A Broken Record Model of Mental Disorders
Our modern fast-paced society is lightheartedly labeled the neurotic generation, although most individuals manage to “roll with the punches.” The increasing number of individuals suffering psychotic episodes, however, present a quite different picture, a rigid mindset indicative of a dependency on such maladaptive perspectives. According to this novel interpretation, the mentally ill individual develops his symptomology in response to certain intractable life experiences, symptoms that may have proven marginally adaptive at the time. These symptoms frequently persist even when the patient is transferred to a more therapeutic environment, where a trained professionals aim to reverse such a trend.
This disturbing scenario appears to be the strongest justification yet for the so-called “broken record” theory of mental illness. In particular, the individual appears stuck within the groove of such previous life experiences directly prevented from playing-out more adaptive potentialities. Even in the general population, certain individuals favor a serious personality, whereas others are more humorous, or exhibit criminal tendencies. These individual extremes extend across a rather broad cross section of society, with well-adjusted individuals exhibiting a tendency to blend the most effective combination: a truly delicate balancing act. An elusive combination of hereditary and/or psychosocial factors appears to cause some individuals to become tenaciously fixated to some particular pattern of communication, even though it clearly becomes maladaptive in changing environmental circumstances. Indeed, the prude at the social mixer is equally as out of place as the joker at the funeral parlor. The mentally ill patient, accordingly, remains completely at the mercy of his ingrained symptomology, a strategy that originally might have offered some perverse measure of power leverage within his earlier environment. Granted, the life of the incarcerated patient is typically somewhat regimented, a circumstance that frequently facilitates such a regressive level of functioning. In the warm glow of such increased understanding, the dream of “universal” mental health might finally be within our grasp, in concert with its further expansion into the realm of communication theory.
Indeed, this transitional explanation for mental illness can further be employed to explain the unfortunate pairing of mental illness with sensationalistic crimes in the news media. Although mental illness exclusively targets the role of the vices of excess (representing extremes within the virtuous realm), it typically remains relatively innocuous with respect to harm directed to others, although harm to oneself can occur as an outward expression of depression. The sensational crimes against the others sometimes committed during a psychotic episode, in turn, represents an overlap with the extreme realm of hypercriminality (which represents a transitional maneuver with respect to the realm of hyperviolence).
+ + VICES OF EXCESS MENTAL ILLNESS (Excessive Virtue (Transitional Excess) + MAJOR VIRTUES LESSER VIRTUES (Virtuous Mode) (Transitional Virtue) ___________________________________ O - NEUTRALITY STATUS ___________________________________ – VICES OF DEFECT CRIMINALITY (Absence of Virtue) (Transitional Defect) – – HYPERVIOLENCE HYPERCRIMINALITY (Excessive Defect) (Transit. Hyperviolence)
It remains to the realm of treatment and diagnosis that the potential applications for the double bind theory of mental illness shine the brightest, directly specifying the various communicational factors underlying the broad range of syndromes. In keeping with the systematic organization of the power hierarchy, it further proves possible to devise an entire 56-part complement of power pyramid definitions for the sphere of mental illness. In particular, this comprehensive set of definitions specifically outlines the precise power leverage to be gained for each specific level within the power hierarchy. In this latter respect, it further proves feasible to determine which specific patterns of communication trigger a given symptom, as well what factors reinforce its repetition (e.g., the facilitation syndrome). This basic determination of trigger events could potentially promote a more therapeutic clinical environment, with treatment options tailored directly to the symptoms of the particular individual. These specific insights, in conjunction with an affiliated degree of behavior modification when symptoms spontaneously occur, could potentially avert any measure of success in employing such symptoms within the clinical environment.
This particular strategy already appears to be effective with respect to certain currently available therapies; most notably, the desensitization techniques employed to treat phobia neurosis. For instance, a client inordinately afraid of spiders is desensitized through a gradual sequence of steps designed to demonstrate the control he has over his fears. This first consists of talking about spiders, followed by photographs or plastic models, finally leading up to a controlled encounter with the genuine article. During each succeeding step, the patient is deprived of any previous advantages associated with his phobia: which, through a process of attrition, ultimately leads to the cure.
A similar degree of success might theoretically be possible for the more bizarre realm of the psychoses, given that the underlying power dynamics have become more fully understood. Here the clinician would enjoy a clear advantage, not only in training and experience, but ultimately in terms of the lucid thought processes so often lacking in the chronically ill. Through such an enhanced degree of guidance, many patients might ultimately benefit from this expanded treatment option, a virtual godsend to those of suitable mindset.
Preemptive Treatments for Mental Illness
Chronically ill patients remain just one segment of the population sure to benefit from such a conceptual innovation. The old adage: “prevention is the best medicine” certainly rings true in this basic respect, in that a broader understanding of the dynamics of mental illness offers the potential for preemptive detection, before the symptoms ever become chronic. This factor certainly figures prominently at the family level, where the dynamics of a domineering mother and a passive father have been implicated in the genesis schizophrenia in susceptible individuals. Indeed, a considerable number of double bind theories of mental illness abound within the literature, although none to the dramatic degree of detail achieved within the context of the power pyramid hierarchy.
A wider public understanding of such dynamical issues offers the further potential for diminishing dysfunctional communication throughout society. Maladaptive patterns in child rearing would directly come under focus, permitting a more effective means of intervention by relatives and/or child-protective services.
A Schematic Comparison of the DCE-I and DSM-IV
In terms of a final overview, one final issue remains to be addressed; namely, how well does the current three-digit coding system fit into the current model of mental illness in general. Initially, it might appear to be just another competing system in relation to the dominant international world-view offered within the DSM/ICD perspective. Fortunately, there is no actual possibility of confusion with the DSM codes in that the latter are encoded in terms of numbers beginning with “2” or “3,”whereas mental illness in the DCE-I specifies numbers with the first place digit of “4.” A further crucial advantage of the current coding system is its seamless and systematic organization. In terms of its earlier origins, the DSM format appears as an inconsistent hodgepodge of numbering that essentially was constructed in a piecemeal style of development. The current three-digit coding system, however, is fully systematically and conceptually complete. Indeed, once one learns the few basic rules for this numbering scheme, one only need to be presented with a unique three-digit number to deduce the identity of the respective syndrome, and vice versa.
In all fairness, the DSM series proved extremely valuable with respect to classifying the personality disorders and the neuroses, making for a seamless correspondence to the formal double bind theory of mental illness for the most basic personal level within the power hierarchy. A similar correspondence to the psychosis, however, is not so formally precise. Here the Anglo-American system is derived primarily from the work of Kraepelin and his successors, with the dichotomy between schizophrenia and manic depression adequately emphasized, although with not much further detail. The systems derived by the German Classificationalists (of which Leonhard emerges as a major proponent) permits a further wealth of clinical classifications that seamlessly fill out each of the predicted slots within the transitional model of the psychoses, analogous to the precision initially seen for the case of the personality disorders and the neuroses. Unfortunately, latter German system is not as widely employed as that championed in the DSM series, a regrettable shortcoming in light of its new-found facility with respect to the current three-digit coding system. Accordingly, a more detailed examination of this German Classificational system is definitely in order here, outlining many of the reasons for its less than universal appeal, as well as potential avenues for remedying such an oversight.
Both the German and Anglo/American enjoy a common foundation in the seminal clinical observations of Emil Kraepelin (1856-1925), who first established a distinction between the manic depressive disorders and schizophrenia. A German contemporary of Kraepelin’s, Carl Wernicke labored in the fields of clinical neurology as well as descriptive psychiatry. Indeed, Wernicke carefully evaluated an entire spectrum of psychopathological conditions in cross-sectional as well as longitudinal studies, and even today is observations retain significant clinical value. Differences in theory between Wernicke and Kraepelin eventually arose, resulting in a certain academic antagonism between the two, eventually resulting in a divergence between these two basic schools of thought. Wernicke’s main successor, Karl Kleist (1879-1960) expanded upon the former’s observations in neurology as well as psychiatry, thoroughly confirming and expanding upon the great wealth of clinical observations. It remained, however, to the efforts of Kleist’s major pupil, Karl Leonhard (1904-1988), to carry this German classification tradition to its logical conclusion; expanding the system to the 58 basic categories of psychosis incorporated within the DCE – I. Leonhard’s studied medicine in Berlin and Munich, eventually appointed senior physician, whence he commenced his pioneering investigations into schizophrenia and the other psychoses. He ultimately attracted the attention of Karl Kleist, who proved instrumental in securing him an academic appointment in recognition of his ground-breaking work.
Leonhard was exempted from military service during WW-II due to a recurrent illness. As a psychiatric clinic director, he was able to save many patients from the state imposed “euthanasia” against the mentally ill imposed by the Nazis. Not surprisingly, German psychiatry was internationally disparaged following the end of the war, with little opportunity for showcasing the observational achievements of Kleist and Leonhard. In 1957, Leonhard was appointed Director of the Department of Psychiatry at Humboldt University in East Berlin, where he remained until the age of 65. The political partitioning of Germany in 1961 further limited his influence within the Western world. Editors for Western journals rejected his papers, in that they were not in strict conformity with the prevailing Anglo-American systems, and because he pursued without compromise the promise of his unique observational findings. Nevertheless, many of his books were widely distributed, and his major work: The Classification of Endogenous Psychoses was translated into English, Italian, Japanese, and Russian.
The reasons why the Wernicke-Kleist-Leonhard school of psychiatry have not more greatly influenced the international community are widely varied. First of all, Wernicke tragically died at an early age, therefore unable to defend his viewpoint from that of the more influential Kraepelin. Furthermore, critics such as Jaspers, without sufficient bakground, labeled both Wernicke and Kleist as “brain mythologists,” downplaying them as well. Leonhard was further criticized on other accounts, with certain skeptics arguing that his categories were too subjective, and that his clinical observations lacked “objective” confirmation through rating scales amenable to third-party scrutiny. Leonhard and his co-workers countered these objections through observations of hundreds (and in certain cases, even thousands) of patients before any particular syndrome was clinically specified. Indeed, his record of investigations spanned many decades, as meticulously described, for example, in his “Berlin Series” of 1,465 cases.
Perhaps the most troubling obstacle to international acceptance, however, concerns the unfortunate legacy of the Nazi extermination of the most seriously mentally ill during WW-II. Although Leonhard endeavored to preserve as many lives as possible under the circumstances, the political taint of such a tragic policy undoubtedly has emerged as a setback that has proved difficult to overcome on the modern international scene. The new found relevance of Leonhard’s system to the three-digit coding system, however, should go a long ways towards ameliorating such a shortcoming in the future; particularly in light of corroborating the communicational dynamics at issue regarding the transitional model of mental illness. Indeed, this innovation proves a fitting tribute to those tragic souls lost during the mental health holocaust of WW-II. Although unrecognized at the time, their enduring case histories prove instrumental in explaining the enigma of the communicational factors underlying mental illness. In this expanded context, the tragically shortened life span of these patients will not have all been in vain, rather, posthumously serving a more noble purpose, to the benefit of all generations of the afflicted to follow.
John E. LaMuth, MSc, P.O. Box 105, Lucerne Valley, CA – USA – 92356