NO DEPRESSION A critique from the post-rationalist psychology
Alfredo Ruiz B.
Party (I)
CRITICAL TO BIOLOGICAL PSYCHIATRY
Alfredo Ruiz:
Indeed Margarita defined the title of this class as "challenging", let me disagree, however, as the problem of depression is a disease is long settled, and to start, I refer to an article he wrote Aaron Beck in connection with the theme of "endogenous depression" published in 1988. In this article he proposed that: "Is it appropriate, he said, talking about depression endogenous and, at a time appropriate to speak of reactive depression? "Why speak of" endogenous depression "means it is a result of illness, and this would obviously be a brain disease, because there is located the central nervous system and thus , disease, and that would be another type of depression called "reactive", it would not be caused by a disease, but a situation that a person experiences in his life, but would have no consequence or cause of a biochemical nature.
However, it imposes the following problem: if the patient is diagnosed with endogenous depression, which is supposed to be a "disease" concomitant treatment would be based on drugs, capable of correcting an alleged biochemical abnormality. If on the other hand, depression is reactive, in which case the indication is a psychotherapy. As we see, the treatment will depend on the type of diagnosis made by the specialist.
Now, studies of Beck depression have a reference for investigations of Seligman. This author made an experimental investigation in which, if you put a dog in a situation which could not have any degree of control over their environment, and, having been repeatedly exposed to negative stimuli, the animal entered what is called an experience of "homelessness learned, "so the dog and offered no resistance and became totally passive (to be adopting an attitude of lying on the grill, where he was being negatively stimulated by electric shocks). Seligman proposes
What, then, is that an organism or a living system, since it is subject to a state of uncontrollability of its environment, that system will be experiencing "homelessness" in terms of learning. But what happens is that, unlike the dog or any animal, human beings have the capacity to give explanations and to "powers" so the person will make attributions in the sense that she has no control over negative stimuli are living, and then, because of this assignment, the person is overcome by depression. In addition, Seligman argues homelessness as a learned behavior, coining the term "learned helplessness", so the depression is to be the product of experience of helplessness.
Based on these studies, Beck argues that, due to a behavioral and emotional experience of helplessness, while it is verifying a decrease in catecholamines. In other words, which postulates Beck-through-Seligman's experiment is that, being in a situation of distress and at the same time, experience a decline in catecholamines, would be like two sides of the same coin and can not exist without the other event. Or, there can be an experience of helplessness without at the same time there is no biochemical situation, which in turn will modulate the experience of helplessness. This means, according to Beck, it is not appropriate to speak of endogenous depression and reactive depression, as they are two aspects of the same: always going to have a depression, like two sides of the same coin, a biochemical reaction.
So, as I said at the beginning, I believed then that the problem had been settled, in that depression is an illness, "for with this, "he said, already have strong evidence, indicated by one of the most authoritative researchers in depression, that this problem is solved."
But this has not happened, since, has continued to believe that depression is a disease. Even more, maintaining the idea that the origin of depression can only be biochemical or genetic, but without conclusive evidence that this is so. I add even more, to complicate matters: the proponents of this theory say that not only depression has a biochemical and genetic origin, but also have the same origin: schizophrenia, psychosis, bipolar disorders, panic disorders, obsessions ... And in general began to consider the whole range of mental disorders presents the biochemical and genetic origin. But this idea is maintained without any conclusive evidence, without any scientifically validated these psychological disorders obey this source.
words, the problem begins to become quite serious. Because if we speak of "illness" mental, which will then be the result of treatment: drugs? The phenomenon that is beginning to verify here, therefore, will be a great development of the pharmaceutical industry, in terms of creating new drugs, specified to treat many different symptoms. However, the interesting thing to note here also that the origin of all these drugs, and antidepressants, neuroleptics, etc.., Not the result of systematic research, but these drugs have been found only by chance. Eg., One of the first antidepressant drugs were discovered was imipramine, which was discovered by chance, its effect in reducing symptoms of depression, and from then on imipramine was identified as an antidepressant.
So therefore, our hypothesis here aims to develop there is no evidence whatsoever for to, or depression, or the supposed "mental illness" (described in the DSM-IV, American Psychiatric Classification) are just "disease." In line with this, a British researcher, Dr. Mary Boyle, the question becomes one of his articles, which is available to you on the website of Inteco-titled "Everything is done with smoke and mirrors . Or how to create the illusion that schizophrenia is a brain disease "-with schizophrenia would be otherwise, in the sense that it is also considered a disease. I quote: "One of the most intriguing aspects in the literature on schizophrenia, is the discrepancy between the power of the belief that schizophrenia is a brain disease and the availability of direct evidence to support it, even among those who accept that there are no data to argue that the Schizophrenia is a brain disease. " Then she asks the question, which I think is key, orienting a bit to change the course of this conference: "Through what methods manifests the concept of depression or schizophrenia to show it as a disease of the brain, such So lack of evidence is undervalued or simply not taken into account. "
So what happens according to the author: Psychiatrists, who are professionals who have "mostly" this notion that these disorders are of cerebral origin, genetic or biochemical somehow do not consider the evidence. It is a very interesting approach, something happens there, we have to explain. Since, as you can see, all this is having major consequences, if it spreads the belief that these diseases are to be solved with drugs, some of which produce, otherwise quite severe side-effects, especially neuroleptics, with which it is psychosis.
There is an author named Richard Bentall, who wrote this book I have here, "recently appeared in the U.S.," Madness Explained, "or also" Blaming the Body, "as he put it. He argues: "The current understanding of schizophrenia and other severe mental illnesses, depression, is fatally flawed. Many contemporary approaches to the problem of mental illness, suggests that although psychiatry wears the appearance of scientific rigor, has more in common with astrology than science. " And then he proposes "a radical change in the way of thinking about the experiences of psychotic illnesses. A perspective at which to leave the psychiatric diagnosis and at the same time, trying to explain and understand the experience and behavior of the mentally ill. "
addition, Bentall think that to understand the origin of this misunderstanding, we must go back to Kraepelin. For those who do not know, Kraepelin is the founder of psychiatric classification. The ranks in the early twentieth century, as a result of all the understanding he had in the nineteenth century, two broad categories of psychiatric illness: a) dementia praecox, and b) the manic-depressive. And nominated for the first time, that these disorders are caused by brain diseases. Now, the classification of Kraepelin is the basis of DSM-III, which is the classification of the American Psychiatric Association's most important and influential today. He was also the one that produced a remarkable change, and very importantly, between the classification of DSM-III and DSM-II classification, all that happens then simply are reviews of this classification of American psychiatry.
However, remember that the DSM-I as a psychiatric classification appears in the fifties, whose orientation is completely analytic, a trend that dominated psychiatry in the United States. Then appears the DSM-II, which remains analytic, but are extended the tables in this classification. However, the DSM-III and can recognize a substantial change, because here you see the influence of what we call "biological psychiatry." That is, change the approach in psychiatry from a psychoanalytic orientation to a biological orientation. What explains this change? , For two reasons: (1) Psychoanalysis was failing dramatically in terms of treatment. And (2) psychoanalysts were away much of what was considered the medical model. What they perceived American psychiatrists, then, was a gradual separation phenomenon with regard to medicine; very important factor for them, as naturally psychiatrists have felt much closer to medicine to psychology or psychotherapy. This is very important to note here, and further then I will mention, which are economic.
For his part, Alvin Pam, the author of this book I have here, "Pseudoscience in Biological Psychiatry, responsible for this mistake, to consider the psychological and mental illness-a biological psychiatry. Thus, he defined biological psychiatry as a discipline dedicated to the investigation of the determinants constitutional disorders psychological, in order to plan appropriate preventive and therapeutic measures for all that could be harmful to the body. This task is carried out using the scientific method, including: empirical research, statistical analysis and formal inferential logic "I stress on this last point, because then we will return to it. "For example," says Pam, "the field of psychopharmacology has been rigorous in testing new drugs, however Breggin maintains that" the misuse of drugs, their side effects makes it possible to call this psychiatry (which applies drugs) "Psychiatry toxic. " Also, Breggin suggests that it should open a debate on the study of side effects or drug side effects. " And here's the important thing, Pam noted that biological psychiatry (and not talking about psychiatry in general, but definitely of Biological Psychiatry) "is a pseudoscience that has become dominant in American psychiatry ..." For Of course, this is perfectly legitimate and applicable to Chile, as in our country the dominant factor in psychiatry is also biological psychiatry. "... And that is a reductionist biology that distorts and misrepresents their investigations. "
other words, this position is consistent with what we saw just now, remember the question asked Mary Boyle, in the sense of why, without evidence, it continues to believe that mental disorders are diseases. In the same vein, Pam believes that "the somatic variables are the predominant factors in the biology of abnormal behavior, and, according to its principles, the individual must suffer from abnormal protoplasmic defect or a constitutional predisposition to mental illness" . Also, Pam accuses "the lack of evidence to indicate exactly what genetic or biochemical are involved in psychiatric disorders, like depression and all mental disorders. " As we see, biological psychiatry has failed to define exactly what those mechanisms. Now, while Bentall is a clinical psychologist, Pam is a psychiatrist, indicating that this problem is emerging within psychiatry. For this author, biological psychiatry can not fulfill his mission because, in its current state, no substance as a scientific discipline, and this for two reasons to test one article of his book, "Biological Psychiatry: Science or Pseudoscience? " In the first, said that "the methodology of biological psychiatry is sufficiently flawed as to doubt the weight of their findings." And the other says that "psychopathology approach based on biological determinism, ideological bias introduced selectively modeling research being done." Also, to Pam "an approach to psychopathology based on reductionist thinking inevitably leads to the investigation will be influenced by implicit biases, which will generate an experimental methodology specifically manipulated to emphasize the crucial role of somatic variables, with result of data used circularly to validate a reductionist theory. " This would, therefore, an excellent answer to the question asked Mary Boyle.
Another interesting articles that make Pam's book is this: "Criticism of the methodology of biological psychiatry." And the criticism as follows: Pam says, that there is a good methodology for psychiatric research, one should adopt the classification method and Akiskal and Web research on the interface between biology and psychology so that, as the author, you have to see clearly what is the relationship between biology and psychology, according to the following methodology:
a) Study of descent, ie genetics.
b) Studies of the pharmacological responses.
c) neurophysiological and neuropsychological findings.
d) and biochemical correlates of emotions.
course, for reasons of time could not develop here the conclusions are with respect to each of these issues that the author develops a methodology. But we will indicate the findings in the four areas, past and present often research has established that either the conclusions found are questionable, or that there has been no evidence conclusive regarding the existence of dominant biological basis of psychological disorders. Therefore, you will understand that science does not work with dubious evidence, or pseudoevidencias, but science works with conclusive evidence. Pam
also points out that "no biological psychiatry in their research meets the standards of scientific quality." In other words, none of these methods, when applied from biological psychiatry, meets the standards of scientific quality.
Now remember that a moment ago I called his attention back to the topic of " logical inferences "since precisely one of the articles of Pam is called" logic error in biological psychiatry. " Below we mention what these logical errors and, again, because of the time, I will make a brief commentary on the "in my view, more significant:
•" Coming from the family, then it must be genetic. " This I can see you clearly when a psychiatrist concluded that depression is endogenous. For if the father had depression and also the grandfather, then the patient suffers from endogenous depression. This is absolutely accepted, almost like a dogma. So, just one member of the family have depression, so that the patient is immediately diagnosed the condition. The same with regard to psychosis, eg., Although it is fashionable diagnosis is bipolar depression.
• "If you answer the medicamentación, you must have biological causes." This is also quite common. That is, if I do this treatment with antidepressants is, it means that the origin of this person's depression is biological. Similarly, I can treat panic attacks with imipramine and if I have success, it follows that the origin of panic attacks is biological. And so if I die out with a neuroleptic delusions, I have to conclude the same source, etc.
• "Laboratory tests can improve the safety of psychiatric diagnosis." This is closely related, for example, with the great development that is now taking brain images. Interestingly, however, I have a patient who took me to the consultation diagnosis and outcome of brain images, but they were all made in the form of questions. In short, there is no evidence to be conclusive in this regard.
• "The role of the psychiatrist is treating biological diseases"
• "The genetic basis of schizophrenia is scientifically established."
• "Depression is based on a biological deficit, probably as serotonin or adrenolérgica function."
• "A placebo is an artifact and, therefore, no intrinsic interest."
Now, we could take some of these approaches and investigate where they are logical errors. Eg., We will take "the pattern of familial transmission, ie if there is any family member having a depression, would mean that the person suffers from depression is genetic. Logical error here is that, if a person is in a position contrary to biological psychiatry, where even hostile to it, may well come to apply otherwise. So you can say that if we find a family history, mean that the problem is "learned" Why not? In other words, the person who has a vision rather than deductions, they exist in biological psychiatry, "I could understand that depressive disorder was a result of learning.
can also detect a logical error by inversion. I mean, if there is no history of genetic or familial transmission, or if a person has depression and is not among the ancestors of someone who has experienced depression, it means then that the problem is not genetic. And the same could be said about that, if the issue is not genetic, it means that it is learned, which is the product of that person's interactions with the environment. Or, alternatively, one could say that the problem is a consequence of both factors.
As we see, logical errors become manifest. And we must add that now, according to the study of "inter-generational transmission" has been observed that the behaviors of interaction with others are very complex behaviors from interactions we have with our "patterns of attachment or linking," as it is called-and, therefore, which is transmitted as a tendency to repeat are the modes of relationship we have had links with the figures. Thus, it debunks the whole approach to the conduct of this type are genetic. For example, this is seen most clearly in abused children, because, then as adults they tend to become abusive parents, then repeating the same behaviors, even it has been investigated up to four generations, proving that they all tend to repeat this pattern of abuse, in order that they are forms of interaction that has children with their parents and vice versa. That is, they would not be learned behaviors, but are very complex ways that we human beings operate and interact with those we relate to significant figures.
Finally, this that I just mentioned, and have criticized from the logical point of view, has been a subject that has in practice been treated as a dogma of biological psychiatry.
Another point I want to develop here is the next logical error: "If medicamentación responds to treatment, then it has biological causes", or, if it satisfies the medicamentación, treatment has to be precisely that. I serve as an example of panic attacks. You recognize the clinical symptoms or panic attack. So, when someone has a panic attack, any observer can see that what the person is suffering at the moment is a panic attack is a situation that is fairly well defined.
But what can happen here, that: you can induce a panic attack (panic attacks can be induced easily, can result in the query, can be induced in a laboratory environment in order) and, at the same time, you can block. Now, this can be done in several ways: it can block with a drug, as would be by imipramine, but perfectly well be blocked with cognitive therapy. In short, you can induce in consultation panic attack and at the same time, lock it with cognitive therapy. What does this mean? Is it true then that if I block a panic attack with a drug, I have to conclude that obeys a biological origin? Is this a valid explanation, so I can still block with cognitive therapy without using any medication, and being that I can lead all the times you want and at the same time, block every time I want?; Draw your conclusions . The same is true of other of disorders, including depression.
Now, it is also seen in panic attacks that did the same occurrence noted in the depressive processes, in the sense that these are families who have a peculiar way of working, being families can quickly conduct called "phobic" agoraphobic with or without panic attacks, but is that all family members are very sensitive people develop phobias. So here too we find this phenomenon that the ease of having panic attacks relates to the way members of this family interact. Consider a situation
specific: I have a patient (which I attended on Monday afternoon) of forty years of age, who is trigger panic attacks, and that he lived as a permanent anxiety that affects a lot, which then generates a great need to take medication in order to reduce anxiety. Now, what we see today was this: when we analyze the panic, we detected that these crises are always in relation to what he feels distant from the mother. He tells me that the mother had gone to lunch outside, and when the nanny told not wait for mom to lunch, he immediately felt neglected by the mother, which was equivalent to feel vulnerable for her. And therefore, the basis of all the anxiety he was experiencing, was feeling unprotected. You see, no matter who the person is forty years, their emotional experience will be the same: he feels unprotected.
And then, once we analyzed all of this, he says: - "Ah, now I see, this is the anxiety that I have." "Of course, anxiety is generated by a sense of vulnerability that you have." Because he had never made the connection that what he named as "anxiety", he felt that something was wrong, that inwardly experienced as a terrible fear that the only way to control it was taking medication, but he never had related to situations where the mother left him alone.
is more, more recently, in this relationship with her mother, she is watching and not as a friend who cares, it's being viewed as an "enemy" and, therefore, he feels even more vulnerable by this mother.
Moving on, another thing happens here with biological psychiatry, as a logical error, is what they also postulate (and this is very interesting for people who work together with psychiatrists) that the most serious diseases that have Humans are of biological origin (well, schizophrenia, psychosis, manic depression or bipolar disorder), which means they are in the field of medicine, and therefore, belong entirely to the field of psychiatry. This is very important, so I said that at the level of mental health team, it makes a big difference between the psychiatrist and psychologist. It's like saying "we have a status of physicians and, therefore, biological treat diseases, to which you, by training, can not access." Or, "You do not worry about such serious diseases as you have to deal with diseases that are not biological and such ... you take them no more, but we do our part to take care of major diseases. " Thus, this position immediately marks the difference with the psychologist.
Even one of my students told me, a few days ago that, when they had meetings clinics, which convened to study the situation of a schizophrenic or psychotic, psychologists guests could not say them, because they do not were able to solve the problem, and this meant, then, that psychiatrists speak only in terms of proposing a diagnosis, how drugs are going to treat the problem, etc.. And finally, "my student, spent this: it was suggested at the meeting had to be treated with this drug, but then at the next meeting, commented that the prescribed medication had not worked, and then the meeting will now be to change the medicamentación, but, as the latter was not, well, nothing remains but the electroshok ... "Do they set you? That is the approach when the psychiatrist gets into this problem.
What I want, then show you is this: that from the standpoint of the team's relationship, the psychiatrist holds a higher status, and the psychologist appears junior professional.
This same problem occurs in the United States, but those who do therapy in this country are not only psychologists, but also nurses who are prepared to do therapy, and, like, the social workers. Thus, the structure of the team, the psychiatrist is the one with the higher status, and the psychologist, or nurse or social worker, are given an almost paramedic; it does, moreover, that it is always making the difference between psychologist and psychiatrist. Indeed, the most affected by this are patients.
Now we can say clearly (and I take to say now) that this instance can see now that all these disorders are not diseases described, then opens a wide field to be treated with psychotherapy. That is, the role will have the psychologist in the future, in treatment of psychological disorders, will be very significant, if this model of biological psychiatry we give up a little bit of scope.
Also, I think the crisis will be triggered just by what we are seeing now is a gradual weakening of biological psychiatry, both in terms of its scientific status as the standards to be met as a science. Let me make this
issue here, and happened to talk a little bit now about the crisis of psychiatric classification; for it, I'll have to refer to the DSM-III. As I said, the DSM-III as taken after the biological psychiatrists, giving the classification development. But this classification, intended to be fully scientific, yet was still influenced by both Kraepelin and neo-Kraepelinian, who also took part in the DSM-III. That is, assuming they follow these principles. Even an author, named Klerman, published a manifesto in which he postulates that mental disorders are diseases, and therefore must be treated as diseases; according to him having a distinct difference between what is mental illness and what a normal person.
However, once this is built, Bentall happens to point out that this is already part of "the industrialization of psychiatry", ie, psychiatry becomes an industry with juicy profits. Says the author: "The DSM-III begins to be heavily influenced by problems of political and economic ..."; now, you do not forget that the DSM-III was published in 1980.
But what comes here, and I would like you to reflect a little in relation to the scientific validity of the classification American Psychiatric. It turns out that in the DSM-II appeared homosexuality as a psychiatric disorder is a mental illness. But however this does not appear in DSM-III. What happened? : That, before editing, or in the years prior to 1980, from the political point of view had big problems with the world "gay" was a growing movement, and this movement began to influence people who were writing or editing the DSM-III, so that homosexuality's taken off the list of mental illnesses, otherwise, they would see serious problems with the gay movement. As you see, then, it was not properly scientific but political reasons, that homosexuality was excluded from DSM-III.
From the economic point of view, now, there is a marked increase in the amount of mental illness in the DSM-III, ie greatly increased the category of mental illness. This made it possible that, when it published the DSM-III, became a bestseller. So that, when the first edition was published in 1980, the APA (American Psychiatric Association) pocketed nearly ten million dollars. Then they were adding a lot of issues, including issues that taught to diagnose DSM-III. I remember that in the year 85, people came to Chile to take courses on how to diagnose DSM-III. So, start working hard the economic issue. To the extent that, shortly after, developed the DSM-III-R, and later made the DSM-IV. And now planned for 2010, bringing to light the DSM-V (commented a man, taking him a little hair to the APA, the DSM-V probably going to report to the APA a whopping one hundred million dollars).
Another aspect that is also related to economic matters referred to is not accepted for any scientific research, including psychotherapy and psychiatric treatments, if there is no classification APA.
addition, no U.S. insurer reimburses health insurance unless it is accompanied, in this case, the DSM-IV. Thus, users of the system are required to comply with American Psychiatric Classification.
and added more. You do not forget that the U.S. pharmaceutical industry is a powerful entity. It says for example that in one of the 90, the "prozac" he reported in income to the laboratory in a year, more than the gross domestic product that year, several Latin American countries. These are the amounts of money are being managed with this thing called "industrialization of psychiatry "or more recently the globalization of psychiatry.
The other drawback to the DSM-III, but now from a scientific standpoint, is that it has recognized or reliability or validity in the diagnosis. As psychologists, you know that when you design a psychological test, it is essential to guarantee reliability and validity, that is indeed what I think is diagnosed to be diagnosed, or that, what I really diagnosed with it. However this does not happen with the DSM-III or DSM-IV, or with the other classifications, even though their representatives say they have solved the reliability factor. But not so. In my opinion, is still unreliable and invalid this classification system.
In short, this is the situation now applies to biological psychiatry. Now, to finish this first part of the class, I would approach it from a wider perspective, namely, from the history of science, or view it from the perspective of what they are, say Kuhn-"scientific revolutions" . Kuhn tells us that science does not operate simply by the accumulation of knowledge but the development of science itself is possible by "paradigm shifts" namely when a paradigm is not sufficiently explanatory, it is necessary for the normal scientific development the creation or construction of new paradigms.
So therefore what we can infer from this is that what happens is that biological psychiatry is still attached to empiricist and rationalist paradigms, and therefore obsolete. Then, as the only biological psychiatrists agree that each new discovery is evaluated only for themselves, leave no possibility that their own findings or enriched can be contrasted with other disciplines or other approaches. This keeps it attached to a science paradigms "stale." How
explained? If we put it in relation to Kuhn's approach, saying that what happens in a normal science is that suddenly, suddenly change their paradigm, but without a comprehensive awareness of it at that time. That is, people are not aware of this, they begin to seek other forms of explanation, they begin to look to other disciplines, and thus knowledge is increased, until it reaches a point where this critical information must be processed differently. And this is what has not happened in Biological Psychiatry.
In this respect we also have Pam's explanation for this aspect, he would read (coining a term), that just as there paradigm shifts in a normal science, in a normal pseudoscience never going to produce this change of paradigm. And this is what I think also the case with psychoanalysis, and also the discipline is maintained so far as a dogma, because it never compared with other theories.
For his part, Karl Popper says that scientific progress works with scientific theories are more explanatory. Always, the prevailing scientific theory is the one with greater explanatory power. Scientific theories work the way Darwin's theory, since the guarantee of survival of a theory is its explanatory power. And, of course, this theory that mental disorders are of biological origin has no explanatory power, as we have shown here. But as the biological psychiatrists have not been open to debate, they are becoming increasingly trapped in their paradigms. Say
finally, that of treating people as if they were sick, very important social implications. The other day I was talking to a group of students, and we did notice that now anyone can get a medical leave for depression when it has no interest in going to work. Even I have had to see patients who have had legal problems, checks protested and the like, and then they go and they go into a Clinic, as it must protect the privacy of patients .... That is, there are also social and legal consequences, involved in biological psychiatry.
Primarily this is what I like to talk with you now, after the break, and I am plain to answer your questions or concerns regarding this issue.
Part (II).
APPROACH FROM DEPRESSION POST-rational.
Questions and Answers.
A final point which I did not mention them very briefly referred to how you can maintain biological psychiatry as a pseudoscience, and they also have the magazine which is "The American Journal of Psychiatry", which is the world's most prestigious publication in psychiatry. Indeed, other chapters of the book is titled in English Bentall Pseudoscience in The American Journal of Psychiatry that can be translated as "Pseudoscience in the Journal of the American Psychiatry." Here are a series of articles published since 90 to 93, showing the logic errors, methodological errors and ideological bias in psychiatric biology.
So, thus perpetuating biological psychiatry, with an ad hoc classification, with a journal ad hoc, and their laboratories and psychiatrists. This is what Hayek would say: a complex self-organizing system in which all that is threatening to the system is neglected or left out. Now
happy answer (if I can) the questions and concerns you can make here. Question
.: Now that you've developed the position that no substantial evidence to conclude that depression is an illness, I wonder then what is your view of depression, what is their approach.
Ans: Well, if we accept that there is no conclusive evidence to show us that depression is a disease with biological or biochemical origin, I believe, therefore, to be start looking at depression as a psychological process. And look at it as a psychological process means that never again would this reductionist view that a single cause explains the whole problem of depression.
also have to look at depression as an experience and not a disease. At this time, eg., The British are talking about "experiences" rather than "diagnoses." So, you can talk of "experience depression," you speak of "schizophrenic experience" of "psychotic experience" in the sense that anyone can have such experiences. Even the most normal person at a time and for a few seconds can have a psychotic experience, or may have hallucinations, anyway.
Now, developing the theoretical issue, the approach by which I mean the depression is the post-rationalist. Very briefly, this approach will reads as follows: when a person lives an emotional experience that is not capable of processing, or developing, that the emotion he is experiencing is not able to integrate the conscious image of himself, then that emotion is going to live as a symptom.
you an example, drawn from clinical experience, "This is the case of a woman who has a good relationship with her husband. At one point they are sitting in the living room watching TV and suddenly the husband gets up and goes to bed, but not dismissed it. Mrs. event can be immediately self-reported and that the husband is left to want, or feel that your husband is no longer as before. But that she experiences an emotional level, not cognitive or unconscious, and experienced as "loss" as a loss of her husband. And this experience is emotional.
Now, as they feel very discouraged, very sad, but not able to recognize on a conscious level that they are feeling abandoned by her husband, or who is losing her husband that she lives as "a sign" and means to live as a symptom experience it with a sense of strangeness of the self. And this is what then the person will point to the psychiatrist, she feels very depressed. And the psychiatrist, as he has not focused on the ordeal but has focused on the symptom, the only thing left to conclude, then, is that since that day she feels depressed "without explanation." As she says, suddenly, without the benefit of all, he felt very sad, not getting to relate his unhappiness with the experience he had with her husband.
This would be a way to explain the situation. But here we should add something from the theoretical point of view. What is happening there is also that the person gives a meaning or a meaning to that experience, and this sense given they are quite personal. So to understand this, we would have to develop the theme of what constitutes personal meanings. If each of us carries a personal meaning, that might explain why a person develops an experience like the one described as "sad" or "depression", and why another person may develop differently, not means a "loss." It depends therefore entirely on the person. That is why, from this approach, the therapy is to reconstruct and analyze the specific emotional experience. Question
.: Even to this very thing I would add the cause and reaction. For the lady, in very clear example that you just put, is acting for a reaction. But she also has the ability to understand that his actions were what caused the reaction of her husband, maybe fix the problem.
Ans: No. .. I would rather by the other side. I say, how this person is autorrefiere the event (which has to do with personal meaning), how we organize, how they live, how they feel on an emotional level, that the husband does not want. But that she is living at a level that is not conscious.
Now, from a theoretical standpoint, this is what is called "self psychology and the psychology of self." And we understand the self as a closed system, the self can be anyone, "in which you can recognize an immediate experience, which is basically emotional, and self-conscious image. So when you experience something emotional level that do not make conscious with an explanation that is where the problem arises when the person does not process or does not make the emotional aspect. And this is what the experiencing person will then as "loss", but without recognizing not be aware of it, because she has not worked or processed as a loss.
But before asking "why I feel this way", it ask "how I'm feeling this." So, this person, through observed and analyzed how it is feeling what you feel, might come to recognize this particular aspect of it, this sensitivity has to experience very quickly that the husband does not like or that the longer want.
other words, it would be "a reaction", but would be a complex experience.
we would also see that the notion of self that we post-rationalist approach is that of a self that is multinivelal, multimodal and multiprocess. So you have to recognize the biological self, neurovegetative aspects, but also recognize sensory aspects, emotional, imaginative and cognitive. This would be the self. And when we say "multiprocess" means "many complex processes." That is the human mind has all these ingredients, which are living in a unitary manner. The self therefore be a unit, a uniqueness, which is also constantly interacting with others, always trying, in this interaction, to maintain their sense of individuality, their sense of identity.
This would have a similarity with what we said Maturana, who notes that the observer will always explain the experience, and this explanation is given of experience, is another experience. So you never explain the experience with an external world, objective or independent of you. Question
.: Whereas this concept of self that you mentioned, where the structure of the human being is given by a set of different processes-emotional, cognitive, behavioral ...-, nevertheless seems to me that You can leave out the biological contribution made by psychiatrists as an explanation of mental disorders ...
Ans: What I would respond is what I was saying recently, that is, that the self is a biological element. But this aspect of biology is part of the one aspect of this self. Although within the whole self is experienced as a unitarity. So yes, the self has a biological side, and could not be otherwise. In this connection, with Maturana were developing a job that meant that the biological part is what we call "the embodiment", which indicates that these processes must have a "location", which would be the entire nervous system central. Question
.: I aim a bit to what we said at the beginning of the class, in terms of critical you did to the reductionist view of biological psychiatry, in which everything is explained from the biological, now, I understand that its position is to consider the mental health only from the psychological processes, and then does not also fall into a reductionism?
Ans: Not true. When I'm talking about "psychological process" means that I'm considering the self as multiprocess and multimodal, but the self always lives a sense of oneness, where one of the most important aspects of the self lies in everything that has to do with the maintenance of a sense of continuity of self, and this is always something happening at a level emotional and that in turn has to do with the type of organization that has the emotional self, which would be equivalent to the emotional domain organization and, therefore, the personal meaning.
Now, at this point we would have to develop the concept of post-rationalism. The idea of \u200b\u200bpost-rationalism implies that rationality does not work alone, but is always working on an emotive issue, which is where we extract the meaning. The meaning that each of us carries, is always a meaning that we give him the emotions that are organized in each of us. But there are many complex processes, in terms of emotional organization, also in terms cognitive, and in terms of the relationship between emotional processes and self-conscious image. Now, none of these processes is reducible to another, and neither the cognitive process is reducible to the biological process, or vice versa, but are multinivelales, and all running at the same time, a never-ending network of complex processes. Question
.: So in that sense it can rescue the biological component of mental illness.
Ans: First, as I said here, we no longer have the notion of "illness" but rather "psychological." Second, as we multinivelales and multimodular, means that psychological processes are modulating other aspects of self. This can be seen very well in what are brain imaging: a single thought you have will affect the entire biochemical system. But that does not mean that the thought occurred or was the cause of the biochemical process, or vice versa, that the biochemical process is to be the cause of thought, but rather both are modulated, either becomes cause the other. Question
.: From a vision post-rational how can you understand the concept of disease?
Ans: We no longer use the concept of "disease", but we speak of psychopathology. In this connection, we have developed a picture of psychopathology, but from a "procedural", or processes. So what we mean by what is "normal" amounts to a person who is flexible, which is abstract and generative. In other words, the same emotional experience you have means, if it is flexible, capable of looking at it from many points of view and is able to look at it, too, breaking out of concrete experience and put it originated in the arch of his life. And all this are complex processes that the person will develop, until it reaches a theory of what is happening, which includes all points of view, is the "abstract individual" as We call.
Take a specific case. The person who has panic attacks is one extremely vulnerable to any situation where you feel imprisoned or feel trapped. Then, when the person has an experience of entrapment, it is likely that she will not ride on elevators, for example., For fear that causes him to think that the elevator stopped and she is trapped in inside. Or if you're driving down the road and overlooking a tunnel, you will experience fear of entering the tunnel, avoiding it and taking a hill, say. In short, the person will avoid all these situations where you feel trapped. Even if there is a situation where he feels trapped, will suffer a large tachycardia and probably going to believe that you will die of this tachycardia (this is what you always describe panic attacks).
Well, this person would, in our approach, a person "neurotic." Because this person is now less flexible, because his experience is only one way: they feel trapped or feel stifled, including its symptoms is that you can not breathe, he feels he is drowning. For her, then this experience, which is experiencing a level of immediate experience, is quite simply a sensory situation, which is that she is sick. Not far from that point of view, always reaches the same conclusion. To the extent that, say, after having had this panic attack, goes to the cardiologist because she felt that the heart was going to explode. "
In short, this person gets the experience as "illness." But what we see here is this: that the person is not able to process their experience in a flexible way, not abstract and generative, but the person stiffens and becomes less flexible by not seeking other viewpoints. His only conclusion therefore is that she is sick.
What we would do in a therapeutic process? Flexibility to the individual, so that your experience did not live as "disease" or to not live as if suffering from heart disease. And, how we would do in clinical practice, we would analyze together with the person, in order that she sees that, this whole experience of being trapped, is inherent in the relationship with her husband.
other words, a time now with her husband's relationship becomes unbalanced, causing her to live with a sense of being trapped in this relationship, as it feels forced, as if she did not feel comfortable being with her husband, but feels stifled, feels trapped in this relationship. But that does not connect. All she is connecting (to be rigid) is that the panic attack is about the elevators, with traffic lights or cars with plugs.
Now, in a normal process the person is able to recognize that this is happening, is explained by the relationship with her husband, which she feels trapped.
In contrast, a neurotic process is a process in which this same experience is viewed only as something sensory, which only deals with physical spaces.
Finally we have a psychotic process. This is a type of processing is also neurotic rigidity characteristics of concrete, but also presents a failure of integration. This means that the person fails to recognize that the problem has to do with it. Why, in a failure of integration, the person perceives the problem as it is so outside of it, which can be materialized in the voices you hear, or else is so foreign to her, that convinced themselves that go chasing to kill , as in a delirium of persecution. Delusions and hallucinations would be failure to integrate emotional experiences a person experience.
This is ultimately the way of understanding psychopathology from a post-rationalist view. But this is a procedural way to understand, ie not in relation to a situation described as well as the DSM-IV. Question
.: Going back a bit the previous question, when you began the conference said that, according to Seligman, the depression is always in relation to an experience of helplessness, but at the same time, in the brain there was a decrease in catecholamine and understand that there lies the connection with the biological component. So, does this mean parallel treatment from the biological point of view?
Ans: No, because if you do a parallel treatment, medication, would involve two consequences that are critical for therapy. On the one hand, the person will still believe she is sick, having a somatic disease, and that can be solved with medication which would stabilize the person in the sick role. Do not forget that most patients who come to the Consultation is because they feel they are suffering from something: "I come to see you because I feel depressed, and the doctor told me that this disease was kind of biochemistry." Or someone who comes with panic attacks: "I sent the cardiologist because he found that the heart I have nothing, then I said you better see a psychologist, and that's why I'm here."
So this is the way in which we keep out of our consciousness certain experiences, that is, externalizing problems. And the outsource in the sense that this is happening to me is not about me, but is the product of a disease. Guidano illustrated this with an excellent metaphor: When the person is experiencing depression, it's like a fever if you are experiencing. While you can not fail to recognize that fever is something that happens to him, nor fail to recognize that suffers from the fever that is suffering. However fever considered as totally foreign to her life like, the cause of his fever, a kind of virus that is infected. Similarly, the person living with depression: "The fact that I feel depressed (a) does not apply to me, is totally external to me. " And so, the psychologist sent to the psychiatrist to prescribe medication confirms that it is sick and therefore is external. This would be a consequence.
And the other, which I think is the most serious is the following. If I take a patient, in order to do therapy, and then say we're going to focus on all aspects that are emotional, who are we to reconstruct and analyze, so that he can reorganize and , thereby overcoming the problem. If this is, first, the message I am giving, yet at the same time say, "Look, then you're going to go where a psychiatrist to prescribe medications, because I, as a psychologist, I can not give medicine ... "That would be giving, then, two contradictory messages. On one side is the message that this is going to solve, when he (she) understand more of their emotions. And if at the same time, I tell you when you are a psychiatrist to take drugs I am taking another message, in the sense that it is a disease that is controlled with medication. This becomes, therefore, in a double bind, that blocks any chance of working. Or is it the one or the other. Question
.: What position should have against any patient who arrives at the office with a suicide attempt, since in this case, we in the limit. We may not have enough time to teaching strategies or help him find certain emotions, etc.
Ans: This does not change in essence, recalls that one of the symptoms of depression is the behavior or suicidal ideation. Then you have to analyze all the time shooting a suicidal ideation, and also have to rebuild the patient's suicidal behavior.
The idea is always this: that you analyze, together with the patient, the emotions of it. So you do not you focus on controlling the patient's suicidal behavior, as was done eg. classical cognitive therapy, and I mean that of Beck and Ellis, psychotherapy I was practicing. I remember that when we tried to suicidal patients, what we did, among other things, was to give a card with our phone, and then we would say "Look, if you going through your mind the idea or the impulse to commit suicide, call me by phone "so you were doing a procedure called" crisis intervention. " And I say that I spent many sleepless nights because I called patients at three or four in the morning to say "Hey, doctor, I want to kill" (laughs). And that was what was happening. But that would merely therapy "control." In contrast here is not: the therapy is directed to the person is able to see how the car she spoke, how she lived, so that it shoots this aspect of life does not make sense and would be better to commit suicide. But that is connected, as I said a while ago, with personal meaning. Question
.: Yeah, okay, but from the standpoint of the patient, when one approaches therapists who are experienced in doing this type of therapy, I do not see any downside to intervention. The problem is how to gain experience for young professionals to stop therapy with pure a case as difficult as described
Ans: Sure, that's why I think it is fundamentally a psychotherapy training. So, anyone can learn to do therapy just by reading books, making the therapy is learning. Fortunately, we now have courses where therapists can train here, and this we are doing at the Institute for over ten years, according to the same model developed in Italy Vittorio Guidano. But I would say that such a patient of that type, say a patient is "high risk", no doubt I would have to be referred to a therapist experience.
Although I believe that it would be necessary to refer to a therapist of a schizophrenic experience, eg., A schizophrenic is not difficult to treat in terms of that internalize hallucinations, or to raise their awareness regarding their way of working, anyway. That is, contrary to what the psychiatrists say, the psychologist is well trained to treat schizophrenia, although, of course, with training, since none of these psychopathological processes the I can try if it is not a workout. Question
.: At some point you talked about the mistake that had fallen biological psychiatry, as well as psychoanalysis, in terms of becoming a pseudoscience. Now, what do you think should be the axis on which psychology as such could possibly escape from falling into the same situation, and, in its way, become another pseudoscience, since there is also a similar criticism in relation to psychology?
Ans: Yes, I believe it is essential to get to develop a scientific psychology, which is what will save us not to fall also in a pseudoscience. Now, for a scientific psychology becomes has to become, in my view, a psychology "explanation", a psychology to explain human experience.
Also I would say that for a psychology is "explanatory", should be in accordance with the postulated K. Popper. This author says you, any theory that aspires to be scientific, it must be capable of being falsified and verified.
Now, from the standpoint of scientific psychology, I believe that the methodology or how it would distort the psychological theories by evolutionary epistemology. I believe that this discipline is likely to restrict any theory that we develop. Evolutionary Epistemology is a discipline that emerged after the Second World War, which studies the origin of knowledge on the individual-in self-like species and also how this knowledge evolves.
And taking into account that, at of scientific psychology, knowledge is not understood as connected only to explicit thought, this is not understood that knowledge is only cognitive but also be seen from this approach, from a scientific psychology, that knowledge also is emotional, that knowledge is also sensory and motor skills is also a kind of knowledge. Ie, that knowledge is much broader than just explicit knowledge. Why: because it turns out the emotions that give you an instant sense of yourself and the world, at all times, and the emotional aspect of it then you can compare, you can distort or check, how: a través de la epistemología evolutiva. De tal modo que, si tú lo ves desde una mirada de epistemología evolutiva, puedes ver que este aspecto emotivo o de experiencia inmediata, tú lo encuentras en todos los animales, o sea no es sólo privativo del hombre. En lo que sí estaría la diferencia (y eso tú también tendrías que contrastarlo) es en “el lenguaje”.
Pero el lenguaje es un instrumento creado por el hombre, lo mismo que la racionalidad. Y tú puedes reconstruir históricamente, evolutivamente, en qué momento aparece el lenguaje y, en qué momento, la racionalidad. Esta sería, a mi juicio, la forma de no caer nunca en una psicología pseudocientífica. Thus, we must be careful that any theory that you develop, you may become falsifiable.
The other thing that would also help us in achieving this end is found in the thesis of Humberto Maturana. How he says: Any explanation is explanation of the experience. But that explanation of experience is not validated from an objective world independent of you, but you have to be validated by another experiment. Here we are, therefore, with all the circular or self-referential aspect of human experience. So he coined the famous aphorism: "Everything said is said by an observer to another observer, this observer is a human being." Here is also a right way to achieve a scientific psychology.
In this sense, then, not only have to consider the biology-as we saw recently, but we also have to consider a wide spectrum of scientific disciplines, among them would be evolutionary epistemology, theories would link science would cognitive theories of complex systems, the biology of cognition H. Maturana ... What is called "interdisciplinary convergence." Question
.: When you say "evolutionary epistemology" will he be that, at some point to be a falsifiable theory?
Ans: What we see is that evolutionary epistemology also has to be falsifiable, anything that has to do with the knowledge has to be fake. Or any theory, to reach the status of a scientific theory must be consistent with the possibility of being falsified, and in fact, at some moment in history, will be distorted. Question
.: You said that, according to Kuhn, paradigms change when you complicate a lot. So to me it makes sense that you raised in terms of going confrontation with other positions, or about theories of other sciences, and in that sense they move in a constant race (Knowing as a career to go creating more and get to know more). But at some point, according to Kuhn line, I get the idea of \u200b\u200ba "Vertigo" in terms of a position of not being able to attain knowledge as such ...
Ans: Yes, I think you're right, in the sense that knowledge is an endless process, or never have the ultimate knowledge, we are going towards the goal, but never arrived, and it belongs to any system of knowledge .
Now, what happens in scientific development is this thing called the "punctuated equilibrium." Ie there are moments of stability, indicating that a paradigm has been assumed by the scientific world, and this paradigm then be expanded and developed, until it reaches a level where it becomes obsolete, thus producing "a paradigm shift. This being completely spontaneous, or is it something that can not be directed from outside.
In 90 I wrote an article, a period when I had the intuition at the time (for what had been happening to me as a person, and also because I myself witnessed what was going on in psychology, when there is the great crisis of cognitive therapy) that were on the verge of a change in the way of understanding human beings. About that I wrote an article-like I say, in the year 90. If we move now to 2004, I have no doubt that we are immersed in another paradigm that we are in what is called "the paradigm of self-organized complexity" or "the paradigm of complex systems self- organized. " This would be the paradigm in which we currently find ourselves.
Now, this means that there is an interdisciplinary convergence, which brings up the notion of "complexity." This notion in turn means that any system has only an order-ever-self-referential, that the experience of the system is built by the system itself, ie does not come from outside. All reality, then, that construct is co-extensive with ourselves, is an extension of us, it is determined by how we live it. That is, everyone I see, the world or the reality that I built, is closely linked to how I feel, that is, the world of meaning that I "see" is according to how I feel. This is what we are developing through the issue of complexity. Question
.: My question is: how is it that there are certain events that do not reach the level of explanation and stay only at the level of immediate experience.
Ans: When you live a non-threatening event for your identity as a system, then you do not processes it. Indeed, we say the following. In these two levels of human experience: the level of immediate experience, on the one hand, which corresponds to all that is unconscious (but not understood in the manner of Freud's dynamic unconscious, but rather everything that is outside the focus of our consciousness), and have another level, that is the explanation, which it is aware, this level of explanation also corresponds to the image conscious that I have of myself. Therefore, if what I'm Experiencing a level of immediate experience is not threatening for the image conscious that I have me, then do not process. Question
.: But if it is threatening to reach a time when it is processed at the conscious level.
Ans: Sure, at thou conscious processes and changes your image of yourself. Question
.: So get to a point where it is processed at the conscious level.
Ans: Sure, it is processed at the conscious level because there is no other, for, if not, the human system it begins life as a symptom. Always remember that the symptom occurs when a person fails to process, the conscious level, which is living as immediate experience. Question
.: OK, but I'll sign that was once conscious but that was immediately lowered to another level, so to speak.
Ans: No, the symptom is an experience that you live it as a symptom when you do not recognize as belonging to you. Question
.: But to recognize it or not, once must have been aware.
Ans: No, you have to make conscious, because if at some point became aware, then you are not going to live as a symptom. For "symptom" does not mean that only you say "ah, that I'm feeling ..." But be aware that mean: I am aware of being aware of what is happening to me. For example, I referred the patient suddenly became conscious. He felt very anxious, he could not stop to be conscious of having experiences of anxiety. But when he was aware that this anxiety was a product that he felt abandoned and unprotected by the mother, then that conscience, now, affects the image-conscious. English is what you would call worness, or "realize." Question
.: Is it merely "sense" the immediate experience?
Ans: No, it's emotional, perceptual and motor. Question
.: And so, at what level this is processed?
Ans: Always at a conscious level, always at an explanatory level. Now, for that to occur in therapy you make it through a methodology, called "method of self-monitoring." I mean, the experience that the person in the example I put in the lady's husband goes to sleep and not leave of her, that experience is the event where she felt ill. "There, in that moment I felt bad," she says, before I was fine, but then I went to bed totally depressed ... "Well, then let's see what happened, including that she felt fine and then went to bed depressed. And it came to this: that when the husband went to bed did not leave it, etc. Then, the event now ranks as you "if the scene from a movie "and you work with the patient. Now the patient can look at this scene of two ways: (a) As the protagonist of the film, in which he speaks in first person, then there you start to rebuild everything she felt, what was happening, As envisioned, etc., all that was not conscious, and now beginning to be conscious. (B) And you put it from an outside perspective of the patient, so that he looks like a "character." So that, through these two modes of being in this scene, the patient is discovered or is being aware of this experience has not processed immediately. Until it becomes aware that she was so depressed because he felt "emotional level" that the husband does not want. Question
.: And where is saved that experience has not been processed?
Ans: Well, is there, and you live it as an experience that can be a sensory level, at the imaginative and emotional level ... So you pass to your immediate experience, and is archived as well as a scene, probably in your emotional memory, to the point that if it is meaningful to you, is like a scene in narrative terms is called a "nuclear scene, a scene full of affection. But it is a scene very compressed, as if the scene was the image, and then when person to unpack, you can tell or can count as an event if she lived.
Put it in narrative terms. The language allows, any experience you live, you can separate the information content of the affective experience. That is, what a moment was emotional after you transform it into information, and that is what is stored. This is transformed into information that is stored as an event, like a compressed scene, a scene that always looks informative and emotional, being saved and an experience where you felt very sad. This person, for example, can be saved that scene on that day at night when she was with her husband, was very sad, and so he was saved. But it can be decoded as sadness, you have to remember the image. Currently
cognitive psychologists will say: "no emotions no pictures or images without emotions." All the emotions we experience we are condensed into images and these images are stored in what is called "episodic memory", which constitutes a series of images always intertwined with each other, and then making an image is connected to another image is due to their analog from an emotional standpoint, and that is, as I say, what is archived in your memory.
Therefore, when you want that person more aware, you have to do that again the appropriate person to discuss this particular scene she lived, but have spent thirty years, never mind. For example we in the training course, we also do this with patients, there are times when we analyze events that may be the first memories that are presented to the person. Thus, a student was able to recall a moment in his life when he was two, and that memory was rebuilt as a scene from an emotional standpoint, we would call "a nuclear scene." Question
.: Since you spoke of the unconscious, I I would like to know from your reading, the differences between psychoanalysis and postracionalista vision of psychology, which apparently has a different interpretation.
Ans: Yes, completely different. What it shows is that psychoanalysis is an unconscious that is dynamic, having forces out there that are struggling to consciousness, and, to these forces, we have defense mechanisms that keep well stored in the unconscious there. Now these forces are active and, therefore, if they appear in consciousness the person may lead to a psychotic process, etc. Instead we here do not have this notion that the unconscious is made up of destructive forces. On the contrary. What we call "unconscious" is all that you live at the level of immediate experience, all that is "experience"-as Maturana would belong to the world-which is not conscious. That's why everything that is outside the focus of consciousness (the consciousness that illuminates everything now, "as Guidano), would be for us the unconscious. Question
.: And what would be the "alternate representations" of which Freud speaks.
Ans: No, I do not know that concept. What I can say is that, seen in post-rationalist terms, "only what you allow your focus of consciousness, or conscious image of you is all that you live and non-threatening to your sense of identity, for the image conscious of yourself.
Now, "the self-conscious image" can be understood as a conscious one likes to see, or you build a self-conscious image, and how the image is aware of every one of us, as we like being watched. And that's how we like to see us relates to the theme of "self", which is part of human experience since we intersubjective beings, then, each one of us will always be recognized interest, dear and legitimized by the others and we like to see us. In other words, we always want to feel that we have a conscious image of ourselves so that we can "be accepted into the club of humans."
Moreover, this is the problem of "meaning depressive organization." Thus, the problem of individuals pertenencientes to this type of organization is based on that they feel like they are marginalized or separated from other humans, and this is what leads to low self-esteem. Ie, have low self-esteem is feeling that you have an image you aware so low that you find intolerable, and the sense of not feeling accepted or legitimized by the other, and that's what you can trigger a depressive episode or panic attack, which in turn is threatening self-conscious image.
And, therefore, have high self esteem ... and, unlike what Beck says in the "cognitive triad", remember that Beck said the depression has a bad image of himself, he was pessimistic about the future , and also feel you can not live in the world in which he lived. But we believe that this is not true of depression, but rather, what happens in depression is that he experiences a drop in self-conscious image, to the point of not being lovable. However, the depressive
have enough awareness of their skills, for example., if the depression is smart, there is no situation that is going to do to change it as it is an intelligent person is in no way modified the image he has of himself. That is, the depression can have a self-consciousness that he is a person who can organize very well in life, has no problems with low self-esteem in that sense, he lacks skills.
But where the depression is vulnerable is in any situation where you feel that it is not lovable, by whom, by the significant other, it will automatically lower your self esteem. The difficulty of depression, then, is that when he feels that he can not control, you can not control the despair of not being wanted, that situation would have a depressive episode, and that we would do an equivalent with endogenous depression or psychotic depression.
For example, it shows very clearly what is defined as "schizoaffective disorder" are people who have very high sensitivity or are highly vulnerable to rejection, and all their life is built on the basis of always feeling abandoned marginalized or isolated, and all delusions that these people may even develop later, are always connected to the issue of abandonment or destruction.
This would be roughly said, the idea of \u200b\u200bthe image self-conscious. Question
.: My question is: What happens when I have a depressive disorder, but the base is a personality disorder. It has happened, in light of the practice of my limited clinical experience, which I can hardly reach the triggering scenes which you speak, because people generally do not remember, and who have had this personality structure to the base that has not allowed them to get there. At heart this is my question, or how long you work the scene.
Ans: First, we do not agree with the diagnosis of personality disorder. " In my opinion, what is called personality disorder would become a person that has been stiffened too much, that's what I said just a moment ago, in the sense that it is a person who does not process emotions more than one way, always reaching the same conclusions.
Now, when we do an analysis of the scene, no scenes look at the past, but scenes that have happened to the person during the week. For example, suppose you had a fit of despair or sadness on a given day, if you saw a person on a Wednesday, and she says it was on Sunday when it struck a fit of despair. Then you say "or ckey, we will rebuild this scene that took place on Sunday" and so you start to analyze from the therapeutic standpoint. I mean, that same scene where the person is a spectator of herself, and is also starring herself. Then from there you will emerge this aspect is emotional or implied, and that the person had failed to recognize. If, for example, is an individual belonging to an organization of meaning depression, the problem always has to do with rejection, with the loss, in the case of an Org. DAP, the difficulty always has to do with the trial of another, with "disappointment" in the case of the Org. Phobic, the problem has to do with being constrained or unprotected, as the patient's case that I presented to the top. Finally, in the case of the Org. Obsessive imbalance occurs with the loss of certainty, the worst that can happen is to feel the obsessive who loses certainty, when: when you make a mistake when he made something that was not anticipated; which can immediately trigger an obsessive one sense of uncertainty, and that experienced as loss of control. These would then, very briefly, the situations that can trigger any imbalance, according to any personal meaning.
But what you are rebuilding is what is called "behavioral repertoire today." With the patient who is symptomatic, you rebuild what is happening at the time of his life, and in turn what has happened in recent days in the last few weeks, or what has passed since the patient had the problem. From the time it appeared the difficulty, if it was six months ago when the patient began to feel depressed, then you analyze those six months. But always, what you work session by session, is what is happening as an event in what we call "video" (also "Moviola"), that you put as the scene of a movie, then you analyze those events that are happening now, and so the patient can achieve realize this happens. Question
.: From this point of view, the problem that each may have, to live certain experiences which in turn are conditioned by the meaning that each of us gives what we live, makes us more awareness of what we feel.
But my question points to this: there could be from other points of view other theories, eg. a problem that we had in childhood, adolescence and in all these phases of our life we \u200b\u200bare determined?
Ans: Yes, of course, childhood is very important because it is supposed to be in childhood where organized personal meaning. And how to organize the meaning staff: according to Guidano, personal meaning is built in childhood, the child's relationship with the mother or the figure linked. This is what is known as attachment theory, the "attachment theory of Bowlby. In other words, the entire construction process of personal identity, and thus, personal meaning, is built in childhood, it is there where you discover your sense of identity. Question
.: Yes, but what I'm saying is that there is a poorly constructed mine from my childhood, a bad meaning that I gave myself some experience and a problem with my mother, I guess.
Ans: No, if the meaning is neither good nor bad, but is the way that makes sense your experience, as you said.
Now, what is true can happen in your childhood, and in fact happens is that the link can be "interfered", which will make possible that the person acquires an ability for psychopathology in adulthood. That is already beginning to see in adolescents, not you forget that statistics show that the highest suicide rate occurs in young people, there were also notes that psychotic episodes occur during adolescence. This is what Bateson called "the double bind", ie when the child had a relationship with her mother where she gave two messages at the same time: "I love you and reject" or "I treat you as a person ..." but rather the child is treated as an object. Then the child was never allowed to grow by the mother. Finally, all these problems occur when the link has been interfered with, where you can see a process psychotic or schizophrenic.
Alfredo Ruiz B.
Director
Inteco Cognitive Therapy Institute, Santiago de Chile Santiago de Chile
, June 30, 2004.
Professor Alfredo Ruiz is a psychotherapist, researcher in psychology and cognitive psychotherapy postracionalista. He is currently director of the Institute of Cognitive Therapy (Intec) and the Institute Postracionalista Psychology (IPRA) is, currently, director, teacher and supervisor training courses in post-rationalist cognitive therapy. Founder and President of the Chilean Society of Clinical Psychology for three consecutive terms. He is the author of several books and scientific papers.
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