This page has been translated into Swedish by Eric Karlsson
The anxiety disorders are the most common
disorders. Nearly all of us know someone, or have suffered
from a panic attack or a phobia. At very least, most of us get
nervous when we are standing in front of a crowd of people who expect
us to say something intelligent or, if nothing else, amusing.
Anxiety is at the root of many, if not
all, of our psychological
disorders. It is, physically, a kind of fear response, involving
the activation of the sympathetic nervous system, in response to a
dangerous situation. More specifically, anxiety is the
anticipation of danger, learned through repeated stress or
trauma. Some people are innately more sensitive to stress, and so
are more likely to experience anxiety and develop anxiety
disorders. But everyone becomes sensitized to stress and trauma
with repeated experiences: Each experience "tunes" the nervous
system to respond more quickly and more profoundly to perceived danger.
We often talk about anxiety as some sort
of genetic issue, and also as
something based on traumas in childhood. But long term stress
is probably more often the root of anxiety disorders. The
constant demands of living in poverty, discrimination, war, and abuse
are a part of daily life for millions of people around the world.
There are basically five ways in
which people respond to
unrelenting stress and trauma and the anxiety that comes with them:
Panic attacks are pretty intense. You know if you have
begin to sweat, tremble, get dry mouth or sick to your stomach. You may
start breathing heavily or feeling palpitations or even chest
You feel like you are going to go crazy, lose control, or even
Some of you may have experienced a bit of this when you first had to
give a speech or be in a play.
Panic disorder is what we call a fairly regular history of panic
attacks. This can be quite debilitating and lead to other
including agoraphobia, below. People who develop panic disorder
to do so early, in adolescence or young adulthood, and it is about
twice as common among women.
Panic attacks are themselves traumatic, and so lead to increased
anxiety, which makes the person more vigilant and more likely to
misinterpret situations as well as bodily symptoms, and so have more
panic attacks. They are the classic example of anticipatory
afraid of having a panic attack is the very thing that causes the panic attack!
Agoraphobia is literally Greek for "fear of the marketplace," but is
now understood as an anxiety disorder that prevents people from leaving
some area that they feel secure in. A common form is the
leave one's home. Some people are even restricted to a couple of
within their homes. Others can leave their homes but are
some real or imaginary boundaries, such as their home town or a border
two miles from home. Less severe versions involve a fear of
of being in a crowded place (that marketplace).
It occurs about twice as often among women than among men. Since 95%
of agoraphobics also have panic disorder, perhaps the two
categories are really only one.
When most people think about anxiety disorders, they think about
specific phobias. A phobia is a strong but essentially irrational
of something. Common examples include snakes, rats, mice, dogs,
spiders, bees, insects in general, heights, enclosed spaces, flying in
airplanes, driving cars, storms, open water, injections, blood, and
clowns. (Personally, I think if you aren't afraid of clowns, you
crazy.) But there are literally hundreds more. Phobias
often start in
childhood, but also often start in one's twenties.
Phobias can be understood in part as a matter of conditioned
fear: Strong anxiety or a panic attack is experienced at
time as the phobic object, and so becomes associated with that
More often than not, the panic is not a response to the phobic object
(snake, mouse, or spider), but rather to the loss of security
experienced when someone (such as your mom or dad) responds
dramatically to that object. If mom or dad is scared, I should be
It also seems that many phobias have a strong built-in
component. Many people are at least uncomfortable, if not phobic,
around snakes, mice, spiders, reptiles, dogs, heights, tight spaces,
birds. These things make us fearful even before we learn their
potential danger. These fears do make some sense, if you consider
the dangers these could have posed for our ancient ancestors. Of
course, it is not the figure of a bird, a snake, a spider, or a dog
that directly leads to
the fear response. It is rather the swooping motion, the
slithering, the unpredictable presence, the low growling noises, and so
Social phobia usually starts in childhood or
adolescence and often begins with an experience of embarrassment or
shame. Many of the same characteristics mentioned with the panic
attack are a part of social phobia. What differentiates social
from other phobias is that it revolves around - wait for it - social
situations, such as public speaking and performance. It is also
associated with a shy or introverted personality. It isn't easy
rid of social phobia and many people live with it their whole
On the other hand, many people simply avoid the situations that bring
it on and do quite well.
Social phobia is another example of anticipatory
expectation of social embarrassment causes the anxiety that leads to
social embarrassment... In the U.S., social phobia often begins
in early adolescence, when peers often humiliate shy children.
This is common in any highly competitive society like ours. Also,
people in lower social positions in a very hierarchical society (and
yes, ours is one) often find themselves victimized this way, and
developing social phobia.
In Japan, there is an interesting variation on social phobia called
taijin kyofusho. This
great anxiety that other people find your appearance, your face, and
your odor offensive.
Generalized anxiety disorder is - yes - the most general form of
the anxiety disorders. It is characterized by a long period
(technically, more than six months) of excessive worryings which
interferes with work and relationships. It often involves other,
physical, symptoms such as fatigue, tension, irritability, and
insomnia. It occurs about twice as often in women as in men.
In Latin America, some people suffer from something called nervios
("nerves"). They feel
a great deal of anxiety, insomnia, headaches, dizziness, even
palpitations. It usually begins with a loss of someone close, or
with family conflicts. Since family is everything in many
cultures, family problems are often at the root of psychological
Post-traumatic stress disorder occurs when people are faced with
stress beyond their ability to handle. Being mugged or raped, be
witness to an accident or murder, or experiencing war or refugee camps,
are examples. Rape victims and war veterans will sometimes try to
back to their ordinary lives, only to find that they are constantly
vigilant, experiencing flashbacks and nightmares, and unable to deal
with the ordinary demands of life. Work suffers, relationships
crumble. Unfortunately, the person with PTSD may resort to what
call self-medication, i.e. alcohol or drugs, to deal with the
course, these only add to the problem.
Many are severely depressed. There is also a degree of dissociation involved, meaning that victims become numb, detached, showing little emotion. They no longer feel real. Perhaps this is actually an adaptive response to traumatic stress. We find this kind of dissociation commonly in refugee populations, who can sometimes seem like zombies. They may simply be protecting themselves from further psychological pain.
PTSD appears to involve a number of problems with the hippocampus
which, if you recall, is devoted to moving short-term memories into
long-term storage. First, intensely emotional events lead to
intense memories called flashbulb memories. It seems that these
memories may actually be partially stored in the amygdala, which
accounts for the fearfulness involved. In addition, the prolonged
stress of experiences such as war or childhood abuse actually begins to
destroy tissue in the hippocampus, making it more difficult to create
new long term memories. Studies show that people who have
suffered long-term trauma have anywhere from 8 to 12% less
hippocampus. The net result could be that they are, in a sense,
stuck in their traumatic past.
About half of people with PTSD remit (get better) within 6
The rest may suffer with it for years, sometimes for life. Again,
is women who suffer most from this disorder. In addition to
genetic predispositions to anxiety, women are more likely victims of
Obsessive-compulsive disorder is a combination of - you guessed
it - obsessions and compulsions. An obsession is a thought that
can't seem to get out of your mind, sort of like a song or jingle, but
with more sinister effects. For example, a person may obsess
idea that they may harm themselves or someone else, or that a disaster
is about to occur. A common obsession is a concern with germs or
toxins. A compulsion is an act, usually repetitive, that the
finds themselves unable to resist, sort of like checking your alarm
clock more than once, or turning around to make sure the door you just
locked is truly locked. Again, the obsessions are more
people need to perform acts over and over, checking doors not once or
twice, but dozens of times; they may feel the need to touch each
parking meter they pass; they may need to put things in order of size
or alphabet. The most common compulsions relate to
people will wash their hands many times, even to the point of skin
damage and bleeding. Others will need to do the laundry
Others still will be unable to shake hands because of their fear of
The disorder is found in equal proportions in men and women, and
tends to start in adolescence and young adulthood. It is
some degree with tics and Tourette's disorder (multiple, sometimes
large, tics, and occasionally vocal grunts and barks or even swear
We are beginning to understand some of the brain activities
associated with OCD . The caudate nucleus (a part of the basal
ganglia near the limbic system) is responsible, among other things, for
urges, including things like reminding you to lock doors, brush your
teeth, wash your hands, and so on. It sends messages to the
orbital area (above the eyes) of the prefrontal area, which tells us
that something is not right. It also sends messages to the
cingulate gyrus (just under the frontal lobe), which keeps attention
focused, in this case on the feeling of something not being right and
needing to be done. It is believed that, in people with
OCD, this system is stuck on "high alert."
It should be noted that OCD responds fairly well to the same
medications (such as Prozac) that help people who are depressed, which
suggests that the seratonin pathways of the frontal lobe and limbic
system are involved, just as they are with depression. More
recently, scientists have discovered several genes that appear
to be strongly tied to OCD.
But don't think OCD is a purely physiological disorder! It
varies a great deal from culture to culture. In some cultures,
the behaviors are even seen as positive. Remember that there are
still all kinds of superstitious behaviors that people engage in today,
which are no different from compulsions. And, while being
obsessed with, say, germs is considered odd, being obsessed with, say,
football is considered perfectly okay in our culture!
The therapist should attempt to help the patient to relax and not fight the tendencies to repeat thoughts and actions. Further, the patient needs to come to recognize his temperamental inclinations towards perfection as fate and learn to accept at least a small degree of uncertainty. But ultimately, the obsessive-compulsive, and the anxiety neurotic as well, must find meaning. "As soon as life's fullness of meaning is rediscovered, the neurotic anxiety... no longer has anything to fasten on." (1973, p. 182)Hoarding
Hoarding can also be seen as a compulsion. People who collect objects, often of no value, to the point where their house or apartment is no longer a healthy place to live are the ones we worry about. A high risk of piles of paper catching fire, of falling over mounds of stuff, developing diseases from living with the feces of mice or rats, problems with insects such as bed bugs, allergic reactions to mold and mildew... the list of potential problems is endless.
Characteristic of hoarding is a degree of anxiety or even panic when one tries to rid themselves of something they've been "saving", or when others attempt to clean your place. Depression is another common associated problem, and contributes to a lethargy that makes any attempt at cleaning even more difficult. After all, it is likely to feel like an impossible task, once it is too far gone.
There are several other disorders that may initiate or contribute to hoarding. Obsessive-compulsive disorder is common, even though on the surface, a hoarding seems the very opposite of the hyper-orderly or super-clean person with OCD. Attention deficit may also contribute, as can psychosis and alcohol or drug dependency.
The other side of hoarding is the act of gathering things in the first place. Hyperactivity and the manic state of bipolar may contribute to buying sprees that get out of hand. Even a hobby, intended to be a calm diversion from the stresses of day-to-day life, can lead to, for example, a collection of tchotchkes that fills your house.
A related problem is the excessive collection of pets, sometimes to the point that you can no longer care for them or for yourself, and maintaining the cleanliness of your home becomes impossible. Pets are, not uncommonly, things that many people become obsessed with, perhaps as a need for affection. Our culture of separate, parallel lives can lead to a deep sense of isolation, which a dog or cat or a dozen or two of them seems to lessen.
As with all the psychological problems here discussed, these are not people to ridicule or shame. They can't help it - that's why we call it a disease!Similar disorders
We might also include hypochondriasis here (even though it is "officially" classified as a somatoform disorder). People with hypochondriasis (called hypochondriacs) are preoccupied with fears of having or getting a serious disease. Even after being told that they do not have the disease they are concerned about, they continue to worry. They often exaggerate minor abnormalities, go from doctor to doctor, and ask for repeated examinations and medical tests. A guess at prevalence of hypochondriacs is that it involves between 4% and 9% of the population.
A curious version of hypochondriasis is found in India, called
dhat. People with dhat suffer
from anxiety, fatigue, aches, weakness, depression, and so on - all
revolving around an obsessive concern with having lost too much
semen! We may laugh, but 100 years ago, westerners also believed
that a man has only so much semen to use in his life-time, and 50 years
ago, coaches would warn their players not to have sex the night before
a big game because it would drain them of energy. In the U.S.
today, people are obsessed with
aging to such a degree that they are willing to undergo surgery and
injections of poisons to appear younger - even though these activities
may actually decrease their life-span!
Three other disorders are similar to obsessive-compulsive disorder
(although officially categorized as impulse-control
Trichotillomania is the
“recurrent pulling out of one’s hair
for pleasure, gratification, or relief of tension that results in
hair loss.” (DSM IV) It is not restricted to hair on head,
and may even involve pulling out eyelashes.
Trichotillomania is often associated with stress, but sometimes occurs
while the person is relaxed as well. It usually starts in
or adolescence. 1 to 2% of college students report having had
at some time.
Kleptomania is the
“recurrent failure to
resist impulses to steal
objects not needed for personal use or monetary value.” (DSM IV)
The person knows it is wrong, fears being caught, and feels guilty
it, but can’t seem to resist the impulse. It is rare, but
more common among women than among men. It is, as you can
imagine, difficult to differentiate from intentional stealing!
Pathological gambling is
“recurrent and persistent
gambling behavior.” (DSM IV) We often call it compulsive gambling. A lot of
with it - superstition, overconfidence, denial. Pathological
tend to be people with a lot of energy who are easily bored, and the
urge to gamble increases when they are under stress. It may
1 to 3% of the population, and two thirds are men.
Depression is related, of course, to sadness. Sadness is a
response to difficult circumstances that cannot be resolved by running
away (that would be fear) or attacking the problem (that would be
anger). Instead, there is the sense that one must wait for the
problem to resolve by itself. In grief, for example, we
ultimately realize that only time will lessen the pain.
We consider sadness to have passed over into pathology when we lose
the sense that the pain will lessen. We continue to suffer, we
have guilt feelings, we dwell on the problem, we even try to shut down
our feelings altogether. Traumatic events such as the sickness or
death of a
loved one are common causes of depression.
But continual stress is also a common cause of depression.
Living with stress causes the depletion of the body's resources,
including changes in the availability of the neurotransmitters
associated with energy,
happiness, and calm. With repeated stress, the nervous system
becomes increasingly sensitive to additional stress, until it no longer
seems to be able to cope. A simple way to say this is that you
emotionally exhausted from life's difficulties.
We find depression more commonly in people who live in the face of
poverty, discrimination, and exploitation. It is not a complete
surprise that 70% of depressed people are women, as living in a
male-dominated society adds to the stresses women must deal with.
It is also more common among people in stigmatized populations.
Cultural psychologist Richard Castillo even suggests that treating
depression as a "brain disease" is a way society avoids facing the
significant social problems that lead to depression.
One well-known explanation of depression considers it a matter of
learned helplessness. If
see ourselves as helpless in the face of stress and trauma, if we see
our suffering as hopeless, we develop depression. This leaves a
dilemma for psychologists: It often helps people to see
depression as a "brain disease" involving low seratonin levels, since
they can stop seeing themselves as somehow responsible for their
condition. But that also means they now see depression as
something that can only be helped by external medical intervention.
Like most existential psychologists, Frankl acknowledges the importance of genetic and physiological factors on psychopathology. He sees depression, for example, as founded in a "vital low," i.e. a diminishment of physical energy. On the psychological level, he relates depression to the feelings of inadequacy we feel when we are confronted by tasks that are beyond our capacities, physical or mental.
On the spiritual level, Frankl views depression as "tension between what the person is and what he ought to be." (1973, p. 202) The person's goals seem unreachable to him, and he loses a sense of his own future. Over time, he becomes disgusted at himself and projects that disgust onto others or even humanity in general. The ever-present gap between what is and what should be becomes a "gaping abyss." (1973, p. 202)Depression is not as common in nonwestern and premodern cultures. In those cultures, it is more likely that emotional exhaustion is expressed via somatization, i.e. in the form of physical complaints. Castillo suggests that the prevalence of depression in modern western societies such as the U.S. is due to our emphasis on financial success, material values, and the idea that we each have individual responsibility for our own happiness. In other societies, people rely more on defined status, tradition, and the social support of extended family. Also in other societies, people don't see happiness as a right. In the U.S., if you are not happy, we assume that there is something terribly wrong!
Bipolar disorder used to be called manic-depression, which was a
good word for it. Instead of cycling between depression and an
ordinary state, they cycle between depression and mania. It is
mania that differentiates it from regular depression.
Mania is a state of mind which involves excitement, irritation,
often a sense of strong well being, and a sense that one can do pretty
much anything. Manics may believe that they are incredibly
are unusually creative, and are immune to danger. They may go on
spending sprees, gambling escapades, sexual adventures, and high-risk
activities. They tend to feel full of energy and their minds
While they may in fact get a great deal done, they are also very near
to something more psychotic, with paranoia and irrational thoughts.
It is likely that mania involves a certain amount of dissociation -
that is, a
refocussing of attention away from painful situations (especially
social ones) and onto a powerful, grandiose fantasy. So bipolar
disorder may be a matter of an energetic fantasy phase
emotional exhaustion followed by another energetic fantasy phase, and
Mania is sometimes
associated with creativity, and a number of famous writers, artists,
musicians, and others are believed to have been bipolar. They
depressed for months, and then have bursts of energetic creative
activity, only to fall back into depression. People believed to
have been bipolar include Ludwig von Beethoven, Abraham Lincoln,
Winston Churchill, Isaac Newton, Charles Dickens, Edgar Allen Poe, Mark
Twain, Virginia Woolf, Kurt Vonnegut Jr., Edvard Munch, Vincent van
Gogh, Marilyn Monroe, Jimmy Hendrix, Sting, Ozzie Osbourne, Adam Ant,
and Kurt Cobain.
There are a number of dissorders that involve an altered state of
consciousness called trance. Trance disorders is not an official
but it is particularly appropriate. First, the somatoform
Somatoform disorders are characterized by a concern with the
Stress and trauma lead to anxiety, but instead of developing one of the
anxiety disorders or depression, some people somaticize: They
the anxiety as fatigue, loss of appetite, body aches, headaches,
gastrointestinal problems, and so on. Somatization is actually
the most common manifestation of anxiety, especially in non-western
It has been noted, since the 1800s, that people with these disorders
are uncommonly easy to hypnotize. This suggests that they may
also find it easy to convince themselves of physical ailments that
don't really exist. This can be understood as a matter of
dissociation (which we discuss under
disorders, below). Some
people (usually nervous extraverts) are able to focus their attention
on some aspects of their bodies (such as aches and pains) and focus
attention away from other aspects (such as the ability to feel their
hands or use their legs). This accounts for the way hypnosis and
folk remedies are able to help people with somatoform disorders.
There are several variations:
People with somatization disorder
have a history of
concerning their physical health, yet show little or no signs of
having the problems they think they have. It is a rare disorder
in western societies, affecting .2 to 2% of women and less than .2% of
men. These people
seem to have a very broad variety of problems, including pain in
parts of the body, gastrointestinal problems, sexual and menstrual
and neurological problems. It has been a concern, however, that
diagnosis has been misused in the past, especially in regards to women
who may very well have had real medical conditions beyond the abilities
of their doctors to diagnose!
In China, somatization disorder is a relatively common problem, and
is labelled neurasthenia.
combines somatization with feelings of anxiety, depression,
irritability, and distraction. In Korea, there is a version
called hwa-byung. It is
most commonly found in less educated, middle aged women who are trapped
in bad marriages.
Conversion disorder was formerly known as hysteria, and became famous as the disorder that inspired Sigmund Freud to develop psychoanalysis. It is similar to somatization, but is more focused on neurological problems such as paralysis of limbs, muscle weakness, balance problems, inability to speak, loss of sense of touch, deafness, vision problems, even blindness, and yet involve no underlying neurological problems! It is very rare, but is considerably more common in women. It is often seen in context of accidents or military activity, and is more common among rural and other people who are medically naive. As Freud and other early psychiatrists noted, the symptoms disappear with hypnosis - but other symptoms usually arise to fill in the gap.
People with pain disorder
have a history of complaints
concerning pain. These people are not lying, and are not
malingering - they really feel pain, even though the cause is not
is relatively common, but many are concerned with using this
There have been real medical problems discovered that had previously
"dismissed" as psychological, such as fibromyalgia. Nevertheless,
we have to be careful not to underestimate our ability to intensify or
even create suffering in ourselves. Simply focussing attention on
small aches and pains can intensify them.
In dissociative disorders, one aspect of a person’s psychological
is dissociated (separated)
from others. A commonality among most
people diagnosed with these disorders is their susceptibility to trance
states, hypnosis, and
suggestibility. Hans Eysenck's research suggests as well that
these are more likely to be nervous extraverts.
Dissocative amnesia is the
“inability to recall
information, usually of a traumatic or stressful nature,” (DSM
more than what we would characterize as ordinary forgetfulness.
It is not
of course, to a physical trauma, drug use, or a medical
condition. Instead, it is due to the ability that these people
have to focus away from certain memories that disturb them.
It has been increasingly common for people to report having forgotten childhood traumas, especially sexual abuse, while in the care of certain therapists. Recent researchers now believe that the “recovered memories” that these patients report are actually implanted in the minds of these very suggestable people by their over-enthusiastic therapists. It is still not known whether all recovered memories should be suspect or not, although memory research suggests that trauma is more typically remembered well, not poorly.
Fugue is amnesia accompanied by sudden travel away from a person’s usual haunts. Time away can range from a few hours to months. When these people return to normal, they often don’t remember what happened while they were away. A few adopt an entirely new identity while “on the road.”
Dissociative identity disorder
- formerly known as multiple
personality - involves someone developing two or more seperate
that take over the person’s behavior from time to time. The
"usual" personality doesn't remember what happens when an alternate
personality takes over. Dissociative identity disorder is not the
as schizophrenia, but does have some similarities. In
schizophrenia, voices and impulses are seen as coming from
outside oneself, while in dissociative identity disorder, they are seen
as coming from within, in the form of these alternate personalities.
One of the first cases to reach the public was the story of Eve
White. Eve White (a pseudonym, of course), was a mild mannered
woman with a domineering husband. She found herself waking up
with garish makeup, hangovers, and other signs that she had been out
carousing during the night. This alternate personality that took
over occasionally was called Eve Black. Eventually, the two
personalities were brought together, and Eve's story was made into a
movie with actress Joanne Woodward called "The Three Faces of
second movie was much more popular: "Sybil." This was the
true story of a woman who had been severely abused by her schizophrenic
mother, and developed (supposedly) 26 personalities.
People with multiple
personalities are usually easily hypnotized, making it likely that this
disorder may be caused or at least aggravated by therapists,
intentionally or unintentionally,
much like recovered memories. It is looked upon with skepticism
On the other hand, it may also be understood as a modern version of
a fairly common occurance in the nonwestern, premodern world:
Spirit possession. In cultures where the powers of gods, ghosts,
and demons are taken for granted, people sometimes feel possessed by
these outside personalities. In more modern societies, lacking
the possession explanation, people assume that the alternate
personality is internal.
Depersonalization is the
“persistent or recurrent feeling of
being detached from one’s mental processes or body....” (DSM
IV) Often the world seems
odd as well, which is called derealization.
may seem distorted and other people may seem mechanical. Again,
people may be particularly easy to hypnotize, and the feeling can be
even in normal people under hypnosis. Half of all adults may have
experienced a brief episode of depersonalization or derealization in
lifetime, but it is most common in people who have suffered from abuse,
the loss of a loved one, or have seen combat. It is also common
under the influence of hallucinogens like
Dissociative trance disorder
is an unofficial category often referred to by psychologists and
psychiatrists working in premodern, nonwestern societies. Trance
is a narrowing of one's attention so that some things (such as sight,
movement, or even outer reality) are placed outside awareness.
Cross-cultural therapist Richard
in his book Culture and Mental
that trance is "an
adaptation with great individual and species survival value." It
is not far from such non-pathological states as hypnosis and meditation.
Castillo gives numerous examples:
Amok is found in Malaysia
and Indonesia. The word comes from the Sanskrit for "no
freedom." It involves a person losing their sense of self,
grabbing a weapon such as a machete, and running through the village
slashing at people. Afterwards, they have no memory of what they
have done and are typically excused from any damage, even if their
actions resulted in someone's death!
Grisi siknis is found among
teenage girls and yound women of the Miskito indians in
Nicaragua. They also run wild with machetes, occasionally
people or mutilating themselves. They have no memory of their
Pibloktoq or arctic hysteria
is found among polar eskimos. For anywhere from a few minutes to
an hour, a person takes off their clothing and runs screaming through
the snow and ice, as a response to a sudden fright.
Latah (in Malaysia)
violent body movements, taking unusual postures, trance dancing,
people, throwing things, and so on.
"Falling out" (in the
Bahamas) involves falling to the ground, apparently comatose, but
hearing and understanding what is going on around you.
"Indisposition" (in Haiti)
is a possession trance understood as a response to fear.
"Fits" (in India) is a
seizure-like response by some women to family stress, curable by
exorcism or by simply telling her husband to protect her from her
In the west, these kinds of behaviors are often classified as
impulse control disorders, along
with trichotillomania, compulsive gambling, pyromania, and
One of these - intermittent
disorder - is
basically the same as running amok, and is commonly known as "going
Mania, conversion disorders, and
somatization disorders lead us into a category distinct from the
As you recall, we construct a "social
reality" for ourselves based on our experiences of others in our
society. This social reality is no where near as solid as our
experiential reality, and we are troubled when it is threatened. During
war or economic depression, immigration or cultural revolutions, some
people become severely depressed or develop neurotic symptoms in a vain
effort to hold on to the stability that our social reality provides.
And some people go through experiences that “break” their social reality altogether. For someone with great resources - intelligence, nurturant upbringing, self-confidence, whatever - this experience could be an enlightenment. For people with few resources - people who don’t have a well-developed understanding of the world - this experience can destroy their psychological integrity. They are reduced to grabbing whatever flotsam they can to fashion a life-raft: bits and pieces of personal experience, social reality, and fantasy are patched together and used as a substitute for understanding. This is psychosis: to live in a second kind of constructed reality which I call idiosyncratic reality.
The psychotic lives in a world of words and ideas that, like that of the conventional person and the neurotic, does not match well with experience. Unlike the conventional person or neurotic, however, the psychotic does not have a community of like thinkers to encourage him or her when the fictions are threatened. He or she is alone and is kept alone by fear of emptiness.
Understand that we all have our idiosyncratic realities: Each of us has a slightly different version of the social reality. Each of us has serendipitous experiences that are not true guides to reality, but have had such an impact on us that we cannot easily discard them, as in the case of childhood traumas. Most of us, however, have some degree of awareness of how it is we differ from others, and label those differences as either our psychological faults or as special virtues, while we retain essential communication with others who share most of our social reality. The psychotic has given that up.Schizophrenia
When people think about "crazy" people and people in mental
institutions, they are often thinking of people with
is the primary example of what psychologists and psychiatrists used to
call a psychosis. The
general characteristic of people with a psychosis is that they seem to
be out of touch with reality. Mood disorders, especially mania,
used to be considered psychoses as well.
Someone with a neurosis
appears to be more emotionally troubled, perhaps even excesssively
reality rather than out of touch with reality. The anxiety
disorders are the primary examples.
Although we don't use these terms as much today, psychology students
should keep them in mind!
The key feature of schizophrenia is a loss of connection to
reality. Perception in particular is disrupted, including the
auditory hallucinations - hearing voices. But thinking and
disrupted as well, all leading to occasionally bizarre behaviors.
Traditionally, we divide the symptom of schizophrenia into positive
ones and negative ones. Positive symptoms are things you "have,"
negative ones are things you "lack."
are irrational beliefs.
ones include delusions of paranoia (everyone is after me) and delusions
of reference (everything is talking about me). Of course, if
is talking about you and looking for you, you must be pretty
important. Hence we sometimes see delusions of grandeur, even to
point (in extreme cases) of believing one is Christ.
perceptions. As I mentioned, auditory hallucinations - voices -
common, and may be accompanied by visual hallucinations. A
of the voices is that they seem to the schizophrenic to clearly come
from the outside, and not from within their own minds.
We also see disorganized speech, which in
turn implies disorganized thinking.
They go from one topic to
sometimes in midsentence, and often do not relate their speech to
anything around them or to other people's conversations.
behavior is found in certain
schizophrenics (called, appropriately, catatonic schizophrenics).
involves a detachment from one's environment, staring blankly into
space, and may involve unusual postures that would seem to be very
uncomfortable. Fortunately, these postures are "waxy," meaning
caretakers can gently reform the postures into something less tiring.
affect means that the variety and
intensity of emotional expression of emotion is reduced. Many
schizophrenics have a bland expression, flat voices, and avoid eye
of speech is
self-explanatory. Many schizophrenics speak slowly with little
is a lack of goal directed
behavior. They may seem not to care about anything.
Schizophrenia usually begins in a person's twenties. It sometimes starts earlier, which is why they originally called it dementia praecox - the dementia of the immature. It usually begins with social withdrawal and loss of interest, and will eventually move on to unusual behaviors. This is when the person's family begins to worry. The disorder can come and go, with periods of lucidity between the bouts of psychosis, but roughly 50 to 70 percent of people with schizophrenia do get better.
Viktor Frankl considers schizophrenia as rooted in a physiological dysfunction, in this case one which leads to the person experiencing himself as an object rather than a subject.
Most of us, when we have thoughts, recognize them as coming from within our own minds. We "own" them, as modern jargon puts it. The schizophrenic, for reasons still not understood, is forced to take a passive perspective on those thoughts, and perceives them as voices. And he may watch himself and distrust himself - which he experiences passively, as being watched and persecuted.
Frankl believes that this passivity is rooted in an exaggerated tendency to self-observation. It is as if there were a separation of the self as viewer and the self as viewed. The viewing self, devoid of content, seems barely real, while the viewed self seems alien.Although Frankl's logotherapy was not designed to deal with severe psychoses, Frankl nevertheless feels that it can help: By teaching the schizophrenic to ignore the voices and stop the constant self-observation, while simultaneously leading him or her towards meaningful activity, the therapist may be able to short-circuit the vicious cycle.
People want lives in folk societies, wherein everyone is a friendly relative, and no act or object is without holiness. Chemicals make them want that. Chemicals make us furious when we are treated as things rather than as persons. When anything happens to us which would not happen to us in a folk society, our chemicals make us feel like fish out of water.Kurt Vonnegut Jr. was talking about alienation. The word comes from the Latin "to be made into a stranger," and it once refered to being deprived of your birthright. But feeling like a fish out of water expresses the feeling quite well.
The sociologist Seeman analyzed alienation into six aspects that still have meaning:
Who hasn't felt at least one of these? Or know others who feel
them? Some psychologists and sociologists have suggested that
is a sign of our times.
Psychological distress is the feeling we experience when we face problems; psychological delight is the feeling we experience as we solve these problems. So delight depends on distress, because solving problems means first having problems. Now, although we spend a lot of time running away from problems - through defensiveness, or aggression, or mindless conformity - occasionally we take on problems. This requires will.
Will is putting aside present distress in order to reach future delight. Or staying hopeful, even eager, in the face of anxiety. Or taking on problems with the intention of solving them. I'm sure you can think of many things that require will: dieting, for example - ignoring the cheesecake and attending to the image of a future god or goddess. Or going to work or to class.... You can see why, in the research literature, will is often refered to as delay of gratification.
When we talk about will, we usually think immediately of what I shall call instrumental will. This is where the means and the ends are artificially connected: The distressful things you have to go through are not "naturally" connected to the delightful goals you are attempting to achieve.
Instrumental production - working for money and such - is the most obvious example: You put up with boredom, fatigue, anxiety, and all sorts of crap at work, so you can experience a little delight at other times (due almost exclusively to your paycheck!). Also qualifying as instrumental production for many people is school: You go to class and read books, not for the joy of learning, but for the almighty grade, followed by the glorious diploma, and hopefully ending with the financially-rewarding job.
In much of research, the motivation behind instrumental production is called extrinsic motivation.
Another example is instrumental association. You find this a lot at work, too. Think of all the people you have to be friendly to, even if you don't want to be. Think of the last time you had to talk to someone you didn't like - perhaps you recall how much your face hurt from smiling at this person all day! But this is a big part of business: You have chickens; Joe has chicken coops; You can't stand him, but for the sake of business, you put up with him.
Another name for instrumental association is Gesellschaft. Instrumental production and association together make up the central concern of economics-style social theories such as exchange theory.
It should be obvious at this point that I have another form of will in mind as well. I call it natural will, and it involves means and ends that are "naturally," even intimately, tied together. With natural will, the distress you put up with is due to the same problem which, when you solve it, provides the delight. Like instrumental will, it comes in two flavors:
Natural production includes much of what we call craftsmanship, art, and even science. The artist "sees" the end result of his efforts in the uncut marble, "sees" the final brush strokes on the blank canvas, "hears" how his unwritten song should sound. The artist knows what he wants, but must struggle to arrive. You sweat, you curse, but in the end you feel much like the child who proudly presents his clay ashtray to his parents.
The motivation behind natural production is often called intrinsic motivation.
There is, of course, also natural association. Lovers, families, friendships, clans, neighborhoods.... You sweat with them, too, and curse. But you "hang around" anyway, even if you don't have to. Although it takes will, we are supported by that totally irrational feeling that makes us want to "hang around" - love, or a sense of belonging at least. Your well-being is tied to another's well-being.
This is also called Gemeinschaft.
It is this natural production and association that does not operate by the economic rules of exchange theory, is not directed towards "outcomes," is done, in fact, for no economic reasons at all. It operates, rather, by non-mathematical principles having to do with increasing complexity in the service of life. Mystical stuff.
Examples abound: The bond between parent and child is often highly unrewarding, considered economically, yet it is a hard bond to break; the loyalty among soldiers will occasionally lead one to sacrifice his very life for the others; there's unrequited love...; the starving artist.... If you consider what we value most in life - honesty, generosity, caring, bravery - you will notice that these things require a lack of concern with costs and benefits! Running into a burning building to save a child only after being promised a million dollars isn't considered brave - just greedy.
It is true that the instrumental side of life has always been with
It seems, for example, that we invented tools before we were who we are
sapiens), and tools are the very symbol of instrumentality.
I feel comfortable calling the natural natural because it seems
likely that it was far more common in our early history than it is
The anthropologist Robert Redfield
called the hypothetical situation of
our earliest ancestors the folk society, and described it so:
[It is] small, isolated, nonliterate, and homogeneous, with a strong sense of group solidarity. The ways of living are conventionalized into that coherent system we call a "culture." Behavior is traditional, spontaneous, uncritical, and personal; there is no legislation or habit of experiment and reflection for intellectual ends. Kinship, its relationships and institutions, are the type categories of experience and the familial group is the unit of action. The sacred prevails over the secular; the economy is one of status rather than the market.
That is, it is a society marked by predominantly natural associations
and natural production. Our society, I think you would agree, is
highly instrumental in comparison.
When, in our highly instrumental society, we find ourselves without natural association and production, we feel alienation.
Normally, living instrumentally doesn't lead to alienation. After a hard day of instrumental association, I can go home and relax with family and friends - my natural associations. I may even have some friends at work. And, at the end of the week, after all my hard instrumental work, I get my paycheck, which (after taking care of the necessities) brings me some natural pleasures - movies, books, restaurants, hobbies, sports.... And I may even get some natural satisfaction in my work itself.
Unfortunately, in a largely instrumental society, these things are easily undermined. First, we may discover that we lack natural associations - that we are rather lonely people. There may be a fundamental scarcity of natural associations: Our families are very small, we move around a lot, friends and lovers come and go. One death in a modern day "subnuclear" family, for example, can be far more devastating than many deaths in a tribal community.
We can also lose faith in people. We teach our kids "never judge a book by its cover," "all that glitters is not gold," "never take candy from a stranger...." We teach them to take people not as they appear to be, but to look for hidden motives, to look for what they are really after - to look at them instrumentally. But what happens, then, when the child decides to put Daddy in the same category he has been taught to use with the used-car salesman? The natural is undermined by the instrumental.
We also discover our lack of natural production - our boredom. Again, the scarcity of natural production is a problem: How many "creative" jobs are there, really? How much of even a good job is actually interesting? How much time and money can we spend on our rather contrived (i.e. instrumental) hobbies and sports?
Further, as with association, instrumental production tends to drive out natural production. Remember Deci's research? Give kids gold stars for what they enjoy doing and, before you know it, they no longer do it unless the gold star is waiting! Paying an artist for creativity or a thinker for inventiveness is like paying someone for sex... the thrill soon evaporates.
But even with little in the way of natural association and production, we can get along quite well. The instrumental life still has its rewards. There has to be something that triggers alienation, that makes us aware of it: This happens when instrumental association and production fail, that is, when we are faced with the fact that all that work actually does not lead to happiness.
The failure of instrumental association and production can happen in two ways. First, it can be a matter of means: If we lose our jobs, to use the obvious example, we can't pay our bills - and our pleasures are the first things we have to sacrifice. If you flunk out of college, there is no degree, and no fine career, waiting for us.
The failure of the instrumental can also be a matter of ends: Money can provide an opportunity for natural enjoyments, but it can't buy them. Our inclination, when life begins to bore us, is to throw more money into "entertainment." But when the entertainment fails to entertain, we ask ourselves "is this all there is?"
Back to the beginning
We can go back and review Seeman's six aspects of alienation using the preceding analysis: In regards to production, we too often find ourselves facing an absence of the natural or intrinsically rewarding (meaninglessness). Further, we face the failure of instrumental means (powerlessness) and the ultimately unsatisfying nature of instrumental ends (self-estrangement).
Likewise, in regards to association, we find ourselves facing an absence of the natural (social isolation), the failure of instrumental means (normlessness), and the ultimately unsatisfying nature of instrumental ends (cultural estrangement).
The solution to alienation is now clear: Correct or reverse the courses described above. First, the alienated person needs to find work that does in fact lead to rewards that are in fact rewarding! This, more often than not, is a social and political issue: Where does one find such work and how does one train for it?
But beyond this, the alienated person needs to find and maintain
of natural production and association - meaningful activities and
relationships. A part of this, too, is social and political, and
often even a matter of luck. But it may also require changes in a
person's ways of perceiving and thinking about work and people and