Alien abduction: a medical hypothesis.

In response to a new psychological study of persons who believe they have been abducted by space aliens that found that sleep paralysis, a history of being hypnotized, and preoccupation with the paranormal and extraterrestrial were predisposing experiences, I noted that many of the frequently reported particulars of the abduction experience bear more than a passing resemblance to medical-surgical procedures and propose that experience with these may also be contributory. There is the altered state of consciousness, uniformly colored figures with prominent eyes, in a high-tech room under a round bright saucerlike object; there is nakedness, pain and a loss of control while the body's boundaries are being probed; and yet the figures are thought benevolent. No medical-surgical history was apparently taken in the above mentioned study, but psychological laboratory work evaluated false memory formation. I discuss problems in assessing intraoperative awareness and ways in which the medical hypothesis could be elaborated and tested. If physicians are causing this syndrome in a percentage of patients, we should know about it; and persons who feel they have been abducted should be encouraged to inform their surgeons and anesthesiologists without challenging their beliefs.

Parkinson's disease as a model for psychosocial issues in chronic neurodegenerative disease.

Throughout the course of PD, opportunities abound for psychosocial interventions that can improve a patient's quality of life. The psychosocial challenges accompanying PD vary by stage of illness, though some challenges persist throughout the course of illness. As illustrated in the tables in this chapter, many of these interventions involve empathic listening and inquiry, education, challenging distorted or overly helpless thoughts and self-conceptions, and facilitating social contact and functioning. Others directly address the needs of caregivers who are confronted with the devastating effects of PD on their loved ones. Although many of the recommendations in this chapter are nonspecific and intuitive, their potential effect should not be underestimated. Although we have been unable to address all of the psychosocial issues confronted by patients facing PD, we hope that this chapter serves as a useful guide for providers looking for additional opportunities for psychosocial interventions designed to increase patient quality of life. These interventions can be delegated to other members of the team, and the assistance of psychiatrists or social workers may be warranted, but PD clinicians themselves can have the most dramatic effect on their patients because of their allocated authority and their salutary alliance with the patient.

Consulting to Star Trek: to boldly go into dynamic neuropsychiatry.

Technical consultation to a screenwriter of episodes for The Next Generation, Deep Space Nine, and Voyager series of Star Trek drew upon the new discipline of dynamic neuropsychiatry to originate ideas for the alien experiences in the science fiction scripts. In particular, the neurologic misidentification syndromes, which elicit complex neuropsychic defenses and illustrate the psychodynamics of object relations, provided a sense of strangeness. The wide, creepy popular appeal of the syndromes, described here, reveals a latent mental defensive structure that is activated by psychopathology and neuropathology, but that is also somehow sensed by those who are more or less neurologically intact. Illustrative examples are drawn from these series and the more recent Enterprise series that has been aired since the consultation. In addition, the changing persona of the physician character in Star Trek is a projection of our changing status in American society.

Elements of dynamics VI: the dynamic unconscious and unconscious dynamics.

The dynamic unconscious remains in contention in cognitive psychology. Academic settings may not provide the compelling evidence of unconscious dynamics regularly experienced by dynamic psychiatrists, psychoanalysts, and other physicians, including neurologists treating psychogenic motor disorders in the movement disorder clinic. An origin of unconscious motor expression is postulated in the intermodal connectivity of neuromental agencies, extending an idea that originated in Freud's (1950/1966) "Project for a Scientific Psychology." Motoric alexithymia is contrasted with synesthesia. Other examples of unconscious psychodynamics of everyday life are readily found in sexual expression. Dynamic pressures that render processes unconscious may also originate interpersonally. Illustrations are drawn from cultural influence, peer and parental pressure, sports competition, military combat, and reactions to dangerous predators.

Motivation, masochism, and slot machine gambling.

In the interaction between the rapidly proliferating slot gambling machines and Americans' minds and brains, there are subtle lures that keep people playing, and that even the game devisers do not fully understand. As they project onto the random machines, people enter a zone that resembles a meditative trance I have called praying to the god of chance. Masochism as it applies to gambling is a dynamic concept that requires the suffering to be viewed by imagined and projected parental imagos, who reward the gambler with love if not gambling success. Other motivations are evident in slot machine players, such as grief gambling and a fantasy of controlling losses. While gambling is as universal as religious instincts, state sponsorship of machine gambling is a conflict of interest for government, which is established to promote the general welfare, not addict the citizenry to raise revenues.

Elements of dynamics III: the face and the couch.

In this article the therapeutic and scientific advantages of face-to-face psychoanalytic treatment are contrasted with the symbolism, power, and mystery of the psychoanalytic couch. Beginning with recent commentary on the meaning of the couch, I consider some problems associated with its use, such as regressive irretrievability of learning, paucity of affective and empathic connection, preservation of shame, and coercive aspects. Compromises between couch and face are offered, and more clinical and research focus on facial affective expression is encouraged.

Elements of dynamics II: psychodynamic prescribing.

Scientific pharmacotherapy, as it should be, is based upon the results of aggregates of patient responses to treatments of specific target conditions for drugs. Although enduring personality traits are increasingly included as targets for pharmacotherapy, in the real world of psychiatric practice transference issues and the patient's character or personality traits play a larger role in the selection, dosage, tolerability, and outcome of treatment than is generally recognized or admitted, other than to attribute undifferentiated placebo effects. Transference and countertransference issues from the marketplace are described, as well as operational parameters of character, character-based decision making, and specific suggestions for medicating according to character types. A new field of psychodynamic pharmacotherapy is encouraged along with attention to culturally informed prescribing.

Elements of dynamics. I: Emotions and audiences.

Improved agreement about the quality and quantity of affect in psychiatric patients may be provided by videotaping them and averaging the scoring of the affects in the tapes by groups of professionals. Affects are real, observable, and discrete phenomena that are of central importance in psychiatric research and training. A natural reliability of affect reading appears to cross regional and cultural boundaries, when the means of groups are compared. Such means may provide valid and reliable scoring norms for the evaluation of psychopathology and treatment, and for calibration of mental health professionals' ascertainment of patients' affects.

Afterword to Krazy: George Herriman's Krazy Kat cartoon and its appeal to E. E. Cummings.

George Herriman's "Krazy Kat," a linguistically innovative and trenchant comic strip that appeared in newspapers from 1916-1944, attracted the attention of our major American poet, e. e. cummings, who wrote a foreword to a collection of the strips and admired it for its transcendent celebration of love over egoism in a triadic relationship, its scorn of politics, and its brick-throwing irreverence. Similarities between Cummings's and Herriman's work include language play, humorous voices, examinations of dimensions of empathy and theory of mind, musicality, and humanistic religiosity.

The Mortal Stage of late life.

A Mortal Stage of later life may be considered as a subdivision of Erik Erikson's eighth stage of life which he called Mature Age, characterized by issues of integrity versus disgust, despair. Mortality poses the optimal task of Realization (in many positive coping and existential senses) versus Denial (or other non-recognition or emotional paralysis) or Fear (or apprehension or even terror). Premorbid awareness of illness may contribute to or challenge Realization. Literary examples also suggest a reviewing of one's life and works, possible regressions from genitality to anal preoccupations, little social withdrawal, and a compassionate interest in the next generation. In dying the self is not given up, but rather the alternate universe of further interpersonal relations had one lived on.

FRONTLINE: teaching affect recognition to medical students: evaluation and reflections.

Techniques developed for teaching more empathic affect recognition and reflection to medical students during their introduction to psychiatric interviewing begin with a concrete grounding in facial muscular movements and facial affect recognition, and proceed to the use of countertransferential affective experience to aid in ascertaining personality types. Observations about the temper of today's medical students by psychoanalysts may be of help in avoiding increasing their already substantial characterological resistance to affective learning and empathy that has recently been reported in the medical education literature.