Let Me In, by John Ajvide Lindqvist

Let Me In, by John Ajvide Lindqvist, narrated by Steven Pacey

Oskar, a 12-year-old boy, is bullied by his schoolmates. He spends his time fantasizing about revenge and stabbing trees with a knife. He obsesses about violent crimes, keeping a notebook of newspaper clippings. One day, a strange girl and her father move in next door. She seems quite unaware of social norms and completely immune to getting cold. Her father and she argue loudly and frequently, which Oskar can hear through his wall. Despite the fact that she tells him they can’t be friends, Eli and Oskar soon form a bond. She encourages him to stand up to his bullies, and he starts growing in self-confidence. But strange murders are suddenly occurring in his neighborhood, and Oskar begins to suspect that Eli is more than he thought she was.

I have been interested in reading this book after reading a fascinating short story of his a few years ago. This book did not disappoint. It was eerie and consuming. It was also very gruesome, and it has some graphic child-sexual-abuse scenes, so beware. Luckily, I had read reviews of this book beforehand and already knew about the child abuse, so I was not quite as repulsed by it. However, this book lost an entire star because of the child-sexual-abuse, which didn’t appear at all in the movies and wasn’t absolutely necessary. The child abuse did help develop the character of Eli’s father as a disgusting and pathetic failure, but I think both attributes could have been manged in other ways. Or, at least, without the graphic scenes.

In general, I am pleased with Lindqvist’s style – it is mysterious and flows well. The characters were well-drawn and believable (in a there-be-vampires sort of way). There dark, dreary mood was set early in the book and retained steadily throughout. There was nothing particularly original about Lindqvist’s vampire, though Eli had some original personality traits and circumstances. Also, I’ve seen this book described as a romance, and I don’t agree with that. Yes, Oskar asked Eli to “go steady,” but that was about it. I mean, he was 12, and those feelings were very naive and not pronounced. This was a book about friendship, not romance.

Overall, I was pleased with the book and would read another by Lindqvist, though I’ll probably wait before I can get through another that has sexual abuse in it. The audiobook was well-read – the voices were distinguishable and the pacing was quite reasonable.

3.5 stars for flow, eeriness, mystery – star lost for child sexual abuse

Hoarding and Body Dysmorphic Disorders

Obsessive compulsive disorder (discussed in a previous post) is grouped in a DSM-5 category called “obsessive compulsive and related disorders.” Other disorders included in this category are hoarding, body dysmorphic, trichotillomania (hair picking), and excoriation (skin picking) disorders.

Upon publication of the DSM-5, there were a lot of ignorant people laughing at the “new” disorder “hoarding,” and giving it as an example of how the DSM-5 encourages over-diagnosis of “normal” individuals. Such people do not understand the dire nature of this disorder. An individual with hoarding disorder finds it extremely distressful to discard objects, regardless of their actual value. These objects fill up their living spaces, leading to impairment of the individual’s ability to live a healthy, functional life.

Hoarding has recently reached the popular eye due to TV shows like A&E’s Hoarders or TLC’s Hoarding: Buried Alive. I haven’t watched either of these shows, so I don’t know if they are a good representative of the dangers of hoarding. But I can give examples of such dangers:

To go along with my Adrian Monk theme in my OCD post, Adrian’s brother Ambrose Monk is an extremely agoraphobic hoarder. In the episode Mr. Monk and the Three Pies, Ambrose’s house is set on fire, and he is unable to exit the house – partly due to the lack of safe pathways through his piles of newspapers.

If you like real-life examples, I have an acquaintance with hoarding disorder. She fell in her home and was unable to get up due to the huge piles of junk surrounding her. She lay there three days before someone found her. Luckily, she was holding a jug of juice when she fell, so she survived surprisingly well during this time.

Obsessive hoarders tend not to respond to the same types of medications or therapies as people with OCD, and their brain activation patterns are different than those recorded in OCD patients. Therefore, it is possible the two disorders might not be as strongly related as categorized in the DSM-5.

People with body dysmorphic disorder (BDD) become obsessed with one or more body parts that they perceive as hideous or deformed. When people with BDD look in the mirror, they often see a defect that is not present, such as the woman above seeing herself as fat when she is actually thin. Such people are often self-conscious about this perceived defect, and believe that everyone around them look down on them for their ugly appearance. People with BDD might spend hours every day looking in a mirror obsessing about their perceived defect, or they might compulsively avoid mirrors altogether. BDD patients often avoid social situations, and sometimes they stop leaving their house altogether. It’s possible, even, that they might have so many plastic surgeries that their nose dies (rumored to have happened to a certain deceased celebrity).

One example you might immediately think of (especially since it is pictured above) is people with anorexia nervosa. However, anorexia is not always a form of BDD. Many anorexics are emaciated and are pleased with their appearance. Some, however, are emaciated and see themselves as fat when they look in the mirror. These are the type with BDD. A long time ago, I remember reading about a study in which a tight-fitting full-body suit was worn by BDD-related anorexics. The tightness of the suit allowed the subjects to change thier proprioceptive perception of their body types. Because they could feel how thin they were, they began to perceive themselves as thin. I’m pretty sure I read about this study in Sandra Blakeslee’s book The Body Has a Mind of Its Own: How Body Maps in Your Brain Help You Do (Almost) Everything Better.

More mainstream treatments for BDD include SSRI’s and a form of cognitive behavioral therapy in which the subject is made to wear clothing or makeup that accentuates the “defect” rather than disguising it. The subject is also told to not look in a mirror, even when they feel compelled to.

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 6: Panic, Anxiety, Obsessions, and their Disorders. Abnormal Psychology, sixteenth edition (pp. 163-210). Pearson Education Inc.

My Life as a White Trash Zombie, by Diana Rowland

My Life as a White Trash Zombie, by Diana Rowland, narrated by Allison McLemore

This book was a huge surprise to me. I was told it was fantastic – funny, fun, good plot – but I didn’t really believe. I mean, there are so many zombie books out there, right? But it really was hilarious and fun. I’m glad I gave it a chance.

Angel Crawford is a down-on-her-luck, pill-popping, high school drop-out who can’t hold down a job and is being dragged down by her alcoholic father and deadbeat boyfriend. One day, she wakes up in a hospital – told that she overdosed and was found naked on the side of the road. Humiliated, she is about to return home when she gets a mysterious note telling her to drink a mysterious power-shake each day, and that she now has a job picking up and helping autopsy dead bodies. She’s told she must keep this job for at least a month, or she’s going to prison for parole violation. Angel is terrified of prison, so she begrudgingly starts her new job.

Strangely, she realizes that she desperately wants to eat the brains of the bodies she’s been autopsying – and she thinks it must be some weird side-effect of the OD…maybe she’s just going crazy. But then hints begin to turn up that she’s been zombified. Proving to be more intelligent than she thought, Angel begins to investigate who zombified her, sent her the mysterious notes, and who, in God’s sake, is the serial murderer who’s beheading all his victims?

Like I said, it was really funny. I loved Angel’s character, and the mystery kept me listening even when I should have been doing other things. Angel really developed during this book – changing from an self-hating loser to an almost self-confident, poised, intelligent woman. (There’s still some room left for “refinement” in the next books, of course.) Much to my surprise and gratification, this was a very character-driven book. I will definitely pick up more from this series.

This book gets 4.5 stars for humor, characterization, and mystery.

Obsessive Compulsive Disorder

Most people are familiar with obsessive compulsive disorder as is popularized in many TV shows and movies. My favorite is Monk, a TV show about Adrian Monk, an investigator who works with the San Francisco police department. Due to Monk’s severe OCD (along with other disorders), he was forced into retirement as a detective with the San Francisco PD. The show is unflinching about the negative effects of Monk’s disorder, but of course it introduces humor into his predicament.

According to the DSM-5, obsessions are “recurrent and persistent thoughts, urges, or images” that are intrusive and cause distress. The individual attempts to ignore the obsessions, but is generally unable to. Compulsions are repetitive behaviors – such as hand washing, checking, praying, counting, or word repetition – that the individual feels compelled to perform in order to reduce anxiety and distress.

Often, the compulsion is meant to prevent a terrible event. That event is often excessive or unrealistic. To give a rather trite but recognizable example, someone might try not to step on cracks because they’d “break their mother’s back,” so they must go back to the beginning again and again just to make sure they didn’t step on any of the cracks. Ritualistic hand washing is generally meant to protect the individual from contamination of germs. Adrian Monk, from my example above, had his assistant carry around hand-wipes so that Monk could clean up after he’d shaken hands with anyone.

OCD can be one of the most debilitating mental disorders because it can take up hours of a person’s day. In order to get a diagnosis, the obsessions or compulsions must take up at least 1 hour each day.

Generally the individual is quite aware that his compulsion is excessive and unnecessary. Monk was an intelligent guy – he knew that if he didn’t touch-and-count every car antenna in that traffic jam that nothing bad would happen. But he couldn’t stop himself, even though it slowed down his progress as he walked up to the “crime scene.”

Common obsessive thoughts include contamination fears, fears of harming oneself or others, and pathological doubt. Another common obsession is the need for symmetry. Mr. Monk had all of these obsessions. Obsessions about sex and aggression are also common. (Well, Monk wouldn’t be as likable if he had those, though he did have a phobia of sex and nudity). OCD is often accompanied by social phobia, panic disorder, generalized anxiety disorder, and PTSD. (Yup. Monk had all of those.)

OCD is thought to be a learned behavior. First, the individual begins to obsess that touching a doorknob will contaminate his hands. As his anxiety increases, he finally breaks down and washes his hands. Washing his hands decreases his anxiety tremendously – he has now learned how to alleviate his distress. So the next time the obsessive thought intrudes, he will wash his hands again. Perhaps this time, he’ll just keep on washing his hands, because that might decrease the anxiety more. Of course, this theory doesn’t explain where the obsessive thoughts come from in the first place.

Top left: basal ganglia; Top right: amygdala;
Bottom: thalamus

In patients with OCD, abnormalities occur primarily in the basal ganglia. The basal ganglia are involved in primitive behaviors such as sex, aggression, and hygiene concerns. In a system known as the cortico-basal-ganglionic-thalamic circuit, urges are passed from the basal ganglia through the caudate nucleus, which filters the urges before sending them to the thalamus, which, in turn, sends the signal to the frontal cortex to create an action-urge. Theories suggest that in OCD, there is something wrong with the filtering aspect of this system, and many inappropriate urges are sent on to the cortex. In addition to connecting to the cortico-basal-ganglionic-thalamic circuit, the basal ganglia is also linked to the limbic system through the amygdala, which is thought to be the source of the “fear network,” as described in my post about panic disorder. This connection explains the panic that the individual feels when the obsessive urges aren’t acted upon.

The most successful treatment for OCD is exposure and response prevention. The individual is asked to rate his disturbing stimuli on a scale of 1 to 100. The individual then exposes himself repeatedly to a stimulus (either by imagination or directly) and is asked not to perform the compulsion. Eventually, the anxiety subsides on its own. Theoretically, each time the individual avoids the compulsion, he becomes a little more sure that the compulsion is not necessary to decrease the anxiety.

For those of you who are interested, Mr. Monk’s greatest fears, in order, are: germs, dentists, sharp or pointed objects, milk, vomiting, death and dead things, snakes, crowds, heights, fear, mushrooms, and small spaces (as listed in the episode “Monk and the Very, Very Old Man). Fortunately for him, his work frequently throws him into situations in which he encounters these things and is unable to fulfill his compulsions. I guess working his its own therapy. 🙂

This is a series of posts summarizing what I’m learning in my Abnormal Psychology course. Much of the information provided comes from reading my James N. Butcher’s textbook Abnormal Psychology. To read the other posts, follow these links:

The Definition of Abnormal
A History of Abnormal Psychology
Abnormal Psychology in Contemporary Society
Contemporary Viewpoints on Treating Mental Illness – Biology
Contemporary Viewpoints on Treating Mental Illness – Psychology
Frontline: New Asylums
Brave New Films: This is Crazy
Clinical Mental Health Diagnosis: Biological Assessment
Clinical Mental Health Diagnosis: Psychological Assessment
Does the DSM Encourage Overmedication?
Post Traumatic Stress Syndrome – The Basics
Panic Disorder
Obsessive Compulsive Disorder
Hoarding and Body Dysmorphic Disorders
Depression – an Overview
Personality Disorders – Clusters and Dimensions
Personality Disorders – Cluster A
Personality Disorders – Cluster B
Personality Disorders – Cluster C
Biological Effects of Stress on Your Body
Somatic Symptom and Related Disorders
Dissociative Disorders
Borderline Personality Disorder
Dialectical Behavioral Therapy
Paraphilic Disorders
Gender Dysphoria – Homosexuality and Transgender
Anxiety Disorders
Bipolar Disorder – The Basics
Suicide – An Overview

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 6: Panic, Anxiety, Obsessions, and their Disorders. Abnormal Psychology, sixteenth edition (pp. 163-210). Pearson Education Inc.

Severed, by Frances Larson

Severed: A History of Heads Lost and Heads Found, by Frances Larson, Narrated by Reay Kaplan

As soon as I heard about this book I just had to read it. I tried to convince my book club to read it for next month, but alas, the subject was too upsetting for them. So I chose to read it anyway. And I most certainly am glad that I did so.

Severed is about Western culture’s fascination with severed heads throughout history. The book begins with Larson’s own fascination with the shrunken heads in Pitt Rivers Museum at Oxford, where she worked. Apparently, they are quite an attractive exhibit there, drawing lots of fascinated people – adults and children alike.

The shrunken heads were made by Shuar and Achuar peoples from South America, ranging from Peru to Ecuador. The heads were considered to have the power of the souls of the former owners, and when the heads were shrunk, the Shuar and Achuar people were able to harvest that power. The shrunken heads were made by removing the brain and skull. The skin of the head was then put in hot water and filled with scalding sand. The sand treatment was repeated several times until the head shrunk down to the size of a fist.

Interestingly, after the heads were shrunk, they no longer had any power. Therefore when Westerners became interested in the heads as novelty items, the Shuar and Achuar people were happy to sell them. Even Westerners wanted a piece of the shrunken head profit: they would fake the heads using heads of monkeys.

Apparently, these shrunken heads are found quite fascinating by the Westerners even today. Many are in display in museums. I used to go to a museum when I was a child – it was called Woolaroc Ranch in Bartlesville, OK – and I was frightened and quite the opposite of fascinated by the shrunken heads. And even today, I searched “shrunken heads” in my stock photo source, and felt a little queasy at the results. Funny, I can read this book with fascination, but I can’t look at a picture of a fake shrunken head without feeling a little off. 🙂

Anyway, Larson’s story of severed heads did not stop there. She discussed trophy hunting during Pacific, Vietnam, and Korean Wars. It’s surprising what a soldier might do when he is in the foreign world of kill-or-be-killed. Again, the idea made me feel sad.

She discussed the sloppy ax beheadings of convicted criminals in the days before the guillotine. How an executioner would be praised by his ability to cut a head clean off, and would be shouted down, beaten, and possibly killed because of a sloppy execution. Because higher society became more “refined,” they decided that the rowdy crowds that executions attracted were disturbing – so they invented the guillotine. The crowds were disappointed by how quick and effortless the executions were, but the executions certainly became more humane.

Larson finally discussed phrenology, plastination, and dissection of heads by medical students (modern and in the old days of stolen corpses). Until she got to the plastination part, I was feeling rather fascinated but disgusted – actually a little high-and-mighty that I certainly did not find dead heads fascinating. (Yes, I recognize the internal contradiction in that sentence.) But then I realized she had a point. I was fascinated. I was fascinated by her book. And when the Bodyworlds exhibit came to the Science Museum of Minnesota, I sure did rush out there to see it. And I didn’t find it disgusting. Of course, there’s a difference between Bodyworlds versus collecting the heads of unwilling donors – the people of Bodyworlds all donated their bodies to this “art” project. In fact, I find mummy exhibits to be a little wrong.

Larson claims that our disgust at the collection of heads is rather a new concept – it isn’t inherent in humans. I find that a little hard to believe, but I recognize that some things that seem naturally right to me were not always “right.” For instance, homosexuality. Not more than a couple decades ago homosexuality was listed in the DSM as a psychological disorder. Now it’s mostly accepted as normal behavior for some people – and the idea that it was considered a mental illness is laughable (or insulting, depending on what personality type you have). So why can’t the same thing be said of my own uncomfortableness about severed human heads? But I’d like to point out my own argument against Larson’s point: if people of the past didn’t find the idea of severed human heads a bit off-putting, then why were they so fascinated by the idea?

Larson’s book was a fantastic read for the Halloween season. It was creepy, fascinating, and creative. The research seemed quite diverse and the narrative was engaging. I really think there’s a lot to learn from this book – at the very least it will make you rethink your own views on the subject of dead heads.

4.5 stars for creative subject, research, and engaging narrative.

Panic Disorder

Fear is an emotion that elicits the “fight-or-flight” response of the autonomic nervous system. It is an immediate (uncontrollable) response to a direct danger – such as a rattlesnake, a gun pointed at your head, or a fast car driving right at you. Fear is generally a helpful response that allows you to protect or remove yourself from the imminent peril.

Sometimes the fear response can occur in the absence of any obvious stimulus – this can lead to a panic attack. Panic attacks are terrifying physiological and psychological events in which your autonomic nervous system ramps you up for fight-or-flight. Often, the person becomes terrified that they are dying – usually of a heart attack. Like intense fear, the heart starts pounding, adrenaline flows, breathing races. Sometimes the victim will run from the room – perhaps to a hospital or perhaps with no direction at all – to escape the unseen threat.

A person who experiences frequent panic attacks can be diagnosed with panic disorder. A person with panic disorder is terrified of having another panic attack – and even that fear can elicit another attack. Such a disorder can be crippling. I have a friend with panic disorder that struggled in college because she’d had a panic attack during a particular class, and she was intensely afraid to go back to that class, fearing that she might have another attack. According to the DSM-5, in order to have panic disorder, a person must have 4 of 13 symptoms including: pounding heart, sweating, trembling, shortness of breath, choking, chest pain, nausea, dizziness, chills or heat, numbness or tingling, feelings of unreality, fear of “going crazy,” or fear of dying.

Panic attacks usually last 20-30 minutes with a peak for about 10 minutes, which is good because any longer than that could pose an immediate danger to the person’s metabolism (in case of diabetes) or cardiovascular system (heart attack).

The fear response in a panic attack originates in the amygdala, which is thought to be the central component of the “fear network.” According to the prevailing theory, panic attacks occur when the fear network is activated. Panic disorder develops in people who have a non-adaptive fear network which is overly-sensitive. Although the physiological response to a panic attack originates in the amygdala, there are also cognitive components to panic disorder (e.g. fear of another panic attack in particular situations). The hippocampus, which is involved in learning and emotional responses, is likely involved in this aspect of panic disorder. The cognitive factors in panic disorder (e.g. fears of dying or going insane) are likely controlled by higher cortical centers of the brain.

There are a couple of theories about the development of panic disorder. In the comprehensive learning theory of panic disorder, a person undergoes classical conditioning – such as Ivan Pavlov discovered when his dogs began to salivate reflexively to the sound of a metronome that was always ticking when the dogs ate. In a process called interoceptive conditioning, the person begins to unconsciously associate physiological arousal (e.g. pounding heart, head rush, increased breathing rate) with panic. Thus, when a person is physiologically aroused, such as while running, she will suddenly experience a panic attack. Panic attacks can also be induced by happy events. For instance, when something exciting happens, such as a marriage proposal, the happy person can suddenly rush into panic.

Another theory of panic disorder is the cognitive theory. In this case, the person consciously associates physiological arousal with impending doom. When his heart is pounding, he thinks he could be having a heart attack. When his breathing becomes labored, this could be lung cancer. Such thinking is called “catastrophizing.”

Panic provocation studies support the cognitive theory of panic disorder. In such a study, a subject is given a stimulant that increases heart rate or other physiological symptoms of arousal. One test group is told in advance that the stimulus will increase heart rate, and that it is completely harmless. The other test group will not receive any explanation. It turns out that people who are forewarned of the physiological arousal are less likely to experience a panic attack. This is not in line with the comprehensive learning theory, in which the panic is induced reflexively, and cognition has nothing to do with the attack.

In all likelihood, both theories play some part in the origin of panic attacks.

Many people with panic disorder are prescribed benzodiazapines such as Xanax or Klonopin. These medications are very useful for anxiety relief, but they can be addictive. Upon cessation of the medication, a patient can undergo uncomfortable side effects such as nervousness, sleep disturbance, dizziness, and panic attacks. For those of you who wonder why we are so dependent upon medications for treatment of anxiety, try undergoing a three hour anxiety attack like the one described in My Bipolar Mixed State. You will soon understand that immediate relief is necessary.

Because of the negative side effects of medication, it is good to treat panic disorder with psychological therapy, such as cognitive-behavioral therapy, as described in Contemporary viewpoints on treating mental illness – psychology. In such treatment, a patient can be exposed to internal stimuli of physiological arousal; for instance, running in place, spinning in a chair, or hyperventilating. The patient must continue this activity until he dissociates the physiological symptoms with panic. Such deconditioning therapy can be combined with education about the nature and causes of panic disorder. The patient can be taught to meditate or control their breathing. Patients are also taught about the cognitive errors that they might be making (i.e. my heart is pounding, I must be having a heart attack).

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 6: Panic, Anxiety, Obsessions, and their Disorders. Abnormal Psychology, sixteenth edition (pp. 163-210). Pearson Education Inc.

Carmilla, by J. Sheridan Le Fanu

Carmilla, by J. Sheridan Le Fanu, narrated by Megan Follows

Spoilers. Sorry. 😦 It’s hard to discuss a book well without spoilers.

Despite the very modern look of this cover, this novella is one of the first vampire books, predating Bram Stoker’s Dracula by 26 years. It was a serial story published in the magazine The Dark Blue from 1871 to 1872. Carmilla is narrated by a sweet, lonely girl named Laura, who is stuck with her father in a castle far from any company. She is eagerly expecting the arrival of a new friend, ward of her father’s friend General Spielsdor. Just before their expected arrival, a letter informs Laura and her father that the girl has died suddenly, and the General is on a quest to discover the murderer.

Almost immediately upon reading this letter, there is a carriage accident involving a lady and her young, amazingly beautiful, daughter. The mother says that she must move on immediately, but the child is sick so she’ll have to leave her in the next town. Laura’s father insists that they keep the child as a ward – she will make a fine friend for Laura.

Sure enough, Laura and Carmilla become tight friends – in fact, creepily tight. Carmilla is almost homosexual in her adoration of Laura. It would be easy to discount such female-love because in the era in which this book was written lesbianism wasn’t really considered an open possibility. I could easily shrug it off as intimacy which was acceptable at the time the book was written. But even Laura is a little creeped out by Carmilla’s love for her.

Soon, lower-class girls in the neighborhood start dying of a strange wasting disease. Meanwhile, Carmilla mysteriously locks herself in her room at night, and doesn’t descend until afternoon. Laura is haunted by terrifying dreams of monsters at night, and begins to waste away herself.

Just in the nick of time, General Spielsdor arrives, telling a strange story of a young, strikingly beautiful, girl who was left in Spielsdor’s care after the mysterious mother needed to leave town suddenly. Spielsdor was convinced that the child was a vampire and had murdered his sweet ward, and then had left town after he’d tried to impale her with his sword. The similarities in the stories were discovered, and Carmilla was henceforth dispatched.

I think the parallels between this story and Bram Stoker’s Dracula are quite striking. They both have a vampire hunter tracing the movements of the abomination. Both vampires sneak in at night and attack the victim several times before death occurs. Carmilla turned into a large cat instead of a dog, as in Dracula, but both vampires slept in coffins. On the other hand, it’s been a while since I’ve read Dracula, but I’m pretty certain he was unable to withstand sunlight, whereas Carmilla moved freely throughout the day. The parallels are likely due to use of the same primary sources of Slavic vampire folklore.

Some consider this book to be the prototype for lesbian vampires; however, as I said above, lesbianism was considered impossible at the time – Queen Victoria declared it so in 1885 when lesbianism was about to be criminalized. So clearly lesbianism could not have been implied. (Though, I suppose, this story was written before lesbianism was royally decreed impossible.)

I enjoyed this book a lot. The narration moved along quite nicely, and the book was short and to-the-point. I would recommend it to anyone who find vampire folklore to be interesting.

References

Le Fanu, J Sheridan. (2010) Carmilla: A Vampyre Tale [BBC Audio Version. Follows, Megan (na).] Retrieved from audible.com.

Post Traumatic Stress Syndrome – the Basics

I think we all have some idea of what we think PTSD is, but it turns out PTSD isn’t as clear-cut as I thought.

Apparently, when PTSD was first introduced into the DSM, the diagnostic criteria required a traumatic event “outside the range of usual human experience” that would cause “significant symptoms of distress in almost anyone.” That fits pretty well with my own perception of PTSD. Rape, war, torture, violent experiences…these all fit into that description. PTSD is a normal response to an abnormal stressor.

However, in the DSM-IV, the nature of the “traumatic event” broadened drastically, and a requisite response was “intense fear, helplessness, or horror.” So in the DSM-IV, PTSD was a pathological response to a potentially less extreme stressor. Someone could be diagnosed with PTSD if they experienced “intense horror or helplessness” after watching a scary TV show or upon being diagnosed with a terminal illness.

Although I don’t wish to undermine the intense stress that someone with pathological responses may feel, I think this definition undermines the intensely awful experience that someone with PTSD (in my mind) has encountered. The statistics agree with my assessment of these criteria: in a community survey, 89.6% of people reported that they had been exposed to a traumatic event and had responses that could potentially qualify them for a PTSD diagnosis.

Luckily, the DSM-5 tightened the traumatic event criteria again, and broadened the range of response to the traumatic event. Now, the traumatic event must occur directly to the subject, and they can exhibit other pathological responses besides “intense fear, helplessness, or horror.”

To be diagnosed with PTSD by DSM-5 standards, a person must be exposed to “actual or threatened death, serious injury, or sexual violence.” They must exhibit one of the following symptoms: intrusive distressing memories of the event, distressing dreams reliving the event, dissociative reactions, intense psychological distress at cues that remind the person of the event, or marked physiological reactions to cues that remind the person of the event. Additionally, the person must persistently avoid stimuli associated with the traumatic event, have negative alterations in cognitions and moods associated with the event (e.g. distorted cognitions about the cause or consequences of the event), and alterations in arousal and reactivity (e.g. hypervigilance or angry outbursts).

In general, people respond to trauma with decreasing pathological symptoms. In order to be diagnosed with PTSD, the patient must have experienced these negative responses for more than 1 month, otherwise they are experiencing “acute stress disorder.”

Despite the common association of PTSD with war veterans, PTSD is actually more common in women than in men – and the traumatic events are more often domestic violence or rape than war. However, a great deal of money and time has gone into research of PTSD in war veterans.

During WWI, symptoms of PTSD were called “shell shock,” and were thought to be caused by brain hemorrhages. However, this belief slowly subsided as doctors realized that the symptoms presented themselves regardless of injury. By WWII, traumatic reactions were known as “operational fatigue” and “war neuroses,” before the terminology finally settled on “combat fatigue” during the Korean and Vietnam wars. A rigorous longitudinal study of PTSD by Smith et. al. in 2008 found that 4.3% of military personnel deployed to Iraq or Afghanistan had PTSD. Of those, the rate was higher (7.8%) in those that had experienced combat compared to those who hadn’t (1.4%). An issue that is (rightfully!) getting much attention lately is the high rate of soldier suicide. Between 2005 and 2009, more than 1,100 soldiers took their own lives – generally with a gun.

There are several risk factors that increase the likelihood of PTSD – being female, lower social support, neuroticism, preexisting depression or anxiety, family history of depression, substance abuse, lower socioeconomic status, and race/ethnicity. (Apparently, compared to whites, African Americans and Hispanics who were evacuated from the World Trade Center in 2001 were more likely to get PTSD.) There is also a genetic factor that increases susceptibility to PTSD. Preliminary studies suggest that people with a particular form of the serotonin transporter gene may be more susceptible to PTSD than those with the “normal” form of this gene.

On the other hand, there is at least one factor that promotes resilience to traumatic events: intelligence. It’s possible that people with higher intelligence are better able to make “sense” of the event by viewing it as a larger whole. Or an intelligent person may be better able to recognize and buffer cognitive distortions such as “I deserved that,” “why should I have lived when they died?” and “If I had only done _______, this wouldn’t have happened.”

Researchers have come up with several ways to decrease likelihood of succumbing to PTSD after a traumatic event.

Stress-inoculation training has proved successful with members of the Armed Forces. Soldiers can be exposed, through virtual reality, to the types of stressors that might occur during deployment. Thus they are better able to deal with the trauma when exposed to the events in real life.

Debriefing after a traumatic event can also be helpful. This allows the victim to process the event in a safe environment, before the details become internalized.

Interestingly, one study showed that subjects who were exposed to a highly disturbing film were less likely to report flashbacks if they played Tetris for 10 minutes after the film than if they sat quietly for those 10 minutes. This team of researchers also showed that simply being distracted after the disturbing video was not enough to decrease flashbacks, and that doing a verbal task actually increased the number of flashbacks. So, apparently, visio-spacial tasks decrease the likelihood of intrusive flashbacks if performed immediately after the traumatic event. I’m not sure this information is particularly useful, but it’s interesting.

As of yet, there isn’t a highly successful way to “cure” people with PTSD. Cognitive behavioral therapy, which helps the victims recognize cognitive distortions (e.g. “I deserved that,” “why should I have lived when they died?” and “If I had only done _______, this wouldn’t have happened.”), can be helpful in reducing anxiety. Antidepressant medications can alleviate some of the depression and anxiety experienced by victims.

One up-and-coming treatment has shown promising results. Someone with PTSD can undergo prolonged exposure to the traumatic events. They can do this through repeatedly reliving the events out loud, or even by re-experiencing them through virtual reality. Unfortunately, many PTSD vitimcs drop out of such treatments because reliving the events is too difficult. However, this treatment method has proven very helpful to people who complete the process, and I hope that work in this area continues.

References:

Butcher, James N. Hooley, Jill M. Mineka, Susan. (2014) Chapter 5: Stress and Physical and Mental Health. Abnormal Psychology, sixteenth edition (pp. 129-161). Pearson Education Inc.

Does the DSM-5 encourage overmedication?

Oh, the irony of life – I clicked on a link to read an article by Dr. Allen Frances (chair of the DSM-IV task-force and author of Saving Normal: An Insider’s Revolt against Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization of Ordinary Life) – and I was forced to wait through a 15 second advertisement on a psychiatric medication. This is exactly the type of thing Dr. Frances complains about. People have “too much” access to information that they are not trained to understand. Dr. Frances urges the public to beware self-overdiagnosis. (This could also be referred to as cyberchondria.)

Before the publication of DSM-5 Dr. Frances strongly argued against many of the changes proposed…he even admitted that there were some mistakes made in the DSM-IV. One of his main arguments is that the DSM-5 added many new diagnoses that could push people formerly considered “normal” into the disordered range. For instance, disruptive mood dysregulation disorder is a new diagnosis for children who have too many temper tantrums; internet gaming disorder is a diagnosis for hard-core gamers. The DSM-5 also rejected the bereavement exclusion, which had previously discouraged clinicians from diagnosing major depressive disorder in people who had undergone a major loss in the past two months.

At the time that DSM-5 was being written, media pounced on the omission of the bereavement exclusion, claiming that people who were going through a natural process of grief would be stigmatized by a “mental illness” diagnosis. But is this really what happens?

The 2012 study The bereavement exclusion and DSM-5 concludes that the symptoms of bereavement aren’t fundamentally different from those of major depressive disorder. If the grieving individual’s symptoms and impairments are as severe as a person with major depressive disorder, they may benefit from treatment – and treatment requires a diagnosis. The purpose is not to throw drugs at every bereaved soul that walks through the doctor’s door. In fact, most people who are bereaved will not go into their doctors because they think their symptoms are “normal.” Those that go into their doctors are most likely suffering from more severe symptoms which might need to be treated.

In his 2013 PsychCentral post How the DSM-5 Got Grief, Bereavement Right, Ronald Pies argued that clinicians will not have to diagnose major depressive disorder in grieving patients, but they will be able to if such a diagnosis would be beneficial.

On the other hand, Allen Frances argues in his 2013 Psychology Today post Last Plea to DSM 5: Save Grief From the Drug Companies that the “medicalization of grief” will provide more “normal” patients at which to fire Big Pharma’s semi-automatic pill-dispensing guns (that’s not a direct quote). It will be a huge profit to the drug companies, but will the over-medicated grievers really be helped? Frances insists that we should focus our attention on the more severely mentally ill, who are in more need of treatment, but who are being lost in the bonanza of over-diagnosis.

Frances argues (understandably, since he was chair of the DSM-IV task-force) that there was no problem in the DSM-IV bereavement exclusion, why fix what isn’t broken? We should let the bereaved grieve with respect and dignity. If they were severely impaired, they were still diagnosable for major depressive disorder, so there was no need for change.

Here’s my conundrum: Who’s right? Ronald Pie or Allen Frances? With the DSM-IV were doctors just as capable of diagnosing a bereaved individual with major depressive disorder if necessary, as Dr Frances claims? If that truly is the case, then I’d say he’s right. Allowing too much freedom in the diagnosis might encourage general practitioners – who, despite their relative ignorance of mental illness compared to psychiatrists, are the go-to doctors for anti-depressants and anxiety meds – to over-diagnose and over-medicate. Generally, allowing the natural grieving process to progress is the best way to heal.

What concerns me about the bereavement exclusion, though, is that grieving patients who have some severe symptoms of major depressive disorder (persistent insomnia, weight loss, profoundly impaired concentration), but who do not admit to suicidal ideation would not be treated for depression. It is too likely that such patients are not entirely honest about their suicidal ideations, and the doctor may therefore miss this crucial criterium for diagnosis. Are we “better safe than sorry” – providing treatment to people who might not need it? Should we risk overmedicating and supporting the “evil” Big Pharma?

Honestly, I don’t know.

References:

Frances, Allen. (2010, July 08). Normality Is an Endangered Species: Psychiatric Fads and Overdiagnosis. Retrieved from: http://www.psychiatrictimes.com/blogs/dsm-5/normality-endangered-species-psychiatric-fads-and-overdiagnosis.

Zisook S, Corruble E, Duan N, Iglewicz A, Karam EG, Lanouette N, Lebowitz B, Pies R, Reynolds C, Seay K, Katherine Shear M, Simon N, Young IT. (2012).The bereavement exclusion and DSM-5. Depress Anxiety. (29):5, 425-43.

Bloodchild and Other Stories, by Octavia E. Butler

Bloodchild and Other Stories, by Octavia E. Butler

This is a book of horror / dark fantasy stories by the amazing author Ocativa E. Butler. Believe it or not, this is the first book by Butler that I have ever read, and I was amazed at her brilliance.

Her stories were incredibly creative. They covered important issues like race, slavery, sexuality, and identity, all in the guise of alien occupation or dystopic disease and other dark fantasy themes. Her prose was smooth and eloquent.

The most interesting of the stories was her novella Bloodchild, which is about a child that is about to be “sexually” adopted by some alien worm-thing. The story encompassed the feelings of the boy, his mother, and the alien – providing some very startling insight.

After each story, Butler included a short essay of what she intended the story to mean or background in her life when the story was written. These brought further understanding to the story, though I was a little skeptical when she insisted that she hadn’t intended Bloodchild to be about slavery. But, I guess, sometimes meanings creep in there unintended. And there’s also something to say for the readers’ interpretation regardless of intended meaning. To me, slavery was one of the many underlying themes of the story.

At the end of the book, Butler included a couple of essays about what it was like being an African American science fiction author, and encouraged young people to follow their dreams and become authors. Finally, there were a couple of never-before-published stories.

This little book is well worth your time if you are interested in deeper cultural issues of race, slavery, and sexuality – possibly even if you are not specifically interested in science fiction and fantasy.

For pure brilliance

This post is for R. I. P. X @TheEstellaSociety and the 2015 Halloween Reading Challenge @ReadingEverySeason. It is also for #Diversiverse, @BookLust, which is all about reading books by people of a variety of ethnic/racial backgrounds, so I will provide tell you a little about the author, Octavia E. Butler.

Octavia E. Butler was born in 1947 into an impoverished African American community to a 14-year-old girl. Despite struggling with dyslexia, she had a passion for reading and writing ever since she was very young. As a teenager, she started attempting to publish her stories, despite the extreme difficulty for African Americans publishing science fiction / fantasy. At the time she was one of only a couple African American sci-fi writers. Despite being taken advantage of by money-hungry agents, she finally published Patternmaster in 1976. This book was praised for its powerful prose, and she ended up writing four prequels. She finally became mainstream upon publication of Kindred in 1979. Butler died outside of her home in 2006.