Madness versus badness: the ethical tension between the recovery movement and forensic psychiatry

The mental health recovery movement promotes patient self-determination and opposes coercive psychiatric treatment. While it has made great strides towards these ends, its rhetoric impairs its political efficacy. We illustrate how psychiatry can share recovery values and yet appear to violate them. In certain criminal proceedings, for example, forensic psychiatrists routinely argue that persons with mental illness who have committed crimes are not full moral agents. Such arguments align with the recovery movement’s aim of providing appropriate treatment and services for people with severe mental illness, but contradict its fundamental principle of self-determination. We suggest that this contradiction should be addressed with some urgency, and we recommend a multidisciplinary collaborative effort involving ethics, law, psychiatry, and social policy to address this and other ethical questions that arise as the United States strives to implement recovery-oriented programs.     

“It’s like a charge – either fuses you or burns you out”: an interpretative phenomenological analysis of extreme mental states in meditation context

Meditation, an ancient Eastern spiritual practice, is increasingly being practised in the West where its benefits for mental and physical health have been established. Extreme mental states that can be encountered in the context of meditation have also been reported and often have been labelled as psychosis or spiritual emergency. This study aimed for more nuanced understanding of the phenomena. Interpretative phenomenological analysis was employed to explore the meaning-making of three meditation teachers from different philosophical traditions. The teachers described phenomenology of various extreme mental states, explained their nature according to their traditions and discussed ways of helping persons who experience these. Significance was given to having a spiritual teacher to provide guidance and support. The study highlights the importance of acknowledging the diverse understandings of the phenomena and cultivating a non-judgemental attitude towards it, which could help clinicians and meditation teachers work together to support persons experiencing these.     

Psychiatry of the physician J.C. Reil--a critical view

Reil (1759-1813) was one of the doctors who developed psychiatry in Germany. He represented a materialist psychiatry with dialectical aspects. His concept, which was orientated mainly on therapy, is based on the assumption that mental disturbances can be healed. He proposed the establishment of psychiatric hospitals in order to eliminate the hospitalization of the sick in the same building as healthy and to permit the application of specific forms of treatment. The methods he used to heal mental disorders were partly repressive, but they also contained elements of psychotherapeutic treatment.     

PCI术前术后的心理障碍识别与处理

概述冠心病经皮冠状动脉介入治疗（PCI）术前术后患者合并心理障碍的较高发生率以及心理障碍对冠心病发生、发展及预后的影响,分析 PCI 术前术后患者出现焦虑抑郁等心理障碍的原因、产生机制及影响因素,强调心内科医生应及时识别 PCI 术前术后患者出现的心理障碍,并以“双心医学”方式对其进行心理精神医学及心血管专科医学治疗,同时对心血管专科医学治疗效果不明显的冠心病 PCI 患者,进行相关的鉴别诊断后也要进行心理精神医学的诊断和治疗,以便有利于 PCI 术患者的康复和预后,减少不必要的检查和治疗。     

Problems Caused for Mental Health Professionals Worldwide by Increasing Multicultural Populations and Proposed Solutions

Psychiatric disorders on a global scale, combined with rapid national population diversification, demand that mental health professionals worldwide become more informed about the realities of diagnosing and treating a multicultural patient population. Recommendations are offered to enable such professionals to most efficaciously diagnose and treat patients from diverse sociocultural backgrounds.     

Perceptions of South Florida Hispanic and Anglo Catholics: From Whom Would They Seek Help?

Hispanic and Anglo Catholics in South Florida who attended Sunday services (N = 473) were surveyed to determine their help-seeking preferences for moral concerns, mental disorders, and practical life/family problems. Respondents were asked to indicate whether they would seek help from a priest; a priest with a degree and license in one of the helping professions (clinical social work, psychology, psychiatry, or mental health counseling); a layperson with a degree and license in one of the helping professions (clinical social work, psychology, psychiatry, or mental health counseling); or if they believed they could deal with the situation without external assistance. The findings suggest that Anglo Catholics prefer assistance from a person who was credentialed in one of the helping professions, whereas Hispanic Catholics would seek help from a priest with or without a background in the helping professions.     

Between Hippocrates and God: Ugandan mental health professional's views on suicide

A negative attitude towards suicide is generally assumed to be predominant in low-income countries. In order to understand the negative attitude in general it is necessary to look at how religion and morality influence the attitudes. Our aim in this qualitative interview study was to investigate what attitudes professional mental health workers in Uganda bear towards suicide and suicidal persons. The professionals argue for their attitude by employing religious, communal and medical ethics arguments, which draw both in a negative and positive direction. The professionals are in general unambiguously negative towards suicide and positive towards suicidal people who are mentally ill. In cases other than mental illness non-accepting attitudes surface. This is discussed against previous research showing that effective treatment of suicidal people is to be based on a trusting and accepting relationship.     

Combating the mental health stigma with nostalgia

We report research implicating nostalgia as an intrapersonal means of warding off the stigmatization of persons with mental illness. We hypothesized and found that nostalgia about an encounter with a person with mental illness improves attitudes toward the mentally ill. In Experiment 1, undergraduates who recalled an encounter with a mentally ill person while focusing on central (vs. peripheral) features of the nostalgia prototype reported a more positive outgroup attitude. This beneficial effect of nostalgia was mediated by greater inclusion of the outgroup in the self (IOGS). In Experiment 2, undergraduates who recalled a nostalgic (vs. ordinary) interaction with a mentally ill person subsequently showed a more positive outgroup attitude. Results supported a serial mediation model whereby nostalgia increased social connectedness, which predicted greater IOGS and outgroup trust. IOGS and outgroup trust, in turn, predicted more positive outgroup attitudes. We ruled out alternative explanations for the results (i.e., mood, perceived positivity, and typicality of the recalled outgroup member). The findings speak to the intricate psychological processes underlying the prejudice‐reduction function of nostalgia and their interventional potential. Copyright © 2013 John Wiley & Sons, Ltd.     

Secular humanism and "scientific psychiatry"

The Council for Secular Humanism identifies Secular Humanism as a "way of thinking and living" committed to rejecting authoritarian beliefs and embracing "individual freedom and responsibility ... and cooperation." The paradigmatic practices of psychiatry are civil commitment and insanity defense, that is, depriving innocent persons of liberty and excusing guilty persons of their crimes: the consequences of both are confinement in institutions ostensibly devoted to the treatment of mental diseases. Black's Law Dictionary states: "Every confinement of the person is an 'imprisonment,' whether it be in a common prison, or in private house, or in the stocks, or even by forcibly detaining one in the public streets." Accordingly, I maintain that Secular Humanism is incompatible with the principles and practices of psychiatry.     

Out of the depths: Pastoral care to the severely depressed

The Judeo-Christian tradition has a unique and important contribution to make to the field of mental health. The knowledge gleaned from such sciences as psychiatry and psychology need not threaten the integrity of that tradition. Instead, a relationship with those disciplines can be mutually beneficial. One such instance is how Psalm 22 enhances our understanding of the experience of depression as well as informing our pastoral response.     

兰恩存在精神病学的心理治疗观

兰恩是20世纪英国著名的存在主义精神病学家,在反对传统精神病学诊疗观的基础上,提出了独特的存在精神病学的心理治疗观。在精神疾病的诊断上,兰恩主张从存在主义——现象学的视角来理解精神疾病,要从一个人的环境或背景中来理解他的行为。在精神疾病的心理治疗上,兰恩强调通过改变患者的生存环境来促进其自我恢复。     

On human self-domestication, psychiatry, and eugenics

The hypothesis that anatomically modern homo sapiens could have undergone changes akin to those observed in domesticated animals has been contemplated in the biological sciences for at least 150 years. The idea had already plagued philosophers such as Rousseau, who considered the civilisation of man as going against human nature, and eventually "sparked over" to the medical sciences in the late 19^th and early 20^th century. At that time, human "self-domestication" appealed to psychiatry, because it served as a causal explanation for the alleged degeneration of the "erbgut" (genetic material) of entire populations and the presumed increase of mental disorders.     

Jung's understanding of schizophrenia: is it still relevant in the ‘era of the brain’?

Jung was highly committed to grasping the meaning of psychotic thinking, and left behind precious insights to treatment scattered through his works written between 1906 and 1958. The tendency of today's psychiatry is to attribute the psychotic process to alteration in the brain's anatomy, biochemistry and electrophysiology, thus exempting the subject, i.e. the afflicted person, from responsibility for attachment to reality and their sanity. Jung understood schizophrenia as an ‘abaissement du niveau mental’, a similar phenomenon to the one encountered in dreams, and caused by a peculiar ‘faiblesse de la volonté’. He contested that complexes in schizophrenia, in contrast with neurotic disorders, are disconnected and can either never reintegrate to the psychic totality or can only join together in remission ‘like a mirror broke into splinters’ (Jung 1939 , para. 507). Accordingly, a person who does not fight for the supremacy of ego consciousness and has let themself be swayed by the intrusion of alien contents arising from the unconscious (even to the point of becoming fascinated by regression) is exposed to the danger of schizophrenia. The contemporary relevance of these notions and their necessity in understanding the psychotic process in the light of modern scientific findings are discussed.     

Thoughts and feelings and things: A new psychiatric epistemology

Epistemology — the study of knowledge — is a philosophical discipline with close ties to psychiatry. When epistemologists address specific questions about how knowledge is actually realized by human beings, their philosophy must be informed by empirical studies of the sort psychiatrists now take up in a variety of forms. As this paper describes, psychiatrists can likewise improve their understanding of human psychology through a deeper appreciation of philosophical analysis in epistemology.The aim of this article is to introduce a unifying framework within which the experience from different approaches to psychiatry — (1) the conceptual schemas of cognitive psychiatry, (2) the mental structures of psychoanalytic psychiatry, (3) the categorical forms of existential psychiatry, and (4) the neural pathways of biological psychiatry — can all be applied productively to the central question of epistemology. By establishing a broad understanding of the problem of knowledge, this new view of epistemology is developed within the idiom of each psychiatric approach. In addressing themselves to a unitary problem, these diverse psychiatric approaches are themselves revealed, not as competing points of view, but as complementary views of a single subject. The result is a new epistemology that can not only bring the insights of psychiatry to philosophy, but can also contribute to the care of patients when psychiatrists bring this broader view to their clinical work.     

New interpretative styles: Progress or contamination? Psychoanalysis and phenomenological psychopathology1

Psychoanalysis has started to recoup, often quite implicitly, a more phenomenological stance, ever since psychoanalysts have started working with borderline and psychotic patients. As many of these patients have commonly been through traumatic experiences, psychoanalysts have been using an approach that questions the role of traditional psychoanalytical interpretation and pays more attention to the patient's inner conscious experiences; this approach is characteristic of a specifi c form of contemporary psychiatry: phenomenological psychopathology, founded by Karl Jaspers in 1913 and developed into a form of psychotherapy by Ludwig Binswanger, with his Daseinsanalyse. If what we could call a phenomenological ‘temptation’ has been spreading over psychoanalysis, so too has a psychoanalytical ‘temptation’ always been present in phenomenological psychopathology. In fact, even though this branch of psychiatry has led us towards a deeper understanding of the characteristics of psychotic being‐in‐the‐world, its therapeutic applications have never been adequately formalised, much less have they evolved into a specifi c technique or a structured psychotherapeutic approach. Likewise, phenomenological psychotherapy has always held an anaclitic attitude towards psychoanalysis, accepting its procedures but refusing its theoretical basis because it is too close to that of the objectifying natural sciences. Psychoanalytic ‘temptation’ and phenomenological ‘temptation’ can thus be considered as two sides of the same coin and outline a trend in psychoanalytic and phenomenological literature which points out the fundamental role of the patient's inner conscious experiences in the treatment of borderline and psychotic patients.     

Beneficence and procreation

Consider a duty of beneficence towards a particular individual, S, and call a reason that is grounded in that duty a “beneficence reason towards S.” Call a person who will be brought into existence by an act of procreation the “resultant person.” Is there ever a beneficence reason towards the resultant person for an agent to procreate? In this paper, I argue for such a reason by appealing to two main premises. First, we owe a pro tanto duty of beneficence to future persons; and second, some of us can benefit some of those persons by procreating. In support of the first premise I reject the presentist account of time in favor of the view that future persons are just as real as presently existing persons. I then argue that future persons are like us in all the morally relevant ways, and since we owe duties of beneficence to each other, we also owe duties of beneficence to future persons. In support of the second premise I offer an account of benefiting according to which an individual can be benefited by an action even if it makes her no better off than she would have been, had the action not been performed. This account of benefiting solves what I call the “non-identity benefit problem.” Finally, I argue that having a life worth living is a benefit, and some of us can cause some persons that benefit by causing them to exist.     

Mindless psychiatry and dubious ethics

Psychiatry all around the world is seen as a specialized branch of medicine. Mental disorders are seen in organic terms and are treated like any other forms of physical disease--with drugs and other forms of organic interventions. This paper argues that the medical model, despite its popularity and continued usage is, to a large extent, unreliable and invalid. Although the present model of psychiatry is in need of an urgent 'paradigm shift', it still continues to exercise immense power and popularity over other approaches to mental illness. The reasons for its popularity and power are analysed and interpreted in historical, scientific, social, economic, and socio-political terms. The practice of psychiatry raises a variety of deep-rooted conceptual and applied issues, particularly those related to the definition and diagnoses of mental illness, treatment procedures, and the ethical practices within psychiatry. It is argued that the need to pathologise every form of mental aberration will be counter-productive in the future. Should this trend remain unchecked it will eventually stifle all forms of scientific, literary, and artistic development.     

A LITERARY TRINITY FOR COGNITIVE SCIENCE AND RELIGION

The cognitive sciences may be understood to contribute to religion‐and‐science as a metadisciplinary discussion in ways that can be organized according to the three persons of narrative, encoding the themes of consciousness, relationality, and healing. First‐person accounts are likely to be important to the understanding of consciousness, the “hard problem” of subjective experience, and contribute to a neurophenomenology of mind, even though we must be aware of their role in human suffering, their epistemic limits, and their indirect causal role in human behavior and subsequent experience. Second‐person discussions are important for understanding the empathic and embodied relationality upon which an externalist account of mind is likely to depend, increasingly uncovered and supported by social neuroscience. Third‐person accounts can be better understood in uncovering the us/them distinctions that they encode and healing the dangerous tribalisms that put an interdependent and communal world increasingly at risk.     

Free will and mental disorder: Exploring the relationship

A link between mental disorder and freedom is clearly present in the introduction of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). It mentions “an important loss of freedom” as one of the possible defining features of mental disorder. Meanwhile, it remains unclear how “an important loss of freedom” should be understood. In order to get a clearer view on the relationship between mental disorder and (a loss of) freedom, in this article, I will explore the link between mental disorder and free will. I examine two domains in which a connection between mental disorder and free will is present: the philosophy of free will and forensic psychiatry. As it turns out, philosophers of free will frequently refer to mental disorders as conditions that compromise free will and reduce moral responsibility. In addition, in forensic psychiatry, the rationale for the assessment of criminal responsibility is often explained by referring to the fact that mental disorders can compromise free will. Yet, in both domains, it remains unclear in what way free will is compromised by mental disorders. Based on the philosophical debate, I discuss three senses of free will and explore their relevance to mental disorders. I conclude that in order to further clarify the relationship between free will and mental disorder, the accounts of people who have actually experienced the impact of a mental disorder should be included in future research.     

Prophylactic psychiatry

The great contributions of Gantt to the problems of prophylactic psychiatry are pointed out. The author reviews his experiences with a 30-year follow-up of a population of 1800 persons. Over the 30 years, there appeared to be a 50% increase of neuroses, which raises great problems for mental health services. The Berlevåg population was offered optimal psychiatric services. Behavior therapy of neuroses and drug treatment of depression may possibly have lowered the prevalence of mental disorders. Psychophysiologic tests were used in the project. It is hoped that such tests may be utilized for early detection and treatment of mental disorders.