Pazar, Ocak 31, 2010

Normal auditory hallucinations among children

According to a study that has been published in The British Journal of Psychiatry, in January 2010, nearly 1 in 10 seven- to eight-year-olds hears voices that aren't really there, according to a new study.

Most children who hear voices don't find them troubling or disruptive to their thinking. These voices in general have a limited impact in daily life. In most cases the voices will just disappear. Up to 16 percent of mentally healthy children and teens may hear voices. While hearing voices can signal a heightened risk of schizophrenia and other psychotic disorders in later life, the "great majority" of young people who have these experiences never become mentally ill.

The researchers looked at 3,870 Groningen primary schoolers. All were asked whether they had heard "one or more voices that only you and no one else could hear" in the past year. Nine percent of the children answered yes. Only 15 percent of these children said the voices caused them serious suffering, and 19 percent said the voices interfered with their thinking. Boys and girls were equally likely to report hearing voices, but girls were more likely to report suffering and anxiety due to the voices.

Although urban children were less likely to hear voices, they were more troubled by them. They were more likely to report hearing several voices at once, voices speaking for a longer time, and voices that interfered with their thinking. This greater severity suggests that the urban children who heard voices might be at higher risk of going on to develop psychotic illness

Anne Harding
Reuters Health, NEW YORK

Cuma, Ocak 22, 2010

Kalbinin sesini dinlemek



1-
Ugraslarimiz ileride anlamli bir butunluk olusturacak sekilde birlesecek mi?
Bunu onceden kestirebilir miyiz? Birlesecegine dair bir inancimiz mi var?
Yoksa hayatin/gercegin burnumuza dayadigini gormeme cabasindan baska bir sey degil midir o cok sevdigimiz ugraslarimiz?

2-
Basarinin agirligi ve yeniden baslamanin hafifligi

Basardiktan sonra basardiklarimiz bizi yonlendirir; sahip olmak kisiyi agirlastirir.
Kaybedecek bir seyi olmayan, olaganustu ozgurdur, yeter ki baskalarinin hayallerini de omzunda tasimasin; cunku basarili olma zorunlugu da, basarmis olmanin kendisi kadar agirlastiricidir.

3-
Gelecekte gelecegi kesin olan tek kesinsizlik ölümdur. "Tum dış beklentiler, gururlar, narsisistik incinme ve basarisizlik korkulari, ölüm karsisinda degerini ve onemini yitirir." Kaybedecek seyler oldugunu bilmek, insani nasil agirlastirirsa, ölüm de ciplak varolusumuzdan baska kaybedecek bir seyimiz olmadigini yuzumuze haykirir. Ölümü dusunmek, hafiflemenin en kestirme yoludur.

Baskalarinin hayatini yasayarak buyuk ideallere sahip olamayiz. O ideallerden gercek kendiligimize bir yol bulamamissak, bu ideallere “mış gibi” bagli olmaya devam ederiz. Baskalarinin hayatini yasayarak kendimizinkini bosa gecirmissek, bu baglantiyi kurma sansini artik yitirmisiz demektir. Baska insanlarin fikirlerinin gurultusunden, kendi kalbimizin sesini isitemez hale gelmissek, ideallerimize olan bagliligimiz gercekte kalbimizden kaynaklanmiyor demektir. Yani bunlar sadece agzimizdan dokulen sozcukler olup, ödünc alinmislardir.

Kalbinin sesini dinlemek bencil olmak demek degildir. Kendinle ilgili kararlari verirken kendine durust olabilmek demektir. Buyuk ideallere bagli olmak, sahte kendilikten kaynaklanmaz; büyük ideallere bagli gorunmek sahte kendilikten kaynaklanir. Insan buyuk ideallere baglandikca buyur, ama buyumek icin baglanirsa bu bag sahtedir.

Kalbinin sesini dinle...

Fakat kalbinin sesini dinledigini zannettigin zaman, zihnindeki duzenegin oyuncagi olma ihtimalin de yok degildir...

Kalbinin sesini dinledigini zannettigin an, aslinda gercegin onunden kaciyor olabilir misin?

Ahmet Corak

Delusions and right hemisphere

Delusions associated with consistent pattern of brain injury

How delusions arise and why they persist.

Patients with certain delusions and brain disorders reveals an injury to the frontal lobe and right hemisphere of the human brain. The cognitive deficits caused by these injuries to the right hemisphere, leads to the over-compensation by the left hemisphere, resulting in delusions.

The article entitled "Delusional misidentifications and duplications: Right brain lesions, left brain delusions" will appear in the latest issue of the journal of Neurology.

Problems caused by these right brain injuries include

~ impairment in monitoring of self

~ impairment in awareness of errors

~ incorrectly identifying what is familiar and what is a work of fiction

However, delusions result from the loss of these functions as well as the over activation of the left hemisphere and its language structures, that 'create a story', a story which cannot be edited and modified to account for reality.

Delusions result from right hemisphere lesions, but it is the left hemisphere that is deluded.

Often bizarre in content and held with absolute certainty, delusions are pathologic beliefs that remain fixed despite clear evidence that they are incorrect.

Most neurologic patients with delusions usually have lesions in the right hemisphere and/or bifrontal areas. For example, the neurological disorders of

~ Confabulation (incorrect or distorted statements made without conscious effort to deceive),

~ Capgras (the ability to consciously recognize familiar faces but not emotionally connect with them) and

~ Prosopagnosia (patients who may fail to recognize spouses or their own face but generate an unconscious response to familiar faces) result from right sided lesions.

The right hemisphere of the brain dominates

~ self recognition,

~ emotional familiarity and

~ ego boundaries.

After injury, the left hemisphere tends to have a creative narrator leading to excessive, false explanations. The resistance of delusions to change despite clear evidence that they are wrong likely reflects frontal dysfunction of the brain, which impairs the ability to monitor self and to recognize and correct inaccurate memories and familiarity assessments. Thus, right hemisphere lesions may cause delusions by disrupting the relation between and the monitoring of psychic, emotional and physical self to people, places, and even body parts. This explains why content specific delusions involve people, places or things of personal significance and distort ones relation to oneself.

In one study, nine patients with right hemisphere infarctions at a stroke rehabilitation unit had frequent delusion. While size of the stroke did not correlate when compared to the control group, the presence of brain atrophy was a significant predictor of delusions. When delusions occurred, it was usually caused by a right hemisphere lesion. Also, one study pointed out that delusional patients with Alzheimer's disease usually have significantly more right frontal lobe damage.

Other research showed that Reduplicative Paramnesia and Capgras syndrome cases with unilateral brain lesions strongly implicate the right hemisphere, usually the frontal lobe of the brain. Among 69 patients with Reduplicative Paramnesia, lesions were primarily in the right hemisphere in 36 cases (52%), bilateral in 28 (41%) and left hemisphere in 5 (7%) -- a sevenfold increase of right over left-sided lesions. Similarly in 26 Capras patients, lesions were primarily in the right hemisphere in 8 (32 %), bilateral in 16 (62 %) and left sided in 2 (7%)- a four-fold increase of right - over left-sided lesions. For both delusional syndromes, many bilaterial cases had maximal damage in the right hemisphere.

Among another study of 29 cases of delusional misidentification syndromes, all patients had right hemisphere pathology, while 15 (52 %) had left hemisphere damage. Fourteen had exclusively right hemisphere damage but none had isolated left hemisphere damage. When lateralized lesions are found, right hemisphere lesions are more common in other delusional misidentification and content specific delusions. Frontal lesions are strongly implicated in misidentification syndromes. Exclusively frontal lesions were associated with delusions in 10 of 29 (34.5) cases- four with right frontal and six with bifrontal lesions. None had lesions sparing the frontal lobes.

Source:
New York University School of Medicine
January 13th, 2009


adapted from
http://www.physorg.com/news151069576.html

Salı, Ocak 19, 2010

Dogustan gelen nesne bilgisi

Bir bebegin severek oynadigi bir oyuncagi, onun gozunun onunde bir mendille ortun, artik o oyuncak onun icin yoktur; mendili acip onun altina bakmak aklina gelmez. Mendili onune cekebilir, ama altindaki oyuncagi bulmak icin degil, sadece mendille oynamak icin. Gozden ırak olan gonulden (zihinden) de ırak olmustur (out of sight, out of mind)

Yani nesneler bebegin duysal alaninda varsa zihinsel alaninda da vardir. Duysal alandan cikan nesne zihinden de cikar. Bebek bu donemde sensory-motor bir aparati andirir. Yani bir zihne sahip olmaktan cok, salt girdi (input) - cikti (output) cihazi gibidir.

Bu nedenle, bir mendilin altindaki oyuncagin yok olmasi gibi, bir duvarin arkasindaki anne de artik yok olmustur.

Piaget'ye gore bu donem 8-9 aya kadar devam eder. Bu aylardan itibaren, bebek gormedigi halde, ortunun altinda oyuncagini, duvarin arkasindaki anneyi arar. Yani fiziksel gozden kaybolan nesne, onun zihinsel dunyasinda hala mevcudiyetini surdurmektedir. Bir nesne, bebegin zihninde artik suregen hale gelmistir.

~
-gen eki anlami siddetlendirmek icin kullanilir (intensifier)...
Nesne artik bebegin zihninde suregidebilmektedir...
Zaman (chronos) icinde bir varlik kazanmistir (chronicle)...
Zihinsel nesne zaman icinde birdenbire gorunup (pop in), aniden kaybolmamaktadir (pop out)...
Bu sureksizlik (kesiklilik), nesnenin zihindeki kronik varligi ile sureklilige (kesintisizlige) donusmustur...


~

Ancak nesne hala diger nesnelerden tam bagimsiz degildir bebegin zihninde. Ornegin beyaz mendilin altina sakladigimiz o cok sevdigi oyuncagini bulmak icin beyaz mendili kaldirmayi ogrenen bebek, onun gozunun onunde bu oyuncagi siyah mendilin altina saklasak bile, yine beyaz mendili kaldiracaktir (perseverative error: stage four error; A-not-B error). Cunku onun zihninde oyuncagi tumuyle bagimsizligini kazanamamis, hala beyaz mendille ilintisi olan bir nesnedir. Yani nesne suregenligi bu bebekte de hala tam olgunlasamamistir. Piaget bu donemi gecis donemi olarak adlandirir. Bebege gore nesneyi var eden bebegin kendi eylemidir. Psikozda hasta bilissel olarak, bazi kisilik bozukluklarinda afektif olarak bu duzeydedir. Bu kisilik bozukluklarinda hasta regresyonla zaman-zaman bilissel olarak da bu duzeye inebilir.

Cocuk 18. aya geldiginde nesne ve kendisini tumuyle ayristirmayi basarabilir; artik nesnelerin, onun eylemlerinden ve algilarindan tamamen bagimsiz bir varliklari vardir.

Piaget'den sonra gelen arastirmacilar nesne suregenliginin ilk belirtilerinin 8-9 aydan daha once gorulmeye basladigini ileri surduler ve bu sureyi 3 aya kadar indirdiler.

Spelke ve Baillargeon bu kadar kisa bir sure icinde bebegin deneyimleme olanagi olmadigini ileri surerek bebegin dogustan bazi bilgileri getirdigini dusunduler; yani bu bilgiler bebeklerin donaniminda (hardware) mevcuttu. Bu bilgiler;

~ nesneler uzayda yer kaplarlar; birbirlerinin icinden gecemezler, cunku katidirlar. Boylece bebeklerin Newtonien bir evrene ve bu evrene uygun sagduyulu önkabuller ile dogdugunu varsaymis oluyoruz (Newton fizigine sagduyu fizigi veya kati hal fizigi de denir)

~ hareketin surekliligi; bir nesne A noktasindan yola cikip B noktasina dogru ilerliyorsa, bir sure sonra B noktasindan gecmesi beklenir. Bebekler daha 3 aylikken gozlerini B noktasina dikerek nesnenin oradan gecmesini beklerler (Cunku A ve B arasina bir ekran konarak hareketli nesne bebegin gorme alanindan cikarilir; ama bebek Piaget'nin dusundugunun tersine hareketli nesneyi B noktasinda gormeyi umar ve tersine bir durumda -mesela baska bir nesnenin orada belirmesi durumunda- sasirir)

Baillargeon'un vardigi sonuclar, baskalari tarafindan da defalarca tekrarlanmistir.

Baillargeon'un asagidaki makalesine ucretsiz erismek mumkun;

Baillargeon R.
Infants' reasoning about hidden objects: Evidence for event-general and event-specific expectations.
Developmental Science (2004)7: 391–424.

http://www.psych.uiuc.edu/infantlab/articles/baillargeon2004.pdf.pdf



Spelke'nin pek cok makalesine ise asagidaki adresten erisilebilir;
http://www.wjh.harvard.edu/~lds/index.html?spelke.html


Ahmet Corak, M.D., PhD.


........................................................................

Kaynaklar

Spelke ES, Breinlinger K, Macomber J, Jacobson K. Origins of Knowledge. Psychological Review (1992), 99: 605-632.

Baillargeon R. Object Permanence in 3 ½ and 4 ½ Month Old Infants. Developmental Psychology (1987), 23: 655-664.

Baillargeon R. Infants' reasoning about hidden objects: Evidence for event-general and event-specific expectations. Developmental Science (2004)7: 391–424.

Piaget J. The Construction of Reality in the Child. Basic Books, New York, 1954

Cumartesi, Ocak 09, 2010

Mirror Neurons

Humans, primates, some birds, and possibly other higher animals have mirror neurons that fire in the same pattern whether performing or just observing a task.

These mirror neurons clearly play an important role in learning motor tasks involving hand eye coordination, and possibly also acquisition of language skills, as well as being required for social skills.

Knowledge in this field could shed light on problems such as autism that may arise when this process goes wrong.

The role of mirror neurons at all levels of social interaction is even greater than had been realized. Mirror mechanism is crucial for emotional recognition and empathy"

Just as the same mirror neurons fire when observing and doing certain tasks, so other mirror neurons may be triggered both when experiencing a particularly emotion and when observing someone else with that emotion.

Mirror neurons involved in emotion resided in both the insula and cingulate cortexes, two regions of the brain known to play roles in emotions and feelings.

In the case of emotions, we can say that there is a good deal of overlap between areas from the insula and cingulate cortexes. These areas become active both when individuals feel an emotion (e.g. disgust) and also when they watch someone else feeling that emotion."

Mirror neurons were discovered in the 1980s by Giacomo Rizzolatti, which placed electrodes in the inferior frontal cortex of macaque monkeys' brains to study neurons dedicated to control of hand movement. This led to the surprising observation that some of the neurons responded in the same way when monkeys saw a person pick up a piece of food as when they were doing it themselves. This introduced the principle of the mirror neuron as a neuron capable of being triggered by imitation, as a mechanism both for learning and empathising in social situations.

While mirror neurons cannot be observed directly in humans because electrodes cannot be inserted into their brains, the action has been inferred by imaging of the whole brain using magnetic resonance imaging (MRI). This showed patterns of brain activity consistent with the firing of motor neurons.

More recently motor neurons have also been discovered in birds. This suggests that such a sensory-motor mechanism is not confined to primates, but is shared by different phyla. However the mechanism is not thought to be present in more primitive animals, including the lower cold blooded vertebrates, that is fish, reptiles and amphibians.

Mirror neurons is closely related with mind-reading abilities.

ScienceDaily (Dec. 21, 2008)

Borderline Personality and Psychoanalytic Theories

PSYCHOANALYTIC THEORIES OF THE PATHOGENESIS
OF BORDERLINE PERSONALITY DISORDER

James F. Masterson (1972) suggested that fear of abandonment is the central factor in borderline psychopathology. He believes that the mother of the future borderline patient interfered with her child's natural autonomous strivings by withdrawing emotionally when the child acted in an independent manner during the phase of development that Mahler (1971) has termed "separation-individuation" Later experiences that require independent behavior lead to a recrudescence of the dysphoria and abandonment panic that the borderline patient felt as a child when faced with a seemingly insoluble dilemma (either continue to behave dependently or lose needed emotional support).

Kernberg (1975) suggested that excessive early aggression has led the young child to split her positive and negative images of herself and her mother. This excess aggression may have been inborn or it may have been caused by real frustrations. In either case, the preborderline child is unable to merge her positive and negative images and attendant affects to achieve a more realistic and ambivalent view of herself and others.

In another theory, Adler and Buie (1979) suggested that failures in early mothering have led to a failure to develop stable object constancy. Because the preborderline child's mothering was inconsistent and oftentimes insensitive and nonempathic, the child fails to develop a consistent view of herself or others that she can use in times of stress to comfort and sustain herself.


Zanarini MC, Frankenburg FR.
THE ESSENTIAL NATURE OF BORDERLINE PSYCHOPATHOLOGY
Journal of Personality Disorders. (2007) 21 (5): 518-36

Cuma, Ocak 08, 2010

Where internal milieu meets with extrapersonal space

INTERNAL MILIEU

1-Simplest and differentiated type of cortex:
basal forebrain structures (ventral and medial surfaces);
Corticoid (cortexlike structures)
-Septal nuclei
-Substantia Innominata
-Amygdaloid complex

2- Allocortex has moderately differentiated layers.
Archicortex: Hippocampus
Paleocortex: Piriform cortex (primary olfactory cortex)

CORTICOID + ALLOCORTEX = LIMBIC ZONE OF CORTEX

3- Paralimbic zone (mesocortex) :
Intercalated between isocortex and allocortex (transitional zone)
Periallocortical structures of the paralimbic areas.

Five major paralimbic formations:
-caudal orbitofrontal cortex
-insula
-temporal pole
-parahippocampal gyrus (entorhinal etc.)
-cingulate complex

Directing drive and emotion to the appropriate extrapersonal and intrapsychic targets
Paralimbic cortex acts as a relay between sensory association cortices and the limbic zone of the cortex

------------ --------- ---------
This zone is the neural bridges that link the
internal milieu (inner world)
and extrapersonal space (outer world),
enabling the individual's need to be dyscharged
according to the limitations of the environment.
Integration of multimodal knowledge (heteromodal)
with drive and emotion (paralimbic)
--------- --------- --------- --

4-Heteromodal association cortex
-Perceptual elaboration and motor planning
Receives convergent input from multiple unimodal areas especially downstream
unimodal areas

5-Unimodal association cortex
-Modality spesific elaboration and encoding of sensory input.

Peristriate region (18, 19) upstream unimodal association area
Inferotemporal cortex (20, 21) : downstream unimodal association area

6-Primary sensory and motor cortices
-idiotypic, homogenos, and dedicated

EXTRAPERSONAL SPACE


Source

Mesulam M. Anatomic Principles in Cognitive Neuroscience. In: Farah MJ, Feinberg TE. Patient-based approaches to cognitive neuroscience
The MIT Press, 2000

Ahtapot anne


Ahtapot anne, verdigi kizini (veya oglunu) kocasinin (veya karisinin) elinden her zaman almaya kadirdir. 20 yil sonra bile...Eli her yere uzanir. Cocuk ABD'de olsun Cin'de olsun farketmez. Iletisim teknolojisinin gelismesi en cok onu mutlu etmistir. Literaturde degil cevremizde bile, gelini bir sekilde ekarte edip ogluyla balayina cikan anneler goruruz.

Cok gucludur ve yenilmezdir. Zira en guclu silaha sahiptir. Kutsal, musfik, fedakar ve cefakar anne imaji. Hic bir insan boyle bir goruntunun arkasinda akil almaz bir bencilligin yatabilecegine inanmaz cunku.

Asagidaki video, kimi anneliklerin fedakarliktan ziyade, bir nesneyi yontma, ona sekil verme icgudusunden kaynaklanan bencillikten ibaret oldugunu oldukca guzel karikaturize etmis.

https://youtu.be/ce8yBOXjI7s


Ahmet Corak

Hollow Self

by James F. Masterson

From SELF magazine, Aug. 1990
permission granted by James F. Masterson, M.D.


"I’m afraid I’m about to make a mess out of a romance." Said Jennifer, thirty-five, an attractive blue-eyed actress. She wasn’t referring to the domineering character she played on a daytime soap opera, whose talent was making messes out of other women’s romances. She meant her own. Afraid of being rejected, Jennifer wasn’t able to tell her boyfriend what she wanted to do, where she wanted to eat, what movie she wanted to see. When her partner had interests she didn’t share, she’d conceal her true feelings and go along just to please him.

When dating someone new, Jennifer seemed to spend hours wondering, "Is he going to call me?" She’d have a semi-panic attack if a man didn’t constantly reassure her of his interest. She’d then become demanding and drive him away. Romantic attraction became a trap because it fed into her wish to be taken care of at the cost of giving up herself.
After receiving a big promotion, Penny, twenty-eight, a junior marketing executive, experienced feelings of panic and helplessness. "I don’t think I can manage myself," she told me...This was the first job in which Penny held substantial responsibility, and she felt incapable of showing initiative and setting goals for herself. "I never had to do that before," she said. "I want others to plan for me."

Both of these women suffer from what psychiatrists call borderline personality disorder, which is characterized by feelings of inadequacy. The word "borderline" comes from the fact that these patients are on the border between neurosis (an emotional disorder due to unresolved conflicts) and psychosis (characterized by a loss of contact with reality). Many of these people are successful, bright and seem to have everything going for them; however, inside they feel hollow and incomplete.

These patients struggle with feelings of depression, loneliness and isolation; they’re caught in a spiral of self-destructive behavior that eventually sabotages their lives. Lacking a stable sense of self, they attempt to compensate by seeking satisfaction in material possessions, superficial friendships and impersonal sexual encounters. They substitute empty lifestyles for real lives and shy away from channeling their energies into personal growth and fulfillment.

In all, I estimate that ten to fifteen million people suffer from borderline problems - many more than were diagnosed fifty years ago, though there are no comprehensive studies, so nobody knows for sure. In contrast, according to the National Institute of Mental health, depression affects about ten million adults each year.

Women are believed to be affected more than men. The problem is that many therapists are quick to diagnose women as having passivity and dependency problems but are reluctant to diagnose these symptoms in men.

Finding meaning in life, of course, isn’t an easy proposition for anyone. Personal satisfaction isn’t a given but must be created through testing and experimentation. A healthy person does this through love and work, by discovering a partner, projects or pastimes that satisfy her needs. Borderline patients neither test nor experiment. They lack the capacity to meet the challenges of an ever-changing world.

BIRTH OF THE FALSE SELF

When we think of someone who is strong and independent, what we admire is her strong sense of self, that vital part of the personality that allows her to have a positive self-image, to identify her own wishes and maintain her self-esteem by asserting herself with other people.

The lack of this inner development is the key to borderline problems, which occur when a young child fails to separate her own self-image from that of her mother. This happens roughly between the ages of two and three, often because of a parent’s own emotional problems. A mother’s encouragement of a child’s self-assertion is vital. When the mother suffers from low self-esteem, she has difficulty encouraging her child’s emerging self. The child experiences this absence as a loss of self, creating feelings of abandonment that lead to depression. To deal with the depression, the child gives up efforts to support her emerging self. Instead, she relies on her mother’s approval to maintain the esteem of a "false self."

Some experts argue that the disorder is genetic; certain children simply are born lacking the capacity for an independent self. Others say environmental trauma plays a role; any life event between the ages of two and three that seriously affects the child’s ability to experiment or the mother’s availability can be a precipitating factor.

THWARTED RELATIONSHIPS

One of my patients described her life this way: "I’m not doing what I want because my ideas - about how I work, how I think, how I dress - and even my hobbies and how I relate to men are filtered through the perception of what others want. I’m good at perceiving what pleases other people and giving them what they want, but I feel trapped, like I’m suffocating inside my skin."

Most of us have occasional doubts about our identities and self-worth and wonder if we’re making the most of our lives. What prevents us from falling apart, though, is the ability to realistically assess these moments rather than resort to the borderline’s self destructive behavior.

People dominated by false self adopt an illusion of coping, which substitutes for genuine self-assertion. They depend on others to constantly provide them with a sense of internal security, a way of relieving feelings of worthlessness.

The borderline personality is constantly on the defensive, guarding against intimacy out of a twin fear of being engulfed and abandoned. While it’s natural to feel anxious about a new relationship, most of us realize that we need love in our lives. The borderline, however, is incapable of handling closeness and substitutes inappropriate relationships with unavailable partners.

The threat of intimacy may lead a borderline patient to become promiscuous. Since her fears make her unable to make a lasting commitment to one person, she goes from one lover to another, acting out the fantasy of somebody taking care of her. Sex tends to be mechanical, in order to avoid the powerful drive to emotional intimacy that accompanies sex. What she seeks is not orgasm but being held, as if to compensate for her not having been held as a child.

CONFRONTING THE DEFENSES

...There are two effective therapy options. In a shorter approach, a patient is see nonce a week for about six to eighteen months, with the goal of finding more constructive ways to respond to relationships and work. In longer psychoanalytic therapy, three- times-a-week sessions with a therapist take place regularly over a period of three to five years.
The central goal of the therapy is what we call the flowering of the individuation - a feeling akin to becoming a new person. Breaking down artificial defenses can liberate the borderline’s real self and enable her to complete her development. All the qualities of the undeveloped real self that had been kept in the closet because of the need to defend against depression come out and mushroom. This brings profound change. Many people become more creative on the job and begin to look forward to challenges. As they develop a sense of inner security, they often break off unrewarding relationships. And when they date on a new basis, they look for mutual sharing, not for dependency and internal security.

In a sense, borderline-personal ity problems can teach all of us about the crucial balance between independence and the need to share our lives with others. Connections - in family, friendships, love and work - are healthy, but building a separate sense of self is critical. While life may involve compromise and some working toward others’ goals, it also requires forging one’s own individual and unique identity.

Delusions

Delusions associated with consistent pattern of brain injury
Source:
New York University School of Medicine

How delusions arise and why they persist.

Patients with certain delusions and brain disorders reveals an injury to the frontal lobe and right hemisphere of the human brain. The cognitive deficits caused by these injuries to the right hemisphere, leads to the over compensation by the left hemisphere, resulting in delusions.

The article entitled "Delusional misidentifications and duplications: Right brain lesions, left brain delusions" appeared in the journal of Neurology.


Problems caused by these right brain injuries include
-impairment in monitoring of self
-awareness of errors
-incorrectly identifying what is familiar and what is a work of fiction

However, delusions result from the loss of these functions as well as the over activation of the left hemisphere and its language structures, that 'create a story', a story which cannot be edited and modified to account for reality.

Delusions result from right hemisphere lesions, but it is the left hemisphere that is deluded.

Often bizarre in content and held with absolute certainty, delusions are pathologic beliefs that remain fixed despite clear evidence that they are incorrect.

Most neurologic patients with delusions usually have lesions in the right hemisphere and/or bifrontal areas. For example, the neurological disorders of
-confabulation (incorrect or distorted statements made without conscious effort to deceive),
-capgras (the ability to consciously recognize familiar faces but not emotionally connect with them) and
prosopagnosia (patients who may fail to recognize spouses or their own face but generate an unconscious response to familiar faces) result from right sided lesions.

The right hemisphere of the brain dominates
-self recognition,
-emotional familiarity and
-ego boundaries.

After injury, the left hemisphere tends to have a creative narrator leading to excessive, false explanations. The resistance of delusions to change despite clear evidence that they are wrong likely reflects frontal dysfunction of the brain, which impairs the ability to monitor self and to recognize and correct inaccurate memories and familiarity assessments. Thus, right hemisphere lesions may cause delusions by disrupting the relation between and the monitoring of psychic, emotional and physical self to people, places, and even body parts. This explains why content specific delusions involve people places or things of personal significance and distort ones relation to oneself, the author explains.

In one study, nine patients with right hemisphere infarctions at a stroke rehabilitation unit had frequent delusion. While size of the stroke did not correlate when compared to the control group, the presence of brain atrophy was a significant predictor of delusions. When delusions occurred, it was usually caused by a right hemisphere lesion. Also, one study pointed out that delusional patients with Alzheimer's disease usually have significantly more right frontal lobe damage.

Other research showed that Reduplicative Paramnesia and Capgras syndrome cases with unilateral brain lesions strongly implicate the right hemisphere, usually the frontal lobe of the brain. Among 69 patients with Reduplicative Paramnesia, lesions were primarily in the right hemisphere in 36 cases (52%), bilateral in 28 (41%) and left hemisphere in 5 (7%) -- a sevenfold increase of right over left-sided lesions. Similarly in 26 Capras patients, lesions were primarily in the right hemisphere in 8 (32 %), bilateral in 16 (62 %) and left sided in 2 (7%)- a four-fold increase of right - over left-sided lesions. For both delusional syndromes, many bilaterial cases had maximal damage in the right hemisphere.

Among another study of 29 cases of delusional misidentification syndromes, all patients had right hemisphere pathology, while 15 (52 %) had left hemisphere damage. Fourteen had exclusively right hemisphere damage but none had isolated left hemisphere damage. When lateralized lesions are found, right hemisphere lesions are more common in other delusional misidentification and content specific delusions. Frontal lesions are strongly implicated in misidentification syndromes. Exclusively frontal lesions were associated with delusions in 10 of 29 (34.5) cases- four with right frontal and six with bifrontal lesions. None had lesions sparing the frontal lobes.

http://www.physorg. com/news15106957 6.html

Baglanma (Attachment)


Bu kitabin kapak resmi baglanmayi guzel anlatiyor.

Baglanma havaya atilan bir cocugun dusmeyecegine olan "derin" inancidir.
Havaya atilan cocuk sag salim tutulacagina nasil guvenirse, evde birakilan cocuk da birincil bakicinin geri gelecegine ayni bicimde guvenir. Bu guven, yardimci bakicinin, birincil bakicinin fonksiyonlarini devralmasini saglar ve bakim kesintisiz devam eder. Bu da kendilik gelisiminin kesintisiz surmesini ve kendilik kapasitelerinin artmasini saglar.

Guvensiz baglanan cocuk birincil bakicidan ayrildiginda terk depresyonu ile basedebilmek icin savunma kullanir. Birincil bakicinin yok oldugu sure zarfinda defansif yasadigi icin gercek kendilik degil, sahte kendilik gelisir. Gercek kendilik ancak birincil bakicinin varliginda devreye girebilirdi, ancak guvensiz baglanma sebebi olan bu bakici, bu durumda dahi cocugun savunma durumunda kalmasina neden olacaktir.

Hasta, annesinin elinden tutarak karsidan karsiya gecirmek istediginde, annesinin telaslanarak elinden kurtuldugunu ve ancak kendi cabasi ile karsiya gectigini ifade ediyor (annenin kendi guvensiz baglanmasi). Boyle bir annenin cocugu da guvensiz baglanacaktir. Hasta, cocukken agactan inemedigini, babasinin kucagina atlamayi ise reddettigini (guvenemediginden) ifade ediyor. Oyle ki, baba bu duruma cok kiziyor, hatta icerliyor ve sasiriyor da. Bu da hasta uzerindeki baskiyi oldukca arttirmasina ragmen agactan babasinin kucagina atlayamiyor. Anneye guvensiz baglanma tum evrene yansir. Babaya da guvenilemeyecegi gibi, bir binaya, trene ve kopruye de guvenmek imkansiz hale gelebilir.

Ahmet Corak

Gercek kendiligin aktiflenmesi

Sahte kendilik acemi bir binicinin ata binmesine benzer; at binicisine kah uyar, kah uymaz, kah ustunden atar, kah yayan yurutur; hasili, at mi binicisine biner, binici mi ata... Acikcasi bu suphe goturur.

Ya da dolu dizgin kosar at, uzaktan bakanlari kiskandirir. Ama binici hep bir yabancilik hisseder ata; gercekten suren o mudur? sanki degil gibidir (lack of sense of entitlement). Bir yandan buyuk zevk alir olan bitenlerden ama gunun birinde basina ciddi bir is acabileceginden surekli endise duyar.

Ama gercek kendilik bir defa hissedildi mi; o, atla yek vücud olmus binicinin hissettigi yetkinlik ve "bunu gercekten ben yapiyorum" duygusu (entitlement) , ve o, duygularin hic yasanmadigi kadar canlı ve net, aynen oldugu gibi hissedildigi anlar; bunlar terapinin bonusu, kremasi gibidir. Terapiye olan inanci tazeler, surdurme gucu verir. Mahler'in alistirma (egzersiz) alt evresini andirir. Cunku orada da gercek kendiligin aktiflenmesine bagli adeta ekstatik bir hal cocugu sarmistir. O hal degil midir ki, bir cocugun bikmadan usanmadan ayni koltuga 30 kere, 130 kere tirmandirir.

Ama terapotik aktivasyondaki hazza hep o meş'um terk depresyonu eslik eder. Bir kez yaptiginiz ertesi gun size cok yabanci gelir. Devam ettiginizde nihilistik duygular sizi sariverir. Bazen de ofke veya sucluluk. Kiminde depresyon daha belirgindir, kiminde ise caresizlik ve umutsuzluk hissi, kiminde yokluk ve hiclik, kiminde yogun bir ofke.

Bu ikisi arasindaki denge prognozu buyuk oranda belirler. Bu nedenle gercek kendiligin aktivasyonu, bir bicimde, yani cerceveyi bozmadan, terapist tarafindan desteklenmelidir. Gercek kendiligi ezilmis hastalar cogunlukla, o kadar kotu durumdadirlar ki, bu aktivasyon uzerine konusmak bile (communicative matching) onlara cok iyi gelir, kendilik aktivasyonlarinin onaylandigini ve desteklendiklerini hissederler. Psikanalitik psikoterapilerde "destekleyici olmadan" dolayli yoldan destekleme terapistin hunerine baglidir.


Dr. Ahmet Corak

Aikido and Psychology



It may seem paradoxical to include martial arts practice as an important aspect to being a therapist. When we think of the martial arts, words such as, “opponent”, “defeat”, and “against” often come to mind. However, Aikido differs from disciplines such as karate, tai chi, and even yoga because it emphasizes the importance of blending with your partner. In Aikido, as in therapy, it is necessary to read body language and understand the intention of the person with whom you are working. These are some of the fundamental reasons that ITP requires the study of Aikido for our Residential students.

The Founder of Aikido, its first sensei, or teacher, forbade competition. The relationship between therapist and client is unlike any other; it is important for the therapist to create a safe space for the client and to be aware of his or her own emotional state before the session starts.

Sue Ann McKean, an Aikido teacher at ITP, says that, “Aikido helps bridge the body and the brain. It gives you experience with the physical connection necessary in transpersonal psychology, while teaching you to be grounded and centered. Aikido helps with knowing where the boundaries are, with containing and setting aside your own feelings and with knowing how and when to blend with the energy of your partner.”

McKean goes on to state that in Aikido classes, “The partner shows where it is that we need to grow. The successful practice of Aikido requires the ability to shift, and when that shift cannot occur, a blockage is often the reason” that the shift is prevented. In transpersonal psychology, as with virtually any therapeutic practice, it is important that the therapist be able to modify his or her responsiveness to a client’s behavior. If the client is projecting; that is, externalizing his or her own emotional state onto the therapist, then the therapist would need to have a different reaction to that situation than if the client had had a moment of insight and needed heartfelt, empathic connection.

Robert Frager, one of the founders of ITP and a longtime aikido practitioner, says, “The principles of transpersonal psychology must be embodied to become real. Otherwise, they are merely idealistic philosophy. Aikido and the other body aspects of the six areas of study at ITP make it possible for us to embody transpersonal principles.”

Frager elaborates on the mind-body connection between aikido and transpersonal psychology by adding, “Aikido teaches us to center ourselves and to deal with our own aggression and control of power. It is important to be comfortable with power, and aikido shows physical power in a concrete way, on the mat. It teaches how to control your own power in response to someone else’s.”

Frager points out that practicing aikido is gratifying because, due to its physical nature, it provides instant feedback

http://www.itp.edu/currents/editorials/aikido.php

Çarşamba, Ocak 06, 2010

Somatopsychic

"Psychosomatic" yes...; but how about "somatopsychic"

Emotion language has an influence on facial muscle activity.

While reading a series of emotion verbs (e.g., "to smile," "to cry") and adjectives (e.g., "funny," "frustrating" ) on a monitor, the activity of zygomatic major (the muscle responsible for smiles) and corrugator supercilii (which causes frowns) muscles were measured.

Reading action verbs activated the corresponding muscles.

For example, "to laugh" resulted in activation of the zygomatic major muscle, but did not cause any response in the muscles responsible for frowning.

Interestingly, when presented with the emotion adjectives like "funny" or "frustrating" the volunteers demonstrated much lower muscle activation compared to their reactions to emotion verbs. The researchers note that muscle activity is "induced in the reader when reading verbs representing facial expressions of emotion."

Can this innate bodily reaction affect our judgments?

In another experiment, volunteers watched a series of cartoons and were subliminally shown emotion verbs and adjectives after each one. They were then asked to rate how funny they thought the cartoons were. Half of the participants held a pen with their lips, to prevent them from smiling, while the remaining participants did not have their muscle movement blocked.

The results reveal that even when emotion verbs are presented subliminally, they are able to influence judgment — volunteers found cartoons to be funnier when they were preceded by smiling verbs than if they were preceded by frowning-related verbs.

However, this effect only occurred in the volunteers who were able to smile — volunteers who had muscle movement blocked did not show this relationship between emotion verbs and how funny they judged the cartoons as being.

The results of these experiments reveal that simply reading emotion verbs activates specific facial muscles and can influence judgments we make. The researchers note these findings suggest that "language is not merely symbolic, but also somatic"

http://www.physorg. com/news16885874 2.html

Dental Anksiyete

“Hasta ne kadar rahatsa diş hekimi de o kadar rahattır” inancı diş hekimleri arasında yaygındır. Bugün bir diş hekimi, hastasının dental anksiyetesini (kaygı) azaltmak için tarihin hiç bir döneminde olmadığı kadar çok seçeneğe sahiptir (Miller, 2006). Buna rağmen dental anksiyete konusunda son 50 yıl içinde hiçbir ilerleme kaydedilememiş tir. Dental tedavi ve analjezi alanında gerçekleşen başdöndürücü ilerlemelerin de buna bir katkısı olamamaktadır (Woodmansey, 2005).

ABD’de yüksek dental anksiyeteye sahip bireylerin sayısı 35 milyona ulaşmaktadır (Zachny ve ark; 2002). Bu bireyler diş hekimine gitmektense ağrı çekmeye katlanmayı tercih etmekte ve sonuçta oluşan kayıpları ve estetik görünümde bozulmayı tolere edebilmektedirler. Yüksek dental anksiyöz hastaların tedavisi daha uzun sürmektedir. Bu hastaların randevularına geç kalma oranları diğer hastalara göre çok daha yüksektir.

Anksiyete hoşnutsuzluk veren spesifik bir durumdur. Organizmanın bir tehlike beklentisi nedeniyle gerilmesi ile karakterize edilir. Anksiyete durumunda otonom sinir sisteminin sempatik bölümünde hiperaktivasyon ortaya çıkar. Bu bölümün çalışması kalp ritminde artış (taşikardi), kalp kasılma kuvvetinde artışı, kan basıncında artış, pupillada (göz bebeği) genişleme, mide ve barsak hareketlerinde azalma, hiperglisemi (kan şekerinde yükselme), kan koagülasyon faktörlerinde artış gibi fizyolojik değişikliklere neden olur. Bu değişiklikler organizmanın tehdit algılamasında yani korku ve kaygı durumlarında ortaya çıkar ve organizmayı uyararak (arousal) savaşa ya da kaçışa hazırlamaya yönelik olarak gerçekleşir.

Açıkça görünen bir tehlike karşısında beliren bu fizyolojik belirtiler sağlıklı tepkiler olarak kabul edilip, onlara eşlik eden emosyona “korku” adı verilir. Tehlike aşikar değil fakat beklenilmekte ise yine aynı uyarılma (arousal) tepkileri ortaya çıkar ve “adaptif anksiyete” adını alır. Psikopatolojiye konu olan “maladaptif anksiyete” ise ya gerçek bir tehlike beklentisinden kaynaklanmakta olup, kişiyi tehlikeye karşı hazırlaması gerekirken organizmayı sararak tersine onu korumasız bırakan ve tehlike ile yüzleşmesini olanaksızlaştıran bir emosyon ve ona eşlik eden fizyolojik belirtilerdir; ya da bilinç düzeyinde var olmayan bir tehlikeye karşı ortaya çıkmaktadır. Dental anksiyete, daha çok maladaptif anksiyetenin, bahsi geçen ilk şekli olarak değerlendirilir. Diş hekiminin muayenehanesinde hastayı reel bir tehlike beklemesine karşın, alınan tedbirler ile muhtemel bir zarar hemen-hemen sıfırlanmıştır. Buna rağmen kişide muayene öncesi bir anksiyete oluşması da normal olup, bu anksiyetenin anormal bir düzeyde gerçekleşmesi ve/veya kişiyi muayene olmaktan alıkoyması psikopatolojiye konu olarak maladaptif anksiyete başlığı altında incelenir. Kişinin bu kaçınma davranışı ertelemeden, senelerce muayenehaneye girmemeye kadar geniş bir skalada derecelenir. Uzun bir süre rutin kontrollerini aksatan bir kişi yüksek dental anksiyöz ve bu duruma da yüksek dental anksiyete adı verilir.

Dental anksiyete büyük ölçüde beklenen ağrıya karşı gelişir. Ağrı ve anksiyetenin birbirini beslediği eski çağlardan beri bilinmektedir. Ağrı beklentisi anksiyete doğurur, bu anksiyete de gelen ağrının daha şiddetli hissedilmesine sebep olur. Diş ağrılarının gece daha yoğunlaşmasının sebebi budur. Gecenin yaklaşması ile, alınabilecek önlemlerin seçenek olarak azalması, ağrı beklentisi içinde olan şahısta anksiyete meydana gelmesine, bu anksiyete de ağrının daha yoğun olarak hissedilmesine yol açar.

Dental anksiyete etiyolojik olarak homojen bir grup değildir ve oluşumu farklı yollarla gerçekleşmektedir (Abrahamsson ve ark, 2000). Bunlardan bazıları olumsuz bilgilenme (mitler ve bilişsel çarpıtmalar), olumsuz deneyimlere şahit olma (davranışçı modelleme) ve olumsuz şartlanmadır (davranışçı öğrenme). Diş hekimi ile geçmişte yaşanan olumsuz bir deneyimin dental anksiyetenin olumsuz şartlanmasında önemli bir katkısı bulunmaktadır (Poulton ve ark, 2000). Şartlanma ile (doğrudan) oluşan anksiyetedeki fizyolojik ve davranışsal tepkiler diğer (dolaylı) yollar ile oluşan anksiyeteye göre daha belirgin olmaktadır (Rachman, 1977). Bu grup dental hastalara enjeksiyon ve diş ampütasyonu içeren filmler gösterildiğinde diğer anksiyöz hastalara göre EMG’lerinde daha yüksek bir kas gerilimi ölçülmüştür (Lundgren ve ark, 2004).

Dental anksiyeteyi ölçen psikometrik ölçekler sınırlıdır. Bunlar arasında en fazla uygulanan ölçek Corah’ın 1969’da yayınladığı dört sorudan oluşan dental anksiyete ölçeğidir (Dental Anxiety Scale-DAS). Bu testte her sorunun değeri 1 (kaygılı değil) ve 5 (aşırı kaygılı) arasında değiştiğinden puanlandırma 4-20 arasında değişir. Testin 1995 modifiye versiyonu (MDAS) daha fazla tercih edilmektedir. Özellikle intravenöz sedasyon, genel anestezi ya da hipnoz kullanan hekimlerin DAS’a daha çok başvurdukları bulunmuştur (Dailey ve ark, 2001).

Dental anksiyete özellikle çocuklarda sık görülmekle birlikte toplumda yüksek bir insidansa sahiptir. Bunun sonucunda ortaya çıkan tedaviden kaçınma davranışı toplum sağlığı üzerine ağır bir maliyet olarak yansımakta ve bu nedenle hekimlerin konu hakkında eğitilmelerinin gereği üzerinde durulmaktadır (Sohn ve Ismail, 2005). Kadınlar erkeklere göre kaçınma davranışını daha fazla göstermektedirler. Hastanın muayene odasındaki olayları kontrol etme arzusunun yüksekliği ile buna ilişkin kontrolünün düşük olduğu algısı kaçınma davranışının anlamlı bir değişkeni olarak karşımıza çıkmaktadır. Bu nedenle hastanın terapi ortamına kontrollü bir müdahalesi sağlanarak kaçınma davranışı azaltılabilmektedir (Sartory ve ark, 2006). Diş hekimliği ve hekimleri ile ilgili pozitif görüntülerin çocuklardaki beklentisel anksiyetede kısa süreli azalmaya sebep olduğu da gösterilmiştir (Fox ve Newton, 2006).

Çözülemeyen dental anksiyetede hasta psikolojik danışman-rehber (PDR)’e ya da bir psikolog/psikiyatri ste danışmalıdır. Çünkü bu kaçınma davranışının yaşam kalitesi üzerinde anlamlı bir etkisi bulunmaktadır. Anksiyete sedatiflerle kontrol edilebilmektedir. Sedatif-hipnotik grup ilaçlar dental hastalara oral, intravenöz ya da inhalasyon yoluyla verilebilmekte, hasta genel anesteziye alınabilmektedir. Psikoterapide ise anksiyetenin çocukluktaki kaynağı araştırılabilir (dinamik terapi), kaygıyı doğuran düşünce biçimleri incelenebilir (kognitif terapi), korku ile aşamalı bir yüzleştirme yapılabilir (davranışçı terapi), gevşeme ve nefes teknikleri öğretilebilir (destek tedavisi), yönlendirilmiş imgelem gibi dikkati başka yöne sevk eden teknikler kullanılabilir, hasta hipnoza alınabilir (Berggren, 2001).

Aşırı dental anksiyetesi bulunan hastalara grup terapisi ve duyarsızlaştırma (desensitization) da uygulanabilir. Yapılan araştırmalarda hipnoterapi, grup terapi ve bireysel duyarsızlaştırma yöntemleri, dental ansiyete, dental inanç, diş hekimi korkusu ölçekleri kullanılarak karşılaştırılmış ve tedaviyi bırakma oranları ile anksiyetenin azalma oranları arasında anlamlı bir fark bulunamamış, ancak her üç tedavi grubunda da kontrol grubuna göre dental anksiyete ve dental inanç ölçeklerinde anlamlı iyileşmeler bulunmuştur (Moore ve ark, 1996). Kadınların erkeklere göre bu tedavilere devam etme oranları daha yüksek bulunmuştur (Moore ve ark, 2002).

Hipnoz dental hastalarda başarılı bir biçimde uygulanagelmektedir . Yukarıda sayılan tekniklerin tümü hipnoz altında da uygulanabilir. Hipnoz ile sedasyon, gevşeme, analjezi, anestezi yapılabildiği gibi doğrudan anksiyete üzerinde çalışılarak anksiyete tedavisi gerçekleştirilebilir. Bu tedavide direkt telkin (hipnoterapi) kullanılabileceğ i gibi etiyolojiye özgü bir çalışma (psikohipnoterapi) da gerçekleştirilebilir. Birey bir kez hipnoza alındığında otohipnoz öğretilerek sonraki seanslarda hipnotik endüksiyon zorunluluğu ortadan kaldırılabilir.

Dental anksiyete tedaviden önce, tedavi esnasında, ve tedaviden hemen sonra devam eder. Dental cerrahi işlemler öncesinde, tıbbi hipnoz ile gerçekleştirilen non-invaziv sedasyonun dental-anksiyö z hastaların subjektif yaşantılarında ve objektif parametrelerde değişim sağladığı gösterilmiştir. Bu parametreler arasında elektroansefalogram , elektrokardiyogram, kalp hızı, kan basıncı, kan gazı değerleri, solunum hızı, tükrük kortizol konsantrasyonu, vücut ısısı gibi ölçümler bulunmaktadır (Eitner ve ark, 2006). Hipnoz etkisinin dental tedaviden sonra da devam etmesi sağlanabilir.

Ahmet Corak, M.D., PhD. (Dentiss'de yayınlanmıştır)


Referanslar

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2- Moore R, Abrahamsen R, Brodsgaard I. Hypnosis compared with group therapy and individual desensitization for dental anxiety. European Journal of Oral Sciences 1996; 104(5-6): 612-618

3- Fox C, Newton JT. A controlled trial of the impact of exposure to positive images of dentistry on anticipatory dental fear in children. Community Dentistry & Oral Epidemiology 2006; 34(6): 455-459

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14- Zacny JP, Hurst RJ, Graham L, Janiszewski DJ. Preoperative dental anxiety and mood changes during nitrous oxide inhalation. The Journal of the American Dental Association 2002 133(1): 82-88

15-Moore R, Brodsgaard I, Abrahamsen R. A 3-year comparison of dental anxiety treatment outcomes: hypnosis, group therapy and individual desensitization vs. no specialist treatment. Eur J Oral Sci. 2002 Aug;110(4):287- 95

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