The symptom (which here refers to both the clinical or ‘objective’ sign, that is, the sign that physicians believe cannot lie, and the patient’s subjective revelation of disorder, which is always considered suspect) has been relegated by a number of semioticians to a category of signs often considered of little consequence, a ‘natural’ sign signaling some specific condition or state within the body whose object stands in a strictly biological and securely determined relationship to the symptom. I believe (...) the symptom, however, is deep, rich, and symbolic in every sense, signifying the misadventures of a body impaled by its perceptual skills and history within its own unique Umwelt or sign-world. Unfortunately, the notion of a sign which reflects biologically coded events alone suggests the body is without the ability to think, learn, and produce a story of unlimited semiosis. This should seem especially problematic to those biosemioticians who find analogic codes of much greater importance than the supposedly digital codes of DNA. I suggest that the disordered and disorderly body and the Umwelt within which it survives offer biosemioticians and those who pursue semiotic models in other disciplines an important opportunity to jointly and more fully explore the experienced world of health and illness, a world in which culture and nature are fully interpenetrated. (shrink)

Depressive symptoms are characterised by reduced cognitive control. However, whether depressive symptoms are linked to difficulty in exerting cognitive control in general or over emotional content specifically remains unclear. To better differentiate between affective interference or general cognitive control difficulties in people with depressive symptoms, we employed a non emotional (cold) and an emotional (hot) version of a task-switching paradigm in a nonclinical sample of young adults (N = 82) with varying levels of depressive symptoms. Depressive symptoms were linked to (...) greater difficulties in exerting cognitive control in complex situations (mixed-task blocks) compared to simple and semiautomatic situations (single-task blocks) in both task versions. Moreover, greater depressive symptoms were associated with longer latencies in the emotional version of the task across all trial types. Thus, the emotion-specific effect was not modulated by the degree of cognitive control required to perform the task. In sum, depressive symptoms were characterised by a general difficulty to exert cognitive control in both emotional and non emotional contexts and by greater difficulty in even simple attentional processing of emotional material. This study granted novel insights on the extent of cognitive control difficulties in emotional and non emotional contexts for people with depressive symptoms. (shrink)

Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years were (...) recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities, socioemotional functioning, psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key. (shrink)

Every statement about language is also a statement by and about psyche. Guided by this primary assumption, and inspired by the works of Carl Jung, in _Symptom, Symbol, and the Other of Language_, Bret Alderman delves deep into the symbolic and symptomatic dimensions of a deconstructive postmodernism infatuated with semiotics and the workings of linguistic signs. This book offers an important exploration of linguistic reference and representation through a Jungian understanding of symptom and symbol, using techniques including amplification, dream (...) interpretation, and symbolic attitude. Focusing on Ferdinand de Saussure, Jacques Derrida, Michel Foucault, and Richard Rorty, Alderman examines the common belief that words and their meaning are grounded purely in language, instead envisioning a symptomatic expression of alienation and collective dissociation. Drawing upon the nascent field of ecopsychology, the modern disciplines of phenomenology and depth psychology, and the ancient knowledge of myth and animistic cosmologies, Alderman dares us to re-imagine some of the more sacrosanct concepts of the contemporary intellectual milieu informed by semiotics and the linguistic turn. Symptom, Symbol, and the Other of Language is essential reading for academics and students engaged in the study of depth psychology. However, the interdisciplinary approach of the work ensures that it will also be of great interest to those researching and studying in the areas of ethology, ecopsychology, philosophy, linguistics and mythology. (shrink)

In current mental health care psychiatric conditions are defined as compilations of symptoms. These symptom-based disease categories have been severely criticised as contingent and boundless, facilitating the rise to epidemic proportions of such conditions as depression. In this article we look beyond symptoms and stress the role of epidemiology in explaining the current situation. By analysing the parallel development of cardiovascular disease and depression management in Finland, we argue, firstly, that current mental health care shares with the medicine of (...) chronic somatic conditions an attachment to risk factor epidemiology, which accentuates risk and prevention in disease management. However, secondly, due to the symptom-based definitions of psychiatric conditions, depression management cannot differentiate properly between symptoms, signs and risk factors such as, for example, cardiovascular medicine, but treats symptoms as signs or risk factors in contexts of treatment and prevention. Consequently, minor at-risk conditions have become difficult to separate from proper cases of depression. (shrink)

Psychiatric researchers typically assume that the modelling of psychiatric symptoms is not influenced by psychiatric categories; symptoms are modelled and then grouped into a psychiatric category. I highlight this primarily through analysing research domain criteria. RDoC’s importance makes it worth scrutinizing, and this assessment also serves as a case study with relevance for other areas of psychiatry. RDoC takes inadequacies of existing psychiatric categories as holding back causal investigation. Consequently, RDoC aims to circumnavigate existing psychiatric categories by directly investigating the (...) causal basis of symptoms. The unique methodological approach of RDoC exploits the supposed lack of influence of psychiatric categories on symptom modelling, taking psychiatric symptoms as the same regardless of which psychiatric category is employed or if no psychiatric category is employed. But this supposition is not always true. I will show how psychiatric categories can influence symptom modelling, whereby identical behaviours can be considered as different symptoms based on an individual’s psychiatric diagnosis. If the modelling of symptoms is influenced by psychiatric categories, then psychiatric categories will still play a role, a situation which RDoC researchers explicitly aim to avoid. I discuss four ways RDoC could address this issue. This issue also has important implications for factor analysis, cluster analysis, modifying psychiatric categories, and symptom based approaches. (shrink)

This study reviews the existing literature on psychiatric interventions for individuals affected by the COVID-19 epidemic. My article cumulates previous research on how extreme stressors associated with COVID-19 may aggravate or cause psychiatric problems. The unpredictability of the COVID-19 epidemic progression may result in significant psychological pressure on vulnerable populations. Persons with psychiatric illnesses may experience worsening symptoms or may develop an altered mental state related to an increased suicide risk. The inspected findings prove that psychological intervention measures for patients (...) affected by the epidemic should be designed and personalized adequately. Preventive measures seek to decrease infection rates and cut down the risk of the public healthcare system to eventually be overburdened. Throughout the COVID-19 crisis, people with psychiatric illnesses may confront a decrease in mental health services. As limitations in the current review, by focusing only on articles published in journals indexed in Web of Science, Scopus, and ProQuest, I inevitably disregarded other valuable sources. Subsequent research directions should clarify the effectiveness of online mental health services in providing remote psychiatric interventions to individuals affected by the COVID-19 epidemic. (shrink)

The main aim of this study is to explore the breadth of the inference field and the type of etiopathogenetic contents of symptom explanations provided by the client and therapist in the first two psychotherapy sessions conducted using a systemic approach. Does the therapist use triadic explanations of psychopathology as suggested by her approach? And do clients resort almost exclusively to monadic and dyadic explanations as did the university students in our previous study? What kind of explanations do they (...) propose? The coding system “1 to 3: from the monad to the triad” was applied to the transcripts of 25 individual systemic therapies conducted by the same therapist. This manual allows to code the inference field of symptom explanations according to three categories: monadic, dyadic and triadic. These three broad categories are also used to analyse the etiopathogenetic content of each explanation: traumatic, intrapersonal, and interpersonal. Our findings showed that clients and their therapist actually used different inference fields: clients resorted almost exclusively to monadic and dyadic explanations, whereas their therapist included the triadic explanatory level. Moreover, the therapist provided more interpersonal explanations than her clients. Hence, the dissonance between client and therapist about the inference fields¬–a crucial premise of one of the most accepted ideas of therapeutic change according to systemic therapies–is proved, at least among our participants. Thanks to this dissonance, clients and therapists can create a new story, potentially able to change clients’ feelings, without disconfirming their emotions. (shrink)

Individuals with idiopathic environmental illness with attribution to electromagnetic fields (IEI-EMF) claim they experience adverse symptoms when exposed to electromagnetic fields (EMFs) from mobile telecommunication devices. However, research has consistently reported no relationship between exposure to EMFs and symptoms in IEI-EMF individuals. The current study investigated whether presence of symptoms in IEI-EMF individuals were associated with a nocebo effect. Data from two previous double-blind provocation studies were re-analyzed based on participants’ judgments as to whether or not they believed a telecommunication (...) base station was “on” or “off.” Experiment 1 examined data in which participants were exposed to EMFs from Global System for Mobile Communication, Universal Mobile Telecommunications System, and sham base station signals. In Experiment 2, participants were exposed to EMFs from Terrestrial Trunked Radio Telecommunications System and sham base station signals. Our measures of subjective well-being indicated IEI-EMF participants consistently reported significantly lower levels of well-being, when they believed the base station was “on” compared to “off.” Interestingly, control participants also reported experiencing more symptoms and greater symptom severity when they too believed the base station was “on” compared to “off.” Thus, a nocebo effect provides a reasonable explanation for the presence of symptoms in IEI-EMF and control participants. (shrink)

The boundary between spiritual experience and mental disorder remains unclear and should invite collaboration between psychiatry and other disciplines, including theology. Jackson and Fulford (1997), using the tools of analytic philosophy, have proposed a model allowing principled differentiation between spiritual experience and psychotic symptoms based on the personal values of the subject, a cognitive problem-solving model. Spiritual experience is described as positively evaluated psychotic experience, which enables the subject to do more than he or she normally does. In the present (...) paper, it is claimed that values and actions cannot alone always discriminate between religious experience and psychopathology. With reference to three case studies, drawn from the practice of one of us, it is argued that spirituality is not all about experience and that it cannot be understood without reference to the subject's personal history and spiritual tradition, however implicit or fragmented. This approach would allow an account of ordinary religious experience in those who have suffered ego disablement during mental illness. Drawing primarily on the Christian tradition, we argue that the use of theological criteria may allow levels of discrimination between spiritual experience and mental disorder not allowed for by philosophical psychopathology. (shrink)

AimThe aim of this study was to determine the presence of depressive symptoms and understand the potential factors associated with these symptoms among physicians in Bangladesh during the COVID-19 pandemic.MethodsA cross-sectional study using an online survey was conducted in between April 21 and May 10, 2020, among physicians living in Bangladesh. Participants completed a series of demographic questions, COVID-19-related questions, and the Patient Health Questionnaire-9. Descriptive statistics, test statistics were performed to explore the association between physicians’ experience of depression symptoms (...) and other study variables. Stepwise binary logistic regression was followed while conducting the multivariable analysis.ResultA total of 390 physicians completed the survey. Of them, 283 were found to be experiencing depressive symptoms. Predictors which were significantly associated with depressive symptoms were gender, the presence of sleep disturbance, being highly exposed to media coverage about the pandemic, and fear around COVID-19 infection, being assaulted/humiliated by regulatory forces and by the general public, while traveling to and from the hospital and treating patients during the countrywide lockdown.ConclusionThe findings of this study demonstrate that there is a high prevalence of depressive symptom among physicians especially among female physicians in Bangladesh during the COVID-19 pandemic. Immediate, adequate and effective interventions addressing gender specific needs are required amid this ongoing crisis and beyond. (shrink)

Psychoanalytic practice and theory do not map together in any seamless ways. Nevertheless, the creative tension between the two is essential in the production of psychoanalytic knowledge. In this paper, I recount Emma’s psychoanalytic journey using a series of five vignettes from her four-year psychotherapy. When I met Emma, she had been unable to walk for six months. The reasons for her affliction were, at this time, mysterious. During her therapy, a transformative process took place reflecting a movement from (...) class='Hi'>symptom to the symbolization of an inner receptive space. The insights that emerged from this psychic journey challenge the conceptualization of a simple linear progression from the pre-Oedipal to the Oedipal moment which is seen to structure subjectivity. I argue that the representation of a receptive inner space is a necessary precondition for thought – and this is especially so for women’s development of mind. This argument calls into question the centrality given to the Oedipus complex and the associated paternal function in the structuring of subjectivity in some psychoanalytic models of mind. I suggest these models sit too closely to patriarchal fantasies which underestimate the complex processes involved in entering the symbolic realm. (shrink)

The aim of this article is to present a conceptual review and analysis of symptom understanding. Subjective bodily sensations occur abundantly in the normal population and dialogues about symptoms take place in a broad range of contexts, not only in the doctor’s office. Our review of symptom understanding proceeds from an initial subliminal awareness by way of attribution of meaning and subsequent management, with and without professional involvement. We introduce theoretical perspectives from phenomenology, semiotics, social interactionism, and discourse (...) analysis. Drew Leder’s phenomenological perspectives deal with how symptom perception occurs when any kind of altered balance brings forward a bodily attention. Corporeality is brought to explicit awareness and perceived as sensations. Jesper Hoffmeyer’s biosemiotic perspectives provide access to how signs are interpreted to attribute meaning to the bodily messages. Symptom management is then determined by the meaning of a symptom. Dorte E. Gannik’s concept “situational disease” explains how situations can be reviewed not just in terms of their potential to produce signs or symptoms, but also in terms of their capacity to contain symptoms. Disease is a social and relational phenomenon of containment, and regulating the situation where the symptoms originate implies adjusting containment. Discourse analysis, as presented by Jonathan Potter and Margaret Wetherell, provides a tool to notice the subtle ways in which language orders perceptions and how language constructs social interaction. Symptoms are situated in culture and context, and trends in modern everyday life modify symptom understanding continuously. Our analysis suggests that a symptom can only be understood by attention to the social context in which the symptom emerges and the dialogue through which it is negotiated. (shrink)

In this paper, I want to make two main points. The first point is methodological: Instead of attempting to give a classical analysis or reductive definition of the term “expertise”, we should attempt an explication and look for what may be called symptoms of expertise. What this comes to will be explained in due course. My second point is substantial: I want to recommend understanding as an important symptom of expertise. In order to give this suggestion content, I begin (...) to develop an account of understanding. Finally, I will draw attention to some consequences of this approach. (shrink)

Background: The classical symptom specificity hypothesis (Blatt, 1974) links obsessional symptoms to autonomous interpersonal behavior. Inconsistent findings from cross-sectional group studies on symptom specificity have previously been associated with several conceptual and methodological limitations intrinsic to nomothetic research. Previous empirical case research reported ambivalences between autonomous and dependent interpersonal behavior in obsessional pathology. Aim and Method: The present ‘theory-building’ case study specifically aims at further refinement of the classical symptom specificity hypothesis by testing specific operationalizations within an (...) empirical single case design. Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of a psychodynamic therapy. Interpersonal functioning is assessed by means of the Core Conflictual Relationship Theme method. The classical symptom specificity hypothesis is contrasted to an alternative hypothesis of interpersonal ambivalences as determinants of obsessional symptoms. Results: Close associations between obsessions and interpersonal dynamics are observed. Findings predominantly affirm the ambivalence hypothesis rather than the classical symptom specificity hypothesis. Psychodynamic interventions focusing on interpersonal conflicts are related to symptomatic changes. Conceptual and methodological considerations, limitations and future research indications are discussed. (shrink)

Observations with respect to the relationship between symptoms and diseases can seriously be biased by selection phenomena. This selection may occur from the general population, via consultation behavior, diagnostic and therapeutic activities of the general practitioner, and by referral.Relationships may be suggested and reproduced even if they do not exist in unselected populations, as a product of diagnostic routines. Correction for selection bias can only be achieved by choosing proper comparison groups. While this can be done in a general practice (...) setting, this is almost impossible after referral, as is demonstrated in this paper. Surprisingly, the most unbiased estimation of the relationship between symptoms and diseases after referral can be made from patient groups that are referred for reason unrelated to the disease under study. (shrink)

In the target article, Cramer et al. suggest that diagnostic classification is improved by modeling the relationship between manifest variables (i.e., symptoms) rather than modeling unobservable latent variables (i.e., diagnostic categories such as Generalized Anxiety Disorder). This commentary discusses whether symptoms represent manifest or latent variables and the implications of this distinction for diagnosis and treatment.

The recent changes in COVID-19 symptoms suggest convergent evolution of respiratory diseases. This process is analogous to the emergence of animal mimetic complexes and complements previously identified types of mimicry. A novel pathogen might go unnoticed or insufficiently counteracted if it resembles a disease that the host already faced on multiple occasions, which creates a selective pressure towards a typical symptomic phonotype. In short, the reason why so many unrelated pathogens cause similar symptoms may correspond to the reasons that drove (...) the evolution of the ‘warning’ wasp-like colouration in various insect species. (shrink)

Avatar, le film de James Cameron (2009), aura ete un succes commercial d'une ampleur exceptionnelle, a considerer davantage comme le symptome d'une certaine societe en crise spirituelle, que comme l'expression personnelle d'un createur, fut-il exceptionnel. Sur cette base, Frank Pierobon, au terme d'une deconstruction tres poussee, en extrait l'embleme de notre postmodernite finissante: un Deus ex Fantasma, soit une derisoire redemption par le reve, faute de tout autre salut.

This essay examines constructions of deafness in medieval culture, exploring how deaf experience disrupts authoritative discourses in three textual genres: medical treatise, literary fiction, and autobiographical writing. Medical manuals often present deafness as a physical defect, yet they also suggest how social conditions for deaf people can be transformed in lieu of treatment protocols. Fictional narratives tend to associate deafness with sin or social stigma, but they can also imagine deaf experience with a remarkable degree of sympathy and nuance. Autobiographical (...) writing by deaf authors most vividly challenges diagnostic models of disability, exploring generative forms of perception that deafness can foster. In tracing the disruptive force that deaf experience exerts on perceived notions of textual authority, this essay reveals how medieval culture critiqued the diagnostic power of medical practitioners. Deafness does not simply function as a symptom of an individual problem or a metaphor for a spiritual or social condition; rather, deafness is a transformative capacity affording new modes of knowing self and other. (shrink)

There is one concept in medicine which is prominent, the symptom. The omnipresence of the symptom seems, however, not to be reflected by an equally prominent curiosity aimed at investigating this concept as a phenomenon. In classic, traditional or conventional medical diagnostics and treatment, the lack of distinction with respect to the symptom represents a minor problem. Faced with enigmatic conditions and their accompanying labels such as chronic fatigue syndrome, fibromyalgia, medically unexplained symptoms, and functional somatic syndromes, (...) the contestation of the symptom and its origin is immediate and obvious and calls for further exploration. Based on a description of the diagnostic framework encompassing medically unexplained conditions and a brief introduction to how such symptoms are managed both within and outside of the medical clinic, we argue on one hand how unexplained conditions invite us to reconsider and re-think the concept we call a “symptom” and on the other hand how the concept “symptom” is no longer an adequate and necessary fulcrum and must be enriched by socio-cultural, phenomenological and existential dimensions. Consequently, our main aim is to expand both our interpretative horizon and the linguistic repertoire in the face of those appearances we label medically unexplained symptoms. (shrink)

Current research suggests that stressful life experiences and situations create a substantive effect in the development of the initial manifestations of psychotic disorders and may influence temporo-limbic epileptic-like activity manifesting as cognitive and affective seizure-like symptoms in non-epileptic conditions. The current study assessed trauma history, hair cortisol levels, epileptic-like manifestations and other psychopathological symptoms in 56 drug naive adult young women experiencing their initial occurrence of psychosis. Hair cortisol levels among patients experiencing their initial episode of psychosis, were significantly correlated (...) with stress symptoms measured by Trauma Symptom Checklist-40, and complex partial seizure-like symptoms measured by the Complex Partial Seizure-Like Symptoms Inventory and LSCL-33. Hair cortisol levels were not found to be significantly correlated with symptoms of anxiety and depression measured by Beck depression Inventory and Zung Anxiety Scale. These findings suggest a significant relationship between epileptic-like symptoms and stress responses demonstrated by patients in their first psychotic episode. These findings may suggest the potential for research to explore usefulness of anticonvulsant treatment in patients who do not respond to usual psychotropic medication. (shrink)

Galen's treatises on the classification and causation of diseases and symptoms are an important component of his prodigious oeuvre, forming a bridge between his theoretical works and his practical, clinical writings. As such, they remained an integral component of the medical teaching curriculum well into the second millennium. This edition was originally published in 2006. In these four treatises, Galen not only provides a framework for the exhaustive classification of diseases and their symptoms as a prelude to his analysis of (...) their causation, but he also attempts to establish precise definitions of all the key terms involved. Unlike other of his works, these treatises are notably moderate in tone, taking into account different views on structure and causation in a relatively even-handed way. Nonetheless, they are a clear statement of the Dogmatic position on the theoretical foundations of medicine in his time. (shrink)

In previous studies, we found that bodily symptoms can be learned in a differential conditioning paradigm, using odors as conditioned stimuli and CO2-enriched air as unconditioned stimulus . However, this only occurred when the odor CS had a negative valence , and tended to be more pronounced in persons scoring high for Negative Affectivity . This paper considers the necessity and/or sufficiency of awareness of the CS–US contingency in three studies using this paradigm. The relation between contingency awareness and the (...) selective conditioning effect, and between contingency awareness and NA was also considered. Both self reported symptoms and respiratory physiology served as dependent variables. A learning effect on symptoms was found only for participants aware of the CS–US contingency, but not all participants reporting contingency awareness showed a learning effect. No conditioning effects appeared on the physiological measures. Also contingency awareness did not account for the selective conditioning effect, and did not interact with NA. Overall, the necessity but insufficiency hypotheses can only be withhold for group data and not for individual data. (shrink)

Our language system is ambiguous in that the same utterance can be interpreted in different ways depending on the intention of the speaker. For example, the phrase, “Nice job!” can be interpreted a...

Following the declaration of the COVID-19 outbreak as a global pandemic in March 2020, a state of alarm was decreed in Spain. In this situation, healthcare workers experienced high levels of stress, anxiety and depression due to the heavy workload and working conditions. Although Spain experienced a progressive decline in the number of COVID-19 cases until the last week of May and the work overload among health workers was substantially reduced, several studies have shown that this work overload is associated (...) with the later emergence of psychological symptoms induced by stress. The aim of the present study was to evaluate the levels of stress, anxiety, depression, post-traumatic stress and compassionate fatigue in health professionals. The sample consisted of 973 health professionals 16.5% men, 82.9% women, and one non-binary person. The data were collected through an online questionnaire sent to the participants by e-mail. DASS-21 was used to measure anxiety, stress and depression, PCL-C to measure post-traumatic stress and ProQOL -vIV to measure compassion fatigue. In addition, other descriptive variables that could be related to these levels of psychological symptomatology were evaluated. The results reveal that after the work overload experienced during the COVID-19 pandemic, healthcare workers report psychological symptoms, post-traumatic stress and compassion fatigue. It is therefore recommended that these professionals be provided with psychological help in order to reduce the emotional impact of COVID-19, and consequently improve their mental health. (shrink)

The clinical encounter begins with presentation of an illness experience; but throughout that encounter, something else is constructed from it – a symptom. The symptom is a particular interpretation of that experience, useful for certain purposes in particular contexts. The hermeneutics of medicine – the study of the interpretation of human experience in medical terms – has largely taken the process of symptom-construction to be transparent, focussing instead on how constellations of symptoms are interpreted as representative of (...) particular conditions. This paper examines the hermeneutical activity of symptom-construction more closely. I propose a fourfold account of the clinical function of symptoms: as theoretical entities; as tools for communication; as guides to palliative intervention; and as candidates for medical explanation or intervention. I also highlight roles they might play in illness experience. I use this framework to discuss four potential failures of symptom-interpretation: failure of symptom-type and symptom-token recognition; loss of the complete picture of illness experience through overwhelming emphasis on its symptomatic interpretation; and intersubjective feedback effects of symptom description altering the ill person’s own perceptions of their phenomenal experience. I conclude with some suggestions of potential remedies for failures in the process of symptom-construction. (shrink)

Through an original combination of phenomenology and psychoanalysis, Ingerslev and Legrand argue convincingly for a complex theoretical framework for making sense of bodily symptoms in psychopathology. The argument is particularly interesting because it manages to show how the theoretical efforts to arrive at a better understanding of bodily symptoms are connected closely with the ethical demand involved in the dialogical situation of therapy. The framework thus operates on two interconnected levels, on the one hand ensuring a more careful clinical differentiation (...) of bodily symptoms and, on the other, encouraging the clinician to adopt a responsive stance that allows for those symptoms to be recognized as... (shrink)

The first clinical symptoms focused on the presentation of coronavirus disease 2019 have been respiratory failure, however, accumulating evidence also points to its presentation with neuropsychiatric symptoms, the exact mechanisms of which are not well known. By using a computational methodology, we aimed to explain the molecular paths of COVID-19 associated neuropsychiatric symptoms, based on the mimicry of the human protein interactions with SARS-CoV-2 proteins.Methods: Available 11 of the 29 SARS-CoV-2 proteins’ structures have been extracted from Protein Data Bank. HMI-PRED, (...) a recently developed web server for structural PREDiction of protein-protein interactions between host and any microbial species, was used to find the “interface mimicry” through which the microbial proteins hijack host binding surfaces. Classification of the found interactions was conducted using the PANTHER Classification System.Results: Predicted Human-SARS-CoV-2 protein interactions have been extensively compared with the literature. Based on the analysis of the molecular functions, cellular localizations and pathways related to human proteins, SARS-CoV-2 proteins are found to possibly interact with human proteins linked to synaptic vesicle trafficking, endocytosis, axonal transport, neurotransmission, growth factors, mitochondrial and blood-brain barrier elements, in addition to its peripheral interactions with proteins linked to thrombosis, inflammation and metabolic control.Conclusion: SARS-CoV-2-human protein interactions may lead to the development of delirium, psychosis, seizures, encephalitis, stroke, sensory impairments, peripheral nerve diseases, and autoimmune disorders. Our findings are also supported by the previous in vivo and in vitro studies from other viruses. Further in vivo and in vitro studies using the proteins that are pointed here, could pave new targets both for avoiding and reversing neuropsychiatric presentations. (shrink)

Semiotics, the theory of sign and meaning, may help physicians complement the project of interpreting signs and symptoms into diagnoses. A sign stands for something. We communicate indirectly through signs, and make sense of our world by interpreting signs into meaning. Thus, through association and inference, we transform flowers into love, Othello into jealousy, and chest pain into heart attack. Medical semiotics is part of general semiotics, which means the study of life of signs within society. With special reference to (...) a case story, elements from general semiotics, together with two theoreticians of equal importance, the Swiss linguist Ferdinand de Saussure and the American logician Charles Sanders Peirce, are presented. Two different modes of understanding clinical medicine are contrasted to illustrate the external link between what we believe or suggest, on the one hand, and the external reality on the other hand. (shrink)

The memorialists attest to the persistent resentment which accompanied the edicts of pacification from 1563 to 1598. Unpublished in their era, they reflect both the discontent associated with the belief that the edicts favoured their adversaries and the diverse means by which a population can translate the permanence of deflected aggression (insults, riots, legal obstacles, defamatory statements), regardless of the date and exclusivity clauses. The little credit attributed to the royal decision encouraging pacific coexistence only constructs, beyond official appearances, the (...) perception of a regression to the very origin itself of the conflicts. (shrink)

This article reports the findings of a study into the role of Dutch nurses in the alleviation of pain and symptoms with a life-shortening intention, conducted as part of a study into the role of nurses in medical end-of-life decisions. A questionnaire survey was carried out using a population of 1509 nurses who were employed in hospitals, home care organizations and nursing homes. The response rate was 82.0%; 78.1% (1179) were suitable for analysis. The results show that in about half (...) of the cases (55.8%) nurses were involved in the decision making by the physician and that nurses were frequently (81.5%) involved in administering the medication. The authors' conclusion is that alleviation of pain and symptoms with a life-shortening intention represents a `grey' area, in which physicians and nurses act on the basis of personal ethical norms rather than legal rules, professional guidelines or shared moral values. (shrink)

Depression has been linked with impaired executive control and specific impairments in inhibition of negative material. To date, only a few studies have examined the relationship between depressive symptoms and executive functions in response to emotional information. Using a new paradigm, the Affective Shift Task (AST), the present study examined whether depressive symptoms in general, and rumination specifically, are related to impairments in inhibition and set shifting in response to emotional and non-emotional material. The main finding was that depressive symptoms (...) in general were not related to inhibition. Set-shifting impairments were only observed in moderate to severely depressed individuals. Interestingly, rumination was related to inhibition impairments, specifically when processing negative information, as well as impaired set shifting as reflected in a larger shift cost. These results are discussed in relation to cognitive views on vulnerability for depression. (shrink)

University students are at elevated risk for psychological distress, especially during the COVID-19 pandemic. The aim of this study was to warmly contact our students and investigate the psychological impact of the COVID-19 pandemic on the subjective wellbeing and levels of psychological symptoms of university students in Belgium. All bachelor and master students of the Vrije Universiteit Brussels were invited for a brief structured telephone interview in March, 2021. In total, 7,154 students were assessed by a structured interview, based on (...) the Kessler Psychological Distress Scale and the Anamnestic Comparative Self-Assessment. Compared to a representative sample, students considered their life during the pandemic as less satisfying compared to their life before the pandemic. Overall, all students have suffered from COVID-19 and the measures taken to contain the pandemic. Twenty percent of our sample of 7,154 VUB students scored above the K6 cutoff, indicating a heightened risk for having a diagnosable mental illness severe enough to cause functional limitations and to require treatment. This study highlights the need for psychological support for all students, during the COVID-19 pandemic. (shrink)

This book explores the future of critique in view of our planetary condition. How are we to intervene in contemporary constellations of finance capitalism, climate change and neoliberalism?

Pain and posttraumatic stress disorder frequently co-occur but underlying mechanisms are not clear. This study aimed to test the development and maintenance of pain and PTSD symptom clusters, i.e., intrusions, avoidance, and hyperarousal. The longitudinal study included 216 adults with burns. PTSD symptom clusters, indexed by the Impact of Event Scale-Revised, and pain, using a graphic numerical rating scale, were measured during hospitalization, 3 and 6 months post-burn. Cross-lagged panel analysis was used to test the relationships between pain (...) and PTSD symptom clusters. Cross-lagged results showed that in-hospital intrusions predicted pain and avoidance 3 months post-burn. In-hospital pain predicted intrusions and avoidance 3 months post-burn and a trend was found for hyperarousal. In the second wave, intrusions predicted pain and hyperarousal. Pain predicted hyperarousal. This study provides support for an entangled relationship between pain and PTSD symptoms, and particularly subscribes the role of intrusions in this bidirectional relationship. To a lesser extent, hyperarousal was unidirectionally related to pain. These results may subscribe the driving role of PTSD, particularly intrusions, which partly supports the Perpetual Avoidance Model. (shrink)

Individuals in late adulthood are often confronted with difficulties and challenges that elicit existential questions and doubts, including religious doubts. Although research has shown that unresolved religious doubts increase the risk for depression, it remains unclear how they are related to each other in late adulthood and which mechanisms are underlying this relationship. Therefore, in a longitudinal study of 329 older adults aged 65-99 and living in a nursing home, the relation between religious doubt and depressive symptoms was explored as (...) well as the mediation effect of rumination on this relationship. The results confirmed the relation between religious doubt and the experience of depressive symptoms, with a bidirectional influence over time. However, the findings indicated that this reciprocal relationship was not mediated by rumination. The study highlights the importance of identifying older adults who experience religious doubt and who are at risk for or suffer from depressive symptoms. (shrink)