Pacientes produtores ativos de saúde (prosumo)

Essa avalanche de informações e conhecimento relacionada à saúde e despejada todos os dias sobre os indivíduos sem a menor cerimônia varia muito em termos de objetividade e credibilidade. Porém, é preciso admitir que ela consegue atrair cada vez mais a atenção pública para assuntos de saúde - e muda o relacionamento tradicional entre médicos e pacientes, encorajando os últimos a exercer uma atitude mais participativa na relação. Ironicamente, enquanto os pacientes conquistam mais acesso às informações sobre saúde, os médicos têm cada vez menos tempo para estudar as últimas descobertas científicas ou para ler publicações da área - on-line ou não -, e mesmo para se comunicar adequadamente com especialistas de áreas relevantes e/ou com os próprios pacientes. Além disso, enquanto os médicos precisam dominar conhecimentos sobre as diferentes condições de saúde de um grande número de pacientes cujos rostos eles mal conseguem lembrar, um paciente instruído, com acesso à internet, pode, na verdade, ter lido uma pesquisa mais recente do que o médico sobre sua doença específica. Os pacientes chegam ao consultório com paginas impressas contendo o material que pesquisaram na internet, fotocópias de artigos da Physician's Desk Reference, ou recorte de outras revistas e anuários médicos. Eles fazem perguntas e não ficam mais reverenciando a figura do médico, com seu imaculado avental branco. Aqui as mudanças no relacionamento com os fundamentos profundos do tempo e conhecimento alteraram completamente a realidade médica. Livro: Riqueza Revolucionária - O significado da riqueza no futuro

Aviso!

Aviso! A maioria das drogas psiquiátricas pode causar reações de abstinência, incluindo reações emocionais e físicas com risco de vida. Portanto, não é apenas perigoso iniciar drogas psiquiátricas, também pode ser perigoso pará-las. Retirada de drogas psiquiátricas deve ser feita cuidadosamente sob supervisão clínica experiente. [Se possível] Os métodos para retirar-se com segurança das drogas psiquiátricas são discutidos no livro do Dr. Breggin: A abstinência de drogas psiquiátricas: um guia para prescritores, terapeutas, pacientes e suas famílias. Observação: Esse site pode aumentar bastante as chances do seu psiquiatra biológico piorar o seu prognóstico, sua família recorrer a internação psiquiátrica e serem prescritas injeções de depósito (duração maior). É mais indicado descontinuar drogas psicoativas com apoio da família e psiquiatra biológico ou pelo menos consentir a ingestão de cápsulas para não aumentar o custo do tratamento desnecessariamente. Observação 2: Esse blogue pode alimentar esperanças de que os familiares ou psiquiatras biológicos podem mudar e começar a ouvir os pacientes e se relacionarem de igual para igual e racionalmente. A mudança de familiares e psiquiatras biológicos é uma tarefa ingrata e provavelmente impossível. https://breggin.com/the-reform-work-of-peter-gotzsche-md/

terça-feira, 11 de abril de 2017

Rorschach and his inkblots: The man, the test, the controversy

https://www.newscientist.com/article/mg23431200-500-rorschach-and-his-inkblots-the-man-the-test-the-controversy/?cmpid=SOC|NSNS|2017-Echobox&utm_campaign=Echobox&utm_medium=Social&utm_source=Facebook#link_time=1491829275

Rorschach and his inkblots: The man, the test, the controversy

When psychiatrist Herman Rorschach used inkblots to open a window into his patients’ minds, he also opened a can of worms

inkblot

Card 2 of Hermann Rorschach’s 10 inkblots. What do you see?

Science Museum/Science & Society Picture Library

NUREMBERG, 1945. Hitler, Himmler and Goebbels were dead, but two dozen other leading Nazis were awaiting trial for crimes against humanity. The prize catch was the creator of the Gestapo and the death camps, Hitler’s number two: Hermann Göring.
While they waited, prison psychologist Gustave Gilbert administered psychological tests, keen to solve the mystery of the “Nazi mind”. Most of the prisoners responded like show-off schoolboys, eager to beat their peers. They did well on IQ tests, but to assess their personality there was another technique to try, and the prison psychiatrist, Douglas Kelley, had written a book on it. He and Gilbert gave 19 Nuremberg prisoners the Rorschach test.
Hermann Rorschach, a psychiatrist working alone in a remote Swiss asylum, had invented the inkblot method in 1917 and published it in 1921. Rorschach was a follower of Freud, though never doctrinaire or dogmatic: he once joked to a colleague, “In Vienna, they’re going to be explaining the rotation of the Earth psychoanalytically before long.” He had also studied with Carl Jung in Zurich, where Jung had developed the first empirical test of the unconscious mind: word association.
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Rorschach was a lifelong artist. In school he was known for his drawing skill and, aptly, his nickname was “Klex”, the German word for inkblot. He was visual, whereas Freud was a word person. Psychoanalysis was built around the talking cure, slips of the tongue, what we say and don’t say, but Rorschach thought how we see was more revealing than what we see.
After extensive revisions, Rorschach decided on 10 inkblots to make up the test. The same 10 are still used today, 100 years on. They are not random smears: they have structure, visual qualities beyond mere ambiguity. For instance, they are challenging to integrate into a whole, so that while some of us can pull together a big picture, others get hung up on details. And do you see movement and life, or only cold, inanimate forms? There’s one blot that almost everyone says looks like a bat or moth; do you say likewise?
Rorschach gave scores based on the frequency of what he termed “whole”, “detail” and “movement” responses, among others. You could calculate ratios with those scores, and track patterns. The test results were derived from these measures. Rorschach originally called his inkblots a perception experiment, not a test; it simply explored how people process visual information. Only later did he realise that different kinds of people tend to see the blots differently.

Nazi personality

In the decades after his early death in 1922, aged 37, of appendicitis, Rorschach’s test languished in Switzerland and Germany. But practitioners in the US helped it surge to prominence. That’s why in 1945, Kelley and Gilbert, both Americans, saw a golden opportunity to try it on prominent Nazis.
Ultimately, though, the Rorschach test wasn’t considered a success at Nuremberg because it didn’t identify a “Nazi personality”. Although it found some common elements, such as a certain lack of introspection, the Nazis showed essentially the same range of variation, from the psychotic to the very well adjusted, as any other group. This result was unacceptable to both psychologists and the general public – surely only monsters could do what the Nazis had done – and so the findings were disregarded for decades.

Meanwhile, in the mid-century heyday of Freudian psychoanalysis, the Rorschach test became the leading “X-ray of the unconscious”. It was used in the most ham-fisted ways imaginable, and was expected not just to reveal mental illness or personality, but to practically read minds. Too many death-related responses to an inkblot dubbed the suicide card and you became a candidate for electroshock therapy.
Had he lived, Rorschach would have been appalled that an inkblot test could result in such drastic treatment. Shortly before his death, he wrote to a colleague eager to use the test to evaluate academic potential: “When I imagine some young person, who has maybe dreamed of going to university from an early age, being prevented from doing so as a result of failing at the experiment, I naturally feel a bit like I can’t breathe.”
“Used in the most ham-fisted ways, the test was expected to practically read minds”
Rorschach anticipated many objections to his test, in particular the potential conflict between its numerical results and a doctor’s subjective insight into their patient. This “dilemma… comes up unfortunately quite often in the test,” he noted. But Rorschach took the side of scientific objectivity: “All my work has shown that crude systematisation is better than arbitrary interpretation.”
Yet many psychiatrists preferred their own interpretations, and so the Freudian incarnation of the Rorschach test captured the world’s imagination, spreading into film noir, advertising and popular culture. This version eventually, justifiably, met with widespread criticism. In the late 60s, it began to fall out of favour, along with Freud. In the UK and elsewhere, it has never recovered. But in the US, the test was reinvented in the 1970s with a renewed emphasis on numerical results.

Rorachach

Hermann Rorschach, doing his best Brad Pitt

www.bridgemanimages.com
From the beginning, the test was meant to be a science, not an art. A priority for Rorschach was that it could be scored objectively. Although he initially logged responses as “+” or “-” for being good or poor descriptions of the card, he collected a large data set as quickly as he could and shifted to scoring answers as Popular or Uncommon, independent of his own subjective judgement.
The mountains of data collected and analysed since the test was invented allowed statistical norms to be established. After psychologist John Exner devised a “Comprehensive System” for scoring in 1974, the test gave a more complex readout than ever before, with all sorts of measurable numerical thresholds. These in turn could be mapped to diagnoses in the US psychiatrist’s handbook, the Diagnostic and Statistical Manual of Mental Disorders, or other accepted assessments.
Whether such mapping is reliable has been controversial for decades, and is the subject of a great deal of research. Is the Rorschach test, even in its modern incarnation, just an excuse for a psychiatrist to draw whatever conclusions they want? According to a giant meta-analysis published in 2013 in Psychological Bulletin, the answer is no. In the light of that study, even some of the test’s most vocal critics agreed that its ability to detect and differentiate between psychotic thought disorders now had scientific support. And those of Exner’s scores that were found not to meet scientific standards of validity and reliability were removed from the system, leaving the rest on a firm footing.
The inkblots have been used in so many ways in the 100 years since Rorschach sent them out into the world that they can seem as hard to pin down as human nature itself. And, as with any tool, there is scope for misuse. Gilbert failed to heed what the inkblots told him in Nuremberg, and continued to believe that there was a “Nazi personality”: in 1963, he published an article with the lurid title “The mentality of SS murderous robots”. Yet Kelley, the more expert Rorschacher, had found nothing particularly out of the ordinary – simply the banality of evil.
No test can get around the complexity of how different people see the world, and that complexity will always generate controversies. One can only wonder what Rorschach himself would have made of it all.
This article appeared in print under the headline “How you see it, how you don’t”




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