Ebook The psychiatric interview in clinical practice (3/E): Part 2
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Ebook The psychiatric interview in clinical practice (3/E): Part 2
CHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2of a loved one to a serious motor vehicle accident, the diagnosis of a life-threatening illness, or being the victim of an assault. Popular attention has focused on the aftermath of severe trauma such as civilian disasters, industrial explosions, natural catastrophes, terrorist attacks, life-threate Ebook The psychiatric interview in clinical practice (3/E): Part 2ning combat situations, rape, and childhood sexual abuse.Many people respond to a traumatic event with an acute stress reaction or an increase in anxiEbook The psychiatric interview in clinical practice (3/E): Part 2
ety of short duration that resolves spontaneously without need for treatment. Some people develop a more chronic traumatic stress response that becomeCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2 fact, even though close to 90% of people will be exposed to some kind of traumatic event during their lifetime, according to a survey conducted in the early 2000s to establish the prevalence of psychiatric disorders in the population, the lifetime prevalence of posttraumatic stress disorder (PTSD) Ebook The psychiatric interview in clinical practice (3/E): Part 2was 6.8%.From the beginning, an essential question of traumatic studies has been what differentiates between people who develop a disabling response tEbook The psychiatric interview in clinical practice (3/E): Part 2
o trauma and those who are more resilient in response to similar tragedies.Traumatic events and their effect on the human psyche occupy center stage iCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2une, loss, death, illness, and suffering are and have339340 • THE PSYCHIATRIC INTERVIEW IN CLINICAL PRACTICEalways been common, for many millennia the stories of sorrow and heartbreak, of soul-sickness and madness, caused by life tragedies, fate capriciousness, and human cruelty were mostly the prov Ebook The psychiatric interview in clinical practice (3/E): Part 2ince of poetry and art, not of medicine and science.It has been suggested that the interest of science in the psychological effects of trauma only becEbook The psychiatric interview in clinical practice (3/E): Part 2
ame relevant when life expectancy in Western societies grew to a length that allowed for concerns other than mere physical survival. It is possible thCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2will of God as an explanation for human events, also played a role. However, by the middle of the nineteenth century, psychiatrists and neurologists started describing with more interest and consistency symptoms that seemed to have their origins in past traumatic events in the patient's life.What ma Ebook The psychiatric interview in clinical practice (3/E): Part 2kes the study of the psychological effects of trauma different from the study of any other mental illness is the necessity of event outside of the humEbook The psychiatric interview in clinical practice (3/E): Part 2
an psyche to occur in order for the disorder to exist. PTSD (and acute stress disorder) is the only diagnosis that requires the clinician to determineCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2ss experienced by soldiers during and after combat. However, military authority and society at large were quick to accuse the sufferer of cowardice, unless a medical explanation could be devised. The cultural moral standard expected men to be capable and willing to fight for then- corm try and their Ebook The psychiatric interview in clinical practice (3/E): Part 2 cause. Soldiers who refused to fight or escaped from the battlefield were accused of desertion and court martialed. Although it might be easy for USEbook The psychiatric interview in clinical practice (3/E): Part 2
to scorn the preoccupation with honor of European countries at the beginning of the 1900s that allowed the unspeakable slaughter of the trenches, it iCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2bstacles veterans encounter even today in accessing and receiving care. During this era, with the exception of a few studies that investigated the effects of trauma in victims of railway accidents, and in survivors of an earthquake in Southern Italy, outside of military hospitals, the other main are Ebook The psychiatric interview in clinical practice (3/E): Part 2a of investigation in the traumatic neurosis was the study of hysteria. Patients suffering from hysteria, mostly women, presented with a host of confoEbook The psychiatric interview in clinical practice (3/E): Part 2
unding symptoms and many somatic complaints. Contrary to war, neither sexual violence nor the abuse of children had been per se the focus of literaturCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2ptions of early life loss, abandonment, neglect,The Traumatized Patient• 341and abuse. Of course, it is a matter of debate whether this is a representation of the inner fantasies of the child, and a projection of our worse fears, or a fair appraisal of what we know to be all too common. The two expl Ebook The psychiatric interview in clinical practice (3/E): Part 2anations do not need to be mutually exclusive; fantasies can be not only projected but also enacted with tragic consequences. At the beginning of theEbook The psychiatric interview in clinical practice (3/E): Part 2
nineteenth century, the Bronte sisters, along with Charles Dickens, offered some interesting descriptions of child abuse and neglect that were quite rCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2nable. However, notwithstanding some sensational-istic reporting in the news of the time, and some increase in the literature of more realistic descriptions of violence and abuse, society was not ready to accept the reality of sexual violence or child abuse as commonly occurring events.Controversies Ebook The psychiatric interview in clinical practice (3/E): Part 2 surrounded the work of Jean-Martin Charcot, who had suggested that the cause' of hysteria in Ills patients was a traumatic e\ ent, most likely a pastEbook The psychiatric interview in clinical practice (3/E): Part 2
sexual trauma. After Charcot's death, Joseph Babinski, who took over the directorship at the Salpêtrière Hospital in Paris, declared that the cause oCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2rinciples were embraced by Trench and German physicians and applied with a rather extreme level of cruelty to "treat" French and German soldiers suffering from war neurosis during World War I. The "treatment" used involved the application of electric shock and was in general so painful and brutal th Ebook The psychiatric interview in clinical practice (3/E): Part 2at the soldiers preferred to go back to the trenches.Pierre Janet was also a student of Charcot but followed the initial course of research and maintaEbook The psychiatric interview in clinical practice (3/E): Part 2
ined the belief that hysteria was caused by a past traumatic event that had caused a "vehement emotion" that created a memory that could not be integrCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2le to make a "narrative of the event." This state of affairs caused a "phobia of the memory" that failed to be integrated, but it left a trace, or idee fixe ("fixed idea"). These fixed ideas were constantly reoccurring as obsessions, reenactments, nightmares, somatic symptoms, and anxiety reactions. Ebook The psychiatric interview in clinical practice (3/E): Part 2 Janet also described the patient's hyperarousal and reactivity to triggers and reminders of the traumatic event. The patient was not better until heEbook The psychiatric interview in clinical practice (3/E): Part 2
or she could integrate the traumatic memory into consciousness.Sigmund Freud studied with Charcot at the Salpêtrière, and in his early writing he initCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2 IN CLINICAL PRACTICEFreud started focusing on infantile sexuality, he changed his view and reinterpreted hysterical symptoms as being a reaction to the fantasy of a seduction and, therefore, a defensive response to a conflict between an unconscious wish and a prohibition, not the somatic response t Ebook The psychiatric interview in clinical practice (3/E): Part 2o a trauma. As far as war neurosis was concerned, Freud recognized the similarities between the symptoms of World War 1 veterans and those of patientsEbook The psychiatric interview in clinical practice (3/E): Part 2
with hysteria. His hypothesis was that the conflict at the core of war neurosis was between a wish to survive and a wish to act honorably. Freud initCHAPTER 10THE TRAUMATIZED PATIENTALESSANDRA SCALMATI, M.D., PH.D.Trauma is common in everyday life. It can take many forms, from the unexpected loss o Ebook The psychiatric interview in clinical practice (3/E): Part 2onflict and rendering the symptoms obsolete.Charles Myers and William Rivers are the two psychiatrists best known for their work with World War I soldiers in Britain. Myers was the first to use the term shell shock. Both were advocates for a more humane treatment of soldiers and a recognition of the Ebook The psychiatric interview in clinical practice (3/E): Part 2ir suffering as real and not a result of cowardice or a preexisting moral weakness.Abram Kardiner, an American psychiatrist, worked with World War I vEbook The psychiatric interview in clinical practice (3/E): Part 2
eterans between 1923 and 1940. He carefully described Iris patients' symptoms and reported that many of these veterans had been admitted to psychiatriGọi ngay
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