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 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.     

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.     

Couples with Schizophrenia "Becoming like Others" in South Korea: Marriage as Part of a Recovery Process

Very little is known about the married life of couples with schizophrenia. In this paper, authors report perceptions and experiences of 5 married couples with schizophrenia on their strategies in forming and maintaining healthy marriage. Our data reveal that participants had realistic expectations of marriage, and recognized benefits as well as obstacles in their marriages with respect to their recovery. This paper examines the importance of extended family members, mental health professionals, and the larger society's attitudes toward marriage as a factor in the recovery process for persons with schizophrenia. The authors identify implications for mental health professionals regarding the respect of client dignity and the applicability of a strengths perspective when working with couples with schizophrenia. The authors argue that mental health professionals' decisions regarding the balance between respecting a client's self-determination and protecting a client from risks associated with cohabitation and marriage should no longer be a dilemma for those working with people with mental illness.     

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.     

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.     

Therapeutische Teams: Theorie—Empirie—Klinik (Therapeutic Teams: Theory—Research—Clinic)

Abstract

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed “narrative enhancement and cognitive therapy (NECT)”. We describe the treatment approach and offer an illustration of it by way of a case vignette.     

Models of madness: Science and soul

The historical interplay between psychiatry and religion is placed in a contemporary context here. In their zeal to embrace new discoveries and technologies in neurophysiology, modern psychiatrists are losing sight of spiritual and cultural dimensions. From a biological perspective, there is confusion about what constitutes a cause, a concomitant, or a consequence of mental illness. Computer metaphors are being used to explain mental illness. This article examines such trends and questions whether, in the decade of the brain, psychiatry is in danger of losing its soul.     

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.     

Social inequality,scientific inequality,and the future of mental illness

Background

Despite five decades of increasingly elegant studies aimed at advancing the pathophysiology and treatment of mental illness, the results have not met expectations. Diagnoses are still based on observation, the clinical history, and an outmoded diagnostic system that stresses the historic goal of disease specificity. Psychotropic drugs are still based on molecular targets developed decades ago, with no increase in efficacy. Numerous biomarkers have been proposed, but none have the requisite degree of sensitivity and specificity, and therefore have no usefulness in the clinic. The obvious lack of progress in psychiatry needs exploration.

Methods

The historical goals of psychiatry are reviewed, including parity with medicine, a focus on diagnostic reliability rather than validity, and an emphasis on reductionism at the expense of socioeconomic issues. Data are used from Thomas Picketty and others to argue that our failure to advance clinical care may rest in part on the rise in social and economic inequality that began in the 1970s, and in part on our inability to move beyond the medical model of specificity of disease and treatment.

Results

It is demonstrated herein that the historical goal of specificity of disease and treatment has not only impeded the advance of diagnosis and treatment of mental illness, but, in combination with a rapid increase in socioeconomic inequality, has led to poorer outcomes and rising mortality rates in a number of disorders, including schizophrenia, anxiety, and depression.

Conclusions

It is proposed that Psychiatry should recognize the fact of socioeconomic inequality and its effects on mental disorders. The medical model, with its emphasis on diagnostic and treatment specificity, may not be appropriate for investigation of the brain, given its complexity. The rise of scientific inequality, with billions allocated to connectomics and genetics, may shift attention away from the need for improvements in clinical care. Unfortunately, the future prospects of those suffering from mental illness appear dim.

     

The Congruence of International Children's Rights and Feminist Principles as a Foundation for Therapy with Young People

SUMMARY

The United Nations Convention on the Rights of the Child, an international treaty that supports and protects humans under age eighteen, embodies several principles that are useful in guiding mental health treatment with young people. Here we summarize relevant tenets of the Convention and offer an analysis regarding its relevance to feminist therapy. Topics covered include participation and limited self-determination, privacy and autonomy, supportive community, access to information and care, least restrictive environment, and access to protection and recovery assistance. We then deconstruct the apparent assumptions underlying the Convention through a feminist, post-modern, social constructionist perspective. We conclude that the Convention offers a useful vision for work with children and is consistent in some ways with feminist-informed practice, although attention must be given to factors about which the Convention is silent, including gender, privilege, and assumptions regarding family, child, mental health, and human development.     

Defining Location in the Mental Health System: A Case Study of a Consumer-Run Agency

In this ethnographic study of a mental health service agency staffed by “consumers,” or fellow “recipients” of services for serious mental illness, the concept of community narrative provides the framework for examining how such an agency preserves its consumer identity while providing services dictated by the established service system. Locating the agency's narrative in its “origins tale,” analysis revealed five principles comprising the agency's identity: a normalizing view of mental illness, a commitment to helping, a dual-valued understanding of the mental health system, and beliefs in recovery and in the significance of employment as a criterion for recovery. Predicted consequences of narrative functioning emerged in social climate and staff expressions of cohesion and commitment. The local meaning of these narrative themes reveals the agency's view of the consumer element in its work and its solution to the dilemma of being both inside and outside of the mental health system.     

Narrative enhancement and cognitive therapy: a new group-based treatment for internalized stigma among persons with severe mental illness

Internalized stigma has been suggested to play a major role in negative changes in identity in severe mental illness. Evidence suggests that roughly one-third of people with severe mental illness show elevated internalized stigma and that it is linked to compromised outcomes in both subjective and objective aspects of recovery. Despite substantial evidence for the impact of internalized stigma, few efforts have been made to develop professionally led treatment to address this issue. In this article, we discuss our development of a new group-based approach to the treatment of internalized stigma which we have termed "narrative enhancement and cognitive therapy (NECT)". We describe the treatment approach and offer an illustration of it by way of a case vignette.     

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.     

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。     

Where the Rainbow Speaks and Catches the Sun

Abstract

Living with a neurobiological brain disorder, commonly known as a mental illness, requires a lifetime of diligent work toward recovery and wellness. This paper outlines the story of one occupational therapist's journey with her own mental illness. She prefers to call her own road of “recovery” one of “discovery,” as it has led her to discover true talents and gifts (strengths) even amongst encounters with old models that emphasize weaknesses and disability over abilities and capabilities. The following journey unfolds as advances in research, changes in services, increased focus on consumer as leader and increased tools and resources available lead the way toward a more positive ability to live a purposeful life, engaging in meaningful activities in spite of an illness. This paper gives a personal account as a tool to be used by other therapists as they travel along their own treatment journeyswhether with, or as consumers, of mental health services.     

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.     

Barriers to Mental Health Care: A 25‐Year Follow‐Up Study of the Orthodox Jewish Community

The current study is a 25‐year follow‐up to a mental health needs assessment in the often overlooked, but rapidly growing, Orthodox Jewish denomination. Results suggest increased acceptance of mental illness and its treatment and satisfaction with quality of care, along with decreased mistrust of the mental health field, belief that religion and psychiatry conflict, and tendency to attach stigmas to psychiatric problems. However, issues of stigma and affordability continue to be obstacles to treatment. El presente estudio es un seguimiento tras 25 años de una evaluación de necesidades de salud mental en la población frecuentemente ignorada, pero en crecimiento rápido, de individuos de denominación judía ortodoxa. Los resultados sugieren una mayor aceptación de enfermedades mentales y sus tratamientos, así como la satisfacción con la calidad de los cuidados, además de una reducción en la desconfianza hacia el campo de la salud mental, la creencia de que existe un conflicto entre religión y psiquiatría, y la tendencia a estigmatizar los problemas psiquiátricos. Sin embargo, problemas relacionados con la asequibilidad y el estigma continúan siendo obstáculos para el tratamiento.