Aokigahara-jukai: suicide and amnesia in Mt. Fuji's Black Forest

Aokigahara-jukai (Jukai), a dense forest at the foot of Mt. Fuji, is well known as the leading suicide site in Japan, with about 30 people committing suicide there every year. This paper describes Jukai and three cases of psychogenic amnesia following attempted suicide there. Amnesia as an alternative to suicide and the significance of death in Jukai are discussed.

Psychotherapy of pathologic grief. Revisions and limitations

A significant minority (14 per cent) of a nonpatient bereaved population may be presumed to develop intense and enduring pathologic grief responses. The promise of recovery with short-term, focused intervention appears to be misleading, as a sizable proportion of patients with pathologic grief will be unresponsive to treatment. Prospective studies have demonstrated a positive correlation of dependent attachment, conflicted attachment, and unexpected loss with specific pathologic grief syndromes; preliminary reports suggest that these specific grief syndromes require specific interventions. The presentation of a nonresponsive case illustrates the clinical application and limitation of a revised strategy of treatment. The development and maintenance of formative imagery and symbols is of crucial support to the patient and therapist.

Development, reliability, and validity of a dissociation scale

Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)

Psychotic symptoms in borderline personality disorder

In a pilot study of 13 patients with borderline personality disorder, analysis of brief psychotic symptoms was done. Derealization and depersonalization were the most common symptoms, but drug-free hallucinations were also observed. The symptoms did not appear to be factitious.

Development, reliability, and validity of a dissociation scale

Dissociation is a lack of the normal integration of thoughts, feelings, and experiences into the stream of consciousness and memory. Dissociation occurs to some degree in normal individuals and is thought to be more prevalent in persons with major mental illnesses. The Dissociative Experiences Scale (DES) has been developed to offer a means of reliably measuring dissociation in normal and clinical populations. Scale items were developed using clinical data and interviews, scales involving memory loss, and consultations with experts in dissociation. Pilot testing was performed to refine the wording and format of the scale. The scale is a 28-item self-report questionnaire. Subjects were asked to make slashes on 100-mm lines to indicate where they fall on a continuum for each question. In addition, demographic information (age, sex, occupation, and level of education) was collected so that the connection between these variables and scale scores could be examined. The mean of all item scores ranges from 0 to 100 and is called the DES score. The scale was administered to between 10 and 39 subjects in each of the following populations: normal adults, late adolescent college students, and persons suffering from alcoholism, agoraphobia, phobic-anxious disorders, posttraumatic stress disorder, schizophrenia, and multiple personality disorder. Reliability testing of the scale showed that the scale had good test-retest and good split-half reliability. Item-scale score correlations were all significant, indicating good internal consistency and construct validity. A Kruskal-Wallis test and post hoc comparisons of the scores of the eight populations provided evidence of the scale's criterion-referenced validity.(ABSTRACT TRUNCATED AT 250 WORDS)

Posttraumatic stress disorder in murderers

Three case histories of men who suffered posttraumatic stress disorders after committing homicides are presented. These men were relatively young and had chaotic childhoods and minimal criminal histories. Each had killed a woman with whom he had a significant but intensely turbulent emotional relationship. The killings all occurred during altered mental states that were unrelated to the use of drugs or alcohol. The clinical significance and some of the medicolegal implications of this phenomenon are discussed.

Psychoanalysis and time

Psychoanalysis is fundamentally related to time because it is an effort to understand how disturbances in the present are determined by events in the past. Technically, we know that the patient who is reporting immediate perceptions is not aware of the passage of time, but he becomes self-conscious as undesirable elements threaten to appear in his associations. Time is not sensed by direct awareness, nor is it an agent of action or events. Various functions of the ego influence how time is experienced consciously, leading to phenomena such as déjà vu, a sensation of timelessness, misjudgment of time duration, the experience of premonition. Psychoanalysis more than any other discipline sheds light on the coexistence of past, present, and future, as influenced by unconscious fantasy thinking. The analyst's understanding of the patient's associations is guided by temporal factors such as context and contiguity, succession of similar or opposite elements. Basically, the self is a time-bound concept; identity implies that a self is the same entity at different points in time. There is a deep-seated rebellion against the tyranny of time, beginning with need frustration in the infant and culminating in the knowledge that man is destined to lose the struggle against death.

Hypnotizability in patients with anorexia nervosa and bulimia

Hypnotizability was assessed with the use of three standardized hypnosis scales in 86 patients with eating disorders. All diagnoses were made according to DSM-III criteria. Sixty-five patients had anorexia nervosa and 21 had bulimia. The anorectic patients were divided into subgroups of 19 abstainers and 46 vomiters and purgers. Bulimic patients were highly hypnotizable, significantly more so than the patients with anorexia nervosa and age-matched populations. There was also a trend for the purging subgroup of anorectics to have higher hypnotic capacity than abstaining anorectics.

Sexual criminality and hypnotizability

Thirty-three sexual offenders, 18 of whom had been convicted of rape, nine of pedophilia, and six of incest, were studied. Two thirds of the subjects had histories of "spontaneous self-hypnotic" experiences (dissociations); seven of these were DSM-III multiples and six were probable multiples. This group had very high hypnotizability scores. The other one third without histories of "spontaneous self-hypnosis" had normal scores. It was concluded that spontaneous self-hypnosis contributed to the perpetration of the crimes in many of these cases, although other factors also directed the antisocial behaviors.

Dissociation and psychotic symptoms

The literature on hysterical or brief reactive psychosis reflects great diversity both in clinical description and theoretical formulation. The authors describe the case of a 17-year-old girl who presented with a diagnosis of bipolar affective disorder, rapid cycling type, but who, in fact, was experiencing dissociative episodes manifested as psychotic states. The patient's successful treatment with hypnosis is described, along with the clinical and theoretical implications of the case.

Dissociative states in multiple personality disorder: a quantitative study

Multiple personality disorder (MPD) patients may experience themselves as several discrete alter personalities who do not share consciousness or memories with one another. In this study, we asked whether MPD patients are different from controls in their ability to learn and remember, and their ability to compartmentalize information. MPD patients were not found to differ from controls in overall memory level. Learning of information by MPD patients in disparate personality states did not result in greater compartmentalization than that of which control subjects were capable. However, there were qualitative differences between the cognitive performance of patients and that of controls attempting to role-play alter personalities. Our results suggest that simple confabulation is not an adequate model for the MPD syndrome, and we consider a possible role for state-dependent learning in the phenomenology of MPD.

Imagery and combat stress in Vietnam veterans

Greater exposure to combat in Vietnam leads to higher levels of Vietnam-linked imagery, as shown by three different measures: a) an experimental task; b) the Impact of Event Scale, a measure of intrusion and avoidance of imagery within the past week; and c) a measure of imagery experienced since return from Vietnam. The results support previous findings from analogue studies and civilian populations concerning the relationship between degree of stress and posttraumatic imagery.

Spontaneous hypnotic age regression: case report

Age regression--reliving the past as though it were occurring in the present, with age appropriate vocabulary, mental content, and affect--can occur with instruction in highly hypnotizable individuals, but has rarely been reported to occur spontaneously, especially as a primary symptom. The psychiatric presentation and treatment of a 16-year-old girl with spontaneous age regressions accessible and controllable with hypnosis and psychotherapy are described. Areas of overlap and divergence between this patient's symptoms and those found in patients with hysterical fugue and multiple personality syndrome are also discussed.

Fantasized companions and suicidal depressions: two case reports

Two acutely suicidal adult patients with fantasized companions integral to the formation of suicide intent are presented. The phenomenon of the fantasized companion is reviewed, differentiated from true hallucinatory or psychotic phenomena, and related to other fantasy and dissociative states, such as daydreaming and multiple personalities. In this regard, the concept of hysterical psychosis is discussed. The functions served by the fantasized companions and their involvement in the successful treatment of the patients are described.

Flashbacks and memory phenomena. A comment on "Flashback phenomena--clinical and diagnostic dilemmas"

Alarcon, Dickinson, and Dohn (J. Nerv. Ment. Dis., 170: 217-223, 1982) recently reviewed the phenomenon of memory flashback following use of hallucinogenic drugs. They point out that while there are a considerable number of explanations concerning the flashback mechanism, little is known about the real causes. This paper examines flashback following drug ingestion in the light of other memory phenomena concerned with "cued retrieval" effects. Such phenomena may include dream recall, delayed post-traumatic stress, mood influence on memory, and drug effects on memory. Rather than view flashbacks as "pathological" in some sense, it may be better to view them as instances of normal memory processes, which may, nevertheless, be accompanied by emotional distress. Such a view relates flashbacks to a wider memory literature, and also makes them amenable to investigation using research designs derived from that literature.

Multiple personality as a post-traumatic stress disorder

This article examines multiple or dissociative personality syndrome as a multiple post-traumatic stress disorder, discussing these patient's developmental histories, their high hypnotizability, and their profound capacity to dissociate spontaneously to protect themselves from emotional and physical pain.

Treatment of multiple personality disorder. A study of 33 cases

This article describes treatment results in 33 patients with multiple personality disorder with respect to the major identifying characteristic of the condition: the presence of separate personalities within a single individual. The author discusses responsiveness to treatment, apparent and stable fusion, follow-up, and reassessment.

Towards a theory of multiple personality and other dissociative phenomena

That dissociation and multiple personality occur has been well documented. In this article the guest editor asks the following question: Are they created? To arrive at an answer he brings together various concepts under the rubric of state-dependent learning and presents ideas about how the states come together psychologically, physiologically, neurophysiologically, and physically.

Nightmares and trauma: a comparison of nightmares after combat with lifelong nightmares in veterans

In this study the chronic traumatic nightmares of men who had been in combat were found to differ from the lifelong nightmares of veterans with no combat experience in that they tended to occur earlier in the sleep cycle, were more likely to be replicas of actual events, and were more commonly accompanied by gross body movements. Traumatic nightmares may arise out of varying stages of sleep and are not confined to REM sleep alone. The group with lifelong nightmares showed evidence of thought disorder on the Rorschach. The men with posttraumatic stress disorder had failed to psychologically integrate their traumatic experiences and used dissociation as a way of dealing with strong affects.

Dissociated rage attacks in a Vietnam veteran: a Rorschach study

A case study of a Vietnam combat veteran with episodic rage attacks is discussed with emphasis on Rorschach formal scoring and content analysis. Rorschach data suggest a near neurotic level of ego organization with massive repression in the form of dissociated violent outbursts. Vietnam combat trauma appears to be a precipitant. Developmental differences between preoedipal splitting and higher level dissociation are discussed. Dissociative states are posited to represent a developmental level of ego organization midway between borderline and neurotic levels and are not easily encompassed by either borderline or neurotic classifications.

Familial fugue--a case report

A case of fugue with a familial pattern is presented. A review of the pertinent literature has been made. A "learned" basis to the development of fugue in the case presented is considered.

Homosexual identity formation as a developmental process

Homosexual identity is conceptualized as a life-spanning developmental process that eventually leads to personal acceptance of a positive gay self-image and a coherent personal identity. Habermas' theory of ego development is utilized to provide a synthesis and understanding of the literature on the construction and maintenance of the homosexual identity. It is concluded that the homosexual identity generally emerges in a three-stage process in which the person progresses from: (1) an egocentric interpretation of homoerotic feelings to (2) an internalization of the normative, conventional assumptions about homosexuality to (3) a post-conventional phase in which societal norms are critically evaluated and the positive gay identity is achieved and managed. Developmental tasks associated with each stage are outlined in terms of their ego-integrative functions. Although the stages in the process of homosexual identity formation are theoretically the same for females and males, because of the paucity of research on the homosexual identity in females, this paper deals chiefly with males.