Psychotherapy

Increasingly, mental disorders, phobias, neuroses, depression and other aspects of mental dysfunction are not seen as an embarrassing inability to cope with life’s demands – a weakness or flaw in the personality -but as illnesses, a number of which can be cured in the same way that a fractured leg can be reset. At the very least, psychotherapy often enables a person to cope with a problem or condition, even if he or she is emotionally or mentally ‘disabled’ to some degree. Broadly speaking psychotherapy can be split into three categories: behavioural, psychoanalytic and psychodynamic, and humanistic. The choice of therapy naturally depends on the underlying disorder, although there are alternative methods of treatment within each category that may be best suited to different personality types. The premise behind behaviour therapy is that because undesirable behaviour or irrational fear is learned, it can also be ‘unlearned’ through a process of deconditioning. For example. Someone suffering from agoraphobia (the fear of open space) and who consequently very rarely ventures A number of specialists may be involved in establishing the cause of an illness. For example, if a patient complains of vague abdominal discomfort and pain when urinating (A) the family doctor should be consulted first of all (B); infection of the urinary tract will probably be diagnosed. If the problem recurs after treatment the patient may here f erred to a specialist in internal medicine (C) for general examination, to a gynaecologist (D), who checks for abnormalities in his field, or to a urologist (E), who may make an internal examination of the bladder, among other things. The following background personnel may also be involved: a bacteriologist (F) to test bacterial resistance to antibiotics, a clinical analyst (G) to perform blood tests, a radiographer (H) to assess X-rays of the urinary tract, or a nuclear officer (I) to measure kidney function.

In addition to being a doctor, Albert Schweitzer (1875-1965) was also a theologian, a philosopher and a musician. He became well-known especially as a tropical doctor, and for the founding of his hospital in Lamb-arene. In 1952 he received the Nobel Peace Prize for his work.

Outside his or her front door, would be encouraged by the therapist to walk a little farther each day until a trip to the shops, say, causes no distress. The succes rate for this type of therapy is relatively high, which may in part be the result of the generally high motivation of the people who seek this kind of help. The explanation put forward by the majority of behaviour therapists is that a person who finds he or she comes to no harm when confronted with the situation he or she had avoided up to that point realizes the groundlessness of the original fear and is then able to function normally. The person who loses his fear of heights when he reaches the top of a ladder and does not fall off would be another example of the way the therapy works.

Psychoanalysis may involve short- or long-term therapy. In each case, the objective is to establish a relationship between the therapist and patient in which the unconscious motivation, fears, anxiety or suppressed guilt of the patient can be brought into the open and thus resolved. Free association techniques, the examination of recent dreams, hypnosis, frank discussion about childhood and personal relationships may all be used by the therapist to draw his patient out and identify underlying emotional problems or conflicts. In short-term therapy the patient may need help in dealing with a problem that has arisen unexpectedly: the inability to cope with the death of a loved one, for example, unemployment or a nervous breakdown. Long-term therapy is more suitable for a person with a history of depression, for example, or persistant mental illness.

The humanistic models of therapy concentrate on giving the patient a positive sens of self. All too often. Humanist therapists argue, a patient’s lack of selfes-teem presents a barrier to effective therapy because he or she does not feel that his or her problems are indeed worth solving. Once the patient has been reassured of his or her ‘right’ to therapy, treatment consists of a precise examination of the motivation behind the patient’s statements during analysis. Group and family therapy, in which patients are encouraged to speak more frankly than they would usually, are two of the many offshoots from the humanistic model.

The use of drugs, electric shock treatment and, in some cses, surgery, also have a place in psychotherapy. Tranquillizers or antidepressants may give a patient a ‘breathing space’ in which anxiety or stress can be coped with. However, because the nervous system is adaptable, and compensates for the presence of drugs, their potency diminishes in the long-term. The continued use of drugs may also prevent patients from tackling the cause of their problem once the immediate crisis is over.

The neuropsychiatrist is a specialist in mental diseases that are caused by organic disturbances in the brain.

Some heart centers work with several operating-theatres functioning at the same time. A number of operations are then undertaken simultaneously: doctors in each theatre open the patient’s chests, and prepare arteries in the legs. When this preparatory work is complete the surgeon arrives to undertake the actual diversion of the coronary arteries.

The staff in an intensive care unit is technically and scientifically extremely well educated. Surrounded by all the apparatus needed for care and surveillance even the patient disappears from view.

This specialism is not recognized in every country.

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