Knowing "what" and knowing "when"

The ability to situate autobiographical memories accurately in the "time-line" of one's own life is a particular aspect of retrograde memory that has received little attention in well-controlled, systematic studies. Here, we addressed this issue by testing the hypothesis that patients with basal forebrain damage would be impaired in their ability to place various autobiographical memories accurately on a 'time-line' of their life. Seven such subjects were contrasted with 11 medial temporal lobe subjects, 8 brain-damaged comparison subjects, and 18 normal comparison subjects, using a procedure in which subjects placed autobiographical events on a time-line of their life. The basal forebrain group was very impaired in this task, relative to the other groups, and on average, misplaced events by more than five years. Although the basal forebrain group was also impaired in retrieving the contents of autobiographical memory, they did not differ statistically from the medial temporal lobe group in this regard (and the medial temporal lobe group did not have impaired time placement of memories). The results indicate an intriguing dissociation between "knowing what" and "knowing when," and suggest that the basal forebrain contains structures that are especially important for "knowing when." Our findings are compatible with the view that the basal forebrain participates critically in retrieval strategies important for memory chronology, which contrasts with the medial temporal lobe's critical role in relational memory per se.     

"Objective" methods and "subjective" experiences

Current psychiatric research and practice emphasize measurement of operationalized variables, quantification, and rigorous hypothesis testing. The fact that mental states can be subjectively experienced and that thoughts can refer to things and events outside the mind suggests that such objectifying methods alone may not provide a complete approach to mental life. Other complementary but systematic methods can be described which stress that (1) words are often natural expressions, not labels, of experiences; (2) usefulness, not agreement with observation, can sometimes validate psychological expressions; (3) some data can only be gathered by interactive involvement, not dispassionate observation; (4) a goal of inquiry can be interpretation, not hypothesis testing; and (5) understanding may require a holistic approach which expands rather than constricts the realm of relevant data.     

The "forty-nine" and "seventeen" problems]

The single most common age of murderers in Japan is 49. Individuals aged between 45 and 54 are, however, likely to commit not offences but suicides comparing with other generations. One factor behind this phenomenon is the trend toward company downsizing, which is thought to affect the mental attitude of workers. This trend is destroying the Japanese lifetime employment system and undermining worker's loyalty to the company. On the other hand, in the broader category of felony crimes (assault, burglary, arson, murder), offenders aged 17 are the most common in Japan. This is thought to be partly due to the effect of so-called "school collapse" (school system failure) on the mental attitude of students. "School collapse" implies dysfunction of educational practice as a result of chattering, bullying and violence in the classroom. It is the reflection of students' dissatisfaction with the group-oriented school system. Therefore, students are unable to find any purposes in school and exhibit aggressive behaviours. In terms of mental health for both middle-age and teenage generations, it is necessary to devise new strategies whereby people can break away from the pressure of loyalty to the group. For both "normal" and "disabled" workers, rights of recuperations, adequate unemployment benefits policy, and support system for occupational change should be established. Simultaneously, for both "normal" and "disabled" students, reform of the school system under the concepts of diversity of education, rights of selection, and rights of refusal is urgently necessary. With respect to forensic psychiatry, without the provision of social supports, labeling of conduct disorder as well as other disorders should be avoided. In particular, instead of introducing security hospitals, drastic improvements of medical reformatories and medical prisons are necessary to provide adequate medical and social supports for offenders with psychiatric disorders.     

Differences between patients classified as "recovered" or "improved" and "unchanged" or "deteriorated" in a psychotherapy outcome study

The concepts of statistical and clinical significance of pre-post-changes have been used to class patients into four groups of therapy outcome: "recovered", "improved", "unchanged" and "deteriorated". Aim of this study is to investigate the advantages of this classification in comparison to a simple division into "successful" and "not successful". 43 patients were examined before and after an in-patient psychotherapy and again two years later with several test inventories. Therapy outcome was measured by the changes in the Global Severity Index of the SCL-90-R. "Recovered" and "improved" patients did only differ in regard to their initial symptom severity, but not in regard to the amount of symptom reduction or stability of therapy effect. "Deteriorated" patients could reduce their increase in symptoms until follow-up. Our results do not indicate a general advantage of the classification into four outcome groups over a division into "successful" / "not successful".     

"Medication"

I have written this article because medication is a very important part of dealing with mental illness. I have not read other articles on this subject and have wanted to write about it for at least a year. Perhaps a better title would have been "Over-Medication." My concern with medications is that high doses, sometimes with more than one antipsychotic medication plus other pills, are prescribed. I wanted to raise consciousness about the ability to function when a person is so heavily medicated. In my journey of mental illness, on two occasions I was heavily medicated and found it very difficult to stay awake--let alone function. Another area touched on is the new concept of patient/therapist partnership. Therapeutic relationships in the past had been more a case of the therapist knew what was best. Today therapeutic relationships, I believe, must be partnerships, especially in the area of medication. Patients know when they feel poorly on a medication. Are their feelings listened to?