Understanding Grief
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Guilt, Shame, and Grief: an Empirical Study of Perinatal Bereavement
Guilt, Shame, and Grief: An Empirical Study of Perinatal Bereavement by Peter Barr 'Death in the sickroom', Edvard Munch 1893 A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy Centre for Behavioural Sciences Faculty of Medicine University of Sydney November, 2003 Preface All of the work described in this thesis was carried out personally by the author under the auspices of the Centre for Behavioural Sciences, Department of Medicine, Faculty of Medicine, University of Sydney. None of the work has been submitted previously for the purpose of obtaining any other degree. Peter Barr OAM, MB BS, FRACP ii The investigator cannot truthfully maintain his relationship with reality—a relationship without which all his work becomes a well-regulated game—if he does not again and again, whenever it is necessary, gaze beyond the limits into a sphere which is not his sphere of work, yet which he must contemplate with all his power of research in order to do justice to his own task. Buber, M. (1957). Guilt and guilt feelings. Psychiatry, 20, p. 114. iii Acknowledgements I am thankful to the Department of Obstetrics and Department of Neonatology of the following hospitals for giving me permission to approach parents bereaved by stillbirth or neonatal death: Royal Prince Alfred Hospital, Royal Hospital for Women, Royal North Shore Hospital and Westmead Hospital. I am most grateful to Associate Professor Susan Hayes and Dr Douglas Farnill for their insightful supervision and unstinting encouragement and support. Dr Andrew Martin and Dr Julie Pallant gave me sensible statistical advice. -
About Emotions There Are 8 Primary Emotions. You Are Born with These
About Emotions There are 8 primary emotions. You are born with these emotions wired into your brain. That wiring causes your body to react in certain ways and for you to have certain urges when the emotion arises. Here is a list of primary emotions: Eight Primary Emotions Anger: fury, outrage, wrath, irritability, hostility, resentment and violence. Sadness: grief, sorrow, gloom, melancholy, despair, loneliness, and depression. Fear: anxiety, apprehension, nervousness, dread, fright, and panic. Joy: enjoyment, happiness, relief, bliss, delight, pride, thrill, and ecstasy. Interest: acceptance, friendliness, trust, kindness, affection, love, and devotion. Surprise: shock, astonishment, amazement, astound, and wonder. Disgust: contempt, disdain, scorn, aversion, distaste, and revulsion. Shame: guilt, embarrassment, chagrin, remorse, regret, and contrition. All other emotions are made up by combining these basic 8 emotions. Sometimes we have secondary emotions, an emotional reaction to an emotion. We learn these. Some examples of these are: o Feeling shame when you get angry. o Feeling angry when you have a shame response (e.g., hurt feelings). o Feeling fear when you get angry (maybe you’ve been punished for anger). There are many more. These are NOT wired into our bodies and brains, but are learned from our families, our culture, and others. When you have a secondary emotion, the key is to figure out what the primary emotion, the feeling at the root of your reaction is, so that you can take an action that is most helpful. . -
In This Issue
July 2020 NEWS Post-Traumatic Stress Disorder (PTSD) Assessment and Treatment In this Issue: Guidelines for Pediatric Primary Upcoming Clinical Care Conversations 5 Clinical Conversation: May 26, 2020 Presented by Sylvia Krinsky, MD, Tufts Medical Center For some children, childhood is far from a carefree time; they Leadership: experience trauma which can disrupt development and lead John Straus, MD to post-traumatic stress disorder (PTSD). At the May Clinical Founding Director Conversation, Sylvia Krinsky, MD, MCPAP site director at Tufts Barry Sarvet, MD Medical Center, discussed how to address PTSD in the primary Medical Director care setting. Beth McGinn Types of trauma Program Manager There are three major types of trauma: Elaine Gottlieb • Discrete Trauma – examples include a car accident, injury, Contributing Writer medical procedure, or a single episode of physical or sexual assault, when life is filled with otherwise helpful and supportive people • Complex Trauma – series of repeated traumas usually in close interpersonal contexts, such as childhood abuse or neglect, witnessing domestic or community violence, or racism and chronic social adversities • Adverse Childhood Event – a term from the Adverse Childhood Experiences (ACE) study, referring to potentially traumatic events that can have an impact on physical and psychological health Discrete trauma is most recognized in the DSM-5, while ACE is more familiar to the medical community, says Dr. Krinsky. 1000 Washington St., Suite 310 One study reported in the Journal of the American Medical Boston, MA 02118 Association (JAMA) found that more than 90 percent of pediatric Email: [email protected] patients seen in a primary care pediatric clinic had experienced a traumatic exposure, and 25 percent met full or partial criteria for www.mcpap.org PTSD. -
Understanding Children's Mental Health Disorders and the Impact On
Understanding Children’s Mental Health Disorders and the Impact on Learning and Functioning 1 2 Introduction to Children’s Mental Health An Overview of Depression 3 Depression is Common Estimates of Incidence 1 % Preschoolers 2 % School age 5 % Adolescents 20 % Lifetime prevalence during adolescence (parallels adult life time prevalence) Birmaher et al., 2002 4 Risk and Reoccurrence Childhood Adolescent Later Onset Depression Adolescent Depression Depression Adult Depression 5 Depression is… a mood disorder a sleep and energy disorder a thinking disorder 6 Depression: Signs and Symptoms Mood Changes Behaviors MEANING Interpersonal Relationships Physical Changes Cognitive Changes School Performance 7 Mood Symptoms Sad Sadness Irritable “mood swings” Anhedonia loss of interest social withdrawal or Anhedonia Irritability isolation boredom 8 Physical Symptoms Sleep Difficulty either with too much or too little sleep Fatigue Appetite Change loss of appetite increased carbohydrate craving 9 Cognitive Symptoms Difficulty concentrating Increased distractibility and “spaciness” Decreased attention and focus 10 Cognitive Symptoms Worried, ruminating thoughts Worthlessness, low self-esteem, guilt Distortions, misperceptions, misinterpretations 11 Symptoms in Infants and Toddlers Mood – Excessive whining – Too little or too much crying – Withdrawn from cuddling, being held – Lack of interest in surroundings 12 Symptoms in Infants and Toddlers Physical – Sleep disturbance – Sad or flat facial expression – Little motor activity – Failure to grow and -
Behavioral Interventions for Anxiety and Irritability in Children and Adolescents with Autism Spectrum Disorder
Behavioral Interventions for Anxiety and Irritability in Children and Adolescents with Autism Spectrum Disorder Denis G. Sukhodolsky, Ph.D. Yale Child Study Center Disclosures • Research support: – NIMH R01 MH101514 – NIMH K01 MH079130 – NICHD R01 HD083881 • Book royalty: – The Guilford Press Autism Spectrum Disorder (ASD) • Core symptoms – Impairment in social interaction and communication – Restricted interests and repetitive behavior • Associated features – Cognitive impairment – Deficits in adaptive functioning – Anxiety – Disruptive behavior problems Anxiety in ASD • Excessive fearfulness • Changes in routines and social situations • Can be related to core ASD symptoms • Co-occurring anxiety disorders may be present • Social anxiety may be difficult to diagnose • Contributes to impairment in functioning Cognitive-Behavior Therapy for Anxiety CBT is a well-established intervention for anxiety in children without autism. Key components: education, emotion regulation, and exposure and response prevention. Short-term duration, 8 to 16 weekly sessions. Treatment is conducted with the child and includes parent involvement. Is CBT helpful for anxiety in ASD? Main Findings: • 8 randomized controlled studies of CBT for anxiety were located. • CBT was superior to waitlist on parent and clinician-rated anxiety. • Effect sizes were 1.19 for parent ratings, 1.21 for clinician ratings and 0.68 for child self-report. Sukhodolsky, Bloch, Panza, Reichow Pediatrics, 2013 Neural Mechanisms of CBT for anxiety in ASD Subjects: • 10 children with ASD and -
Dysphoria As a Complex Emotional State and Its Role in Psychopathology
Dysphoria as a complex emotional state and its role in psychopathology Vladan Starcevic A/Professor, University of Sydney Faculty of Medicine and Health Sydney, Australia Objectives • Review conceptualisations of dysphoria • Present dysphoria as a transdiagnostic complex emotional state and assessment of dysphoria based on this conceptualisation What is dysphoria? • The term is derived from Greek (δύσφορος) and denotes distress that is hard to bear Dysphoria: associated with externalisation? • “Mixed affect” leading to an “affect of suspicion”1,2 1 Sandberg: Allgemeine Zeitschrift für Psychiatrie und Psychisch-Gerichtl Medizin 1896; 52:619-654 2 Specht G: Über den pathologischen Affekt in der chronischen Paranoia. Festschrift der Erlanger Universität, 1901 • A syndrome that always includes irritability and at least two of the following: internal tension, suspiciousness, hostility and aggressive or destructive behaviour3 3 Dayer et al: Bipolar Disord 2000; 2: 316-324 Dysphoria: associated with internalisation? • Six “dysphoric symptoms”: depressed mood, anhedonia, guilt, suicide, fatigue and anxiety1 1 Cassidy et al: Psychol Med 2000; 30:403-411 Dysphoria: a nonspecific state? • Dysphoria is a “nonspecific syndrome” and has “no particular place in a categorical diagnostic system”1; it is neglected and treated like an “orphan”1 1 Musalek et al: Psychopathol 2000; 33:209-214 • Dysphoria “can refer to many ways of feeling bad”2 2 Swann: Bipolar Disord 2000; 2:325-327 Textbook definitions: dysphoria nonspecific, mainly internalising? • “Feeling -
The Neuroscience of Animal Welfare: Theory 80-20
Review Article The neuroscience of animal welfare: theory 80-20 La neurociencia del bienestar animal: teoría 80-20 Genaro A. Coria-Avila, DVM, PhD1*, Deissy Herrera-Covarrubias, BSc, MSc2 1Centro de Investigaciones Cerebrales, Universidad Veracruzana, Xalapa, Ver., México 2Doctorado en Neuroetología, Universidad Veracruzana, Xalapa, Ver., México. Recibido: 28 de agosto de 2012 Aceptado: 16 de octubre de 2012 Puedes encontrar este artículo en: http://www.uv.mx/eneurobiologia/vols/2012/6/6.html Abstract Animal welfare is commonly regarded as the physical and psychological well-being of animals, fulfilled if animals are free: 1) from hunger, thirst and malnutrition, 2) from discomfort, 3) from pain, 4) to express normal behavior, and 5) from fear and distress. This paper is meant to provoke the reader to re-think the concept of welfare. Evidence indicates that animal welfare is not a constant state, but rather it must be fulfilled several times a day. A theory is proposed arguing that well-being occurs when the proportion of desiring and obtaining something occurs in a 80-20% proportion, respectively. The neurobiological bases of motivated behaviors are discussed to support a new view on animal welfare. Key words: Dopamine, Opioids, Environmental enrichment, Well-being, Desire, Reward. Resumen Comúnmente se considera al bienestar animal cuando los animales están bien física y psicológicamente. Esto se logra cuando están libres: 1) de hambre, sed y malnutrición, 2) de incomodidad, 3) de dolor, 4) para expresar conducta normal, 5) de miedo y estrés. Este artículo tiene la intención de provocar al lector para reconsiderar el concepto de bienestar animal. -
Traumatic Neuroses* DR
Traumatic Neuroses* DR. DWIGHT M. PALMER** INTRODUCTION Before proceeding to the subject at hand, it seems vise to in- troduce the general subject of psychoneurosis or as it is more commonly called, neurosis. Psychoneurosis or neurosis is one of the four types or varieties of mental illnesses, the other three being Psychosis, Mental De- ficiency, and Psychopathic Personality. Definition of Neurosis. Neurosis is a form of maladjustment in which a patient, despite the fact that he is well oriented to the external world, uses complaints or symptoms of a physical nature to express psychological needs which arise from conflicts that are hidden from the conscious aspect of his mind." He may use com- plaints or symptoms either to satisfy the self-protective needs aris- ing from his unconscious conflicts, or as a defense against them. For example, in the first situation a headache may serve as an ex- cuse for avoiding a situation in which the patient would feel in- secure, while in the second case a paralysis of a hand may act as a defense against an unconscious need to use that hand in some forbidden, aggressive or guilt-laden act. It should always be em- phasized that, by definition, the dynamics of this process are un- conscious in nature, and therefore not known by the patient. Other Types of Mental Illness. In contrast, the individual who suffers from Psychosis has lost some or all of his ability to orient himself to the real world about him; that is, he shows some loss of contact with reality. The third classification of mental illness, Men- tal Deficiency, comprises those individuals who are commonly de- scribed as feeble-minded. -
The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic Criteria for Research
The ICD-10 Classification of Mental and Behavioural Disorders Diagnostic criteria for research World Health Organization Geneva The World Health Organization is a specialized agency of the United Nations with primary responsibility for international health matters and public health. Through this organization, which was created in 1948, the health professions of some 180 countries exchange their knowledge and experience with the aim of making possible the attainment by all citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. By means of direct technical cooperation with its Member States, and by stimulating such cooperation among them, WHO promotes the development of comprehensive health services, the prevention and control of diseases, the improvement of environmental conditions, the development of human resources for health, the coordination and development of biomedical and health services research, and the planning and implementation of health programmes. These broad fields of endeavour encompass a wide variety of activities, such as developing systems of primary health care that reach the whole population of Member countries; promoting the health of mothers and children; combating malnutrition; controlling malaria and other communicable diseases including tuberculosis and leprosy; coordinating the global strategy for the prevention and control of AIDS; having achieved the eradication of smallpox, promoting mass immunization against a number of other -
Sexual Hysteria, Physiognomical Bogeymen, and the "Ghosts"
Sexual Hysteria, Physiognomical Bogeymen, and the "Ghosts" in The Turn of the Screw Author(s): Stanley Renner Reviewed work(s): Source: Nineteenth-Century Literature, Vol. 43, No. 2 (Sep., 1988), pp. 175-194 Published by: University of California Press Stable URL: http://www.jstor.org/stable/3045173 . Accessed: 27/10/2011 11:48 Your use of the JSTOR archive indicates your acceptance of the Terms & Conditions of Use, available at . http://www.jstor.org/page/info/about/policies/terms.jsp JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact [email protected]. University of California Press is collaborating with JSTOR to digitize, preserve and extend access to Nineteenth-Century Literature. http://www.jstor.org Sexual Hysteria, Physiognomical Bogeymen, and the "Ghosts"in The Turnof theScrew STANLEY RENNER R readers and critics for whom the true-and clearly the richer-story of James's The Turn of theScrew is its dramatizationof a woman's psychosexualproblem and the damage it does to the childrenin her charge, the immovablestumbling block has alwaysbeen the governess'sdetailed descriptionof Peter Quint, a man dead and buried whom she has never seen. If James does not mean for readers to take Quint (and subsequentlyMiss Jessel) as a bona fide ghost,so the argumentruns, whydoes he arrange thingsso thatthe only wayto account for her descriptionof him is thatshe has seen a supernaturalmanifestation? Asks A.J.A. -
Association of Irritability and Anxiety with the Neural Mechanisms of Implicit Face Emotion Processing in Youths with Psychopathology
Supplementary Online Content Stoddard J, Tseng W-L, Kim P, et al. Association of irritability and anxiety with the neural mechanisms of implicit face emotion processing in youths with psychopathology. JAMA Psychiatry. Published online November 30, 2016. doi:10.1001/jamapsychiatry.2016.3282 eAppendix. Prior Research. eMethods 1. Participant Assessment. eMethods 2. Image Acquisition and Processing. eMethods 3. Estimating Neural Activation and Amygdala Functional Connectivity. eResults 1. ANX vs HV Only: A Comparison to a Prior Study. eResults 2. DMDD vs HV Only: A Comparison to a Prior Study. eResults 3. Analysis by Primary Diagnosis Instead of Anxiety and Irritability Dimensions. eResults 4. Cross Validation. eTable 1. Dimensional Measures by Primary Diagnosis. eTable 2. Excluded Participants. eTable 3. Details of Post Hoc Analyses of Medication Effects. eFigure 1. Positive Control of Activation. eFigure 2. Accuracy is Related to Irritability When Viewing the Higher Intensities of Anger. eFigure 3 Significant Connectivity Effects Not Depicted in Main Text. eFigure 4. Activation Maps of the Effect of ARI by Emotion on Activation. eReferences This supplementary material has been provided by the authors to give readers additional information about their work. © 2016 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/01/2021 eAppendix: Prior Research Prior investigations involving youths with severe, chronic irritability (operationalized either as severe mood dysregulation (SMD)1-4 or DMDD5) suggest the neural basis of irritability-associated face-emotion processing impairments.2 Of note, these prior studies involved two categories of irritability-related disorders, bipolar disorder and SMD/DMDD, and were designed to investigate their shared or distinct pathophysiology.6 They generally found that chronic irritability is associated with aberrant neural responses to different face emotions in visual (e.g. -
Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention
BETH-00899; No of Pages 15; 4C: Available online at www.sciencedirect.com ScienceDirect Behavior Therapy xx (xxxx) xxx www.elsevier.com/locate/bt Exploring Longitudinal Mechanisms of Irritability in Children: Implications for Cognitive-Behavioral Intervention Spencer C. Evans Harvard University Jennifer B. Blossom Seattle Children’s Hospital and University of Washington School of Medicine Paula J. Fite University of Kansas depressive symptoms, anxiety, reactive aggression, opposi- Severe irritability is a common and clinically important tionality, intolerance of uncertainty, and poor emotion problem longitudinally associated with internalizing and coping. From T1 irritability to T2/T3 outcomes, mediation externalizing problems in children. To better understand was found for poor sadness coping leading to reactive these mechanisms and to inform treatment research, we tested aggression and oppositionality; poor anger coping to anxiety, cognitive-behavioral processes as candidate mediators in the depressive symptoms, and oppositionality; and intolerance of paths from irritability to later problems. Methods: A school uncertainty to anxiety. Results offer further evidence for sample (N = 238, 48% female, ages 8–10) was assessed at internalizing and externalizing outcomes of youth irritability ~6-month intervals in fall (T1) and spring (T2) of third to and new evidence suggesting underlying mechanisms. Irrita- fourth grade, and again the following fall (T3). Measures bility may confer risk for externalizing problems via poor assessed irritability (T1/predictor); anger and sadness sadness/anger coping, and for internalizing problems via poor coping, intolerance of uncertainty, and rumination; (T1– anger coping and intolerance of uncertainty. Theoretical T2/mediators); and anxiety, depressive symptoms, reac- models and psychosocial treatment should consider address- tive aggression, and oppositionality (T1–T3/outcomes).