Jo, vi upptäckte att vi hade en mus i köket, de flyttar in nu de små rackarna. Eftersom Zorro och Teddy kamperar i varsin del av huset nattetid på grund av Zorros benbekymmer, Teddy har inte tillgång till köket då, så ställde vi ut en bur för att fånga musen. För musen var ju naturligtvis inte ute och sprang runt i köket när vi var uppe och stökade runt.

Och se, i morse så satt den arma musen i buren, något som Teddy så klart såg på en gång! Och då såg Zorro detsamma. Kan bara tänka mig den arma musens ångest, en katt på ena sidan som tassade på buren och en gigantisk hund som frustade som jag vet inte vad på andra sidan. Jag släppte ut musen i trädgården, tänkte att hon eller han genomlidit tillräckligt. Två minuter senare kommer en stolt katt in genom sin katttlucka, med en väldigt död mus… Jo han är en riktig jaktkatt Teddy!

Och när man talar om trollen, nu kom kattskrället in med en levande råtta!

Sko som både jeg og katta ville hatt glede av. Den ene kanskje mer enn den andre. Bildet er fra all4humor.

Musen fanns inte i min finfina fälla när jag vaknade, och den hade inte rört maten heller, så den är nog helt enkelt död. Det är nog bäst att jag börjar leta efter den innan det börjar lukta… :S

Har visserligen varit uppe en timme eller två, men nu är det dags att sätta sig i bilen och åka upp till ikea. Vi behöver köpa lite lakan, värmeljus och annat smått och gott.. Hörde nått om en liten shopingrunda inne på a6 oxå ^_^

Idag kör jag muffin/metalic vave/velvet på ögonlocken. Sjukt snygg mix – jag blev NÖJD!
Det kan ju öven hända att vi är ett av de mest posande paren i stan… återigen – just the way we like it ^_^

Har bokat en eftermiddags/kväll-date med Carro-love oxå. Vi ska skvallra av oss och tjata hål i huvudet på varandra, just the way we like it! Jag råkar veta att hon har galet mkt skvaller just idag.. sånt gillar vi ^^

Idag har varit en händelserik dag, den började imorse klockan 06.30 av att min kära katt Müsli kom jamandes in med en mus. De var levande och smet in under min säng, och där är den förmodligen fortfarande…

Sedan har jag skrivit för fullt på bloggBATTLEinbjudningarna, så nu är det upp till Sebastian Kjersén att få dem att se lite snygga ut också. För dej som inte vet kommer bloggBATTLE att vara under fashionDAYS 26-28 november så om du vet någon bra bloggare som borde vara med så LÄNKA!

Har försökt få tag på sand till akvariet också, men det enda (och bästa) stället, Borås Zoologiska, hade inte rätt sort så jag får leta vidare…

• Nuveen Investments to Offer New Mortgage Opportunity Term Fund
• China Signals That It May Allow Currency to Rise Against Dollar
• TFC October Monthly Update
• Illinois speeding toward budget disaster, study says
• How the middle class are shoplifting to keep up appearances
• Oil demand: A developing thirst
• Barrick shuts hedge book as world gold supply runs out
• ‘On the Brink,’ New York Must Cut, Paterson Says
• The Downside of a Loan Pickup
• Yuan to Resume Gains
• A 69% Capital Gains Tax Hike . . .
• Why Jim Rogers Isn’t Buying The Equity Rally (GLD)

Nuveen Investments to Offer New Mortgage Opportunity Term Fund

Posted: 11 Nov 2009 01:45 AM PST

Nuveen Investmentsannounced plans of a new closed-end fund, Nuveen Mortgage Opportunity Term Fund. Objective is to generate attractive total returns through opportunistic investments in mortgage-backed securities (“MBS”). Its investment objective investing in MBS directly, and indirectly through a separate investment in a public-private investment partnership formed pursuant to the Public-Private Investment Program (“PPIP”) established by the U.S. Department of Treasury (the “UST”).

Check out how others are using ETFs to capitalize on this news or add your own opinion

How the middle class are shoplifting to keep up appearances

Posted: 11 Nov 2009 07:07 AM PST

Middle-class shoppers who have been hit by the recession are stealing hundreds of millions of pounds of expensive food in an effort to maintain their high standard of living, according to a new survey.

ETFDesk users see this as a potential opportunity to: sell Retail HOLDRS; sell SPDR-Consumer Discretionary; sell SPDR S&P Retail ETF; sell iShares MSCI-U.K.;

Check out how others are using ETFs to capitalize on this news or add your own opinion

Oil demand: A developing thirst

Posted: 11 Nov 2009 07:58 AM PST

Transport will account for 97% of this increase as rising numbers of cars hit the roads of the developing world. Demand from these countries will overtake that of the industrialised OECD nations by 2030. By then, America, Japan and Europe will be using less oil than in 1980.

ETFDesk users see this as a potential opportunity to: buy PowerShares Dynamic Oil & Gas Services Portfolio; buy United States 12 Month Oil Fund, LP;

Check out how others are using ETFs to capitalize on this news or add your own opinion

Barrick shuts hedge book as world gold supply runs out

Posted: 11 Nov 2009 08:45 AM PST

Global gold production is in terminal decline despite record prices and Herculean efforts by mining companies to discover fresh sources of ore in remote spots, according to the world’s top producer Barrick Gold.

ETFDesk users see this as a potential opportunity to: buy Market Vectors Gold Miners ETF; buy streetTRACKS Gold Trust;

Check out how others are using ETFs to capitalize on this news or add your own opinion

‘On the Brink,’ New York Must Cut, Paterson Says

Posted: 11 Nov 2009 08:51 AM PST

Representative of financial problems of state and local governments

ETFDesk users see this as a potential opportunity to: sell iShares S&P National Municipal Bond Fund;

Check out how others are using ETFs to capitalize on this news or add your own opinion

The Downside of a Loan Pickup

Posted: 11 Nov 2009 09:23 AM PST

The danger for fixed-income investors is that ultraloose monetary policy, combined with a lack of new issuance, has pushed loan prices beyond reasonable levels. After all, a year-to-date total return of 80% on triple-C loans, as measured by S&P LCD, doesn’t come without risks. An increase in new issuance, while a sign of healing, would add to pressure for a correction in the near term.

ETFDesk users see this as a potential opportunity to: sell Van Kampen Senior Inc Tr; sell Van Kampen Dynamic Credit Opportunities Fund;

Check out how others are using ETFs to capitalize on this news or add your own opinion

Yuan to Resume Gains

Posted: 11 Nov 2009 10:59 PM PST

China will probably let the yuan start rising against the dollar in early 2010

ETFDesk users see this as a potential opportunity to: buy WisdomTree Dreyfus Chinese Yuan Fund;

Check out how others are using ETFs to capitalize on this news or add your own opinion

A 69% Capital Gains Tax Hike . . .

Posted: 12 Nov 2009 12:02 AM PST

Pelosi’s 5.4% income surtax would hit capital gains and dividends.

ETFDesk users see this as a potential opportunity to: sell DJIA DIAMONDS; sell S&P 500 SPDR; buy BlackRock MuniHoldings Insured Fund, Inc.;

Check out how others are using ETFs to capitalize on this news or add your own opinion

Why Jim Rogers Isn’t Buying The Equity Rally (GLD)

Posted: 12 Nov 2009 12:24 AM PST

“The only bubble I see forming in the Western world is in the U.S. government bond market. Other than that I don’t see any bubbles going on.”

ETFDesk users see this as a potential opportunity to: buy iShares Silver Trust; buy Market Vectors Gold Miners ETF; buystreetTRACKS Gold Trust; buy iPath Dow Jones-AIG Cotton Total Return Sub-Index.; buy iPath Dow Jones AIG Coffee Total Return Sub Index;

Check out how others are using ETFs to capitalize on this news or add your own opinion

Onsdag

Är jag full av energi eller vad? Under dagen har jag lärt mig en hel del nya saker som varit riktigt intressanta. Vem skall utföra en s.k. energideklaration av fastigheten och när – här idag svingat mig i §§§§ och föreskrifter hos Boverket. Innan hemgång hann jag med ett leverantörsbesök i Varberg också och fick lära mig lite om lysrör/lågenergilampor vs LED.

Idag var dessutom första gången jag hört om en organisation som heter IDA – International Dark-Sky Association. De jobbar mot ljusföroreningar – vad är nu detta? Jo, man vill undvika ströljus som ändå inte gör nytta, onödigt ljus kostar energi och är ofta irriterande.

Nu till något helt annat!

Jag kom tänka på denna bilden, som jag tog 2007, när en arbetskamrat berättade att han hade fått musbesök i helgen, eller rättare sagt hans fru fick sin dammiddag förstörd då en mus sprang över fötterna på gästerna i köket. Dagen efter var familjen ute på inköpsresa och letade efter en katt. Jag måste citera C:

- Jag ville inte som familjen ha en kattunge, utan jag ville ha en färdigutbildad bondkatt

Musen på bilden fastnade mellan tröskeln och dörren in till vårt garage när den försökte smita in. Jag hann före och slog igen dörren och lyckades på så sätt klippa musen mitt itu. Vad är oddset att lyckas med att fånga en mus i en dörr?

De flesta flygbolag är väldigt måna om säkerheten för sina flygningar. Men ibland inträffar saker som sätter denna på sin spets. Många tidningar, t ex DN, Expressen, SvD  och AB skriver om hur en berusad pilot stoppades i sista minuten innan han skulle lyfta med 124 passagerare från Heathrow. 

Ett annat sorts problem drabbade ett Boeing-plan enligt DN. En liten mus har nästlat sig ombord på planet och har trotsat alla försök att få bort den. Så nu har man tvingats att sanera hela planet.

De här engelska frimärkena ger ett gott intryck av kraften i ett modernt passagerarplan. Det vill till att piloterna har kvar all sin förmåga till att hantera det och att inga störande moment inträffar under flygning, ens om de orsakas av en liten oskyldig mus. Märkena utgavs 2002 till minne av 50 år med jetdrift i passagerartrafik. De visar dels nosen på en Airbus A340 och dels motorerna på det första jetpassagerarplanet, det så olycksdrabbade Comet.

Läs även andra bloggares åsikter om flygbolag, berusad pilot, mus, airbus, comet

An essay by Peter Kemp orginally published on Co-Cure

WordPress Shortlink: http://wp.me/p5foE-2lq

Medically Unexplained Psychologising of ME (MUPs)

Permission to repost

10 October 2009

In this essay I will explore some psychic phenomena that might be relevant to psychologising of illness.

Generalisations cannot practically be made, MUPs is not just heterogeneous from a psychic viewpoint – it is likely to be individual. So I can only explore my impressions and I hope you will read my theories as falling somewhere between the Origin of Speciousness and A Tale of Two Settees.

Use of some terminology has been unavoidable but I include a few definitions and illustrations as ‘Asides’ that I hope will help make the essay accessible to PWME.

Peter Kemp

Acronyms:

PWME = Person (or People) With ME

MUPs = Medically Unexplained Psychologising of ME

Medically Unexplained Psychologising of ME (MUPs)

Aside 1

AN ILLUSTRATION OF ‘PROJECTION’

Jack thinks that it would be very bad to be envious; this might be something his parents taught him. He notices envy in other people and condemns them for being envious. The envy that he so often notices might be real or not, it does not matter because it is HIS envy he is seeing. He is Projecting his envy onto other people to try and hide and control it within himself.

WITHDRAWAL OF PROJECTION

Projection is an unconscious process, people are not aware when they are doing it, but if they can become aware of the true source of a problem there may be an opportunity for growth.

One day Jack says to Jill, ‘I think you are envious of Mary’s little lamb’; and Jill says, ‘actually, I love Mary so much I gave her that lamb. I think you are envious because I get on so well with Mary.’ Jack’s theories fall apart and his projection is laid bare. If he is honest and humble enough he can then discover his own envy and stop projecting it. It may help if Jill points out ‘what’s wrong with being envious anyhow? It is part of how I know what I like and what I want’.

Through this uncomfortable experience Jack stops projecting envy and finds that natural feelings of envy can help him to make decisions about what he wants in life.

———————————————

Projected Fear

PWME represent ‘ideal’ subjects for the projection of all sorts of fears, Fear of losing control, Fear of weakness, Fear of illness, Fear of physical inadequacy, and perhaps worst of all, Fear of fear. For some MUPs I suspect that subtler projections and issues arise, such as Fear of being wrong and Fear of being misunderstood. All these fears have their roots in the psyche and are most troublesome when their origins are unconscious and when strongly denied. This may result in odd behaviour that may nevertheless be easily justified, but the justifications do not reveal the true motives behind the behaviour, instead they contribute to their concealment.

To confront fear it must be acknowledged but if it originates from an intense inner conflict it might be that the ego is not ready to withstand it. In these circumstances an internal struggle is maintained to repress some aspects of a complex in order to protect the ego. Enacting these conflicts in the world is a common way of reinforcing defences and avoids addressing the conflict directly. Unfortunately, this never resolves the issue at its source and means that substitute conflicts must constantly be found. As such projecting Fear may be predisposing and initiating; and because projection is an avoidance strategy, it is likely to be a maintaining factor in MUPs.

Withdrawal of Projection

For some people in whom contact with PWME arouses issues with fear, the psyche may seize this as an opportunity for growth. If someone projects fear onto another they may sometimes be able to compare their projection with the actual person. If discrepancies are found then the projection might start to weaken, then the projector has an opportunity to challenge and eventually withdraw the projection.

For example; a person fearful of losing control might project this onto a PWME; if they then realize that the PWME is actually coping well (with what for many people is a terrifying aspect of disability), the projector may think something like; ‘I thought he was weak, but I could not cope so well with such a loss of control’. This represents a stage of withdrawal of a projection as the projector has discovered that the source of the fear is within himself. Such situations might be considered MUPs based on transient / opportunistic factors; and is I suspect, a very common occurrence. Some MUPs might be able to relate to this if they find they vacillate between impatience and respect towards a PWME. This could be a sign that projections are weakening and the source of fear might be discoverable.

Victim Role and Rebelliousness

MUPs may assume a victim role when PWME decide they do not like their ideas. When PWME have been ill for a few years, they have probably been given so many ‘good’ suggestions that they may lose patience. Some such suggestions are not wholesomely motivated examples of Christian kindness. Instead, they originate from fear of helplessness. Even the most puerile suggestion can give the ‘suggester’ some sense of control over fear of being helpless. But if a PWME rejects these the MUPs might feel victimized (and they are, to the extent that the PWME has deprived them of a defence).

MUPs that promote psychological research and interventions sometimes go rather further than people who simply recommend ‘Yak’s milk yogurt’; and sometimes appear to actively court controversy in the way they promote their theories. This suggests that among other psychological processes there may be a desire to be rejected and to become a victim.

Rejection and criticism result in a feeling of victimization which may provide psychic rewards and become a maintaining factor. MUPs may include in their persona the progressive thinker, dissenter, radical and challenger. Inspection of such notions among active MUPs appears to show that they operate within systems that ensure they are safe and encourage their activities; so they appear more like conformists playing at dissention, contriving a ‘victim’ role.

The victim role is revealed when MUPs complain about patients. Some MUPs also complain about patient activists and patient support groups. To these MUPs, patients that oppose their ideas might reinforce a belief that they are acting honourably and bravely, challenging convention and standing-up to wicked bullies to promote the truth.

A MUPs persona of being a victim might appear ridiculous but is probably not in the sense that they may be experiencing some unconscious persecution; in the form of guilt. This common human experience results in a frequently seen phenomenon. Films, TV programmes and stories, both fiction and non-fiction carry stories of people who are ‘wrongly accused’. This theme is common because almost anyone can identify with it as it connects to profound aspects of the psyche.

Being unjustly accused is a desirable occurrence – provided that people have the opportunity and resources to defend themselves (else they are simply Scapegoats). It is desirable because it provides the chance to suppress by denial and misdirection, deep inner guilt. The guilt may originate from aggressive feelings towards the parents – Good Breast / Bad Breast (Klein); and Oedipus / Electra (Freud/Jung). Also present may be denied anger at very critical or weak parents. These and other troublesome psychic factors can make a victim role an attractive defence; and this is aside from the fact that people who are falsely accused are ‘outside the law’ – so to speak; so their defensive behaviour is pre-justified.

So false accusations give an opportunity to be aggressively self-righteous, all other sins and crimes sink into the background, suppressed by the noble fight to achieve justice.

If the Freudian or Kleinian developmental stages mentioned above interact with a critical complex the result can be deep and painful guilt. The crushing fear and powerlessness created by this type of complex make them very difficult to confront – quite simply, the conflict destroys the courage needed to address the complex; making it a self-perpetuating feature of the psyche. One way of controlling such powerful conflicts without addressing them directly is by enacting them in the world through projections.

Aside 2

ARCHETYPE AND COMPLEX

An ARCHETYPE is a symbol of some aspect of being human. Some important archetypes are Mother, Father, Child, Self, Masculine, Feminine.

Around these symbols gather ideas that represent aspects of the archetype. i.e., the Mother COMPLEX might include; ‘nourishment, nurture, protection, boundaries, discipline, control’ etc.

A complex can become one-sided if only certain aspects seem acceptable. A one-sided Mother complex might acknowledge ‘nourishment, nurture, protection’ but deny or repress ‘boundaries, discipline, control’.

A person with such a one-sided Mother complex which becomes significant in an interpersonal relationship (regardless of whether man or women) may find that they cannot establish boundaries or discipline or have any control.

———————————————

Rebellious Child

Associated with unconscious guilt is likely to be the rebellious child. MUPs may enact a characterisation of this aspect of the child complex which may have been suppressed in favour of the obedient child; or may never have had an opportunity to be satisfactorily expressed if parents were over-indulgent. The suppressed or undeveloped side of a complex does not disappear or remain completely powerless nor unexpressed. To put it crudely, it leaks out and as Freud and others recognised, it manifests itself in ‘Freudian slips’ and other unconscious behaviour including projection.

MUPs could cope with the rebellious child by projecting the characteristic onto PWME and then ‘deal with it’ there. This would provide 2 opportunities for the MUPs psyche, and these are likely to be attractive maintaining factors.

First is an opportunity to gain control of the ‘child’, enact parental control and superiority and enforce the parent’s will. This would be an expression of the internal struggle to contain the rebellious aspect of the child complex.

Second, the MUPs may attempt to relate to the ‘child’ in their projection. The MUPs may seek a point of contact through which they can start to understand the ‘child’ and through which relationship can be established. Because the process is unconscious, based on a projection and lacks a Mediator to relate the conflicting sides this would almost certainly lead to failure. Either of these enactments would almost certainly be a useless and confusing experience for the PWME.

Aside 3

MEDIATOR

When opposing sides of a psychic conflict are exaggerated; i.e., one side is very ‘good’ and the other very ‘bad’; they are unlikely to be managed or related without the help of a Mediator. In the example of the Child Complex opposing sides might be the Obedient Child and the Rebellious Child. In the richness of human experience there would also be within the complex other characterisations of the Child – for example a playful or mischievous child. These other aspects of the complex may be able to relate to both sides of the conflict so encouraging and developing them would reduce the power of the conflict. A benevolent Parent characterisation might be help to start this process – but the final goal would be a self-balancing complex rich with possibilities and choices.

———————————————

If a MUPs doctor is enacting a one-sided complex through interaction with a PWME, they are likely to be entering into a confusing relationship with an aspect of their own psyche; and will find, as expected, they cannot control it. So rather than resolving the MUPs conflict, interaction with their projection reinforces the need for repression and projection.

In these interactions the rebellious child can slip into the proceedings and can be observed when MUPs fail to conceal contempt for PWME by casting aspersions, usually in an indirect but unmistakeable manner. This behaviour may be ‘justified’ by assertions of an intent to help but these barely conceal the urge to attack PWME. This is an unconscious expression of frustration and suppressed rage at not being able to freely express or adequately control the rebellious aspect of the child complex.

As such PWME may pose a constant challenge to MUPs which leads to circular reasoning and an addictive maintaining factor. Because PWME represent both rebelliousness and weakness, which MUPs both fear and envy – the possibilities for projection are endless. The psychic attraction of PWME to MUPs is immeasurable in their construction of a love-hate relationship that meets their conflicting urges. Unfortunately for the PWME, the most one can say is that they might be in there somewhere.

If this sounds excessively speculative, consider this: What is it about ME that attracts MUPs? A desire to help? Take a good hard look at the outcome of their ‘help’; now you get the picture.

People are drawn towards other people that fulfil their need for either psychic safety or growth – this can override everything (IMO). It is this drive that MUPs perceive in ME – in other words, they believe the patient will throw away almost everything important in their life in pursuit of some psychic need manifesting via erroneous illness beliefs. The irony is, that this is precisely what some doctors who are MUPs appear to be doing; throwing their lives away on ME. Their failure to actually help patients is irrelevant compared to the fabulous psychic reward of finding the ideal subjects for projection. That their time and talents are being wasted is a negligible price to pay.

People who have very frightening one-sided complexes might be burdened with the idea that they are cowards; and might desperately struggle to conceal this. As Stephen King points out in Dolores Claiborne, the one thing a coward must prevent at all costs – is allowing anyone to discover they are cowardly. To this end people suffering inner fear may try to compensate by doing things they believe are ‘brave’; and this does work in many instances when the realization dawns that it is acceptable to be afraid. The ego is then prepared to confront the real source of its fears. Until this is achieved some people may feel that it is not alright to be afraid or show fear. This can result in people not only denying fear in themselves but also attacking it wherever they perceive it.

Parents of Children with ME

If MUPs have significant issues relating to a parent or parent figure this will almost certainly feature in their interactions around ME. Parents who show concern for a child with ME may be seen as not behaving as ‘proper’ parents should behave. A MUPs with child/parent issues might be envious of the child and angered by the parent – whose natural behaviour they deem wrong. As a result, instead of attacking their own parents – which could be a repressed desire, a MUPs may attack other parents, accusing them of over protectiveness and causing the child’s illness.

When MUPs doctors blame parents for a child’s ME they supersede the parents. Both the parent(s) and child are self-deceived but the deceit is inferior to the MUPs knowledge and powers of perception – so here is superiority. The MUPs is being a ‘better’ parent and therefore they are assuming a parental role. This might result in an unconscious expression of , ‘I wish my parents had been firmer with me’, manifesting as inconsiderateness for the child and condemnation of the parents.

Alternatively, a MUPs may attempt to construct a reparative experience, psychically forcing themselves into the parent/child relationship as both parent and child. This could be done in an attempt to evolve some missing condition needed for their psychic development as a child. This would be a disastrous intervention in which neither the parents nor their child with ME would be real; but relegated to characters in a MUPs reconstructed and alternatively-enacted childhood.

Bullying

Emerging from aggression and fear and directed at vulnerable people, bullying might be a tempting reward for some MUPs and a maintaining factor. Bullying MUPs may be torn between a longing to be treated sympathetically and a desire to be abused – and may unconsciously believe this is also what other people want. As a result of confused understanding of what constitutes a healthy relationship, some MUPs might feel justified in behaviour that equates to bullying.

Against all logic and evidence some MUPs claim that people with ME get sympathy for being ill. This is possibly because they themselves confusingly long for both sympathy and chastisement. They appear oblivious to the fact that the stigma of an ME diagnosis is horrible, or that no amount of sympathy could compensate for the terrible pain, disability and losses of ME; so they probably perceive stigma as more attention. Confusion over what makes a healthy relationship can become a regressive neurosis that prevents maturity and results in expression of either childish-weakness or childish-authoritarianism. The ‘childish’ aspect of these behaviours is recognisable in denial of responsibility; denying the feelings of others and ignoring criticism.

Aside 4

SELF-REFLEXIVITY

This is the ability to be sensitively aware of one’s own thoughts and feelings, even when subtle. In self-reflexive people these useful messages get through to consciousness and can be helpful in understanding interpersonal relationships. Self-reflexivity can be hampered if many thoughts and feelings are shut out by introjected ‘shoulds’ and ‘oughts’ (Rogers). These ‘shoulds’ can dictate not only what behaviour is acceptable, but also what thoughts and feelings are acceptable. This kind of internal censorship can obscure insightful thoughts and feelings.

EMPATHY

This is the ability to understand another person’s feelings ‘as if’ they were one’s own; being able to put oneself ‘in another persons shoes’ and accurately sense what it feels like for them. This is different from simply observing other people and having feelings about those observations, because this lacks the ‘as if’ quality. Some problems may prevent or distort empathy such as autistic spectrum disorders, narcissistic personality disorder, etc.

———————————————

The desire to control Weakness and Power may be an initiating factor in some MUPs if their psychic needs draw them towards vulnerable people. Many physicians and other healers have the predisposing factors proposed above, to become MUPs (sometimes termed ‘the wounded healer’) yet many do not succumb because they have, countering qualities.

The most important countering qualities are self-reflexivity and empathy. These can help as honest self-examination when the healer thinks; i.e., ‘God, I really hate that patient’, and then asks ‘why?’; continues to question their reaction and tries to understand the patient. In self-reflexive people this can bring the conflicting desires; 1. help the patient kindly and 2. clobber the patient with a bed-pan; into consciousness where they can be simply contained and not allowed to sabotage the healer/patient relationship. Because the self-reflexive healer has thereby dissolved potential rewards for MUPs; i.e., opportunities to project and bully, they do not succumb.

This kind of self-reflexivity is closely connected to psychic development and the gradual balancing of one-sided complexes; but can be challenging because it threatens the sense of knowing what to do and how to be. The conditions for resolution of many neuroses are created when people accept confusion and helplessness. When the taught and introjected rules of thought and behaviour are found to be inadequate in the complexities of adult interpersonal relationships, it is essential for a maturing individual to accept the confusion and lack of control inherent in such situations. Attempts to control or dominate these interactions is an enactment of the parental control over the child (or vice versa); and are an attempt to simplify complex interactions because of inadequate resources.

From this one might see that if MUPs insist on ‘knowing’ (what is wrong with) and taking ‘control’ of patients (symptoms) with ME they are setting up a Projective Identification. A suppressed part of the MUPs personality – for example, a rebellious and uncooperative child; is projected onto the patient. Once this has happened the patient, as a human being, all but disappears behind the projection.

The projection may be reinforced by the patient’s response. The vulnerable patient, who may be very ill and desperate for help may find it impossible to remain authentic; true to themselves. The patient may be drawn into the MUPs projection when they either respond as they believe the MUPs wants or react negatively. Once this happens the Projective Identification may set like concrete and will be very difficult to shift. From this point the chances for an authentic Adult-to-Adult, or Healer-to-Patient relationship are almost zero.

Aside 5

———————————————

PROJECTIVE IDENTIFICATION

This occurs when a projection subject is manipulated into responding in a way that confirms the projection.

Jack thinks Jill has issues with anger. Jack is a passive/aggressive and anger is Jack’s unconscious problem but he is projecting it on Jill. Every time they meet he says something like, ‘I hope you are not angry’; ‘please don’t get angry with me’; finally Jill gets angry and tells him to ‘shut up!’. Now Jack’s projection is confirmed – ‘I knew she was angry’; and by now she is – so the projection is identified in Jill and becomes a 2-way aspect of their relationship.

———————————————

The Self-Serving Bias

Maintaining factors of MUPs may include a phenomenon known as the ‘Self-Serving Bias’. This is a tendency to blame other people for personal or systemic failures along with a tendency to take credit for successes. This natural characteristic can become exaggerated in egotistical people; those for whom being ‘right’ and ‘winning’ are imperatives. It may be an expression of deep-seated insecurity compensated by a super(wo)man-complex. This common trait can go too far to the extent that people can lose the capacity to blame themselves. This means they are unable to question their logic; acknowledge challenges or admit fault. People with this trait, are highly susceptible to flattery (which they will hotly deny – believing that their honesty and powers of judgment are so excellent, that if they think they are right, that is praise enough for them). Their inability to question their logic is due to an imperative to not change their minds – not to be wrong; and may go beyond simple arrogance or overconfidence to indicate a fragile psychic structure propping up too much ego that must be protected by ‘being right’. In other words, the fragility must be constantly repaired and reinforced because the consequences of being wrong is feared to be (and could be) catastrophic for the ego.

Fear of Movement

Some research papers refer to ‘fear of movement’ (kinesophobia) in people with ME. In every human at every point in their life, there exists some potential – and at every moment of their life they experience at some level the struggle between stasis; remaining the same; and growth; ‘moving’ into the potential person. Stay still too long and when the change/growth/movement comes it is likely to be an upsetting – though possibly also a cathartic experience.

Transformation almost invariably includes loss of something along with what is gained. Theorists that study the Phases of Life tend to believe that major transitions occur every few years and can sometimes be traumatic or at least dramatic in some way; but that once the transition is accomplished the person is reasonably set and stable for the ensuing phase. Whether development is continuous or phasic or includes both, there is always a possibility of some difficult undeveloped aspects of the psyche presenting problems.

So ‘fear of movement’ could be a projection of ‘fear of (psychic) movement’. The person who is perceived as afraid to move represents an inner fear of moving and transforming – with the threatened loss that accompanies such change.

‘Fear of movement’ theories might also represent an enactment of the battle of wills that can occur between parent and child, often occurring during the ‘terrible twos’ and the anal stage (Freud). Simply, the PWME says that movement is difficult, painful, exhausting; the MUPs says it is not, the PWME is just afraid; so to the MUPs this is a battle of wills.

This provides the MUPs with an opportunity to enact a representation of parental ‘bullying’, exercising power against a physically weaker, less powerful person. The MUPs assumes the role of power which is the parent, so in their enactment the PWME represents the child.

In the Anal phase, children of psychologically healthy parents get enough of their own little victories to begin to find their independence. If parents are excessively controlling or obsessive then children may fail to gain a balanced and sharing view of power and control – losing their ‘self-will’ and introjecting the parent’s will. If the parents are neglectful or overindulgent the child might miss out on learning to strive for and eventually, negotiate for their wishes.

In this important phase of development a warped process would be likely to result in major control and power issues. Claiming that a person severely incapacitated by ME is afraid to move is an enactment of an excessively controlling parent and a projective identification (in which the PWME does not have to do anything – which is just as well).

Deception

A fundamental factor in MUPs is that the patient is not believed. Patient’s statements about symptoms and disability are untrue – whether false, exaggerated or originating from misperception; they are not telling the truth. PWME can encounter this attitude just about anywhere, from the supermarket to their doctor’s surgery; from relatives to complete strangers writing in a newspaper.

This might relate to MUPs fear of being misunderstood, whilst at the same time believing that they cannot be understood. No one will believe them and their actions will be misinterpreted. In the curious balancing (or rebalancing) nature of the psyche this means they unconsciously seek to discover and understand deception.

This gives them power over deception; and because it relates to an inner sense of guilt – when deception is exposed it brings a sense of safety. The defences against the danger of being misjudged have been strengthened and the guilt remains hidden.

One conflict that might arise is a longing to be completely honest conflicting with a desire to keep something safely hidden – which might relate to what Jung described as ‘the secret’, ‘the rock on which the patient will break.’

This might lead to cunning behaviour and dalliance with risks that would expose the secret, an exciting game of ‘chicken’ or ‘catch me if you can’; which might at the same time strengthen defences against discovery of guilt. This leads to the Trickster.

The Trickster Archetype

Looking for the psychic liar and deceiver leads to an interesting archetype, that of the Trickster. A good example of the Trickster archetype is Gollum in Lord of the Rings. The Trickster may appear friendly and turn nasty or vice-versa, but in the end their activities and interaction with them results in growth and is generally desirable.

When MUPs perceive deception in ME they are unconsciously seeking input from the Trickster. This indicates that the psychic status-quo is ready and waiting to be disrupted; there is an unconscious drive to seek the challenges and chaos from which a matured ego can emerge.

The problem with the Trickster is that it cannot be controlled – that is its whole purpose in being unreliable, to remove control and deliver the reluctant psyche into chaos. All one can do with the Trickster is respond to it on an event-by-event basis, all knowledge and experience prove inadequate as the Trickster leads to greater and greater confusion and danger; as well as excitement and opportunity.

The MUPs disbelief of PWME suggests fear of losing control conflicting with a longing to plunge into the crazy world of the Trickster; where fragile (and useless) structures of the conscious ego will crumble and a matured, stronger ego can eventually emerge. As the Trickster may be a companion of the Hero it is the Hero that embarks on the journey into chaos and battles with the monsters found there. So here again we see the need for courage – a characteristic that some MUPs appear to assign to themselves, whilst denying the same in PWME. However, Heroes fight monsters in order to be heroic; they don’t go tilting at windmills.

Being Disabled

As mentioned above, at an unconscious level people are always seeking psychic growth and are drawn towards activities and other people that can provide opportunities for growth. As the greatest growth is almost always arduous and often frightening, the urge for growth is hampered by the longing for comfort and safety.

Considerable disability is seen in a substantial number of PWME, though they don’t always look ill or have obvious signs to connect with their disability. Therefore when the actual person and their illness and suffering is ignored or denied, PWME may be perceived as being like a dependent child. This might evoke envy in those who feel unsupported in some aspect of their lives and who long to regress into childish dependency. In such people any doubt about PWME’s entitlement to support is likely to evoke an aggressive reaction to what they perceive to be the fraudulent acquisition of what they desire.

Several theories/philosophies describe ideas about the importance of later life development with concepts such as Individuation, Self-Actualization, Psychosynthesis, Becoming, etc. A number of psychic factors can hamper this development to the point where they may render it an almost impossible goal. Fear is likely to be foremost among these when it is experienced from very one-sided complexes, but with almost equal power to stop growth, is ego-inflation. The sense of power and knowledge that come from getting some way into maturity can be highly seductive – and not altogether illusory. People who can get through the early, difficult and often embarrassing stages of developing the Inferior Function, integrating the Shadow and resolving some conflicts can gain some real wisdom – though not as much as is sensed. The sensation of power can lead to ego-inflation that without effort, honesty and humility can completely stop growth and lead to a warped personality.

Combined with fear, which makes movement challenging; ego-inflation could feel like a wonderful reward for staying right in one place – which would be the same as becoming psychically disabled. It would be little wonder therefore, if an egotistical MUPs was strongly attracted towards people who are disabled – but who ‘ought’ to get back into action. If this occurred it could be a projective identification with such an exquisite match that no input from the PWME is required – all they have to do is exist. In fact if they did not exist the MUPs would have to create them.

When honesty and humility are not enough to counter ego-inflation, people are sometimes helped by the astounding mistakes that can result from this warped state (though they may not always be ‘mistakes’ but unconscious contrivances; perhaps designed by the Trickster). Provided they do not wriggle out of these mistakes, they can be a powerful call to the inflated-ego to do some honest self-evaluation which restores human frailty to the ego; rescuing the psyche from stagnation and restoring the Self’s potential.

Conclusion

MUPs appears to be a defence. It can protect a fragile psyche from Fear, the discovery of guilt and subsequent blame and provides opportunities to project and avoid addressing inner conflicts. Because MUPs is an avoidant process it may become self-perpetuating.

© 2009 Peter Kemp

Quittenmus

Quittje

Den langweiligen Sonntag habe ich genutzt, mir eine höchst aromatische Süßspeise zuzubereiten: Quittje-Mus. Die Quittje zeichnet sich durch ihre sonnengelbe Strahlefarbe, ihren angenehm fruchtigen, intensiven Geruch und ihren herben Geschmack aus (zumindest wenn roh verzehrt). Man könnte sie als eine etwas störrische Frucht bezeichnen und insofern passt sie dann auch sehr gut zu mir.

Quittenmus Rezept:

“Quittenmus wird wie Apfelmus hergestellt. Man gibt zu 1 Liter durchgestrichenem Mus 100g Zucker.”

Rezept Quittenmus

Und Apfelmus? Apfelmus geht eigentlich logisch. Aber nach Rezept geht es folgendermaßen:

“Die Quitten werden sauber gewaschen, in Schnitze geschnitten und mit wenig Wasser weichgedämpft.”

Sauber gewaschen.

"Wurmige oder faulige Teile müssen entfernt werden." Kerne auch?

In Schnitze geschnitten.

Mit wenig Wasser ins Dampfbadsieb.

Bis das Obst weich ist.

“Danach treibt man dasselbe durch ein Sieb,gibt Zucker nach Geschmack zu und kocht es so dick wie möglich ein.”

80 Jahre später benutzt man noch schnell einen Pürierstab...

...gibt Zimt&Zucker zu...

..und drückt die Quittje dann durch ein Sieb.

“Zum Schluss füllt man das Mus in trockene, gut erwärmte Gläser und stellt sie so lange in den Backofen, bis sich oben eine lederartige Haut gebildet hat.”

Bä! Das spar ich mir:

Hm. Naja. Durch den Zimt isses halt nimmer sonnengelb.

Quittjemus mit Joghurt. SEEEEHR LECKER!

Schmeckt echt sehr gut und besser als Apfelmus. Aromatischer und frischer irgendwie. Und irgendwie anders…

So. Wer das Originalrezept haben möchte, der kann das gerne hier bei mir anfordern oder sich mit mir zum Quittjemusnachmittag verabreden. In Hamburg isses ja total in, Kochkurse zu belegen. “Kochen lernen” ist wieder attraktiv geworden und nicht jeder hat schließlich so ein superduper-Oma-Kochbuch, wie ich. Werde demnächst probieren, die Quittjes auch in meine Weihnachtsbäckerein einzubauen. Sicher auch toll.

Wusste ja schon Herr von Ribbeck auf Ribbeck im Havelland, dass Quitten äußerst vergnügliche Früchten sind, die zu lyrischen Köstlichkeiten führen. Havelland. Genau. Wo ist das eigentlich, dieses “Ribbeck”? Dachte mir schon, dass das irgendwo in Norddeutschland sein muss. Und siehe da, nur 250km von Hamburg entfernt liegt “Ribbeck” an der Hamburger Straße! Ja geht denn die 250km lang von Hamburg nach Ribbeck?

Ribbeck an der Hamburger Straße (googlemaps)

Wäre auch mal eine Idee für eine Fahrradtour

E

Baby Z, som den australske babyen blir kalt, har en genetisk feil som kalles molybdenum cofactor deficiency. Denne defekten fører til en opphopning av giftig sulfid og fører vanligvis til anfall, hjerneskade og smertefull død innen få måneder.

Les også: Giuliano (5) er verdens sterkeste barn

Først i verden:
Bare tre dager etter at den lille jenta, som den første i verden, hadde fått medisinen, gjorde hun store framskritt. Medisinen var tidligere ikke var testet på mennesker. Medisinen var angivelig før kun testet på mus!
”Når vi ser henne nå, er hun bare et mirakel, hun har trosset alle”, sier moren til Baby Z, som ikke kan navngis, skriver nyhetsbyrået AFP. Dette vil gi håp også for andre som evt. måtte få denne sykdommen, alternativt også andre sykdommer.

Det beviser vel bare at avstanden mellom mennesker og dyr sine gener i sammenheng med sykdom, kanskje ikke er så stor som vi gjerne vil tro! Vi vet jo fra før at hjerter fra gris er blitt innoperert i mennesker, (om enn med større eller mindre hell).

Ba om hjelp:
Baby Z begynte å få anfall innen tre døgn etter at hun ble født i mai 2008 begynte. Familien ba biokjemiker Rob Gianello om hjelp til å behandle den tidligere uhelbredelige tilstanden som bare rammer en av en million. Altså er dette en uhyre sjelden sykdom heldigvis!

Akex Veldman, som er den lille jentas lege, forteller at Gianello ble oppmerksom på medikamentet som tyskeren Gunther Scwarz med hell hadde brukt på mus, men aldri hadde testet på mennesker.

Jobbet på spreng:
Mens legene jobbet på spreng for å få dette medikamentet, cyclic pyranopterin monophosphate (cPMP), sendt fra Tyskland til Australia, og samtidig jobbet for å etisk godkjennelse for å bruke det, ble tilstanden til Baby Z dårligere og dårligere.
Få timer etter at den lille hadde fått sin første dose av cPMP, falt sulfidnivået med mer enn to tredeler og nådde normalt nivå innen tre dager.

Utrolig respons:
Ifølge Veldman livnet Baby Z raskt til og i løpet av tre uker av antall anfall redusert med 90 prosent. ”Vi kan behandle dette hos mennesker for første gang i menneskehetens historie. Det har potensial til å redde liv rundt omkring i hele verden”, legger han til.

Les også: Nesten 1000 kinesiske barn blyforgiftet

Fysisk aktiv:
Hjerneskaden Baby Z fikk som følge av den genetiske defekten, hadde hemmet utviklingen hennes. Ifølge moren er den nå 18 måneder gamle jenta fysisk aktiv og har begynt å snakke.
”Det går bedre og bedre dag for dag. Vi betrakter henne hver dag og tenker: “Wow”, sier hun.
Veldman mener Baby Z vil trenge en dose cPMP hver dag resten av livet.

Les hele saken på VG

1. Raner i sædbanken: Drikk 1 dl sperma! Skremt drikker hun… Raneren tar av masken, det er hennes mann som sier: Der ser du! Du kan hvis du vil!

2: Det smarteste i kroppen? Orgasmen! Uten den hadde vi pult oss i hjel…

3: Ifølge ny skattelov vil det bli lagt skatt på aktiv sex. Du kan derfor regne med å få penger tilbake…

4: Denne SMS er fra toll og skattedirektoratet. Vi er nå begynt å innkreve skatt for SEX, og vi vil derfor informere deg om at du får penger tilbake i år…

5: Hva er likheten mellom KIWI og å runke? Kjapt, trygt og billig…!

6: Konklusjonen på en kvinne i overgangsalderen: Det siste egget er lagt, men høna er like god…!

7: Vet du hva som er mindre enn musa til myggen? Dotten til knotten…

8: Hva er loddent utenpå og deilig og varmt inni? Hint: Begynner på FI har to T’er og slutter på ER… Svar: FILTTØFLER!

9: Oppskrift på trollkrem: Pass på når dama har eggløsning, da putter du fitta full av tyttebær… og så puler du som faen!

10: På sinnssykehuset: En neger står på rommet sitt med pikken stappa nedi en pose peanøtter. En ansatt spør: “What are you doing”? Pasienten: “I’m fucking nuts”!

Extra Small Pinkies                                                                                                                                                                                                                                                                                                                                                                                                                                  1 dag gammel . uten pels og de er rosa i farge .

Antall pr Pakke   : 100 stk
Lengde (Cm)        : 1.20 – 2.5*
Vekt (Gram)         : 0.5 - 1,9 g

Small Pinkies                                                                                                                                                                                                                                                                                                                                                                                                                                                                      1 til 2 dag gammel . uten pels og de er rosa i farge .

Antall pr Pakke   : 100 stk
Lengde (Cm)        : 1.20 – 2,5*
Vekt (Gram)         : 3.1 – 4,4 g

IKEAs senaste. Mus 9kr. Inhandlad på “nya IKEA” i Malmö igår.

I bakgrunden IKEAs råtta

Säger bara en sak……SUPERSTRESS….vilket jag inte är riktigt bra på att hantera längre…..jag orkar egentligen rent praktiskt bara 2 saker max om dagen……det låter lite men är för mig ett berg att bestiga…….ny denna vecka ligger det på 3 saker per dag….och det är tisdag…….reflektion 3 dagar kvar…….hur sjutton skall man orka ?……..Jag var tvungen att lägga mig som vanligt en stund på eftermiddagen……det går en hel del tid till att sova……..Idag fick jag gjort mitt avstämningsmöte med FÖRSÄKRINGSKASSAN……de kommer att ligga lågt till slutet på februari….då en ny avstämmning skall göras…..PUST nu var det över men det är som vanligt en pärs……

Vännen som suttit anhållen släpptes idag……..oskyldig!!!!!!!.Ja han var oskyldig……det gläder mitt hjärta att han var det….så mycket…….Tyvärr vet jag ju också vem som gjorde det…vilket å andra sidan är en tragedi…..Varför skall det alltid vara så komplicerat ?

Klösan

Apple gör så sjukt snygga grejer. Så snygga att man bara vill köpa allting nytt som de släpper. Så var det med deras senaste släpp av ny hårdvara och den här musen ser ju bara så underbart snygg ut. Måste ha på direkten alltså. Som tur är har jag inte ännu någon mus till min MacBook så när den här väl kommer ut i butik tänkte jag köpa upp en på direkten. Vad tycker ni själva?

Mus

Mooi plantenbakje gekregen, pinda’s en vetbol erop.
En binnen 5 minuten hebben de vogeltjes het mooie decor al gevonden
Ook namens de vogeltjes bedankt
Foto ’s zijn gisteren gemaakt, opvallend is dat op de achtergrond de klaproos weer helemaal opgekomen is.

Dit vond ik ook zo grappig een mus en een pimpelmees aan de pinda’s.
Is weer volop genieten in de tuin.

Image | belgianchocolate | Creative Commons

Keywords

APA    DSM    DSM-IV    DSM-V    WHO    ICD    ICD-10    ICD-11    American Psychiatric Association    Diagnostic and Statistical Manual of Mental Disorders    World Health Organization    Classifications    DSM Revision Process    DSM-V Task Force    DSM-V Somatic Distress Disorders Work Group    Somatic Symptom Disorders Work Group    DSM-ICD Harmonization Coordination Group    International Advisory Group    Revision of ICD Mental and Behavioural Disorders    Global Scientific Partnership Coordination Group    ICD Update and Revision Platform    WHO Collaborating Centre    CISSD Project    MUPSS Project    Somatoform    Somatisation    Somatization    Functional Somatic Syndromes    FSS    MUS    Myalgic encephalomyelitis    ME    Chronic fatigue syndrome    CFS    Fibromyalgia    FM    IBS    CS    CI    GWS

The Elephant in the Room Series Three:

Journal of Psychosomatic Research In Press: Is there a better term than “Medically unexplained symptoms”?

WordPress Shortlink for this posting: http://wp.me/p5foE-2d6

24 October 2009

An In Press version of the Editorial: Is there a better term than “Medically unexplained symptoms”?, to be published in a forthcoming issue of the Journal of Psychosomatic Research, is already available online (purchase required). The Editorial needs to be read in conjunction with a white paper from:

The European Association for Consultation-Liaison Psychiatry and Psychosomatics (EACLPP) http://www.eaclpp.org/

A white paper of the EACLPP Medically Unexplained Symptoms study group

Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems  (Gillian.D.Dunkerley@manchester.ac.uk )

The White Paper can be downloaded from the EACLPP site here: http://www.eaclpp.org/working_groups.html

The document is approx 76 pages long, including tables and charts.  I had considerable difficulty opening this document, in May, due to a corrupted table and I note that the file on the EACLPP site is still glitchy. A copy of the document was therefore obtained directly from the EACLPP and can be opened by clicking the link below.  Note that there may have been revisions to the document as supplied on 19 May, but it will serve as reference for those who might also experience difficulties opening the file from the EACLPP website. If you would like a copy of the file sent to you as a Word.doc, email ME agenda with “EACLPP MUS DOC” in the subject line and I will forward a copy [600 KB].  The tables and charts are slow to load.

Draft – prepared by: Peter Henningsen and Francis Creed January 2009

EACLPP Working group on MUS version 16 Jan 2009

The current issue of the Journal of Psychosomatic Research is Volume 67, Issue 5, Pages A1-A4, 367-466 (November 2009)  http://www.sciencedirect.com/science/journal/00223999

Journal of Psychosomatic Research

In Press

Editorial
Is there a better term than “Medically unexplained symptoms”?

Abstract: http://tinyurl.com/jpsychoresMUS

doi:10.1016/j.jpsychores.2009.09.004

References and further reading may be available for this article. To view references and further reading you must purchase this article.

Editorial

Francis Creed a, Elspeth Guthrie a, Per Fink b, Peter Henningsen c, Winfried Rief d, Michael Sharpe e and Peter White f

a University of Manchester, Manchester, UK 
b University Hospital Aarhus, Denmark
c Technical University, Munich Germany
d University of Marburg, Germany
e University of Edinburgh, UK
f Queen Mary University of London, UK

Received 24 August 2009; revised 24 August 2009; accepted 7 September 2009. Available online 17 October 2009.

Article Outline

Introduction

“Medically unexplained symptoms” – one advantage, but many reasons to discontinue use of the term

Criteria to judge the value of alternative terms for “medically unexplained symptoms”

Terms suggested as alternatives for “medically unexplained symptoms”

Implications for treatment

Implications for DSM-V and ICD-11

Conclusion

References

Note:

Francis Creed is Co-Editor of the Journal of Psychosomatic Research.

Francis Creed, Per Fink, Peter Henningsen and Winfried Rief were all members of the international CISSD Project, (Principal Administrators: Action for M.E.; Co-ordinator: Dr Richard Sykes. Dr Sykes is now engaged in the “London MUPSS Project” in association with the Institute of Psychiatry).

Michael Sharpe was UK Chair for the CISSD Project.

Michael Sharpe and Francis Creed have been members of the APA’s DSM-V Somatic Distress Disorders Work Group since 2007.

Francis Creed (UK), Peter Henningsen (Germany) and Per Fink (Denmark) are the co-ordinators of European EACLPP MUS Work Group.

Francis Creed and Peter Henningsen were the authors of “A white paper of the EACLPP Medically Unexplained Symptoms study group – Patients with medically unexplained symptoms and somatisation – a challenge for European health care systems”, January 2009.

Draft white paper here: http://www.eaclpp.org/working_groups.html

Per Fink is a member of the Danish Working Group on Chronic Fatigue Syndrome, established in August 2008 and expected to complete its work in spring 2009.

An Editorial: The proposed diagnosis of somatic symptom disorders in DSM-V to replace somatoform disorders in DSM-IV – a preliminary report by DSM-V Work Group members, Joel Dimsdale and Francis Creed on behalf of the DSM-V Workgroup on Somatic Symptom Disorders was published in the June 2009 issue of the Journal of Psychosomatic Research.

Full text of the June 2009 DSM-V SSD Work Group preliminary report can be accessed here:

http://www.jpsychores.com/article/S0022-3999(09)00088-9/fulltext

See section: Psychological factor affecting general medical condition 

“…The conceptual framework that we propose will allow a diagnosis of somatic symptom disorder in addition to a general medical condition, whether the latter is a well-recognized organic disease or a functional somatic syndrome such as irritable bowel syndrome or chronic fatigue syndrome…”

No updates or reports have been published on the APA’s website by DSM-V Task Force or Work Groups since brief reports issued in April 2009. DSM-V is anticipated to be finalised in May 2012 with field trials expected to start this October. No detailed Timeline for DSM-V is available.

Previous DSM Task Force chairs, Robert L Spitzer and Allen Frances, have been two of the most vocal critics of the current Task Force’s oversight of the revision process. Read their joint letter to the APA Board of Trustees here:  Letter to APA Board of Trustees July 09. In Dr Frances Responds to Dr Carpenter: A Sharp Difference of Opinion, Psychiatric Times, 9 July, Frances called for the posting of all the suggested wordings for DSM-V criteria sets well before considering field trials.

Javier Escobar, co-author of the Special Report: Unexplained Physical Symptoms: What’s a Psychiatrist to Do? Psychiatric Times, Aug 2008, was also a member of the Work Group for the “Conceptual Issues in Somatoform and Similar Disorders (CISSD) Project.

Javier Escobar is a member of the DSM-V Task Force, serves as a Task Force liaison to the Somatic Symptom Disorders Work Group and said to work closely with this work group.

http://www.psychiatrictimes.com/display/article/10168/1171223

01 August 2008
Psychiatric Times. Vol. 25 No. 9
Special Report

PSYCHIATRY AND MEDICAL ILLNESS
Unexplained Physical Symptoms What’s a Psychiatrist to Do?

Humberto Marin, MD and Javier I. Escobar, MD

According to Escobar and Marin:

“The list of somatoform disorders kept expanding with the addition of vague categories, such as “undifferentiated somatoform disorder” or “somatoform disorder NOS [not otherwise specified],” which, unfortunately, are the most common diagnoses within the somatoform genre. These terms failed to transcend specialty boundaries. Perhaps as a corollary of turf issues, general medicine and medical specialties started carving these syndromes with their own tools. The resulting list of “medicalized,” specialty-driven labels that continues to expand includes fibromyalgia, chronic fatigue syndome, multiple chemical sensitivity, and many others (Table 1).

Table 1

Functional somatic syndromes

Irritable bowel syndrome
Chronic fatigue syndrome
Fibromyalgia
Multiple chemical sensitivity
Nonspecific chest pain
Premenstrual disorder
Non-ulcer dyspepsia
Repetitive strain injury
Tension headache
Temporomandibular joint disorder
Atypical facial pain
Hyperventilation syndrome
Globus syndrome
Sick building syndrome
Chronic pelvic pain
Chronic whiplash syndrome
Chronic Lyme disease
Silicone breast implant effects
Candidiasis hypersensivity
Food allergy
Gulf War syndrome
Mitral valve prolapse
Hypoglycemia
Chronic low back pain
Dizziness
Interstitial cystitis
Tinnitus
Pseudoseizures
Insomnia
Systemic yeast infection
Total allergy syndrome”

These labels fall under the general category of functional somatic syndromes and seem more acceptable to patients because they may be perceived as less stigmatizing than psychiatric ones. However, using DSM criteria, virtually all these functional syndromes would fall into the somatoform disorders category given their phenomenology, unknown physical causes, absence of reliable markers, and the frequent coexistence of somatic and psychiatric symptoms.”

DSM-V and ICD-11 have committed as far as possible “to facilitate the achievement of the highest possible extent of uniformity and harmonization between ICD-11 mental and behavioural disorders and DSM-V disorders and their diagnostic criteria” with the objective that “the WHO and APA should make all attempts to ensure that in their core versions, the category names, glossary descriptions and criteria are identical for ICD and DSM.”

The International Advisory Group for the Revision of ICD-10 Mental and Behavioural Disorders most recent meeting took place on 28 – 29 September. It is anticipated that a Summary Report of the meeting will be available in late November/December.

For detailed information on the proposed structure of ICD-11, the Content Model and operation of iCAT, the collaborative authoring platform through which the WHO will be revising ICD-10, please scrutinise key documents on the ICD-11 Revision Google site:

https://sites.google.com/site/icd11revision/
https://sites.google.com/site/icd11revision/home/documents

For information around the DSM and ICD revision processes see DSM-V and ICD-11 Directory page: http://meagenda.wordpress.com/dsm-v-directory/