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Biomedical subjects

T Nadelson

Publications and source records attributed to T Nadelson.

At least 19 recordsLinked to original sources
PubMed1996

Psychotherapy, revelation, science, and deep thinking.

Psychodynamic psychotherapy has evolved in the 30 years since John Nemiah was the author's mentor in the endeavor. It has always occupied an epistemologic position somewhere between the scientific standard of physics and the postmodern or poststructuralist view that the search for truth using language is totally futile. However, the awkward niche that psychotherapeutic practice occupies is closer to literary imagination than "hard science." The use of such imagination was presented 25 years ago by John Nemiah in his paper on "Deep Thinking." The poet's "revelation ... not discovered by the rational intellect alone" often imparts in psychotherapeutic practice a compelling urgency toward a previously unrealized choice. Such vision is, however, always located at the periphery of acceptable scientific theory. Psychotherapists persist, often with doubts, because their place is reflective of humanity's awkwardness. Evolution and civilization mutually enfold the human ability to resonate to the anguish of others as well. A species altruism directed toward repair of human problems is coupled with the skills of affectively linked "deep thinking." There is a continuing marginalization of such efforts, which now need to be cared for deeply.

Humans↗
PubMed1989

Chronicity. Adjustment differences of Vietnam combat veterans differing in rates of psychiatric hospitalization.

The study focuses on the frequency of inpatient care for patients with Posttraumatic Stress Disorder (PTSD). This factor, termed "chronicity," is, perhaps surprisingly, largely overlooked in many PTSD studies. The significance of chronicity was addressed through administration of Minnesota Multiphasic Personality Inventory (MMPI) to Vietnam Theater and Era veterans in an inpatient psychiatry service. MMPI scores were analyzed for two main effects: combat exposure and chronicity (i.e., number of inpatient psychiatry admissions). The results replicated research showing combat exposure is associated with greater maladjustment (i.e., higher MMPI scores). Moreover, chronicity also emerged as a significantly important variable: of all groups compared, Vietnam combat veterans higher in chronicity scored higher on MMPI clinical scales, particularly on scales Paranoia, Psychasthenia, and Schizophrenia, thereby (a) empirically establishing (a) the methodological point that number of admissions must be controlled and (b) the substantive point that chronicity is important in studies of PTSD.

Adaptation, Psychological↗
PubMed1987

The inhuman computer/the too-human psychotherapist.

There has been an understandable rejection by psychotherapists of any natural language processing (computer/human interaction by means of usual language exchange) which is intended to embrace aspects of psychotherapy. For at least twenty years therapists have experimented with computer programs for specific and general purpose with reported success. This paper describes some of the aspects of artificial intelligence used in computer-mediated or computer-assisted therapy and the utility of such efforts in general reevaluation of human-to-human psychotherapy.

Computers↗
PubMed1985

False patients/real patients: a spectrum of disease presentation.

This paper presents a synthesis of varying frameworks and value systems in which all patients are viewed by clinicians. A gradient of behaviors is arrayed which places disease simulation (Munchausen syndrome, malingering) at one end of a spectrum, with the other end anchored by 'real' disease. Between these two polarized opposites are placed the patients with 'psychological' origins to somatic presentations. These patients often called 'crocks' are somewhat different from those patients who present with disease simulation. Such patients are often referred to as 'crooks' in that they are absolutely false in their presentation and aware of such deception. The advantage of this particular schema is that it presents a gradient of behavior instead of isolated categorization. As such it is much more easily understood and used by clinicians and it presents the 'normal' and 'abnormal' within a single conceptual gradient instead of discreet categories.

Adult↗
PubMed1980

Multiple sclerosis and hysteria. Lessons learned from their association.

Four patients with organic neurological disease (multiple sclerosis) had additional major hysterical disability. Patients with unequivocal organic disease often have coexistent psychological disturbances. The preexisting personality, nature of the organic disease and its disability, and the psychosocial setting interact and create an illness whose components are difficult to separate. In some patients there are definite secondary gains from an illness. The combination of hysteria and multiple sclerosis serves as a model for the coexistence of organic and psychological disorders; it serves as an example of the general questions of how the sick deal with their infirmities and how the physician comprehensively deals with illness.

Adult↗
PubMed1980

The Oklahoma complex. A common form of conversion hysteria.

Hysteria is not a homogeneous illness. Some patients with symptoms of apparent neurological dysfunction develop a disability because they cannot cope with life's demands. This article calls attention to several hysterical patients who share similar histories. Treatment by a nonpsychiatric physician in these three cases consisted of simple emotional support and easing of responsibilities, ie, saying no for the patient. Recognition of the psychological state of some patients with hysterical symptoms, and administration of treatment that eases environmental stresses, can be effective.

Adult↗
PubMed1980

Engagement before alliance.

An approach to the psychotherapy of ego-depleted states or with morbid disease involves the commitment of the therapist far beyond a distant psychoanalytic stance. Engagement must occur before a therapeutic alliance and exploration of underlying issues can begin. The patient in a helpless state needs the therapist's concern (both by frequent visits and telephone), active participation with family, and occasionally medication. The 'all out' effort allows the patient to borrow some of the therapist's strength. Within this approach, one may expand or contract goals; many patients went on to further explorative work. This mode stands outside of many of the usual values and canons of psychoanalytic therapy, and many therapists need encouragement when they risk closeness with patients' desperation and/or disease.

Adaptation, Psychological↗
PubMed1979

The Munchausen spectrum: borderline character features.

In this paper the author presents a continuum of disease simulation that ranges from hysteria to malingering, with a range of relative unawareness to awareness of producing such deception. Focus is on the particular group of patients who consciously and repeatedly simulate disease. The frequency and form of such disease mimicry vary within such a group. A continuum in terms of frequency ranges from occasional adventures to the simulation of disease as the center of a person's life. Two groups of patients designated as exhibiting Munchausen Syndrome are defined within this continuum: (a) those who work (mostly as nurses or in other medical professions) and (b) those called "hospital hobos" --the more prototypical Munchausen patient. The author takes a somewhat different approach to Munchausen Syndrome in that it is viewed as a subgroup of the borderline character. Further, the often found exhortation for psychiatric treatment of Munchausen patients is reexamined, and caution regarding such zeal and its potential negative effects is registered.

Adult↗
PubMed1978

Sending the patient home.

Some patients become grossly disorganized during a hospital stay for medical illness. In the midst of a confusing medical picture, the unpredictable behavior of such patients causes great consternation among the medical or surgical staff. Families also become particularly anxious; their concern about the medical problem shifts to concern about the altered mental state. Physicians and family members frequently agree that such patients should continue their hospital stay past the point where medical attention per se is needed in order to regain control over the disturbed mental functioning. This paper presents an alternative therapeutic approach, suggesting that sending the patient home to a more familiar environment may result in improved psychological functioning. A model for viewing the interaction between 'constancies' in the brain/mind environment (particulary the hospital milieu) is presented. This model takes into account the facts of the internal regulatory mechanisms of the brain, the facts of illness and lack of the more familiar orienting cues in the environment.

Adolescent↗
PubMed1978

A person's boundaries: a meaning of skin disease.

This report attempts to broaden understanding of the psychological meaning of skin disease by describing patients' fantasies of healthy vs diseased skin. All disease states have emotional concomitants in ideas, attitudes, and fantasies--much at variance with what the clinician views in an "objective" focus. Skin disease particularly is invested with affectively charged ideas. The issue of "dirt" contained, in fantasy, by healthy skin is explored. Skin lesions are particularly difficult for many patients to master emotionally, because such lesions engender a sense of dirtiness--a feeling of lack of control over body contents.

Adult↗