Functional Neuroimaging (fMRI) studies of fear, specific phobia, social anxiety and PTSD are compared in the article by Etkin & Wager (2007) indicates to us how the different kinds of fear- and anxiety-related disorders differ in activation in the brain.
As therapists we learn to treat each patient’s symptoms as individual. Language to describe fear-type emotions can be limited to a few adjectives. The experiences of different patients are different. fMRI studies show that biologically, these symptoms are also not similar.
The findings mentioned in this paper also accentuates the point that no anti-anxiety drug can remove the symptoms for all fear-based disorders. This often leads the medical professionals to prescribe cocktails of drugs as a measure.
Etkin, A. & Wager, T. D. (2007). Functional neuroimaging of anxiety: a meta-analysis of emotional processing in PTSD, social anxiety disorder, and specific phobia. American Journal of Psychiatry, 164(10), 1476-1488.
This is not an article against the use of psycho-pharmaceuticals. Antidepressants, antipsychotics etc. use save lives and alleviate suffering but have side effects. The individual is left to choose: work through mental suffering by talking to someone, or use a medication but numb out the possibility to feel human empathy. Ultimately the use of these drugs leads us to dependency and destroys our ability to interact with others in a contact-ful way. The result is existential loneliness.
Christopher Bollas, in the Q&A session of this lecture recorded in video below, gave a thought provoking opinion on how psycho-pharmaceuticals like antidepressants, anxiety drugs, and pain killers reduces a persons capacity for empathy.
Empathy and Your Loved Ones
Empathy is what make a person human. It helps us to have relationships and build bonds of love with others. If one of your loved ones –spouse, children, siblings, etc.– suddenly loses his/her empathy, you have lost that bond with that person, because this person is no longer able to relate to you as another human being. At best, to this person, you are but an object. He/she is not able to feel for you or care for you.
Taking painkillers, according to Bollas, does just that: strips off the empathic nature of a person. He cites an interesting article of a study written by Mischkowski et.al (2016) entitled From painkiller to empathy killer: acetaminophen (paracetamol) reduces empathy for pain, to illustrate this fact.
Bollas says that taking psycho-pharmecuticals is not the same as taking medicine for physical ailments. If one has a problems related to the mental state, talking to another person is the cure. The challenge is to find someone who would care to listen without judging or controlling you. Such a professional is called a psychotherapist.
ADHD Diagnosis Robs Children of their Capacity for Empathy
People do have the right to take medications to alleviate their suffering. Bollas is, however, concerned by people giving medications to children for psychological disorders. Children have no rights to decide if they want to be incapacitated in a way that they can no longer feel emotions. Not feeling emotions free us from unpleasant feelings, and it also causes us to live in a lonely paranoid world stripped of feelings of being loved. The person may have people loving him, but he cannot feel the love. In turn he will not be able to love back, and end up losing relationships.
When children get diagnosed with ADHD (attention deficit hyperactive disorder), the child is suffering NOT because of the disorder itself. The child is reacting to stressors in his life and environment that causes him suffering. In fact, it is the parents who suffer as a result of the child’s behavior, and many are desperate for the fix… which they can get through diagnosis of ADHD. The drug erases that child’s ability to feel the suffering, and wipes out his ability to feel empathy as well.
Bollas believes that the children are victims of stress put on them by society’s expectation and the educational system.
War Kill the Humane Part of the Soldier
Military training and work… boot camp turns you into a killer. In combat, you also kill people. If you keep doing it, you’re going to be shattered. It is called ptsd. this is the consequence of sending people to war. When you send people to war, you kill off the the humane parts of the personality. At war, if one is empathic or thinks too much one becomes a danger to one’s unit.
“(W)e need to continue a kind of a political cultural anthropology that consistently deconstructs our social delusions in a way that we as societies continue to cover up our own destructive processes, because most societies have parts that are extremely destructive.”
Bollas, C. (2016). Christopher Bollas: Mental Pain. Video on Youtube. https://www.youtube.com/watch?v=y9Frb4wMifw Townsend Center for the Humanities.
Meanings for the term “dissociation” continue to evolve. Dissociation was originally seen as a type of hysteria, related to conversion, and distinct from depersonalization. It included amnesia, fugue, certain altered states (e.g., somnambulism), and multiple personality.
Dissociation is a criteria in DSM III for diagnosis of PTSD and ASD, as “flashback or dissociative episodes”. While flashbacks denotes sensing of something there that is not (positive symptoms), dissociative episodes denotes absence of sensing what is there –detachment, reduced awareness, derealization, depersonalization and amnesia (negative symptoms).
In Borderline Personality Disorder, dissociation in DSM-5 is described as “transient, stress-related…severe dissociative symptoms” with depersonalization as example.
3 distinct meanings of dissociative experiences (p.180):
Dissociation of some of one’s mental functions or faculties. The DSM-5 definition: “a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior” (p. 291). “Negative” dissociative symptoms involve the withdrawal of something, such as dissociation of memory (amnesia), sensation (conversion anesthesia), or affect (emotional blunting). “Positive” dissociative symptoms involve the intrusion of something, such as the sensory reexperiencing of a trauma (flashback), or any other intrusion of affect, knowledge, sensation (in any modality), or behavior (action, unintended vocalization, etc.). Most of these symptoms may occur within a single consciousness.
Depersonalization/derealization. These may be experienced as the withdrawal of the sense of reality. These are also considered as intrusions in the DSM.
Dissociative multiplicity. This is a plurality of consciousness, in which the first two types of dissociation commonly co-occur; thus, there is always the possibility that cases featuring the first two types of dissociation may have covert multiplicity as well. The DSM-5 definition does not really work for multiplicity because once there is more than one self occupying the center of consciousness, there is more than one center of subjective experience and consequently more than one set of symptoms.
Dissociation in Childhood Experience of Abuse
Freud and his colleague Josef Breuer (1895) identified the root of hysteria in women as child sexual abuse, specifically incest. Freud eventually reversed that emphasis to focus on a child’s fantasies of sex instead of the reality of sexual abuse. Other contemporaries—notably Pierre Janet (1889) outside the psychoanalytic movement, and Sandor Ferenczi (1949) within it—retained a focus on the trauma of childhood abuse, positing dissociation rather than repression as the main method a child (and later an adult) uses to cope. They observed that if the trauma were not worked through and resolved at some point, its residual effects would often have a lifelong (and negative) influence across various domains.
Lingiardi, Vittorio. Psychodynamic Diagnostic Manual, Second Edition (Page 182). The Guilford Press. Kindle Edition.
Dissociative effects of PTSD
Dissociation is PTSD is not psychosis. The person has a flashback — a momentary out of sync with reality, and reliving an experience in a traumatic past experience.
Dissociation is an altered state of consciousness. Unlike psychosis, the individual is functioning but loose track of time/space, etc. The persons may also have a sense of watching him/herself and not being there.
Dissociative effects from Childhood Neglect
The video above addresses dissociation from own feelings. This happens to children of child abuse from narcissistic parent. Most likely the condition of suffering is not unlike complex PTSD.
Individuals suffering PTSD display symptoms that look like that of those suffering from trauma symptoms associated with the narcissistic personality (TANS).
This article by Simon (2002) sheds clear light on distinguishing between the 2 types of patients. The table below is an extract from the article:
If we were to extract the gist of the difference between PTSD and TANS, we may be able to summarize that unlike in PTSD, patients with TANS main “damage” is that of the grandiose image of the self. There is more shame and humiliation underlying. This is manifested by anxiety about damage to a kind of grandiose self image. In PTSD symptoms, the anxiety is mainly about survival.
Knowledge of these differences facilitate the psychotherapeutic treatment of the patients, since both types of patients experience the relationship with the therapist differently. This also reflects the difference between event onset trauma in the case of PTSD, and developmental attachment related trauma in the case of complex trauma.
Simon, R. I. (2002). Distinguishing trauma-associated narcissistic symptoms from posttraumatic stress disorder: A diagnostic challenge. Harvard Review of Psychiatry, 10(1), 28-36.