Andrew Sims

The phenomenology of post-traumatic stress disorder. A symptomatic study of 70 victims of psychological trauma.

This study analyses and categorises the subjective experiences and psychological symptoms of those involved in a major disaster but not themselves physically injured. It examines the concept of post-traumatic stress disorder (PTSD) and relates it to other psychiatric diagnoses and also to the particular nature of the disaster. 70 police officers are the subjects of this study, 59 men and 11 women, all of them involved in the Hillsborough Football Stadium Disaster. Assessment included detailed psychiatric history and examination with an account of the events experienced by the informants and their psychological reaction to this at the time and subsequently. Psychiatric diagnosis was made and quantified measurements were also recorded, including a rating scale for the criteria of PTSD, the General Health Questionnaire and rating scales for depression and anxiety. Severity of PTSD symptoms was associated with higher scores on rating scales for both depressive and anxiety symptomatology. Subjective depressive symptoms and depersonalisation were associated with severity of PTSD. Frustrated helplessness was a recurring theme in the psychopathology. Alcohol consumption of those who were already drinkers increased. Social functioning at work and in marriage deteriorated with increased severity of PTSD. Although PTSD has features that distinguish it from other conditions, the degree of distress and long-term disability is more related to depressive symptomatology than to the severity of PTSD itself.

What is Neurosis

This is a book about that unfortunate person, the neurotic; not about him (or her) in isolation but about how he gets on with his family and friends, and the people he rubs shoulders with in the street — ‘society’. It is descriptive, a travel book if you like, but a journey you have made as well as I. Perhaps yours was only the occasional fleeting visit; your neurotic patient who was in hospital for management of his congestive cardiac failure; your divorced client who could not manage on supplementary benefit, and so took it out on you, her social worker. Such uncomfortable acquaintance with neurosis is shown in this letter from a general practitioner to a consultant psychiatrist.

Neurosis and Personality Disorder

Neurotic behaviour implies carrying out an act in response to a stressor in a manner that is inappropriate to deal with that stress; for example, the husband who breaks down his own front door with his fists because his wife locks him out. Neurotic illness is a consistent pattern of maladaptive behaviour occurring over a longer time in response to either a prolonged stress, or a stress with long term repercussions; for example, the young woman who cannot, because of chronic anxiety, separate from her mother and so spends her time at her family home rather than with her husband, so jeopardising her marriage. ‘Neurotic personality’, ‘neuroticism’, ‘abnormality of personality’ or ‘personality disorder’ is a life-long characteristic in the context of which such reactions of behaviour or illness may occur; for example, the exessively cautious sensitive schoolboy chooses his future occupation partly because of his personality constitution, and becomes the over-conscientious, fussy bank clerk constantly worried by scruples of detail. He is more prone to anxiety neurosis because of his personality structure.

Managing Professionals in Multidisciplinary Teams: A Case Study from Psychiatry

Addresses what “management” means in a multidisciplinary professional team. Looks at one particular profession – psychiatry – in which multidisciplinary teams are common and often problematic. Considers some of the issues that arise in the management of such teams, and particularly the tendency for competing professionals to wish to colonize each others′ area of operation. Proposes that the key to managing such teams is to have a clear role of problem definition within the team; someone needs to ensure that the most suitable care is provided for each patient, even if that care is outside their own competence. This activity is similar to that of senior management in other sectors, where problem definition tends to be associated with senior management. The management of professionals in multidisciplinary teams requires someone to be given a role as “wise generalist”.

The Abraham Dilemma: A Divine Delusion

The Abraham Dilemma: A Divine Delusion By George Graham, Oxford University Press 2015, £29.99 (hb), 192 pp. ISBN 9780198728658nnThe Abraham Dilemma is a philosophical exploration, proposing a theory of religious or spiritual delusion. It includes several modern case histories, some protagonists

General Principles of Treatment

Too often with neurosis, description of a method of treatment has not been accompanied by definition of the patient population or evidence for efficacy. This and the next chapter are intended for those who are not experienced in particular forms of treatment, but who come into contact with neurosis in their daily work and require some general principles. This is therefore eclectic and practical at the risk of being simplistic, and does not represent any theoretical purity. The whole discussion of treatment for neurosis must be considered provisional. We know very little about the efficacy of different types of treatment and until we know more we should not be dogmatic.

An Illness that Needs Treatment

The point has been made in the first chapter that neurosis is not fundamentally organic, and therefore in one sense, not a medical condition. In the second chapter we have described the long argument between the organicists and the psychologists, and again the consensus is that neurosis is not organic. Why then are neurotics seen by doctors? Why do the medical profession, and other health professions (nursing, social work, clinical psychology), concern themselves with the management of neurosis? Professor Eysenck (1975) in his pamphlet The Future of Psychiatry claimed that there was no future in psychiatry for the treatment of the neuroses. He wrote, ‘it seemed desirable and historically justifiable to split psychiatry into two independent parts, one concerned with organic disorders and their treatment, which in turn was largely medical in nature; the other concerned with behavioural disorders and their treatment, which in turn was largely behavioural. It was argued that the former discipline should be the prerogative of medically trained psychiatrists, while the latter should be the prerogative of non-medical psychologists trained in special courses for posts as clinical psychologists’.

The Evolution of an Idea

Neurosis, like the poor, we have with us always. It has been viewed and treated in very diverse ways at different times. The terminology and the emphasis have changed in response to altered public attitudes. Theories of aetiology have oscillated between the organic and the psychological: localisation in particular organs, for example the womb, or an origin which is magical or diabolical. Theories about neurosis reflect the philosophical set of the generation which propounds them. Those disorders which we now call neuroses have sometimes been thought to originate outside the world, sometimes outside the person but inside the world, sometimes inside the body but remote from the brain, sometimes in the brain and sometimes in a ‘mind’ not anatomically defined. The confines of neurosis have similarly fluctuated, sometimes to include many cases of physical illness, for example asthma and epilepsy but more often a group of conditions without underlying pathology. In this chapter we look at how the term has evolved in England over the centuries.

The Elderly Neurotic

Much is unpredictable in our society, but one thing that is certain is that the proportion of the population which is old will undoubtedly increase. Between 1970 and 1980, the population of those aged over 65 increased by nearly one quarter. In England and Wales there were less than one and a half million people aged over 65 in 1901, about six and a half million in 1971, and expected to be seven and a half million by 1991. The number of people in England and Wales aged over 80 is expected to rise to more than 1 600 000 people by the end of the century.

The Phenomena of Neurotic Illness

In this chapter, I am embarking upon an impossible task. If all the novels and all the autobiographies that were ever written were combed for descriptions of neurotic pathology, there would still be much omitted. Many neurotics looking in these pages to see a picture of themselves will be disappointed. All I have been able to do is describe some of the commoner presentations.