Principles and Practice of Genetic Psychiatry - Essay Example

Writing Customer’s Name Customer Tutor’s Name Customer’s Grade Course 27th September 2010 Abstract This paper analyzes one of the less common disorder in the world and which is connected with the moody and cognitive problems: Borderline personality disorder. The paper starts at analyzing one of the movies which characterizes this disorder; the Girl Interrupted and then analyzes this disorder with connection to the movie and the character highlighted; Susanna. With this, we are able to learn the applicable medications and psychiatry method of treating this disorder, as well as ethics involved in it. Introduction Movie synopsis: Girl, Interrupted This movie revolves around a girl by the name Susanna who is suffering from stress and borderline personality disorder and seeks attention of a psychiatrist. Her problems started after completing her secondary school education and perhaps her sleeping with a husband to her parent’s friend. She attempts to commit suicide by combining high beer with aspirin in which the doctor calls as a dangerous attempt for her and that there are many other ways of coping with this problem. The plot and the story is a well crafted one intended to send a message, but it is also a dramatic one on a story of Susanna who struggles to find sanity, independence as well as integrity. This girl is depressed as well as lost focus of the world she wants to lead after finishing her high school education. She is diagnosed with bonderline disorder by a psychiatrist and some of the problems she is facing include: struggling to make sense of her life in the rapidly changing world, feeling of insecurity, confusion, strong self image, mental interruptions/ disturbances and long term goals. When she wants to commit suicide, she finds herself in Claymore hospital, a hospital of the crazy yet noisy people. There she finds company in some friends like Georgina the pathological liar, sexually abused Daisy, Polly the burn victim and the hypnotic Lisa. One of the girls in this hospital is a girl named Lisa who is a real trouble maker and one who easily commands a following. And so, Susanna had a new found friend and so rebels against conforming to be a better person. In a more dramatic change of events, Susanna realizes changes in her world and has to defeat her convictions of the world to become a more realistic person. The challenge is to bringing Lisa along with her to the new found world, a world where there is no destroying of people and which has peace of mind. She has to find a course to lead and in this, she has to drag along some of her friends like Lisa to this civilized world. As a grown up woman, Susanna regrets her time in 1960’s but opts to lead the new life. Borderline Personality Disorder This is a disorder which needs a psychiatric diagnosis and denotes a psychotic mental illness. It is more characterized by bizarre actions giving one unstable mind and is known to emanate from an action or actions one had done in the past which still has repercussions in the future of the person (Gundeson & Links 2008). According to Paris (1994), this disorder is an accepted diagnosis and even though some misconceptions are that it is rare and untreatable, there are guided procedures to curing this and it is common in this world. There are no known drugs which can be administered to cure this disease or the condition. The approach to curing this disease can only be a systematic and a behavioral approach. The movie Girl Interrupted has a girl who is suffering from both Axis I and Axis II problems, that is, the problems she is facing are both connected to some cognitive problems and still a personality disorder. For axis I, Susanna is seen as having mental disturbances right after she finishes her high school education and for axis II, Susanna is suffering from the now common personality disorder in the world: Borderline personality disorder. According to Aneshensel & Phelan (2006), the axis disorders include, paranoid, borderline, antisocial, schizoid, schizotypal, histrionic, avoidant, dependent and narcissistic while the axis I includes clinical disorders such as cognitive problems, mood, anxiety and factitious. This disorder is characterized by instability in mood, black and white thinking, idealization and devaluation episodes and some chaotic and unstable interpersonal relationships (Sadock, 2008). This disorder may also include a shift and switch between the idealization and demonization of others when he or she views them as having other influenced agendas (Sadock, 2008). There are some defense mechanisms in people suffering from this disorder. Some of such include reaction formation, denial and projections where the reaction formation is used against some perceived forms of aggression towards him or her. The mental status of such a person is that they do not engage in activities of the others and so, it makes the patients always stay groomed. According to Schultz (2008), there are a number of types associated with this disorder. These include: Discouraged borderline which includes avoidant, depressive or dependent features; impulsive borderline including histrionic and being antisocial, petulant borderline which includes negativistic features, and self destructive borderline which includes being depressed or masochistic features. Some individuals may exhibit one of them or others may show signs of all of the four types. A person suffering from this sees life as not a reality and as though it is unfair to him or her (Gray, 2008). The person can only imagine of some events which could be happening in his or her life and when he or she thinks about it seriously, the realization is that virtually events are not favoring him or her and are not a necessity to him or her. For example, if some friends or other people happen to laugh about something else, this person would put this situation seriously in mind to a realization that these people are actually discussing him or her. This is because the person is always thinking of how his or her environment is against the person’s nature. They are usually incompatible with other people’s views and they would always tend to think that theirs is the best and no one should resist it. Therefore when there are some opposing stimuli, they can easily interpret this to mean that those who are arguing against him/her are actually doing so because they want to despise him or her. According to Johnson (1991), the borderline disorder is prevalent in the world by from the range of 0% to 57% especially to the anorexic people. This disorder is best explained by the psycho structural theory which looks at the human psyche as being formed with limited number of some basic underlying psychological organization. And therefore, there is possibility that there can be malfunctioning of the mind if the person does not follow basic sociology rules of engaging other people. On the general population, the prevalence on people this disorder is about 2% and 10% of the psychiatric outpatients, and 20% of the psychiatric inpatients. It is more frequent on the females than in the males with females taking 75% of all studied to have this disorder, and the males taking the rest 25% prevalence. According to Horwitz (1996), there are some pervasive patterns of instability in the mood of the person, the self image, the interpersonal relationships and the self image in this disorder, and his is learned to start at early stages of life. These figures are characteristics of a world population which is facing threats from the increase of this disorder, and perhaps doctor’s intervention may not change the situations much. What is needed is a more procedural approach to curing this rather than confining a person to a hospital with crazy people like that one where Susanna in the move Girl Interrupted. As Agronin (2006) writes, this disorder is a non-bizarre and has less frequent hallucinations to make anyone not be treated using a psychological approach rather than prescribing some medications which may actually not work at all. According to Weiner (2010), the treatment which can be administered on someone who is suffering from this disorder is the one which can help minimize the effects of some of the symptoms. Such drugs could only be anti-depression since this disorder is both characteristic of axis 1 problems as well as axis 2 problems. Some of such include the Monoamine Oxidase Inhibitors which include norepinephrine, serotonin, and the dopamine. Even though medication can not really treat someone with this disorder, with the minimized effects, other methods can be applied. Linehan (1993) notes that, this disorder can be treated using the cognitive or behavioral methods for the person to come out of the state he or she is in. According to Lieberman & Tasman (2006), the largest percentage of the people suffering from this disorder does not respond well to using antipsychotic drugs. This shows that before any drug is administered, it is proper to check the levels of the disorder, and whether it can just be cured using some psychiatric help. Perhaps the greatest effect on the patient suffering from borderline disorder is seen in the psychosocial factors. According to Boyd (2007), this disorder has a reputation of being chronic and can actually be a resistant to some treatments. Most of them do not like agreeing that the problem exists while in actual sense is deeply affecting them. The patients suffer from loneliness in unknowingly manner while still opting to stay alone. For example, they may appreciate what others are doing but cannot like to engage in them. This problem is deeply set in the patient’s mind and it is better for him or her to suffer alone rather than share it with a friend (Boyd, 2007). The parents and his or her close family members are largely affected by this especially in staying with a person who cannot open up his or her problems. In this case, therapies are too open for such families so as to cope with this (Kreger, 2008). Such implications are too seen in the patient’s work place where the person cannot easily relate with the people he or she is working with, and this can also affect the performance and the rate of job/assignment completion. For example, if a person is put in the customer relation’s desk, that person may not actually handle the issues which come with this task. When all this is related to Susanna in the movie Girl Interrupted, it can be seen then that the individual, that is, Susanna was herself under intense stress to cope up with the issue, and so moving along well with the likes of Lisa was a great option. There are discriminations associated with the suffering from borderline disorder and other related psychosocial problems and such remains to be the isolations from other people. According to Colman (2009), this kind of discrimination can be a trigger to the effects of the disorder and thus people surrounding this kind of person and who understands what the person is going through should actually offer help and closeness instead of far distance isolation. Perhaps the acts and assessments of being bizarre is what keeps people away from such a person, but unless the person is shown real love and associations, the problem would only be aggravating. In one of five main categories of the systems in any psychopathological features/disorders; and that includes the Borderline personality disorder, the Psychosis, and lack of motivation from other people helps in adding the seriousness of the problem in a person (Oldham 2005). Alienations are noted to be the key to making the problem become worse and the patient sees this as a form of persecution from the people who are supposed to be close to him or her. According to Janssein (January 2003), a significant 2.7% of the patients included in a study reported that they are discriminated by the people due to their problem. Approaches to borderline disorder therapy One of the common suggested therapies to borderline disorder is the Dialectical Behavior Therapy (DBT) so as to decrease the tension, and anxiety which is common in the disorder. It has been studied to be a fast growing treatment for people suffering from Borderline Personality Disorder with a notable success rate of 60% for the non-violent patients and 42% for the ones who are violent. The main goal in this approach is to bring the parts of the mind together and to control the emotional and the rational thoughts which cause this person to be more knowledgeable on the torture he or she is going through. The main goal in this approach is to thwart the aggression which is common in people suffering from this disorder. Another approach is the Cognitive Behavioral Therapy (CBT) which is an approach of consistent and structured kind of treatment. It is grounded on empirical consistent relationships on the symptoms which could be exhibiting themselves on the person suffering from this disorder. This approach is also connected with the psychosocial view point which has the aim of encouraging the person gain confidence in him or her. Occupational therapy refers to the use of some purposeful activities or some interventions which are designed to achieve some functional outcomes. The aim is to help people regain their level of functioning and the therapies address: the activities of daily living, work or productive activities and play or leisure activities. There are various forms of ethics considerations and violations which are encompassed in borderline personality disorder. According to Roberts (2008), the identified ethical considerations include: Confidentiality, fidelity, informed consent, justice and scope of practice. In this, the principles are: beneficence and nonmaleficence, confidentiality and respect for persons, justice and respect for autonomy, justice and veracity and nonmaleficence and respect for autonomy. For example, in modern therapies or cure for health, autonomy for persons comes first and the psychiatrists have to ask for the consent before administering any drug. According to Beauchamp & Childress (2001), ethics and more so, respect for autonomy, informed consent and confidentiality should be first among equals. Szabo (May 2000) writes that the failure to practice ethics in the psychiatry medication is a violation of fundamental rights to the patients and if investigated to be of high conduct, the psychiatrist can as well be liable to the law of South Africa. Therefore, while practicing any form of medication, it is of paramount importance to always study the recommended actions in the practice rather than just assume that the patient does not have the rights simply because he or she is sick of mind. In a study, Szabo (May 2000) notes that ethics are highly violated by many practitioners and which is a worrying trend because, the sole aim of treating a person suffering from the psychological torture can actually harm himself or herself. Recommendations Medical operations are sensitive and any therapist should take utmost care while going about the business of treating or offering counseling. Such a disease which requires utmost care is the Borderline personality disorder. From the analysis of the movie; Girl Interrupted, the first option which Susanna took to consult a psychiatrist was wrongly guided because she lands herself into a hospital for the crazy people. The situation only becomes worse when she finds people of her character. So instead of rushing to get drugs and other medication, it is crucial that this method be applied first, and it would only be important to consult the doctor if this method fails. However, in many instances, we have seen that using a counselor is actually found to be helpful. The other issue connected with this therapy is in the application of ethics in the practice. Ethics helps guide one in his or her profession and in connection with borderline personality disorder therapy, it is important to adhere to the set ethical considerations. References Agronin, M. (2006). Principles and Practice of Genatric Psychiatry. Philadelphia: Lippincott & William Wilkins. Aneshensel Carol S. & Jo C. Phelan (2006). Handbook of the sociology of Mental Health. New York: Springer Science + Business Media LLC Beauchamp, T. & Childress, R. (2001). Principles of Biomedical Ethics. New York: Oxford University press. Boyd, M. (2007). Psychiatric Nursing: Contemporary Practice. Philadelphia: Lippincott Williams & Wilkins. Colman, A. (2009). Oxford Dictionary of Psychology (3rd ed). New York: Oxford University Press. Gray, S. (2008). Psychopathology: A competency-Based Assessment model. Belmont: Thomson Higher Education. Gunderson John G. & Paul S. Links (2008). Borderline Personality Disorder: A clinical guideI. Washington D.C: American Psychiatric Disorder Horwitz Leornado (1996). Borderline Personality Disorder: Tailoring the psychotherapy. Washington D.C: American Psychiatric Press Janssein, I. (2003). “Discrimination and Ideation.” A journal of department of psychiatry and neuropsychology, Maastricht University Netherlands, Vol. 1 No 1, pp 71-76. Johnson Craig (1991). Psychodynamic treatment of anorexia, nervosa and bulimia. New York: Guilford Press Kreger Randi (2008). The Essential Family Guide to Borderline Personality Disorder: New tools and techniques to stop walking on eggshells. Minnesota: Hazelden Publishers Lieberman A. & Tasman, A. (2006). Handbook of Psychiatric Drugs. Canada: John Wiley & Sons Linehan Marsha (1993). Cognitive-behavioral treatment of borderline personality disorder. New York: Guilford Press Oldham John M. (2005). The American Psychiatric Publishing textbooks of personality disorder. Washington D.C: American Psychiatric Publishing Paris Joel (1994). Borderline Personality Disorder: A multiple Dimension Approach. Washington D.C: American Psychiatric Press Reid, W. (1989). The Treatment Of Psychiatric Disorder Revised for the DSM-III-R. New York: Brunner/Mazel. Roberts, L. (2008). Professionalism and Ethics: Q & A self-study guide for mental disorder. Arlington: American Psychiatric publishing, inc Sadock, B. (2008). Kaplan & Sadock’s concise textbook of Clinical psychiatry (3rd ed). Philadelphia: Lippincott William & Wilkins Schultz, J. (2008). Lippincott’s Manual of psychiatric nursing care plans. Philadelphia: Lippincott’s William & Wilkins Szabo, C. (May 2000). “Ethics in the practice of psychiatry in South Africa.” A South Africa Medical Journal (SAMJ), Vol. 90 No 1, pp 1-6. Weiner, L. (2010). The Corsini Encyclopedia of Psychology Volume 2. Canada: John Wiley & Sons. Read More