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CHAPTER TEN: Nursing home

Paul Williams Karnac Books ePub

“Monsieur?”

Black swarthy eyes of a robed salt & pepper bearded pirate answered the knock on the heavy school door.

“Ah, bonjour, bonjour. Entrez.”

Pirate took his hand in both of his.

“Entrez, entrez. Je m’appelle Père Robine et je suis directeur de l’institut ici, au petit séminaire. Je suis enchanté de faire votre connaissance. Suivez moi.

Vous venez d’arriver?” 1

What?

Père Robine led him down a wood-panelled corridor a book-lined study chair glass of water awful English apologising in French brought to his senses a reminder that his French was awful no it wasn’t yes it was look at what was happening. McMorine said he was good at French how come he couldn’t understand a word the bus driver the woman in the shop the old man said now the pirate? The French didn’t speak French they spoke rat-a-tat-tat machine gun French not French he would have to learn as well? Should he leave all a mistake before he could Père Robine leaned forward make a point needed to reply at least something concentrated on the soft barrage made out nothing for a moment wondered Père Robine was Spanish or Italian taken the wrong plane wave of anger McMorine put him in this position Père Robine stopped staring awaiting a response not knowing what to say came up with

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Appendix

Paul Williams Karnac Books ePub
Medium 9781855750753

CHAPTER FOUR. Catatonia 1: psychotic anorexia

Murray Jackson Karnac Books ePub

Catatonia is the term used to describe a disorder, the main feature of which is a recurrence of episodes of catalepsy. The actual term was first used in a psychiatric context by Kahlbaum in 1874 in a classic monograph entitled “The Tension Insanity” (Johnson, 1993). Catalepsy is a state of extreme physical immobility and mutism, lasting for minutes or hours at a time. A characteristic of catalepsy is the spontaneous adoption of postures, perhaps statuesque or stereotyped, and the automatic maintenance of bodily positions imposed by the examiner. Cataleptic phenomena may also include trance or stupor. The origin of catalepsy can be psychogenic (as in hypnotic suggestion), pharmacogenic (induced by certain drugs, including neuroleptics), or organic (neurological disease such as encephalitis lethargica).

The association of catalepsy with schizophrenic features led to the diagnostic category of catatonic schizophrenia (Bleuler, 1950) and later to hopes that such patients might respond to psychoanalytic psychotherapy (Rosen, 1953). Initial optimism proved unjustified, and it was found that most attacks could be cut short by electro-shock treatment, although recurrence was usual. Catatonic schizophrenia was once commonly encountered in psychiatric practice and is now relatively rare. This is probably due to the powerful symptom-reducing capability of neuroleptic drugs and an increasing preference by clinicians for more sophisticated diagnoses. Nevertheless, catatonia remains a common presenting problem and challenges the psychiatrist’s skills in evaluating organic and psychogenic factors in each individual case.

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CHAPTER SEVEN: Halcyon days

Paul Williams Karnac Books ePub

Rugby needs boots teacher said play rugby boots no boots shoes slip another situation couldn’t speak about ashamed halfway season photographs hid found at back no feet teacher found boots too big old boots ran around what for? Ways to be violent few unexpected conflicts predictable moves repetitive fouls penalised chase pull them down hard as you like little talk the odd shouting no words part not part of a team ran round the same not the same.

Physical exercise out of breath not puffed the way you get after a workout heave bent double gulp in air after short running lag behind others. Pace himself offset worst effects no difference discovered how bad it could be running cross country quarter mile first stop each quarter heave dizzy stop sit lie go on last the only race useless. Years later asthma people called parents smoked grey box fume filled era of no risks the man called father never without a Player’s Navy Cut Woodbine Capstan Full Strength cancered to early grave courtesy of the three. The woman called mother continued to smoke the man called husband died of a heart attack do you hear this? Breathlessness sport repeated breathless exertion thousands of times a child overcome tired cold hunger fear the upshot walking the streets out of breath gasping abuse neglect exhaustion. At dawn in America an adult noticed a line of Black workers waiting for a bus slim blonde white woman tracksuit top shorts jogged past iPod music eyes of the queue follow her as one not ogling thinking.

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4. Thomas Freeman. The delusions of the non-remitting schizophrenias: parallels with childhood phantasies

Paul Williams Karnac Books ePub

Thomas Freeman

M Bleuler’s (1978) follow-up studies have confirmed the clinical observation that the course of the illness in non-remitting schizophrenias is towards the establishment of relatively stable ‘end states’. The term ‘end state’ as used by M Bleuler (1978) does not mean that the process of illness has come to an end, is incapable of further development for good or ill, or that further changes may not affect the personality. Only when the illness has continued in this relatively steady condition for five years can it be designated an ‘end state’. Although acute attacks may occur during ‘end states’ they are ephemeral and there is a return to the quiescent condition. M Bleuler distinguishes three types of’end state’: severe, moderately severe and mild. Dementia and defect state were the terms used in past times to describe the first two. The third type consists of those patients whose illness is not immediately obvious, who can conduct a rational conversation without the intrusion of delusional and hallucinatory experiences and can undertake useful work. The delusions which occur during the initial, acute attack of a schizophrenic psychosis are inclined to disappear along with other acute manifestations (E Bleuler 1911). In contrast the delusions which make their appearance when the illness follows a chronic course (non-remitting) tend to persist unchanged over many years (E Bleuler 1911). The introduction of drug therapy has not altered this apart from causing a transient disappearance of the delusions. The long-term observation of schizophrenic patients whose illnesses have reached ‘end states’ suggests that the content of the delusions is different from that present during the initial attack. The delusions to be described here are drawn from 12 cases, four of which had reached a severe ‘end state’ (three women and one man), six had reached a moderately severe ‘end state’ (four women and two men), and two, a mild ‘end state’ (one man and one woman). The retrieval of the delusions was sometimes easy, but occasionally very arduous. The greatest difficulty was encountered when there was inattention, withdrawal and cognitive disorganisation. The presence of thought-blocking, derailment of speech, the inappropriate use of words (loss of the symbolic, function), aberrant concepts (Schilder 1923) and neologisms combined to conceal the content of delusions (Freeman 1969). Perseverations, transitivistic phenomena and apper-sonations expressed in speech contributed to the confusion caused by the breakdown of syntax. The recovery of delusions in such severe ‘end states’ can therefore only be accomplished piecemeal. Fortunately there are occasions, however brief, when speech regains its communicative function and a detail of the patient’s delusional reality makes its appearance. These are occasions when the patient has a pressing need or is angry because of a disappointment (Freeman 1969). Although patients whose illness has reached a mild ‘end state’ can communicate verbally when they so desire, it is unusual for them immediately to reveal the details of their delusions. The reticence tends to disappear when they discern that an interest is being taken in their circumstances. After some weeks, however, a reluctance to continue with daily sessions begins to appear. Patients fear that they are wasting the psychiatrist’s time. Then they either stop attendance or become increasingly withdrawn. The psychiatrist may be accused of exerting a malevolent influence. Such a sequence of events occurs despite the chemotherapy. After a few weeks it is sometimes possible to re-engage patients in further meetings. However, after a short while the reluctance and withdrawal appear once more.

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