INSTITUTIONAL DENIAL ABOUT THE DARK SIDE OF LAW SCHOOL

[PCRev]

Exactly! Simply put, the scientifically unproven notion is that painful memories are pushed out of normal memory and packed into a powerful unconscious. Then those "forgotten" memories supposedly cause people to act in certain ways. The unproven Freudian-based idea is that if what is hidden in the unconscious can be exposed, then people will know why they behave the way they do and then with such self-knowledge they change their thinking and behaving. Thus, if a "forgotten" memory of abuse is "remembered" in therapy, that serves as an explanation for one's present behavior.

While acknowledging the reality of childhood sexual abuse, Loftus for instance, a research psychologist specializing in memory, believes that in many cases, people create false memories of non-existent abuse, prompted to do so by their psychotherapists. Writing in the first person with coauthor Ketcham (with whom she wrote "Witness for the Defense"), Loftus critiques the tools used by some therapists ("trance work," hypnosis, dream analysis, journal writing, etc.) to "recover" patients' buried memories. She presents numerous case histories involving presumed memories that turned out to be fabrications and reports on a study in which false memories of childhood events were created in men and women volunteers. She also discusses her involvement in the case of Paul Ingram, a Washington deputy sheriff who confessed that he was a priest in a satanic cult and sodomizer of children after his two daughters accused him of sexual abuse; he later retracted his confession but was imprisoned anyway.

Loftus makes it clear that human memories are reconstructions. They are not accurate in a scientific sense, nor meant to be. Memories are reconstructions because what the tribal mind wants is conformity to what is believed by the tribe now. So human memories are intermittently reconstructed to conform to the "truth" as the individual under the influence of the tribe sees it at present. What happened years ago is important to the tribe only as it connects to the present, and it is usually the political present that is important. Therefore memories need not be factually accurate; it is far more important that they be politically correct. To make them politically correct they must be malleable since the political wisdom changes over time. The idea of "repressed" memories fits into this scenario wonderfully. The memory is said to be "repressed" until such time as it is politically necessary to retrieve it and then it is voodooed up and molded to fit the current power politics. It's like the rewriting of history in Orwell's 1984, or medieval trials by fire or water. Through the suggestive and coercive power of therapists (quasi-priests), memories are rewritten to suit the needs of the therapists, and alas, sometimes the needs of a district attorney bent on furthering his or her career at any price.

Not to mention, Becky, that the status of the unconscious mind can be viewed as a social construction -- the unconscious exists because people agree to behave as if it exists.

Probably the most detailed and precise of the various notions of 'unconscious mind' — and the one which most people will immediately think of upon hearing the term — is that developed by Sigmund Freud and his followers. As we know it all too well by now consciousness (C) in Freud's topographical view (which was his first of several psychological models of the mind) was a relatively thin perceptual aspect of the mind, whereas the subconscious (S/C) was that merely autonomic function of the brain. The unconscious was considered by Freud throughout the evolution of his psychoanalytic theory a sentient force of will influenced by human drive and yet operating well below the perceptual conscious mind. For Freud, the unconscious is the storehouse of instinctual desires, needs, and psychic actions. While past thoughts and memories may be deleted from immediate consciousness, they direct the thoughts and feelings of the individual from the realm of the unconscious.



Freud proposed a vertical and hierarchical architecture of human consciousness: the conscious (C) mind, the preconscious (P/C), and the unconscious mind (U/C) -- each lying beneath the other. He believed that significant psychic events take place "below the surface" in the unconscious mind, like hidden messages from the unconscious -- a form of intrapersonal communication out of awareness. He interpreted these events as having both symbolic and actual significance. For psychoanalysis, the unconscious does not include all that is not conscious, rather only what is actively repressed from conscious thought or what the person is averse to knowing consciously. In a sense this view places the self in relationship to their unconscious as an adversary, warring with itself to keep what is unconscious hidden. The therapist is then a mediator trying to allow the unspoken or unspeakable to reveal itself using the tools of psychoanalysis. Messages arising from a conflict between conscious and unconscious are likely to be cryptic. The psychoanalyst is presented as an expert in interpreting those messages. For Freud, the unconscious was a repository for socially unacceptable ideas, wishes or desires, traumatic memories, and painful emotions put out of mind by the mechanism of psychological repression. However, the contents did not necessarily have to be solely negative. In the psychoanalytic view, the unconscious is a force that can only be recognized by its effects — it expresses itself in the symptom. Unconscious thoughts are not directly accessible to ordinary introspection, but are supposed to be capable of being "tapped" and "interpreted" by special methods and techniques such as random association, dream analysis, and verbal slips (commonly known as a Freudian slip), examined and conducted during psychoanalysis.

HOWEVER

There is a great controversy over the concept of an unconscious (U/C) in regard to its scientific or rational validity and whether the U/C exists at all. Karl Popper argued that Freud's theory of the U/C was not falsifiable, and therefore not scientific. He objected not so much to the idea that things happened in our minds that we are unconscious of; he objected to investigations of mind that were not falsifiable. If one could connect every imaginable experimental outcome with Freud's theory of the unconscious mind, then no experiment could refute the theory. In the social sciences, John Watson, considered to be the first American behaviorist, criticizes the idea of an "U/C mind," for similar line of reasoning, and instead focused on observable behaviors rather than on introspection. Unlike Popper, the epistemologist Adolf Grunbaum argues that psychoanalysis could be falsifiable, but its evidence has serious epistemological problems. David Holmes examined 60 years of research about the Freudian concept of "repression," and concluded that there is no positive evidence for this concept. Given the lack of evidence of many Freudian hypotheses, some scientific researchers proposed the existence of unconscious mechanisms that are very different from the Freudian ones. Ludwig Wittgenstein and Jacques Bouveresse argued that Freudian thought exhibits a systemic confusion between reasons and causes: the method of interpretation can give reasons for new meanings, but are useless to find causal relations (which require experimental research). Wittgenstein gave the following example: if we throw objects on a table, and we give free associations and interpretations about those objects, we'll find a meaning for each object and its place, but we won't find the causes.

For Freud, the truth about you lies in your unconscious, which is distanced from you. Furthermore, you have unconscious resitances against this unconscious truth. Yet, there is no hidden riddle. Everything is in consciousness, everything is luminous. Your knowledge to be gained is the understanding of the radical assimilation of "being-in-itself-for-itself" (that is, the attempt to be Being, or to be God) with "being-for-others." A recognition of one's situation as being that of a freedom confronted with the freedom of others, of being in a necessarily conflictive relationship with others, and recognizing one's responsibility for that situation, and recognition of the freedom to "convert radically" from the specifics of that mode of being to another mode. You are not in search of a "cure," as with Freud, but a grasping of one's self in all its possibilities. Not a freeing from the past, but an acknowledgement that this freedom always already exists. There never were any shackles except the ones you invented.

[kobacka]

For Freud, the truth about you lies in your unconscious, which is distanced from you. Furthermore, you have unconscious resitances against this unconscious truth. Yet, there is no hidden riddle. Everything is in consciousness, everything is luminous. Your knowledge to be gained is the understanding of the radical assimilation of "being-in-itself-for-itself" (that is, the attempt to be Being, or to be God) with "being-for-others." A recognition of one's situation as being that of a freedom confronted with the freedom of others, of being in a necessarily conflictive relationship with others, and recognizing one's responsibility for that situation, and recognition of the freedom to "convert radically" from the specifics of that mode of being to another mode. You are not in search of a "cure," as with Freud, but a grasping of one's self in all its possibilities. Not a freeing from the past, but an acknowledgement that this freedom always already exists. There never were any shackles except the ones you invented.

Each individual's "desire to be" is an attempt to solve the problem of the Absolute, and each individual's attempt is unique and constitutes an original choice of being-in-the-world. Sartre calls these choices "ORIGINAL PROJECTS" (or "fundamental," or "initial" projects). Could he have done otherwise without modifying his original project? At what price? The price would be a "radical conversion of his being-in-the-world." This RADICAL CONVERSION -- which is always possible (here is where Sartre differs deeply from the determinists) -- would amount to his choosing a new self; it would amount to choosing a new fundamental project, because the choice would manifest itself not only in that moment, but in hundreds of other ways. For Sartre, the self is not a series of fragmented behaviours, but a TOTALITY. The "original project" manifests itself in every act, big or small. But the original project is not equated with some event, decision, or fantasy in the past; rather, it is recreated at each moment through the choices we make and the actions we perform. And because the possibility of radical conversion always exists, we are responsible for what we are. This is like Nietzsche, who says that after a certain age a man is responsible for his face.

[do nothing]

[...] If we had a free market in drugs, we could similarly buy all the barbiturates, chloral hydrate, and morphine we want and could afford." Szasz argued that the prohibition and other legal restrictions on drugs are enforced not because of their lethality, but in a ritualistic aim. He also recalls that pharmakos, the Greek root of pharmacology, originally meant "scapegoat". Szasz dubbed pharmacology "pharmacomythology" because of its inclusion of social practices in its studies, in particular through the inclusion of the category of "addictiveness" in its programs. "Addictiveness" is a social category, argued Szasz, and the use of drugs should be apprehended as a social ritual rather than exclusively as the act of ingesting a chemical substance. There are many ways of ingesting a chemical substance, or "drug" (which comes from pharmakos), just as there are many different cultural ways of eating or drinking. Thus, some cultures prohibit certain types of substances, which they call "taboo", while they make use of others in various types of ceremonies.

In 1968, French journal Tel Quel published a long essay by Jacques Derrida named "Plato's Pharmacy" in two parts, which was later included in his 1972 book 'La Dissémination', translated into English as "Dissemination." This book uses Plato's Phaedrus as a departure point. Although the word-chain pharmakeia-pharmakon-pharmakeus appears several times in Plato's texts, he never uses a closely related term, pharmakos, which means 'scapegoat'. According to Derrida, that it is not used by Plato does not indicate that the word is necessarily absent, or rather, it is always-already present as a 'trace'. Certain forces, tendencies of linguistic association unite the words that are 'actually present' in a text with all the other words in the lexical system, whether or not they appear as words in such text. Derrida points out that the textual chain is not simply 'internal' to Plato's lexicon. It is possible for one to claim that all the 'pharmaceutical' [another component of the same chain] words do actually make themselves present in the text, although always hidden at the back, always showing stealth.

"It is in the back room, in the shadows of the pharmacy, prior to the oppositions between conscious and unconscious, freedom and constraint, voluntary and involuntary, speech and language, that these textual 'operations' occur." What is in stake here is the very idea of the inside/outside dichotomy; if the word pharmakos that Plato does not use still resonates within the text, then there can be no possibility of closure as far as a text is concerned. If the outside is always-already part of the inside, at work on the inside, then what is the status of the concepts "present" and "absent", "body" and "soul", "center" and "periphery"? However, it is important to remember that Derrida classifies pharmakos as something in the back room; in other words, 'outside' present in 'inside' never becomes a pure presence, but remains hidden as a 'trace', a hint, an 'aporia'. Through his dogged insistence in this, he avoids the trap of what he called "Metaphysics of Pure Presence", or 'Logocentrism'.

In ancient Athens, the ritual of the pharmakos was used to expel and shut out the evil (out of the body and out of the city). To achieve this, the Athenians maintained several outcasts at public expense. In the event of any calamity, they sacrificed one or more than one outcast as a purification and a remedy. The pharmakos, the 'scapegoat', the 'outsider' was led to the outside of the city walls and killed in order to purify the city's interior. The evil that had infected the city from 'outside' is removed and returned to the 'outside', forever. But, ironically, the representative of the outside (the pharmakos) was nonetheless kept at the very heart of the inside, the city, and that too in public expense. In order to be led out of the city, the scapegoat must have already been within the city. The ceremony of the pharmakos is played out on the boundary line between the 'inside' and the 'outside', which it has as its function ceaselessly to trace and retrace' Similarly, the pharmakos stands on the thin red line between sacred and cursed, ... beneficial insofar as he cures - and for that, venerated and cared for - harmful insofar as he incarnates the powers of evil - and for that, feared and treated with caution'. He is the healer who cures, and he is the criminal who is the incarnation of the powers of evil. The pharmakos is like a medicine, pharmakon, in case of a specific disease, but, like most medicines, he is, simultaneously, a poison, evil all the same. Pharmakos, Pharmakon: they escape both the sides by at once being and not being on a side. Both words carry within themselves more than one meaning, that is, conflicting meanings.

Pharmakos does not only mean scapegoat, It is a synonym for pharmakeus, a word often repeated by Plato, meaning 'wizard', 'magician', even 'poisoner'. In Plato's dialogues, Socrates is often depicted and termed as a pharmakeus. Socrates is considered as one who knows how to perform magic with words, and notably, not with written letters. His words act as a pharmakon (as a remedy, or allegedly as a poison as far as the Athenian authority were concerned) and change, cure the soul of the listener). In Phaedrus, he fiercely objects to the evil effects of writing, which, obviously, is what makes Derrida so interested in this book. Socrates compares writing to a pharmakon, a drug, a poison: writing repeats without knowing, creates abominable simulacra. Here Socrates deliberately overlooks the other meaning of the word: the cure. Socrates suggests a different pharmakon, a medicine: dialectics, the philosophical form of dialogue. This, he claims, can lead us to the truth of the eidos, that which is identical to itself, always the same as itself, invariable. Here Socrates again overlooks the 'other' reading of the word 'pharmakon': the poison. He acts as a magician (pharmakos) - Socrates himself speaks about a supernatural voice that talks through him - and his most famous medicine (pharmakon) is speech, dialectics and dialogue leading to ultimate knowledge and truth. But, ironically, Socrates also becomes Athens's most famous 'other' pharmakos, the scapegoat. He becomes a stranger, even an enemy who poisons the republic and its citizens. He is an abominable 'other'; not the absolute other, the barbarian, but the other (the outside) who is very near, like those outcasts, who is always-already on the inside. He is at once the 'cure' and the 'poison', and just like him, the Athenians chose to forget one of those meanings according to the need. And, at the end, Plato put Socrates in what he considered to be the vilest of all poisons: in writing, that survives to this day. Phaedrus and Socrates both stand as a metonym [very significantly meaning "beyond names"] for the whole contest between speech and letters, for the central (if such an inappropriate word can be excused) theme of the Derridian project. The interplay between the words pharmakon-pharmakos-pharmakeus is another example of Derridian 'Trace'.

Pharmakos is an undecidable. Writing is the undecidable pharmakos of philosophy. Found inside philosophy (Plato writes), it needs to be cast out (Plato condemns writing). Philosophy is set against itself. And then the trace. Neither simply present nor simply absent, the trace is an undecidable. The relay of differences (pig, big, bag, rag, rat, etc) depends upon a structural undecidability, a play of presence and absence at the origin of meaning. Undecidability at the "origin," between presence and absence. Whether written or spoken, no element can function without relating to another element which itself is not simply present. Each element is constituted on the basis of the trace in it of the other elements of the system. Nothing, in either the elements or the system, is anywhere ever simply present or absent. The notion of the trace suggests first of all that all language is subject to undecidability. The play of the trace is a kind of deforming, reforming slippage -- an inherent instability which language cannot escape. This applies to philosophical language as well. The vocabulary of metaphysics (being, truth, centre, origin) has to be recognized as a vocabulary. It's a set of words, and they cannot escape the play of the trace. Now, if the trace is a constant sliding between presence and absence, those philosophical words cannot establish full, replete presence. This strikes at the very roots of Western metaphysics, because it's the claim to full presence which underpins metaphysical concepts and procedures.

[modeld after]

[...] men are not gentle creatures, who want to be loved, who at most defend themselves if they are attacked; they are, on the contrary, creatures among whose instinctual endowments is to be reckoned a powerful share of aggressiveness. As a result, their neighbour is for them not only a potential helper or sexual object, but also someone who tempts them to satisfy their aggressiveness on him, to exploit his capacity for work without compensation, to use him sexually without his consent, to seize his possessions, to humiliate him, to cause him pain, to torture and to kill him."

According to Freud, human civilisation is based, and has to be based, on the repression of the basic "sexual" or "instinctual" energy he believed humans to have. What happened, in Freud's view, was that this repressed sexual energy was diverted into the work which had to be engaged in to produce the things humans needed to survive and build up the material side of civilisation.

niki, Freudian theories do not necessarily rule out a free, non-repressive society. Freud's speculation that civilisation is originally based on a necessary sexual repression recognized for its merits, it has been suggested that:

(1) only a part of this has come from the conditions of scarcity which obliged humans to work, with another part coming from living in class-divided societies where ruling classes impose an extra repression over and above that arising from natural scarcity,

(2) with the coming of automation and the like, scarcity has now been conquered. This being so, sexual repression -- that imposed by natural conditions as well as that imposed by class-divided society -- is no longer necessary. Civilisation need no longer be based on sexual repression. A free, non-repressive society is possible.

Herbert Marcuse has in fact explained why people accept capitalism -- they have been psychologically manipulated into wanting it. In other words, their basic "instincts" have been remoulded so as to fit in with capitalist society. The issue now is how will such people come to want to get rid of capitalism.

In his 1955 book "Eros and Civilization" Marcuse imagines an early stage of human history, a "primitive" utopia, occurring during a time of low economic productivity, where there was a near equal distribution of recources among members of a tribe, little accumulation of wealth across generations, and a quasi-democratic structure of authority. Opposed to this model is the phase of human development that begins with large-scale settled societies and an expanding population that brings political domination by a ruling elite made up of an alliance of priests and kings. Here a large economic surplus -- material wealth beyond basic survival needs -- is generated which, instead of being retained by the common people who produce it in order to reduce labor time, create leisure, and satisfy higher needs, is appropriated by the rulers as private wealth and for public monuments and warfare. The common people continue to experience life as dictated by necessity, hard labor, scarcity, and repression, compensated, as it were, by the promise that all would be made well in the afterlife of the soul. Now Marcuse imagines a second version of utopia, occurring in a fully developed industrial society after the conquest of scarcity. He takes the level of economic activity in the US prevailing at the time of writing [1950s] as his starting point. If consumption was limited to "basic needs" such as food, housing, clothing, and leisure, the existing industrial technologies would be able to satisfy them for everyone with a drastically reduced workweek. Choosing this option means a "considerable reduction" in the prevailing standard of living, at least for those in the upper half of the spectrum of material wealth. What would be offered in return? The degree of repression necessary for life in civilized society is relative to the struggle with nature and the level of wealth achieved thereby. Where this struggle is artificially maintained at a level of intensity no longer required by social order, a "surplus repression" results, that could be reduced through reforming social and economic institutions. The reduction of the working day to a point where the mere quantum of labor time no longer arrests human development is the first prerequisite for freedom.

Marcuse interpreted this conclusion in terms derived in part from Freud. Extending Freud's theory of the instincts, he argued that labor in the service of survival is the response to necessity, that is, gratification of needs [including aesthetic needs, represented in culture]. On this account repression appears to be a necessary feature of the human psyche. But where Freud had treated the instincts as quasi-biological constants, Marcuse reinterpreted them as historically malleable. In a free society "Eros, the life instincts, would be released to an unprecedented degree." These words were published in 1955, during a decade in which American popular culture embraced a repressive, conformist, suburban lifestyle as the pinnacle of human achievement. But for anyone who lived through the decades of the 1950s and 1960s in the nations of the West, Marcuse's words are eerily prophetic of the social movement that would erupt there a mere 10 years later. Taken at its best, the counterculture celebrated a rejection of endless consumerism, of rigid nuclear-family suburban lifestyles, of sexual repression -- especially for women, of the fear of intoxication, of hypocritical churchgoing, and the social ideologies that affirmed war, racism, and inequality. As a California resident Marcuse had a front-row seat, as it were, witnessing both the triumph and the denouement of this movement. But by 1968 Marcuse was more than a local figure. He had become a household name around the world -- when he was already 70 years old! -- in the double context of the growing resistance against the war in Vietnam and the "cultural revolution" represented by the student movement on university campuses and the streets of major cities not only in America but also in Europe, Latin America, and Japan.

[Orietta]

DEPRESSION (di-pres/en) -- a lowering of vital energy (Webster's Dictionary)

Depression is a broad term used to refer to a range of different diseases recognized by the medical field. We also use the term to refer to temporary and minor negative feelings (i.e. I'm depressed because the Pacers lost last night or the post-holiday blues.) Depressive illnesses include major depression, the bipolar disorders, dysthymia, cyclothymia, and variations of these based on timing of the onset (i.e. seasonal or post partum), duration of symptoms, or severity of symptoms. These illnesses impact over 19 million adults in America each year. Depression is frequently seen as a complicating factor in heart attack, stroke, diabetes and cancer patients. In fact, depression increases one's risk of having a heart attack. Almost anyone who kills him or herself suffers from a mental disorder, most often a form of depression or substance abuse or both.

The key factor in diagnosing most of these illnesses is the presence of a major depressive episode. To be diagnosed with a major depressive episode your symptoms must last at least 2 weeks. The symptoms must also appear to be a change from previous functioning. There are people who resemble Winnie the Pooh's Eyre their whole life but are not depressed. The symptoms of a major depressive disorder include:

• Depressed mood.
• Diminished interest or pleasure in most activities.
• Significant weight loss or gain without effort or loss of appetite.
• Difficulty sleeping or sleeping too much.
• Psychomotor agitation or retardation.
• Fatigue.
• Feelings of worthlessness or excessive or inappropriate guilt.
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death, suicidal ideation, or a suicide attempt or plan.

Thankfully, most people do not experience all of the symptoms. To be diagnosed with a major depressive episode one must experience at least 5 of the above symptoms and 1 of the 5 must be either depressed mood or diminished interest or pleasure in most activities. If one meets several of these symptoms, but less than 5, there are milder depressive disorders that can still be diagnosed. It is important to remember that each person will experience a different set of symptoms with their depression and that the symptoms will look different with different people. No two people will experience depression in exactly the same manner. There are, however, some common themes that do repeat themselves, particularly in lawyers. In lawyers the most common symptoms are closely related to the work we are trying to do. Reduced ability to concentrate is one of the most bothersome symptoms for attorneys. They may have had trouble sleeping and a poor appetite for some time but attorneys often seek treatment when they realize that their ability to concentrate and get their work done is compromised. When you add together reduced ability to concentrate with fatigue and loss of interest in most all activities it is highly likely that the attorney's work is going to suffer at least in quantity if not in quality. In addition, attorneys in this condition often try to remedy the problem by working longer hours to keep up on the quantity of their work. In doing so they reduce contact with significant, supportive people in their life, reduce the amount of time they spend on exercise, hobbies, and other stress reducing activities, and cut back further on what is most likely already inadequate sleep. In their attempts to solve the problem they are doing the opposite of what they need and falling deeper into the hole of depression.

If you have a strong family history of depression you may decide that it is best to stay on medication for some time. On the other hand, if you have no family history and your depression occurred during the year that your divorce was final, your mother died, and you lost your job, you might have more of an acute and situational depression and might not be on medication very long. Regardless, the skills you learn in therapy are what will help you to avoid future episodes of depression. This is critical because it is generally accepted in the psychiatric field that if you have one episode of depression there is a 50% chance that you will have a second episode. If you have a second episode of depression there is a 70% chance that you will have a third episode and if you have a third episode there is a 90% chance that you will have yet another episode. Clearly, it is worthwhile to do all you can to treat a first episode of depression to increase the chances that it will be your only experience with depression.

Erand, marvellous post!

[paragraph]

Orietta, too bad that's copied and pasted!

[nano]

DEPRESSION (di-pres/en) -- a lowering of vital energy (Webster's Dictionary)

Depression is a broad term used to refer to a range of different diseases recognized by the medical field. We also use the term to refer to temporary and minor negative feelings (i.e. I'm depressed because the Pacers lost last night or the post-holiday blues.) Depressive illnesses include major depression, the bipolar disorders, dysthymia, cyclothymia, and variations of these based on timing of the onset (i.e. seasonal or post partum), duration of symptoms, or severity of symptoms. These illnesses impact over 19 million adults in America each year. Depression is frequently seen as a complicating factor in heart attack, stroke, diabetes and cancer patients. In fact, depression increases one's risk of having a heart attack. Almost anyone who kills him or herself suffers from a mental disorder, most often a form of depression or substance abuse or both.

The key factor in diagnosing most of these illnesses is the presence of a major depressive episode. To be diagnosed with a major depressive episode your symptoms must last at least 2 weeks. The symptoms must also appear to be a change from previous functioning. There are people who resemble Winnie the Pooh's Eyre their whole life but are not depressed. The symptoms of a major depressive disorder include:

• Depressed mood.
• Diminished interest or pleasure in most activities.
• Significant weight loss or gain without effort or loss of appetite.
• Difficulty sleeping or sleeping too much.
• Psychomotor agitation or retardation.
• Fatigue.
• Feelings of worthlessness or excessive or inappropriate guilt.
• Diminished ability to think or concentrate, or indecisiveness.
• Recurrent thoughts of death, suicidal ideation, or a suicide attempt or plan.

Thankfully, most people do not experience all of the symptoms. To be diagnosed with a major depressive episode one must experience at least 5 of the above symptoms and 1 of the 5 must be either depressed mood or diminished interest or pleasure in most activities. If one meets several of these symptoms, but less than 5, there are milder depressive disorders that can still be diagnosed. It is important to remember that each person will experience a different set of symptoms with their depression and that the symptoms will look different with different people. No two people will experience depression in exactly the same manner. There are, however, some common themes that do repeat themselves, particularly in lawyers. In lawyers the most common symptoms are closely related to the work we are trying to do. Reduced ability to concentrate is one of the most bothersome symptoms for attorneys. They may have had trouble sleeping and a poor appetite for some time but attorneys often seek treatment when they realize that their ability to concentrate and get their work done is compromised. When you add together reduced ability to concentrate with fatigue and loss of interest in most all activities it is highly likely that the attorney's work is going to suffer at least in quantity if not in quality. In addition, attorneys in this condition often try to remedy the problem by working longer hours to keep up on the quantity of their work. In doing so they reduce contact with significant, supportive people in their life, reduce the amount of time they spend on exercise, hobbies, and other stress reducing activities, and cut back further on what is most likely already inadequate sleep. In their attempts to solve the problem they are doing the opposite of what they need and falling deeper into the hole of depression.

If you have a strong family history of depression you may decide that it is best to stay on medication for some time. On the other hand, if you have no family history and your depression occurred during the year that your divorce was final, your mother died, and you lost your job, you might have more of an acute and situational depression and might not be on medication very long. Regardless, the skills you learn in therapy are what will help you to avoid future episodes of depression. This is critical because it is generally accepted in the psychiatric field that if you have one episode of depression there is a 50% chance that you will have a second episode. If you have a second episode of depression there is a 70% chance that you will have a third episode and if you have a third episode there is a 90% chance that you will have yet another episode. Clearly, it is worthwhile to do all you can to treat a first episode of depression to increase the chances that it will be your only experience with depression.

Erand, marvellous post!

It does not say what the best treatment for severe depression is: ECT. Electroconvulsive Therapy has a higher success rate for severe depression than any other form of depression treatment. ECT has received some bad press as a result of what the treatment used to be. Dr. Demitris Popolos sheds some light on the issue. It can be life-saving and produce dramatic results. It is particularly useful for people who suffer from psychotic depressions or intractable mania, people who cannot take antidepressants due to problems of health or lack of response and pregnant women who suffer from depression or mania. A patient who is very intent on suicide, and who would not wait 3 weeks for an antidepressant to work, would be a good candidate for ECT because it works more rapidly. In fact, suicide attempts are relatively rare after ECT. ECT is usually given 3 times a week. A patient may require as few as 3 or 4 treatments or as many as 12 to 15. Once the family and patient consider that the patient is more or less back to his normal level of functioning, it is usual for the patient to have 1 or 2 additional treatments in order to prevent relapse. Today the method is painless, and with modifications in technique it bears little relationship to the unmodified treatments of the 1940s.

The patient is put to sleep with a very short-acting barbiturate, and then the drug succinycholine is administered to temporarily paralyze the muscles so they do not contract during the treatment and cause fractures. An electrode is placed above the temple of the nondominant side of the brain, and a second in the middle of the forehead (this is called unilateral ECT); or one electrode is placed above each temple (this is called bilateral ECT). A very small current is passed through the brain, activating it and producing a seizure. Because the patient is anesthetized and his body is totally relaxed by the succinycholine, he sleeps peacefully while an electroencephalogram (EEG) monitors the seizure activity & an electrocardiogram (EKG) monitors the heart rhythm. The current is applied for one second or less, & the patient breathes pure oxygen through a mask. The duration of a clincally effective siezure ranges from 30 seconds to sometimes longer than a minute, and the patient wakes up 10 to 15 minutes later. Upon awakening, a patient may experience a brief period of confusion, headache or muscle stiffness, but these symptoms typically ease in a matter of 20-60 minutes. During the few seconds following the ECT stimulus there may be temporary drop in blood pressure. This may be followed by a marked increase in heart rate, which may then lead to a rise in blood pressure. Heart rhythm disturbances, not unusual during the period of time, generally subside without complications. A patient with a history of high blood pressure or other cardiovascular problems should have a cardiology consultation first.

[Peter s Father In Law]

It does not say what the best treatment for severe depression is: ECT. Electroconvulsive Therapy has a higher success rate for severe depression than any other form of depression treatment. ECT has received some bad press as a result of what the treatment used to be. Dr. Demitris Popolos sheds some light on the issue. It can be life-saving and produce dramatic results. It is particularly useful for people who suffer from psychotic depressions or intractable mania, people who cannot take antidepressants due to problems of health or lack of response and pregnant women who suffer from depression or mania. A patient who is very intent on suicide, and who would not wait 3 weeks for an antidepressant to work, would be a good candidate for ECT because it works more rapidly. In fact, suicide attempts are relatively rare after ECT. ECT is usually given 3 times a week. A patient may require as few as 3 or 4 treatments or as many as 12 to 15. Once the family and patient consider that the patient is more or less back to his normal level of functioning, it is usual for the patient to have 1 or 2 additional treatments in order to prevent relapse. Today the method is painless, and with modifications in technique it bears little relationship to the unmodified treatments of the 1940s.

The patient is put to sleep with a very short-acting barbiturate, and then the drug succinycholine is administered to temporarily paralyze the muscles so they do not contract during the treatment and cause fractures. An electrode is placed above the temple of the nondominant side of the brain, and a second in the middle of the forehead (this is called unilateral ECT); or one electrode is placed above each temple (this is called bilateral ECT). A very small current is passed through the brain, activating it and producing a seizure. Because the patient is anesthetized and his body is totally relaxed by the succinycholine, he sleeps peacefully while an electroencephalogram (EEG) monitors the seizure activity & an electrocardiogram (EKG) monitors the heart rhythm. The current is applied for one second or less, & the patient breathes pure oxygen through a mask. The duration of a clincally effective seizure ranges from 30 seconds to sometimes longer than a minute, and the patient wakes up 10 to 15 minutes later. Upon awakening, a patient may experience a brief period of confusion, headache or muscle stiffness, but these symptoms typically ease in a matter of 20-60 minutes. During the few seconds following the ECT stimulus there may be temporary drop in blood pressure. This may be followed by a marked increase in heart rate, which may then lead to a rise in blood pressure. Heart rhythm disturbances, not unusual during the period of time, generally subside without complications. A patient with a history of high blood pressure or other cardiovascular problems should have a cardiology consultation first.

Well, to maximize the benefits of ECT and minimize the risks, it is essential that the patient's illness be correctly diagnosed, that ECT be administered only for appropriate indications, and that the risks and adverse effects be weighed against the risks of alternative treatments.

During the few minutes following the stimulus, profound and potentially dangerous systemic changes occur. First, there may be transient hypotension from bradycardia caused by central vagal stimulation. This may be followed by sinus tachycardia and also sympathetic hyperactivity that leads to a rise in blood pressure, a response that may be more severe in patients with Essential Hypertension. Intracranial pressure increases during the seizure. Additionally, cardiac arrhythmias during this time are not uncommon (but usually subside without sequelae). Thus, certain patient groups that would be adversely affected by these manifestations are at increased risk. There are two categories of central nervous system effects. Immediately after awakening from the treatment, the patient experiences confusion, transient memory loss, and headache. The time it takes to recover clear consciousness, which may be from minutes to several hours, varies depending on individual differences in response, the type of ECT administered, the spacing and number of treatments given, and the age of the patient. The severity of this acute confusional state is greatest after bilateral sine wave treatment and least when non-dominant unilateral pulsed ECT is administered. Severity also appears to be increased by longer seizure duration, close spacing of the treatments, increasing dosage of electrical stimulation, and each additional treatment.

Depressive disorders are characterized by cognitive deficits that may be difficult to differentiate from those due to ECT. It is, however, well established that ECT produces memory deficits. Deficits in memory function, which have been demonstrated objectively and repeatedly, persist after the termination of a normal course of ECT. Severity of the deficit is related to the number of treatments, type of electrode placement, and nature of the electric stimulus. Greater deficit occurs from bilateral than from unilateral placement. Sine wave current has been found to impair memory more than pulsed current.The ability to learn and retain new information is adversely affected for a time following the administration of ECT; several weeks after its termination, however, this ability typically returns to normal. However, research conducted as long as 3 years after treatment has found that many patients report that their memory was not as good as it was prior to the treatment. They report particular difficulties for events that occurred on average 6 months before ECT (retrograde amnesia) and on average 2 months after the treatment (anterograde amnesia). Because there is also a wide difference in individual perception of the memory deficit, the subjective loss can be extremely distressing to some and of little concern to others.

There are other possible adverse effects from ECT. Some patients perceive ECT as a terrifying experience; some regard it as an abusive invasion of personal autonomy; some experience a sense of shame because of the social stigma they associate with ECT; and some report extreme distress from persistent memory deficits. There are insufficient systematic studies to permit any definitive assessment of the prevalence of these various perceptions among ECT patients.

[solis]

I got epidural (to relieve pain during labor/delivery) and the doctors were negligent, with the procedure having complications in my case. To initiate epidural anesthesia a local anesthetic, an opioid (or a combination of both) is delivered into the epidural space via a special needle. The medication diffuses through the dura mater, the arachnoid, and the pia mater to the spine. Bathing the spinal cord and nerve roots, the local anesthetic and opioid block pain impulses before they reach the brain.



Because the epidural needle and catheter are large, a sudden tear of the dura mater during epidural insertion can result in CSF (cerebrospinal fluid) leaking into the epidural space. You got a "wet tap" if you have sudden severe headaches when upright. I took the hospital to court for not being careful when tearing the dura mater and the hospital was dishonest enough to falsify all documentation to evade liability.

Hospitals have an army of lawyers to protect them. The best you can do with them is to settle in advance.

[caracosta]

The frenzy of destruction and the rejoicing in blood and ritualized murder arise from the fact that few can admit that none of our immortality systems or our glory fixes works at all. They are elaborate deceptions, illusions, rituals with no power to save.  No matter how much wealth the rich person accumulates, or how great the power wielded by the king, everyone knows that the relatives will be fighting over the spoils before the body gets cold. Everyone knows that no Reich lasts a thousand years and no family line is assured of perpetuation. Furthermore, insofar as I derive my glory from merging myself with another person or system, to that degree I am less than whole. Borrowed glory is not my glory.

But these are the only buffers people have to shield themselves from the terrible dark and cold of the Void. The frenzy arises from the constant undercurrent of realization that the immortality strategies are illusion. The fact that they cannot save must be denied, hidden, repressed. [...]

Don't you think that just by saying it - that all these "buffers" can not shield us from the terrible dark and cold of the Void, that all these immortality strategies are illusions - you're evoking something that should have not been?!