Psychotic break

The Black Oil

To me, this seems to be one of those terms that's used in popular culture, a short hand way of throwing in some supposedly fancy psychobabble without alienating the audience. Psychosis is a real condition, but is the notion of a 'psychotic break' genuine? If not, what is a better description - a trigger that leads to psychosis?

JuliusCaesar

Do you mean a psychotic episode? Yes, people can have a psychotic episode, recover, and never have psychosis again.

Odysseus

My initial thoughts would be that when I hear the term psychotic break it signifies a leading in to a genuine psychosis, psychosis episode being something that can happen to someone who is not psychotic. Though psychosis for me is a structural diagnosis rather than a series of symptoms. I would use the term trigger too as in something triggering the psychotic break/episode.

Do you see the term break as problematic? I wouldn't see it as psychobabble or used incorrectly like when people refer to schizophrenia as some type of split personality disorder.

Kooli

I'd think of it as a 'psychotic episode' too.

One phrase I always struggle with in terms of popular culture is 'nervous breakdown' - I'm still not sure what that actually means!

Valmont

Odysseus wrote: »

Though psychosis for me is a structural diagnosis rather than a series of symptoms.

What do you mean here? It looks like psycho-babble to my unaccustomed eyes!

Odysseus

Valmont wrote: »

What do you mean here? It looks like psycho-babble to my unaccustomed eyes!

As you know I a psychoanalyst, psychoanalytic psycho diagnostics well Lacanian ones refer to a structual diagnosis, reather than the ICD DSM type. We still use the three structures neurosis, psychosis, and perversion.

A quote by Fink:
“…to go beyond weighing the relative importance of certain clinical characteristics, comparing them with lists of features in manuals such as the DSM-IV, and to focus instead on a defining mechanism-that is, a single determinant characteristic. For, as Freud was wont to say, repression is the cause of neurosis. In other words, repression is not simply associated with neurosis; it is constitutive of neurosis. One becomes neurotic due to repression. Similarly, Lacan puts forward a causal argument: foreclosure is the cause of psychosis. It is not simply associated with psychosis; it is constitutive of psychosis”. [Fink 1997:


Hence psychosis is caused by a mechansim called foreclosure and pereversion by one called disavowal. These all being ways we negoigate the odeipal situation and enter the world of language. May this could be continued on the psychoanalysis thread if of course you are interested, I don't want to over take this one on psychoanalytic theory.

Does that answer you question?

Kooli

Odysseus wrote: »

As you know I a psychoanalyst, psychoanalytic psycho diagnostics well Lacanian ones refer to a structual diagnosis, reather than the ICD DSM type. We still use the three structures neurosis, psychosis, and perversion.

A quote by Fink:
“…to go beyond weighing the relative importance of certain clinical characteristics, comparing them with lists of features in manuals such as the DSM-IV, and to focus instead on a defining mechanism-that is, a single determinant characteristic. For, as Freud was wont to say, repression is the cause of neurosis. In other words, repression is not simply associated with neurosis; it is constitutive of neurosis. One becomes neurotic due to repression. Similarly, Lacan puts forward a causal argument: foreclosure is the cause of psychosis. It is not simply associated with psychosis; it is constitutive of psychosis”. [Fink 1997:


Hence psychosis is caused by a mechansim called foreclosure and pereversion by one called disavowal. These all being ways we negoigate the odeipal situation and enter the world of language. May this could be continued on the psychoanalysis thread if of course you are interested, I don't want to over take this one on psychoanalytic theory.

Does that answer you question?

Can you put that in layman's terms? That makes literally no sense to me.

JuliusCaesar

Kooli wrote: »

One phrase I always struggle with in terms of popular culture is 'nervous breakdown' - I'm still not sure what that actually means!

Me too. I figure it's a phrase used by the general public to mean some sort of mental distress and/or inability to cope.

Odysseus

Kooli wrote: »

Can you put that in layman's terms? That makes literally no sense to me.

I'll try. Ok, psychoses are either schizophrenia of which IIRC there are 27 subtypes in the ICD-10 , and delusional disorder leaving aside the notion of drug induced disorders. The general criteria for these disorders are made by the presence or absence of certain symptoms and a certain amount of symptoms need to be present for a disorder to be met. Now that is over simplifying it a tad, but that is the gist of it.

Now with psychoanalysis a diagnosis is met by an analysis of the person’s speech, it was the original talking therapy; and the modality of transference. The transference will be different say between a neurotic and a psychotic; as will their speech.

However, as you know there are different schools of psychoanalysis I would draw heavily upon Lacan's reading of Freud. Lacan was very much interested in structural anthropology and structural linguistics, hence the dictum of “the unconscious is structured like a language”, Freud's concepts of condensation and displacement are seen in linguistic terms as metaphor and metonym. The Oedipus complex is seen in linguistic terms too.

As we negotiate the oedipal situation we are seen as entering the world of the symbolic, of language. We come through Oedipus either by repression, foreclosure or disavowal. This will leave us either as neurotic, psychotic or perverse. These are considered ways of being in the world not value judgements say with a perverse structure.

So the three structural diagnoses being neurosis, psychosis, and perversion, say within neurosis you have hysteria, obsessional neurosis, and phobias. So rather than basing a diagnosis on whether certain symptoms are present, we are listening for evidence of say repression being present, with neurosis the repressed always returns, slips of the tongue, dreams etc. In psychosis repression did not occur and foreclosure can be seen within the transference and the use of language will be different. Visual hallucinations can be present in say hysteria whereas with the ICD it would be more associated with schizophrenia.

A long post and a gross simplification, but in general does that make it a tad clearer? As I said above I am happy to continue this if you are interested but maybe in the psychoanalysis thread, I don't want to derail this one.

Are you familiar with Freud and Lacan?

Odysseus

JuliusCaesar wrote: »

Me too. I figure it's a phrase used by the general public to mean some sort of mental distress and/or inability to cope.

Yeah it a type of catch used to signify some form of psychical/mental problem really. One of those that says nothig really as it can meant anything.

Odysseus

Another one that gets me is clinical depression, what is that? I can understand patients and the gereral population to a certain degree. However, when a clients come and says my GP told me I have clinical depression. It does baffle me???

JuliusCaesar

Odysseus wrote: »

Another one that gets me is clinical depression, what is that? I can understand patients and the gereral population to a certain degree. However, when a clients come and says my GP told me I have clinical depression. It does baffle me???

That's easy; it means a real, necessitating treatment depression, rather than just feeling ticked off for a few days. It distinguishes a disorder from a transient mood. "I'm totally depressed" is totally misused to describe any small upset. :rolleyes:

Odysseus

JuliusCaesar wrote: »

That's easy; it means a real, necessitating treatment depression, rather than just feeling ticked off for a few days. It distinguishes a disorder from a transient mood. "I'm totally depressed" is totally misused to describe any small upset. :rolleyes:

I know what your saying JC, but what I mean is it is not an actually diagnosis, like it is not contained within DSM, ICD. I have heard some people use it to mean that it signifies a depression which is biological based.

The Black Oil

JuliusCaesar wrote: »

Do you mean a psychotic episode? Yes, people can have a psychotic episode, recover, and never have psychosis again.

Hmm, possibly. But I don't know if episode means it has a beginning, middle and end, unless there's another way of looking at it.

Odysseus wrote: »

Do you see the term break as problematic? I wouldn't see it as psychobabble or used incorrectly like when people refer to schizophrenia as some type of split personality disorder.

Problematic? Maybe a little bit because TV stuff often doesn't elaborate and I guess in my head break sounds like snapping or crashing to the extent that something can't be repaired or healed. I don't know if TV scripts mean that the break is the key point in the psychosis or a symptom.

Kooli wrote: »

One phrase I always struggle with in terms of popular culture is 'nervous breakdown' - I'm still not sure what that actually means!

Hah, yes. I take it to mean super stressed to the point it causes problems, I guess.

Odysseus wrote: »

Another one that gets me is clinical depression, what is that? I can understand patients and the gereral population to a certain degree. However, when a clients come and says my GP told me I have clinical depression. It does baffle me???

What is there - depression, manic, recurring depression, er?

JuliusCaesar

Odysseus wrote: »

I have heard some people use it to mean that it signifies a depression which is biological based.

What is a biologically-based depression?

Odysseus

JuliusCaesar wrote: »

What is a biologically-based depression?

I know, but you not going to put a spotlight on the patient over this. Generally it is followed by "I have been told I have a chemical imbalance":rolleyes:

The Black Oil

JuliusCaesar wrote: »

What is a biologically-based depression?

Question for Leaving Cert Psychology, 2013? :pac:

JuliusCaesar

Odysseus wrote: »

Generally it is followed by "I have been told I have a chemical imbalance":rolleyes:

No, I don't get much of that at all. In fact I can't remember the last time a client said anything of the sort to me.

Valmont

JuliusCaesar wrote: »

No, I don't get much of that at all. In fact I can't remember the last time a client said anything of the sort to me.

That may be so, but the opinion that depression is a biological condition inflicted on people against their will, much like an actual disease is pervasive. Does the biopsychosocial model not promulgate this theory?

JuliusCaesar

No, it doesn't Valmont. You're forgetting the 'psycho' and the 'social' in that. It's basically saying that it's multifactorial and we can't know for sure which factors exactly are involved in this episode in this individual. However, we do know that we can treat it, especially with a combination of anti-depressant/anti-psychotic medication and CBT. Oh, and ask the Social Worker to look at helping the person sort out finances/benefits, accommodation and maybe family issues. We'll also in therapy ask and talk about issues of gender, class, minorities etc if relevant. There you go: the biopsychosocial model in action. And we do generally come at it from a recovery perspective.

Valmont

JuliusCaesar wrote: »

You're forgetting the 'psycho' and the 'social' in that. It's basically saying that it's multifactorial and we can't know for sure which factors exactly are involved in this episode in this individual. However, we do know that we can treat it, especially with a combination of anti-depressant/anti-psychotic medication and CBT

So we can't know for sure if any one individual's depression is biologically based but we do know we can treat it with psychiatric medication? That doesn't add up. And considering there are no diagnostic tests to objectively determine the presence of biological depression, why include the bio in the biopsychosocial model at all?

JuliusCaesar

Well, Valmont, if you can't live with a LOT of uncertainty, the clinical end of psychology will not be attractive to you at all. We might think that medicine is full of certainty, but the more more you know, the more you realise that the less you know, and that goes treble if not more for psychology.

Valmont

JuliusCaesar wrote: »

Well, Valmont, if you can't live with a LOT of uncertainty, the clinical end of psychology will not be attractive to you at all. We might think that medicine is full of certainty, but the more more you know, the more you realise that the less you know, and that goes treble if not more for psychology.

I understand how this uncertainty is inherent when practising psychology. However, the definition of the area as 'clinical' and as a 'science' (and the implied precision that goes hand in hand with such terms) seems to be in glaring contradiction of the reality, so I'm not sure why the medical pretense is kept up? For example, talking about mental 'illness' and brain 'diseases'? It looks like an attempt to borrow some of the scientific acumen naturally present in the traditional concept of disease to make psychology and psychiatry seem more accurate and precise when they are anything but.

JuliusCaesar

Yes, but I as a psychologist don't talk about mental illness or disease. I talk about disorders, about dysfunctional approaches to problems. Most disorders are due to the person trying to cope, but using ways which backfire. As Steve Hayes (ACT) says, it's the attempt to get away from unpleasant emotions which causes most disorders.

Psychology and psychiatry are not always on the same page at all!

Valmont

JuliusCaesar wrote: »

Psychology and psychiatry are not always on the same page at all!

What is it like working in a team with a psychiatrist given the divergence in professional opinion? If you're saying dysfunction and they're saying disease, how does this work for the patient if he/she might be receiving conflicting information?

Odysseus

Valmont wrote: »

What is it like working in a team with a psychiatrist given the divergence in professional opinion? If you're saying dysfunction and they're saying disease, how does this work for the patient if he/she might be receiving conflicting information?

I'll answer from my side where there is even more difference, my consultant never even heard of Lacan. I just take care of my side of things, getting the patient to put words on things. Confer when necessary of course, JC's experencev will differ of course.

JuliusCaesar

Valmont wrote: »

What is it like working in a team with a psychiatrist given the divergence in professional opinion? If you're saying dysfunction and they're saying disease, how does this work for the patient if he/she might be receiving conflicting information?

It depends very much on the psychiatrist*, but in general it works out fine. Pragmatically, we all want the client to get better, and different means will be better for different clients. The main thing is that we all as team members have our own areas of expertise to contribute, whether SW, OT, or whatever. We meet, we discuss, we work, and hopefully the client will feel the better for our various contributions.

We don't tend to argue dysfunction/disease, but rather what we think would be best for that client at that time. Clients don't tend to arrive with one problem, but many; they are not just depressed, but they have a job they hate, housing that's unsuitable, in need of input from a few or many of us. And of course they also have opinions on how they'd like to be treated, which we take into account. But if there's a 6 month waiting list for psychology, then maybe the day centre with a key nurse and group therapy and OT will be useful in the meantime.

*I can't actually recall having a problem with any consultant psychiatrist over the years...not even the psychoanalytically inclined ones!