Person perception and scientific objectivity

The perception of other people is shown to require a different set of scientific assumptions than that used in traditional psychology. Mind-body dualism, subject-object dichotomy and traditional notions of scientific causality are shown to be inapplicable to the perception of people, except where people are being seen as objects. The ?predict and control' model of psychology, and the ?medical model' of psychiatry both involve the perception of people as objects. The ?participant observer' model is seen to be the optimal one for the study of human beings.     

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.     

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.     

More focused attention upon relationship; another call for paradigm shift in psychiatry

Much of what are understood as ‘mental health difficulties’ reflects shortcomings in the ability to develop and sustain healthy relationships. Many of those embarking upon life as someone with a psychiatric diagnosis are people whose difficulties can be traced to adolescence, or even earlier in life. Unsatisfactory relational experiences during childhood are acknowledged contributors to subsequent psychological vulnerability. Numerous studies identify associations between other forms of relational disturbance, and the onset and maintenance of psychological difficulties. Some eighty years’ psychotherapy research has repeatedly suggested that the quality of therapeutic relationship is a major determinant of outcome. Sophisticated analyses of large databases now confirm this beyond doubt. All concur that social exclusion and stigma are the most disabling consequences of living as someone with a psychiatric diagnosis. None of these facts are disputed but there is continuing resistance to broad acknowledgement of their implications. This has many parallels with other examples of paradigm shift, as so clearly outlined by Thomas Kuhn. Uncertainties about the value of medical psychiatry and growing recognition of the role relationships play in the genesis and relief of mental health difficulties suggest that psychiatry can be seen in similar terms. This paper develops that thesis.     

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.     

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.     

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.     

An introduction to organic brain syndromes

Organic brain syndromes are of forensic interest for several reasons. First, patients with organic brain syndromes may require judicial determination of competence in any of a number of areas, e.g., testamentary capacity, need for financial guardianship, or competence to make medical decisions. Second, any patient whose mental state is of legal interest will need evaluation for contributing organic factors; uncovering these factors may have considerable medical and legal consequence. Third, the discovery of organic factors may be decisive in the outcome of a judicial proceeding, where “hard” biological data are often accorded more weight, and are thus more persuasive, than “soft” psychological data. This article provides an introductory overview of the organic brain syndromes. For each syndrome, the clinical features are described and are illustrated with a case vignette, the more common etiologies are presented, and selected aspects to the evaluation are highlighted. In addition, since the detectian of malingered mental illness is a key component in many forensic contexts, characteristics are described which help to distinguish actual from malingered mental illness.     

?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.     

L’enfance et l’adolescence in situ : facteurs environnementaux facilitateurs et inhibiteurs de troubles cognitifs et comportementaux

The definition of mental health associates three fundamental variables: biological variables, psychological variables and environmental variables. In this article, we will focus on environmental variables that inhibit and facilitate cognitive and behavioural disorders in childhood and adolescence. Environmental psychology considers the interrelations between human and environment in its spatial, social and chronological dimensions and considers it as a characterized and undissociated system. We will bring to mind social and physical environmental variables with which children and adolescents interact frequently and, through a literature review, we will enlighten environmental variables that are susceptible to induce behavioural disorders and psychological variables that modulate children's and adolescent's relations to environment. We then suggest possible outcomes of this approach in clinical practice as well as in terms of therapeutic applications in child psychology and psychiatry. Finally, we evoke the necessity of taking in account neurobiological fields in order to outline a model of human development integrating the three variables that define mental health.     

Developing the therapeutic alliance in acute mental health care

The establishment of a good working relationship, or therapeutic alliance, is seen as a key indicator of good outcome in all forms of psychological therapy. Such a relationship, however, is difficult to establish in acute mental health, when the patient may both need and fear therapeutic contact. The patient care plan can give the appearance of a positive working alliance when this is not truly established. The Care Plan Approach can prioritize case management and risk assessment over treatment. A good therapeutic alliance can often be achieved in times of acute crisis, but only when the difficulties in so doing are recognized and acknowledged. The distinction between benign and malign dependency can be a useful way of conceptualizing therapeutic and non‐therapeutic factors in acute care. Apparently progressive paradigms in mental health care serve to deny the inherent difficulties and conflicts involved in establishing a therapeutic alliance in cases of severe mental illness. Developing a genuine therapeutic culture in acute mental health requires that organizational structures and protocols are clinically informed and are congruent with the therapeutic ethos desired. Examples from a recently established Acute Day Hospital will illustrate how a psychodynamically‐informed group‐based treatment can be effective in developing the therapeutic alliance. I will focus on Psychiatric Nursing, although I hope that the content of the paper is more widely applicable.     

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.     

Kleptomanie und Ladendiebstahl: Ein historischer Überblick

The phenomenon of illness-indicating theft acts committed by apparently psychologically normal offenders engages psychiatry since the beginning of the 19^th century. With the specialist term kleptomania therefore an independent syndrome was created, which was seen as an isolated disturbance of the will (monomania). Structural abnormalities of the brain, women-specific life conditions, problems in early childhood development and the seductions of offensive advertisement strategies of modern big stores were esteemed as causally responsible. In spite of often voiced criticism, the conception of a mental disorder, which is expressed only by theft acts had outlasted more than 150 years. In the currently valid classification systems of mental diseases, kleptomania as well as the leading symptoms are classified as an impulse control disorder. This fact by all appearances has awarded them the grade of detectability. However, in fact these criteria prove as unspecific. The problem with it is that the question of an illness background of theft acts is posed mostly in the context of assessing the criminal responsibility. In fact illness-conditioned stealing is found only as a symptom among other quite different mental diseases and extraordinary situational charges. The concentration to the only theft act carries the risk of disregarding the careful exploration and preparation of the real psychological problem.     

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.     

Psychoanalytic and biological approaches to mental illness: schizophrenia.

Biological psychiatrists tend to look upon the phenomena of mind and meaning, which are the data of psychoanalysis, as meaningless epiphenomena, and propose reductive explanations of complex mental states, whereas psychoanalysts tend to ignore the proliferation of neurobiological data indicating the importance of constitutional factors in mental illness. Interactive models which confuse biological causes and psychological consequences, or vice-versa, are theoretically unsound. A scientific model hierarchy is proposed, along with some principles for coexistence and collaboration between neurobiology and psychoanalysis. The problem is illustrated with schizophrenia, a condition whose probable biological underpinnings are now generally considered to remove it from the realm of psychoanalysis. Schizophrenia-vulnerable phenotypes consistent with organic findings and clinical observations are hypothesized, and some ideas about their development in the context of early object relations, leading to pathological forms of symbiosis, are elaborated. A neurobiological rationale for the psychoanalytic treatment of schizophrenia is presented, and special problems related to the biological and symbiotic substrate are examined.     

A Psychoanalytic Dialectical Model for Sexual and Other Forms of Workplace Harassment

Beginning with a brief literature review, the present paper outlines a dialectical model for sexual and other forms of workplace harassment in which the role dependent models of bully, victim and bystander are seen to complexly interact and facilitate each other. An organization which has a bully always has the other two roles represented according to the model. It is suggested that for a workplace to function harmoniously all three roles must be addressed, and the power struggle resolved. The theory is illustrated with a series of case studies drawn from a forensic psychiatry practice. These include some more unusual forms of harassment such as the harassment of a Mexican American woman by an African American woman, the harassment of a middle-aged conservative man by two young women, the harassment of a man by several male employees together with traditional patterns of an older male employer harassing a younger female employee. Psychoanalytic processes which explain the pathological patterns are illustrated with material drawn from a psychoanalysis of a harassed woman. The paper concludes with some brief suggestions for a plan for workplace intervention.     

SPIRIT HEALING,MENTAL HEALTH,AND EMOTION REGULATION

Abstract. Spirit healing is widespread across societies in diverse world regions. Its ritual forms appear in local, popular religions as well as a variety of organized churches. Although aspects of ritual, suchas the identification of spirits and use of symbols and paraphernalia, vary with culture and type of religion, there appear to be basic components of ritual healing process shared by its diverse forms. Using data on Spiritist healing in Puerto Rico as a case example, I first examine aspects of the interface between mental illness as defined by psychiatry and spirit healing. I then raise the question: If spirit healing is effective with some emotional disorders (as I have discussed in previous reports), how does it work? Emotional transactions could be considered foundational to most or all spirit healing rituals as they are to some psychotherapeutic and alternative‐medicine modalities. One model of emotion regulation is proposed as a lens through which to view specific processes of change in feelings and emotions in the context of culturally specified ritual structures.     

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.     

A psychiatrist's reflections on the workers' compensation system

In the ‘looking-glass land’ of workers' compensation psychiatry, symptoms are not always what they seem, treatments may have little or no positive effect, and workers' claims of continued disability may puzzle and perplex. Disability is in part a social role, and a simple medical model cannot explain the complex interactions of sociology, psychology, anthropology, medicine, economics, and law characteristic of the workers' compensation system. Psychiatrists functioning within and reciprocally shaped by this semi-adversarial system will rarely encounter an ‘ideal’ patient. Factors in all areas of workers' lives, including those integral to the workers' compensation system, influence their movement along a health-illness, ableddisabled axis. This paper identifies a number of interacting factors that may prolong, or even subvert, the recovery process following a work-incurred injury or illness.