Some myths about ‘mental illness’

Radical psychiatrists and others assert that mental illness is a myth. The opening and closing portions of the paper deal with the impact such argument has had in law and psychiatry. The body of the paper discusses the five versions of the myth argument prevalent in radical psychiatry: (A) that there is no such thing as mental illness; (B) that those called ‘mentally ill’ are really as rational as everyone else, only with different aims; that the only reasons anyone ever thought differently was (C) because of unsophisticated category mistakes or (D) because of an adherence to the epistemology of a sick society; and (E) that the phrase ‘mental illness’ is used to mask value judgments about others’ behavior in pseudo‐scientific respectability. Reasons are given for rejecting each of these versions of the argument that mental illness is a myth.     

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 Windows program to assist in preparing reports of emergency psychiatry nursing assessments

The Emergency Psychiatry Nursing Assessment Report Framework (EP Nurse) is designed to guide the nurse through the interview-and-reporting process, and to produce a report of the nursing evaluation in emergency psychiatry in 5–10 min. Input includes identifying information, presenting complaints, substance-use history, medical history and vitals, psychiatric medications, treatment history, history of mental illness, last hospitalization, family history of mental illness, nursing diagnosis, and nursing intervention. EP Nurse is intended to be used by licensed nurses familiar with nursing assessment in emergency psychiatry. It is suitable for adult patients.     

Mental illness and the mind-brain problem: Delusion,belief and Searle's theory of intentionality

Until recently there has been little contact between the mind-brain debate in philosophy and the debate in psychiatry about the nature of mental illness. In this paper some of the analogies and disanalogies between the two debates are explored. It is noted in particular that the emphasis in modern philosophy of mind on the importance of the concept of action has been matched by a recent shift in the debate about mental illness from analyses of disease in terms of failure of functioning to analyses of illness in terms of failure of action. The concept of action thus provides a natural conduit for two-way exchanges of ideas between philosophy and psychiatry. The potential fruitfulness of such exchanges is illustrated with an outline of the mutual heuristic significance of psychiatric work on delusions and philosophical accounts of Intentionality.     

Griesinger's psychiatric approach

The standpoint from which Griesinger considered mental illness and the closely connected relationship between body and mind is described. The conclusion is drawn that Griesinger, realising that body and mind form an entity with the brain as an organ and psychological processes as its function, regarded mental illness as an organopathological process. This played a great role in raising psychiatry to the status of the purely somatic fields of medicine.     

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.     

克雷佩林与精神病人的时代形象

精神疾病分类学不仅构建了对于这种疾病的评价,也决定了病人的名誉及其在法律关系中的责任。通过这些直接或间接的作用,精神疾病分类学塑造了一个时代的精神病人的形象。概述了克雷佩林的理论体系和分类思想,分析了贯穿其间的哲学讨论及其产生的社会影响,在此基础上说明起始阶段的精神疾病分类学如何塑造了那样一种精神病人的时代形象。     

神经症躯体症状的特点与诊断原则

作为临床医生,难免与一些难以解释的躯体症状打交道,这其中有些最终可以确定是精神障碍的躯体症状。从躯体症状识别精神障碍,没有捷径可走,除了良好的医学基础,更要了解精神障碍的特点。这样即便是躯体疾病同样存在的情况下,也能发现精神障碍。套用政治术语,叫做"两手抓,两手都要硬"。即便如此,还有一些医学难以解释的症状,其发生基础无论从生物学医学还是精神病学角度都还不清楚,而这正是需要我们着力研究的学科交叉点。     

Genetically-determined abnormal behavior in dogs: Some implications for psychiatry

This paper discusses the neglect of behavioral genetics by psychiatry; summarizes experiments on a stable and an unstable strain of the pointer dog (reported in detail in a companion article); and points up the value of the obtained results for models of mental illness. The importance of genetically-determined extreme variations in temperament in shaping the individual's responses to particular environments is emphasized. These variations occur spontaneously among animals, and probably are relatively favored for procreation among civilized man and domesticated animals. Various dimensions of temperament and of inborn perceptual, cognitive, and integrational deficiencies are placed alongside early experience and later-life stresses, as equally important in contributing to mental breakdowns.     

Madness or Mental Illness? Revisiting Historians of Psychiatry

Is madness medical disease, problems in living, or social labeling of deviance? Does the word merely refer to behavior peculiar enough to be disturbing? Are the mad mad because of mental, physical, or environmental vulnerabilities? No one knows the answers to these questions because there is no scientific validation for any theory or specific causes of madness. Nonetheless, a view of madness as medical/bodily disease has been receiving concrete and rhetorical support from the government mental health bureaucracy, Big Pharma, mental health lobby groups, the organized profession of psychiatry, hundreds of thousands of providers of mental health services and countless books and articles. This article explores the role that medicalized language and its use by seven noted historians of psychiatry (Norman Dain, Albert Deutsch, Gerald Grob, Roy Porter, Charles Rosenberg, Andrew Scull, and Edward Shorter) might have played in shaping the contemporary view of madness as mental illness. The evidence we uncover suggests that historical “facts” about madness, much as psychiatric “facts” supporting the disease model, are shaped by belief, bias, error or ambiguous rhetoric rather than the facts of the matter.     

The role of the symptom in psychopathological states

Abstract.— Four approaches to the role of symptoms in psychopathological states are discussed. These are: Prepsychoanalytic psychiatry, psychoanalysis, family communication theory, and the view that symptoms as a sign of mental illness do not exist. The latter comprises labelling theory and social learning theory. Particular interest is attached to the contentions of symptom substitution and symptomatic treatment. Both are rejected as myths. A theory of action is briefly outlined, and on the basis of this, an alternative interpretationof phenomena ordinarily conceptualized as mental pathology is suggested. The concepts of "psychopathology" and "symptoms" are redefined in accordance with present knowledge, and the importance of formulating human action in an ethical frame of reference is pointed out.     

?Psychische St?rung�� als Begr��ndung f��r staatliche Eingriffe in Grundrechte des Individuums

When dealing with ?old cases?? of preventive detention as well as retrospectively ordered preventive detention, a continuation of confinement should be possible if the offender involved suffers from a ??mental disorder?? which constitutes the danger of future serious violent or sexual crimes. In this psychiatric article it will be explained that the terms ??mental illness?? and also ??mental disorder?? must retain an empirical scientifically definable psychiatric content in order not to instigate deception. They must also be functionally defined in each judicial environment (police law, social law, civil law and criminal law) with respect to the capabilities of the individual which are impaired by the mental disorder. Such an approach could prevent a misuse of psychiatry for purely political security purposes.     

Maternal Care and Individual Differences in Defensive Responses

Abstract— Familial transmission of mental illness is common. Recent studies in behavioral neuroscience and biological psychiatry reveal the importance of epigenetic mechanisms of transmission that center on the developmental consequences of variations in parental care. Studies with rats suggest that environmental adversity results in patterns of parent–offspring interactions that increase stress reactivity through sustained effects on gene expression in brain regions known to regulate behavioral, endocrine, and autonomic responses to stress. While such effects might be adaptive, the associated cost involves an increased risk for stress-related illness.     

A brief historicity of the <Emphasis Type="Italic">Diagnostic and Statistical Manual of Mental Disorders</Emphasis>: Issues and implications for the future of psychiatric canon and practice

The Diagnostic and Statistical Manual (DSM) of the American Psychiatric Association, currently in its fourth edition and considered the reference for the characterization and diagnosis of mental disorders, has undergone various developments since its inception in the mid-twentieth century. With the fifth edition of the DSM presently in field trials for release in 2013, there is renewed discussion and debate over the extent of its relative successes - and shortcomings - at iteratively incorporating scientific evidence on the often ambiguous nature and etiology of mental illness. Given the power that the DSM has exerted both within psychiatry and society at large, this essay seeks to analyze variations in content and context of various editions of the DSM, address contributory influences and repercussion of such variations on the evolving landscape of psychiatry as discipline and practice over the past sixty years. Specifically, we document major modifications in the definition, characterization, and classification of mental disorders throughout successive editions of the DSM, in light of shifting trends in the conceptualization of psychopathology within evolving schools of thought in psychiatry, and in the context of progress in behavioral and psychopharmacological therapeutics over time. We touch upon the social, political, and financial environments in which these changes took places, address the significance of these changes with respect to the legitimacy (and legitimization) of what constitutes mental illness and health, and examine the impact and implications of these changes on psychiatric practice, research, and teaching. We argue that problematic issues in psychiatry, arguably reflecting the large-scale adoption of the DSM, may be linked to difficulties in formulating a standardized nosology of psychopathology. In this light, we highlight 1) issues relating to attempts to align the DSM with the medical model, with regard to increasing specificity in the characterization of discrete mental disease entities and the incorporation of neurogenetic, neurochemical and neuroimaging data in its nosological framework; 2) controversies surrounding the medicalization of cognition, emotion, and behavior, and the interpretation of subjective variables as 'normal' or 'abnormal' in the context of society and culture; and 3) what constitutes treatment, enablement, or enhancement - and what metrics, guidelines, and policies may need to be established to clarify such criteria.     

Psychiatry: The Importance of Understanding Persons While Treating Diagnoses

Modern psychiatry emphasizes chemical, genetic, psychosocial, and similar theoretical biological sciences. While these sciences can explain mental disorders they fail to generate a full understanding of the patient as a person. I argue that psychiatry, to not stereotype persons, must integrate both the important advances in molecular and social sciences needed to diagnose and treat mental illnesses and provide an encounter with the person who is the patient. Standardized forms of diagnostic interviewing now dominate in the psychiatrist–patient relationship. Individualizing forms of inquiry, by contrast, elicit a personal understanding of the patient and her problems and the information necessary to diagnose and treat the patient's mental disorders.

This understanding attitude towards individuals is essential so that psychiatrists avoid falling into over-simplified stereotyping explanations of the persons who are their patients. If psychiatry allows its diagnoses of disordered processes that occur within persons to function as labels for persons, then psychiatry appears scientifically to condone the uses of stereotypes. With an understanding attitude towards patients, psychiatry can better treat mental disorders, while also respecting human diversity.     

Computational psychiatry

Computational ideas pervade many areas of science and have an integrative explanatory role in neuroscience and cognitive science. However, computational depictions of cognitive function have had surprisingly little impact on the way we assess mental illness because diseases of the mind have not been systematically conceptualized in computational terms. Here, we outline goals and nascent efforts in the new field of computational psychiatry, which seeks to characterize mental dysfunction in terms of aberrant computations over multiple scales. We highlight early efforts in this area that employ reinforcement learning and game theoretic frameworks to elucidate decision-making in health and disease. Looking forwards, we emphasize a need for theory development and large-scale computational phenotyping in human subjects.     

INTERNISTS OF THE MIND OR PHYSICIANS OF THE SOUL: DOES PSYCHIATRY NEED A PUBLIC PHILOSOPHY?

Although psychiatry is interested in what both body and mind contribute to behavior, it sometimes emphasizes one more than the other. Since the early 1980s, American psychiatry has shifted its interest from mind and psyche to body and brain. Neuroscience and psychopharmacology are increasingly at the core of psychiatry. Some experts claim that psychiatry is no longer interested in problems in living and positive goals such as mental health, happiness, and morality but rather has narrowed its focus to mental disorders addressed with psychotropic drugs. In view of this trend, psychiatry needs to confront two questions in social philosophy. If it is no longer directly concerned with health and happiness, how does it relate to these positive goals? And how does it relate as a medical institution to religious institutions, schools, and other organizations that directly promote health, happiness, morality, and the purposes of life? It is not enough for psychiatry to renounce its moral role; its practices still shape cultural values. Psychiatry should take more responsibility for developing a public philosophy that addresses these issues.     

The story of a ghost

SUMMARY

This paper is concerned with the relationship between psychotherapy and general psychiatry. This relationship is examined from historical, clinical and theoretical perspectives. Psychotherapy is an integral part of psychiatric practice imparting to it a means of participating in, as well as observing, the patient's subjective experiences. Mental illnesses, whatever their nature have fundamental elements in common. This common ground is most apparent when mental illnesses are conceptualised in psychological terms. Such an approach in no way undervalues the importance of the hereditary and somatic influences which contribute to the predisposition to mental illnesses. Viewed in this psychobiological way it is not difficult to discern what is common to neuroses, psychoses and disturbances of the personality. The clinical phenomena provide the basis for a developmental theory which portrays the essential unity of mental illnesses. The paper concludes with a discussion of why psychotherapy is being gradually divorced from clinical psychiatry. The dangers which this separation hold for the clinical tradition in psychiatry are emphasised.     

The Growing Evidence for Demonic Possession: What Should Psychiatry’s Response be?

Evidence of evil spirits is voluminous and comes from many cultures, both ancient and modern. Cases from China, India, and the United States are examined and evaluated. The actual experience of spirit victims, the universality of spirit oppression, the superhuman phenomena associated with possession, and the comparative success of deliverance and exorcism vs. psychiatry are considered. Potential arguments against the spirit hypothesis center on the antecedent improbability of spirits, multiple personality disorder, and the effectiveness of medication; but these can be countered. Psychiatrists should question their materialist assumption that mental illness is strictly a matter of an aberrant brain, carefully examine the literature of possession, experiment to determine why exorcists and deliverance ministers often succeed where psychiatry fails, and develop a more complete inventory of techniques for healing the complete person.