Falling Into the Fire: A Psychiatrist's Encounters with the Mind in Crisis (28 page)

involuntary, 12, 104–6, 163

role of, 27

Hudson River, 155–56

hugging, Amma’s use of, 118

humor, as coping mechanism, 42–43, 86–87, 100–101, 106

hurricane, as metaphor for life trauma, 93–96

hygiene, 4, 121, 124

hyperstates, 106

hypnotism, 192

hysterectomies, 189

hysteria, 184–89, 190–92

mass, 196–203

Hysterical Men
(Micale), 185

“hysterical paroxysm,” 185

hystero-epilepsy, 191

iatrogenic harm, 177

“imagined ugliness,” 69

Imlin’sche family, 198

“In a Dark Time” (Roethke), 208

India, 118–19, 198, 199

infanticide, 141–43

laws pertaining to, 154–55

Infanticide Act (British; 1922), 155

infection, 21

inferiority, 78

infidelity, projection in, 45–46

intentional ingestion, 19–33, 42–43, 75, 207

items swallowed in, 23–24, 25, 27–29, 31–32, 42–43, 208

self-injury by, 12, 21–29

see also
Lauren

Internet, 117

interpersonal conflict, 50

intubation, 177, 178

“Iron Rations: Fakirs Swallow Swords, but Amateurs Take Cake Lunching on Hardware,” 42

isolation:

body image in, 69, 71

desire for, 11, 16

early, 48–49

in filicide, 155

social, 194–95

Israel, 119–21

Jamison, Kay Redfield, 112

Jane 5 ward, 44

Japanese tourists, 121

Jehovah’s Witnesses, 90

Jerusalem syndrome, 119–21

Jesus Christ:

Colin and, 97–98, 101

delusions involving, 34, 56, 59, 120

Jim and Wendy (author’s neighbors), 95

Joan of Arc, 130

Johnson, Eric Michael, 150, 153–54

José (mental health worker), 190

Joseph (catatonic patient), 3–11, 12, 16–17, 196, 207, 208

Journal of Abnormal Psychology,
50

Journal of Applied Philosophy,
88

Journal of Clinical Psychiatry,
34

Journal of Hand Surgery,
86

Journal of Neurological Sciences,
92

Journal of Neurology,
178

Julie (BDD patient), 74–75, 86

Justice Department, U.S., 141

Kalogjera-Sackellares, Dalma, 176, 182–83

Kay (grandmother’s friend), 114

Kleeman, Jenny, 118

Klein, Melanie, 45

kleptomania, 37

koro,
198–99, 202

labor, 74

LaFrance, W. Curt, Jr., 176–83, 193–96, 203, 208

Lauren (intentional ingestion patient), 19–33, 207

causes for disorder of, 50–51, 54–55, 56

as chronically returning patient, 19, 29, 31, 43–44, 54, 60–62

compared with amputation patient, 58–59

failure of health care system for, 62–64

family background of, 55

hostility of, 21–23, 38–44, 46–47, 60

projective identification as response to, 46–47, 50

superficial/moderate self-mutilation in, 36–37, 59

treatment strategy for, 31–33, 37–38, 51, 54–55, 56, 59–64

Lee, Nathaniel, xi

Levy, Neil, 87–89

Lidofsky, Diana, 53

lightbulbs, 19, 21–23

Literary Digest,
42–43

Little Green Men, Meowing Nuns, and Head-
Hunting Panics
(Bartholomew), 198

London Eye, 149

loss, death and, 209–11, 215

Loudun, France, 200

Lowell, Robert, 107, 110

“lunatics,” 13

Macbeth
(Shakespeare), 1

McGeoch, Paul D., 92–93

McKee, Geoffrey R., 156–57

Mad Pride, 110

“Mad Tourists” (Halim), 121–22

Maestripieri, Dario, 152–53

Magherini, Graziella, 122–23

“magical genital loss,” 199–200

magnetoencephalography, 92

Maines, Rachel, 186–88

major self-mutilation, 33–35, 59

malingering, 8–9, 180–81

managed care,
see
health insurance companies

mania, 127–28, 130

depression and, 106–7

manslaughter, vs. murder, 155

marijuana, 21, 103

Martha (tourist), 122

Mary, Virgin, 34

mass psychogenic illness:

causes of, 202–3

examples of, 196–202

“Maternal Filicide Risk Matrix,” 156–57

Matthew, Book of, 33, 67, 207

Mayo Clinic, 72

Medea
(Euripides), 135, 142

media, images of perfection in, 78

Medical and Behavioral Treatment Plan, 26–28

medication:

effective, 30, 125–26

ineffectiveness of, 29–30, 88, 145

for mental illness, 16, 23, 29, 103–4, 119, 130–32

misuse of, 127–28

patient volition and, 12, 104, 105, 108, 163

reliable use as important in, 31, 67, 79, 107, 116

in seizure threshold, 171

side effects of, 31

see also
specific drugs

medicine:

author’s evolving perception of, 1–2

“cover your ass” (CYA) approach in, 165

ethical issues in, 14, 25, 56–60, 85, 87–93, 104–6, 119, 125–27, 131–32

financial issues in, 14, 16, 29

hierarchies of decision making in, 164–75

intersection of psychiatry and, 163–205

judgment calls in, 128–30

omission vs. commission in, 58–59

potential treatment hazards in, 177

shortcomings of, 17, 46–47, 77

see also
doctors;
specific disciplines

meditation, 17

medulla, 10

Melancholy,
15

memories, personal, 13

memory loss, 8

men, and hysteria, 184–85, 189

mental illness:

dangers of undertreatment of, 107–8

drug use in, 7

ethical issues in, 56–60, 131–32

historical treatment and mistreatment of, 13–17, 188–89, 190–93, 197–98, 200–201

importance of correct diagnosis in, 12, 146–47, 157–58, 166, 176–77, 182

interdisciplinary conference on, 109–13

myth of romantic madness in, 15, 110–13, 132

onset of, 115–16

perceptual acuity in, 39–41, 136

physical illness vs., 93, 129–30

social circumstances vs., 29–30

subjects as “spectacles” in, 15, 190–93, 201–2

see also
specific disorders

mental retardation, 35

Messiah
(Handel), 111

Mexico, 85

Micale, Mark, 185

Michigan, author’s fondness for, 65, 114, 147, 212, 213

midwives, 186–87

migraines, 11

mind:

as domain of psychiatry, 11–12, 17

intersection of body and, 12, 163–205, 207

mysteries of, 12

minimal engagement, 4

mirrors, obsession with, 68–70, 80

misdiagnosis:

dangers of, 12

of depression, 30

Missouri, University of, 33

mockingbirds, 114–15

Molière, 163

Monica (manic patient), 127–28

monkeys:

bonding research on, 48–49, 55

cortisol and stress in, 152–54

Monro, Thomas, 16

Montross, Christine:

contemplation of hard questions by, 1–3, 16, 17, 90–91, 93, 112–14, 117, 119, 126–33, 147–53, 203, 207–16

doubts and unease of, 1–3, 16, 17, 38–42, 44–47, 61–65, 77, 90–91, 108–9, 110, 116, 131, 160–61, 165, 168, 170–75, 180, 182, 212, 215

evolving perceptions of, 1–2, 12–13, 207–16

grandmother of, 114–15

hurricane experience of, 93–96

mission of, 2–3, 39–40, 106

motherhood of, 6, 12–13, 61, 65, 82, 93–95, 114, 130, 133, 147–53, 164, 203–5, 213–16

parents of, 148, 211

partner of,
see
Deborah

presentation on theme of madness by, 109–13

psychiatry as career choice of, 2–3, 19, 167–68, 208, 212

residency of, 3, 19, 39, 67, 72, 99, 163, 207

as risk-averse, 164–65

mood disorders, 30

mood stabilizers, 29

Morselli, Enrico, 69–70

mortification, 200

Mother Nature
(Blaffer Hrdy), 153–54

mothers:

fears of, 149–53

harming of children by, 135–61

murders by, 141–44

movement disorders, 176, 193–96, 202

Mrs. Dalloway
(Woolf), 111

Munch, Edvard, 110

Munthe, Axel, 192

murder:

manslaughter vs., 155

of one’s own children,
see
filicide; infanticide

mutilators, 51

mystics, 12

nail biting, 36

Nancy (paranoid schizophrenic patient), 124–26

Natchez, Miss., 197

natural selection, 150, 153

nausea, induced, 16

neglect:

child, 53–54

in predisposition for self-injury, 47–48

neonaticide, 141–43

nerves, 11

“nervous breakdowns,” 185

Nervure,
121

neurological examination, 5–7

symptom validity tests in, 8–10

neurology:

BIID origins in, 91–92

intersection of psychiatry and, 11–12, 172, 175–84

neuropsychiatry, 176–84, 193

Neuropsychology Review,
92

New York, State University of, Buffalo, 117

New York State, 202

New York Times,
30, 118, 122, 196

New York Times Magazine,
202

New Zealand, 155

Nigeria, 199–200

nipples, in BDD, 73

nonhuman primate research, 48–49

nonmutilators, 51

nonsuicidal self-injury, 35

Northwestern University, 189

noses, in BDD, 72, 74–75, 86

nuns, 200–202

nurses:

briefing role of, 3, 169

functions of, 20, 169–70, 174

resentment felt by, 37–38, 46, 174, 182, 190

object relations theory, 45

Observationum et Curationum Medicinalium ac Chirurgicarum, Opera Omnia
(van Foreest), 186

obsession:

in BDD, 67–81

in BIID, 90

command hallucinations vs., 146–47

of harming child, 135–40, 152, 158

obsessive-compulsive disorder, 36, 147, 158–60

see also
Anna

ocean, as metaphor for life, 212–14

O’Connor v. Donaldson,
105

Ojibwa tribe, 201–2

“ominous extravagance,” 106

One Flew Over the Cuckoo’s Nest,
105, 107

opiates, 7, 165, 180

natural occurrence of, 50–51

orgasm, as treatment for hysteria, 185–88

Osiris, 15

ovarian compressor belt, 192

ovaries, 189, 192

Oxford English Dictionary, The,
69, 83

pain:

assessing of, 9

in BDD, 73–75

as deterrent to self-injury, 33

distancing from, 179

as evaluative tool, 5–6, 8, 10

lack of sense of, 35, 50–51

as penance, 34, 200

physical vs. psychic, 21–23, 47, 75, 86, 202, 208

physiological response to, 6

in psychogenic disorders, 181

paralysis, 9

paranoia, 15, 109, 115, 122, 123, 124–26, 143, 163

paraphilias, 83

parent-infant bonding:

in attachment theory, 53

research on, 48–50

parenting:

author’s experience of, 6, 12–13, 61, 65, 82, 93–95, 114, 130, 133, 147–53, 164, 203–5, 213–16

psychiatry compared with, 13

research on, 48–49

parietal lobe, 92–93

Paris, 190

Paris syndrome, 121

paternalism, 104

patients:

abiding with, 12, 136

antagonistic stance of, 21–23, 38–43

autonomy issues and, 12, 89–90, 104–6, 119, 125–27, 163

briefing routine for, 3–4

as chronically returning, 4, 14, 23–24, 99, 157, 164

classification of, 14

doctors duped by, 6, 136, 170–75, 180–84

“gravely disabled,” 105

as imposters, 182–84

nonjudgmental relationship to, 181–82

palliative measures vs. cures for, 26

premature discharging of, 14, 23

resentment engendered by, 37–38, 42–45

self-perception of, 102, 103

self-reporting by, 50

sense of loss in, 209–11

short-stay, 13–14, 99

threats of violence by, 78–79, 116, 135–40

vulnerability of, 2–3

see also
specific individuals

Patty (self-mutilation patient), 34–35

pediatricians, 7, 142

pedophilia, 136

penises:

self-amputation of, 35

shrinking and disappearing of, 12, 198–200, 202

pep squad, mass psychogenesis in, 196–97, 203

pharmaceutical companies, 30

phenothiazine, 130

Phillips, Katharine, 72, 73–75, 77–78, 81

Phyllis (seizure patient), 169–75, 177, 178, 180, 182, 184, 188, 190, 207

Pierre, Jean, 155–56

Plath, Sylvia, 110, 113

polyps, 31

Ponte Vecchio, 123

possession, demonic, 200–201

postpartum psychosis, 30, 112, 157

postpartum stress, 150–51, 155

post-traumatic stress disorder (PTSD), 169–70

poverty, 31

preaching, 121

pregnancy, stress during, 150

Price, Lawrence, 30–31

prodromal phase, 109

projection, 45–47

projective identification, 45–47, 50

prostitution, 55

Prozac, 79

pseudoseizures (psychogenic nonepileptic seizures), 171–80, 182, 185, 188, 195

history of, 190–93

Psychiatric Times,
140

psychiatry:

author’s hard questions about, 1–3, 16, 17, 90–91, 93, 112–14, 119, 126–33, 147–48, 207–16

difficulty of determining a diagnosis in, 108–9, 126, 128, 132, 137, 146–47, 157–58, 163–64, 166, 170–75, 182–84

doctor’s nonjudgmental stance in, 181–82

domain of, 11–12

emergency procedures in, 166–69

historic evolution of, 13–17

intersection of medicine and, 163–205

lack of certainty in, 168

as medical discipline, 11