Lexicon of Madness -- Nightmare

Nightmare, Henry Fuseli (1781)

Nightmare: A long, frightening dream that wakes a person from sleep. (If there is no awakening, then it is simply a "bad dream.") The frightened feeling is maintained after awakening, often to the point where the person is afraid to go back to sleep. The nightmare images and feelings might haunt the person for days or even years afterward. Common nightmares themes include being chased, falling, and the death or injury of loved ones (or self). In addition to fear, emotions such as anger, guilt, sadness, disgust, or frustration might be evoked by the nightmare. Traumatic nightmares are dreams of events that have actually occurred in the dreamer's life. There might be some alterations of details, but traumatic nightmares tend to vividly recapitulate the original trauma. Repetitive traumatic nightmares are a hallmark of Posttraumatic Stress Disorder (PTSD). Not all persons with PTSD are awakened by their dreams about the traumatic event, but bed partners will often report that the person talks, screams, or thrashes wildly in his sleep. The insomnia observed in many patients with PTSD is often stems from an attempt to avoid trauma-related nightmares. An effective treatment is to write out in detail as much of the dream as can be remembered. During the day, read the dream account to yourself several times, taking care to calm yourself with focused breathing or visualization after each reading. Before going to bed, engage in a relaxation ritual (bath, reading, etc.) because the more relaxed you are when you go to bed, the less likely it will be that you will have a nightmare that night. On the next day, re-write your dream account, changing a couple of key details (but not giving the dream a "happy ending"). Rehearse the revised dream account several times (calming yourself as needed), and go to bed that night in a relaxed state. It is possible that this procedure is effective because it makes clear the distinction between the traumatic dream and the trauma itself.

Lexicon of Madness -- Munchausen's Syndrome by proxy

Munchausen's Syndrome by proxy: In Factitious Disorder, a person intentionally feigns or produces symptoms so as to gain admission to a hospital, receive attention and treatment from a physician, and more generally "assume the sick role." Factitious Disorder has also been called Munchausen's Syndrome, after a 17th Century German baron and soldier known for telling tall tales. There are no external incentives for his behavior. Patients may assiduously study various physical disorders in order to more effectively mimic their presentation. They might ingest small amount of toxic substances or rub fecal matter into a cut in order to produce an infection that requires medical attention. They might feign severe abdominal pain and, after a series of negative medical tests, agree readily to exploratory abdominal surgery. Their surgeons may observe a herringbone pattern of scarring from past surgeries. A significant percentage of patients with factitious disorder eventually die, from either self-poisoning or complications from unneccessary medical procedures. These "professional patients" can become demanding or even litigious, especially when they feel that their claims are not believed. Many of these patients underwent extensive or repeated medical treatment during childhood, often as the result of physical abuse or neglect. In Factitious Disorder by proxy (or, Munchausen's Syndrome by proxy), a caregiver, almost always the mother, feigns or induces illness in her young child. In that way, she indirectly assumes the "sick role" and garners sympathetic care and attention. While presenting as the "ideal parent," she can also be quite demanding and controlling, insisting on invasive medical tests and risky procedures. Many of these mothers have had nursing training, or claim some kind of medical background. Upon hospitalization, the child often improves, unless the mother continues administering toxins during her visits. Several pediatric hospitals utilize hidden cameras in the rooms of children whose mothers are suspected of Muchausen's Syndrome by proxy.

Lexicon of Madness -- Loose associations

Loose associations: One of the most commonly observed forms of thought disturbance among patients with schizophrenia. The flow of thought is marked by rapid and unexpected shifts from topic to topic: "Christmas is my favorite holiday. Bills have to be paid; there's no money tree in the backyard. Gotta keep the dogs in house -- they might kill the cat." With careful listening and thorough familiarity with the patient, an astute clinician may be able to discern the subtle connections among what appear to be unrelated statements. Derailment is a term used to describe thought processes that deviate unexpectedly and without any apparent association between the two ideas: "A mother is a good thing to have. Noses and eyes get red." Clang associations involve the linking of words or phrases by rhyme or punning, but not logic or meaning:  (said to a clinician with a white beard) "Santa Claus! Wipe your paws, you dirty dog. Where's your raincoat, London Fog?" In thought blocking, the patient abruptly stops in the middle of his train of thought, does not complete the thought, and seems unable to recall what he had been starting to say: "When I was in school, we had this science teacher -- " (Dr.: "Yes, go on, you had this science teacher...") "Science teacher?" Circumstantiality describes speech that takes a long and indirect route from origin to endpoint. It is often marked by overinclusive details and parenthetical remarks: (Dr.: "How have you gotten along with people at work?") "I used to work at a flower shop, we'd have a lot of people come in, there was this one guy, Mr. Rose, that was his name, and he never did buy a rose, I didn't get paid much there but I had a nice apartment, pretty nice, for just $200 a month I think it was, so it paid the bills, so to speak, though the water was somethings real, real cold in the mornings and you had to run the tap for a while, but I didn't pay the water bill, so 'utilities included,' if you know what I mean, I used to work in the back, by myself, they sort of left me alone, kinda ignored me I guess, teased me a bit, I don't blame them, I couldn't do the deliveries because driving makes me nervous." Tangentiality describes thought processes that never get from origin to endpoint; there is an absence of goal-directed speech: (Dr.: "How far did you go in school?") "School was okay, I liked baseball, watched it on t.v., more day games back then, I think, I'd skip school sometimes, I had a friend, he was weird, too, they called us 'the weirdos,' his father was an electrician, working with electricity all day, I wonder if his hair always stood up on end." Incoherence describes thought that is disorganized and not understandable. Word salad is incoherent speech composed of seemingly disconnected words and phrases: "Baubles isn't babble but trouble and oil don't mix." Neologisms are new words created by the patient, which may be reflective of their psychological state: "I ain't no war-Mongo" (said by a combat veteran who resembled the character Mongo, from Blazing Saddles); "Dr. Vishnewski said I have issues with trust and intimacy -- all I need is some medicine for my honorrhea."

Lexicon of Madness -- Korsakoff's Syndrome

Korsakoff's Syndrome: An amnestic disorder associated with prolonged, heavy use of alcohol. Afflicted persons demonstrate impairment in the ability to encode novel experiences into long-term memory. They suffer from both retrograde amnesia (loss of ability to recall stored memories) and anterograde amnesia (the inability to make new memories). Often, the amnesia is accompanied by apathy, lack of insight (i.e., they are not aware that they have memory problems), and confabulation. When a patient with Korsakoff's confabulates, he provides exaggerated or absurd responses to questions about his recent autobiographical past. When asked what he did last weekend, he might reply, "I ran away and joined the circus." It has been suggested that confabulation is an unconscious process that attempts to reconcile the patient's belief that he should know what he did last weekend with his inability to recall any details of that time period. The actual cause of the disorder is nutritional (Vitamin B1/thiamine) deficiency, which is often associated with chronic alcoholism. It has been suggested that fortifying alcoholic beverages with thiamine could prevent new cases of Korsakoff's. Treatment with intravenous thiamine may help reduce negative effects in some patients, but for many the condition is irreversible and completely incapacitating. The disorder was named after Russian neuropsychiatrist Sergei Korsakoff (1854-1900).

Lexicon of Madness -- Insanity Defense

Insanity Defense: More formally, the Not Guilty by Reason of Insanity (NGRI) defense. "Insanity" is a legal, even moral, concept, rather than a clinical one. (Clinicians do not determine a defendant's "insanity," only judges or juries do.) The intent of NGRI laws is to prevent the punishment of someone who committed a "bad act" due to a mental disease or defect. A person whose actions were influenced by a psychotic disorder or other mental problem is not considered as blameworthy or culpable as a normal adult. The NGRI defense is rarely used, and is not always successful when it is used. NGRI defenses are more likely to be successful if the defendant is female, has a clear psychiatric history (bipolar disorder or schizophrenia), and is tried by a judge (not a jury). A typical NGRI case might involve a 35 year old woman with a history of hospitalizations for schizophrenia who came to believe that her children are possessed by the Devil. In order to free them of Satanic influence, she threw them off a bridge, before jumping herself. In most cases of "successful" NGRI acquittals, the accused end up spending more years in a psychiatric institution than they would have spent in prison had they been convicted. John Hinckley, Jr., who shot President Reagan and three others in 1981 has been hospitalized at St. Elizabeth's in Washington, DC ever since. In contrast, the Federal sentencing guidelines for a person convicted of Assault with Intent to Commit Murder, in which a victim sustains life-threatening injuries, suggest 16 to 20 years of incarceration.

Lexicon of Madness -- Hypomania

Hypomania: A hypomanic episode is marked by increased energy, decreased need for sleep, enhanced self-esteem ("I can do anything"), distractibility, high levels of physical and mental activity ("My mind is racing and I can't sit still"), and excessive pleasure-seeking. The patient's mood may be elevated, expansive, or irritable. Grandiose delusions (e.g., "I am on a mission from God") or other psychotic symptoms are unlikely to be observed during hypomania. This mood state must persist for at least four days. People with Bipolar II Disorder experience alternating episodes of hypomania and major depression. People with Cyclothymic Disorder experience frequent alternating episodes of hypomania and mild depression. Intoxication with cocaine or other stimulants (including caffeine) can mimic hypomania. High achievement and overcommitment to multiple pursuits might reflect a hypomanic personality pattern, especially in late adolescents or young adults whose parents value them more for what they achieve than for who they are.

Lexicon of Madness -- General paresis

General paresis: Short for "general paresis of the insane." General paresis is the tertiary stage of neurosyphillis, which was the most prevalent mental disorder of the late 19th century, accounting for up to 10% of all asylum inmates. The symptoms of general paresis include psychosis, dementia, paralysis, and, at that time, inevitable death. In 1917, Austrian psychiatrist Julius Wagner-Jauregg injected the blood of a soldier infected with malaria into nine patients with general paresis. One died, two were sent to asylums, and six showed significant improvement (although four of these later relapsed). Of the 200 patients who first received this "fever-treatment," 50 eventually improved. For this pioneering work with severely ill patients previously thought to be beyond hope, Wagner-Jauregg was awarded the Nobel Prize in Physiology or Medicine in 1927, one of only three psychiatrists to receive that honor. Flushed with this success, biological psychiatrists happily set off to discover somatic treatments for other mental illnesses. Unfortunately, because schizophrenia and other psychiatric disorders do not have any simple, identifiable organic cause (such as the bacterial infection that causes neurosyphillis), no more miraculous treatments have been discovered. The advent of penicillin, which made malarial treatment obsolete, as well as Dr. Wagner-Jauregg's late-life admiration for the Nazi Party (he applied twice for membership), have caused him to become a generally forgotten figure in the history of medicine.

Lexicon of Madness -- Formication

Formication: A tactile (or "haptic") hallucination in which there is a false perception of a crawling sensation either on or under one's skin. Most commonly associated with heavy use of cocaine or methamphetamine ("meth mites"), or during withdrawal from alcohol (delirium tremens). The patient may report feeling "bugs crawling under my skin" or seeing "ants all over my arms." People will scratch vigorously at the affected areas, causing excoriations or even deep gouges in their skin. Psychotic drug users have used knives or other sharp implements in order to get at what they perceived to be insects burrowed under their skin. The condition was first reported among chronic cocaine users in 1889. "Formication" is derived from the Latin word for "ant," formica. Another condition, delusional parasitosis, is more commonly found in non-drug using middle aged women. These patients come to believe that their bodies have become infested with tiny parasites or worms. They will often collect "evidence" of the infestation in small plastic bags and bring them to their physicians. To the doctor's eyes, the bags usually contain nothing but lint or dust, but the patient insists that these are parasite body parts. The women are not reassured by physical examination or negative test results. In many cases, the husband is also convinced of the presence of his wife's parasites (folie a deux, the madness of two).

Lexicon of Madness -- EMDR

Eye Movement Desensitization and Reprocessing (EMDR): A form of exposure therapy for posttraumatic stress. The patient is instructed to relate the details of his traumatic experience while following with his eyes the rhythmically waving index finger of the therapist. It has been suggested by Francine Shapiro, the charismatic developer of EMDR, that eye tracking somehow aids "information processing," although the neuroscientific basis for this claim is dubious. Regardless, patients in clinical trials are more likely to experience reduced PTSD symptoms if they are randomly assigned to receive EMDR, versus being assigned to a wait-list control group (i.e., receive no treatment). In fact, EMDR appears to be just as effective as other trauma therapies. Interestingly, in studies in which therapists deliver EMDR either with or without the finger-waggling/eye-tracking, patients seem to improve the same amount no matter what group they are in. In other words, the finger-waggling doesn't seem to be an active ingredient in the treatment. EMDR has been compared to Mesmerism, in which the power of suggestion was the only therapeutic agent; this does not seem quite fair, however. It seems that what patients are getting is simply a variant of exposure therapy, but with a quasi-neurological facade. Because EMDR sounds to laypersons more "scientific" than traditional "talk therapy," some patients may be more amenable to trying it.

Lexicon of Madness -- Defense Mechanisms

Defense Mechanisms: In Freudian psychology, unconscious processes that defend the ego from anxiety. Defense mechanisms are employed by both normal and pathological individuals, and can be ranked from "immature" to "mature." Denial is perhaps the most immature of ego defense mechanisms. In denial, painful aspects of reality are kept from conscious awareness. For example, a soldier under bombardment acts as if he is back in civilian life, selling shoes. In projection, undesirable impulses of the individual are projected outside the self. I unconsciously hate you but I believe instead that it is you who hates me. Displacement involves shifting a strong emotion from one object or person to one that is less threatening. I kick the cat, unaware that my true hostility is towards my boss. In reaction formation, a person transforms an unacceptable impulse into its opposite. A person with unconscious impulses to soil things or put them into disarray becomes a neat freak. A latent homosexual becomes a zealous "anti-gay" crusader. Rationalization enables people to justify instinctual, selfish, unacceptable motives. I refuse to give money to a beggar because "he'll just spend the money on drugs." Repression is the "queen of the defenses," according to Freud, for without repression there could be no civilization. Without unconscious repression of our instinctual urges, we would live in a state of nature, a war of all against all. In fact, civilization (with its courts and police) was invented by man so that we might more effectively repress ourselves. Many people mistakenly believe that Freud advocated against repression, but it is people whose defense mechanism of repression failed them who end up in prison ("There, but for my defense mechanisms, go I"). Mature defenses include altruism (serving others in a instinctually gratifying way that does not harm the self), humor (expressing unacceptable desires in a comedic manner that does not make others uncomfortable), and sublimation (channeling instinctual energies towards socially acceptable ends). Becoming a surgeon, rather than a serial killer, could allow one to sublimate a desire to cut into human flesh with sharp instruments. Becoming a teacher could allow one to sublimate an exhibitionistic desire.

Lexicon of Madness -- Cotard's Syndrome

Cotard's Syndrome: Also called nihilistic delusional disorder. First described by 19th Century French psychiatrist Jules Cotard. The patient with Cotard's Syndrome is preoccupied with having lost status, possessions, or even internal organs. A patient might claim to have been bankrupted, evicted from his home, or abandoned by his family. He is not reassured when presented with evidence to the contrary. A patient might ask for his apparently healthy arm to be amputated surgically because "it's dead and rotting -- I can't stand the smell." He might believe that he himself has died and that clinicians are playing a mean trick on him by not burying him in a timely manner. Cotard delusions are usually associated with schizophrenia or psychotic depression. In the case of psychotic depression, electroconvulsive therapy (ECT) is indicated. Chronic Cotard's delusion may reflect the presence of a dementing syndrome such as Alzheimer's dementia.

Lexicon of Madness -- Borderline Personality Disorder

Borderline Personality Disorder: Arguably the most severe of the personality disorders. As originally conceived, people with this characterological disorder stand on the border between neurosis and psychosis. In the past, some have called the condition "ambulatory schizophrenia." Their personalities are marked by instability -- unstable mood/affect (e.g., "happy one minute and in a rage the next"); unstable relationships (e.g., "they think you are perfect one day and the next day you are the devil"); and, unstable sense of identity (e.g., "they can't maintain a stable sense of who they are, or whether they are completely worthless or not"). Borderline Personality Disorder (BDL) is found in about 2% of the general population and is twice as common in women as in men. There are high rates of comorbidity, especially substance abuse disorders and major depression. Many people with BDL are often misdiagnosed with Bipolar Disorder. BDLs have chaotic lives and their relationships are tempestuous, to say the least. Because they are both hostile and dependent, their behaviors drive people away and this results in panic over being "abandoned." They see people as either "all good" or "all bad" (i.e., they engage in "splitting"). It has been proposed that BDLs project the despised part of themselves onto other people (i.e., "projective identification"), which is why they can unload such intense anger onto those around them. Until relatively recently, self-harming behavior (e.g., cutting, or repeated low-lethality suicidal behaviors such as wrist-slashing) was almost pathognomic for BDL. Unfortunately, these behaviors have since spread more generally. Under stress, BDLs may experience psychotic symptoms (e.g., delusional beliefs, or hearing someone calling their name). Often, they simply feel empty inside. They cannot tolerate being alone, and will behave promisciously to attain superficial intimacy. They will also take dramatic action to prevent "abandonment" (e.g., "I'll kill myself if you leave me!"). They are at significantly higher risk for completed suicide and for substance abuse. A majority of BDL patients report having been sexually abused in childhood. Marsha Linehan's Dialectical Behavioral Therapy (DBT) has been shown to be the most effective treatment for these severely disturbed patients.

Lexicon of Madness -- Alexithymia

Alexithymia: The inability to describe one's own emotions or mood, or difficulty in being aware of what one is feeling. Alexithymia is more common in males than females. Developmental studies have shown that girls have far larger "emotional vocabularies" than boys do, and that parents are much more likely to ask their daughters about their feelings than they are to ask their sons. Depressed North American men are more likely to report feeling "fine" than to say, "I'm depressed." Anger and irritation are more likely to be reported than feelings of sadness or helplessness. When asked "How have you been feeling lately?" a depressed man might say, "Well, my wife says I've been kinda grouchy lately." Some of the reasons that women are twice as likely as men to be diagnosed with depression are 1) women are more likely to seek clinical help; and, 2) clinicians are more likely to focus on subjective reports of depressed mood. When assessing adult males, it is critical to evaluate other symptoms of depression -- even when depressed mood is denied. These symptoms included disturbed appetite or sleep, fatigue, diminished concentration, diminished interest in pleasurable activities (including sex), and suicidal ideation.

Lexicon of Madness -- Zeigarnik Effect

Zeigarnik Effect: Refers to the finding that uncompleted tasks are remembered better than completed ones. Russian psychologist Bluma Zeigarnik (1901-1988) had participants begin simple tasks (e.g., making clay figures, solving arithmetic problems). She let participants complete some tasks but interrupted them before they could complete others. A few hours later, she asked them about the tasks and found that the participants had better and more detailed recall for the tasks that had been left uncompleted than for those that had been completed. The Zeigarnik effect suggests that it might be best to complete your unfinished business, because unfinished tasks may be using a significant amount of your mental resources, even when you are not directly attending to them.

Lexicon of Madness -- Yerkes-Dodson Law

Yerkes-Dodson Law: The psychological "law" that suggests that performance in moderately complex tasks is enhanced by moderate physiological arousal. Simple tasks (e.g., running a race) are performed better when accompanied by high arousal (i.e., getting yourself "pumped up" before the race), while complex tasks (e.g., playing chess) are best performed when relatively calm. People suffering from anxiety are chronically overaroused -- their bodies are responding as if their environment is full of serious threats. This leads to decreased performance in life tasks, as well as chronic tension, edginess, and fatigue. People with anxiety disorders feel unable to regulate their amount of arousal. Relaxation techniques, biofeedback, and cognitive interventions (e.g., perspective taking) can all help reduce arousal. Alcohol, a depressant, is often used by anxious people to manage their levels of arousal (e.g., the socially anxious man takes a few drinks before introducing himself at a party). Benzodiazapines (e.g., Ativan, Xanax, Valium), which are not chemically dissimiliar to alcohol, are often prescribed to patients who report excess anxiety.

Lexicon of Madness -- XYY Syndrome

 

XYY Syndrome: The result of a mutation marked by the presence of an extra male (Y) sex chromosome. These men tend to be taller (generally over six feet), have lower IQs, and have histories of severe acne. In a study of 4,139 Danish men over six feet tall, 12 were found to be XYY (which is twice the 1-in-1,000 rate seen in the general population). Five of those 12 (41.7%) had criminal histories for non-violent offenses, versus only 9.3% in a normal XY control group. In other words, men with the XYY chromosomal mutation were four times more likely than XY men to have convictions for property crimes. Because XYY is the result of a genetic mutation, it is not a heritable condition; therefore, this finding does not demonstrate the genetic heritability of criminal behavior -- twin studies are needed for that. Studies of the concordance rates of criminal behavior among monozygotic (MZ; identical) and dizygotic (DZ; fraternal) twins consistently show significantly greater concordance rates among MZ twins than among DZ twins. If you are a male, and your identical twin is a criminal, the chance that you are also a criminal is about 50%. If your fraternal twin is a criminal, the chance that you are also a criminal is only about 20%. Studies such as these generate a heritability estimate for criminal behavior of about .60, which suggests that more than half of the variability in law-abiding/criminal behavior in a population can be attributed to genetic, not environmental, differences.

Lexicon of Madness -- Withdrawal Syndrome

Withdrawal Syndrome: A collection of signs and symptoms associated with sudden discontinuation of a substance. Contrary to popular belief, withdrawal from opioids (e.g., heroin, OxyContin) is rarely fatal. Withdrawal symptoms usually commence within 8 hours of the last dose, but only after one or two weeks of continuous use. The withdrawal syndrome is nasty and painful (especially considering that some researchers have found that heroin users have lower pain thresholds than non-users), and resembles the effects of influenza (e.g., diarrhea, vomiting, muscle cramps, abdominal cramps). Temperature dysregulation (either hypothermia or hyperthermia) and piloerection (gooseflesh) are often observed (hence the term, "cold turkey"). Withdrawal symptoms usually peak after about 72 hours and mostly resolve within one week. A repeat dose of the drug will quickly eliminate all withdrawal symptoms. Sudden withdrawal from alcohol, on the other hand, can be medically very serious, even fatal. Suddenly stopping heavy drinking can lead to tremulousness (the "shakes"), psychotic symptoms (e.g., delusions or hallucinations), seizures, and delirium tremens (the "DTs"). Delirium tremens is fatal in about 20% of untreated cases. It is marked by disorientation, visual or tactile hallucinations (e.g., seeing blood coming out of the walls or feeling insects crawling on one's skin), diaphoresis (heavy sweating), insomnia, anxiety, and hypertension. Benzodiazepines and fluid replenishment are the usual treatment for alcohol withdrawal. Withdrawal from cocaine and other amphetamines is usually marked by a physical and emotional crash -- depression, lethargy, ravenous hunger, and nightmares. There is anecdotal clinical evidence that long-term, heavy users of methamphetamine may experience permanent anhedonia after the cessation of drug use. People who drink large amounts of coffee during the workweek may experience caffeine withdrawal (headaches, irritability, and fatigue) on the weekends. The existence of a cannabis withdrawal syndrome has been controversial in the research literature. Heavy users who suddenly stop smoking marijuana may experience modest increases in irritability and restlessness, along with diminished appetite. The predominant cannabis withdrawal symptom, however, is the recovery of short-term memory abilities.

Lexicon of Madness -- Visual Cliff

Visual Cliff: In developmental psychology, a research apparatus designed to look like a cliff, but which actually has a clear plexiglass platform so that an infant could safely crawl from one end to the other. No matter which side of the visual cliff they are placed on (i.e., "safe level ground" or "dangling over open air"), non-crawling infants do not show increased physiological response (fear). This is because they have not yet developed depth perception and so cannot be tricked by the research optical illusion. Depth perception develops as the crawling ability develops. Crawling infants placed on the "safe, high" side of the visual cliff are highly reluctant to crawl over the "edge" and off the "cliff." Crawling infants placed onto the plexiglass on the "open air" side show heightened physiological response. However, infants can be coaxed over the edge of the cliff if their mothers encourage them to crawl towards them. A smiling, gesturing mother can entice an infant to disregard all the perceptual information that is telling him that if he crawls one more foot he will tumble from a great height. (Conversely, the children of mothers who display a fearful expression will stay put on the "safe" side, even if an experimenter is trying to coax them over the edge by waving an interesting toy.) This simple research apparatus was originally designed to test the development of depth perception, but has since been used to demonstrate the power of the mother-infant attachment bond. If positive attachment can provoke such a "leap of faith," then what about the converse -- just how bad is it when children grow up without a strong attachment bond? What happens to children who never feel loved, never feel secure, never feel that there is someone in the world who will put his interest above her own? The state prisons and rehab facilities are full of them.

Lexicon of Madness -- Unconditional Positive Regard

Unconditional Positive Regard: A core ingredient of Rogerian client-centered therapy. Everyone needs warmth, respect, sympathy, and acceptance. Unfortunately, for most people, this positive regard is offered only conditionally. Your parents were warm towards you only as long as you behaved as they wanted you to behave. They respected you when you performed as they expected you to perform. They accepted you only so far as you met their conditions of worth. Most other people -- teachers, spouses, bosses -- also provide only conditional positive regard. Conditional positive regard can, at best, result in conditional positive self-regard, i.e. you like and accept yourself only when you are meeting other people's expectations. Psychological problems arise as we become increasingly aware of the incongruity between the values we have introjected from our other people and the values we experience as arising from our true selves. According to Carl Rogers, a therapist should provide clients with unconditional positive regard. This does not, however, entail blind acceptance of a client's despicable behaviors. Empathy and genuineness must precede the unconditional positive regard. Through careful questioning and active listening, the therapist comes first to truly know and understand the client, without trying to direct or control her. The therapist also monitors his own feelings and experiences within the counseling relationship, demonstrating congruence between his true experience and how he is thinking or feeling about the experience. When a genuine person says that he is "glad to see you," it is because he is actually experiencing gladness at the sight of you. He doesn't "think" he is glad, or "feel" that he is glad (and he certainly isn't saying it just because it seems like an appropriate thing to say) -- he is genuinely experiencing gladness. It all sounds so simple, doesn't it? Sadly, unconditional positive regard, empathy, and genuineness are vanishingly rare.

Lexicon of Madness -- Type A Personality

Type A Personality: As originally conceived, a personality type marked by impatience, hurriedness, excessive competitiveness, irritability, and hostility. The Type A won't let his 8 year old beat him at a board game and can't stand waiting in line. Type Bs are more calm, cooperative, and tolerant. Type A Personality was originally thought to be a risk factor for myocardial infarction (heart attack). However, only the hostility component seems to be predictive of cardiac problems. In one study, men who had already had heart attacks had a monitor attached to their cars' steering columns. Participants who used their car horns more frequently had an increased risk of dying from a second heart attack. Psychotherapy has been shown to be remarkably effective with men who have a heart attack, in one study reducing risk of a second heart attack by 25% compared to wait-list controls.