Felicity Doyle - Freud in the Emergency Department

FREUD AND HIS RELEVANCE

FREUD IN A NUTSHELL: HIS EARLY LIFE HISTORY

THE ROLE OF DEFENCES AND SURVIVAL INSTINCTS

NEUROSIS

ANXIETY NEUROSIS

OBSESSIONAL-COMPULSIVE NEUROSIS

SOMATOFORM DISORDER

PSYCHOSIS

BORDERLINE PERSONALITY STATE AND DISORDER

FREUDIAN TERMS, MECHANISMS AND PRINCIPLES

ID

EGO

THE UNCONSCIOUS

SUPEREGO

LIBIDO

COMPLEX

ANAL CHARACTERISTICS

DREAM INTERPRETATION

FREE ASSOCIATION

TRANSFERENCE AND COUNTERTRANSFERENCE

PARENTAL AND SOCIETAL INFLUENCES - THEIR ROLE IN CEREBRAL PROGRAMMING

SUPEREGO-ID-EGO-EXTERNAL WORLD RELATIONSHIP

RELATIONSHIP OF THE COMPONENTS OF THE PSYCHE

FREUDIAN DEFENCE MECHANISMS AND PRINCIPLES

REPRESSION

REGRESSION

DENIAL

ISOLATION

DISPLACEMENT

REACTION FORMATION

UNDOING

RATIONALISATION

DERATIONALISATION

INTELLECTUALISATION

IDENTIFICATION

INTROJECTION

ACTING OUT

SUBLIMATION

DISSOCIATION

AVOIDANCE

PROJECTION INWARD

PROJECTION OUTWARD

DEPROJECTION

PROJECTIVE IDENTICATION

WITHDRAWAL

SPLITTING

CONVERSION

CONDENSATION

SIMULTANEOUS EXPERIENCE OF POLAR OPPOSITE EMOTIONS

COUNTER PHOBIC IDEATION

OMNIPOTENT PHANTASY

DEFENCES SHOW DIFFERING DEGREES OF MATURITY AND SOPHISTICATION

OEDIPUS COMPLEX

OEDIPUS COMPLEX IN HUMANS AND ANIMAL BEHAVIOUR COMPARED

THE DEATH INSTINCT

SYMBOLISM, VERBAL AND NON VERBAL CEREBRATION AND UNITS OF MENTAL ENERGY

THE NATURE OF THE EGO COMMUNICATION

MEMORY TYPES AND ACCESS

PSYCHOANALYSIS AS A SCIENCE AND ART

ANTISOCIAL PERSONALITY DISORDER

NARCISSISTIC PERSONALITY DISORDER

PARANOID PERSONALITY DISORDER

DISSOCIATIVE PERSONALITY DISORDER

OBSESSIVE-COMPULSIVE PERSONALITY DISORDER

DEPRESSIVE PERSONALITY DISORDER

MASOCHISTIC PERSONALITY DISORDER

HISTRIONIC PERSONALITY DISORDER

SCHIZOID PERSONALITY DISORDER

SOCIETAL WITHDRAWL

SELF HARM INTRODUCTION

OVERDOSE AND OTHER SUICIDE GESTURES AND ATTEMPTS

ASSESSING THE RISK OF SUICIDE

MIND-ALTERING SUBSTANCE ABUSE AND ADDICTION

EATING DISORDERS

BODY MODIFICATION

GAMBLING

GENERAL LIFESTYLE ERRORS

AGGRESSION AND VIOLENCE BACKGROUND THEORY

ANTISOCIAL BEHAVIOUR

PATIENTS WHO STEAL

PATIENTS WHO HAVE COMMITTED MURDER

DELIBERATE INJURY OF CHILDREN

INTOLERANCE OF MINORITY GROUPS

SEXUAL VARIATION AND DEVIATION

SEXUAL VARIATION

MALE HOMOSEXUALITY

FEMALE HOMOSEXUALITY

SEXUAL IDENTITY

SEXUAL DEVIATION

TRANSVESTITISM

PAEDOPHILIA

FETISHISM

SADISM AND MASOCHISM

SEXUAL DEVIATIONS OCCURING IN A PUBLIC MEDIUM.

SEXUAL ASSAULT AND SEXUAL ABUSE

RELATIONSHIP FAILURE

BEREAVEMENT

FOLK TALES AND THE NHS

WHERE THE RESOURCES GO TH E TALE OF THE GIANT TROLLS, THE WOODCUTTERS AND THE LOAVES

HEALTH TOURISM THE TALE OF THE GOLDEN TIPPED JASMINE FLOWERS

THE STRESSFUL EFFECT OF PATIENTS ON EMERGENCY DEPARTMENT STAFF

FREQUENT, INAPPROPRIATE AND OTHER ABNORMAL ATTENDANCE

MIGHT THIS PATIENT ATTACK ME?

DEALING WITH PSYCHIATRIC FLARE UPS

PAEDIATRIC BEHAVIOUR PROBLEMS

SLEEP DIFFICULTIES

TANTRUMS

FOOD REFUSAL

BREATH HOLDING EPISODES

HELPFUL LINES OF QUESTIONING FOR PSYCHOSOCIAL MATTERS

OPENING QUESTIONS

QUESTIONS DESIGNED TO PUT THE PATIENT ON THE RIGHT TRACK

SURVIVAL IN THE EMERGENCY DEPARTMENT

REQUEST FOR FEEDBACK ON THIS BOOK

Dedicated to loved ones
And colleagues

All of life is a mind game. When the body fails, its still a mind game.

Emergency Department staff are, of course, mere humans dealing with human illness and injury, which are often stressful to manage in their own right. Adding the personality factor of dealing with patients just increases the stress further. Indeed, the interaction between personalities can sometimes be one of the key features in the stress of the job. It is an inescapable human fact that there is an emotional reaction during the meeting of any two people, which rapidly intensifies and is a reflection of many, many deep layers of previous psychological encounters that have occurred throughout the lives of the two participants. For patients, the Emergency Department can be a sanctuary, a threatening environment or an admixture of both.

Much of what is required to understand human nature - or at least to begin to understand it - was written by Freud, the founder of psychoanalysis. Medicine is unknowable for it is such a vast subject and medical practice itself is a very sticky wicket with bad luck and time pressures just adding to the difficulties of Emergency Department work. Freud stated that his primary aim for his patients was to convert their lives from their current plight into ordinary misery and he developed methods of achieving this via a process of providing insight into the origins of learnt patterns of dysfunctional thought and behaviour, thereby preventing repetitive cycles of these. Freud had no notion of providing a personal psychological utopia for his patients.

This book does not in the slightest purport to provide a means for Emergency Department staff to achieve Freuds primary aim for patients, just to provide some form of understanding of their psyche using his principles. Nor does this book attempt to deal in any detail with formal psychiatric illness, but rather focuses mostly on personality factors. In other words, this book merely attempts to give a psychoanalytic viewpoint of why patients behave as they do. Quite simply, using existing and well-known Freudian concepts, it attempts to explain some of the interactions between patients and staff. It is hoped it will make this difficult aspect of Emergency Department work more bearable by giving staff an understanding of what is happening and therefore enabling them to take a step back from the stress of the interaction. In fact, all of the emergency services have to deal with difficult aspects of human emotion and behaviour, for the people they face will usually be in a mentally stressed state and almost certainly in totally unfamiliar circumstances. Each person being helped will on some level feel vulnerable in some way and the way in which they behave will be a reflection of their psychological life history. Emergency personnel of all of the blue light services will deal with the whole spectrum of personality expression; ranging from the charming and quaint bespectacled great-great grandmother, to a sociopathic hulk of a man who has just bludgeoned a man half his size whom he felt had shown some (imagined) disrespect. It is obviously easier for staff to deal with the suffering of the elderly lady and to feel empathy for her, but the point is that on some level the hulk may have an inner psyche in which he suffers unimaginable torment due to previous appalling psychic trauma. The delightful grandmother may have come from a genteel and stable background and thereby benefited from having loving and devoted parents, but the hulk may have come from a disastrous dysfunctional background characterised by brutal abuse and neglect when he was a defenceless toddler.