Tuesday, May 10, 2011

Tiresias or the DSM

In therapeutic sessions, patients often express their fears. If a patient is extremely disturbed, he might believe that there are little men lurking outside his window. He might think these men are talking and that they are telling him to do something, even something rather trite. If the condition is not too severe, the therapist might attempt to help the patient to understand that he is displacing or projecting his own feelings and thoughts onto another person. Hypochondriacs feel they are sick when they are perfectly fine, and parents who suffer from the esoteric syndrome called Münchausen’s syndrome by proxy have very real but illusory feelings about their children being sick. Amongst the neurological symptoms that indicate distorted cognitions is Capgras syndrome, in which the sufferer believes a friend or relative is an imposter, a stranger occupying a familiar-seeming face and body. This last is dramatized by Richard Powers in his novel The Echo Maker. The horror classic The Invasion of the Body Snatchers (1956) is particularly terrifying in that it creates a funhouse view of this very real phenomenon. The reverse neurological symptom is prosopagnosia, in which the afflicted person is no longer able to recognize the faces of those he would otherwise know. Capgras might create paranoia, but prosopagnosia is an adult form of stranger anxiety in which the comfort of familiarity is lost. The DSM, the manual that psychologists and psychiatrists use to categorize and identify illnesses, lists conditions ranging from eating disorders, compulsivity about the search for pleasure (a form of hedonism), and anhedonia (the inability to tolerate pleasure at all), to more far-ranging disorders like psychosis and schizophrenia. Joanne Woodward starred in a movie about multiple personality called The Three Faces of Eve (1957). David and Lisa (1962) elaborated on the theme of schizophrenia and Olivia de Havilland starred in The Snake Pit (1948), a classic about abusive treatment of the mentally ill that foreshadowed the deinstitutionalization of the many severely disturbed patients who would go on to constitute our vast homeless population. But more disturbing than symptoms that are rooted in paranoia and delusion are those that turn out to be rooted in a grim reality. Let’s say a patient had walked into a therapist’s office in Tokyo six months ago and said that he had the feeling that the Northern coast of Japan would be hit by a huge wave that in turn caused a nuclear meltdown? What would we tell to sufferers from pre-9/11 nightmares about terrorists taking over jetliners and flying them into World Trade Center? What would we say to the patient who is obsessed with the idea that it was a genetically engineered double and not Osama bin Laden who was murdered last week?

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