The poor survival rate of primary sources for the history of Irish women in the early modern period is mitigated by the sophistication with which extant sources are now being analysed. When re-examined without reference to the demands of the traditional historical grand narrative, when each text itself is permitted to guide its own interrogation, previously undervalued texts are revealed to be insightful of individual existential experience. The memoir of eighteenth-century Dorothea Herbert, hitherto much ignored due to the authors (...) mental illness, is becoming increasingly respected not just for its historic evidential value but for the revelations it contains of a distressed individuals use of literature to manage her circumstances. The interpretive tools deployed on such a text by different research specialisms necessarily lead to divergent conclusions; this in turn may lead to creative re-imagining of history although they cannot all equally reflect what was likely to have been the lived reality of the original author. (shrink)

Dissociative Identity Disorder is an uncommon disorder that has long been associated with exposure to traumatic stressors exceeding manageable levels commonly encompassing physical, psychological and sexual abuse in childhood that is prolonged and severe in nature. In DID, dissociation continues after the traumatic experience and produces a disruption in identity where distinct personality states develop. These personalities are accompanied by variations in behaviour, emotions, memory, perception and cognition. The use of literature in psychiatry can enrich comprehension over the subjective (...) experience of a disorder, and the utilisation of 'illness narratives' in nursing research have been considered a way of improving knowledge about nursing care and theory development. This research explores experiences of DID through close textual reading and thematic analysis of five biographical and autobiographical texts, discussing the lived experience of the disorder. This narrative approach aims to inform empathetic understanding and support the facilitation of therapeutic alliances in mental healthcare for those experiencing the potentially debilitating and distressing symptoms of DID. Although controversies surrounding the biomedical diagnosis of DID are important to consider, the lived experiences of those who mental health nurses encounter should be priority. (shrink)

Can existential themes, such as anxiety, the will to die, or our simultaneous will to live forever be logically described? Does a literary language or philosophical and psychiatric term exist that can express phenomena nonreferential to the external world? In short, does a genre exist that can redefine the relationships between symbol and meaning? Drawing upon various theoretical perspectives developed by Michel Foucault, Ludwig Binswanger, Gaston Bachelard, and Karl Jaspers, this paper discusses the ability to depict life as we are (...) living it, whether it is a product of mental illness or a matter of normal schizophrenic imaginings. (shrink)

This paper explores evolving treatments for hysteria in the eighteenth century by examining a selection of works by both physician-writers and educated literary women. The treatments I identify—which range from aggressive bloodlettings, diets, and beatings, to exercise, fresh air, and writing cures—reveal a unique culture of therapy in which female sufferers and doctors exert an influence on one another's notions of what constitutes appropriate management of women's mental illness. A scrutiny of this exchange of ideas suggests that female (...) patients were not simply oppressed and silenced by male practitioners; rather, their collective voice, intellect, and expertise helped to form progressive treatments for eighteenth-century hysteria. (shrink)

Introduction: Intimate Partner Violence (IPV) has unfavorable consequences for women as well as for newborn babies, which is very serious and preventable public health problem. It is believed to have an excessive occurrence in lives of women in South Asia. The objective of this study is to describe the prevalence, risk factors and consequences of IPV in Bangladesh. Methods: A scoping review was carried out based on the past 12 years of posted and gray literature about IPV (...) in Bangladesh using Arksey and O’Malley’s framework. Only the literature addressing abuses or violence in households or outside including physical, sexual or mental violence on the married woman in Bangladesh were taken into consideration for the study. Results: The overall prevalence of IPV in Bangladesh, the latest reviews of rates ranging from 15.5-82.7%.Most of the IPV in Bangladesh was based totally on the experience of legally married women. The main risk factors of IPV in Bangladesh were women being younger, from lower socioeconomic reputation, from lower academic attainment and lower education of husband, dowry, child marriage, perceived disobedience of wives, family conflict, children had recently been ill, and incapability of to furnish sexual satisfaction. Maternal depressive symptoms, signs of stress, anxiety and constraint to the better health of young children are the main consequences of IPV in Bangladesh. Besides, IPV causes unwanted pregnancy, pregnancy loss in the form of miscarriage, induced abortion, or stillbirth and termination of pregnancy in Bangladesh. Conclusions: Woman’s empowerment may reduce IPV and understanding attitudes towards IPV in cultural context could be crucial for developing interventions to reduce IPV and its consequences. (shrink)

Evidence-based practice (EBP), a derivative of evidence-based medicine (EBM), is ascendant in the United States’ mental health system; the findings of randomized controlled trials and other experimental research are widely considered authoritative in mental health practice and policy. The concept of recovery from mental illness is similarly pervasive in mental health programming and advocacy, and it emphasizes consumer expertise and self-determination. What is the relationship between these two powerful and potentially incompatible forces for mental health reform?This paper identifies four attempts, (...) in the mental health literature, to delineate the role of “evidence” in recovery. One is the strong version of evidence-based practice—an applied science model—and three others address weaknesses in the first by limiting the authority of probabilistic findings. The paper also offers a fifth version, based on the concept of communicative accountability, which is derived from Habermas’ work on communicative action. The fifth version responds to the other four and emphasizes learning, disclosure and respect in clinical and other helping relationships. (shrink)

Failure to follow prescribed treatment has devastating consequences for those who are seriously and persistently mentally ill. Nurses, therefore, try to get clients to take psychotropic medication on a long-term basis. The goal is either compliance or adherence. Although current nursing literature has abandoned the term compliance because of its implications of coercion, in psychiatric nursing practice with patients suffering from serious long-term mental illness compliance and adherence are in fact different goals. The ideal goal is adherence, which (...) requires the patient to be an active participant in the team. This goal is consistent with nurses’ ethical values, but for such patients this is frequently unrealistic. If the person is severely psychotic, treatment may be involuntary and the goal compliance. Psychiatric nurses participate in involuntary treatment and thus should acknowledge the ethical implications of compliance as a goal and not obscure the issue by calling compliance adherence. (shrink)

This study aims to develop guidelines of key concepts and specific considerations to make the research more ethical when conducting neurological examinations and treatment interventions in mentally ill patients. We analyzed guideline development theory and literature, previous issues, and discussions with specialists of philosophy, medicine, sociology, and bioethics. The selection of research participants, drafting of intervention plans, and informed consent process were examined with reference to the dual burden; the minimal risk as a general rule of ethical allowance (...) levels, assent and dissent to assess the individual’s judgment capacity for consent, relational autonomy for personal consent with assistance by the proxy, and risk/benefit assessments. When conducting studies, this guideline requires that these three processes be set up appropriately on a case-by-case basis. (shrink)

Mental and substance use disorders have been identified as the leading cause of global disability, and the global burden of mental illness is concentrated among those experiencing disability due to serious mental illness. Music has been studied as a support for SMIs for decades, with promising results; however, a lack of synthesized evidence has precluded increased uptake of and access to music-based approaches. The purpose of this scoping review was to identify the types and quantity of research at intersections of (...) music and SMIs, document evidentiary gaps and opportunities, and generate recommendations for improving research and practice. Studies were included if they reported on music's utilization in treating or mitigating symptoms related to five SMIs: schizophrenia, bipolar disorder, generalized anxiety disorder, major depressive disorder, or post-traumatic stress disorder. Eight databases were searched; screening resulted in 349 included studies for data extraction. Schizophrenia was the most studied SMI, with bipolar disorder studied the least. Demographics, settings, and activity details were found to be inconsistently and insufficiently reported; however, listening to recorded music emerged as the most common musical activity, and activity details appeared to have been affected by the conditions under study. RCTs were the predominant study design, and 271 unique measures were utilized across 289 primary studies. Over two-thirds of primary studies reported positive results, with 2.8% reporting worse results than the comparator, and 12% producing indeterminate results. A key finding is that evidence synthesis is precluded by insufficient reporting, widely varied outcomes and measures, and intervention complexity; as a result, widespread changes are necessary to reduce heterogeneity, increase replicability and transferability, and improve understandings of mechanisms and causal pathways. To that end, five detailed recommendations are offered to support the sharing and development of information across disciplines. (shrink)

There are reasons to believe that decision‐making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women’s decisional capacity. Decision‐making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to ‘understanding’ alone. A systematic literature search identified a total of 20 empirical studies focused on (...) women’s decision‐making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women’s autonomy. To fill in the significant gap in clinical knowledge about laboring women’s decision‐making capacity, well‐designed prospective and retrospective studies may be required. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Should Clinicians’ Views of Mental Illness Influence the DSM?Elizabeth H. Flanagan (bio) and Roger K. Blashfield (bio)Keywordsclinicians, DSM, values, psychopathology, scienceThe relationship between clinicians and the DSM is complex. Clinicians are the primary intended audience of the DSM. However, as Widiger (2007) pointed out in his commentary, there is a tension associated with trying to meet the clinical goals of the DSM and also trying to optimize the scientific (...) goals of the DSM. Most commentators would agree that the recent editions of the DSM (from the DSM-III onward) have favored scientific values (e.g., Sadler 2005). Some commentators have taken sides and aligned themselves with either clinicians or with the science of classification. For instance, Garb (2005) has argued that clinicians should receive incentives to align themselves more closely with the science of the DSM. In contrast, Westen and Shedler (1999) have favored a clinician-based approach to the DSM and have argued that an ideal classification should be based on the prototypes that clinicians use to conceptualize diagnostic categories. Perhaps an extreme suggestion on how to deal with this tension between the values of clinicians and the values of scientists is to adopt the ICD-10 solution and create two versions of the next DSM. One version would be written for clinicians and another for researchers (Phillips et al. 2003).Widiger (2007) wondered whether the two of us as authors are on the fence about how the views of clinicians should affect the DSM. As clinical psychologists who are both clinicians and researchers, we understand his comment, especially in light of our attempt in our article not to overgeneralize from the time-consuming, labor-intensive, yet methodologically limited study we reported in our major paper.Nonetheless, our answer to the question asked in the title of this response, “Should clinicians’ views of mental illness influence the diagnostic manual?” is a clear and unequivocal yes. In our view, too much of the research literature stimulated by the recent DSMs has primarily used the diagnostic criteria in these DSMs to specify patient samples and then perform various experiments to study the DSM categories. We favor a different approach to research which is consistent with a comment once made by the philosopher of science, Karl Popper: “scientific theories originate from myths, and... a myth may contain important anticipations of scientific theories” (1963, 39). We believe that clinicians, with their years [End Page 285] of experience dealing with the ambiguities, the emotionality, and the chaos of psychopathology, have formed complex conceptual systems to try to understand the mysteries of abnormal behavior. We strongly support increased research attempts that will use clinicians as subjects and that will attempt to understand how clinicians use diagnostic concepts to understand patients.Although research on clinicians has not attracted a large amount of attention in the field, there is a long history of such research studies. For instance, in the 1970s, Overall used multivariate techniques to create graphical maps of how clinicians represented relationships among diagnoses (Overall et al. 1977). Widiger has used a similar strategy in some of his research (Widiger et al. 1987). In the early 1980s, a view of concept formation from cognitive psychology was used by Cantor et al. (1980) to look at psychiatric diagnoses as representing prototypes. Horowitz and colleagues extended this research. Blashfield and his colleagues had a grant to use the prototype model to study personality disorders and performed research investigating both case histories (Blashfield et al. 1985) and analyses of diagnostic criteria (Blashfield and Breen 1989; Davis, Blashfield, and McElroy 1993). Westen and colleagues have attempted to reconceptualize DSM personality disorder categories using the prototype model (Westen and Shedler 1999). Ahn and her colleagues (Ahn et al. 2006; Kim and Ahn 2002) have taken more recent applications of ideas from cognitive psychology to study how clinicians use and understand diagnostic categories. Finally, Flanagan and colleagues (Flanagan and Blashfield 2006; Flanagan, Keeley, and Blashfield, in press; Flanagan, Miller, and Davidson, submitted) have used qualitative and quantitative data analysis techniques to try to understand the diagnostic concepts held by experienced clinicians.Besides empirical studies of how clinicians use diagnostic concepts, we also support the increased interest in... (shrink)

In this chapter, I consider the idea that physician-assisted death might come into question in the cases of psychiatric patients who are incapable of making autonomous choices about ending their lives. I maintain that the main arguments for physician-assisted death found in recent medical ethical literature support physician-assisted death in some of those cases. After assessing several possible criticisms of what I have argued, I conclude that the idea that physicianassisted death can be acceptable in some cases of psychiatric (...) patients who lack autonomy ought to be taken into account in assessing the moral and legal acceptability of physician-assisted death. (shrink)

ABSTRACTSince 2004 in Australia, there has been a significant amount of interest in the issues of lawyers and mental illness. As a result there is now a substantial body of literature that examines...

A sociological conceptualisation of space moves beyond the material to the relational, to consider space as a social process. This paper draws on research that explored the reproduction of legitimated knowledge and power structures in intensive care units during encounters, between patients, who were experiencing mental illness, and their nurses. Semi‐structured telephone interviews with 17 intensive care nurses from eight Australian intensive care units were conducted in 2017. Data were analysed through iterative cycling between participants' responses, the literature and (...) the theoretical framework. The material and relational aspects of space in this context constitute a dynamic process that is concerned with the reproduction of everyday life, the preservation of the biomedical authority of intensive care, and the social othering of people experiencing mental illness. The work of theorists such as Löw, Harvey and Foucault underpins the exploration of space as a multi‐dimensional, malleable social process that both produces and is the product of social interaction and the social world. In this paper, we argue that the performative work of knowledge and power production and reproduction, considered here in relation to intensive care spaces, enables ongoing othering and disenfranchisement of people experiencing mental illness. (shrink)

The question "What is mental illness?" raises many issues in many contexts, personal, social, legal, and scientific. This chapter reviews mental health problems as they appear to the person with the problems, and to family and friends-before the person attends the clinic and is given a diagnosis-a time in which whether there really is a problem, as opposed to life's normal troubles and variations, is undecided, as also the nature of the problem, if such it be, and the related matter (...) what kind of expert advice should be sought. Once at the clinic, a diagnosis may be given-using criteria well-worked-out in the diagnostic manuals. The chapter discusses the conceptualizations of mental disorder in the diagnostic manuals, their rationale, and what can and cannot be reasonably expected of them. There are more position statements than definitions, and while they signal many dilemmas, they do not resolve them. Attempts to do so in the surrounding literature on the concept of mental illness are reviewed in the chapter, with conclusions favoring the features emphasized in the diagnostic manuals: distress and impairment. Finally the chapter considers how far the science may help draw boundaries around mental illness. (shrink)

In "Peripheralities: 'Minor' Literatures, Women's Literature, and Adrienne Orosz de Csicser's Novels" Steven Tötösy de Zepetnek discusses events surrounding Adrienne Orosz de Csicser's work. For the contextualization of the events Tötösy de Zepetnek employs his own framework of "comparative cultural studies" here applied to "minor literatures" and women's literature and Shunqing Cao's "variation theory." While Orosz's novels are not considered exceptional, the author achieved notoriety after locked up in a mental institution. In addition to three published (...) novels, in an unpublished novel Orosz narrates her love affair with a Roman Catholic bishop. Knowledge about her novel's contents resulted in the bishop orchestrating Orosz's commitment to a mental hospital. The context in which Orosz's texts are located in is the socio-political situation in Hungarian society prior to and shortly after the First World War. (shrink)

A compelling and incisive book that questions the overuse of mental health terms to describe universal human emotions Public awareness of mental illness has been transformed in recent years, but our understanding of how to define it has yet to catch up. Too often, psychiatric disorders are confused with the inherent stresses and challenges of human experience. A narrative has taken hold that a mental health crisis has been building among young people. In this profoundly sensitive and constructive book, psychologist (...) Lucy Foulkes argues that the crisis is one of ignorance as much as illness. Have we raised a 'snowflake' generation? Or are today's young people subjected to greater stress, exacerbated by social media, than ever before? Foulkes shows that both perspectives are useful but limited. The real question in need of answering is: how should we distinguish between 'normal' suffering and actual illness? Drawing on her extensive knowledge of the scientific and clinical literature, Foulkes explains what is known about mental health problems-how they arise, why they so often appear during adolescence, the various tools we have to cope with them-but also what remains unclear: distinguishing between normality and disorder is essential if we are to provide the appropriate help, but no clear line between the two exists in nature. Providing necessary clarity and nuance, Losing Our Minds argues that the widespread misunderstanding of this aspect of mental illness might be contributing to its apparent prevalence. (shrink)

This paper describes the content and evolution of a fourth-year course for medical students on teaching pathographies of mental illness. (It is a follow-up to Nathan Carlin’s Pathographies of Mental Illness that appeared as an Element in the Bioethics and Neuroethics series published by Cambridge University Press.) The course originally centered on classic (and some contemporary) memoirs; however, responding to student evaluations, newer material now ensures more diversity, with material written by women and people of color, and describes the (...) difference that can make. (shrink)

Medical accounts of the absence of conscience are intriguing for the way they seem disposed to drift away from the ideal of scientific objectivity and towards fictional representations of the subject. I examine here several contemporary accounts of psychopathy by Robert Hare and Paul Babiak. I first note how they locate the truth about their subject in fiction, then go on to contend that their accounts ought to be thought of as a “mythos,” for they betray a telling uncertainty about (...) where “fact” ends and “fantasy” begins, as well as the means of distinguishing mental health from mental illness in regard to some social roles. (shrink)

This thesis is concerned with philosophical perspectives on the stigma of mental illness, with each chapter exploring different philosophical issues. Chapter one delineates the central concept around which the rest of the work revolves: the stigma of mental illness. It provides an outline of the stigma mechanism, how it applies to mental illness, why it is such a large public health concern and what has been done so far to combat it. Chapter two is concerned with the application of recent (...) literature in the philosophy of implicit bias to the topic of mental illness. It suggests that we have hitherto been preoccupied with explicit formulations of the stigma mechanism, but argues that there are distinctive issues involved in combatting forms of discrimination in which the participants are not cognisant of their attitudes or actions, and that anti-stigma initiatives for mental illness should take note. Chapter three applies the philosophical literature concerning the ethics of our epistemic practices to the stigma of mental illness. It contains an analysis of how epistemic injustice- primarily in the forms of testimonial injustice and stereotype threat- affects those with mental illnesses. The fourth chapter brings in issues in the philosophy of science to explore the possibility of intervening on the stigma process to halt the stigma of mental illness. The first candidate is discounted, and the second is tentatively endorsed. The fifth chapter is concerned with how language facilitates the stigma of mental illness. It suggests that using generics to talk about mental illness is deeply problematic. In the former, it conveys insidious forms of social stereotyping. In the latter, it propagates misinformation by presenting the category as a quintessential one. (shrink)

Several studies reveal that positive attitudes towards individuals with a mental illness are correlated with knowledge about mental illness. The aim of this study was to explore and describe psychiatric nurses’ experiences of living next to people with mental health problems. In addition, it sought to identify and describe how they handle situations arising in a neighbourhood where people with a mental illness live. Two men and seven women participated in the study. The constant comparative method of grounded theory (...) was used for data collection and analysis. The process of ‘behaving as a nurse or not’ was identified as a core category. Four subcategories were identified: ‘receiving involuntary information’, ‘to take action or not’, ‘behaving as a mediator in the neighbourhood’ and ‘the freedom of choice’. The findings show that psychiatric nurses with professional knowledge about mental illness have moral concerns about their role as nurses during their leisure time. In conclusion, it is not obvious that psychiatric nurses want to live in the same neighbourhood as persons with a mental illness. However, this study shows that their knowledge about mental illness creates for them a moral dilemma consisting of a conflict between whether to care for these mentally ill persons or to preserve their own leisure time. (shrink)

Women’s entry into the legal academy in significant numbers—first as students, then as faculty—was a 1970s and 1980s phenomenon. During those decades, women in law schools struggled: first, for admission and inclusion as individual students on a formally equal footing with male students; then for parity in their numbers in classes and on faculties; and, eventually, for some measure of substantive equality across various parameters, including their performance and evaluation both in and in front of the classroom, as (...) well as in the quality of their experiences as students and faculty members and in the benefits to be reaped from their tenure. This part of the story of women’s entry into the legal academy in the 1970s and 1980s—a story of attempted admission, then inclusion, then integration and assimilation, and then, finally, equality—is now a familiar one, at least in broad outline. It is not, in its entirety, an uplifting story. According to a raft of articles produced by women law students in the 1980s, 1990s, and 2000s, women law students during those decades participated less in the classroom, were called on and responded to differently when they did participate, suffered from more law-school-induced anxiety disorders and other mental health issues, graduated with lower GPAs and less law review experience, published fewer notes and filled fewer editorial positions on those journals, held fewer leadership positions overall while in law school, and had far more difficulties connecting with mentors, teachers, and would-be recommenders among the faculty than male students. Women law professors during those decades were tenured at significantly lower rates than men and, particularly at high prestige schools and at schools with fewer female faculty among the tenured ranks, were hired at lower rates that did not reflect their number in the pool of qualified applicants, had trouble asserting or maintaining authority in the classroom or being perceived as having authority, taught lower-prestige courses and received low teaching evaluations, and, like their students, were published far less frequently in the major and most prestigious law reviews. Much of this, albeit not all, has not changed much for either students or faculty. As women in law schools enter the posttenure and midcareer phase, many of the old problems persist while new ones appear: women faculty are invited to participate on panels less often than men, and both women students and faculty are underrepresented as authors in law reviews. Although gender-neutral parental leave is now available to faculty at most law schools, many such policies are still ad hoc. There is considerable worry, although no hard evidence, over whether men disproportionately use the time off to write rather than care for children. Women are still disproportionately overrepresented in some fields and underrepresented or unrepresented in others, and those fields correlate in unsurprising ways with levels of prestige: the more women in a field, the less prestigious. As elsewhere in the workforce, women faculty in legal education suffer from sexual harassment, most of which is unremedied. Women still suffer a pay gap in law schools that remains unaddressed at most universities, as it does elsewhere in academia. There is a sizeable literature on these depressing phenomena that stubbornly do not seem to abate. In these comments, however, I want to focus on another, less appreciated, part of the story of women’s entry into the legal academy in the 1970s and 1980s: the emergence of a body of scholarship—sometimes called feminist legal theory—produced by some of these women legal scholars over the same time period. The story I want to focus on, in other words, is not that of second- or third-wave women’s struggles within the academy, either for admission, acceptance, assimilation, or equality in law schools. Rather, this Article focuses on the story of the scholarship some of those second-wave assimilated women produced once they got there. Feminist jurisprudence, understood largely as scholarship on issues pertaining to gender equality, was launched in the 1970s, endures today, and continues to shape debates. Feminist legal theory, however, was in effect a subfield within feminist jurisprudence and, as its name implies, was an attempt to fashion a broad- based theoretical account of the relationship of law in liberal legal regimes to women’s subordination, patriarchy, and gender and sexual inequality— particularly in a post–civil rights era, when women enjoyed broad access to rights of formal equality, reproductive liberty, and liberal antidiscrimination law. Feminist legal theory so understood—a body of scholarship in search of a theoretical understanding of the relation of law to women’s subordination or, more simply, of law and patriarchy—was birthed in the 1970s, nurtured in the 1980s, and matured in the 1990s. I suggest in this Article that it is now seemingly in decline, and may soon disappear altogether. The reasons for this trajectory, I believe, are to date unexplored. Some reasons are fairly self-evident. Feminist legal theory was a product of three time-specific factors peculiar to the 1970s and 1980s: it reflected the political and the legal struggles of second-wave feminism. The critical theory schools were, to varying degrees, present or thriving in the academy in the 1970s and 1980s, within which feminist legal theory was birthed, grew, and then coexisted with critical theory, albeit at times very uneasily; and this feminist theory reflected second-wave women faculty and students’ mixed experiences of assimilation, success, and alienation in law schools themselves, as briefly recited above. Those three factors—the background politics, the presence of critical theory in law schools, and the differences in women’s experience of those schools—are all themselves either disappearing or dissipating in felt urgency, albeit in different ways and at different speeds, and that dissipation clearly is a part of the story of feminist legal theory’s decline. There are other reasons for its decline as well, however. Some are internal to feminism and feminist theory, and some pertain to the changing nature of legal scholarship from the 1980s to the present. I explore these reasons in Part II below. The story of the development of a distinctively feminist legal theory during the 1970s through the 1990s, and the story of its decline in the 2000s, is of obvious relevance to the history of second- and third-wave feminism. It should also be of interest for what it reveals about the nature of legal scholarship as it was understood, received, and produced in those decades. Its decline likewise reveals something about the changing nature of legal scholarship and the legal academy today. Thus, one conclusion I draw is that the feminist legal theory of the 1970s through the 1990s—regardless of the truth or lasting power of its claims—stands as an example of a type of legal scholarship that was somewhat distinctive to those decades. That form of legal scholarship, furthermore, likely can only emanate from the legal academy. For a host of reasons, we are currently in danger of losing this entire genre of intellectual work, which would be the polity’s loss, not just feminism’s or the legal academy’s. (shrink)

Cancer, a terminal illness, has long been a focus of attention due to its fatal nature. Its diagnosis results in distress not only to the patients and physicians, but also the families and caregivers involved. This distress is of a multifaceted nature, including psychological, financial and physical distress. The present paper aims to explore mental health issues that specifically influence cancer patients’ caregivers. However, in a country like Pakistan literature is not very rich regarding the mentioned issue. Therefore, giving (...) rise to the immense need to create awareness concerning this pressing issue. In this paper, an effort has been made to identify the types of mental health problems and variables which could potentially affect the mental health of a cancer patient caregiver. An analysis on the type of issues and associated determining variables reveals various patients’ variable, situational variable or the caregiver’s own personality which makes them susceptible to poor mental health. Furthermore, the paper tries to answer the different question regarding the prevalence rate, current status of, and awareness on the above mentioned aspect. In the end some possible recommendations have also been made in the context of the mental health issues regarding the caregivers of cancer patients discussed in the paper. (shrink)

Resumo Os estudos literários têm comumente recorrido a ferramentas auxiliares ligadas às ciências sociais, mormente à filosofia e à sociologia. Tal postura tem dado origem a análises interessantes a respeito do discurso literário como produto ideológico configurador de verdades coerentes e totalizantes no que concerne a grupos sociais diversos, o que envolve, freqüentemente, a prática de estigmatização desses na tessitura da engenharia social. Nesse contexto, o presente artigo pretende trabalhar com a representação das beatas valendo-se da análise da personagem Magdá (...) na obra naturalista O homem , de Aluísio Azevedo. Reconhecendo que a estigmatização dessa personagem religiosa tem sua gênese no esquadrinhamento do corpo, recorremos à "fala" saudosista de Magdá no intuito de analisar dialeticamente a relação entre religião, patologia e feminilidade na obra naturalista. Conclui-se que, apesar de a representação da personagem beata em O homem obedecer à lógica do positivismo científico então vigente, em que a saudade religiosa é compreendida como um dos principais elementos sintomáticos configuradores da psique doentia da mulher na obra em questão, essa pode se converter dentro de um movimento dialético em um elemento de referência na ressignificação das experiências místicas da personagem Magdá. Palavras-chave: Saudade religiosa; Literatura naturalista; Beata; Gênero e religião.Literary studies have frequently depended on auxiliary tools related to social sciences, mainly philosophy and sociology. Such position has produced relevant analyses regarding literary discourse as an ideological product that represents coherent and absolute truths concerning diverse social groups, which often involves the practice of stigmatization of the those groups in the structure of social engineering. In that context, this article focuses on the representation of devout women, based on the analysis of the character Magdá in Aluísio Azevedo's naturalist novel O homem. Recognizing that the source of Magdá's stigmatization is the scrutinizing of her body, we investigate Magdá's longing discourse in order to analyze dialectically the relation between religion, pathology and femininity in the text. We conclude that, although the representation of the devout woman in Azevedo's novel obeys the logic of 19 th-century scientific positivism, according to which religious longing is one of the main symptomatic elements of woman's mental illness, it can be converted, in a dialectic movement, into a reference element in the re-signification of the Magdá's mystical experiences. Key words: Religious nostalgia; Naturalist literature; Devout women; Gender and religion. (shrink)

Recent literature has suggested that generics can harbor and propagate worrying ideologies in a manner which is often not appreciated by speakers. In this article, I argue that the use of generics to convey information about mental illness is unhelpful, whether the knowledge structure conveyed by the generic is 'accurate' or not. Inaccurate generics contribute to insidious forms of social stereotyping and stigma by encouraging us to simplistically generalize characteristics found in very few category members to other members of (...) that kind.Yet, even where the knowledge structure underlying the generic is accurate, generics remain an unhelpful way of talking about mental illness. This is because... (shrink)

People with mental illness are subjected to stigma and discrimination and constantly face restrictions in the exercise of their political, civil and social rights. Considering this scenario, mental health, ethics and human rights are key approaches to advance the well-being of persons with mental illnesses. The study was conducted to review the scope of the empirical literature available to answer the research question: What evidence is available regarding human rights and ethical issues regarding nursing care to persons with mental (...) illnesses? A scoping review methodology guided by Arksey and O’Malley was used. Studies were identified by conducting electronic searches on CINAHL, PubMed, SCOPUS and Hein databases. Of 312 citations, 26 articles matched the inclusion criteria. The central theme which emerged from the literature was “Ethics and Human Rights Boundaries to Mental Health Nursing practice”. Mental health nurses play a key and valuable role in ensuring that their interventions are based on ethical and human rights principles. Mental health nurses seem to have difficulty engaging with the ethical issues in mental health, and generally are dealing with acts of paternalism and with the common justification for those acts. It is important to open a debate regarding possible solutions for this ethical dilemma, with the purpose to enable nurses to function in a way that is morally acceptable to the profession, patients and members of the public. This review may serve as an instrument for healthcare professionals, especially nurses, to reflect about how to fulfil their ethical responsibilities towards persons with mental illnesses, protecting them from discrimination and safeguarding their human rights, respecting their autonomy, and as a value, keeping the individual at the centre of ethical discourse. (shrink)

The title Expert-by-Experience has been used frequently in mental health literature and policy making in recent years. The implication is that by virtue of suffering from a mental disorder, the person has access to a unique form of knowledge that would separate them from others, affording them the status of an expert. In this article, the concept is put under philosophical scrutiny. I use Wittgenstein's Private Language Argument and Ryle's work on introspection to show that personal experience could not (...) be a basis for expertise. Personal experience and introspection could not be a basis for knowledge underpinning expertise. (shrink)

This paper explores why ethical issues associated with mental illness have been generally neglected in the literature and texts of the discipline of bioethics. I argue that the reasons for this are both philosophical and structural, involving the philosophical framework of principlism in bioethics, in particular the privileging of the principle of autonomy, and the institutional location and disciplinary boundaries of bioethics as a profession. Other contributing factors include developments outside of bioethics, in medicine and law and in the (...) delivery patterns and funding sources of mental health services, and above all the pervasive stigma that attaches to mental illness. My goal is to show both how the attention bioethics could bring would benefit this neglected area of health care, and why attending to the issues surrounding mental illness would benefit bioethics in meeting its professional obligations as the public voice on matters of ethical significance in health care. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry (...) on Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

Given the dramatic rise in the frequency of nursing research that involves eliciting personal information, one would expect that attempts to maintain the balance between the aspirations of researchers and the needs and rights of patients would lead to extensive discussion of the ethical issues arising. However, they have received little attention in the literature. This paper outlines and discusses some of the issues associated with qualitative research. The discussion converges on the specific case of phenomenological research, which involves (...) the invasion of participants’ personal worlds, and draws attention to some of the ethical issues that arise when the participants are psychiatric patients. (shrink)

This article is a review of the literature on the subject of how nurses who provide palliative care are affected by ethical issues. Few publications focus directly on the moral experience of palliative care nurses, so the review was expanded to include the moral problems experienced by nurses in the care of the terminally ill patients. The concepts are first defined, and then the moral attitudes of nurses, the threats to their moral integrity, the moral problems that are perceived (...) by nurses, and the emotional consequences of these moral problems are considered in turn. The results show that the moral behaviour of nurses, which is theoretically grounded in commitment to care and to the patient, appears to be shaped by specific processes that lead to engagement or to mental and behavioural disengagement in morally difficult situations. Nurses often appear to fail to recognize the moral dimensions of the problems they experience and also to lack the skills they need to resolve moral problems adequately. Although the findings show that several elements that are beyond the control of nurses, owing to their lack of autonomy and authority, influence their moral experience, intrinsic factors such as feelings of insecurity and powerlessness have a profound effect on nurses’ perceptions and attitudes in the face of moral problems. The moral problems perceived by these nurses are related to end-of-life issues, communication with patients, the suffering of patients, and the appropriateness of the medical treatment. (shrink)

Indigenous women in Canada face a range of health and social issues including domestic violence. Indigenous women (First Nations, Inuit and Métis) are six times more likely to be killed than non-Aboriginal women (Homicide in Canada, 2014 ; Miladinovic and Mulligan, 2015 ). Aboriginal women are 2.5 times more likely to be victims of violence than non-Aboriginal women (Robertson, 2010 ). These and other statistics highlight a significant difference in the level of violence experienced by (...) Indigenous women to that experienced by women in the mainstream population in Canada. The historical impacts of colonization and forced assimilation are viewed as the main social determinant of health for aboriginal people in Canada, as they led to intergenerational trauma, with communities struggling today against discrimination, stigma, poverty and social exclusion. Most disturbing and damaging are the outcomes of domestic violence, mental health and addiction issues (Prussing, 2014 ). First Nation's women who want to leave a violent situation have limited access to helping services, as most are located in large cities and towns, far from remote reserves where many of the women live. Services were originally designed by and for the mainstream population. First Nation's women who manage to access these programs often find staff with limited cultural competence and program supports that have little cultural safety or relevance for them. Indigenous culture is defined in various levels of legislation as having a set of specific rights based on their historical ties to a particular region, with cultural or historical distinctiveness from the mainstream and other populations (Indigenous Peoples at the UN, 2014 ). In Canada, indigenous cultural beliefs are closely tied to belief in a creator, ancestors and the natural world, influencing their spirituality and their political perspectives (Waldram et al., 2006 ). Cultural safety, a concept that emerged in the 1980's in New Zealand, is viewed as an environment that is spiritually, socially, emotionally and physically safe for people; where cultural identity is recognized and valued through shared respect, meaning, knowledge and the experience of learning together. This paper will explore current evidence-based literature to determine if there is empirical evidence to support program policies and practices that reflect culturally safe, competent and relevant domestic violence services to address the cultural needs of Indigenous women in Canada. (shrink)

Environmental ethicists and experts in human health have raised concerns about the effects of hydraulic fracking to access natural oil and gas resources found deep in shale rock formations on surrounding ecosystems and communities. In this study, we analyzed the prevalence of discourse on brain and mental health, and ethics, in the peer-reviewed and grey literature in the five-year period between 2016 and 2022. A total of 84 articles met inclusion criteria for analysis. Seventy-six percent (76%) mentioned impacts on (...) brain (e.g., neural tube defects, neurological symptoms), and mental health (e.g., negative psychological effects, stress, depression) briefly; 11 reports dedicated substantive discourse to either or both together. References to safety (77%) dominated the ethics context. Discussion of environmental injustices as fracking sites disproportionately affect vulnerable communities appeared in 38% of the papers. We examine the findings through the lens of environmental neuroethics that brings human-made changes to the environment, brain and mental health, and ethics together into three interwoven lines of inquiry. (shrink)

The COVID-19 pandemic outbreak has led to a general reorganization of health services and an increase in outpatient telemedicine in mental healthcare for physically ill people. Current literature highlights facilitators and obstacles concerning the use of new technologies in psychotherapy, an underrated topic of research in the context of supportive expressive psychotherapy. More insight is needed to explore the characteristics of video in therapeutic alliance for treatment of specific mental disorders experienced in psychosomatics, particularly with people suffering from a (...) disturbed body- and self-image. Using two clinical vignettes, it is the authors’ intention to enrich the critical debate on current knowledge in psychosomatic remote psychotherapy, with special focus on mentalization deficits and their impact on therapeutic alliance in the consultation-liaison psychiatry setting. In particular, we will question the interpersonal processes at stake related to mirroring and the disruption caused by the use of videoconference applications. We will also reflect upon the relationship between the therapeutic alliance and the medical team, and that between patient and psychotherapist. The aim is to improve psychotherapeutic alliance maintained during the pandemic for specific mental disorders and to inform about possible clinical factors that could be the subject of future empirical studies or professional guidelines. (shrink)

Research has established that the burdens of externalities associated with industrial production are disproportionately borne by socially and politically vulnerable groups, and this is particularly true for farmworkers who are at high risk for environmental exposures and illnesses. The impacts of these risks are often compounded by farmworker communities’ social vulnerability. Yet, less is known about how the intersection of race, class, and gender can position some farmworkers to be at higher risk for particular types of oppressions. We extend the (...) literature by analyzing the case of Black women farmworkers in Apopka, Florida, which was historically home to a large agricultural community. Drawing on the concept of critical environmental justice, we investigate the lived experiences of these women in the context of racialized, gendered, and economic oppressions during their time working on the farms. We use the case of Apopka to ask: how the policies and socio-historical context of the agricultural industry in the American South contributed to injustices experienced by Black women farmworkers in Apopka, Florida; and how race, gender, and class intersected and intersect to create and legitimize environmental injustices in the workplace for these farmworkers. Our data include semi-structured in-depth interviews, newspaper and media coverage, and archival materials. Our analysis advances work on critical environmental justice and intersectionality by mapping the relationship between structural and environmental intersectional oppressions for Black women farmworkers. (shrink)

Psychiatric patients sometimes ask where to draw the line between who they are – their selves – and their mental illness. This problem is referred to as the self-illness ambiguity in the literature; it has been argued that solving said ambiguity is a crucial part of psychiatric treatment. I distinguish a Realist Solution from a Constructivist one. The former requires finding a supposedly pre-existing border, in the psychiatric patient’s mental life, between that which belongs to the self and that (...) which belongs to the mental illness. I argue that no such border exists, and that attempts to find it might even render the felt ambiguity worse. Instead, any solution must be constructivist; the patient (and others) should deliberate and discuss what to identify with or not. I further argue that psychiatric patients need not see their mental illness as wholly distinct from themselves to avoid ‘identifying with their diagnoses' in a problematic way. Finally, we can excuse problematic behaviour by mentally ill people – in fact, we can do so in a more nuanced and constructive way – while rejecting the view that the mental illness is wholly distinct from the patient’s self. (shrink)

Mental disorder (earlier entitled “illness” or “disease”) is ascribed to deviations from normal thoughts, reasoning, feelings, attitudes, and actions that are considered socially or personally dysfunctional and apt for treatment. Schizophrenia, depression, and bipolar disorder are core examples. The concept of mental disorder plays a role in many domains, including medicine, social sciences such as psychology and anthropology, and the humanities, including literature and philosophy. Philosophical discussions are the primary focus of the present entry, which differs from the entry (...) on Philosophy of Psychiatry in noting several different approaches—not only those of the philosophy of science and mind, but also those arising from phenomenology and social theory. -/- Mental disorder is a widely contested concept and there are longstanding debates on whether disorders are biological or social in nature. Even uncontroversial disorders, such as those listed above, were not always regarded as disorders in the past (Porter 2002). Moreover, the status of mental disorder has frequently indicated ethical, as much as other deficiency (Irwin 2013). Such reminders direct our attention to contemporary medical psychiatry’s sometimes uncompromisingly neurobiological, and avowedly value-free “medical model”, with its incumbent analogies and assumptions, and to the general question of how the taxa of psychiatric classifications are to be viewed as objects of natural science. This model has received intensive philosophical scrutiny, including arguments that deny these conditions are deficiencies at all. Along with issues arising from cognitive psychology and the neurosciences, such foundational matters make up much of the following entry. Because of their focus on issues central to the philosophy of mind and ethics (e.g., the mind-body problem, moral responsibility, agency and identity), analyses of mental disorder have extensive implications for those fields. As clinical phenomena, they also reflect an inescapable, everyday, social reality, giving theoretical inquiries additionally urgent practical, moral, and legal implications. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Enigmatic Lady PudentillaVincent HuninkRoman literature, like Roman society in general, was dominated by males. From this “men’s world” only a few women seem to stand out as individuals. Hence it is not surprising that whenever a Roman text presents a marked female personality, the relevant data from the text are readily used by scholars to reconstruct her biography.This is certainly the case for Aemilia Pudentilla, the (...) wife of the famous orator and Platonic philosopher Apuleius of Madauros, who lived in Africa in the third quarter of the second century a.d. Between the lines of his extant speech Pro Se de Magia, commonly known as the Apology, Apuleius seems to provide much information about his wife. And in fact, we do not know, about any other woman from this period and this province, even approximately as much as we know about Pudentilla.Thus Pudentilla has become quite popular among modern historians of her place and time, perhaps even more so than her husband. She appears in many studies on the social and economic history of the Roman Empire.1 In 1992 Andreas Gutsfeld devoted a lengthy article expressly to her, in which he attempted a reconstruction of her manifold possessions and her commercial activities, in the context of the economic mentality of the upper class to which she belonged. Even more recently, Elaine Fantham (1995) has attempted to correct Apuleius’ picture of his wife and to examine the situation from Pudentilla’s point of view.Relevant and interesting as these approaches may be, some caution seems due here. It must be realized that we know absolutely nothing about Pudentilla from any other, independent source: every single detail is derived from Apuleius’ speech. More important, however, is [End Page 275] that the Apology is not an official document but a judicial speech, which is, moreover, characterized by a strongly literary color. Historians have not always taken these special circumstances sufficiently into account.Discussion below reviews the most important pieces of information about Pudentilla provided by the text and considers them in relation to the aims and strategies of the speaker. In the end, this will prove to be of some consequence for the portrait of Pudentilla.There is a crucial problem concerning her, which lies at the heart of the speech. Apuleius’ opponents have suggested that she must have been out of her mind to agree in marrying the much younger, impoverished philosopher Apuleius. Under the influence of magical powers, so they suggested, she was robbed by Apuleius of a great capital (e.g., 67.4).2 He, on the contrary, asserts that she had rational, sensible, and practical arguments to marry him, and that she lost no money to him. So we immediately see two conflicting images of Pudentilla: she is considered either as a bewitched hysteric or as a prudent and responsible lady. Who is the real Pudentilla?Hard FactsAn entirely reliable answer to this question will always remain out of reach, since we only have Apuleius’ account to go by. Nonetheless, in practice some pieces of information may be taken or inferred from his text. Surely, it contains some elements which seem beyond reasonable doubt.First, the “previous history” to the marriage, as presented by Apuleius at 66–73, seems clear and plausible.Apuleius says that he was a friend of Pontianus, Pudentilla’s elder son. On his way to Alexandria, he fell ill in the town Oea, where Pontianus lived. He was forced to stay there for the winter, and there he met Aemilia Pudentilla. She had been a widow for fourteen years by then. From her marriage to Sicinius Amicus she had two sons, Pontianus and Pudens. The boys’ grandfather was legally in charge of them and, moreover, could decide on the inheritance of their father. Being well [End Page 276] aware of this, he put pressure on Pudentilla to marry his second son. Pudentilla, however, had rejected that idea and remained a widow. Only after this grandfather’s death had she become freer to act, as Pontianus had become the legal tutor of his younger brother. She then decided she would remarry, mainly for specific, medical reasons. Pontianus offered... (shrink)

Samuel Beckett and Jorge Luis Borges have presented 20th century literature with a distinctive gallery of solitary figures who suffer from a series of physiological ailments: invalidism, decrepitude, infirmity and blindness, as well as neurological conditions such as amnesia and autism spectrum disorders. Beckett and Borges were concerned with the dynamics between illness and creativity, the literary representation of physical and mental disabilities, the processes of remembering and forgetting, and the inevitability of death. This article explores the depiction of (...) physically and mentally disabled characters in Borges' Funes the Memorious (1942)—a story about an Uruguayan gaucho who has been left paralysed after a fall from a horse which simultaneously endowed him with an infallible memory and perception—and Beckett's Trilogy: Molloy (1951), Malone Dies (1951) and The Unnamable (1953). It examines the prodigious memory of Funes and the forgetful minds of Molloy and Malone with reference to influential neuropsychological studies such as Alexander Luria's twofold exploration of memory and forgetfulness in The Mind of a Mnemonist (1968) and The Man with a Shattered World (1972). The article demonstrates that in contrast to Beckett's amnesiacs and Luria's brain-damaged patient, who are able to transcend their circumstances through cathartic writing, Borges' and Luria's mnemonic prodigies fail to achieve anything significant with their unlimited memories and remain imprisoned within their cognitive disabilities. It reveals that medical discourses can provide invaluable insights and lead to a deeper understanding of the minds and bodily afflictions of literary characters. (shrink)

I am in the process of trying to organize an ethics committee at a large community mental health center in Central Massachusetts and am seeking advice from anyone with experience in this or a similar milieu. The agency is a large (almost 700 employees), nonprofit, community-based program that operates under the auspices of a broad, academically affiliated, behavioral health system. An independent board of trustees, responsible to the parent organization governs the agency. The agency primarily provides outpatient care and treatment (...) to adults and children with mental health, substance abuse, developmental disabilities, and homelessness issues. It does not provide any psychiatric emergency or acute in-patient mental health services but does operate an inpatient detoxification unit for substance abuse treatment and DUI program. Additionally, the agency has a vast network of residential programs and transitional facilities for individuals with a history of chronic mental illness and substance abuse problems. Outpatient medical care is also provided to homeless clients who reside in area shelters (including a shelter for men and women) and a large number of clients who have HIV/AIDS and/or who have been dually diagnosed (substance abuse and mental illness), and are part of a scattered-site supportive housing program. (shrink)

Consumer-operated services organizations (COSOs) are independent, non-profit organizations that provide peer support and other non-clinical services to seriously mentally ill people. Mental health consumers provide many of these services and make up at least a majority of the organization’s leadership. Although the dominant conception of the COSO is as an adjunct to clinical care in the public mental health system, this paper reconceives the organization as a civic association and thereby a locus of citizenship. Drawing on empirical research on (...) COSOs in one state and the citizenship and civic democracy literatures, COSOs are analyzed here as membership organizations with democratic norms and strong ties to local communities. The suggestion is made that by embracing and enhancing their status as civic associations, COSOs may advance the goals of the social movement that spawned them and avoid predictable obstacles to further growth and development. (shrink)

The literature studying the characteristics associated with revictimization in Intimate Partner Violence is heterogeneous and inconclusive. The absence of studies on the role of the emotional variables of the victims and the failure to distinguish revictimization by the same or different aggressors are two of the main limitations in this area of research. The aim of this work was to study the relative contribution of the material, social, and emotional resources available to IPV victims in predicting revictimization by the (...) same or different perpetrators. The sample consisted of 290 women registered in the city of Madrid who had filed at least one police report for intimate partner violence. The material resources of the victims were evaluated through their level of monthly income and employability status, the social resources through perceived social support, and the emotional resources through emotional regulation and coping strategies. Hierarchical multinomial logistic regression models were estimated to predict single-offender victimization, same-offender revictimization, and multiple-offender revictimization. The results revealed that: differentiating between revictimization by the same and different aggressors improved the fit of the model by 50.8% compared to when only differentiating between victimized and revictimized women; material resources had no significant weight in the prediction of any type of revictimization; SRV women had more social support than VSRDA women ;, those victims who had made several reports to the authorities of violence by different aggressors, had worse emotional regulation than those victims who had made a single report to the authorities ; and VSRDA obtained the worst mental health indexes and they used more coping strategies based on positive reappraisal than the VSR women and those victims with several reports by the same aggressor. These results show that being a victim of several episodes of intimate partner violence by different aggressors should be understood as a form of revictimization of great severity associated with worse emotional regulation and less social support. (shrink)

In 2018 the World Heath Organization decided to re-examine the classification of gender identity disorder and exclude it from being defined as a mental illness. This re-examination means that sex a...

Global Mental Health is a field of research and practice that addresses the expansion of universal and equitable mental health care worldwide. This article explores the ways the concept of culture is employed in Global Mental Health literature. Global Mental Health advocates and critics assume an ontological separation between ‘nature’ and ‘culture’ to typify mental illness, linking it predominantly to one or the other of these two categories. Advocates of Global Mental Health view mental disorders as a nature–culture hybrid, (...) while critics see them as typically cultural phenomena. The cultural critique of Global Mental Health can be strengthened by a sociological approach to both the role of critique and the uses of the concept of culture within social sciences. As an alternative to the ontologization of culture, we propose a different theoretical approach to the social issues involved in the expansion of international public health care in mental health: Arthur Kleinman's and Didier Fassin’s moral anthropological approaches. (shrink)

Co-production, in the field of mental health, aims to bring together academic and clinical researchers and those with lived experience. Often, research projects informed by this methodology involve the meeting of opposing attitudes, whether to the legitimacy of psychiatry, determinants of mental ill health, or the most appropriate interventions. This has meant that whilst some have reported positive experiences of co-production, many people with lived experience of mental ill health, sometimes referred to as ‘experts by experience’ (EbE), report harms which (...) have taken place or been perpetuated during co-produced research projects. In the literature, nearly always, this is understood as a kind of epistemic injustice in Miranda Fricker's sense. In this paper, I argue that whilst Fricker's view does provide a plausible explanation of what's at play, we can gain more insight into the structural factors which exclude EbE by applying a framework of epistemic oppression. By highlighting the systemic and structural factors which work to keep certain knowers and their contributions out of our collective epistemic resources, we begin to understand the enormity of the task required to redress injustices in our knowledge production systems. (shrink)

Foreward by Pramod K. Nayar -- Prologue -- Acknowledgments -- Introduction -- The dys-abled players of Samuel Beckett's Endgame -- The circumcised body of Franz Kafka's select letters -- 'Connoisseurship ... of disease' and Thomas Mann's Death in Venice -- 'Undiscovered countries' with Virginia Woolf's On being ill -- 'Connect nothing with nothing' in T.S. Eliot's The wasteland -- Epilogue -- Pathography -- Index.

SWORD W, CLARK AM, HEGADOREN K, BROOKS S and KINGSTON D. Nursing Inquiry 2012; 19: 51–62 The complexity of postpartum mental health and illness: a critical realist studyPostpartum depression (PPD) is a major public health issue that profoundly impacts the woman, her infant and family. Although it may be linked to hormone changes, no direct hormonal aetiology has been established. A large body of evidence implicates numerous psychosocial predictors of PPD. While a history of depression predicts about 50% of cases (...) of PPD, it remains unclear why some women with a history do not develop depression following childbirth, even taking psychosocial factors into account. The aim of this study was to identify the main mechanisms and factors associated with the presence or absence of PPD in women with a history of depression, and the presence of PPD in women without a history, using a critical realist approach. The findings indicate a number of personal and contextual factors that influence postpartum mental health and illness. In addition, and perhaps most importantly, women who did not develop depression identified goal‐oriented actions that were protective. These factors and processes did not exist in isolation and the interplay among them in influencing health was apparent. More research is needed to explore the effects of these mechanisms in different contexts. (shrink)

Recent policy debates in the US over access to mental health care have raised several philosophically complex ethical and conceptual issues. The defeat of mental health parity legislation in the US Congress has brought new urgency and relevance to theoretical and empirical investigations into the nature of mental illness and its relation to other forms of sickness and disability. Manifold, nebulous, and often competing conceptions of mental illness make the creation of coherent public policy exceedingly difficult. Referencing a variety of (...) approaches to ethical reflection on health care, and drawing from the empirical literature on therapeutic efficacy and economic efficiency, we argue that differential rationing, ‘disparity,’ is unjustifiable. (shrink)

In Europe the elderly population is projected to increase from 18.5% (93.9 million) in 2014 to 28.7% (149.1 million) by 2080. In the USA it is estimated that by the year 2030 more than 20% of the population will be aged 65 years or over. This specific population is at high risk of unrecognised or untreated psychiatric illnesses and suicide. It is well known that completed suicide rate increases with age in both men and women. Although elderly people attempt (...) suicide less often than other age groups, they show a higher completion rate. Generally the methods chosen by elderly are more lethal, the intent is more serious, they are more determined and they show fewer warning sign than the younger population. A recent systematic review and meta-analysis of psychosocial intervention following self-harm in adults found that cognitive behavioural therapy was the most effective in these patients. Unfortunately there have been few reported trials of other potentially effective interventions. Because the scientific literature on psychosocial suicide prevention interventions in the elderly is still scant we decided to conduct a mini-review in order to take stock of the situation. Studies were identified through electronic searches of the Cochrane library, MEDLINE, Scopus and Web of Science databases. PRISMA guidelines were followed and only 7 articles met the inclusion criteria. No firm conclusions can be drawn about this topic because there is still little data and studies used inconsistent outcome measures and designs. Nonetheless, the existing data suggests that psychosocial interventions are promising. (shrink)