Sergio Hernandez, MD. An Introduction to the Mind

Transcription

1 Sergio Hernandez, MD An Introduction to the Mind

2 Objectives By the end of this presentation students should be able to: Describe 4 aspects which make up the mind. Define the unconscious and the how it effects human behavior. Explain why understanding the mind is important and how it may affect patient care. Define the concepts of transference, resistance, and theory of mind and how they may impact patient care.

3 What is the Mind? What makes it up? Why does it matter? Is it valuable in general medicine?

4 The Mind The mind of everyone is unique, subjective, and worth knowing. Made up of dreams, fantasies, fears, hopes, impulses, wishes, self image, perception of others, etc.

5 What are fantasies? What do we mean by fantasies? A private construction of how we believe the world should happen. Not the world as it is. Important to know.

6 Examples of Fantasies The fantasy of medical school the first year, the third year professor fantasies The birthday party What do these examples suggest?

7 The Unconscious Much of mental life is out of our awareness and motivates behavior. It is dynamic (meaning active, in motion ) Emotionally difficult and conflictual ideas are kept out of our awareness.

8 The Unconscious It is timeless and irrational - no linear space time. Past, present, and future are one. However, it has rules that can be followed to understand and make sense.

9 The Unconscious Nothing in the mind happens randomly or arbitrarily. All mental acts have causes and meanings. This allows symptoms to make sense.

10 Not a cookbook! There is always more going on than is obvious. Behavior can have many possible meanings and causes. Can express many possible things.

11 So far The mind is a collection of dreams, fantasies, wishes, beliefs, etc. Much of the mind is out of our awareness (unconscious). Difficult material is kept out of our awareness. Nothing in the mind is arbitrary and therefore can be studied to extract meaning.

12 Blank Space Nice to meet you, where you been? I could show you incredible things Magic, madness, heaven, sin Saw you there and I thought Oh my God, look at that face You look like my next mistake Love's a game, want to play? New money, suit and tie I can read you like a magazine Ain't it funny, rumors fly And I know you heard about me So hey, let's be friends I'm dying to see how this one ends Grab your passport and my hand I can make the bad guys good for a weekend So it's gonna be forever Or it's gonna go down in flames You can tell me when it's over If the high was worth the pain Got a long list of ex-lovers They'll tell you I'm insane 'Cause you know I love the players And you love the game 'Cause we're young and we're reckless We'll take this way too far It'll leave you breathless Or with a nasty scar Got a long list of ex-lovers They'll tell you I'm insane But I've got a blank space baby And I'll write your name Cherry lips, crystal skies I could show you incredible things Stolen kisses, pretty lies You're the king baby I'm your Queen Find out what you want Be that girl for a month Wait the worst is yet to come, oh no Screaming, crying, perfect storm I can make all the tables turn Rose gardens filled with thorns Keep you second guessing like "Oh my God, who is she?" I get drunk on jealousy But you'll come back each time you leave 'Cause darling I'm a nightmare dressed like a daydream Boys only want love if it's torture Don't say I didn't say I didn't warn ya Boys only want love if it's torture Don't say I didn't say I didn't warn ya

13 Further Considerations How does the mind develop? What do we do with conflictual material of which we are not aware?

14 Development of the Mind The mind develops in the context of our interactions and experiences with primary care givers and the environment.

15 Past, Present, and Future Our primary relationships and experiences form the template for all of our past and future experiences. Since the unconscious is timeless, the past can be experienced in the present and shape our future decisions.

16 Transference All of our interactions with others will be based on past relationships (our template). Even if the current relationship is nothing like the past!

17 Unconscious Conflict The unconscious contains conflictual material of which we are not aware. How can we know what is in conflict if we are not aware of the content?

18 Conflictual example Studying on a party night.

19 Resistances The mind is always in conflict. Resistance serves to maintain equilibrium and homeostasis. Therefore easy solutions and interventions are rarely meaningful and lasting.

20 Evidence of the Conflict We can use the behaviors and symptoms we see to help infer the underlying conflict. This is a process of discovery with the patient, not imposed on the patient.

21 Clinical Context 19 year old male just recently diagnosed with diabetes, type I, presenting for his second admission for Diabetic Ketoacidosis resulting from non adherence to his insulin regimen.

22 Questions How do you approach this patient? What would you like to know? Is there an evident symptom or possible conflict?

23 Conflicts as Symptom Conflict can manifest as almost anything: Neuro symptoms (seizure, paralysis) Physical symptoms Depression, Anxiety, Phobias Repetitive patterns of behavior

24 When an inner situation is not made conscious, it appears outside as fate. - Carl Jung

25 Theory of Mind The ability to consider another s perspective. In other words, the ability to put oneself in another s shoes (mind) emotionally. In a sense, the ability to empathize.

26 Tying it all Together The mind is present in all of us and worth knowing. The unconscious is rich and often conflictual. Conflict in the unconscious can manifest in multiple ways, such as behavior and symptoms. Through listening and questioning, we can learn about patient conflict and help resolve unwanted symptoms.

27 Tying it All Together Curiosity about our patients and their lives is deeply important - both for the care of our patients and our own gratification in our work. Knowing that there is always more to know should help us maintain a healthy skepticism.