Sigmund Freud and Psychoanalysis

Born Sigismund Schlomo Freud in Freiberg, Moravia, Freud was openly his mother’s favorite child; she called him “Golden Siggie.” When Freud was four years old, the family moved to Vienna and Sigismund became Sigmund. Sigmund completed a medical degree and in 1886 he opened a medical practice specializing in neurology, and married Martha Bernays. Eventually, he developed the “talking cure” that was to become an entirely new psychological approach: psychoanalysis.

In 1908, Freud established the Psychoanalytic Society, which ensured the future of his school of thought. During World War II, the Nazis publicly burned his work, and Freud moved to London. He died by assisted suicide, after enduring mouth cancer.

Key works
1900 The Interpretation of Dreams
1904 The Psychopathology of Everyday Life
1905 Three Essays on the Theory of Sexuality
1930 Civilization and Its Discontents”

The Fight, Flight or Freeze Response

The fight or flight response has been around as long as human beings have been around. It’s the body’s hardwired alarm system. If you think of the human body as a computer, the fight-­or-­flight response is an essential part of the operating system. You couldn’t really function (or live that long) without it.

When you encounter a dangerous or threatening situation, this alarm system goes off, and your body goes through a number of changes. For example, during the fight-­or-­flight response, you may experience the following symptoms:

  • An increase in heart rate
  • Perspiration or sweating
  • Narrowing of field of vision (also called “tunnel vision”)
  • Muscle tension
  • Sensitive hearing
  • Racing thoughts
  • Shortness of breath
  • Goose bumps
  • Dry mouth

These experiences aren’t random; they all serve a very important purpose. They prepare you for immediate action. They are preparing you either to flee the situation to avoid any harm or to fight if escape is not possible. In situations where fleeing or fighting is not necessarily a good option, your body may also freeze (kind of like a deer caught in a car’s headlights).

This response is automatic. It occurs without thinking. This is important because it allows you to respond quickly when you are in a dangerous situation. For example, let’s say that you are walking through the woods and come across a bear. Your fight-­or-­flight response will be activated, and you will likely freeze or flee. The sudden and automatic changes that your body goes through will help keep you alive in this dangerous situation. Now, if you had to think about the situation before the fight-­or-­flight response was activated, you would waste precious time. You would have to evaluate the size of the bear and the sharpness of its claws and teeth. And, by the time you figured all of that out, you would probably be supper for the bear! Therefore, the fight-­or-­flight response is incredibly helpful and adaptive. We likely wouldn’t be alive as a species today without it.

Sources: The Dialectical Behavior Therapy Skills Workbook for Anxiety

What is Tardive dyskinesia?

Tardive dyskinesia (TD) is a neurologic disorder associated with the long-term use of certain medications (dopamine receptor-blocking agents) for some types of mental illnesses, such as major depressive disorder, bipolar disorder, and schizophrenia. TD causes involuntary movements of the body such as facial-tics, rapid eye blinking, sticking out of the tongue, lip pursing, and jaw clenching.

Some people experience involuntary twitching and jerking of their arms, legs, or torso. In this video, Lauren shares her personal experience with TD, and also sits down with Dr. Leslie Citrome, a psychiatrist and Clinical Professor of Psychiatry and Behavioural Sciences at New York Medical College, and who specializes in tardive dyskinesia.

Anxiety or Panic?

We, as humans, need anxiety. Why? Anxiety is information.

It tells us when we must freeze, flee, or fight and mobilizes our body to respond quickly, without thinking. Without anxiety, we would not be able to avoid real threats to our well-being.

However, we also feel anxiety about imagined threats that may or may not be meaningful or real. In a sense, our minds have evolved to be extra careful about threat detection. They are more likely to evaluate things as threats than not. This way we do not miss anything that might harm us.

Also, our minds do not have an “off button.” This means that sometimes anxiety becomes a problem because it doesn’t give us useful information and contributes to our distress and avoidance.

All humans experience anxiety when they experience stressful events, such as receiving an upsetting medical diagnosis. Public speaking, social events, relationship problems, stress on the job, and financial worries are also common triggers that make people feel anxious. However, sometimes life events can trigger anxiety disorders or panic disorder. So, what’s the difference?

Example 1:

Your social media feed is full of divisive political talk, there are risks of layoffs due to the decimated economy, and there seems to be no clear end in sight.

In the meantime, you have a project deadline tomorrow.

You feel stressed, squeezed, and overwhelmed. You feel tired and worried, unsure about what the future holds, whether you will get done what you need to do, whether you will help your child cope with it all.

Example 2:

It is the middle of the night, and you can’t go to sleep. Your thoughts are racing.

What if …? Your mind can’t stay away from the stream of catastrophic worries that keep circling. Your heart pounds. You’re exhausted. You look at the clock—it’s 3:15am.

Example 3:

You’re out with your friends at a restaurant, laughing at a joke one has just told.

All of a sudden, there’s a sensation of your blood rushing to your ears, and your heart rate accelerates. Your hands are clammy, and you wonder whether you’re having a heart attack.

Intense fear grips you, and you feel the urge to leave, to escape the situation. You get up without excusing yourself and run for the door.

Understanding the differences between naturally occurring anxiety, worry, and panic can help people take steps to address their feelings. Knowledge of these conditions can also help individuals recognize if their condition is serious enough to require treatment.

Example 1: A Normal Level of Anxiety

This describes an individual experiencing very natural, understandable anxiety around a challenging situation. Fear of an uncertain future, memories of a difficult past, threats (both real and perceived), and confusion about the world around us are all triggers for anxiety.

Example 2: A Concerning Level of Anxiety

The second example describes an individual experiencing worry and depending on the level of distress and functional impairment caused, may indicate that treatment for anxiety might be helpful.

Worry is a mental activity that, somewhat counterintuitively, functions as an anxiety avoidance strategy, though it’s one that doesn’t work very well. It’s hard to simply stop worrying.

Typically, when individuals find themselves stuck in a worry cycle, learning acceptance and mindfulness skills from acceptance-based behavior therapy can be useful.

Example 3: Panic

This is an individual experiencing a panic attack. Panic attacks are rarer and more severe than anxiety. They can come out of the blue, without warning or provocation.

People having panic attacks can experience shortness of breath, dizziness, nausea, and numbness. Some shake and sweat. Individuals struggling with panic often are very watchful for the physical sensations that might be harbingers of panic and avoid places where panic attacks may have occurred in the past. Sometimes those struggling with panic avoid leaving their homes at all.

The good news is that panic disorder is highly treatable with exposure therapy.

Sources: McLean Hospital

Dealing With Trauma Triggers

Most of us are aware of the larger trauma triggers. We can recognize some of the people, places, and things that harmed us, and do our best to avoid them all. For example, if our trauma had something to do with the beach we can avoid any area with sand or any sounds of the beach. We can sit down with our therapist and make a list of all of the things that we know trigger our trauma response or bring us back to those frightening events. But what about the unconscious triggers? The ones we don’t recognize, and often find upsetting us, pulling us into flashbacks and causing us to dissociate.

Schizoaffective Disorder: What are Hallucinations?

Hallucinations are a psychotic symptom of schizoaffective disorder. People experiencing hallucinations may hear, see, smell, taste or feel things that aren’t really there, and which other people can’t hear, see, smell, taste or feel.

Auditory hallucinations are the most common type of hallucination. They are mostly experienced as voices. To a person with schizoaffective disorder, these voices sound just like people speaking to them, and people with the illness cannot differentiate between what is real – for example a friend speaking to them – and what is a hallucination.

Voices might be heard in the second person – for example someone saying “you stink”, “you’re ugly”, “they hate you”. Sometimes voices might command a person to do something – by saying, for example, “jump off the bridge”, “take an overdose”. People with schizoaffective disorder may also have third person hallucinations, which commonly take the form of two or more voices talking among themselves or commenting on the person’s behaviour. Third person hallucinations are common in both schizoaffective disorder and schizophrenia, but are seen less frequently in bipolar disorder.

In most cases the experience of auditory hallucinations in the form of voices is unpleasant. Voices are frequently accusatory, reminding the person of past misdeeds, some imaginary, and some real. However, in a minority of cases, voices can be pleasant or even helpful.

In addition to voices, auditory hallucinations can involve noises, such as buzzing, screeching and ringing. Additionally, people with schizoaffective disorder may think that their own thoughts are being broadcast, or can be heard by other people. They may also think that other people’s thoughts are being forced into their own minds, or that their thoughts have been stolen from their heads.

Hallucinations of all five senses may be experienced. In addition to auditory hallucinations, people may have tactile hallucinations – such as feeling as though you are being pushed, touched or held down – visual hallucinations – such as seeing things that aren’t there or feeling that colours are brighter than they should be – hallucinations of smell and hallucinations of taste.

Visual hallucinations occur much less frequently than auditory hallucinations, and are more common in conjunction with auditory hallucinations – for example seeing and hearing someone who no one else can see. Hallucinations of smell and taste are more unusual and tend to focus on things tasting or smelling different than usual. This can lead to people with schizoaffective disorder thinking that their family and friends are trying to poison them.

Sources: Schizoaffective Disorder Simplified

Francis Galton and the Nature vs. Nurture Debate

Francis Galton counted many gifted individuals among his relatives, including the evolutionary biologist Charles Darwin. So it’s not surprising that Galton was interested in the extent to which abilities are either inborn or learned. He was the first person to identify “nature” and “nurture” as two separate influences whose effects could be measured and compared, maintaining that these two elements alone were responsible for determining personality. In 1869 he used his own family tree, as well as those of “judges, statesmen, commanders, scientists, literary men… diviners, oarsmen, and wrestlers,” to research inherited traits for his book Hereditary Genius. As predicted, he found more highly talented individuals in certain families than among the general population. However, he could not safely attribute this to nature alone, as there were also conferred benefits from growing up in a privileged home environment. Galton himself grew up in a wealthy household with access to unusually good educational resources.

Galton proposed a number of other studies, including the first large survey by questionnaire, which was sent out to members of the Royal Society to inquire about their interests and affiliations. Publishing his results in English Men of Science, he claimed that where nature and nurture are forced to compete, nature triumphs. External influences can make an impression, he says, but nothing can “efface the deeper marks of individual character.” However, he insists that both nature and nurture are essential in forming personality, since even the highest natural endowments may be “starved by defective nurture.” Intelligence, he says, is inherited, but must be fostered through education.

In 1875, Galton undertook a study of 159 pairs of twins. He found that they did not follow the “normal” distribution of similarity between siblings, in which they are moderately alike, but were always extremely similar or extremely dissimilar. What really surprised him was that the degree of similarity never changed over time. He had anticipated that a shared upbringing would lessen dissimilarity between twins as they grew up, but found that this was not the case. Nurture seemed to play no role at all.

The “nature—nurture debate” continues to this day. Some people have favored Galton’s theories, including his notion—now known as eugenics—that people could be “bred” like horses to promote certain characteristics. Others have preferred to believe that every baby is a tabula rasa, or “blank slate,” and we are all born equal. Most psychologists today recognize that nature and nurture are both crucially important in human development, and interact in complex ways.

Sources: The Psychology Book (DK)

Identify Your “Triggers”

Each person has specific types of situations that set their automatic negative path in motion; these are their triggers. To address your problems, you need to know which situations are difficult and trigger your negative path.

While many people are aware of their triggers, some have trouble identifying their specific trigger situations. For example, a person may tell you that they are “always” sad, or “always” drink too much, and can’t identify specific problematic situations. Identifying your triggers helps you start to see patterns and then know what to focus on in therapy.

A helpful first step is to monitor your problematic feelings or behaviors and see if there are some situations where your feelings are stronger or your behavior is more extreme. For example, a person came to therapy because they were always angry. When asked for examples of specific situations, they responded that they were angry “all the time.” The first homework assignment was to monitor their angry feelings and see when they were strongest. They came back having discovered that they were the most angry when their teenage son didn’t do what they wanted him to do; for example, when he did his homework at 2 a.m., broke curfew, or did not do his chores. They discovered that their anger toward her son was spilling over into the rest of her life.

Frequently, people will describe their trigger situation in vague terms, and don’t really understand what happened. They need to become more specific and concrete. A specific and concrete description includes what happened, with whom, and the specific time and place it occurred. For example, a vague description of a situation would be “My partner doesn’t respect my work”; a more concrete and specific description would be “My partner told me that they thought their work was more important than mine.”

The more specific and concrete your description of the situation, the more you will be emotionally engaged with the situation, and the more you will have access to your feelings and thoughts. Think of someone you are a little annoyed with. Now, think of a specific situation when you were annoyed with this person. Try to remember the situation in detail. Chances are that as you thought about a specific situation, you became more annoyed and your feelings and thoughts became more immediate.

Sometimes your situation is a long, complicated story. In this case, consider the whole story and then ask what was the worst or most difficult part for you. It is helpful to identify a situation that lasts from a few seconds to three minutes, any longer and you will probably have a large variety of feelings and thoughts, and it will be hard to focus on the main ones.

Sources: CBT Made Simple

A Structured Cognitive Behavioral Therapy (CBT) Session

A structured session means that there is an order and organization to the therapy session. Here is a brief overview of the five basic components.

Check in. This is a quick update on what has happened since the previous session and includes a bridge to that session.

Set the agenda. You and your therapist decide together which problems to focus on in the current session. Homework from the previous session can be reviewed during the check-in or as part of the agenda-setting process.

Work the agenda. This involves addressing the identified problems on the agenda.

Homework. You and your therapist collaborate to develop homework for the following session.

Review. At the end of the session you briefly review with your therapist what was covered in the current session and give feedback.

Sources: CBT Made Simple

Humorism and the Four Personality Types

The Roman philosopher and physician Claudius Galen formulated a concept of personality types based on the ancient Greek theory of humorism, which attempted to explain the workings of the human body.

The roots of humorism go back to Empedocles (c.495–435 BCE), a Greek philosopher who suggested that different qualities of the four basic elements—earth (cold and dry), air (warm and wet), fire (warm and dry), and water (cold and wet)—could explain the existence of all known substances. Hippocrates (460–370 BCE), the “Father of Medicine,” developed a medical model based on these elements, attributing their qualities to four fluids within the body. These fluids were called “humors” (from the Latin umor, meaning body fluid).

Two hundred years later, Galen expanded the theory of humorism into one of personality; he saw a direct connection between the levels of the humors in the body and emotional and behavioral inclinations—or “temperaments.”

Galen’s four temperaments—sanguine, phlegmatic, choleric, and melancholic—are based on the balance of humors in the body. If one of the humors develops excessively, the corresponding personality type begins to dominate. A sanguine person has too much blood (sanguis in Latin) and is warm-hearted, cheerful, optimistic, and confident, but can be selfish. A phlegmatic person, suffering from excess phlegm (phlegmatikós in Greek), is quiet, kind, cool, rational, and consistent, but can be slow and shy. The choleric (from the Greek kholé, meaning bile) personality is fiery, suffering from excess yellow bile. Lastly, the melancholic (from the Greek melas kholé), who suffers from an excess of black bile, is recognized by poetic and artistic leanings, which are often also accompanied by sadness and fear.

According to Galen, some people are born predisposed to certain temperaments. However, since temperamental problems are caused by imbalances of the humors, he claimed they can be cured by diet and exercise. In more extreme cases, cures may include purging and blood-letting. For example, a person acting selfishly is overly sanguine, and has too much blood; this is remedied by cutting down on meat, or by making small cuts into the veins to release blood.

Galen’s doctrines dominated medicine until the Renaissance, when they began to decline in the light of better research. In 1543, the physician Andreas Vesalius (1514–1564), practicing in Italy, found more than 200 errors in Galen’s descriptions of anatomy, but although Galen’s medical ideas were discredited, he later influenced 20th-century psychologists. In 1947, Hans Eysenck concluded that temperament is biologically based, and noted that the two personality traits he identified—neuroticism and extraversion—echoed the ancient temperaments.

Sources: The Psychology Book (DK)