The triumph of American psychiatry: How it created the modern therapeutic state

Over the past 170 years, American psychiatry has progressively asserted its authority over a larger segment of the American population. From the mid-1800s to the end of World War II, psychiatry had authority over the asylum population, which markedly increased in the first half of the twentieth century due to the influence of eugenics, an ideology that argued the ‘mentally ill’ had to be segregated from society. After the war, American psychiatry adopted Freudian conceptions of mental disorders, which enabled it to begin treating people in the community who were ‘neurotic’ in some way, which dramatically expanded its influence in society. Then, in the 1970s, when many in American society were questioning psychiatry’s legitimacy as a branch of medicine, the American Psychiatric Association (APA) responded by adopting a disease model for diagnosing mental disorders, which it set forth in the third edition of its Diagnostic and Statistical Manual. There were no scientific discoveries that led to this new model, but soon the APA was informing the American public that mental disorders were diseases of the brain, and that psychiatric drugs helped fix those diseases, ‘like insulin for diabetes.’ The APA, in concert with pharmaceutical companies, has successfully exported this belief system to much of the developed world. In order to break free of this ‘therapeutic state,’ the public needs to understand the history of how it came to be, and see the social injury it has caused.     

Asylum psychiatry, neurology, social work, and mental hygiene: an exploratory study in interprofessional history

The author proposes that an adequate appreciation of the American mental health movement will require, ultimately, an appreciation of the concurrent developments in the histories of related professions (e.g., asylum psychiatry, neurology, social work, and public mental health). In this exploratory review, the author demonstrates some reciprocal influences between these professions which were significant determinants for their present positions. Suggestions are offered for other needed interprofessional historical studies in this area.     

Mental health care and the politics of inclusion: A social systems account of psychiatric deinstitutionalization

This paper provides an interpretation, based on the social systems theory of German sociologist Niklas Luhmann, of the recent paradigmatic shift of mental health care from an asylum-based model to a community-oriented network of services. The observed shift is described as the development of psychiatry as a function system of modern society and whose operative goal has moved from the medical and social management of a lower and marginalized group to the specialized medical and psychological care of the whole population. From this theoretical viewpoint, the wider deployment of the modern social order as a functionally differentiated system may be considered to be a consistent driving force for this process; it has made asylum psychiatry overly incompatible with prevailing social values (particularly with the normative and regulative principle of inclusion of all individuals in the different functional spheres of society and with the common patterns of participation in modern function systems) and has, in turn, required the availability of psychiatric care for a growing number of individuals. After presenting this account, some major challenges for the future of mental health care provision, such as the overburdening of services or the overt exclusion of a significant group of potential users, are identified and briefly discussed.     

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.     

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。     

Self-harming behaviours of asylum seekers and refugees in Europe: A systematic review

The increasing number of asylum seekers and refugees in Europe calls for even more professionals to take care of refugees' mental health. Although different studies claim that migration could be a potential risk factor for self-harming behaviours, an in-depth exploration of the presence and characteristics of self-harm in the context of asylum is needed. In accordance with PRISMA guidelines, a systematic review was conducted across the databases Scopus, PubMed, Web of Knowledge and PsycArticles, regarding the main features of self-harming behaviour among refugees in Europe. Twelve articles and 3 main trajectories were identified: (1) A context at-risk: self-harm and detention centres; (2) A target at-risk: self-harm and unaccompanied minors; (3) A comparison between the mental health of asylum seekers and natives. Research on this topic in Europe is still underdeveloped and disorganised. Studies have mainly carried out wider quantitative investigations on mental health, usually overlapping self-harm with suicide. Detention centres emerged as the most widely investigated context and the one with the highest risk for self-harming behaviours. Instead, unaccompanied minors emerged as a particularly vulnerable category. Research in this field should be improved, combining quantitative and qualitative methods for a deeper understanding of the meanings of self-harm across cultures.     

The Importance of Resources and Security in the Socio-Economic Integration of Refugees. A Study on the Impact of Length of Stay in Asylum Accommodation and Residence Status on Socio-Economic Integration for the Four Largest Refugee Groups in the Netherlands

In many European countries, including the Netherlands, refugees stay in asylum accommodation pending a decision on their asylum request. While it seems evident that the lack of resources and insecurity about the future experienced during this stay will impact refugees’ subsequent ability to integrate with the host society, so far this has hardly been studied in an extensive way. Also, the type of residence status granted can be a source of insecurity that impacts their integration. Previous studies on refugee integration have already shown the impact of pre-migration stressors such as traumatic experiences on mental health and integration. In this study, we use a large-scale dataset containing detailed information on about 4,000 refugees to show that also post-migration stressors affect mental health and hinder the socio-economic integration of the four largest refugee groups in the Netherlands: Afghan, Iraqi, Iranian and Somali.     

‘I Feel Like a Beggar’: Asylum Seekers Living in the Australian Community Without the Right to Work

While numbers of asylum seekers received by Australia are small compared to global figures, a range of deterrence measures have been implemented in response to increasing numbers arriving by boat in recent years. One of the more recent measures was denying asylum seekers who arrived by boat after 13 August 2012 the right to work upon their release from immigration detention into the community. There are around 26,000 asylum seekers who have been subject to this policy with most still waiting for their initial interview for refugee status and none have had their refugee claims resolved. This paper examines the findings of a study that explored the implications of this policy for asylum seekers. It draws on 29 semi-structured interviews with asylum seekers and highlights the distress and fear that many are enduring, caused by the denial of the right to work and ongoing uncertainty about their refugee claims. The study’s findings provide support for the conclusions of earlier research that highlight the importance of the right to work and securing employment for the mental health of asylum seekers, as well as studies that found there were negative mental health consequences of forcing asylum seekers to live for long periods with uncertainty around their protection claims.     

Examining mental health literacy and its correlates using the overclaiming technique

The present study examined mental health literacy among the British general public using the overclaiming technique, where participants rate for familiarity a series of items, some of which are foils resembling real items. In total, 344 Britons rated for familiarity 30 mental health disorders, of which six were foils, and also completed measures of the Big Five personality factors, self-rated intelligence, self-reported knowledge of psychiatry, psychiatric skepticism, and their personal details. Using signal detection analysis, responses on the overclaiming measure were used to compute an accuracy index (accuracy in distinguishing real mental health disorders from foils) and a response bias (the tendency to response affirmatively to both real disorders and foils). Preliminary analysis showed that there were no significant sex differences on either the accuracy or response bias indices. Further analyses showed that greater accuracy was significantly predicted by higher self-rated intelligence, greater knowledge of psychiatry, and lower psychiatric skepticism. These results are discussed in terms of the benefits of using the overclaiming technique and signal detection analysis in the study of mental health literacy.     

Psychopathologie und Aufenthaltsstatus

This study compared the mental health status of various groups of people living in Switzerland. A total of 65 asylum seekers, 34 refugees, 21 illegal migrants, 26 migrant laborers and 56 Swiss citizens were assessed for psychopathological symptoms of posttraumatic stress, anxiety and depression. Specifically, it was tested if the residence permit status was associated with psychopathology if potentially confounding factors, such as social desirability, trauma history and integration were statistically controlled. The results showed that the majority of the asylum seekers, refugees and illegal migrants included in the study suffered from substantial psychopathological symptoms. An association between residence permit status and psychopathology was found even after controlling for other influencing factors. The results imply that not only trauma experiences lead to psychopathology in specific population groups with a migration background but also factors related to an insecure residence permit can contribute to psychopathological symptoms.     

Psychoanalysis in the university: the natural home for education and research

Psychoanalysis as a theory of human mental functioning and a derived therapeutic for disturbed functioning would have its natural home in the university, and Freud gave evidence of harboring such an ambition. But the sociopolitical structure of the early 20th century Austro-Hungarian Empire precluded this, and analysis developed, by default, its part-time, private practice-based educational structure. Psychoanalytic penetration of academic psychiatry in the United States after World War II made possible a counter-educational structure, the department of psychiatry-affiliated psychoanalytic institute within the country's medical schools. This paper outlines, beyond these, other more ambitious vistas (David Shakow, Anna Freud, The Menninger Foundation, Emory University [US], APdeBA [Argentina]), conceptions even closer to the ideal (idealized) goal of full-time placement within the university with strong links to medicine, to the behavioral sciences, and to the humanities.     

Psychiatry in the labyrinth: Deconstructing deviancy

Abstract

Deviancy is a key concept in psychiatry and other therapeutic disciplines, because it dramatizes the way in which they depend on the establishment of norms, in order to justify their theory and practice. The writings of Derrida as well as Goethe provide a different view: that “deviation” from a “norm” can be fundamentally important to the well‐being of the norm. Thus deviancy can be viewed not as something to be “corrected” but rather as a creative possibility to be encouraged and shaped in productive ways. As a case of “deviancy” we have selected the writings of John Perceval, whose Narrative provides a critique of the mental‐health establishment of his day, particularly the asylum, and offers an alternative to 19th‐century views of “lunacy.” We see his “schizophrenic” commentary on his “psychosis” and its treatment as analogous to the deconstructive, “schizophrenic” discourse of postmodernity which is similarly critical of the reigning, modernist psychiatric order.     

“The tempest in my mind”: Cultural interfaces between psychiatry and literature, 1844–1900

The professional literature of the first generation of American psychiatrists is replete with poetical passages drawn from the imaginative works of such English authors as Shakespeare, Byron, and Scott as well as the writings of residents of the asylums they tended. A close reading of such passages in the American Journal of Insanity (AJI), the central medium through which members of this nascent profession attempted to “popularize the study of insanity,” suggests they were not simply textual ornaments or signs of the underdeveloped state of American psychiatry in the mid-nineteenth century. Indeed, literary manifestations of the imaginative minds of patients and renowned writers were scrutinized by psychiatrists seeking to advance their understanding of mental disease. Moreover, the English authors were often elevated to the status of medical experts and their poetry and prose were commended to fellow medical practitioners as sources of psychological insight. Toward the turn of the century psychiatrists' engagement with these literary forms was less pronounced in the AJI, due in large part to the impact of rising asylum populations and the coming of a culture of positivist medicine. Yet literary influences on psychiatric writing are still evident in this period, indicating the complexity of the cultural interfaces between psychiatry and literature and the importance of examining the historical processes that have served to define and distinguish the enterprise of the psychiatrist from that of the poet.     

Applicability of two violence risk assessment tools in a psychiatric prison hospital population

The risk of violent behavior is known to be higher for patients who suffer from a severe mental disorder. However, specific prediction tools for clinical work in prison psychiatry are lacking. In this single-center study, two violence risk assessment tools (Forensic Psychiatry and Violence Tool, “FoVOx,” and Mental Illness and Violence Tool, “OxMIV”) were applied to a prison hospital population with a primary psychotic or bipolar disorder and subsequently compared. The required information on all items of both tools was obtained retrospectively for a total of 339 patients by evaluation of available patient files. We obtained the median and inter-quartile range for both FoVOx and OxMIV, and their rank correlation coefficient along with 95% confidence intervals (CIs)—for the full cohort, as well as for cohort subgroups. The two risk assessment tools were strongly positively correlated (Spearman correlation = 0.83; 95% CI = 0.80–0.86). Such a high correlation was independent of nationality, country of origin, type of detention, schizophrenia-spectrum disorder, previous violent crime and alcohol use disorder, where correlations were above 0.8. A lower correlation was seen with patients who were 30 years old or more, married, with affective disorder and with self-harm behavior, and also in patients without aggressive behavior and without drug use disorder. Both risk assessment tools are applicable as an adjunct to clinical decision making in prison psychiatry.     

Health-Related Quality of Life of Asylum Seekers and Refugees in Germany: a Cross-Sectional Study with Data from the German Socio-Economic Panel

The purpose of this study was to estimate the health-related quality of life (HrQoL) of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017. The analysis was based on the 2016 and 2017 refugee samples of the German Socio-Economic Panel (n = 6821). HrQoL was measured using a modified version of the SF-12v2 questionnaire and presented as physical (PCS) and mental (MCS) component summary scores. PCS and MCS scores for the total sample, males and females were calculated by sociodemographic characteristics. Associations between PCS and MCS scores and sociodemographic variables were examined by a linear regression with bootstrapped standard errors. The mean PCS and MCS scores of the sample were 53.4 and 47.9, respectively. Female sex was statistically significantly associated with lower PCS and MCS scores. The SF-12 subscale general health was valued highest with a score of 55.4, whereas the subscale role emotional was valued lowest with a score of 46.9. Employment was statistically significantly associated with higher PCS and MCS scores. Persons from Afghanistan had statistically significantly lower MCS scores than persons from Syria, whereas MCS scores were statistically significantly higher for persons from Eritrea. Physical and mental HrQoL of asylum seekers and refugees that arrived during the European migrant and refugee crisis in Germany between 2014 and 2017 was higher and lower than the German norm, respectively. Female sex, older age, unemployment and being separated, divorced or widowed were negatively associated with HrQoL. The three largest ethnical groups of asylum seekers and refugees, Syrians, Afghans and Eritreans, differ inherently in their HrQoL.

     

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.     

Reflections on the use of patient records: Privacy,ethics, and reparations in the history of psychiatry

One of the most common questions we get asked as historians of psychiatry is “do you have access to patient records?” Why are people so fascinated with the psychiatric patient record? Do people assume they are or should be available? Does access to the patient record actually tell us anything new about the history of psychiatry? And if we did have them, what can, or should we do with them? In the push to both decolonize and personalize the history of psychiatry, as well as make some kind of account or reparation for past mistakes, how can we proceed in an ethical manner that respects the privacy of people in the past who never imagined their intensely personal psychiatric encounter as subject for future historians? In this paper, we want to think through some of the issues that we deal with as white historians of psychiatry especially at the intersection of privacy, ethics, and racism. We present our thoughts as a conversation, structured around questions we have posed for ourselves, and building on discussions we have had together over the past few years. We hope that they act as a catalyst for further discussion in the field.     

The Role of Christianity and Islam in Explaining Prejudice against Asylum Seekers: Evidence from Malaysia

ABSTRACT

Prejudicial attitudes toward asylum seekers are prevalent, and an emerging body of literature has revealed that this is partly driven by religious affiliation. The population of Malaysia is multireligious, making it a fruitful location for testing religion-based prejudice hypotheses. Thus, across 2 studies we tested the roles of Christianity and Islam in explicit and implicit prejudices against asylum seekers in the Malaysian context. In Study 1 (n = 97), we present evidence that there are religion-based differences in prejudice against asylum seekers; specifically, Muslims reported higher levels of (classical) explicit prejudice toward asylum seekers than Christians (there were no differences in conditional or implicit prejudices). In Study 2 (n = 117), we tested the hypothesis that these religion-based differences are qualified by the religion of the asylum seeker. In this study, we used a framing paradigm to experimentally manipulate the religion of the asylum-seeking targets. The results revealed an out-group exacerbation effect; that is, participants reported higher levels of prejudice toward asylum seekers who had a different religion from their own. For classical explicit prejudice, the effect was strongest from Muslims toward Christian asylum seekers. Conversely, for implicit prejudice, the reverse was true: The effect was strongest from Christians toward Muslim asylum seekers. These findings are discussed in terms of the political and social circumstances in Malaysia, but we interpret these findings as evidence that explicit and implicit attitudes toward asylum seekers are driven by a complex pattern of religion-based intergroup biases.     

Divergences in American psychiatry during the Depression: somatic psychiatry, community mental hygiene, and social reconstruction

The differences between somatic psychiatrists and mental hygienists, already apparent earlier, became much more pronounced during the Depression years, partly as a consequence of their different perspectives on this social crisis. Somatic psychiatrists, emboldened by the apparent success of new medical treatment methods, reasserted the central position of the mental hospital within psychiatry, attempted to improve the discipline's position within medicine, and promoted basic research. Mental hygienists, following the ideal of prevention, proposed far-reaching programs of community mental hygiene to alleviate widespread mental distress. A small group of mental hygienists embraced socialism and advocated measures of radical social reconstruction.     

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.