of-control" than control subjects. This finding supported the hypothesis that alcoholics may possess a neurophysiologic feedback dysfunction that contributes to their relative inability to regulate ethanol intake.

Mental illness and creative activity in female writers.

OBJECTIVE: This study addressed three questions. Are female writers more likely to suffer from mental illness than members of a matched comparison group? If so, does a familial basis exist for their psychopathology and creativity? What factors predict overall creativity in women? METHOD: Questionnaire and interview data were obtained on 59 female writers and 59 members of a matched comparison group. These data were used to assess overall creativity and to identify psychiatric disorders in subjects and their first-degree relatives. RESULTS: Female writers were more likely than members of the comparison group to suffer not only from mood disorders but from drug abuse, panic attacks, general anxiety, and eating disorders as well. The rates of multiple mental disorders were also higher among writers. Although there was evidence for the familial transmission of psychopathology, physical or sexual abuse during childhood also loomed as a potential contributor to later psychological difficulties. Creativity also appeared to run in families. The cumulative psychopathology scores of subjects, their reported exposure to sexual or physical abuse during childhood, mental difficulties in their mothers, and the combined creativity scores of their parents represented significant predictors of their overall creativity. CONCLUSIONS: The high rates of certain emotional disorders in female writers suggested a direct relationship between creativity and psychopathology. But the relationship was not necessarily a simple one. As the results of the predictive analysis indicated, familial and environmental factors also appeared to play an important role.

The medical basis of psychiatry.

The authors state that the medical model represents the most useful and appropriate model available for the practice of psychiatry. They discuss the implications for psychiatry of the three essential features of the medical model: the concept of disease and diagnosis, the concept of etiology and treatment, and the nature of the doctor-patient relationship. They conclude that the adoption of the medical model for psychiatry would have profound implications for residency training, continuing education, delivery of care, standards of ethical and professional practice, dealings with third-party payers, and conflicts with other professions.

Treating psychiatric problems in medical students.

The medical school educational experience is very stressful for many students, prompting some to seek formal psychiatric care. The authors describe the Medical Student Support Services program of the University of Kentucky College of Medicine. From July 1983 to June 1985, this program served 66 patients, representing 417 visits. On the basis of retrospective chart review with the examining clinicians, the authors present DSM-III diagnoses, types of problems seen, descriptive profiles of the patients, duration of treatment, types of therapy used, and data on marital issues. They discuss the intricacies of providing psychiatric services to medical students and make recommendations for program development for such patients.

Nerves, but not mentally.

This report attempts to delineate the nature of "Nerves" using data collected from 101 Social Security Disability petitioners from Eastern Kentucky. Statistical analysis of Cornell Medical Index items reveals a relatively unique constellation of symptoms for individuals claiming disability primarily due to "Nerves" rather than somatic or mental causes. The report concludes that "Nerves" serves as a useful clinical label for a fairly consistent pattern of somatic and emotional complaints incorporating the distinctive Appalachian world view and life style.

Intoxication and sobriety. Implications for the understanding of multiple personality.

This speculative article compares the switch from drunkenness to sobriety with what transpires in the switch from one personality to another in multiple personality disorder. State-dependent learning is discussed as a particularly fruitful area of investigation into the understanding and interpretation of diverse manifestations of multiple personality disorders as well as alcoholism.

Cognitive processes associated with "spontaneous" recovery from alcoholism.

Interviews were conducted with 29 alcoholics who claimed a "spontaneous" remission from alcoholism to elucidate the cognitive processes associated with the initiation and maintenance of absolute or relative abstinence. Factors associated with the initiation of abstinence included hitting a personal bottom, alcohol-induced physical problems, allergy or physical aversion, change in lifestyle and spiritual-mystical experiences. With respect to the maintenance of abstinence, the majority periodically resorted to willpower, some claimed the disappearance of craving and others were protected by their physical aversion to alcohol. Cognitive factors underlying the maintenance of abstinence overwhelmingly involved negative associations to the notion of drinking. The implications of these findings for psychotherapy are discussed.

The relationship of alcohol withdrawal experiences to impaired cognitive function.

Analysis of the scores of alcoholics on five tests of withdrawal, alcohol craving and cognitive function failed to support the hypothesis that the severity and frequency of alcohol withdrawal are related to impaired cognitive function.

Stimulus intensity modulation and alcohol consumption.

In a study of men alcoholics, cortical average evoked response proved to be a good indicator of subsequent alcohol acquisition and consumption behavior in the laboratory.

Comparison of three outpatient treatment interventions: a twelve-month follow-up of men alcoholics.

Men inpatient alcoholics (N = 174) from a Veterans Administration medical center who were preselected by employment status were randomly assigned to one of three outpatient treatment interventions: (1) medication only, (2) active support or (3) untreated medical monitoring. Subjects were followed monthly for 1 year, with an 85% 12-month follow-up rate. Although the sample as a whole showed reduced alcohol misuse and improved social functioning after 12 months, the specific form of treatment was unrelated to outcome. These findings suggest that the intensity of the outpatient treatment experience is not related to outcome and that time-consuming interventions are not differentially cost-effective.

Pavlov's "bells" and alcohol craving.

This study pertains to the reported factors governing the experience of craving in sober alcoholics. 150 alcoholics were administered a semi-structured interview and asked to report situations which triggered a desire to drink in a manner comparable to a conditioned stimulus. Respondents mentioned a wide variety of such stimuli, many of which were unique to certain individuals. Almost 93% reported at least one cue associated with heightened craving for alcohol. In the author's opinion, these results have important implications for treatment programs for alcoholics.

Reflections on creativity and madness.

The author reflects on the long-assumed relationship between creativity and madness. He comes to the conclusion that, while not a prerequisite, a touch of madness could enhance creativity. He attempts to define creativity and breaks it down into the basic elements of creative person, creative process, and creative product. He touches on the influence of a particular culture on the emergence of creative works.

Creative achievement and psychopathology: comparison among professions.

This study was designed to determine (1) whether members of the 8 "creative arts" professions (i.e., architects, artists, musicians, composers, actors/directors, essayists, fiction writers, and poets) display greater rates of psychopathology than members of other professions, and (2) whether a significant relationship exists between creative achievement and mental disturbance. The final study sample (n = 1,005), constituting 18 separate professions, consisted of all appropriate individuals whose biographies were reviewed in the New York Times Book Review over a 30-year period (1960 to 1990). The results, in their entirety, suggest (a) that different patterns of psychopathology, if any, tend to be associated with different professions and at different periods in individuals' lives, (b) that different professions are associated with different levels of creative achievement, and (c) that certain types of psychopathology are associated with creative achievement across all professions.

Culture and creativity.

The relationship between cultural and creative expression is complex. Cultural factors clearly have a profound influence on appropriate outlets for creative expression, on the nature of the subject matter and form of expression, on the functions that various forms of expression serve, and on the types of individuals selected for, or engaged in, creative activity. There are many different ways by which societies shape all aspects of creative expression, ranging from the availability of resources to the provision of rewards or punishments. It also becomes apparent that the association of creativity with originality is largely a Western outlook and that artistic achievements in other cultures do not necessarily have this requirement. Despite the powerful impact of culture on the creative expression of individuals, this relationship is often reciprocal. For whatever reasons, there tend to be individuals in all societies who challenge the cultural norm and societal tradition, despite the consequences, and who thereby help to shape the nature and form of art.

The disabled society?

Benefit payments and numbers of clients on the disability payrolls have substantially increased, while the numbers and proportions of those terminating because of recovery or rehabilitation have steadily decreased. The powerful effects of compensation on the disability process, psychological factors, bureaucratic interests, the weakening work ethic, and changing social values contribute to this problem. The responsibility of medicine with respect to the problem of disability is discussed.

"Nerves": a sociomedical diagnosis ... of sorts.

"Nerves" represents a common complaint among individuals from Appalachia. It appears to be a conglomerate term to encompass chronic anxiety without panic, mild depression without despair, neurasthenia without malaise, a smattering hypochondriasis and a surfeit of illness behavior, all superimposed on passive, dependent individuals with borderline normal intelligence and exposed to profound sociocultural deprivation. Definitive treatment of this disorder entails major changes or modifications in almost every aspect of their lives, including family structure, education, vocational training, and basic value systems. This may eliminate "nerves" but will not prevent the development of the more conventional psychiatric disorders to which more educated, middle-class individuals are vulnerable.

Is there life after tenure?

Within academic medical settings, the issue of tenure is highly controversial. Advocates maintain that tenure is necessary to protect academic freedom and reward accomplishment; critics claim that it promotes sloth and encourages incompetence. Unfortunately, the available facts do not support any clear-cut answer. Studies on the scholarly, research, and service activities of faculty do not reveal any clear relationship between tenure and a decline in productivity. Nor, for that matter, does tenure seem to have any bearing on the exercise of academic freedom. As to the viability of tenure, economic and political factors may have more of an impact than the presumed merits or weaknesses of this system.

Who is someone?

The ways of knowing another human being are limited to personal information provided by the individual, creative expressions by the individual, personal observations of the individual, and empathic identification with the individual. Each of these sources of information, while valuable, possesses certain inherent limitations, often contributing to a distorted picture of who a person is. To a large extent, such distortions can be attributed to the still unresolved issue of what is meant by a "self." Addressing this issue allows for a more rational formulation of just who someone is.

Psychiatry and psychotherapy: past and future.

The place of psychotherapeutics in psychiatry is again in question. In many ways the situation recapitulates that of the late 19th century when psychotherapeutics first came upon the medical scene. The psychiatric hegemony over psychotherapeutics was the outcome of three fierce internecine "battles", (1) the "medicalization" of psychotherapeutics (1870-1910); (2) securing the psychiatric monopoly of psychotherapeutics (1890-1930); and (3) the "medicalization" of psychoanalysis (1920-1940). Three "revolutions" in psychiatry have occurred, since the stable halcyon 1950s, that have loosened the knot which binds psychotherapeutics to psychiatry. The emergence of specific psychopharmacologic therapies, the resurgence of the laboratory tradition (behaviorism) and the community-mental-health movement have diluted the importance of psychotherapeutics in treatment and widened the therapeutic franchise. In addition, there is evidence that the function of psychotherapeutics in society is itself changing. The future of psychotherapeutics in psychiatry is discussed in light of these developments.