In a message dated 8/26/99 8:15:42 PM Pacific Daylight Time, Ebmaine@...
writes:

<< What I find so devastating is the approach that says, "This is a
biological
  problem," by which they are really saying, "This has nothing to do with me
  personally. I as an individual in this community really can't do anything.
  It's a chemical imbalance."  >>

This whole post was very nice.  I perfectly agree.

Diane M. Gartland Psy.D.

"The mind is not a hermit's cell"
              Charles Horton Cooley

Thanks for all the comments on subtance abuse and its relationship to physical
disorders and personaity disorders.  I, too, like to look at studies as well as
anecdotes, but mostly I'm seeing "studies show" rather than citations.  As I
tell my students, anyone can say "studies show."  There seems to be an awful lot
of disagreemnet on what "studies show" when it comes to the effectiveness of
talk versus pill treatments for depression.  The most consistent reports I get
from people who actually suffer from depression are that medication facilitates
therapy in the way that David has described.

If trauma can cause chemical imbalance and depression, does that mean that the
chemical imbalance is always the result of trauma, abuse, etc.?  As regards the
relevance to object-relations, it is clear that different O-R theorists have
different beliefs about the roots of poor object relations. Are they due to
excessive aggressive impulses from the subject or poor responses from the
object?  Some assume abuse or neglect on the part of the parents merely on the
evidence of the existence of a child's disorder.  Witness the reactions to
Littleton.

A facilitating environment, in Winnicottian terms, includes many factors
internal and external to the infant.  If I continually feed my allergic infant
milk that hurts her stomach (esp. nursing, bcause often doctors will tell you it
can't be the milk if you are nursing, for heaven's sake), she will likely begin
to develop some defenses.  If, in addition, I am neglectful or abusive, the
problems will be compounded.  As long as physical conditions go undiagnosed and
untreated, might they trigger part of the complex of defenses that may become a
personality disorder--rage directed against the object, etc.?  I have read most
of the major O-R theorists, and don't see much attention to this.  But I'm an
admitted novice and would like to know what might be directly relevant.

Kathy Agar

Anecdotal evidence may not be convincing, but it sure as heck gets a discussion
going!

Since I have worked in a hospital many years, Kathy Agar's daughter's
unfortunate experience interested me. It seems to me that the physians'
reaction to their inability to find out what was wrong with a
persistently sick child is what seems to demand psychodynamic
investigation. The inability to admit uncertainty is a human failing,
but does not necessarily have to be as prevalent as currently it tends
to be among the medical profession. Moreover, the fairly offensive
response -- to insinuate that the patient has "psychological problems,"
or may just be malingering, is not, in most cases, an assessment arising
out of careful evaluation. Most physicians are not really trained in
techniques of assessing psychosomatic symptoms. They have a clerkship in
psychiatry in medical school, and then go on to concentrate on things
they enjoy much more.

Frequently the modal doctor feels a greater than socially normative
level of anxiety in having to confront patients who are ambivalent,
erratic, etc. I work in an emergency room, and recall an incident when a
doctor (in this case, actually a psychiatrist) said something like: "Oh,
why does this woman bother me so much?" I said: "It's because you're an
anal character and she isn't." I've had many opportunities to repeat
this little lesson and tend to point out that the process of becoming a
physician self-selects people who are capable of much focussed activity,
much deferral of gratification, much acceptance of petty tyranny, etc.
"Think of all those times you could have gone drinking, gone dancing,
had a good meal, gotten laid, and you stayed in your room studying
organic chemistry or microbiology." I then put this in positive terms,
and point out that while not everybody ought to have the characteristics
necessary to becoming a physician, some people may need to -- though
perhaps not to over develop them to the extent that contemporary
American medical training does.

However, as Elizabeth suggested, it is rather appalling that Kathy's
child had to go to so many doctors in so many states before they got the
idea of testing her appropriately. That is something that might do well
as a letter to one of the better medical journals. some of them, like
the NEW ENGLAND JOURNAL, or the JAMA, might be willing to give a forum
to such thoughts. After all, what happened to Kathy's child is not an
example of the inevitable limitations of knowledge. It was bad medical
practice.

Christopher Rhoades D˙kema

To add to this discussion, let me relate a clinical situation I dealt with
several years ago.  I began wwork with a young (30ish) woman who was married and
had one son.  She was diagnossed as being depressed and certainly had many
relationship problems, was sexually abused as a child and was generally in a
life
space that would lead one to suspect depression.  We engaged in successful
treatment of most of those issues.  As for the depression, it turned out to be a
"side effect" of a mix of medications her doctor had prescribed for her (for
urinary tract infection is all I rememebr at this point).  This was "diagnosed"
by w friend of ehrs who was also a nurse.

Later on in my work with this family we dealt with problems her son was having
in
school. The school officials refused to have the boy assesed for a possible
learning disability, arguing that his problems stemmed from his unstable home
environment. We got his assessed by an independent psychologist, he was
diagnossed with a learning disability. After a struggle we got the school to
make
adaptations the boy needed in his learning environment and he did quite well in
school.

Rob Twigg

Ebmaine@... wrote:

> Dear Kathy:
>
> I see what you're aiming at. The point I gain from your notes is that at
> times the doctor's don't know what's wrong, and because they can't find
> anything, they start to "assume" it's a pysch issue.  On the other hand,
> you've indicated that in fact your daughter was finally diagnosed as
> suffering from allergies. Given this day and age, I'm frankly surprised it
> took someone that long to take that into consideration. This sounds very
> regrettable. On the other hand, we can't expect physicians to be gods and
> know everything. There's a lot they don't know. But a very young child with a
> personality disorder? Depression--yes, but a full-blown personality disorder?
> Would there have been time to have gotten that far? Sounds doubtful to me. At
> any rate, that too could have been diagnosed if in fact that existed. It's
> pretty clear that wasn't the issue. On the other hand, who can say about a
> lot of things. Many things do have a psychogenesis ... which isn't to say
> there isn't an underlying predisposition to showing up a psych problem in a
> certain way. People predisposed to alcoholism have a funny way of exhibiting
> their personality problems by becoming full-blown alcoholics, for example.
>
> My real point was that if one thinks one has something, and is convinced of
> this, but the tests all turn out negative, then there's at least a raised
> eyebrow as to why someone would persist in believing they had something that
> was negatively diagnosed--if after testing your daughter for every possible
> allergan and she was negative for all tests, yet she persisted in belieiving
> she had allergies, one would wonder.
>
> A few drinks generally doesn't make one who is predisposed to alcoholism an
> alcoholic. I'd say everyone in my family is genetically predisposed to
> alcoholism--but only a few of us have succumbed--because we sat down and
> drank--heavily. And you'll find that most alcoholics can put away an enormous
> amount of alcohol--far more than your average joe. It's only after the
> alcoholism has reached a certain level that the tolerance level starts
> dropping. By then, you've got someone who's been drinking heavily for a
> number of years. Like most chemical addictions, there's a physiological
> change that happens. It may happen in the face of a predisposition, true.
> But, you don't get hooked on cocaine, or heroine on one occasion. It takes
> more than that. The body has to have time to respond by changing the
> receptors. At any rate, there is a lot of literature on this.
>
> Warmly, Elizabeth
>
> ------------------------------------------------------------------------
>
> eGroups.com home: http://www.egroups.com/group/object-relations
> http://www.egroups.com - Simplifying group communications

In a message dated 8/27/99 9:42:08 AM, kervy@... writes:

>People in the recovery movement have refined a treatment for personality
>disorders.  They call it a twelve step program.  Fortunately or
unfortunately,
>depending on your perspective, that method appears to work better and is
>less
>expensive than conventional MH psychotherapy.  I enjoy working with patients
>who
>are also participating in twelve step programs.
>
>I do believe that mental health folks would be wise to borrow the recovery
>metaphor in their work and not only with AXIS I patients.  It can be a
>unifying
>concept across disciplines.
>
>Kevin

I have been following this thread with interest. Elizabeth presents material
based on research, which whether one likes it or not, is at least available
to evaluate. But much of the other ideas so far have been based on anecdotal
evidence, which on a case by case basis may seem quite persuasive, may not in
fact hold up under closer scrutiny.

The success of 12 step programs is on such instance. There is no systematic
data collected and no reliable evidence that this approach works better
across the board than any other.

And one reason that psychiatry has turned to psychopharmacology has to do
with issues of professional turf and economics. We have come to rely on third
parties to pay for most treatment and the economic forces there want what is
cheap and fast, not necessarily what is best.

In any case, none of this addresses the issue of object relations and how
they play a role in the development of the various addictions. It might be
interesting to reflect on that rather than on the politics of treatment.

Cheryl L. Fuller
Portland, ME.

--
Kevin J. Kervick, M.S.
Marriage and Family Therapist
Responsive Community Resources
Indian Valley Psychological Center
203 East Broad Street
Souderton, PA 18964
http://www.kervick.com

Ebmaine@... wrote:

> What I find so devastating is the approach that says, "This is a biological
> problem," by which they are really saying, "This has nothing to do with me
> personally. I as an individual in this community really can't do anything.
> It's a chemical imbalance." Whereas what the person really needs is the
> community--support, expertise, and correction, education, etc.  I am reminded
> again of the biography of Paul Nash i just finished reading, where we are
> reminded that once upon a time the mental breakdown of geniuses was more or
> less taken in stride and the broken down were allowed to slip away to an
> asylum for much needed rest and therapy. The community took care of its
> mathematicians and scientists and feared losing them totally to
> schizophrenia, or depression, or whathave you. In our society, however, we
> think the sick--whether physically or psychologically--are so "dirty", we
> just want to clean it up quickly with drugs.  We want to "fix" it as if it
> were a machine.

This is profound.  Are you saying that asylums were places of healing?  That
would be a countercultural thought but one that I believe probably has merit. 
In
our zeal to deinstitutionalize we have tended to biologize human struggles and
we've lost much of the healing power of community.  Do you or Nash have ideas
for
humane treatment of "genius" conditions?

Regards,

Kevin

--
Kevin J. Kervick, M.S.
Marriage and Family Therapist
Responsive Community Resources
Indian Valley Psychological Center
203 East Broad Street
Souderton, PA 18964
http://www.kervick.com

--
Kevin J. Kervick, M.S.
Marriage and Family Therapist
Responsive Community Resources
Indian Valley Psychological Center
203 East Broad Street
Souderton, PA 18964
http://www.kervick.com

Katherine Agar wrote:

> Here are a few thoughts about what Elizabeth has written and a little
background
> to my question.  I have a child who has suffered from allergies for years,
some
> of the symptoms being lack of energy, stomach pain, listlessness,
irritability,
> multiple "sore" throats. These did not occur together, but got worse in the
> teens. She did not have hay fever symptoms. I took her to doctor after doctor
> who told me: she had viruses, they couldn't find anything, she needed
> anti-depressants, she had chronic fatigue syndrome.  She was subjected to
> numerous blood tests. It was strongly hinted to me that she was having
> psychosomatic symptoms, and I didn't know whom to believe.  She became
depressed
> and withdrawn, reclusive even--angry that no one thought she was really sick
or
> could help her.  Worse, the doctors treated her like a malingerer, and I even
> began to wonder if it was all psychological (some reasons for that, too!)
> Finally, she developed severe tonsilitis in her late teens, which went
> undiagnosed until I found a good ENT. Then I took her to an allergist.  She
has
> very strong reactions to almost every basic food, and many respiratory
> allergies.

I agree with Kathy's assessment that diagnosis is a complex activity.

And I would add that these difficulties can be minimized if practitioners
utilize a
biopsychosocial approach which is a recognition that ALL symptoms are
simultaneously
influenced by biological, psychological, and social factors.  And some would all
the
spiritual dimension as well.  So instead of looking for THE cause one is able
accept
the inevitability of multiple causality.

As more primary care physicians are schooled in this approach care is beginning
to
improve.

Kevin

--
Kevin J. Kervick, M.S.
Marriage and Family Therapist
Responsive Community Resources
Indian Valley Psychological Center
203 East Broad Street
Souderton, PA 18964
http://www.kervick.com

--
Kevin J. Kervick, M.S.
Marriage and Family Therapist
Responsive Community Resources
Indian Valley Psychological Center
203 East Broad Street
Souderton, PA 18964
http://www.kervick.com

Ebmaine@... wrote:

> Kathy  Agar writes:
>
> << It would seem that some
> chemical dependencies arise from physiological deficiencies.  Even where a
> personality disorder is present, how do you know whether or not the disorder
> is a response to some phisical distress that hasn't been remedied?  Or does
> it matter in treatment? >>
>

This is always an interesting discussion.  At a former clinic site the mental
health people who were across the field from the addictions people liked to
comment that the addicts were really people with personality disorders.  Treat
the PD and the addiction would go away, these MH folks maintained.  The
addictions staff always thought that the MH people missed a lot of addictions in
their treatment families.  Get the patient/parent into rehab and other symptoms
will subside.

We use different language to describe similar phenomenon.  Recently a patient
who
is also in AlANON was using language of "the program" to describe her behavior
while I was responding in kind thinking in the language of personality disorder
and speaking in the language of the program.

People in the recovery movement have refined a treatment for personality
disorders.  They call it a twelve step program.  Fortunately or unfortunately,
depending on your perspective, that method appears to work better and is less
expensive than conventional MH psychotherapy.  I enjoy working with patients who
are also participating in twelve step programs.

I do believe that mental health folks would be wise to borrow the recovery
metaphor in their work and not only with AXIS I patients.  It can be a unifying
concept across disciplines.

Kevin

--
Kevin J. Kervick, M.S.
Marriage and Family Therapist
Responsive Community Resources
Indian Valley Psychological Center
203 East Broad Street
Souderton, PA 18964
http://www.kervick.com

Elaine,

I first suffer from depression in the second grade(as well as I can
remember).  At age eleven, I was involved in "Play Therapy".

When I was nineteen I began treating my depression with alcohol.  While
still nineteen I got to the point of experiencing the shakes from daily
drinking.  I developed the habit of drinking myself sick on a regular
basis.  That continued for fourteen years.

During that time I went through a marriage and several treatments for
anxiety attacks (I was prescribed Valium.  That  was a good time!).  And
I got a  lot of talk therapy.

I stopped drinking at age 33.  After I stopped drinking I became
seriously depressed.  I went to a counselor and tried talk therapy again.
  I got evicted  for the second time and lived in the streets.  I applied
for and recieved disability due to my depression.

The depression continued for two years(despite therapy) until I happened
upon a newspaper article announcing a test of antidepressants.  I joined
the test and that was the beginning of the end of my depression.

Today I work and support myself and an adult daughter and pay taxes.  I
am now fifty years old and I'm still taking antidepressant.  Despite full
recovery while taking antidepressants, when I stop the depression
returns.  I would rather be dead than go back to the way I felt before I
recieved medication for depression.

All total I have had about 17 years of talk therapy.  I've always enjoyed
therapy and according to my therapists responded well,  but the fact is
it didn't effect my depression.  From personal experience I can tell you
that depression so distorted my perception of life that I was unable to
benefit from talk therapy until I was properly medicated.

You say,

	  >> I would argue that that chemical situation is not predetermined in
the body, but is the result of some trauma or situation, and can be
addressed through the "talking cure." Studies bear that out.<<

If this is the case why are most psychiatrists today
psychopharmacologists?  I quess my studies don't agree with yours.

There is an old saying "Talk is Cheap"  but talk is not "Cheap" if you
are a psychiatric patient being talked out of mental illness.  Trying to
talk the mentally ill out of it costs them quite a bit.  They have a
right to be healed in the least time necessary.

Please excuse my passion.  No disrespect intended.

Regards, David



Your post,

"In a message dated 8/26/99 10:30:06 PM, el.gringo1@... writes:

<< Physical or physiological conditions can result in depression or other
psychiatric disorders for which the individual copes by using substance
abuse.  This is fairly common.  Among the disabled, substance abused is a
big problem.   Also some forms of personality disorder are believed to be

related to
child abuse.--David Heyer, CASAC >>

Hi David:

Yes, I am fully aware of this. But, this wasn't exactly Kathy's question,

which was:
  << It would seem that some chemical dependencies arise from
physiological
deficiencies.  Even where a personality disorder is present, how do you
know
whether or not the disorder  is a response to some phisical distress that

hasn't been remedied?  Or does it matter in treatment?
  >>
I don't presume that depression is a "physiological deficiency" in the
sense
that there is some genetic lack of an enzyme, for example. There are
plenty
of people who believe that depression is caused by a faulty chemical
situation, but I would argue that that chemical situation is not
predetermined in the body, but is the result of some trauma or situation,
and
can be addressed through the "talking cure." Studies bear that out.

Secondly, sure alcoholism can follow in the heels of depression. Fairly
common phenomena. But, that certainly isn't an argument for a
physiological
deficiency per se. It is simply an argument for an inefficient coping
mechanism--forget, fall asleep, disengage, zone out.

I don't have much doubt about personality disorders being the result of
child
abuse. And I suspect a pattern of thinking and emotional responding gets
set
up--and, yes, one can think of a physiological situation--the
neurological
paths of a thought. But, change the thinking; change the emotive
response,
and you're going to change the path of neuronal firing, decreasing
receptors
here and increasing them there, and thence, a new pathway of processing
information is created. This is neuronal plasticity at work. But,
throwing
prozac on the situation doesn't change any neuronal pathways, the way
thinking a new thought can. With a personality disorder, you're looking
at a
long time to change that situation, but ... well, that's known.

What I find so devastating is the approach that says, "This is a
biological
problem," by which they are really saying, "This has nothing to do with
me
personally. I as an individual in this community really can't do
anything.
It's a chemical imbalance." Whereas what the person really needs is the
community--support, expertise, and correction, education, etc.  I am
reminded
again of the biography of Paul Nash i just finished reading, where we are

reminded that once upon a time the mental breakdown of geniuses was more
or
less taken in stride and the broken down were allowed to slip away to an
asylum for much needed rest and therapy. The community took care of its
mathematicians and scientists and feared losing them totally to
schizophrenia, or depression, or whathave you. In our society, however,
we
think the sick--whether physically or psychologically--are so "dirty", we

just want to clean it up quickly with drugs.  We want to "fix" it as if
it
were a machine.

Regards, Elizabeth

Regards, Elizabeth"
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In a message dated 8/26/99 10:30:06 PM, el.gringo1@... writes:

<< Physical or physiological conditions can result in depression or other
psychiatric disorders for which the individual copes by using substance
abuse.  This is fairly common.  Among the disabled, substance abused is a
big problem.   Also some forms of personality disorder are believed to be
related to
child abuse.--David Heyer, CASAC >>

Hi David:

Yes, I am fully aware of this. But, this wasn't exactly Kathy's question,
which was:
  << It would seem that some chemical dependencies arise from physiological
deficiencies.  Even where a personality disorder is present, how do you know
whether or not the disorder  is a response to some phisical distress that
hasn't been remedied?  Or does it matter in treatment?
  >>
I don't presume that depression is a "physiological deficiency" in the sense
that there is some genetic lack of an enzyme, for example. There are plenty
of people who believe that depression is caused by a faulty chemical
situation, but I would argue that that chemical situation is not
predetermined in the body, but is the result of some trauma or situation, and
can be addressed through the "talking cure." Studies bear that out.

Secondly, sure alcoholism can follow in the heels of depression. Fairly
common phenomena. But, that certainly isn't an argument for a physiological
deficiency per se. It is simply an argument for an inefficient coping
mechanism--forget, fall asleep, disengage, zone out.

I don't have much doubt about personality disorders being the result of child
abuse. And I suspect a pattern of thinking and emotional responding gets set
up--and, yes, one can think of a physiological situation--the neurological
paths of a thought. But, change the thinking; change the emotive response,
and you're going to change the path of neuronal firing, decreasing receptors
here and increasing them there, and thence, a new pathway of processing
information is created. This is neuronal plasticity at work. But, throwing
prozac on the situation doesn't change any neuronal pathways, the way
thinking a new thought can. With a personality disorder, you're looking at a
long time to change that situation, but ... well, that's known.

What I find so devastating is the approach that says, "This is a biological
problem," by which they are really saying, "This has nothing to do with me
personally. I as an individual in this community really can't do anything.
It's a chemical imbalance." Whereas what the person really needs is the
community--support, expertise, and correction, education, etc.  I am reminded
again of the biography of Paul Nash i just finished reading, where we are
reminded that once upon a time the mental breakdown of geniuses was more or
less taken in stride and the broken down were allowed to slip away to an
asylum for much needed rest and therapy. The community took care of its
mathematicians and scientists and feared losing them totally to
schizophrenia, or depression, or whathave you. In our society, however, we
think the sick--whether physically or psychologically--are so "dirty", we
just want to clean it up quickly with drugs.  We want to "fix" it as if it
were a machine.

Regards, Elizabeth

Regards, Elizabeth

Hi!

In my experience I would think that if there were a personality disorder
common to substance abusers it would be antisocial personality disorder.
In light of other personality disorders I would think antisocial symptoms
would be overlooked.

Thinking back to my early experience with AA there seemed to be two
classes of members.  One group was characterized by a criminal history,
admitted to multi drug use and opposed the imposition of any order.  The
other group denied any suggestion that they had somehow been out of
control ever,  maintained they had never been influenced by anything but
alcohol and lived for order.  It was like cops and robbers, priests and
murderers, good guys and bad guys, Republicans and Democrats, Harvard and
Yale. They were all brothers and sisters in AA but they definitely had
their own cliques, and corresponding personality profiles.

I have generally noted though you don't have to have a personality
disorder to become a substance abuser,  some very healthy people become
substance abusers.  And as far as substance abuse causing PD's,  SA
effects different people differently.  I remember reading of a wise man
who listed around 260 possible symptoms for alcoholism alone.

David Heyer


Eddy's post,

"I wanted to add to the statements concerning the possibility of finding
a
personality disorder common to addictions in general.  My clinical
experience makes me agree with Al Turner in the sense of accepting a high

rate of co-morbidity.  However, the variety of personality dx found among

these patients is high.  Although in my practice I have found a high
percentage of perversions and/or sociopathic personalities, these are by
no
means the only ones.  The host of personality disorders sharing
addictions
is vast, and I can't see a single "umbrella-like" disorder regarding
addiction."
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Elizabeth,

Physical or physiological conditions can result in depression or other
psychiatric disorders for which the individual copes by using substance
abuse.  This is fairly common.  Among the disabled, substance abused is a
big problem.

Also some forms of personality disorder are believed to be related to
child abuse.

David Heyer, CASAC


Your post,

"Hi kathy and group:

I don't think I've ever heard of personality disorder being a response to
a
physical distress. I've seen people try to convince themselves of
that--Marfans, mitral valve prolapse, etc, for example, as possible
excuses
for their inability to cope in life, when they've been told over and over

again by extremely competent physicians that there's no physiological
reasons
for their "exhaustion, poor sleep hygiene, lack of energy, inability to
work,
etc." If there is a physical distress, or a physiological distress, these

should be able to be isolated, more or less. Furthermore, it would seem
to me
that personality disorders have a certain flavor to them that don't
necessarily arise in cases where there is in fact a real physical or
phsiological distress.

At any rate, I'd be highly suspicious of someone who attempted to make me

believe that their problems were related to some physiological distress
when
after a thorough work-up, if not many thorough work-ups, nothing is
found. In
fact, that would probably make me more confident in assessing a
personality
disorder.

As for chemical dependencies arising out of physiological lacks--?? So,
someone lacks the gene that makes the enzyme that makes one process
alcohol
in a certain way. But, that doesn't make one an alcoholic. Nope, the
repetitive drinking does that.

Hope that helps some.

Regards, Elizabeth"



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Dear Kathy:

I see what you're aiming at. The point I gain from your notes is that at
times the doctor's don't know what's wrong, and because they can't find
anything, they start to "assume" it's a pysch issue.  On the other hand,
you've indicated that in fact your daughter was finally diagnosed as
suffering from allergies. Given this day and age, I'm frankly surprised it
took someone that long to take that into consideration. This sounds very
regrettable. On the other hand, we can't expect physicians to be gods and
know everything. There's a lot they don't know. But a very young child with a
personality disorder? Depression--yes, but a full-blown personality disorder?
Would there have been time to have gotten that far? Sounds doubtful to me. At
any rate, that too could have been diagnosed if in fact that existed. It's
pretty clear that wasn't the issue. On the other hand, who can say about a
lot of things. Many things do have a psychogenesis ... which isn't to say
there isn't an underlying predisposition to showing up a psych problem in a
certain way. People predisposed to alcoholism have a funny way of exhibiting
their personality problems by becoming full-blown alcoholics, for example.

My real point was that if one thinks one has something, and is convinced of
this, but the tests all turn out negative, then there's at least a raised
eyebrow as to why someone would persist in believing they had something that
was negatively diagnosed--if after testing your daughter for every possible
allergan and she was negative for all tests, yet she persisted in belieiving
she had allergies, one would wonder.

A few drinks generally doesn't make one who is predisposed to alcoholism an
alcoholic. I'd say everyone in my family is genetically predisposed to
alcoholism--but only a few of us have succumbed--because we sat down and
drank--heavily. And you'll find that most alcoholics can put away an enormous
amount of alcohol--far more than your average joe. It's only after the
alcoholism has reached a certain level that the tolerance level starts
dropping. By then, you've got someone who's been drinking heavily for a
number of years. Like most chemical addictions, there's a physiological
change that happens. It may happen in the face of a predisposition, true.
But, you don't get hooked on cocaine, or heroine on one occasion. It takes
more than that. The body has to have time to respond by changing the
receptors. At any rate, there is a lot of literature on this.

Warmly, Elizabeth

Here are a few thoughts about what Elizabeth has written and a little background
to my question.  I have a child who has suffered from allergies for years, some
of the symptoms being lack of energy, stomach pain, listlessness, irritability,
multiple "sore" throats. These did not occur together, but got worse in the
teens. She did not have hay fever symptoms. I took her to doctor after doctor
who told me: she had viruses, they couldn't find anything, she needed
anti-depressants, she had chronic fatigue syndrome.  She was subjected to
numerous blood tests. It was strongly hinted to me that she was having
psychosomatic symptoms, and I didn't know whom to believe.  She became depressed
and withdrawn, reclusive even--angry that no one thought she was really sick or
could help her.  Worse, the doctors treated her like a malingerer, and I even
began to wonder if it was all psychological (some reasons for that, too!)
Finally, she developed severe tonsilitis in her late teens, which went
undiagnosed until I found a good ENT. Then I took her to an allergist.  She has
very strong reactions to almost every basic food, and many respiratory
allergies.

The allergist's literature explained that untreated allergies sometimes resulted
in personality problems, and I can sure believe it.  Her attitude has improved
immensely since she has been treated, but there is a lot of residual anger over
the way she was handled.  So when all those "extremely competent" physicians
tell you that there is nothing physically wrong, well, I don't know. It can do a
lot of damage when there really is something wrong.  By the way, she went to
doctors in Maryland, Georgia, Nebraska and New York, all of whom found nothing
"physically wrong."  I just have to wonder about the effects of such
nonspecific physical disorders, especially in infants and young children.  The
world must seem like a pretty hostile place to them.

I also have a friend who was addicted to drugs (speed) and was diagnosed
(finally) in adulthood with ADD.  After treatment, he no longer seems to need to
self-medicate.

Those particular examples led to my own questions.  Also, I would say that if
lack of a gene (for the sake of argument) predisposes one toward alcohol
addiction, one might not know it until after indulging in behavior considered
normal--having a few drinks.  One might get hooked before one knows it.  With or
without a personality disorder?  Just wondering.  It all seems quite complex to
me.

Thanks for the thoughtful comments.

kathy


>
> I don't think I've ever heard of personality disorder being a response to a
> physical distress. I've seen people try to convince themselves of
> that--Marfans, mitral valve prolapse, etc, for example, as possible excuses
> for their inability to cope in life, when they've been told over and over
> again by extremely competent physicians that there's no physiological reasons
>
> for their "exhaustion, poor sleep hygiene, lack of energy, inability to work,
>
> etc." If there is a physical distress, or a physiological distress, these
> should be able to be isolated, more or less. Furthermore, it would seem to me
>
> that personality disorders have a certain flavor to them that don't
> necessarily arise in cases where there is in fact a real physical or
> phsiological distress.
>
> At any rate, I'd be highly suspicious of someone who attempted to make me
> believe that their problems were related to some physiological distress when
> after a thorough work-up, if not many thorough work-ups, nothing is found. In
>
> fact, that would probably make me more confident in assessing a personality
> disorder.
>
> As for chemical dependencies arising out of physiological lacks--?? So,
> someone lacks the gene that makes the enzyme that makes one process alcohol
> in a certain way. But, that doesn't make one an alcoholic. Nope, the
> repetitive drinking does that.
>
> Hope that helps some.
>
> Regards, Elizabeth

Kathy  Agar writes:

<< It would seem that some
chemical dependencies arise from physiological deficiencies.  Even where a
personality disorder is present, how do you know whether or not the disorder
is a response to some phisical distress that hasn't been remedied?  Or does
it matter in treatment? >>

Hi kathy and group:

I don't think I've ever heard of personality disorder being a response to a
physical distress. I've seen people try to convince themselves of
that--Marfans, mitral valve prolapse, etc, for example, as possible excuses
for their inability to cope in life, when they've been told over and over
again by extremely competent physicians that there's no physiological reasons
for their "exhaustion, poor sleep hygiene, lack of energy, inability to work,
etc." If there is a physical distress, or a physiological distress, these
should be able to be isolated, more or less. Furthermore, it would seem to me
that personality disorders have a certain flavor to them that don't
necessarily arise in cases where there is in fact a real physical or
phsiological distress.

At any rate, I'd be highly suspicious of someone who attempted to make me
believe that their problems were related to some physiological distress when
after a thorough work-up, if not many thorough work-ups, nothing is found. In
fact, that would probably make me more confident in assessing a personality
disorder.

As for chemical dependencies arising out of physiological lacks--?? So,
someone lacks the gene that makes the enzyme that makes one process alcohol
in a certain way. But, that doesn't make one an alcoholic. Nope, the
repetitive drinking does that.

Hope that helps some.

Regards, Elizabeth

----Original Message Follows----
From: Katherine Agar <kagar@...>
To: object-relations@egroups.com
Subject: [object-relations] Re: Are we having a relationship?
Date: Thu, 26 Aug 1999 08:40:24 -0600 (MDT)

In message Al Turner writes:
  > "Dr. Ron Spielman" wrote:
  > >
  > > I feel that addiction is a serious disorder with sidgnificant
underlying
  > > personality disorder, requiring an object relations approach to
understand
  > > the individual and particularly their behaviour in the clinic - let
alone
  > > in
  > > therapy.
  >
  > Could you expand on your beliefs. I believe that comorbidity is
  > high...and the research proves this out. However, it is not necessary
  > for there to be a personality dx for addiction to exist....
  >
  > --
  > Al Turner BA CADC


I hope the practitioners will talk more about this.  It would seem that some
chemical dependencies arise from physiological deficiencies.  Even where a
personality disorder is present, how do you know whether or not the disorder
is
a response to some phisical distress that hasn't been remedied?  Or does it
matter in treatment?

Kathy Agar


This is my first time participating so please forgive any technical mistakes
in this message.
I wanted to add to the statements concerning the possibility of finding a
personality disorder common to addictions in general.  My clinical
experience makes me agree with Al Turner in the sense of accepting a high
rate of co-morbidity.  However, the variety of personality dx found among
these patients is high.  Although in my practice I have found a high
percentage of perversions and/or sociopathic personalities, these are by no
means the only ones.  The host of personality disorders sharing addictions
is vast, and I can't see a single "umbrella-like" disorder regarding
addiction.  I would like to clarify that my experience with addictions is
mostly with alcoholism and prescription drugs, these seem to be the most
common in Costa Rica, so I would be hard pressed to speculate about other
forms of addiction.

Eddy Carrillo, M.Sc., M.A.







______________________________________________________

In message Al Turner writes:
> "Dr. Ron Spielman" wrote:
> >
> > I feel that addiction is a serious disorder with sidgnificant underlying
> > personality disorder, requiring an object relations approach to understand
> > the individual and particularly their behaviour in the clinic - let alone
> > in
> > therapy.
>
> Could you expand on your beliefs. I believe that comorbidity is
> high...and the research proves this out. However, it is not necessary
> for there to be a personality dx for addiction to exist....
>
> --
> Al Turner BA CADC


I hope the practitioners will talk more about this.  It would seem that some
chemical dependencies arise from physiological deficiencies.  Even where a
personality disorder is present, how do you know whether or not the disorder is
a response to some phisical distress that hasn't been remedied?  Or does it
matter in treatment?

Kathy Agar

"Dr. Ron Spielman" wrote:
>
> I feel that addiction is a serious disorder with sidgnificant underlying
> personality disorder, requiring an object relations approach to understand
> the individual and particularly their behaviour in the clinic - let alone in
> therapy.

Could you expand on your beliefs. I believe that comorbidity is
high...and the research proves this out. However, it is not necessary
for there to be a personality dx for addiction to exist....

--
Al Turner BA CADC
Supervisor - Outpatient and Residential Aftercare Services
Lutheran Social Services of Illinois
Behavioral Health Services
675 Varsity Dr.
Elgin, IL. 60120
847-741-2600 x33

In a message dated 8/24/99 8:02:11 AM Pacific Daylight Time,
kagar@... writes:

<< We have had
  some good exchanges over oR interpretations of films, and some clinicians
have
  shared cases. >>

Kathy,

I am afraid I am a bit confused.  The list to which I think I belong at
object-relations@eGroups.com just started last month.  There are only 12
(including this one) postings that have been made.  I am getting the
impression that there is another list or missing archives or something.
Please clarify if you can.

Diane

For anyone's interest and information:  There is also a lovely web site at
http://www.human-nature.com with a link to an online dictionary of mental
health that has some Kleinian links (may be a little outdated) but much other
info.
http://www.psyctc.org/mirrors/ispso/ is also a nice site devoted to the psa
study of organizations.  Any other psa sites?

Diane Gartland

Psyche Matters has a Winnicott bibliography with links to other
Winnicott sites.  The articles pages include works related to
Winnicott as well.

http://www.psychematters.com

As to "why" there are not many Winnicottian sites, I can't answer
that.  I often wonder why there is no site devoted to Melanie Klein
either (although the Melanie Klein Trust is in the process of
developing such a site).  Perhaps it is a function of contemporary
psychoanalysis tending to blend theories and finding the works of many
classical theorists of benefit, so the sites include works related to
the collective rather than devoting to an individual.

Cheryl

On Sun, 22 Aug 1999 09:27:14 -0400, you wrote:

>*i* would be interested to know if there are any good Winnicott
>resources on the web.  I've searched, and not found much.  Have
>I missed some?  If there are none, why?

In a message dated 8/22/99 6:05:33 AM Pacific Daylight Time,
alturner@... writes:

<< does anyone find object
  relations useful in the tx of addictions?
   >>
Yes.  Dr. Henry Krystal (Drug Dependence; Integration and Self Healing;
Adolescence and the Tendencies to Develop Substance Dependence in
Psychoanalytic Inquiry Vol 2(4), 1982).  Also try Essential Papers on
Addiction published by NYU press in 1997.  This is a  collection of
psychoanalytic papers.

Diane Gartland Psy.D.


"The mind is not a hermit's cell"
              Charles Horton Cooley

Al Turner wrote:
>
> psychdocdg@... wrote:
> >
> > I am curious as to whether anyone ever writes anything "to the list" to
> > try to start a discussion.  Is anyone out there?  Is this a discussion
> > forum?  Or is this a forum for receiving messages about new papers?
>
> I'd be happy to start a bit of converstaion here.
>
> I read Flores book on group work with addicts and had an ah-ha when I
> read the chapter on object relations.
[snip]

*i* would be interested to know if there are any good Winnicott
resources on the web.  I've searched, and not found much.  Have
I missed some?  If there are none, why?

\brad mccormick

--
    Prove all things; hold fast that which is good. (1 Thes 5:21)

Brad McCormick, Ed.D. / bradmcc@...
914.238.0788 / 27 Poillon Rd, Chappaqua, NY 10514-3403 USA
-------------------------------------------------------
<![%THINK;[XML]]> Visit my website: http://www.cloud9.net/~bradmcc/

psychdocdg@... wrote:
>
> I am curious as to whether anyone ever writes anything "to the list" to
> try to start a discussion.  Is anyone out there?  Is this a discussion
> forum?  Or is this a forum for receiving messages about new papers?

I'd be happy to start a bit of converstaion here.

I read Flores book on group work with addicts and had an ah-ha when I
read the chapter on object relations. Unfortunately that was about four
years ago in school and I did not really follow-up on that experience
until I saw an opportunity to join this list. The book is at work and
the details of the insight escape me at this time. So, until I go to
work (and remember to bring home Flores' book!), does anyone find object
relations useful in the tx of addictions?

Regards,

Al Turner BA CADC
Supervisor - Outpatient and Residential Aftercare Services
Lutheran Social Services of Illinois
675 Varsity Dr.
Elgin, IL. 60120
847-741-2600 x33

I am curious as to whether anyone ever writes anything "to the list" to
try to start a discussion.  Is anyone out there?  Is this a discussion
forum?  Or is this a forum for receiving messages about new papers?

Diane M. Gartland Psy.D.
Michigan, USA

I have decided to make the archives of both
human-nature-info
and
human-nature-books
accessible to subscribers and to anyone else, as well. This means that if
you want to consult either of these archives from time to time, it is not
necessary to be a subscriber to either egroup. I think it's easier and more
attractive to get the messages in ones and twos, but the choice is there,
as is the option of being a subscriber and only getting digests.

Here is the relevant informatin about Human-Nature-Info,
in case you want to subscribe and/or send it to other forums or friends:


HUMAN NATURE INFORMATION
human-nature-info@egroups.com
Archive: http://www.egroups.com/group/human-nature-info/

	 For some time I have felt that the web sites are unsatisfactory to
which I regularly contribute information about email forums, web sites and
other information of potential interest to people concerned with various
aspects of human nature, the human sciences, psychoanalysis, psychotherapy,
philosophy of science, medicine and related matters.
	 The two main sites are the
Guides to the Internet at the Sheffield Centre for Psychotherapeutic Studies
http://www.shef.ac.uk/~psysc/guides.html
(largely compiled by me and with many entries which are dated or obsolete)
and
The Online Dictionary of Mental Health
http://www.human-nature.com/odmh/index.html (largely compiled by Ian
Pitchford).
	 I expect those sites to remain valuable, but I now intend to
complement them with a new one which has the advantage that it is very easy
to add new entries to it. It takes the form of a web-based eGroup with an
archive which is easy of access. From now on I will archive any new
information there which I think may be of  specialist interest, as well as
other items which may be of general interest, e.g., cultural publications,
free software, conferences, etc. Subscribers will receive each announcement
as it is posted, and they will all be archived at the eGroup's web site.
Over time this is likely to build into a considerable resource.

To join the eGroup, send an e-mail with no message to
human-nature-info-subscribe@egroups.com

The eGroup's messages, calendar, document vault, and more are
available on the web at   http://www.egroups.com/group/human-nature-info/
Subscribers and anyone else has access to the archive, etc.

I will act as the forum moderator. Suggested items for inclusion on the
forum and for placement in the archive will be submitted for my
consideration.
Anyone wishing to set up their own forum and archive, with their own rules
and procedures, can do so free of charge at http://www.egroups.com

Here is the eGroup description:
This forum is an archive of information about email forums, web sites,
archives and other
information of potential interest to people working or interested in human
nature. It includes the human sciences, philosophy, psychoanalysis and
psychotherapy, psychiatry, philosophy of science, issues in medicine and
the history of medicine, social studies of science, cultural studies, brain
science and any other topic which appears to be relevant, including
publications and information of  general interest to internet users.

Subscribers can also raise issues with me directly at robert@...



Here is the relevant information about Human-Nature-Books:

HUMAN NATURE BOOKS
human-nature-boks@ONElist.com
Archive: http://www.egroups.com/group/human-nature-books/

	 This is an announcement list for the purpose of sharing personal
knowledge about good and excellent books about human nature. It is our
opinion that many - perhaps most - people on the net have patchy knowledge
of the literature in this very broad field. From time to time Ian Pitchford
or I will offer views on particular books and series which one of us knows
well or have reason to recommend.
	 The project will inevitably centre around topics where  he and/or I
are knowledgeable. I am  particularly well-read about psychoanalysis,
psychotherapy, philosophy, history & philosophy of the human sciences,
social malaise, and Darwinism, while he is more _au fait_ with evolutionary
psychology, psychiatric theory, sociobiology, human biodiversity and
evolutionary theory. We are particularly industrious in these areas because
of research and writing in which we are separately and collaboratively
engaged.  Both of us also try to remain well-informed about more general
and reflective books about human nature and society. We will also recommend
works in any related field, e.g., fiction, social science, world affairs,
which have come to our attention and which we think well of.
	 Access to the archive will be open to anyone, not just subscribers
to the egroup. We will also supply urls for ordering those of the books
which we recommend which are in print. People who order by this route will
pay the usual price, while we will benefit to the extent of a few per cent
of the price, money which we will devote to our research, net activities
and publishing. People who subscribe or make use of the archive are, of
course, free to purchase the books from anywhere they like or borrow them
from a library. Buying them from our recommended suppliers is not essential
to making use of this resource (though we would appreciate it). Suggestions
for books to include in the recommended list are welcome.

Subscription URL
It is easy to subscribe to human-nature-books. ONElist has created a URL
that you can use
to join the list. The URL is:
http://www.onelist.com/subscribe/human-nature-books

The archive of the egroup's messages is accessible by both subscribers and
by anyone else at http://www.egroups.com/group/human-nature-books/

Note that the archive is in the eGroups format. I set the forum up at
ONElist, but, as far as I can discover, they do not have archives. So I
created one at eGroups. I intend to move the whole list to eGroups in due
course, but I'll wait for some time before doing so. Existing subscribers
should sit tight and await the announced change of host. New subscribers
can subscribe directly to human-nature-books-subscribe@egroups.com

I hope you will feel inclined to avail yourself of this facility.

Best, Bob Young





Robert Maxwell Young
robert@...
http://www.human-nature.com - writings & extensive archive
'You will not complete the task, but you may not give it up.'

Chapter 7 of Stephen Mitchell's _influence and Autonomy_ is now
available online at Dallas Society for Psychoanalytic Psychology.

"The Analyst's Knowledge and Authority " is provided online with
permission of the Analytic Press.  Philip Ringstom's review of the
book is also available.

DSPP is sponsoring a workshop presentation featuring Dr. Mitchell on
November 13, 1999.  Add it to your calendar and check the DSPP website
for additional details.

http://www.dspp.com

Cheryl Martin RN, LPC
DSPP Web and Bulletin Editor

I have placed the following essay at my web site:

'New Ideas about the Oedipus Complex' 60k
http://www.human-nature.com/rmyoung/papers/pap121.html

This article began life as a talk to the Guild of Psychotherapists for a
conference on the Oedipus complex in 1993. I decided that I was unclear about
Kleinian vs other ways of thinking abut it, and this was the outcome. It was
published in  excellent journal, _Melanie Klein and Object Relations_  12 (no.
2): 1-20, 1994.

There are innumerable writings, many of them mine, at the Human-Nature.com
web site
http://www.human-nature.com

Robert Maxwell Young
robert@...
http://www.human-nature.com - writings & extensive archive
'You will not complete the task, but you may not give it up.'

It would be a pity to predetermine the scope and emphases of this forum, but its inspiration is an interest in Klein, Post-Kleinians, Winnicott, Fairbairn, Guntrip and other and more recent writers in the object relations tradition within psychoanalysis. There is an existing list on Bion and there is an object relations web site, but there is no forum or web site specifically dedicated to this particular stratum of psychoanalytic theory. This forum and its associated web site are designed to fill this void.

Any topic within the broad domain mentioned above is welcome. So are interventions aimed at mounting critiques of this tradition, broadly conceived. However, civility must be the norm. In addition to theoretical and clinical issues, we are particularly interested in encouraging applications to the object relations tradition to literature, film and other aspects of culture and cultural studies. Submissions for essays for consideration for the web site should be sent to either of the forum moderators.

Form Moderator:
Robert M. Young robert@...
Professor of Psychotherapy and Psychoanalytic Studies
Centre for Psychotherapeutic Studies
University of Sheffield

Co-moderator: 
Michael Szollosy egp97ms@...
Research Student in English Literature  Psychoanalytic Studies
University of Sheffield

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