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.     

The development of a Spanish language version of the Worn Out scale of the General Well-Being Questionnaire (GWBQ)

The paper describes the development of a short Spanish-language version of the General Well-Being Questionnaire (GWBQ; Cox and Gotts, 1987), based on the 12 items of its Worn Out scale. Research has shown the English-version Worn Out scale to be sensitive to aspects of the design and management of work. This study aimed to test its cross-cultural consistency in a Spanish-language workplace context. The data were collected from a sample of 229 workers in Valencia (Spain). Confirmatory Factor Analyses showed the factorial validity, reliability, and concurrent validity of the new Spanish version to be adequate. The sensitivity of the new measure to safety behavior and the reporting of accidents was also assessed and shown to be good. The new questionnaire extends the usefulness of the parent questionnaire to occupational health psychology research in the Spanish language by offering a short assessment tool appropriate for workplace studies.     

Biases in the perceived timing of perisaccadic perceptual and motor events

Subjects typically experience the temporal interval immediately following a saccade as longer than a comparable control interval. One explanation of this effect is that the brain antedates the perceptual onset of a saccade target to around the time of saccade initiation. This could explain the apparent continuity of visual perception across eye movements. This antedating account was tested in three experiments in which subjects made saccades of differing extents and then judged either the duration or the temporal order of key events. Postsaccadic stimuli underwent subjective temporal lengthening and had early perceived onsets. A temporally advanced awareness of saccade completion was also found, independently of antedating effects. These results provide convergent evidence supporting antedating and differentiating it from other temporal biases.     

The child in time: The influence of parent–child discussion about a future experience on how it is remembered

We investigated the influence of preparation provided by parents on preschoolers’ recall. One day before children participated in a staged novel event, parents discussed the event with their child either with (verbal+photos) or without (verbal) photographs. Parents and children in a control condition read an unrelated story. Then 8–10 days later the children were interviewed about the event. Children in the verbal+photos condition recalled significantly more than those in the control condition. Parental preparation style (e.g., evaluations, hypothetical language) was associated with the child's contributions to the preparatory discussion, but no aspect of parent or child style or content was associated with children's verbal recall. Similarly, there were no significant associations between children's performance on a task of episodic future thinking, and their preparatory discussion or recall, although episodic future thinking was strongly associated with language ability. The potential underlying mechanisms and theoretical implications are discussed.     

Individual Differences in Child Kaleidoblock Responses

The relationship between self-esteem and parental identification was investigated. The hypothesis that self-esteem is positively correlated with parental identification was supported for female college students by two out of three self-esteem measures. For male subjects one social self-esteem measure correlated negatively with maternal identification and a self-concept measure correlated positively. No relationship between self-esteem and paternal identification existed for males: hence the hypothesis was refuted. The importance of social self-esteem in the feminine self-concept and its basis in parental identification is emphasized in the discussion.     

The effects of relationship context and modality on ratings of funniness

There is evidence to suggest that humour is an important part of mate choice and that humour may serve as an indicator of genetic quality. The current study investigated how rated funniness from a video clip was related to an individual’s attractiveness as a short-term or long-term partner. We additionally tested for the presence of an attractiveness halo effect on humour ratings by comparing ratings of funniness from video clips, audio-only presentations, and photographs. We found that funniness was most strongly correlated with attractiveness for short-term relationships, especially in videos of males. We also found that attractiveness was related to funniness ratings differently across video, audio-only clips, and photographs. Relative to their rated funniness in the audio-only condition, with no appearance cues, attractive individuals were rated as funnier in video clips than less attractive individuals. An additional study demonstrated that ratings of flirtatiousness and funniness were strongly correlated. Perceived similarity between producing humour and flirting may explain why humour is more preferable in a short-term partner as flirting may be seen to signal proceptivity. The effects of attractiveness on humour judgement may also be explained by an association with flirtation as flirting may be most enjoyable when directed by attractive individuals.     

Understanding,respecting and integrating difference in therapeutic practice

The purpose of this paper is to promote thought and discussion around how and why we treat patients in chosen ways. In the present climate practitioners are required to treat patients following NICE guidelines in which cognitive behavioural therapy (CBT) is the treatment of choice in the majority of diagnoses. This paper raises concerns that this may lead to an homogenization of treatment, loss of invaluable skills and understanding from other treatment approaches, and loss to the patient who may be best cared for by a combination of treatments and approaches, most notably patients presenting with complex pathology. This paper aims to present this as a general principle, and by way of example, will focus on coupling two specific treatment orientations, cognitive behavioural therapy with psychodynamic psychotherapy, with the specific diagnosis of obsessive compulsive disorder (OCD).

Methods: Clinical material is drawn from case studies from practice in secondary adult mental health care services within the NHS. All patients were referred to the psychological services for treatment for OCD and provided with 1:1 therapy with UKCP‐registered therapists. Details have been anonymized by describing fictitious cases re‐constructed from clinical material. A theoretical understanding is included which provides both an overview for integrating treatment for the specific example of OCD and is intended by extension to other diagnoses.

Results: Working with the commonalities of therapeutic approaches, and integrating specific skills of CBT and psychodynamic psychotherapy, appears to offer a viable mode of treatment for cases resistant to single‐orientation therapies.

Conclusions: Coupling the skills of different therapies can be effective in treating complex patients that are referred to the secondary mental health services. Conversely, restricting practice to single orientation therapies can lead to an impoverished care for patients and diminution of invaluable therapeutic skills which may become underused, undervalued and lost in the practice of mental health care within the NHS. Acknowledgement of the skills of others, valuing these and learning from each other can help to avoid the defensive reactions of practitioners, where each may defensively retreat to their corners of specialism. Respecting and sharing skills from different orientations, and acknowledging this in the NICE guidelines, is good for both mental health services and patient care and addresses the concerns raised by practitioners exemplified by Bateman (2000 Bateman, A. 2000. Integration in psychotherapy: An evolving reality in personality disorder.. British Journal of Psychotherapy, 17(2): 147–156.  [Google Scholar], p. 147) that ‘psychotherapy continues to be bedeviled by ideological schisms with practitioners apparently ignoring alternative conceptualizations and potentially superior interventions’.