Karma Shrink http://www.karmashrink.com Integrative Psychiatry with Dr. Stephen Proskauer Thu, 02 Feb 2012 15:10:33 +0000 http://wordpress.org/?v=2.3.1 en The Case of Tommy Continued http://www.karmashrink.com/2012/02/02/the-case-of-tommy-continued-6/ http://www.karmashrink.com/2012/02/02/the-case-of-tommy-continued-6/#comments Thu, 02 Feb 2012 15:10:33 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/02/02/the-case-of-tommy-continued-6/ Adults who behave as if they look at life in this immature way often suffer from arrested development caused by traumatization under the age of three years. Given the developmental stage at which the second hospitalization occurred, it is likely that Tommy interpreted the pain and separation of heart surgery as a terrible punishment for angry thoughts, fantasies or actions. This could explain the symptoms of irrational guilt and inhibited assertiveness that persisted into his adult life, completely undermining his
sense of security when traumatic memories were triggered by separation from loved ones.
A relentless series of further blows to Tommy’s inner security followed. He had to be hospitalized five more times during the latency period between ages 6 and 11, a stage when children are developing self confidence out in the world by mastering issues of separation from home, school skills, and social norms relating with peers. Tommy was already having a hard time in school because of learning disabilities due to residual brain damage from his first subdural hematoma, but repeated retraumatization by separation
from home and school routines during five more hospitalizations must have shaken his self confidence enormously, even to the point of feeling constantly anxious about the next impending disaster that would suddenly interrupt his life and subject him to another painful ordeal of hospitalization with separation from family, school and friends.

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]]> http://www.karmashrink.com/2012/02/02/the-case-of-tommy-continued-6/feed/ The Case of Tommy Continued http://www.karmashrink.com/2012/01/31/the-case-of-tommy-continued-5/ http://www.karmashrink.com/2012/01/31/the-case-of-tommy-continued-5/#comments Tue, 31 Jan 2012 15:10:58 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/31/the-case-of-tommy-continued-5/ At age 18 months when Tommy had his heart surgery, most children have attained secure object constancy but their notions of cause and effect are still primitive and magical. They cannot distinguish clearly between fantasy and reality. It is the stage of omnipotent wishes and fears. If toddlers want something and feel angry for not getting it and then something
hurtful happens to the object of their anger, toddlers believe that their anger caused the damage. Likewise, toddlers interpret painful events as punishments for angry thoughts or naughty behavior, whether or not there is any true causal connection. They believe that all events in the outer world revolve around them and respond only to their feelings and actions.

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]]> http://www.karmashrink.com/2012/01/31/the-case-of-tommy-continued-5/feed/ The Case of Tommy Continued http://www.karmashrink.com/2012/01/26/the-case-of-tommy-continued-4/ http://www.karmashrink.com/2012/01/26/the-case-of-tommy-continued-4/#comments Thu, 26 Jan 2012 15:10:11 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/26/the-case-of-tommy-continued-4/ After hearing his story, I immediately suspected that Tommy had been misdiagnosed and that his underlying problem was Posttraumatic Stress Disorder. The ages of his hospitalizations were key to his specific PTSD symptoms. At age 8 months when Tommy was first hospitalized, most babies have bonded to their mothers or primary caregivers, are scared of strangers and extremely sensitive to separation from mother. Many have not yet developed full capacity to maintain object constancy, a trust in her continued
existence when she is out of the room. She disappears and reappears from sight, but the infant has no stable inner representation of her when she is outside the field of vision. With this developmental understanding, it is not difficult to understand how separation in the hospital under the care of strangers while drugged and in pain could trigger terrifying catastrophic fantasies, including the permanent loss of his family, irrational ideas that
resurfaced 26 years later to cause panic the night he couldn’t reach his family by phone.

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]]> http://www.karmashrink.com/2012/01/26/the-case-of-tommy-continued-4/feed/ The Case of Tommy Continued http://www.karmashrink.com/2012/01/24/the-case-of-tommy-continued-3/ http://www.karmashrink.com/2012/01/24/the-case-of-tommy-continued-3/#comments Tue, 24 Jan 2012 15:10:11 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/24/the-case-of-tommy-continued-3/ Tommy had been hospitalized seven times in childhood for sudden and serious medical problems: at 8 months for subdural hematoma following a fall on his head, at 18 months for heart surgery, at 8 years for pneumonia and later the same year for meningitis, at 9 years for a ruptured appendix, at 10 years for a second subdural hematoma after a bicycle accident, and at 11 years for tonsillectomy complicated by post-operative bleeding. Five of
these episodes required surgery and all of them involved sudden separations from his family and were potentially fatal.

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]]> http://www.karmashrink.com/2012/01/24/the-case-of-tommy-continued-3/feed/ The Case of Tommy Continued http://www.karmashrink.com/2012/01/17/the-case-of-tommy-continued-2/ http://www.karmashrink.com/2012/01/17/the-case-of-tommy-continued-2/#comments Tue, 17 Jan 2012 15:10:43 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/17/the-case-of-tommy-continued-2/ When I first saw him, Tommy did not appear depressed. His primary problems were panic attacks against a background of pervasive anxiety accompanied by shaky self esteem, shyness and irrational guilt, all of which were exacerbated by separation from important people in his life. Tommy came from an intact family and described a close relationship with loving parents. He denied any abuse, but once he recounted his remarkable medical history, the genesis of his irrational anxiety became immediately clear.

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Big Heart Healing a Multidimensional Approach to Trauma and Abuse

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]]> http://www.karmashrink.com/2012/01/17/the-case-of-tommy-continued-2/feed/ The Case of Tommy Continued http://www.karmashrink.com/2012/01/12/the-case-of-tommy-continued/ http://www.karmashrink.com/2012/01/12/the-case-of-tommy-continued/#comments Thu, 12 Jan 2012 15:10:59 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/12/the-case-of-tommy-continued/ Three years before, Tommy had made a serious suicide attempt while away from home at college, slashing his wrist following a painful breakup with a girlfriend in the midst of other school problems. He was hospitalized, diagnosed as having a Major Depressive Disorder and treated with antidepressants and counseling, neither of which he felt had helped him.
Psychological testing done later suggested the same diagnosis and documented Tommy’s specific learning disabilities.

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Big Heart Healing a Multidimensional Approach to Trauma and Abuse

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]]> http://www.karmashrink.com/2012/01/12/the-case-of-tommy-continued/feed/ The Case of Tommy http://www.karmashrink.com/2012/01/10/the-case-of-tommy/ http://www.karmashrink.com/2012/01/10/the-case-of-tommy/#comments Tue, 10 Jan 2012 15:10:43 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/10/the-case-of-tommy/ Tommy’s story offers a dramatic example of how important developmental cues can be for accurate diagnosis and treatment. Tommy was a 27 year old college student who came in suffering from lingering anxiety two months after a panic attack that occurred while he was on summer break living with his parents and brother. While on a brief visit away from home, Tommy was unable to reach any of them by phone. He imagined something
terrible had happened and began to sweat, shake, and his heart started to race as he terrorized himself with one disaster scenario after another. Overcome with panic, Tommy felt compelled to drive a long distance in the middle of the night to find them, only to discover his family peacefully asleep in their beds with their phones turned off. After this episode, his confidence in himself was so shaken that he dropped out of college for a semester and sought help.

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Big Heart Healing a Multidimensional Approach to Trauma and Abuse

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]]> http://www.karmashrink.com/2012/01/10/the-case-of-tommy/feed/ Developmental Issues http://www.karmashrink.com/2012/01/05/developmental-issues/ http://www.karmashrink.com/2012/01/05/developmental-issues/#comments Thu, 05 Jan 2012 15:10:00 +0000 Stephen Proskauer MD http://www.karmashrink.com/2012/01/05/developmental-issues/ In the last century, psychoanalysts and researchers into cognitive development made major contributions to our understanding of the child’s inner life at various developmental stages. I am fortunate to have received training and supervision from child analysts in the clinical application of these developmental principles. A working knowledge of child development is critical to the recognition of subtle differences in PTSD symptoms that
arise from trauma and abuse at different ages. Some forms of PTSD go unrecognized
and untreated, or misdiagnosed and ineffectively treated, when clinicians are not alert to stage-specific symptoms.

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]]> http://www.karmashrink.com/2012/01/05/developmental-issues/feed/ Adult State of Consciousness to Help Patients Release Trauma http://www.karmashrink.com/2011/12/29/adult-state-of-consciousness-to-help-patients-release-trauma/ http://www.karmashrink.com/2011/12/29/adult-state-of-consciousness-to-help-patients-release-trauma/#comments Thu, 29 Dec 2011 15:10:31 +0000 Stephen Proskauer MD http://www.karmashrink.com/2011/12/29/adult-state-of-consciousness-to-help-patients-release-trauma/ Psychotherapists use many different methods to facilitate recovery and integration of repressed trauma from intrinsic memory. I prefer the body centered desensitization technique to bring painful and frightening memories into conscious awareness and release the emotional charge on them, along with Voice Dialogue, journaling exercises and Inner Child work to help with integration. I avoid hypnotherapy or drug-induced trances that in my view give over too much control to the therapist and may bring up more emotional intensity than the patient is ready to integrate. I have never needed to override the normal adult state of consciousness to help patients release trauma and integrate it into extrinsic memory. Perhaps hypnosis can be used safely with severely abused patients in experienced hands, but I prefer to proceed at the patient’s pace and trust the bodymind to bring forth whatever memories are tolerable at a given stage of therapy to promote healing. This is consistent with my therapeutic philosophy of empowering the patient every step of the way and maintaining my role as a catalyst and supportive partner in the process. Heroic attempts to force the recall of traumatic memories too often backfire
and are more likely to cause retraumatization than healing.

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Big Heart Healing a Multidimensional Approach to Trauma and Abuse

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]]> http://www.karmashrink.com/2011/12/29/adult-state-of-consciousness-to-help-patients-release-trauma/feed/ Psychological Integration http://www.karmashrink.com/2011/12/22/psychological-integration/ http://www.karmashrink.com/2011/12/22/psychological-integration/#comments Thu, 22 Dec 2011 15:10:27 +0000 Stephen Proskauer MD http://www.karmashrink.com/2011/12/22/psychological-integration/ Less emphasized than catharsis in early psychoanalytic theory is the “working through” process native to all forms of psychotherapy that accomplishes the second step of psychological healing: the cognitive retraining required for integration of recovered memories into a mature and effective coping strategy for dealing with present and future stressful situations. Cognitive Behavioral Therapy and other such approaches offer clearly delineated methods for accomplishing this retraining process, especially in treatment resistant psychiatric problems such as Obsessive Compulsive Disorder and Borderline
Personality Disorder. In the former problem, the symptom pattern is often too deeply entrenched to permit effective release of the formative memories. With borderline patients, stress tolerance is frequently too low and the capacity for maintaining a stable therapeutic alliance too fragile to tolerate very much emotional uncovering. Whether or not formally trained in specific cognitive methods, all effective therapists have found their own ways of utilizing the warmth and safety of the therapeutic relationship to teach and model mature coping skills, an essential aspect of treatment for PTSD symptoms following severe childhood abuse.

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