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Method: We assessed probands with DSM-IV pathological gambling, controls, and their first-degree relatives. Results: Ninety-five pathological gambling probands, 91 controls, and their 1,075 first-degree relatives over age 18 (537 relatives of pathological gambling probands, 538 relatives of controls) were evaluated between February 2005 and June 2010.
Pathological gambling is a major public health problem characterized by poorly controlled and maladaptive gambling behavior. The primary goals of the study were to definitively determine whether pathological gambling is familial, examine patterns of familial aggregation of disorders, and investigate demographic and clinical characteristics that might contribute to the familial aggregation of pathological gambling.
Pathological gambling probands were recruited through a study registry (n = 19), psychiatric treatment facilities (n = 15), gambling treatment programs (n = 19), advertisements (n = 19), Gamblers Anonymous meetings (n = 15), and word-of-mouth (n = 7). Pathological gambling is highly familial, with rates of lifetime pathological gambling and subclinical pathological gambling significantly greater among the relatives of probands with pathological gambling (11% and 6%, respectively) than among comparison relatives (1% and 1%, respectively).
Pathological gambling relatives had higher rates than control relatives of major depression, bipolar disorder, any mood disorder, social anxiety disorder, any substance use disorder, posttraumatic stress disorder, and antisocial personality disorder. Antisocial personality disorder, social anxiety disorder, and posttraumatic stress disorder were more frequent in case relatives independent of the presence of pathological gambling. Pathological gambling probands were required to meet lifetime DSM-IV1 pathological gambling criteria, have a South Oaks Gambling Score (SOGS)20,21 ? 5, and have a lifetime National Opinion Research Center (NORC) DSM Screen for Gambling Problems (NODS)5,22 score ? 5.
Diagnostic information was collected on relatives who were deceased, chose not to participate, or could not be located or for whom the proband would not allow contact. Subjects were rated for the presence of pathological gambling, subclinical pathological gambling, recreational gambling, and no gambling.
Social and clinical characteristics of probands and their first-degree relatives were compared using the ?2 test (or Fisher exact test) for categorical variables and the Mann-Whitney test for dimensional variables.
Pathological gambling and control probands were compared on lifetime psychiatric disorders. The familial relationship between pathological gambling and comorbid psychiatric disorders was examined using logistic regression with GEE for correlated data.36 First, we established which disorders occurred more frequently among the first-degree relatives of pathological gambling probands, indicating a common familial etiology. The logistic regression GEE model was also used to test whether pathological gambling proband characteristics were associated with pathological gambling in relatives. The total sample included 1,261 individuals: 186 probands (95 pathological gambling probands, 91 control probands), 318 directly interviewed first-degree relatives (148 relatives of pathological gambling probands, 173 relatives of control probands), and 757 indirectly assessed relatives (389 relatives of pathological gambling probands, 365 relatives of control probands). Table 1 presents a comparison of pathological gambling and control probands and their respective first-degree relatives. Distribution of type of relative (parent, sibling, offspring) was similar for the 2 groups (Table 1). Pathological gambling probands were more likely than control probands to have a co-occurring psychiatric disorder (Table 2).
First-degree relatives of pathological gambling probands met criteria for pathological gambling–related phenotypes significantly more often than control relatives (Table 3). Pathological gambling relatives had significantly higher rates than control relatives for major depression, bipolar disorder, alcohol use disorders, drug use disorders, social anxiety disorder, and antisocial personality disorder (Table 4).
Major depression, bipolar disorder, any mood disorder, any substance use disorder, PTSD, social anxiety disorder, and antisocial personality disorder occurred more frequently in the pathological gambling relatives. For many years, pathological gambling was considered by some experts to fall within an obsessive-compulsive spectrum.48,49 We found little evidence supporting a familial link with obsessive-compulsive disorder.
The results argue for molecular studies that aim to identify a genetic etiology for pathological gambling. First, pathological gambling probands were recruited because they had received psychiatric or gambling-related treatment services, responded to an ad, were on a study registry, or learned of the study through word-of-mouth.
Although many books have been written about the psychology of violence (as I learned during my days directing a program for court-referred perpetrators), Dr. The same dynamic of denial applies to entire nationsa€”and goes far toward explaining why the a€?nicesta€? and most restrained people sometimes pick up a gun.
Listening to the Rhino deals not just with outwardly expressed violence, however, but with confronting and transforming archetypal violence (as imaged by the dream figure of the Rhino) manifesting from within the psyche. Following up on Jung's advice to translate emotions into images, Dallett writes about how a symptom or an illness, whether somatic or psychogenic (or both), represents an attempt at incarnation imparted by a spiritual force badly in need of translation from a literal source of suffering into an actively lived symbolic work. Active imagination furnishes a primary Jungian tool for this kind of deep work, but as Dallett reminds the reader, Marie-Louise von Franz always insisted on the importance of completing at least these four steps: setting the ego aside, tending the images, reacting to the images, and putting the results to work in life (italics added).
This belief may well be a candidate for what Dallett identifies in another context as a pathological identification with spirit: what Jung identified as inflation. In the chapter a€?Sedating the Savage,a€? Dallett presents many examples of how psychotropic medication represses unpleasant emotions while supporting artificial idealized states of happiness and surface contentment.
While the matter of healing is a major theme of this book, the other is violence, and Dalletta€™s point here is that when violence is repressed it puts the individual and collective into grave peril. Dallett returns our attention to the potency of active imagination as a tool to activate the psychea€™s potential for literal physical healing as well as psychological wholeness. On the cover is a picture of a rhinoceros with two birds perched on its back, a classic example of a mutually beneficial biological symbiosis. Jungians are often the last bulwark in todaya€™s field of mental health practitioners, who remember the unavoidable reality and necessity of darkness and violence.
We must develop an ego that is strong enough to contain the violent side of human nature, Dallett suggests, in order to live up to a€?what Jung saw as the millennial task (of) carrying the divine opposites of good and evil within the individuala€? (p.87).
To contain the worst kinds of violence, Dallett suggests that we find a way to give expression to our destructive impulses without causing too much harm.
The gist of Dalletta€™s argument, however, points towards incorporating more of the almost lost Jungian technique of Active Imagination. The Rhino did not simply show up to heal the dreamer, but to inform her that she was to serve him. In Pat Britta€™s own words a€?During my early association with The Rhino, I could tell he wanted something of me, but I did not know what. In the alchemical laboratory of human life we are also mirrors for transformations on a larger scale, the transformation of the spirit in nature. Dallett reminds us that one-sidedness is one of our greatest dangers, be it the lopsided, misunderstood spirituality that denies the spiritual reality of violence or the overly rational slant of todaya€™s scientific community. We read in some detail here about the work of Jungian analysis, with special emphasis on active imagination, a method for bringing unknown parts of oneself into awareness and into connection with onea€™s everyday personality. Seamlessly, the book then turns to two major topics of special concern in todaya€™s world: the nature of violence and the use of psychotropic drugs.
While this discussion of violence focuses on the psychic sources of explosive violence, another section, on the use of psychotropic drugs, looks at contemporary uses of prescription drugs to damp down or cover up difficult, painful, unwelcome emotions (and violence). What we have in this small book is the fruit of a penetrating mind nourished by long experience of the psyche, and now offering us the essence of that experience, fueled by passionate concern over issues of todaya€™s world. Why is there so much violence around us - shootings in colleges, bullying in schoolyards, violent movies in theatres, graffiti in public spaces, news on television? Janet Dallett is a Jungian analyst in her seventies, now living in Port Townsend, Washington. Britt had hundreds of Rhino dreams in the course of her nine-year analysis with Dallettt, which always focused on the meaning of his latest appearance.
Britt truly grasped the Rhino, writing poetry about him, painting his picture, and even casting him in bronze so he could stand in her front hall, and her damaged heart healed. Dallett attributes Britta€™s healing to her commitment to the Rhino, a voice for what Jung calls the Self, the God within.
We are doing to the wild part of our psyche what we have done to the wild parts of the earth. All these different names for one disorder, and the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, brought on yet another, calling it Excoriation (Skin-Picking) Disorder.
Most online definitions I find point to it meaning that skin is worn away, such as by chafing, but I have also found definitions that talk about tearing the skin away and even flaying.
Whatever the reason or reasons for choosing this name for what the community typically calls dermatillomania, this is the first time it is appearing definitively in the DSM at all.
The skin picking causes clinically significant distress or impairment in social, occupation, or other important areas of functioning.
Considering how many pickers are often judged as being drug users, it’s both a great and important that the DSM-5 acknowledges and emphasizes that the picking and the disorder as a whole are separate from drug use and is not drug induced. According to the DSM-5, about 1.4% (“or somewhat higher”) of people have this disorder, with the vast majority being female. Like with others BFRBs, there is a ritualistic nature to skin picking, which can involve the skin or the scabs. A tricky topic, or maybe potentially embarrassing topic, with skin picking is how a person feels doing it. The majority of consequences that the DSM-5 talks about are functional, meaning the effect on a person’s everyday life.
Excoriation disorder is usually accompanied by other mental disorders, such as obsessive compulsive disorder, trichotillomania and major depressive disorder.
Like with the section on trichotillomania, there is a part of the section on excoriation that I disagree with, don’t understand, and which is not explained in the text. In the end, thought, for it first official categorization in the DSM-5, what the editors and medical professionals have collected so far as information is pretty decent and fairly thorough.
What is muscle dysmorphia, bigorexia, reverse anorexia, Muscle dysmorphia, also called bigorexia or reverse anorexia, symptoms, causes and treatments. Muscle dysmorphia - wikipedia, the free encyclopedia, Muscle dysmorphia, sometimes called "bigorexia", "megarexia", or "reverse anorexia", is a subtype of body dysmorphic disorder, but is often also grouped with eating. Bodybuilding obsession leading to 'bigorexia' - youtube, A potentially dangerous obsession with bodybuilding is increasing among men, according to experts. Milliken said thyroid disease, arthritis, psoriasis and diabetes was common among PTSD victims from the Vietnam War, and in the latest military actions by United States troops saw poor health functions resulting from smoking and alcohol abuse as well as an increase in arthritis and digestive disorders, including ulcers.
The risk factors for veterans committing suicide, she said, included being divorced or widowed, unemployed, no support group, previous suicide attempts, substance abuse and depression.
Soldiers who reported abuse as children were three to eight times more likely than those who were not abused to report suicidal behavior, he said. We sought to examine the familiality of pathological gambling and determine patterns of familial aggregation of disorders. Detailed family history information was collected on relatives who were deceased or unavailable. Mood and substance use disorders may emerge as a consequence of the pathological gambling or as a more complex syndrome.
The study was developed to replicate and extend our pilot studies12,13 and improve upon earlier family studies. On the basis of earlier studies, we hypothesized that pathological gambling would occur significantly more often among the first-degree relatives of pathological gambling probands than among comparison relatives and that certain patterns of coaggregation of disorders would occur among pathological gambling first-degree relatives, including higher rates of mood and anxiety disorders, antisocial personality disorder, and substance use disorders. Controls were recruited via random digit dialing by the Center of Social and Behavioral Research (University of Northern Iowa, Cedar Falls) and were group matched to pathological gambling subjects for age, sex, and educational level. This familial association suggests that pathological gambling may share an underlying genetic diathesis with these disorders.
A roster of first-degree relatives was obtained from probands and permission was sought to contact relatives ? 18 years old. Only definite and probable cases of pathological gambling and subclinical pathological gambling were included in the analyses.
Generalized estimating equation (GEE) models were used to account for within-family correlation in outcomes.34,35 The same GEE model was used to compare pathological gambling and control relatives for lifetime psychiatric disorders. To determine possible independent transmission, the additional diagnosis of interest in the proband (eg, major depression) was included in the model.
Mood disorders, substance use disorders, and anxiety disorders were more frequent in pathological gambling probands.

In general, using more stringent criteria for affected status (ie, definite) resulted in larger ORs.
Table 5 shows the ORs with 95% CIs for comorbid disorders that occurred more frequently in pathological gambling than control relatives. Along with published twin data,15–17 the data suggest that pathological gambling may have a hereditary basis. In contrast, PTSD, social anxiety disorder, and antisocial personality disorder occurred among pathological gambling relatives regardless of the presence of pathological gambling. Some investigators have suggested that pathological gambling in women may not be genetically transmitted,12,19 but Slutske et al37 showed that the genetic influences for “disordered gambling” in women are just as important as for men.
Early candidate gene association studies have focused on dopamine receptor and transporter genes thought to be involved in the brain’s reward mechanisms, with at least 1 positive finding reported for DRD1, DRD2, and DRD4.54 Genome-wide studies are needed to target genes implicated in pathological gambling and to investigate gene-gene and gene-environment interactions. National Opinion Research Center at the University of Chicago (NORC): Gambling Impact and Behavior Study, Report to the National Gambling Impact Study Commission, April 1, 1999. Dallett's clearly and concisely written book offers thoughtful and sometimes surprising reflections, case anecdotes, and scholarly musings on violence as a spiritual problem. It is easy for introverts in particular to skip the final step, but doing so severs inner from outer, contemplation from action. James Hillman has presented a similar critique, which can be summed up by the dictum: Silence the symptom and lose the soul.
It is tiresome to be reminded that Jung believed active imagination to be the sine qua non of coming to terms with the unconscious. Oxpeckers or a€?tick birdsa€? sit on top of the rhino eating insects and noisily warn of approaching danger. It contains big ideas that deserve to be pondered and digested many times and reading this book is an excellent way to re-engage this material. Dallett reminds us that the etymology of the word a€?violencea€? suggests a close relationship between violence and God. Dallett makes a convincing case that our culturea€™s addiction to love, peace and happiness in effect creates senseless violence and that we must learn and find a way to teach our children, that the terrible side of life is not going anywhere.
Dallett reminds us that, once a respectful and responsible attitude towards the unconscious psyche has been developed, the meditative dialogue of Active Imagination is the technique for the on-going and life- long task of engaging emerging images. Dallett grounds her reflections by allowing us a glimpse into the lives of two former patients, Pat and Teresa and she shows us the difference in attitude of these two women towards powerful inner animal dream figures. Britt had this dream, but because she took the image seriously and engaged it for decades to come.
It is a potentially dangerous, primitive animal that has visited the dreams and fantasies of Ms. Dallett makes the analogy to the alchemical work, which Jung had translated into psychological terminology. At first I thought his message was personal a€“ urging me to view life as whole, not with the limited eye of my rational ego.
Our collective ego is still trying to maintain its autonomy in relation to the larger mysteries while the power of the feminine in her own totality is pressing into consciousness.
This discussion is unusually clear and thorough, giving a readable and rounded picture of this form of psychological worka€”both its potentiality for healing and its dangers. And why are we so fascinated by violence that crime, killing, and war are often at the top of the news?
I hear him pronounce: a€?If a thing is worth doing it is worth doing easily!a€? By this he means, according to Britt, that if a thing is worth doing it is worth taking the time to get to know it, so the thing can show you how it wants to be done. When connected to your inner program something beyond the ego comes to your aid, but when you try to go against your destiny you hit a wall. Later she realized he wanted to reach a wider audience; he wanted to speak for life, all life, animals, plants and the earth itself. We North Americans have naively idealized the Christian virtues of kindness and self-sacrifice, dangerously repressing our so-called negative emotions.
We are sedating the suffering of body and soul with psychoactive drugs, unaware that pain is a reaction against something that needs to change. Although it’s not defined in the DSM-5, I wanted to first highlight what “excoriation” or to excoriate, means.
Interestingly, before the DSM-5, most definitions I found for excoriate had to do with scratching away the skin, which I felt was largely inaccurate for skin picking disorder, but I don’t see many, if any, of those definitions now. Despite any controversy and beyond the difficult wait for it to finally be acknowledged, it’s finally there, and this is what the DSM-5 has to say about it so far. Equally important is for it to acknowledge that the disorder is not Body-Dysmorphic Disorder, although the difference is still a little muddy (in my opinion) based off of the letter “E” description alone.
Excoriation disorder spans across many ages, with the most common starting point being puberty, which is likely because of acne or another skin condition. Some have particular kinds of scabs that they search for to pick and after picking, some “examine, play with, or mouth or swallow the skin.” Some people even pick the skin of other people. I feel there is a lot to still be learned and discovered about skin picking since this is the first time it’s really being looked at or taken seriously. Those who feel they are a burden on society, a sense of not belonging and combat exposure constitute the most common three variables for suicide, Krowel added. In contrast, antisocial personality disorder, social anxiety disorder, and posttraumatic stress disorder may share a common familial etiology with pathological gambling. Using the same data, Slutske et al16,17 concluded that pathological gambling, substance use disorders, and antisocial personality disorder were genetically-linked, while Potenza et al18 drew similar conclusions with regard to pathological gambling and major depression. Pathological gambling probands were recruited from the community, and controls were recruited through random digit dialing procedures. We believe the results will lead to a better understanding of the etiology and pathophysiology of pathological gambling, its classification, and both treatment and preventive strategies. Participating relatives were interviewed in person or by telephone by raters blind to the status of the proband (pathological gambling or control). Children < 18 years old were evaluated by using similar procedures along with the Child Behavior Checklist,23 completed by the proband.
The groups were similar in terms of sex, age, marital status, and having more than 1 child. Significant differences were also observed for eating disorders and antisocial personality disorder. The prevalence of definite pathological gambling was substantially higher in pathological gambling than in control relatives, and the odds were more than 8 times greater. Results are presented sequentially to show how proband diagnosis for each disorder and pathological gambling affect the group comparison (pathological gambling vs control relatives). These data suggest that mood and substance use disorders may develop as a consequence of pathological gambling (eg, gambling losses inducing depression), but PTSD, social anxiety disorder, and antisocial personality disorder may share a common familial etiology with pathological gambling.
Further, environmental factors associated with familiality included childhood adversity and “unhealthy” behavioral control reported by the proband and occurring within the family context.
Second, probands were adults, and older age may have reduced the estimate of familial risk, given that research suggests rates of pathological gambling may be higher in youth.55,56 Third, the low participation rate of minority subjects may reduce the generalizability of our findings to these populations.
Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions.
Behavior genetic research on gambling and problem gambling: a preliminary meta-analysis of available data.
A twin study of the association between pathological gambling and antisocial personality disorder. The South Oaks Gambling Screen (SOGS): a new instrument for the identification of pathological gamblers. Reliability, validity, and classification accuracy of the South Oaks Gambling Screen (SOGS).
Psychometric evaluation of the National Opinion Research Center DSM-IV Screen for Gambling Problems (NODS). Marital status, childhood maltreatment, and family dysfunction: a controlled study of pathological gambling.
Pathological gambling: relationship to obesity, self-reported chronic medical conditions, poor lifestyle choices, and impaired quality of life. The relationship between obsessive-compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Clinical features and psychiatric comorbidity of subjects with pathological gambling behavior.
Schizophrenia and schizophrenia-spectrum personality disorders in the first-degree relatives of children with schizophrenia: the UCLA family study. A family study of bipolar I disorder in adolescence: early onset of symptoms linked to increased familial loading and lithium resistance. A meta-analysis examining the relations among pathological gambling, obsessive-compulsive disorder, and obsessive-compulsive traits. DSM-5 Guidebook: The Essential Companion to the Diagnostic and Statistical Manual of Mental Disorders.
Changes in genetic and environmental influences on depressive symptoms across adolescence and young adulthood. Genetic and environmental influences on trauma exposure and posttraumatic stress disorder symptoms: a twin study.
Dimensional representations of DSM-IV cluster B personality disorders in a population-based sample of Norwegian twins: a multivariate study.
Genetic aspects of pathological gambling: a complex disorder with shared genetic vulnerabilities.
Updating and refining prevalence estimates of disordered gambling behaviour in the United States and Canada.
Comparability of telephone and face-to-face interviews in assessing Axis I and II disorders. Diagnostic interviewing for family studies: comparing telephone and face-to-face methods for the diagnosis of lifetime psychiatric disorders. Also criticized is the widespread habit of using meditation to get rid of (repress) the emotionally charged images flowing from the unconscious. I would like to see this insightfully expressed logic extended more often to the state of the oppressed struggling on every side and in all corners of the world. The Indoa€“European root of the word a€?violenta€? is wei, which means vital force and one definition of the word God is a€?an immanent vital forcea€? (p.86). The reader is encouraged to reflect on seemingly counter-intuitive statements, such as a€?violence is the human spirita€™s protest against the enforcement of more goodness than it can stomacha€? (p.92).
This suggestion, although fundamentally right, may need more elaboration than this book provides, because the danger of infection by archetypal forces is high and not to be taken lightly.
With reference to Barbara Hannah, Dallett devotes a segment of the book to a much needed review of what Active Imagination is and discriminates what it is not. We are informed on the front page that this book was written with contributions by The Rhino and by Dalletta€™s former patient Pat Britt. Dallett writes, a€?The Rhino has been the central figure in hundreds of Pata€™s dreams continuing still today. The alchemists believed that their work was to redeem God or the son of God, whom the alchemists imagined as a a€?fabulous being conforming to the nature of the primordial mothera€? (p.
We are encouraged to look at the place within ourselves where we remain a€?fundamentalista€?, where spirit is trapped in a literal, concrete enactment, physical illness or cherished convictions of the nature of reality. The cover photo of a rhinoceros with two small birds casually perched on its back leads us into a text full of insight into both interior and outer worlds.
Only a profound understanding can put forth such subtle and complex ideas in such apparently plain talk.

Britt had been so ill with bacterial endocarditis and kidney failure that she was expected to die in her early forties. However, if something is hard to do you should change your relationship with it, or let it go. We are suppressing the healthy masculinity of normally active children with Ritalin, either because the way we are living is driving our children crazy or because they do not conform to our expectations.
I wonder if these imprecise and scattered definitions of the word are why the editors of the DSM-5 chose to call it Excoriation (Skin-Picking) Disorder as opposed to simply Excoriation Disorder, to avoid confusion as to what the action actually is. The face, arms and hands are often the go-to areas for pickers, but the DSM-5 does also note that picking can occur anywhere on the body. Overall, picking can be focused or automatic—meaning that sometimes it is a conscious effort whereas other times it is more absent-minded—and sometimes people have a mix of both types of behaviours.
The DSM-5 says that the picking is typically “preceded or accompanied by various emotions states,” such as anxiety or boredom.
Clearly people have been and continue to hide, and there are very few people I know that openly admit to skin picking.
The disorder, to them, is still in its infancy, and probably as it is able to recognized in more patients, more will be learned from each individual case. DeBakey VA Center in Houston, said that there is a need for more family-centered treatment for PTSD for returning veterans than in previous wars and that the unemployment rates are higher. In 2012, there were 319 suicides among active duty service members and 203 among reserve service members, compared to 237 combat-related deaths of active duty service members in Afghanistan, according to the Department of Defense. The phenotype may extend beyond pathological gambling to include subclinical forms of the disorder. In summary, converging data suggest that pathological gambling is familial, coaggregates with several psychiatric disorders, and is probably genetically transmitted to some extent. Comprehensive evaluations of probands and first-degree relatives were conducted by trained raters. To preserve the blindness of study objectives, relatives were told that they would be participating in a family study of “emotions and behavior.” Subjects gave written informed consent through procedures approved by the University of Iowa Institutional Review Board. Relatives with unknown status for the phenotype of interest (pathological gambling, subclinical pathological gambling) were excluded from both a numerator and denominator. Lastly, the presence of pathological gambling in first-degree relatives was included in the models to determine whether the comorbid disorder is transmitted independently of pathological gambling. Both pathological gambling and control relatives were evenly split by gender, and most relatives were of European-Caucasian ancestry.
With the base model, ORs are significant for all conditions except alcohol and drug use disorders. This finding is more robust for a definite (ie, meeting all DSM-IV criteria) than a probable pathological gambling diagnosis, but it is also significant for those with subclinical pathological gambling.
This underlying diathesis could be genetic and biologically based (eg, shared neurocircuitry),46,47 but nongenetic causes cannot be ruled out (eg, childhood adversity).
Both childhood adversity and disturbed family dynamics have been linked to the development of several psychiatric disorders, including major depression, PTSD, antisocial personality disorder, and borderline personality disorder.51–53 Similar processes may be at play in the development of pathological gambling in vulnerable persons. Fourth, control probands may have agreed to participate based on personal concerns about emotional illness. In my men's groups we always knew which men were at greatest risk for another violent incident: those who maintained that their anger was an aberration they had now overcome with penance and good intentions. An overemphasis on decency and virtue not only darkens the personal and collective shadow, it unconsciously identifies with divine goodness and thereby falls into inflation and self-righteousness. These and other New Age maneuvers are enlisted in the service of propping up the happy persona that conceals the darker dimensions of conflictual psychic life.
Yet Dallett goes farther: Psychiatric medication should only be used to contain severe symptoms, she argues, preferably in small doses and even then only temporarily.
Most of the examples of violence in this book break forth from the uptight middle class, where swings are removed from parks to prevent lawsuits. In Jungian thought, the Self, which is the psychological equivalent to the image of God, often breaks into consciousness violently. Active Imagination is not guided fantasy nor is it art, but, following Hannah, Dallett sees Active Imagination as a creative function. 28), an earthy, fabulous, night creature, like the Rhino, equally life threatening and life giving. We meet the rhino of the title as he first appears in the dreams of a gifted woman whom the author has known for more than 30 years, initially as her Jungian analyst. Rage, she says, is a natural instinctive response to a threat to the Self; violence is the human spirita€™s protest against the enforcement of more goodness than it can stand. The targets for skin pickers include healthy skin, minor imperfections, pimples, callouses and old picking scabs, which can be picked at with fingernails (most common) or even tools like tweezers or pins. These are the rituals that the DSM-5 lists, but there are likely more that haven’t been noted yet.
There is also a sense of tensions that can be felt before, during or while resisting picking, which is often alleviated after the picking. The fact that skin picking is in the DSM-5 at all is a big deal for those of us with the disorder seeking treatment, and so this entry is a great step in the right direction. But until the military culture in which two-thirds of soldiers feel that reporting mental health problems is detrimental to their careers is changed, the nation can look forward to more troubled veterans. Detailed family history information was collected on relatives who were deceased or were unavailable, usually from multiple sources. Random interviews (~ 10%) were videotaped for training, quality control, and reliability assessment purposes. Interrater reliability of the best estimate procedure was examined in a subsample of 30 probands and first-degree relatives. Pathological gambling relatives were less likely to be employed in the last year, but more likely to be retired or disabled. The second series of models adjusts for the presence of the comorbid disorder of interest in the proband to control for the potential that disorders are transmitted independently from pathological gambling.
To minimize potential bias, control probands were identified through a stringent sampling method using random digit dialing within the community in which the pathological gambling probands resided (eastern Iowa), matching on important characteristics. In the light of this observation, the missionary and the terrorist stand revealed as brothers-in-arms.
Making a work of art, breaking a therapeutic impasse, or modifying a relationship are three of many possibilities for new forms of expression that liberate the archetypal power from remaining trapped a€?in mattera€? (in symptom or illness). One can almost hear in popular a€?thinking positivea€? propaganda the voice of the family cheerleader castigating brothers and sisters for being so a€?depressinga€? as to discuss Dad's alcoholic violencea€”or on a national level, the violence inflicted by the precarious rule of empirea€”out in the open. Although the alarm should be raised about overmedicationa€”psychotropics are even being found in public water suppliesa€”I have known people with major psychiatric disorders for whom the advice to go off meds to do a€?psychological worka€? has been disastrous.
Dallett pleads us to acknowledge that the terrible in human life is real and that only by confronting it, by taking it by its horns, do we have a chance of not being controlled by it. The Rhino represents an instinctual mercurial principle in psyche that holds the power to heal or to wound. The Rhino becomes an imaginal companion for Pat Britt and Dallett speculates that his a€?dependable presence may compensate the uncertainty of a life in which death is always at handa€? (p.33). We follow the patienta€™s devoted inner work with the dream rhino, as he emerges into a living imaginative reality: mentor, opposite and guide, and we learn of the healing of her life-threatening physical illness. In Britta€™s initial dream, the dream that is thought to foretell the course of therapy, a small rhinoceros charges her, but she catches him by the horn and holds on.
If you can let it speak to you, and give it what it needs you will have an inner partner for the life that remains to you, however long or short that may be.a€? (p.
Royalties, in part, go to the International Rhino Foundation, which helps to preserve the rhinoceros from extinction. In this model, bipolar disorder, social anxiety disorder, PTSD, and antisocial personality disorder are significantly more frequent in pathological gambling relatives. I am thinking of people legitimately diagnosed with bipolar disorder who took similar advice from their gurus and ended up psychotic; one, a former student, is still homeless and ranting in the streets. As fantastic amounts of money continued to be funneled upward, the number of Americans living below the poverty line soars higher than ever before. There is a story about the late Edward Edinger in which someone asked him, a€?What is new in Jungian psychology?a€? He replied, a€?New? Then I am reminded of the story of Edinger and his comments about what is old and what is new in Jungian psychology. Instead she asks us to recognize violence as an intrinsic aspect of the collective psyche, one that must find expression and that does have a purpose as when a€?the Self often breaks into consciousness in ways that are violent, primitive, even monstrous.
The unconscious is a minefield of devastating, destructive potentials, but without venturing, and at times suffering this minefield, there is no way of getting to the treasures. In Pat Britta€™s case, it was the spirit released from a life threatening illness that took the image of this large, gravelly voiced Rhino.
Finally we see that this work gives the former patient her independence of analysis and analyst. The groups were similar in terms of interview status, but interviewed pathological gambling relatives were more likely to have an in-person interview. The third series of models also controls for the presence of pathological gambling in relatives to determine whether the disorders cosegregate with pathological gambling.
While probands were assessed in person, most relatives (80%) were interviewed by telephone, and it is possible that some disorders were missed, although research shows that telephone and in-person interviews are comparable.57,58 Sixth, we made every effort to keep raters blind to a subject’s family status (pathological gambling vs control) and subjects blind to study objectives. I have also known people with schizophrenia who could never hold down jobs or attend school without some kind of long-term antipsychotic medication. People still dona€™t understand the old.a€? Author Dallett might heartily agree with this sentiment. He speaks to our desperate post-modern world, saying we must turn away from our arrogance and learn again to live with the rhinos, the crocodiles, and all the natural, instinctive forms of life a€“ now, before they are gone, leaving us alone, alienated, and doomed to extinctiona€? (p.37). Social anxiety disorder, PTSD, and antisocial personality disorder are significantly more frequent in pathological gambling relatives independent of the presence of pathological gambling. If the blind was broken by the rater regarding study objectives or by the subject with regard to family status, this unblinding did not occur in a systematic fashion.
What's important in such cases is to prescribe a correct and accurate dosage not only to contain extreme symptoms but to make psychological work possiblea€”work that includes dealing with the psyche's responses to the need for medication.
If the Self in such sufferers is enraged, social constraints and injustices give it excellent reason to be, for as Martin Luther King pointed out long ago, a riot [like a symptom] is the language of the unheard.
In her latest offering she reanimates many penetrating insights from Jung and reminds us that they are as cogent and urgent now as when Jung first presented them.
In response to her dream, the woman took up the task of relating to the unconscious through art, dialogue with the rhinoceros and study of dreams.
The remarkable dreams and healing experience of this dreamer make up one part of this rich book and serve to illustrate and put flesh on the abstract bones of some of C.G. In these cases, assessment was based on information provided by the proband and ? 1 relative in 84% of cases.
But the growing data about the impact of a deep alignment of psyche and body reveals that we have merely scratched the surface of that mysterious intersection. A connection and engagement to the depths of the psyche that stimulates powerful healthy growth and that transforms body as well as psyche is unhappily still on the fringe of accepted consensus today, this in spite of what depth psychologists, in addition to Jung, have intimated or stated for over one hundred years.

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