Blindness

Hysterical blindness is thought to be common in ophthalmological practice (2 23 and 24) and is often incomplete. It may present as blurring of vision or difficulty in reading in adolescents facing examinations. Tubular or spiral visual fields may be found on testing by perimetry. The measurement of visual fields involves moving a small spot systematically from the margin to the centre and asking the patient to detect the spot. Normal fields are wider at a distance than close to the eye. If the size of the field does not change, regardless of the distance from the eye, the patient has tubular vision. A spiral change in the visual field is obtained when the examiner starts at one point and obtains a visual field of a given magnitude which then gradually decreases as he moves the spot around the field in a circle. By the time the test spot has been moved through 360° it may be visualized in a position much closer to the centre on the axis where it started than was originally found. Many patients with functional visual losses of these types have no evidence of psychiatric disease at the time of testing or on follow-up. Inconsistent spiral fields, like tubular vision, may often be due to the persuasive powers of the examiner or to high suggestibility in the patient. Stress may also cause the patient to give inconsistent replies.

Disabling hysterical blindness presents more difficulties. Evoked-potential studies will help to demonstrate intact visual pathways. Other evidence on the processing of visual information may be obtained by using colour filters and by finding discrepancies in reading different sizes of print at different distances. Polaroid projector slides with polaroid goggles can help to demonstrate discrepancies in what the patient reports. Optokinetic nystagmus should not occur with organic causes of blindness. Blepharospasm can sometimes be so severe that it seriously hinders vision, but such cases are usually due to extrapyramidal dyskinesia. It may be due to severe anxiety.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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