Qi-Gong Psychotic Reaction: DSM-IV [Archive]

GLW

06-21-2006, 02:18 AM

you need to keep the DSM in perspective.

It serves several basic functions.

One is to give a similar diagnosis foundation for mental health professionals across different countries, cultures, etc...

However, if you are talking about its uses in the US....

The BIGGEST use and important aspect of the the DSM is its use in diagnosis for patients being seen in a professional setting where INSURANCE or 3rd party copay is involved.

Basically, the therapist/doctor will always choose a DSM disorder that (A) fits the patient's complaints the closest and (B) is one that the patients 3rd party payer as in Insurance, Medicare, Medicaid, or whatever - will cover and pay for.

You will NEVER see a patient in a psychiatric facility with a disorder from the DSM that is NOT one that the insurance company pays for.

Putting it into perspective :

Adolescent Adjustment Reaction - a VERY common diagnosis for just about any adolescent in any treatment facility.

Defined as :

"An adjustment disorder is defined as an emotional or behavioral reaction to an identifiable stressful event or change in a person's life that is considered maladaptive or somehow not an expected healthy response to the event or change. The reaction must occur within three months of the identified stressful event or change happening. The identifiable stressful event or change in the life of a child or adolescent may be a family move, parental divorce or separation, the loss of a pet, birth of a brother or sister, to name a few."

Now, if the adolescent in question has insurance or a family with money and insurance, they are diagnosed as having Adolescent Adjustment Reaction and spend time in a treatment facility.

If they don't have the insurance, have a family that is loathe to use psychiatrists, or don't have money, AAR all of a sudden becomes delinquent or some such behavior and the kid ends up in front of a judge and then in juvenile detention.

Amazing how money works :)

So, is there some politics in a Qi Gong Psychosis - yes. It CAN be families trying to get a person out of a cult...but it can also be families trying to get the strange one that got stranger some help.

Every instance is different. But....at the same time, keep in mind that if you have gotten drunk TWO times in the past year, according to the DSM, you may have an alcohol abuse problem. (the two times do NOT exclude New YEar's and Labor Day)

alquimista

06-21-2006, 05:30 AM

well ... i can see by your reply that you dont take DSM-IV very serious but ... did any of you read the "Qi-Gong Psychotic Reaction" chapter? Even if they exagerate i would like to know what are the symptoms ... i dont want to buy the book just to read that chapter ... so if anyone knows what are the symptoms in the book i will appreciate very much if you share the information.

thank you all for the reply,
enjoy,
Jorge

Scott R. Brown

06-21-2006, 07:51 AM

Hi alquimista,

I'm still looking for a better link, but try this one for now:

http://www.spiritualcompetency.com/dsm4/lesson3_5.html

alquimista

06-21-2006, 03:04 PM

Thank you Scott ... It´s a very interesting link with a lot of symptoms that can happen during meditation http://www.spiritualcompetency.com/dsm4/lesson3_5.html
It doesnt say much about the DSM IV-Qi-Gong Psychotic Reaction but i guess its should be very similar.
I conclude that those symptoms are all related to a "Yang Rising" TCM syndromes that happen because the meditation focus to much on the "heaven" and too little on the "earth" or because a person has a lack of Yin energy. I feel in my body some of this Yang Rising symptoms when i practice meditation for long periods. One day i realized that the symptoms decreased when i meditate and breath also with my legs and feet or when i meditate in grounding stance (tree stance) with my feet in the grass and with the palms of my hands turning down to get the Earth Yin energy.
Some of the symptons described on the link can be very serious mental psychotic disorders ... i think that can only happen if someone is not ready (balanced) to practice meditation like schizophrenics or other serious unbalanced persons who insist to meditate.
I think that a person with a balanced body/mind (Yin/Yang) and with a good Earth relation during the day activities should not feel any "Yang Rising" symptoms during the meditation practice (even when your kundalin awakes).

Thank you all for cooperating in this thread,
Jorge

Scott R. Brown

06-22-2006, 02:15 AM

Hi alquimista,

I am trying to locate the actual DSM entry. I thought I had a copy of it at work, but I can’t find it right now! I’ll keep looking.

I really don’t consider it having anything to do with Chi or Chi Kung. The vast majority of people suffer no ill effects from Chi Kung even when they practice it in what may be considered by some the “wrong” way.

All things may be abused and all things affect each individual a little differently. IMO the individuals who suffer psychotic symptoms had a lack of basic emotional maturity or psychotic tendencies in the first place. Chi Kung practice is nothing more than a stimulating event. If an individual is emotionally unstable to begin with or does not have the tools to correctly handle and interpret the resultant experiences they may experience negative effects, but it is not the fault of Chi Kung. Destabilizing events can be anything from substance abuse to acute or deep seated traumas. People with delusions of grandiosity generally have deep seated insecurities to begin with.

Some who drink alcohol become alcoholics; some who drive cars get in accidents. In America over the recent holiday we had a BASE jumper fall to her death when her parachute didn’t open. I can step outside tomorrow and get struck by lightening. Life is full of risk and nothing is ever guaranteed. Is it alcohols responsibility that someone becomes an alcoholic, is the parachutes responsibility the BASE jumper died, is it the cars responsibility someone crashed it? Individuals are responsible for their own actions, not the inanimate objects that were the means of their undoing.

GLW

06-22-2006, 02:16 AM

It is not that I don't take the DSM IV seriously... it is just that I was in the mental health field (back when it was the DSM III) and before I went into engineering.

The ONLY time a therapist or a psychiatrist pulled out the DSM was to get the approved code for a patient to make sure their insurance would pay for hospitalization or sessions. In the academic world, it was pulled out to classify a subject into the right bucket for statistical analysis.

It DOES have a good broad brush of what the various basic disorders are - classes and such.

If you are an MD (psychiatrist with prescription drug privileges), you can get an idea as to what drugs to give.

But, if you are a therapist, you still have to do the work to devlop a relationship and work through the issues.

Psychosis is one of those things that requires drugs and then therapy. Very often, the therapy ends up centered around how to live with the drugs.

Then, you have drugs to counteract the side effects of the anti-psychotic drugs - like Haldol as an anti-psychotic and Cognetin for the EPS (side effects). Problem is, the side effect drugs can often produce psychosis too.

Qi Gong Psychosis -- then TCM ideas....this can get really messy since you would be using a western diagnosis modality and then switching to a TCM treatment modality...and they rarely map easily.

alquimista

06-22-2006, 06:24 AM

Scott ... i will apreciate very much if you can find the DSM chapter about the ChiKung Psychotic Reaction ... thank you

cjurakpt ... thank you for the links ... i get a lot of information about Qigong Psychosis in the 2nd link

GLW ... i didnt know that psychiatrists in US use DSM only because of the insurances ... maybe they do the same in Europe ... interesting ... but i really want to know what DSM says about "Qi-Gong Psychotic Reaction" ... are you a TCM student or a TCM therapist ?

thank you all,
Jorge

mawali

06-22-2006, 08:18 PM

"Devil running fire" is the translation of the term associated with adverse experiences in qigong circles. It has many manifestations like moderate to severe anxiety, heart palpitations, self harm (manifesting as cutting off one's hands, arms, legs, etc) or psychoses, schizophrenia and delusional behaviour.

DSM-IV is a Western coding tool relating for reimbursement for insurance and doesn't say much on the matter. Only that it has a potential code.
Many of the 'devil running fire' group may have undiagnosed mental health issues (Mainland China does not believe in mental health per a Western framework) but with modernization, they will see a 100 fold increase due to rapid societal shakeup that will point to the less vulnerable.

GLW

06-22-2006, 11:20 PM

Mawali pretty much got it.

The entry in the DSM was probably made so those treating Chinese patients could put a diagnosis to something. It is doubtful that any insurance or third party copayer would accept that particular diagnosis (at least in the west...no telling what would happen in someplace like Singapore).

But what you do get from having it is a nice place for the mental health professionals in China to get hooked in to the whole DSM process - statistcs, tracking...and eventually coopting them into the western view of psychiatry.

while this may sound weird, in the PRC, anti-psychotic drugs are expensive and not readily available. They also tend to prescribe lower doses for similar patients than do their western counterparts.

The main mode of treatment is to use the drugs to get a level of normal functioning and then switch into the "Long Discussion" ---or some such phrase which basically means very deep one on one sessions with a therapist (or lay-therapist) - and this tends to be closer to reality therapy than strange things like...oh...Freudian analysis :)

But, western psychiatric treatment is more geared to the 45 minute hour, pills, and not spending the depth of time needed with each patient. In a western setting, if the patient hits on something that is a breakthrough at 44 minutes into the hour, the therapist is winding down and talking about picking up there next time (meaning that it takes that much longer).

In the Chinese version, they tend to keep going and actually accomplish something. Part of this is the culture and philosophy. The other part is that it is of no advantage in China for a therapist to drag treatment out for years or to have a relapse. They don't have the insurance/get rich on the patient approach.

When you see a psychiatrist come into a hospital where their patients are and hit one floor after another...starting at the top and working down...and then having the nursing staff round up their patients on each floor and herd them in one at a time...for 5 minutes max....and then realize that each patient was charged for a 45 minute hour PLUS the charge for hospital treatment from the shrink, you begin to see how the mental health field has a big racket going on.

And the really good therapists are the ones that get burned out and leave the field

I have studied some TCM and follow my Qi Gong teacher who is a TCM doctor and was a founding teacher of the Shanghai College Of TCM....before he retired. - to answer the question...

alquimista

06-23-2006, 01:55 AM

Mawali ... some translated also has "Mislead the fire and enter the devil", in PiYin is "Zou Huo Ru Mo". I know already a lot about Qigong deviations by Chinese and TCM point of view but im looking now for the western point of view. I dont want to discuss if DSM is good or bad ... i just want to know what does it say about "Qi-Gong Psychotic Reaction". You say "DSM-IV is a Western coding tool relating for reimbursement for insurance and doesn't say much on the matter" ... have you read it? What does it say about "Qi-Gong Psychotic Reaction" ?

GLW ... i think everybody got it ... i agree with everything you say ... the point is that anyone here knows for sure what DSM says about "Qi-Gong Psychotic Reaction" ... do you know?

The point in this thread is not to discuss about DSM or Qigong deviations, but about what DSM says about "Qi-Gong Psychotic Reaction". Maybe we can start another thread so we can share what we know about qigong deviations or discuss about DSM and learn more about it. For now i would like to know what DSM says exactly about "Qi-Gong Psychotic Reaction" and ... since you all know so much about DSM ... maybe you can help me to find out ...

thank you a lot for your effort and patiente in helping me with this question,
Jorge

Scott R. Brown

06-23-2006, 11:07 AM

Hi Jorge,

Apparently the DSM-IV really doesn’t say much about Qi Gong psychotic reaction. Here is the listing I have found it is only from citations of the DSM-IV. I cannot find the DSM-IV at work yet.

DSM-IV Appendix I:

This appendix lists cultural specific disorders and there quite a number of them. There is no diagnosis number that I have been able to determine and all the DSM really says is:

Qi Gong psychotic reaction:

A time-limited episode characterized by paranoid and other psychotic symptoms. Can occur after participating in the Chinese folk health-enhancing practice qi-gong.

This is basically what has been cited in many of the above links.

I have 4 years experience with acute psychotics in nursing, running the daily programs and participating in therapies and groups as well as Doctors interviews and I can confirm that everything that GLW and cjurakpt have said is accurate about the Western or at least American Psych system.

dwid

06-23-2006, 02:10 PM

Wow, sounds like people have seen some bad psychiatric care.

At the hospital where I work, there are treatment teams. Each patient is assigned a psychiatrist, a social worker, an occupational therapist, and a nurse. Of course, the nurses rotate through, according to the shifts they work, but we chart pretty thoroughly so the docs and residents and everyone else on the team can follow a relatively seamless description of day to day changes.

In my experience, it is not the psychiatrist's role to treat with therapy. Psychiatrists are there for medication management and to direct the overall treatment goals. To be honest, psychiatrists, being MD's are simply too expensive to rely on to conduct therapy. There is no reason why someone needs to be an MD to conduct therapy, and further, acute inpatient care isn't really the time to begin therapy anyways. The only reason for a patient to be in inpatient psychiatric care is that they are in some kind of crisis, so on some level they are a threat to themselves or someone else. Once they're stable enough to leave, then they are in a good position to benefit from therapy, and if someone wants therapy, regardless of their ability to pay for it, their social worker can probably find something that is available to them. The fact is, many if not most patients would rather just take a pill. In adult inpatients, there is an extremely high comorbidity of substance abuse and psychiatric illness, and many of these patients refuse to take responsibility for themselves, so they will not follow up with any treatment that, like therapy, requires a great deal of effort on their part.

As far as the DSM, it is mainly a reimbursement tool, and there's nothing wrong with that. Psychiatric illness is by its very nature more nebulous than physical ailments. The DSM allows for people in the position to make a clinical judgment about a patient's need for care to make that judgment. Any other way and you are likely to exclude from treatment people who really need help.

The mental health system in the U.S. is flawed for sure. Thank Ronald Reagan and de-institutionalization for one thing and the tendency of people (within the medical community as well as without) to not really respect psychiatric medicine as a valid branch of medicine. Still, the idea that it is some kind of racket is somewhat ludicrous to me. Most people involved in mental health are overworked and underpaid. Nurses are paid the same salary in our facility as in the regular hospital, which is as it should be, but psych nursing does not command the respect that other nursing positions do, and you can see how it slowly wears away at the people who do it. As far as psychiatrists, in the hospital setting you are seeing fewer and fewer residents who want to go on to be psychiatrists because the earning potential is not nearly what it is in other areas of medicine. Maybe it's different in other places or in private practice. Further, psychiatric units as parts of large hospitals often barely get by, or even operate at a loss. The types of patients that are in need of acute care often do not have insurance, so you're talking Medicaid (at best).

Scott R. Brown

06-23-2006, 02:21 PM

dwid

06-23-2006, 03:18 PM

Hi dwid,

I did not intend my comments to be taken in a negative respect. My clinical experience is very similar to the one one you have outlined, with the exception that mine took place in a Correctional setting. To be honest with you I have somewhat of a knack for Psych nursing so I did not find it stressing in the least. Most of my stress was caused by fixing the problems caused by inept or immature staff.

I didn't really take your comments negatively, I just wanted to add my perspective to the mix. I've actually given thought to going to work in the Correctional system myself once I finish school. The pay is very good for NPs, and I think you probably see a broader spectrum of diagnoses than you do almost anywhere else. In the private sector, most psychiatric professionals compartmentalize and just treat a particular level of acuity, type of patient, etc..., but in Corrections you have acutely ill people and also people suffering from a mental illness that is subacute and requires treatment.

I agree with you about about the Psychiatrist, it isn't their job to spend a great deal of time with the patients. That is left to the many others in the therpeutic team. I must also admit that many or maybe even most of the Psychiatrists I have worked with were as nutty as the patients, mostly neurosis though rather than psychosis, but some psychotic controled with meds, LOL!!

LOL, I think it helps to be a little nutty in this field. And it takes a particular type of person to be suited to the environment. As far as the shrink with more severe mental illness, I think that's what gets some people into psychiatric work in the first place, just trying to figure themselves out

alquimista

06-23-2006, 03:19 PM

Ok ... i found it ... this is what DSM-IV says:

“Qi-Gong Psychotic Reaction: DSM-IV General Information: Appendix I, Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes:
qi-gong psychotic reaction A term describing an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms that may occur after participation in the Chinese folk health-enhancing practice of qi-gong ("exercise of vital energy"). Especially vulnerable are individuals who become overly involved in the practice. This diagnosis is included in the Chinese Classification of Mental Disorders, Second Edition (CCMD-2).”

There is a new edition of CCMD-2 (CCMD-3) and say this:

“42.1 Mental disorders due to Qigong [F43.8]
In the tradition of our country, Qigong is a way to keep healthy and cure the sickness. The method is usually to keep special posture or practice some exercises, and keep concentration on some points, pondering and reading silently, relaxation and regulating respiration.
Mental disorder due to Qigong refers to the phenomena that an exerciser is kept in a state of Qigong for so long as not to stop because of improper operation of Qigong (e.g., excessive exercise), the manifestations include symptoms of thought, emotion, and behavior, loss of ability of self-control.
A. Symptom criteria:
(1) Directly caused by Qigong exercise;
(2) The symptoms are closely related to the content of Qigong books and periodicals, and exercise of Qigong. The patients show abnormally mental symptoms repeatedly and continuously, without self-control;
(3) With at least 1 of the following:
psychotic symptoms, e.g. auditory hallucination, delusion;
hysteria-like syndrome;
neurosis-like syndrome.
B. Severity criteria:
Impairment of social function;
C. Course criteria:
The course is transient, patients may recover immediately by being out of spot, stopping exercise and proper treatment.
D. Exclusion:
(1) Excluding similar manifestations regarded as tricks to cure the sickness for oneself or others, or tricks to obtain money or attain other goals, excluding similar manifestations that can be involuntarily self-induced or self-ended;
(2) Excluding any kind of other disorders, especially hysteria or stress disorder due to psychological trauma.”

I got the answer for my question, the symptoms for Qi-Gong Psychotic Reaction by western psychology in DSM and CCMD are:
. Directly caused by Qigong exercise
. an acute, time-limited episode characterized by dissociative, paranoid, or other psychotic or nonpsychotic symptoms
. symptoms of thought, emotion, and behavior, loss of ability of self-control
. abnormally mental symptoms repeatedly and continuously, without self-control
. psychotic symptoms, e.g. auditory hallucination, delusion
. hysteria-like syndrome
. neurosis-like syndrome
. Impairment of social function
. Excluding any kind of other disorders, especially hysteria or stress disorder due to psychological trauma

I think it will be better to start a new topic if you want to continue changing information about psychology so more people in the the forum will be able to share also they experiences

Thank you for helping me ... cjurakpt, GLW, mawali and Scott

Enjoy,
Jorge

GLW

06-23-2006, 05:59 PM

Thanks to Scott for posting that listing of the DSM description.

It was something I had read earlier and my take was "Typical DSM IV - falls into the category of that's nice, but so what"

The description doesn't tell you much and can be used to even describe a person who might describe seeing lights as brighter or haloed...or seeing auras after practicing Qi Gong. That does not mean that it WOULD be used that way.

However, I HAVE seen such vague diagnosis areas used to keep people committed under a psychiatric warrant based upon ulterior motives in the family (like the rich male patient who didn't get along with his wife, left and spent all of his time living on his docked sailboat, drinking beer and fishing....and she would have him committed about once a year to try to get a power of attorney over his assets. He MAY have had a drinking problem but he was sharp as a tack and was still making money....and the only person he ever had an issue with was his wife.)

Wouldn't it be just fine if such a diagnosis was also used by a husband to get his wife committed so then he could divorce her and keep custody of the kids? In such an instance, if the wife got upset and argumentative about being incarcerated, the nursing staff would log it as inappropriate behavior. If the wife were to take things in stride and then continue practicing Qi Gong, the doctors and nursing staff would probably mark that as "strange behavior" and still, it would be used to keep her hospitalized.

Not that far fetched.

For Qi Gong side effects, I would say it would be more valid to examine the things that are listed in TCM and totally ignore the DSM IV.

dwid

06-23-2006, 08:54 PM

The point is really moot from the perspective of practice here in the U.S. No psychiatrist would ever use that diagnosis for inpatient documentation. At least from my perspective, most psychiatrists rely on the DSM as little as possible. Someone with psychotic symptoms and no history of schizophrenia or other psychotic illness would simply by written up as Psychosis NOS and that would be their diagnosis until a more useful or valid diagnosis could be obtained.

As far as the other stuff re: commitment with ulterior motives. That's some wild stuff. I'm sure it happens, just like wives falsely accuse husbands of domestic violence to gain leverage, etc... A good staff would figure out the game pretty quick though. We don't just watch people and take copious notes on their behavior. We talk to the patients and try to understand what's going on from their perspective. In acute care, you can separate the people who belong on the unit from those who don't pretty easily in most cases just by spending some time with a person.

mawali

06-23-2006, 11:51 PM

Jorge,

The Western medical professional will probably see this as foolish (qigong psychotic reaction) and at best, that the individual is a nutcase. It will be a useless designation and the indiviudal will probably committed or undergo counselling!

alquimista

06-24-2006, 02:31 AM

i know that mawali ... i just wanted to know how western psychology classifies a Qigong Deviation ... just as simple as that ... i dont want to use it ... i dont care if its foolish or not ... i dont care if it´s useless ... but now i know what it means if someone come to me with a "Qigong Psychotic Reaction" from is psychiatrist ...

Enjoy,
Jorge

Scott R. Brown

06-24-2006, 03:43 AM

In America or at least California it is for the most part illegal to lock someone up in a hospital against their will. They must be documented to be a clear danger to themselves or others. It is not illegal to be nuts!!

GLW

06-24-2006, 11:02 PM

It is typical that the proof required for a mental health warrant for committment is "dangerous to themselves or others"

However, that is pretty broad and open to interpretation. I have seen the dangerous part applied - in rality the danger was to the bank book or stocks...or that the family member was going to be cut off due to the 'crazy' one...and I have also seen those that were truly dangerous or suicidal NOT be committed because of having a lawyer or just flat out no one would start the process.

It is a horribly flawed system.

But, the benefit of the doubt lies with the psychiatrist and such when the hearing comes off. The judge issues a committment warrant, the person is put in the hospital for observation, there is then a committment hearing and the person is either released or committed for a period of time (usually 90 days in Texas..and then a re-examination takes place at those intervals).

But once in the hospital - such things as anger, despondency over being in there, bewilderment over bieng there, feelings of betrayal for their family member that had them committed - are all taken as proof of needing to be there. While this may be true, In 5 years in the field...before I left it, I only saw TWO Patients come in on warrants and leave directly from their hearing. One was due to insurance and no bed space at the county ward - strange how he was deemed not so dangerous when they had no space in county and no way to pay for him otherwise. The other had a good lawyer and his wife had done this thing repeatedly. He was most pleasant and simply refused to talk with the staff about much of anything...on his lawyer's advice.

I saw several asian patients come in for depression...and NONE of them had therapists that knew jack about their culture or how important their family would be in treatment.

mawali

06-28-2006, 10:22 PM

One point of view

pincha aqui:
http://www.hkjpsych.com/Culture_bound.pdf#search='qigong%25pdf'

Judge Pen

06-29-2006, 12:41 AM

At least from my perspective, most psychiatrists rely on the DSM as little as possible. Someone with psychotic symptoms and no history of schizophrenia or other psychotic illness would simply by written up as Psychosis NOS and that would be their diagnosis until a more useful or valid diagnosis could be obtained.

I've been told, at least informally, that it's because of the difficulty to distinguish between actual illness and pre-established personality disorders. What's your perspective on that?

alquimista

06-29-2006, 10:56 PM

One point of view

pincha aqui:
http://www.hkjpsych.com/Culture_bound.pdf#search='qigong%25pdf'

thank you mawali ... its a good link

Enjoy,
Jorge

dwid

06-30-2006, 01:56 AM

I've been told, at least informally, that it's because of the difficulty to distinguish between actual illness and pre-established personality disorders. What's your perspective on that?

Well, in the strictest sense, "personality disorders" are an axis 2 diagnosis in the DSM, while disorders such as Depression and Schizophrenia fall on Axis 1. But if I understand your question correctly, you mean the difference between what a person has become through his or her environment, upbringing, choices, etc... vs. what he or she is predisposed to biologically. In the current mental health system, it is particularly difficult with adult patients to differentiate what nature gave them and what lifestyle has given (or exacerbated) due to the extremely high comorbidity of mental illness and substance abuse. It turns into a kind of chicken and egg thing, though for the purpose of acute inpatient treatment, it's a largely academic point. Treatment is the same regardless of causal factors. Ultimately, you want to refer them for further substance abuse treatment following discharge, and it will effect some of the supplemental meds you give (you don't want to throw a lot of ativan at a junkie). However, the diathesis stress model has been widely accepted for a long time, and it suggests that biology combines with life stresses to create active mental illness in many cases. Stresses can be a bad childhood, substance abuse, homelessness, any number of things.

Anyway, I think a big part of the reason why people tend to utilize the DSM in a limited fashion is because its greatest diagnostic clarity is in regards to the more commonly seen illnesses, such as Bipolar, Major Depression, Schizophrenia, and the Anxiety Disorders. A lot of the other stuff, the stuff you see greater changes in from one iteration of the DSM to the next, is maybe more to get you thinking of possibilities when you have a wtf kind of case. But this is largely conjecture on my part, just my thoughts based on my observation and experience.

mawali

06-30-2006, 07:54 PM

Another link
Abuse of government authority in political way to intimate opponents.
Psychiatric abuse:

haga click:
http://www.jaapl.org/cgi/reprint/30/1/126.pdf

Christopher M

07-04-2006, 03:23 AM

...acute inpatient care isn't really the time to begin therapy anyways. The only reason for a patient to be in inpatient psychiatric care is that they are in some kind of crisis, so on some level they are a threat to themselves or someone else. Once they're stable enough to leave, then they are in a good position to benefit from therapy, and if someone wants therapy, regardless of their ability to pay for it, their social worker can probably find something that is available to them. The fact is, many if not most patients would rather just take a pill...

On the other hand, medication compliance, particularly with psychotic populations, can be extremely low. And this idea that it is the patient's responsability to put forth the effort to attend and benefit from therapy is part of a particular culture of therapy rather than a necessary principle of therapy in general. It's possible to do extremely beneficial therapeutic work with inpatients, it just takes a different mindset than therapists are typically trained to have.

In my experience, it is not the psychiatrist's role to treat with therapy.

Right, but the problem is that it isn't clearly anyone's role any more. Which is probably why active therapeutic approaches, such as that mentioned above, are so rare. Even clinical psychologists are largely abandoning psychotherapeutic roles for strictly psychodiagnostic ones. Good therapists typically have training as therapists alongside whatever profession they have, but this is preventing the development of 'therapist' as a professional identity, along with the benefits that this would bring.

dwid

07-04-2006, 08:44 PM

On the other hand, medication compliance, particularly with psychotic populations, can be extremely low. And this idea that it is the patient's responsability to put forth the effort to attend and benefit from therapy is part of a particular culture of therapy rather than a necessary principle of therapy in general. It's possible to do extremely beneficial therapeutic work with inpatients, it just takes a different mindset than therapists are typically trained to have.

Well, part of it may be mindset. Part of it is that if you are only keeping a person in inpatient care until they are no longer a threat to themselves or others, then by definition, they are in a state in which they are not equipped to attend to or benefit much from therapy. This is not to say that they cannot benefit at all, just that if thereapy is to be conducted, it must have very specific, simple, and short-term goals. Further, it may be sad to accept, but the system for the most part is just not set up for this. The people in the best position to conduct therapy in an inpatient unit are the nurses, and they simply have too much to do to be able to work with each patient in this way. I know of one hospital in Columbus in which they actually do some inpatient therapy (conducted by the psych nurses), but that hospital is selective about what patients it takes. When all your patients are insured or can pay for their care, and are not mainly substance abusers with behavioral issues (but rather legitimately ill people), you can afford to reduce the patient to nurse ratio somewhat and can actully get some therapy done.

Regarding the whole patient's responsibility to engage therapy, I'm not saying we should write off patients that are unable or unwilling to actively participate in therapy, but in my opinion it is simply a fact that until someone accepts that they are ill and takes an active interest in getting better, no therapy is going to be an effective long-term solution. Therapy=work. The therapist can try to help a person to understand why the work is worthwhile, medication can help clear a person's thoughts so they can start to make decisions that are in their best interests, but ultimately, I can't think of a therapy that works with patients who are not actively participating. If there is such a therapy, please refer me to some resources/research.

Right, but the problem is that it isn't clearly anyone's role any more. Which is probably why active therapeutic approaches, such as that mentioned above, are so rare. Even clinical psychologists are largely abandoning psychotherapeutic roles for strictly psychodiagnostic ones. Good therapists typically have training as therapists alongside whatever profession they have, but this is preventing the development of 'therapist' as a professional identity, along with the benefits that this would bring.

As someone who is training to ultimately prescribe and conduct therapy, this comment strikes close to home. The whole chaotic nature of the professional environment for people like myself (who see the value of therapy and want it to be a large part of what they do) makes me very nervous about my future. There are big problems with the system right now in terms of poor continuity of care within mental health and the absence of mechanisms to help people stay on track when they have the will but sometimes lack the cognitive or financial resources to do so.

Christopher M

07-05-2006, 12:47 AM

Part of it is that if you are only keeping a person in inpatient care until they are no longer a threat to themselves or others, then by definition, they are in a state in which they are not equipped to attend to or benefit much from therapy. This is not to say that they cannot benefit at all, just that if thereapy is to be conducted, it must have very specific, simple, and short-term goals.

I'm not sure this is necessarily true. Certainly therapy in this venue will have elements of 'crisis management' but unless crisis management is understood as antithetical to the goals or methods of long-term therapy, there's no reason why one couldn't be working on both at once. Although inpatient stays are so short these days that perhaps we should be talking about 'post-psychiatric' patients rather than inpatients.

Further, it may be sad to accept, but the system for the most part is just not set up for this.

This is definitely true, but again I think it's part of the problem of there being no professional identity and not really much support for therapy.

Regarding the whole patient's responsibility to engage therapy, I'm not saying we should write off patients that are unable or unwilling to actively participate in therapy, but in my opinion it is simply a fact that until someone accepts that they are ill and takes an active interest in getting better, no therapy is going to be an effective long-term solution.

I would suggest that "accepting you are ill and taking an active interest in getting better" is part of the progress of therapy rather than a pre-requisite. To the extent that it's treated as a pre-requisite, severe mental illness is in principle excluded from therapy, and the therapeutic goals in cases of less severe mental illness become restricted to initial complaints (which are what gets defined as the illness and as what the patient has an interest in affecting, but which, from a long-term therapeutic perspective, are not infrequently defenses in themselves that need to be addressed).

dwid

07-05-2006, 06:09 AM

I'm not sure this is necessarily true. Certainly therapy in this venue will have elements of 'crisis management' but unless crisis management is understood as antithetical to the goals or methods of long-term therapy, there's no reason why one couldn't be working on both at once. Although inpatient stays are so short these days that perhaps we should be talking about 'post-psychiatric' patients rather than inpatients.

I understand where you're coming from here, and, like I said, I can see there being a point to very short-term goal-oriented stuff, but the lack of continuity of care (a systemic problem) ultimately precludes getting very much done. I agree that there's no reason to not "work on both at once," but without a mechanism for a smooth transition/continuity from the acute setting to the outpatient one, a lot of whatever progress can be made in therapy stands to be lost in this transition.

I would suggest that "accepting you are ill and taking an active interest in getting better" is part of the progress of therapy rather than a pre-requisite. To the extent that it's treated as a pre-requisite, severe mental illness is in principle excluded from therapy, and the therapeutic goals in cases of less severe mental illness become restricted to initial complaints (which are what gets defined as the illness and as what the patient has an interest in affecting, but which, from a long-term therapeutic perspective, are not infrequently defenses in themselves that need to be addressed).

Well, severely acute patients suffering from a psychotic episode or a manic episode, in my opinion, cannot benefit much from therapy until they transition out of the acute phase of their illness. Further, therapy alone is highly unlikely to help someone suffering from a severe illness such as schizophrenia. Without medication, all the therapy in the world is not going to do a whole lot. Therapy in such a case is a great supplement to meds, but is no substitute. Further, while the goals in less severe illness may initially be restricted to "initial complaints," an individual who is sincere in seeking help will likely be receptive to the initial complaint representing a symptom rather than the illness itself. Most modern therapies aren't really built around the idea of digging all that deep from an initial complaint anyway, and some of the more modern therapies, such as cognitive and cognitive-behavioral therapies, have pretty stong support in the research for their efficacy.

Christopher M

07-05-2006, 06:44 AM

...but without a mechanism for a smooth transition/continuity from the acute setting to the outpatient one, a lot of whatever progress can be made in therapy stands to be lost in this transition.

Right, which is another reason why I think we need a clearly identified professional role of 'therapist' so there is someone to provide this continuity.

Well, severely acute patients suffering from a psychotic episode or a manic episode, in my opinion, cannot benefit much from therapy until they transition out of the acute phase of their illness. Further, therapy alone is highly unlikely to help someone suffering from a severe illness such as schizophrenia. Without medication, all the therapy in the world is not going to do a whole lot. Therapy in such a case is a great supplement to meds, but is no substitute.

Well, I'm not suggesting an either-or situation, but in my experience valuable work can be done both with and without medication, and also in acute stages; although, again, methods and experience specific to this situation are needed. From one point of view, as I mentioned above, medication compliance can be an issue in the therapy, and so therapeutic work with nonmedicated patients can be part of an overall progress towards the patient's involvement and interest in their treatment (including, here, psychopharmachological treatment). Again, this important contribution is foreclosed if medication is considered a prerequisite for psychotherapy.

dwid

07-05-2006, 05:19 PM

Well, I'm not suggesting an either-or situation, but in my experience valuable work can be done both with and without medication, and also in acute stages; although, again, methods and experience specific to this situation are needed. From one point of view, as I mentioned above, medication compliance can be an issue in the therapy, and so therapeutic work with nonmedicated patients can be part of an overall progress towards the patient's involvement and interest in their treatment (including, here, psychopharmachological treatment). Again, this important contribution is foreclosed if medication is considered a prerequisite for psychotherapy.

I can agree with you there. I think we're pretty much in agreement, I just had maybe a more rigorous definition in mind of what constituted therapy.

Researcher

07-14-2006, 01:51 AM

What is Qi Gong Psychosis?

It is a time limited psychotic mental break. The classic case often quoted from China involved a house painter, self-taught in Qi Gong, that began to believe he could speak to beings from another dimension. It is included in the DSM as a Culture Bound Syndrome.

Most sites agree that the event happens when too many Qi Gong sessions are performed in a compact time frame. But they believe the mental break is caused by miss-handling universal life energy, Chee. Some claim performing the Kata incorrectly is the cause. One site blames demons.

The actual cause is much simpler but it reveals how Qi Gong actually works and contradicts the beliefs of those who practice Qi Gong. (Sometimes there is a price for advancing knowledge.)

In the 1960’s designers building new close-spaced office workstations encountered a problem when knowledge workers using them began to have mental breaks. The problem was investigated and psychologists determined that Subliminal Sight and Peripheral Vision Reflexes had acted in the “special circumstances” those workstations created to cause the mental events. The Cubicle solved the problem by 1968.

It is difficult to see at first but performing Qi Gong in-groups also creates those “special circumstances.” Concentration in the form of eyes-open meditation substitutes for the mental investment to perform knowledge work. The movement of others close beside you provides detectable movement in peripheral vision to trigger repeating attempts to cause a peripheral vision reflex.

One way to look at the problem is that the constant subliminal appreciation of threat, movement in your Subliminal Peripheral Vision, eventually colors thought and reason creating paranoia, fear, and the psychiatric outcomes. (Google the "Awakening of Kundalini.")

Your brain does not identify the nature of the moving object it just reacts to the movement. It is a warn first identify second system. The reaction is a startle and sudden gut wrenching apprehension which forces you to look and identify the detected movement. You will learn to ignore safe movement but that does not turn the system off. That means you can also be exposed to visual Subliminal Distraction in many places. The additional exposure during Qi Gong performances would push you past the threshold of exposure and cause the mental break.

Low level long-term exposure for some users of Qi Gong and Kundalini Yoga creates fixed altered mental states in which the user begins to believe they have superhuman strength and supernatural powers. One such belief is that a Qi Gong master can cast Chee from his fingertips to strike an opponent. For Kundalini Yoga users these beliefs include the ability to levitate, walk unharmed through solid objects, dematerialize - become invisible, and read other’s minds and control their actions by mental telepathy. These beliefs are usually called “psychotic-like.”

This means that the actual reason you have health and mental state improvements by performing Qi Gong is operant conditioning.

VisionAndPsychosis.Net is a private psychology project, which includes Qi Gong deviation as evidence that visual Subliminal Distraction is an unknown and unevaluated cause of mental illness.

One of the first mistakes investigators make is to believe that the disorders of the DSM actually exist. They are observed then grouped and named behaviors. The names are given based on the length of the acute phase and the content of the behavior. Authors of the DSM openly admit they do not know what causes any of the disorders. Trauma is the latest theory. Most of the theories involve a belief in the fragility of the human psyche.

http://visionandpsychosis.net/QiGong_Psychotic_Reaction_Diversion.htm Start by performing the psychology demonstration and scanning the Everquest Connection page.

Illustrations will be added to facilitate communication later this summer.

One of the first symptoms is "hearing voices." This is shown through investigation of other Culture Bound Syndromes.

If you suspect you are beginning to have the epidode stop performing Qi Gong and search your daily activities for other places of exposure. It is not necessary to eliminate them all. We each have exposure daily. Most of it is harmless.