Anaesthesia psychica dolorosa

In order to complete my graduation research I interview and conduct psychological testing of depressive patients at the V. M. Bekhterev Psychoneurological Research Institute, which is situated in an industrial district of St. Petersburg, Russia, the city where I live. Some time later I want to tell here the story of Vladimir Bekhterev (1857—1927), the founder of this institute, who in the beginning of the 20th century embraced a truly integral framework, attempted to integrate individual and social psychology, neurology and behavioral studies, materialism and spirituality in a unified gesture of his works. Bekhterev was a person of profound spiritual insight, possibly having a stable access to witnessing consciousness; he is also known for his studies on the subjects of telepathy, clairvoyance, hypnosis, and  other altered states of consciousness. He was a founder of some of the major schools of the Soviet psychology. It is rumored that he was murdered by Joseph Stalin after assessing him as mentally ill. But all of this in a hopefully forthcoming post; right now I want to speak about something else.

With depressive patients I conduct a simple semi-structured interview that I designed based on The Integral Intake form created by Andre Marquis. Since I am doing an empirical research at this point and, therefore, am not working with the patients as a consultant or a therapist I significantly shortened the number of questions. In general, however, I am attempting to make a survey that touches some points that are essential to my research in all quadrants (psychological, behavioral, social, and cultural, including inquiries regarding patient's current state of consciousness, education, professional background, sleep behavior, destructive and self-destructive tendencies, sociocultural activities, religious attitudes, the meaning of life, and so on). (Initially, I wanted to do a different kind of research involving the state of consciousness assessment but it appeared that I didn't have enough time, tools, and support to complete such an investigation prior to graduation. As you may see, I still inserted some of the questions regarding the first-person experience into the qualitative part of my study.)

In the beginning of the week I interviewed a patient diagnosed with recurrent depressive disorder. A woman, 27 years old, has two kids. One of the striking features of her current state, based on her first-person account, was acute depersonalization, a condition that was historically called anaesthesia psychica dolorosa. This condition is characterized by painful mental insensibility, apathy, anhedonia, alienation from the self and others, lack of emotions, feelings, and concerns for oneself and relatives (in this case, including husband and children). She characterized her state as the state of "emptiness," "lack of feelings," "lack of love." This lack of feelings causes acute psychic pain, an overwhelming feeling of loss, of missing something important. This leads to intensifying questioning of the purpose and meaning of life and whether it is possible to continue living in such a disturbed state of consciousness.

During the clinical interview I asked a usual question in this case, which is about whether she currently experiences suicidal thoughts. She replied affirmatively and stated that in February (before being hospitalized) she actually made a suicidal attempt (took some pills) because she didn't want to live anymore, life was meaningless. After the interview, when I read her case file, I haven't found any mention of suicidal attempts or dangerous self-destructive tendencies, which was surprising because these are foundational data that must be gathered during the medical history examination by a psychiatrist (and, in the case, it is repeated over and over that there are no dangerous behavioral tendencies observed). I informed the local clinical psychologist, a graduate student with whom I collaborate on this research, and asked her to tell the doctor about these findings of mine, that this woman's behavior should probably be observed more closely. I also rated her very high on the clinical depersonalization scale (it was actually the first time I used that scale); and the tests results came also with very low scores in all essential indexes. All of it I sent by email right away. The response I got was that the doctor was aware of the suicidal attempt and "it was demonstrative" (no mention of it in the case file) and he was also aware of her suicidal thoughts (while the case file stated no dangerous behavioral tendencies). Today, I received an email from the clinical psychologist saying that in the morning the patient attempted a suicide by cutting her wrists (fortunately, unsuccessfully), so I was right when raising my concerns regarding her current psychoemotional condition. The patient is now under a special observation. 

Now I'm left with mixed feelings. It was the first patient whom I interviewed of whom I am aware that she attempted a suicide afterward. In fact, I read a case file of another patient whom I interviewed on the same day in which there was a doctor's note (dated the next day after my interview) that the patient feels better. Obviously, I don't think that the simple interview and attention of psychologist (i.e. me) was the crucial factor, but I think the change was at least in some ways supported by the interview because usually by the end of the interview patients leave seemingly in a better state than that which I observed in the beginning (as in that particular case). In the case of the suicidal patient she was very fixed on her depressed emotional state and showed little, if any, improvement by the end of the interview. (Pharmacotherapy, according to the patient's subjective account, didn't seem to help alleviating her interior pain either.)

Every time I meet patients for an interview it is always a challenge for me, because on the subtler level of communication I become increasingly aware of the qualia of the state of consciousness the patients are in; and I attempt to give full space to this state in my awareness. Most of the time after meeting especially strong cases I recognize shifts in my own mood and state of consciousness. I haven't learned yet how to minimize these effects; and I am not sure they must be minimized. As one my friend said, in the process of any kind of healing the most valuable gift is the pain one suffers. Pain is what is usually an authentic connection to experiencing reality; anything else may be more of an illusion.