An Introduction to the Mind Sergio Hernandez, MD

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.

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

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.

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.

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

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.

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.

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

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.

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.

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

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

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

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!

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?

Conflictual example Depressed student

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

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.

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. Patient's mother has had diabetes throughout the patient's life. She is poorly controlled and he has witnessed her be repeatedly admitted to the hospital, suffer recurrent infections and face potential amputations. Patient has had to care for her and his 2 siblings often due to her illness. He once had to called 911 when he found his mother seizing after accidentally taking too much insulin. The highlight of his week was a Sunday dinner at his grandmother's house.

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

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

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

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.

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.

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.