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Hardcastle, N. (1951). 'Discussion on the Treatment of Obsessiona Neuroses': June 13, 1950. Proceedings of the Royal Societv of Medicine, Section of Psychiatry, 1950, 43, 999–1010.. Int. J. Psycho-Anal., 32:331-332.
Psychoanalytic Electronic Publishing: 'Discussion on the Treatment of Obsessiona Neuroses': June 13, 1950. Proceedings of the Royal Societv of Medicine, Section of Psychiatry, 1950, 43, 999–1010.
(1951). International Journal of Psycho-Analysis, 32:331-332
Dr. Emanuel Miller in opening the discussion declared his belief in the validity of Freudian psycho-dynamics but felt himself free in treatment to use such ancillary methods as occasion demanded. He gave notes from a series of case records to illustrate the complex nature of the condition, for not only did they present a very wide variety of symptoms but their psychopathology ranged from the later stages of mental organization to those disorders which are mainly psychotic in character. He emphasized that choice of treatment rested on this distinction, and for the clarification of this diagnosispersonality studies were essential. He felt there is a very real danger in lightly undertaking analysis where obsessional compulsive states screen a larval schizophrenia. He disapproved of leucotomy being practised in any child before puberty. On the other hand no one should object to leucotomy in extreme cases.
Dr. Karin Stephen gave a concise account of the accepted psycho-analytic views concerning the nature and treatment of obsessional neuroses. She also stressed the fact that severe obsessional neurosis may mask a psychosis, but did not consider this danger was necessarily a bar to the analytic approach, as it would be possible to change over to a supportive type of therapy.
Dr. William Sargant and Dr. Eliot Slater regretted that there were no clear-cut indications for the various forms of treatment which were in vogue to-day. They lamented that personal bias and rule of thumb played such a prominent part in the choice of treatment. They gave a short account of their experiences with the physical methods of treatment. Sleep
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treatment: only of occasional value as these patients cannot relax; confusional states are often engendered by the excessive doses of narcotics required by these patients. Modified insulin treatment: rarely helps; its effect is often paradoxical, for by increasing the physical well-being the intensity of the conflict is also increased. They had no records of uncomplicated obsessionals being improved by insulin coma. They pointed out that endogenous depression is frequently a symptom of the obsessional constitution and it is here that electroshock has proved itself of the greatest value, especially when there is retardation combined with early morning wakefulness and morning depression, but when the depression is more marked in the evening and sleep good, there is the danger that shock treatment may make the patient worse. They define that the good effects of shock treatment are limited to the relief of depression and retardation, but that it has no effect on tension. When, however, tension and compulsive symptoms are secondary to depression these will clear. Their experience has been that E.C.T. and drug abreactive treatment tends to make the obsessional patient worse. On the other hand, they found that methedrine does not causedissociation, but the patient is temporarily released from his obsessional preoccupation and is able to re-associate. They regard leucotomy as a treatment for anxiety and tension—the patient improves because his symptom ceases to excite the same emotional response. The best results are obtained from patients with good premorbid personalities. In patients where the obsessional state covers schizophrenia the operation will frequently precipitate this state.
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Hardcastle, N. (1951). 'Discussion on the Treatment of Obsessiona Neuroses'. Int. J. Psycho-Anal., 32:331-332