Biomedical subjects

D B Diamond

Publications and source records attributed to D B Diamond.

4 recordsLinked to original sources

PubMed1997

The fate of the ego in contemporary psychiatry with particular reference to etiologic theories of schizophrenia.

Despite its fruitfulness, the concept of the ego has fallen into disuse in contemporary psychiatry. It is the aim of this paper to explore the phenomenon of the decline of the concept of the ego by looking at the psychoanalytic theory of schizophrenia in which the ego is central and the genetic/neurochemical theory in which the ego is absent. Kuhn's (1970) explication of the competition of explanatory paradigms is utilized to frame this investigation and some of the factors involved in the displacement of the ego-oriented theory with the genetic/neurochemical theory are elucidated. Each theory is reviewed as to its theoretic and epistemological assumptions and its overall explanatory power. The psychoanalytic theory centers on the role of regression to an early state of ego development, and utilizes an intersubjective mode of data collection to describe developmental determinants of pathognomonic ego deficits. The genetic/neurochemical theory rests on the therapeutic outcome of neuroleptic treatment and family clustering of the illness. In failing to take into account data derived from intrapsychic, interpersonal, and cultural influences, the genetic/neurochemical theory is limited in its ability to provide a comprehensive understanding of the nature of schizophrenia. The ego-oriented theory gains significance at the border of these limitations. The concept of the ego is capable of integrating a wide range of biologic, developmental, and social influences that can account for the clinical phenomena of schizophrenia and should be restored to a central position in etiologic theories.

Adoption↗

PubMed1988

Psychologic conflict underlying bioethical dilemmas in a chronic disease hospital. Empathy, treatment refusal, and the role of the consulting psychiatrist.

Bioethical dilemmas concerning treatment refusal commonly arise in the chronic disease hospital setting. Psychologic conflict often underlies these dilemmas and the consulting psychiatrist's use of empathy in defining them is elucidated. The limits to empathy imposed by the clinical situation have significant implications for understanding the psychologic aspects of treatment refusal. The need for further study of the psychologic needs of patients in life-extended situations is advocated.

Adult↗

PubMed1987

Psychotherapeutic approaches to the treatment of panic attacks, hypochondriasis and agoraphobia.

Various theoretical orientations suggest different treatment approaches to the agoraphobic syndrome. In this paper a self-psychology formulation is applied to the treatment of panic attacks, hypochondriasis and agoraphobia. When these symptoms are viewed as manifestations of self-fragmentation, their treatment can be conceptualized as a process of improving self-cohesiveness. The initial management of symptoms sets in motion a self-object transference which is the foundation of treatment. As therapy proceeds, the defences against affect which are associated with a primary defect in anxiety regulation can be understood in the light of childhood reconstruction and worked through in the transference. The resultant restructuring of defences promotes an increased capacity to tolerate affects without the threat of self-fragmentation. Through this path a more durable self-cohesiveness is achieved.

Adaptation, Psychological↗

PubMed1985

Panic attacks, hypochondriasis, and agoraphobia: a self-psychology formulation.

The clinical and theoretical material presented points to the value of looking at the syndrome of panic attacks, hypochondriasis, and agoraphobia from a self-psychology perspective. From this vantage, the nature of the constellation of symptoms and its relationship to premorbid personality characteristics can be understood and a coherent view of the syndrome can be constructed. Phenomenologically and pathogenetically, panic attacks, hypochondriasis, and agoraphobia are related to states of self-fragmentation. Despite longstanding faulty anxiety-regulatory mechanisms, from which arises the vulnerability to self-fragmentation, a cohesive self may be formed in childhood through compensatory and defensive structures. If these structures are undermined, cohesion is lost and as the self experiences fragmentation, panic ensues. The panic state has far-reaching consequences by setting in motion a regression to a precohesive state and evoking powerful feelings as well as the need for selfobjects appropriate to that early troubled developmental period. Hypochondriasis and agoraphobia arise out of this regressed matrix: hypochondriasis as a somatic representation and elaboration on the state of self-fragmentation, and agoraphobia as a defense against and an attempt to repair self-fragmentation. Transference phenomena during the treatment of patients with the syndrome can best be understood in the light of this formulation.

Adult↗