“Time Dimension” Revisited in
Clinical Practice and Research in Psychiatry
Time dimension, seems to be the core of objective reality of human existence. Almost all aspects of judgment, insight, object relation, sense of reality and other psychic functions are time-related. Disturbances related to time dimension, recorded as circumscribed symptoms, are usually included under disorders of the sense of time (e.g stagnation, cessation, nihilism, galloping, interruption and distortion). This is essentially related to what the patient records as well as to what the clinician could grasp.
Certain patients describe time as visible phenomenon. This could be related to what Arieti called active concretization (Arieti, 1972). Other patients describe time as if the magnified seconds are arranged, one after another, in a slow motion pattern like looking in the raw picture of an old cinema film (Rakhawy, 1999). This is very close to trailing phenomenon described as a variant of disorders of the process of thought. When time disorder in certain patients with schizophrenia or epilepsy is described as gushes and stops (Okasha, 1988), this may refer more to some longitudinal disharmony (disorganization) in time dimension.
After the vast advance in reorientation about time dimension, psychiatric practice has to sharpen and rearrange their clinical tools and intuition as much as their theoretical background about this dimension.
From a functioning teleological point of view it is not possible to consider time apart from events occupying it. Any fixed lasting (psychic) game, script or mental mechanism could refer to the possibility of functional cessation of time. The interpretation of repeated behavior of OCD is that what is done (or said or thought of) was not recorded as done, since time is claimed to act in a closed circuit pattern. This would make the patient repeat it again and again in a trial to vitalize the proper function of time, but usually in vain. Almost all repetitive symptoms such as tics, rituals, stereotype, perseveration, catatonic posturing, and mannerisms are to be considered as declaring some sort of such cessation of time.
Considering growth as the continuous positive march of time, it could be assumed that any marked slowing down or cessation of such march is responsible for some sort of abnormal pattern of growth. The positive march of time includes expansion of awareness, responsibility, mature object relation, dialectic relation to reality and the open ended creative rebirth along the extended biorhythmic pulsations.
In psychotherapy, considering the duration at the outset is one of the most essential items of preliminary contracting. Such definition would shape the how and stages of whatever psychotherapy given. During psychotherapy in general and in lengthy one in particular, timing is another very crucial responsibility. When to do (and not to do) or what? to say (and not to say), is one of the basic skills that should be cultivated by the therapist.
Inspiring Zowail’s achievement picturing certain chemical reactions in what is called phantom second, one can hope (or dream) that one day the biological shifts or process could be accessible to such sophisticated recording, some way or another. Putting this in mind would motivate psychiatrists; both in clinical practice and research, to record whatever possible minute qualitative changes that may be observed or assumed through clinical intuition. Follow up of such mini-alteration may prove that this has been the turning point during the process of therapy. This assumption is apt to reinforce optimistic attitude, objective waiting and to minimize reductionism of the patients’ experience to what could be recorded crudely as gross overt behavior.
Egypt. J. Psychiat. (2000 January) 23:5-7
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