Jung At Heart Archive May 2008

Breggin on Bipolar kids

Following up further on last week's Newsweek cover story on bipolar children, Peter Breggin writes in Huffington Post

"First, all of these preadolescent children are being wrongly diagnosed by conventional psychiatric standards. We have no evidence at all that temper tantrums and other unruly behavior, however extreme, is a precursor to being diagnosed with bipolar disorder as an adult.

Second, since there is no known connection between children diagnosed bipolar growing into adults diagnosed bipolar, the data about a 10% risk of suicide is misleading and irrelevant.

Third, there's no evidence whatsoever that individuals diagnosed "bipolar" have a "miswired brain." There's not even any such evidence for a biological flaw in adults who suffer from full-blown manic-like episodes, let alone children whose parents and teachers cannot control them. 

The concept that children have bipolar disorder and should be treated with highly toxic adult psychiatric drugs is strictly a drug-company marketing ploy. If it's true that 800,000 children have been diagnosed, it has become an enormously successful marketing strategy with tragic results for children and their families.

There's an even more sinister aspect to all this. There has been a real increase in teenagers and young adults who display episodes of manic-like symptoms such as insomnia, excessive energy, racing thoughts, grandiose ideas about themselves, irrational and outrageous behaviors, extreme irritability, paranoia, and psychosis. However, in my three and one-half years of intensive psychiatric training in the 1960s, I saw only one case of a young person suffering from these symptoms. In the following years through approximately 1990, I saw few other cases. Yet nowadays I evaluate many teens and young adults with manic-like symptoms in my medical and forensic practice. The reason for the change? As I document in detail in Brain-Disabling Treatments in Psychiatry (2008), antidepressant drugs, so freely given to children and youth, cause a high rate of manic-like behaviors."

Now it is true that Breggin is a controversial figure in psychiatry, but to my mind no more so than those pushing the bipolar agenda. Breggin is generally opposed to overmedicating, which seems to me to be a worthy position. In these times, howvere, to take this stance is quite heretical, at least in the mainstream psychiatric world.

Like Breggin, when I was first in practice in the 70's, w saw *very* few children presenting with symptoms of major mental illness. And it was almost unheard of for young children to be on psychiatric drugs of any kind. Already though there were movements toward diagnosing ADHD in younger and younger children and putting them on Ritalin -- it just had not yet become widespread practice. 

We face the law of unintended consequences as more of these kids who have been medicated nearly all of their lives with psychiatric drugs with as yet unknown long term effects. Ad I don't think what we will see will be pretty.

Dreaming more fully into existence

There are a number of writers in psychoanalysis that I enjoy reading. Thomas Ogden is one of them. Last week I read this description by him of the analytic process, a description which I find to be quite lovely:

"A person consults a psychoanalyst because he is in emotional pain, which unbeknownst to him, he is either unable to dream (i.e. unable to do unconscious psychological work) or is so disturbed by what he is dreaming that his dreaming is disrupted. To the extent that he is unable to dream his emotional experience, the individual is unable to change, or to grow, or to be become anything other than who he has been.The patient and analyst engage in an experiment within the terms of the psychoanalytic situation that is designed to generate conditions in which the analysand (with the analyst's participation) may become better able to dream his undreamt and interrupted dreams. The dreams dreamt by the patient and analyst are at the same time their own dreams (and reveries) and those of a third subject who is both and neither patient and analyst.

In the course of participating in dreaming the patient's undreamt and interrupted dreams, the analyst gets to know the patient in a way and at a depth that may allow him to say something to the patient that is true to the conscious and unconscious emotional experience that is occurring in the analytical relationship at a given moment. What the analyst says must be utilizable by the patient for purposes of conscious and unconscious psychological work, i.e., for dreaming his own experience, thereby dreaming himself more fully into existence. "

From This Art of Psychoanalysis:Dreaming Undreamt Dreams and Interrupted Cries

Conventional wisdom

Synchronicity struck in my world again this week. Just as a discussion about why more Jungian therapists and analysts do not treat schizophrenics began on the IAJS discussion list, Furious Seasons posted a link to an article which challenged my assumptions.

For as long as I have been in practice, it has been the custom to treat schizophrenics and others with psychosis with medication and hospitalization and rarely if ever with therapy. I think in 35 years I have seen only one person carrying a diagnosis of schizophrenia and he did not stay in therapy long. Lacking experience working with people with  this kind of problem, I admit I doubt my own ability to do so effectively, but I had really not questioned the conventional wisdom, surprising really given my general bias for therapy. Then I read of this study, reported in the Journal of Nervous & Mental Disease a year ago. 

"This prospective longitudinal 15-year multifollow-up research studied whether unmedicated patients with schizophrenia can function as well as schizophrenia patients on antipsychotic medications. If so, can differences in premorbid characteristics and personality factors account for this? One hundred and forty-five patients, including 64 with schizophrenia, were evaluated on premorbid variables, assessed prospectively at index hospitalization, and then followed up 5 times over 15 years. At each follow-up, patients were compared on symptoms and global outcome. A larger percent of schizophrenia patients not on antipsychotics showed periods of recovery and better global functioning (p < .001). The longitudinal data identify a subgroup of schizophrenia patients who do not immediately relapse while off antipsychotics and experience intervals of recovery. Their more favorable outcome is associated with internal characteristics of the patients, including better premorbid developmental achievements, favorable personality and attitudinal approaches, less vulnerability, greater resilience, and favorable prognostic factors. The current longitudinal data suggest not all schizophrenia patients need to use antipsychotic medications continuously throughout their lives."

If I stop and think about it, the results make sense. Why should it be any more necessary for someone with schizophrenia to necessarily require medication forever than it is for someone with depression? Why have we assumed, with very little, if any, question, that those with major mental illness must always be medicated? What does it mean that we are in the process of "promoting" depression, ADHD and probably others into the category of major mental illness by expanding the definition of bipolar disorder? 

It seems to me that for the most part the debate about the majors -- schizophrenia, bipolar, and other disorders involving psychosis, pretty much ended in a conclusion that they are primarily biological some years ago. At least I have not heard or read of anyone arguing otherwise for a long time. And somehow that came to equal chronic and requiring medication much the way diabetics require insulin.

But if there is a group of people with these disorders in whom they are relapsing and remitting in nature, then it would seem worthwhile to reconsider these assumptions. And why not therapy as part of treatment? If a patient is not floridly psychotic, why wouldn't therapy be both helpful and possible?

I am thinking that the person who raised the question in the IAJS discussion had a point. 

Bipolar children, again

After reading the Newsweek article on bipolar disorder in children that both Furious Seasons and CP&P write about this week -- and please read them as they critique the article far better than can I -- I recall a child I was called to consult on years ago. This little guy was 4 and the nurse in his school was certain he had childhood schizophrenia. He had echolalic speech (Echolalia is the repetition of vocalizations made by another person) and made bizarre hand motions when he spoke, both of which are among the indicators for autism and childhood schizophrenia. I made a home visit and I saw a child who did indeed exhibit these odd behaviors But something about him didn't seem to fit those rather dire diagnoses. There was something in the way he looked at me and made eye contact with me that didn't fit. So on as a wild shot, I ordered a hearing exam by an audiologist. And lo and behold, it turned up a 75% loss in both ears. His speech and hand motions were also common in deaf children.

So I was thinking of him as I read about Max in the Newsweek article, Max who now at age 10 has been on 38 different psychiatric medications which have had who knows what effect on his brain development. And I wonder what would have happened to that little boy I saw years ago if he turned up today presenting the same symptoms. Would anyone think to look for horses instead of zebras? Or would he, like Max, be submitted to the none-too-tender mercies of medications not even certified for use in children? 

Those years ago, there were very few psych meds in use and even fewer with children. Without the hammer of medication, every symptom was not a nail. 

I wonder what was wrong with Max in the first place, back before he was "treated"?

Negative Mother Complex Writ Large?

I have been thinking a lot about sexism, gender slurs and misogyny as the political campaign has unfolded. This morning I posted some thoughts here, spurred by references to a couple of articles. It seems clear to me that there is something operating in the cultural unconscious that allows  the things that Marie Cocco reports in the Washington Post the following, among others,:

"I will not miss seeing advertisements for T-shirts that bear the slogan "Bros before Hos." The shirts depict Barack Obama (the Bro) and Hillary Clinton (the Ho) and are widely sold on the Internet.

I will not miss walking past airport concessions selling the Hillary Nutcracker, a device in which a pantsuit-clad Clinton doll opens her legs to reveal stainless-steel thighs that, well, bust nuts. I won't miss television and newspaper stories that make light of the novelty item."

Grouped together, as they are in her piece, the ugliness leaps out and makes one feel a little ill.

Judith Keller, in a piece in the Chicago Tribune, reminds us that this is 

" a familiar image in books, films, songs, comic books, TV series, video games and, now, politics: The woman as monster. The over-large, over-ambitious, overbearing creature who irritates everybody, the death-defying witch who just won't go away—and who therefore must be destroyed.

She's a vampire, a zombie, an alien, a werewolf, a psychopath, a serial killer. She's Alex, the Glenn Close character in "Fatal Attraction" (1987), who ... keeps ... on ... coming. She's the looming, clutching, stifling mother or wife or girlfriend in a Philip Roth novel. (Which novel? Take your pick.) She's the eerie, outlandish creature in the Sylvia Plath poem "Lady Lazarus" (1965), who proclaims, "Out of the ash / I rise with my red hair / And I eat men like air." She's the vengeful giantess in the 1958 film "Attack of the 50 Foot Woman."

The relative absence of outrage and acceptance by commentators, pundits and ordinary men and women suggests that we may be in the grip of a cultural complex, an example of the negative mother complex on a large scale.

Today I ran across a short article by Clarissa Pinkola Estes, known to many as author of Women Who Run With The Wolves in which she to speculates that what we are seeing is the negative mother complex writ large --


The negative mother complex is as above, but also is understood as a sudden negative reaction to a woman in particular– that reminds a person in some way, consciously but more often unconsciously, of negative experiences with one’s earliest mother figure. A person caught in a negative mother complex projects that the stranger or known woman before them now, is somehow like ‘the old mother’… and lashes out in the present as they might have wished to long ago when they were smaller and powerless against, say, an unfair or self-centered mother, or an ineffectual, helpless mother.

In a woman, her tone of voice especially, but also a certain kind of unassailability, or a form of confidence or sureness about oneself, certain physical features, certain fragrances, certain words, a certain look in the eyes, a certain slant to the mouth… can act as triggers, setting off the negative mother complex in a person.

The complex does not allow the person to perceive or react to the woman before them as human, just as they did not see the early mother figure as human, but rather as spiteful, selfish, imperious, or impervious to them… among others reactions.

Cultures can carry and react with negative complexes also, sometimes carrying
unconscious desire to punish anyone reminding them of an earlier time when ‘the people’ had not ‘enough’ respect or notice or nourishment from a governmental source they depended on…

Now, large groups in the culture jump at innocent leaders just because they carry some words or tones or features that somehow remind of the time the people were badly mistreated or mal-nurtured by the previous regime… and more so, reminding the people of the worst: their own powerlessness to change that dark time or intervene in it.

None of this is to suggest that opposing Clinton is indicative of pathology, only that she has become a lightning rod for a negative mother complex that afflicts the culture as a whole, demonizing in particular powerful women. When this happens, the criticism becomes not of her behavior or policies, but become tinged with often violent imagery out of proportion to the actual behavior criticized.

That it is a complex and largely unconscious can be seen in its acceptance as just the way things are, with hardly a murmur raised to confront it. Indeed, to raise the issue is to run the risk of being attacked for "playing the gender card" as if gender were not a significant issue.

Cocco concludes:

There are many reasons Clinton is losing the nomination contest, some having to do with her strategic mistakes, others with the groundswell for "change." But for all Clinton's political blemishes, the darker stain that has been exposed is the hatred of women that is accepted as a part of our culture.



Mother

My mother died 15 years ago today. She was a difficult woman, and as is the case for many, dealing with her influence in my life occupied a great deal of my analysis.

The mother complex is a potentially active component of everyone's psyche, informed first of all by experience of the personal mother, then by significant contact with other women and by collective assumptions. The constellation of a mother complex has differing effects according to whether it appears in a son or a daughter.(The Jung Lexicon)

It isn't possible to escape the influence of mother in the development of any and all of us.

Jung tells us of several forms the mother complex can take in a woman --

 The exaggeration of the feminine side means an intensification of all female instincts, above all the maternal instinct. The negative aspect is seen in the woman whose only goal is childbirth. To her the husband is . . . first and foremost the instrument of procreation, and she regards him merely as an object to be looked after, along with children, poor relations, cats, dogs, and household furniture.(Jung, CW 9i., par. 167.)

and

In another version, what Jung calls the feminine instinct is inhibited or wiped out --

As a substitute, an overdeveloped Eros results, and this almost invariably leads to an unconscious incestuous relationship with the father. The intensified Eros places an abnormal emphasis on the personality of others. Jealousy of the mother and the desire to outdo her become the leitmotifs of subsequent undertakings.(Jung,CW9i par. 168.)

This inhibition can also be expressed in another way, in which the woman identifies with the mother.

As a sort of superwoman (admired involuntarily by the daughter), the mother lives out for her beforehand all that the girl might have lived for herself. She is content to cling to her mother in selfless devotion, while at the same time unconsciously striving, almost against her will, to tyrannize over her, naturally under the mask of complete loyalty and devotion. The daughter leads a shadow-existence, often visibly sucked dry by her mother, and she prolongs her mother's life by a sort of continuous blood transfusion.(Jung, CW9i, par. 169.]

And then there is the negative mother complex, the stuff of novels and films, where there is tremendous resistance to mother and all that she stands for.

It is the supreme example of the negative mother-complex. The motto of this type is: Anything, so long as it is not like Mother! . . . All instinctive processes meet with unexpected difficulties; either sexuality does not function properly, or the children are unwanted, or maternal duties seem unbearable, or the demands of marital life are responded to with impatience and irritation.(Jung,CW9i., par. 170.]

This kind of daughter knows what she does not want but is usually completely at seaas to what she would choose as her own fate. All her instincts are concentrated on the mother in the negative form of resistance and are therefore of no use to her in building her own life.

"As we know, a complex can be really overcome only if it is lived out to the full. In other words, if we are to develop further we have to draw to us and drink down to the very dregs what, because of our complexes, we have held at a distance.

This type [the woman with a negative mother complex] started out in the world with an averted face, like Lot's wife looking back on Sodom and Gomorrah. And all the while the world and life pass by her like a dream -- an annoying source of illusions, disappointments, and irritations, all of which are due solely to the fact that she cannot bring herself to look straight ahead for once. Because of her unconscious reactive attitude toward reality, her life actually becomes dominated by that which she fought hardest against...But if she should turn her face, she will see the world for the first time, so to speak, in the light of maturity, and see it embellished with all the colors and enchanting wonders of youth, and sometimes even of childhood. It is  a vision that brings knowledge and discovery of truth, the indispensable prerequisite for consciousness. A part of life was lost, but the meaning of life has been salvaged for her."(Jung, CW9i)


How it works

Someone asked me -- and I am so grateful that people keep asking me these things because they give me topics for posts -- someone asked me how therapy works, if it isn't about telling people what to do.

So here is how therapy works, in my opinion. And I am not talking here about cognitive-behavioral therapy here -- which is short term and not so much about relationship.  

In therapy, no matter how much you may believe you are controlling your responses and behavior, over time your habitual ways of thinking and acting about yourself and your world show up. These are the stories you tell yourself about yourself. As the therapist questions your habitual responses and views and challenges your ideas about yourself and the world, ever so gradually, you start to change -- daring to be more open, to question what you have believed, to try new ways of behaving. It is slow and subtle. The therapist has to be both patient, caring and willing to challenge the patient. And able to not take personally the feelings the patient has toward her or him.  

Gradually the story the patient tells herself about herself changes. The things that used to be self-defining recede a bit to allow other self-perceptions and beliefs to come to the fore. The more deeply ingrained the patterns, the longer it takes to change them.

It's not magic. It isn't quick. It is work. It does work.

To what end?

I received an email the other day from a reader asking me what I thought the diagnosis for Sophie of In Treatment would be. The reader speculated either Oppositional Defiant Disorder or Bi-Polar Disorder, because of the suicide attempt. So I thought I would write about that today.

Back in the dark ages when I was first in grad school in clinical psychology, it was *very* unusual for a teenager to be given a major psychiatric diagnosis. Our understanding then was that teenagers are in the normal course of things pretty volatile and that distinguishing normal adolescent mood swings and behavior from pathology is very difficult. Having now had 35 years of clinical experience plus the opportunity to be up close and personal with my own children and their friends, I see no reason to change that notion. 

The excuse given for burdening children and teens with these major diagnoses is that it gets them treatment earlier. But when that treatment all too often consists only of psychotropic meds with very little if any literature about their long term effects on development, one has to wonder if treatment is of net benefit to them. To say nothing of what it means to an adolescent to have a psychiatric label become a significant part of her identity. And we know that identity formation is one of the major developmental tasks of adolescence.

Sophie appears to be doing fine in school and she is a talented gymnast. There do not seem to be any behavioral concerns about her from either of those quarters of her life. She does have a great deal of conflict with her mother, but that is not of a magnitude or seriousness to warrant a diagnosis of any kind. To me, it appears that her symptoms are primarily in response to issues in her environment -- her father's neglect and acting out, the poor boundaries of her coach. I can't see any of her symptoms as other than at the outside of what teenagers sometimes do.

Sophie also responds very well to therapy. She forms a solid therapeutic relationship with Paul and makes significant progress. This argues against major mental illness. 

So my inclination would be to avoid any major diagnosis -- if pressed I would likely use adolescent adjustment disorder. Given the research showing the over-diagnosis of bi-polar disorder and the questions many, including me, have about the appropriateness of making a BPD diagnosis in a minor, that diagnosis seems unwarranted altogether.

The basic message I would want to convey to Sophie and her parents is not that she is "sick" or "mentally ill", but that she is under considerable stress and that with help she can learn better means of handling stress so that her life works better for her. I would want to concentrate on empowering her in developing good decision making skills and other tools necessary for successful life as an adult. 

Why Magritte?

A little over a year ago, I wrote a post about memory and used three of several paintings by Magritte. The images are very provocative and I continue to reflect on them. What intrigues me beyond the images themselves is that for some reason people keep coming to this blog via a Google search on Magritte and La Memoire. I have noticed in my blog stats for some time that there have been a few hits every week on this search string, but lately it has been several a day from all over the world. And I have no idea why. So, if anyone reading this post got here via a search for that image, would you leave a comment or drop me an email -- the contact form is on the right if you scroll down a bit -- and tell me about your interest. Because it is driving me nuts!

Overdiagnosed? No, Really?

Thanks to Furious Seasons for pointing me to this study suggesting what many have known a long time, namely that bi-polar disorder is overdiagnosed, though I would submit that it is but one of several instances of overdiagnosis.

"Lead author Mark Zimmerman, M.D., director of outpatient psychiatry at Rhode Island Hospital and associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, notes, "Clinicians are inclined to diagnose disorders that they feel more comfortable treating. We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive." He continues, "This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder."

That a  patient might be diagnosed as bi-polar, in one setting and borderline in another while presenting the same symptoms suggests how primitive our ability to make distinctions really is. Local custom, training of the examiner, examiner biases, insurance coverage, perceived stigma carried by various diagnoses, and funding sources can all influence the diagnosis made as much as the behavior and history of the patient.

That such factors as funding sources and examiner bias influence diagnosis goes against the image of the medical model as scientific. However, subjective and external factors often matter more than the symptoms displayed. In private practice, the fact that medical and insurance records cannot be guaranteed to be private, the tendency is to choose the least stigmatizing diagnosis possible. Occasionally a psychiatrist or therapist might apply a more serious diagnosis to someone they find irritating, in an unconscious attempt at retaliation. Or a facility has beds for patients with one kind of diagnosis but not another, so the effort is made to fit the patient where the space is. Or health insurance severely limits coverage for treatment for minor disorders but is more generous for ones that are more serious, resulting in the push to gain coverage, not strive for accuracy in diagnosis. All of these disturbances, in what we might like to believe are an orderly and scientifically based process, reflect variations in the consensus reality and its deviance from the ideal.

Another factor is the mostly unconscious desire of the prescriber to be perceived by the patient as helpful. Peter Giovacchini wrote some years ago that he thought the reason there were so many antidepressants on the market was that the depressed often do not respond rapidly to therapy and thus can be less than gratifying to treat but when the psychiatrist could prescribe a medication, the patient was often very grateful. Of course he was writing in the day when most psychiatrists did therapy as well as prescribe medications. 

More than sixty years ago, Jung was expressing doubts about the value of establishing a diagnosis:

It is generally assumed in medical circles that the examination of a patient should lead to the diagnosis of his illness, so far as this is possible at all, and that with the establishment of the diagnosis an important decision has been arrived at as regards prognosis and therapy. Psychotherapy forms a startling exception to this rule: the diagnosis is a highly irrelevant affair since, apart from affixing a more or less lucky label to a neurotic condition, nothing is gained by it, least of all as regards prognosis and therapy. (Jung, Collected Works, vol. 16, p86)


Of course we're introverted!

An online friend of mine from Sweden -- and isn't it grand that this medium allows us to form relationships with people in far flung places that we might never otherwise  meet? -- and I have been talking about the relative typology of his country and my part of the country and joking that Sweden and New England have in common an introverted preference. I was just guessing, based on my experience of living here most of my life, but as it turns out, it seems I am right, at least according to Richard Florida's column in yesterday's Boston Globe -- 

"But what accounts for such psychogeographical clustering? One potential explanation is that people migrate to places where their psychological needs are easily met: Open people choose to live in places with hustle and bustle to satisfy that craving for new experiences, while conscientious people settle in places where the atmosphere is ordered to meet their need for predictability.

Or perhaps, personality is influenced by our surroundings. More emotionally stable people who live in places where neurotic types form the majority may become irritable and stressed because the people around them are getting to them...

Our research suggests another possibility as well: the link between personality and the willingness to move. Conscientious and agreeable types in particular are less likely to move. Once they find a place, they tend to spread out gradually over time. Extroverts, on the other hand, are much more likely to move over greater distances. Open-to-experience types are drawn to thrills and risk, and moving, after all, is one of life's biggest new experiences.

This fuels a process of selective migration whereby agreeable and conscientious regions are drained of the most driven, most creative, and most mobile - only reinforcing their psychogeographic profiles, while magnifying the innovative edge in places where open-to-experience types concentrate."

So my observation to my friend that New England feels quite introverted fits this research. With all the caveats about typing a region or a country in mind, it seems to me that New England is generally a place of "if you don't bother me, I wont bother you" attitudes, the more so the further north you go. People here are cordial and welcoming to tourists and newcomers, provided they do not think they will be taken in as the equivalent to long lost family. 

When I first moved to Maine more than 35 years ago, I met a woman who had lived in my small town for more than 70 years. Naively I said, "So you must be a native then." 

"Oh no ,dear," she gently corrected me, "I'm from away. I was born in New Hampshire."

Not for us the expansiveness of the South or the West. We mark our land and our lives with our stone walls and live happily together savoring our tradition and lack of excitement. Our humor is dry -- listen to any of these samples to see what I mean.

"Psychologists have shown that human personalities can be classified along five key dimensions: agreeableness, conscientiousness, extroversion, neuroticism, and openness to experience. And each of these dimensions has been found to affect key life outcomes from life expectancy and divorce to political ideology, job choices and performance, and innovation and creativity."

Wikipedia tells us of these 5 dimensions, derived from The IPIP-NEO (International Personality Item Pool Representation of the NEO PI-R™):

"The Big Five factors and their constituent traits can be summarized as follows:

Openness - appreciation for art, emotion, adventure, unusual ideas, imagination, curiosity, and variety of experience.

Conscientiousness - a tendency to show self-discipline, act dutifully, and aim for achievement; planned rather than spontaneous behaviour.

Extraversion - energy, positive emotions, surgency, and the tendency to seek stimulation and the company of others.

Agreeableness - a tendency to be compassionate and cooperative rather than suspicious and antagonistic towards others.

Neuroticism - a tendency to experience unpleasant emotions easily, such as anger, anxiety, depression, or vulnerability; sometimes called emotional instability."

short form of the test is available here. 

Psychologists really can't resist typological measures. Something in us seems to want to look again and again at clusters of trait and attitudes that will allow us to characterize large groups of people. Wikipedia offers an overview of some of them here.

You can view the maps of our psychogeography here.









© Cheryl Fuller, 2007. All  rights reserved.