Existential psychopathology


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A lecture given at the 1st international conference on humanistic and existential psychotherapy, Lima, Peru. I consider whether psychiatric diagnosis is consistent with an existential approach to psychotherapy, using the recent protests against the REMOVAL of the diagnosis Asperger's Syndrome from DSM 5 as an example

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Existential psychopathology

  1. 1. Existential Psychopathology: A possibleRelationship? (Psicoterapia Existencialy Psicopatología Clínica): ¿Una relaciónposible? Digby Tantam
  2. 2. First cousins of the Queen inhospital since 1941. Burke’sPeerage stated thatKatherine (below) died in 63,but she is still alive
  3. 3. Paralympic classification C14•  An IQ below 75•  Impairment in adaptive functioning - for example, social, domestic and communication skills•  The disability must have occurred before the age of 18
  4. 4. Jeffrey Ige C14 weight lifter
  5. 5. Gaze following andthe interbrain
  6. 6. Jessica Kingsley, 2012
  7. 7. Autism spectrum disorder, DSM5 criteriaA. Persistent deficits in social B. Restricted, repetitive patterns ofcommunication and social interaction behavior, interests, or activities asacross contexts, not accounted for manifested by at least two of theby general developmental delays, and following:manifest by all 3 of the following: 1.  Deficits in social-emotional 1.  Stereotypies reciprocity 2.  Routines and rituals 2.  Deficits in nonverbal communicative behaviors used 3.  Special interests for social interaction 4.  Hyper-or hypo-reactivity to 3.  Deficits in developing and sensory input or unusual maintaining relationships, interest in sensory aspects appropriate to developmental level (beyond those with of environment caregivers)
  8. 8. The relationship of social communication disorder and ASDSocial communication Autism spectrum disorderdisorderA. Persistent difficulties in pragmatics or A. Persistent deficits in socialthe social uses of verbal and nonverbal communication and social interactioncommunication in naturalistic contexts, across contexts, not accounted for bywhich affects the development of social general developmental delays, andreciprocity and social relationships that manifest by all 3 of the following:cannot be explained by low abilities in 1.  Deficits in social-emotionalthe domains of word structure and reciprocitygrammar or general cognitive ability. 2.  Deficits in nonverbal communicative behaviors B. Persistent difficulties in the acquisition and used for social interaction use of spoken language, written language, and other modalities of language (e.g., sign language) 3.  Deficits in developing and for narrative, expository and conversational maintaining relationships, discourse. Symptoms may affect comprehension, production, and awareness at a discourse level appropriate to developmental individually or in any combination that are likely to level (beyond those with endure into adolescence and adulthood, although caregivers) the symptoms, domains, and modalities involved may shift with age.
  9. 9. Impact of diagnosis: key themes and subthemes. Pitt L et al. Psychiatric Bulletin 2009;33:419-423©2009 by The Royal College of Psychiatrists
  10. 10. Theaut.com•  I will be ending the year with a series of posts that list 50 autistic people I found inspiring this year. Before beginning, I want to explain my reasons for doing so.•  My inspiration here was the Out100, a list of outstanding LGBT citizens produced yearly by Out Magazine. Being openly autistic, and not ashamed about it, is as revolutionary a concept today as Gay Liberation was in the 1970s. Each of the people on this list has come forward and said in public, "I am autistic." If youve never done that, you dont know how scary it is. You have probably not experienced what it is like to be ridiculed, marginalized, or ignored because you have been honest about your own brain. Most of these people do, and they deserve to be recognized for their bravery.
  11. 11. •  There is great consternation in Autismland over an article that just appeared in The New York Times (From www.theautcast.com). Dr. Fred Volkmar is sounding alarm bells over the proposed changes in how autism is approached by the DSM-V:•  “The proposed changes would put an end to the autism epidemic,” said Dr. Fred R. Volkmar, director of the Child Study Center at Yale University School of Medicine and an author of the new analysis. “We would nip it in the bud — think of it that way”.•  Why people should add their names to an online petition (2865 signatories) www.change.org/petitions/do-not-remove-aspergers-syndrome-and-other-autism-sub-types-from-dsm•  “… understanding and awareness about Autism spectrum disorders have only recently begun to increase. Individuals diagnosed with Aspergers have obtained some degree of understanding due to exploration of the condition on television shows like Parenthood. Removing this diagnosis from the DSM would undermine all of the progress that has been made in this regard”.
  12. 12. Pandya, A., C.Bresee, et al.(2011)."Perceivedimpact of thedisclosure of aschizophreniadiagnosis."Community MentHealth J 47(6):613-621.
  13. 13. Impact of diagnosisNational Alliance on Mental Illness: Schizophreniasurvey (http://www.nami.org/Content/NavigationMenu/SchizophreniaSurvey/Analysis_Living_with_Schizophrenia.htm)
  14. 14. http://aspieside.com/category/dsm5-changes/
  15. 15. Tucker, I. (2009). ""This is for Life": A Discursive Analysis of theDilemmas of Constructing Diagnostic Identities." Forum: QualitativeSocial Research 10(3): Article 24.•  3 respondents •  Relieved to have a diagnosis because ‘something wrong’ •  Negative identity
  16. 16. Meaning or demeaning: more or less reason for living•  Autonomy•  Agency •  That the world matters enough to act within it•  Identity •  That we matter enough to the world to be accorded a place
  17. 17. Does a diagnosis make you:•  More free?•  Less free?•  Personality disorder diagnosis never freed anyone
  18. 18. Autonomy•  “Our Life is compassed round with Necessity; yet is the meaning of Life itself no other than Freedom”(THOMAS CARLYLE Sartor Resartus II. ix, in Frasers Mag. Apr. 447/2
  19. 19. Agency•  "Autistic people have an innocence, a childlike quality, regardless of age or education. This is very obvious when we are anxious or upset...Our emotions are raw, immature and childlike. Nowhere is this more apparent than when we get excited."- Rudy Simone (Aspergirls, pg 46/48)
  20. 20. Schizophrenia:the Most Identity Complex People In The World By: decasanova1 http://www.experienceproject.com/stories/ Have-Schizophrenia/1544828Aspergian Pride advocates Firstly,I would like to say I am notrecognition and acceptance of the ashamed. I am not ashamedautistic community as an intelligent, because I believe having paranoidcompetent minority group with many thoughts,ideas,imaginations doesworthwhile qualities. This site contains not make me a crazy. Society thinkarticles and web links that present they work on a one way street,butpositive views of autistic identity as a let me tell you thats not the case.unique, meaningful culture and as a Life is a limitless directionalway of being. Here we affirm our intersect. So anyone sound minded knows that if you are listening to thestrengths, our joy in life, and the value monotonous people, than we theof our existence as capable, healthy, deviants refuse confinement overpurposeful individuals within the liberation. 4ways are better tonormal range of human variation. We understand than one(intersection). -are a part of creation in all its beauty Peaceand wonder.
  21. 21. Aspergian Pride intelligent, competentMinority groupworthwhile qualities.positive, meaningfulstrengths, our joy in life,healthy, purposeful individuals beauty and wonder.
  22. 22. Schizophrenia:the Most Complex People In The WorldBy: decasanova1http://www.experienceproject.com/stories/Have-Schizophrenia/1544828not ashamed having paranoid thoughts,ideas,imaginationsdoes not make me a crazyLimitlesswe the deviantsrefuse confinement
  23. 23. Identity•  Diagnosis should make it clearer what is ‘I’ and what is the problem I am grappling with •  Personality disorder does not allow room for the development of an unsullied identity •  ASD does—people with ASD sometimes have stronger identities than most
  24. 24. Agency•  Making the best future possible means: •  Removing unnecessary obstacles •  Cutting down those that cannot be removed •  Taking account of what cannot be cut down or removed•  Diagnosis should enable this distinction•  “When we are no longer able to change a situation, we are challenged to change ourselves.” Victor Frankl ‘Mans search for meaning’
  25. 25. Last thoughts•  DSM-5 neurobiological turn to be welcomed•  It’s not the diagnosis that conveys meaning, but the meaning that is given to the diagnosis•  Perhaps people with ASD are fortunate that there is no treatment•  They must face the challenge of adapting to their communicative impairment themselves