Transcultural psychiatry is at the confluence of culture, mental health and illness. It places the patient at the centre of the relationship while respecting his or her individual and collective way of thinking and doing. Culture defines ontological representations, explanatory models and therapeutic practices which influence expressions of suffering and specific modes of coping and healing, as diverse as the cultures from which they arise. Yet, Western psychiatry is just as indivisible from the culture from which it (...) emerged, which brings up the question of mental suffering and care in transcultural situations. Transcultural psychiatry brings the clinician to question and widen his or her clinical practice with regards to social, geopolitical and historical issues which colour the bonds in the social fabric, in power imbalances and in access to health care for individuals of cultural minorities. How can we make our consultations with patients from different parts of the world and who speak different languages ethical? How should one care for patients when faced with cultural otherness? And what are the effects on the mental health of today’s youth, who are raised in global societies which generate complex identity challenges that can lead to radicalization? This article offers some answers to these clinical and ethical questions through the hybridization of representations, in order to ensure a harmonious coexistence and a renewed creativity, for an “ethos of solidarity” in mental health care. (shrink)

This book discusses outcomes of a study by the National Institute of Mental Health, Czech Republic, examining moral integrity in the post-communist Czech-speaking environment. Chapters map the history of the Euro-Atlantic ethical disciplines from moral philosophy and psychology to evolutionary neuroscience and socio-biology. The authors emphasize the biological and social conditionality of ethics and call for greater differentiation of both research and applied psychological standards in today’s globalised world. Using a non-European ethical system – Theravada Buddhism – as a (...) case study, the authors explore the differences in English and Czech interpretations of the religion. They analyse cognitive styles and language as central variables in formatting and interpreting moral values, with important consequences for cultural transferability of psychological instruments. This book will appeal to academics and other specialists in psychology, psychiatry, sociology and related fields, as well as to readers interested in the psychology of ethics. (shrink)

Response to commentaries on the three-paper set 'Outline for an externalist psychiatry'.

This book is psychiatry's reply to the diverse group of antipsychiatrists, including Laing, Foucault, Goffman, Szasz and Bassaglia, that has made fashionable the view that mental illness is merely socially deviant behaviour and that psychiatrists are agents of the capitalist society seeking to repress such behaviour. It establishes, by the use of evidence from historical and transcultural studies, that mental illness has been recognised in all cultures since the beginning of history and goes on to explore the philosophical (...) and medical basis for psychiatry's diagnosis and treatment of mental illness. Finally, it tackles two issues where psychiatry has recently been seen as at odds with the values prevailing in society: involuntary hospitalization and the insanity defence. The Reality of Mental Illness does not pretend to offer simple answers to the complex problems it discusses, but will leave the reader with a much greater understanding of psychiatry's aims, practices and problems. (shrink)

Previous studies have shown the operational potential in political discourse analysis from the proximization perspective. This study adopts a cross-disciplinary approach to analyze political communication across transcultural contexts, especially in the cyber discourse space. Based on the spatial–temporal–axiological model, we compare the journalistic discourses on two social media platforms by China Xinhua News Agency, an official speaker for China worldwide. The corpuses are constructed with microblogs on Weibo in Chinese and Twitter in English containing key words of Sino–US (...) trade war. It is found that the speaker has shaped different realities of discourse in accordance with the cultural contexts and proximized from corresponding dimensions to increase political legitimacy. (shrink)

Resumen: En este artículo se estudia la dimensión estética de prácticas denominadas artísticas, que no fueron concebidas dentro de los cánones clásicos europeos del “Arte”. Nos centramos en el problema disciplinar que se genera al separar las prácticas estéticas -es decir todas aquellas manifestaciones sensibles- de culturas no-europeas de aquellas que sí pertenecen a los cánones académicos o institucionales de tradición europea; las primeras perteneciendo al ámbito de la antropología y arqueología y las segundas al arte y la estética. Sostenemos (...) que estas divisiones epistemológicas se fundamentan en parte en los prejuicios civilizatorios que tomaron fuerza con el evolucionismo social y que dividieron como categorías separadas lo “civilizado” de lo “primitivo”, relegando sobre todo esta última al ámbito de estudio científico. Sin embargo, se resaltan en este artículo aquellas vertientes de pensamiento que, desde las humanidades de tradición europea, se pueden entretejer con las agencias y significados que yacen detrás de las prácticas estéticas transculturales. Abstract: This article studies the aesthetic dimension of so-called artistic practices, which were not conceived within the classical European canons of “Art”. We focus on the disciplinary problem generated by separating aesthetic practices -that is, all those sensitive manifestations- of non-European cultures from those that do belong to the academic or institutional canons of European tradition; the former belonging to the field of anthropology and archaeology and the latter to art and aesthetics. We argue that these epistemological divisions are based in part on the civilizational prejudices that gained strength with social evolutionism and that divided the “civilized” from the “primitive” as separate categories, relegating the latter mainly to the realm of scientific study. However, this paper highlights those strands of thought that, from the humanities of European tradition, can be interwoven with the agencies and meanings that lie behind transcultural aesthetic practices. (shrink)

Publication date: 30 November 2016 Source: Author: Wen Lee Ng, Manimangai Mani, Wan Roselezam Wan Yahya While the growing body of research on Tan Twan Eng’s The Gift of Rain focuses on the protagonist, Philip Hutton’s traumatic condition, his Chinese identity, and his ambiguous identity, this study devotes particular attention to the complexity of interactions between various cultures practised by Philip. This study aims to address this gap by applying the concept of transculturalism to analyse the processes of acquiring a (...) foreign culture and incorporating the foreign culture into traditional cultures experienced by Philip. In other words, this study employs the concept of transculturalism to examine multicultural depictions in the novel. Scholars, such as Khan, Tiwari, Sheoran and Tan C. S. who have examined multicultural depictions in various literary texts, have found that multicultural circumstances cause certain ethnic groups to lose their cultures and identities. Hence, the multicultural circumstances depicted are perceived as negative phenomena. However, this study has found that by examining the interactions between various cultures, rather than focusing on the end products such as portrayals of hybridity, the positive sides of multicultural depictions could be revealed. The transculturation process experienced by Philip shows that the new cultural practices he has created are made up of both his traditional cultures and the foreign culture he has acquired. This means that Philip does not totally lose his traditional cultures and identities. Therefore, this study concludes that multicultural depictions in The Gift of Rain could be read positively, provided that the interactions between various cultures, which resulted in the incorporation of a foreign culture into traditional cultures, are examined. (shrink)

Launched in 1971, _Adolescent Psychiatry_, in the words of founding coeditors Sherman C. Feinstein, Peter L. Giovacchini, and Arthur A. Miller, promised "to explore adolescence as a process...to enter challenging and exciting areas that may have profound effects on our basic concepts." Further, they promised "a series that will provide a forum for the expression of ideas and problems that plague and excite so many of us working in this enigmatic but fascinating field." For over two decades, _Adolescent Psychiatry_ has (...) fulfilled this promise. The repository of a wealth of original studies by preeminent clinicians, developmental researchers, and social scientists specializing in this stage of life, the series has become an essential resource for all mental health professionals working with youth. Volume 20 of the series serves as a tribute to editor emeritus Sherman C. Feinstein. In addition to an appreciation of, and contributions by, Dr. Feinstein, it contains heretofore unpublished papers by two other major figures in adolescent psychiatry, founding father William Schonfeld and a Viennese colleague transplanted to America, Siegfried Bernfeld. With sections on general considerations of adolescence, specific syndromes, and treatment modalities, volume 20 presents the work of many of today's preeminent minds in adolescent psychiatry. (shrink)

Psychiatry is increasingly dominated by the reductionist claim that mental illness is caused by neurobiological abnormalities such as chemical imbalances in the brain. Critical psychiatry does not believe that this is the whole story and proposes a more ethical foundation for practice. This book describes an original framework for renewing mental health services in alliance with people with mental health problems. It is an advance over the polarization created by the "anti-psychiatry" of the past.

Drawing on the records of an “alcoholism counselling service” launched in the 13th arrondissement of Paris in 1954, this article studies how social work became part of the new scope of psychiatric care for alcohol addiction, at a time when new medical cures were becoming available. The content and structure of patient records, which we analyse in comparison with papers from medical and social work journals, provide an insight into the day-to-day tasks of the social workers, who (...) worked as closely as possible with alcoholic patients and their families. The article shows that the action of the social worker, which became central, although subordinated to that of psychiatric medicine, took on a psychotherapeutic dimension and was characterised by the need to gain the patient’s trust and ensure their adherence to treatment, thus marking a clear inflection in the relationship with beneficiaries. However, social work was still characterised by its constitutive ambiguity; its control and surveillance functions created difficulties, misunderstandings and disputes with the patients and their relatives. (shrink)

[opening paragraph]: Reading the article by Naudin et al. on Husserlian reduction in psychiatry prompted me to review a few chapters of my intellectual autobiography. I entered graduate school enamoured with Husserl, believing him a potent and necessary antidote to the hubris of the ‘natural attitude’ expounded by natural science. But I left graduate school believing that Husserl was too wrapped up in the debate as to whether reality was objective or subjective. Hence I ask in response to Naudin (...) et al.: must we take on Husserl's Cartesian baggage only to shed it as we move from trascendental subjectivity to the life world to narrative? The Husserlian apparatus seems a needlessly complicated and convoluted tool for exploring the essentially social deficit of the schizophrenic. Perhaps the most valuable contribution of phenomenology to psychiatry is its assiduous cultivation of ‘beginner's mind’ as it is often spoken of in Zen practice. (shrink)

Thinking through other minds encompasses new dimensions in computational psychiatry: social interaction and mutual sense-making. It questions the nature of psychiatric manifestations in light of recent data on social interaction in neuroscience. We propose the concept of “social physiology” in response to the call by the conceivers of TTOM for the renewal of computational psychiatry.

The authors describe the arrival and treatment of 164 severe chronic psychiatric patients who were displaced from the Serbian army-controlled Jakes psychiatric hospital and off-loaded on the afternoon of 28th of May, 1992 at the gates of the Psychiatry Clinic in Tuzla. Through analysis of their incomplete medical records, which arrived with the patients in Tuzla, and analysis of their activities during and after the war, they found that 83 of the patients (50%) were males and 147 (89.6%) were (...) admitted to the Psychiatry Clinic in Tuzla. Of the patients, 86 (58.5%) were found to be Serbs. The majority of them were incapable of independent living and required ongoing medical and social care. They were from all regions of Bosnia-Herzegovina, 81.6% had schizophrenia and 70 (47.6%) were over 50 years of age. For its humanitarian work, its contribution to peace and for the maintenance of the multi-ethnic Bosnia-Herzegovina, the Psychiatry Clinic in Tuzla received the Golden Award for Peace from the International Legion of Humanists in May 1998. (shrink)

Several fields contributing to psychiatric advances, such as psychology, biology, and the humanities, have not yet met to produce a cohesive and integrated picture of human function and dysfunction, strength and vulnerability, etc., despite advances in their own areas. The failure may have its roots in a disagreement on what we mean by the human person and his or her relationship with the world, for which the incommensurate language of these disciplines may be partly to blame. Turns taken by western (...) philosophy over the past 400 years may help to explain this. Language is such an important tool for psychiatrists, that examination of it may afford an insight into the reasons for divisions in the field. This paper aims to examine and compare psychologies (and hence psychiatries) derived from modern western philosophy, with similar concepts in other cultures, through the study of developments in terminology, in terms of the simplest facts about what it means to be human. Terminology used in mental health in western cultures is examined, with particular consideration of the term “self” as it has come to be used in a technical sense. Analogous terms from non-English speaking European languages, and some non-western cultures are studied. Western philosophy and psychology have evolved a meaning for the term “self” which is quite different from equivalent terms in non-western cultures. It is a moot point whether or not the development in western psychiatry of what are now technical terms to describe normal human experience has become needlessly obscure and ambiguous. It is not evident that this “new” language represents a genuine advance in understanding; it distances mental health professionals from those who are not familiar with it; and it makes transcultural dialogue difficult. (shrink)

This review essay explores recent historical and anthropological literature on the emergence and development of transcultural psychiatry in the second half of the twentieth century. It examines how postcolonial psychiatry attempted to remove itself from its erstwhile colonial frameworks and strove to introduce new concepts and paradigms to make itself relevant in the context of decolonization and postwar reconstruction. The essay looks at both continuities and discontinuities between colonial and post-colonial transcultural psychiatry, asking how the (...) recent surge of scholarly literature in this field engaged with these issues. It also aims to identify the most important avenues for future research. (shrink)

Medicalization in contemporary psychopharmacology is increasingly dominated by commercial interests that threaten the scientific and ethical integrity of psychiatry. At the same time, the proliferation of new social media has altered the manner in which the social groups and institutions that have stakes in medicalization interact. Consumers are at once more powerful than ever before, but also more vulnerable. The upshot of all these developments is that medicalization is no longer simply the professed enemy of anti-psychiatry (...) and its supporters. It is now also an enemy of psychiatry. Once a welcome ally of psychiatry, medicalization appears to have turned into a fearsome enemy. (shrink)

With contributions from psychiatry, psychology, neuroscience, and philosophy, this book provides the most comprehensive account to date of the interplay between biological, psychological, and social factors in mental health and their ethical dimensions.

Is social psychiatry at a tipping point, acknowledging that many normal types of behavior are being over-medicalized? What notions of enchantment can we glean from Max Weber's social thought as they relate to our modern, rational, bureaucratic world? Giedraitis explores these issues using the German economist and sociologist Max Weber's theories of rationalization and disenchantment, and connects them to the dangers of bureaucratizing mental health. Giedraitis conducts an innovative study using psychotherapists as respondents to measure varying degrees (...) of "rational" thought in their clients, thereby indirectly measuring Weberian rational thought as related to certain types of depression. This book is recommended to those who would like an introduction to Weberian notions of rationality and disenchantment, or general Weberian socio-economic theory. This book is also suggested to those seeking to understand a possible connection between Weberian rationalization, disenchantment, bureaucratization and mental health. (shrink)

The idea of global justice faces a serious challenge. We live in one global society and many regional and local societies at the same time. The existing plurality of institutional as well as cultural levels of social connection leads to this general question: what is the right site for addressing different questions of justice? Some philosophers argue that the paramount place for thinking about justice is the global level, but other philosophers claim that questions of justice presuppose a certain (...) institutional structure. It is therefore only at the local level, preferentially in the form of sovereign states, where questions of justice arise. I want to argue that it is possible to understand some issues of justice as global in an irreducible way, while other issues are best addressed on a local level not only for pragmatic reasons, but also for reasons that have to do with the normative significance of local institutions, cultural connections and social identities. (shrink)

I argue that psychiatric researchers, clinicians, and the wider public actively regulate the minds of individuals with mental disorder through the prescriptive processes of mind-shaping (see Andrews in South J Philos 53:50–67, 2015a; Andrews in Philos Explor 18(2):282–296, 2015b; McGeer, in: Folk psychology re-assessed, Springer, Berlin, 2007; McGeer in Philos Explor 18:259–281, 2015; Mameli in Biol Philos 16(5):595–626, 2001; Zawidzki in Philos Explor 11(3):193–210, 2008; Zawidzki, in: Kiverstein (ed) The Routledge Handbook of Philosophy of the Social Mind, Taylor and (...) Francis Group, London, 2016). Consequently, all those with a vested interest in the language of mental disorder should take a critical and dialogical approach in how concepts of psychopathology are developed, disseminated and used. Mind-shaping describes how our folk-psychological categorizations actively regulate the behaviour of those categorized. This is done through setting certain norms, which can be achieved through the application of folk-psychological concepts. I argue that psychiatry has embedded norms and goals in its activities that are non-epistemic in nature and these are not only bound up in disorder concepts, but also in the social roles that clinicians, researchers and patients play. In this way, psychiatry uses folk-psychological type tools for the social understanding of individuals with mental disorder, and the application of these tools also helps it meet these non-epistemic goals. Given this, I characterise psychiatry as partaking in mind-shaping. When we characterise psychiatry as mind-shaping, we are then able to explain occurrences of looping effects between disorder categories and individuals categorized (Haslam in J Psychopathol 22(1):4–9, 2016) and provide a theoretical basis for the occurrence of hermeneutical injustice in the field of mental health. (shrink)

This is a comprehensive resource of original essays by leading thinkers exploring the newly emerging inter-disciplinary field of the philosophy of psychiatry. The contributors aim to define this exciting field and to highlight the philosophical assumptions and issues that underlie psychiatric theory and practice, the category of mental disorder, and rationales for its social, clinical and legal treatment. As a branch of medicine and a healing practice, psychiatry relies on presuppositions that are deeply and unavoidably philosophical. Conceptions (...) of rationality, personhood and autonomy frame our understanding and treatment of mental disorder. Philosophical questions of evidence, reality, truth, science, and values give meaning to each of the social institutions and practices concerned with mental health care. The psyche, the mind and its relation to the body, subjectivity and consciousness, personal identity and character, thought, will, memory, and emotions are equally the stuff of traditional philosophical inquiry and of the psychiatric enterprise. A new research field--the philosophy of psychiatry--began to form during the last two decades of the twentieth century. Prompted by a growing recognition that philosophical ideas underlie many aspects of clinical practice, psychiatric theorizing and research, mental health policy, and the economics and politics of mental health care, academic philosophers, practitioners, and philosophically trained psychiatrists have begun a series of vital, cross-disciplinary exchanges. This volume provides a sampling of the research yield of those exchanges. Leading thinkers in this area, including clinicians, philosophers, psychologists, and interdisciplinary teams, provide original discussions that are not only expository and critical, but also a reflection of their authors' distinctive and often powerful and imaginative viewpoints and theories. All the discussions break new theoretical ground. As befits such an interdisciplinary effort, they are methodologically eclectic, and varied and divergent in their assumptions and conclusions; together, they comprise a significant new exploration, definition, and mapping of the philosophical aspects of psychiatric theory and practice. (shrink)

Originally published in 1973, this book is about people and psychiatry. About people who rejected psychiatry as it was generally practised at the time, people who sought for and found alternative ways of caring for and healing one another. The author, who had been active in radical alternatives to psychiatry for some time, offers us a programme based not on drugs, repression and a 'questionable' expertise, but on human caring, greater awareness of the body, deeper communication between (...) persons and a willingness to let the emotions flow. It is a challenging alternative which came at a time when the viability of scientific, theoretical and chemical approaches to distress were being questioned at all levels of society. This alternative includes the new direct methods of healing (making whole) such as Encounter, Gestalt, Bioenergetics, Psychofantasy - methods that do not do things to people but allow them to feel their way into change through experiment, flow and choice. The main focus of the book is People, not Psychiatry (PNP), the network set up by the author in 1969. PNP is open to all, and people in it help one another in times of stress and crisis, if they are asked to and when they are needed. One of the main assets of these networks is that they are an alternative and they are there. The book tells the story of PNP's birth and growth. It is a personal story, a moving story, a story about people. In addition, the book contains some lively theoretical discussion, both simple and clear, in the course of which the author tentatively offers his own theory of neurosis - that many people become victims of the primitive logic patterns laid down in infancy, patterns that become reinforced through fear and habit and have to be dissolved or replaced if we are to enjoy a full, healthy, free-flowing life. The book is directed at doctors, patients, consultants, nurses, psychologists, social workers, therapists, in fact anyone involved in any way in the field of psychiatry. It is also offered to all those whom psychiatry touches, that it to say - everyone. (shrink)

Psychiatry presents a unique array of difficult ethical questions. However, a major challenge is to approach psychiatry in a way that does justice to the real ethical issues. Recently there has been a growing body of research in empirical psychiatric ethics, and an increased interest in how empirical and philosophical methods can be combined. Empirical Ethics in Psychiatry demonstrates how ethics can engage more closely with the reality of psychiatric practice and shows how empirical methodologies from the (...) social sciences can help foster this link. -/- The book is divided into two sections. In the first section there are discussions of the possibility of empirical ethics from a theoretical standpoint and an overview of the history of empirical medical ethics in general. The second, larger section is made up of chapters, discussing specific research projects in empirical psychiatric ethics. The contributors reflect on their choice of method: how and why they combine empirical and philosophical work, and how the two approaches relate to each other. The chapters in the second part thus have two purposes. The first is to present examples of empirical ethics in psychiatry; the second is to reflect on the way in which empirical research can support ethical analysis. -/- Empirical Ethics in Psychiatry is a unique contribution to bioethics and will be fascinating reading for all those working within the field, as well as mental health care professionals. (shrink)

_Moving in early career from public health physician to psychiatrist gives me a public health view of psychiatry and an interest in pursuing the goals of widening access to community-based services for people with mental disorders and promoting mental health in communities. Training in social medicine in the UK and psychiatry in Australia lead to studies of homelessness in people living with psychotic disorders, the health of family caregivers, assessing quality of life and mental health promotion. Work (...) with the World Health Organization (WHO) in the Western Pacific Region and the World Psychiatric Association (WPA) worldwide has given me opportunities to work with psychiatrists, mental health workers, service users and others in governments and non-government organisations implementing the recommendations of the World Health Report 2001 in countries with limited resources. My work as WPA Secretary for Publications seeks to improve information exchange in countries irrespective of their wealth. This is an exciting time to be working in a global village with technical capacity to reach into its furthest corners. Psychiatrists supported by WPA can help ensure that vulnerable people and communities and people living with mental disorders are well served in this new environment and no longer left out and left behind._. (shrink)

ABSTRACTThe authors describe the arrival and treatment of 164 severe chronic psychiatric patients who were displaced from the Serbian army‐controlled Jakes psychiatric hospital and off‐loaded on the afternoon of 28th of May, 1992 at the gates of the Psychiatry Clinic in Tuzla.Through analysis of their incomplete medical records, which arrived with the patients in Tuzla, and analysis of their activities during and after the war, they found that 83 of the patients were males and 147 were admitted to the (...) Psychiatry Clinic in Tuzla. Of the patients, 86 were found to be Serbs. The majority of them were incapable of independent living and required ongoing medical and social care. They were from all regions of Bosnia‐Herzegovina, 81.6% had schizophrenia and 70 were over 50 years of age.For its humanitarian work, its contribution to peace and for the maintenance of the multi‐ethnic Bosnia‐Herzegovina, the Psychiatry Clinic in Tuzla received the Golden Award for Peace from the International Legion of Humanists in May 1998. (shrink)

If we do not shrink from making rough generalizations and adopt a broad, conventional approach, then what we call modernity refers to the process whereby a state of heterogeneity progresses toward homogeneity in time, space, human collectives, social order, and other areas. In his book The Cheese and the Worms, Carlo Ginzburg discusses a late-16th century incident of heterodoxy that cannot be classified into previously existing standard categories. As new knowledge was disseminated thanks to the invention of the Gutenberg (...) printing press, old and new knowledge came into conflict in the mind of a heterodox figure by the name of Menocchio. He attacked the church, saying that it was more important to love one’s neighbor than to love God. Through these small, humble manifestations of change, Ginzburg was able to reveal the juncture when European modern knowledge first emerged from a muddled, undifferentiated state into one of clarity, whereby over the course of about a century of fermentation, its contours eventually became clearly evident around the year 1800. This process has been termed by the pioneer of conceptual history Otto Brunner as the “threshold era”, and by Reinhart Koselleck as the beginning of the “saddle era”. (shrink)

Psychiatry uncomfortably spans biological, psychological, and social perspectives on mental illness. As a branch of medicine, psychiatry is under pressure to conform to a biomedical model, according to which diseases are characterized primarily in biological terms. But psychiatry also draws on the psychotherapeutic tradition, which explains mental distress in terms of life experience and social influences.These approaches ought to complement each other, but historically this has not happened. With no theory creating global, systematic links between (...) the two approaches, psychiatry is divided... (shrink)

One of paradoxes of current mental health care is that we never have known more about mental disorder and at the same time been more uncertain about the conceptual basis—and, therefore, the legitimacy—of psychiatry.This is remarkable. Psychiatry as a science flourishes. Over the last three decades, there has been an enormous increase in empirical research on the genetic, neurobiological, psychological, and social determinants of mental disorder. At the same time, mental health care has improved a lot, at (...) least in most Western countries. Reform in legislation and in the organization of care has led to more autonomy of the patient, more control on the process and outcome of therapy... (shrink)

_Disaster Psychiatry: Intervening When Nightmares Come True_ captures the state of disaster psychiatry in the aftermath of the terrorist attacks of September 11, 2001. This emergent psychiatric specialty, which is increasingly separated from trauma and grief psychiatry on one hand and military psychiatry on the other, provides psychotherapeutic assistance to victims during, and in the weeks and months following, major disasters. As such, disaster psychiatrists must operate in the widely varying locales in which natural and man-made (...) disasters occur, and they must establish their role among the chaotic array of organizations involved in direct disaster response. Editors Anand Pandya and Craig Katz have captured the challenge and promise of disaster psychiatry through first-person narratives. We hear from psychiatrists who have encountered disasters at various stages of their career and in widely varying social, political, and personal contexts. Accounts of psychiatric involvement with adults and children during and after 9/11 have understandable pride of place in this collection. But they are balanced by richly informative narratives about other domestic and international disasters. Fraught with the drama attendant to the events they describe, these essays delineate the dizzying array of challenges that confront the disaster psychiatrist. They range from the intense emotional responses that are part of the aftermath of any disaster, to the need to legitimize a psychiatric presence within diverse cultural and medical contexts, to the subtle task of providing therapeutic boundaries at a time when all rules seem to be suspended. Special attention is given to the daunting task of working with children whose parents' are disaster victims. What emerges from these testimonies is compelling documentation of skilled and compassionate psychiatrists at the outer limits of their specialty, pursuing their calling into uncharted realms of therapeutic engagement. (shrink)

Launched in 1971, _Adolescent Psychiatry,_ in the words of founding coeditors Sherman C. Feinstein, Peter L. Giovacchinni, and Arthur A. Miller, promised "to explore adolescence as a process... to enter challenging and exciting areas that may have profound effects on our basic concepts." Further, they promised "a series that will provide a forum for the expression of ideas and problems that plague and excite so many of us working in this enigmatic but fascinating field." For over two decades, Adolescent (...) Psychiatry has fulfilled this promise. The repository of a wealth of original studies by preeminent clinicians, developmental researchers, and social scientists specializing in this stage of life, the series has become an essential resource for all mental health practitioners working with youth. With volume 22, the editorship of _Adolescent Psychiatry_ passes to Aaron E. Esman, a distinguished clinician and educator whose wide-ranging sensibilities gain expression in a collection rich in clinical, developmental, and scholarly insight. Encompassing developmental topics timely clinical issues, historical commentaries, and a special section on "ambient genocide and adolescence," volume 22 ably meets the needs of professional and scholarly readers interested in this vitally important stage of life. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Incorporating Religion into Psychiatry:Evidenced–Based Practice, Not a Bioethical DilemmaMary D. MollerFor over sixteen years I was the owner and clinical director of an advanced practice nurse–managed outpatient rural psychiatric clinic staffed by APNs, a social worker, a licensed counselor and several graduate students. Many of our patients were victims of severe and often brutal trauma and abuse suffered at the hands of family, friends, and various professionals (...) including spiritual leaders. We also uncovered sources of abuse suffered from those involved in occult practices ranging from seemingly innocent white witchcraft (Wicca, Paganism, New Age) that includes such activities as astral projection and remote viewing to the darkest possible black witchcraft (perpetrating evil, incanting evil spirits, casting spells and hexes, creating dissociative identities) such as occurs in ritual abuse and satanic rites. Both types of witchcraft also typically involved family, friends, various professionals, and spiritual leaders. Recognizing the controversy surrounding the reality of witchcraft I am sharing a story that I hope will help break down the barriers that prevent many patients from receiving the treatment that would provide the most benefit to recovery.Seeking services for these patients led me on an intense personal and professional journey that included a profound Christian born–again experience at almost 50 years of age. My professional career grew in nearly indescribable terms as a result of the incorporation of prayer and deliverance ministry as part of the services we selectively provided. Today I always include assessment of spiritual experiences a patient has as well as spiritual supports that are available with every new patient intake. For patients who indicate that prayer is one of their supports, I ask if they would like prayer at the conclusion of the session. The gratitude that is expressed by individuals who appreciate being able to pray with a psychiatric provider is often profound.In the field of psychiatry there has been a long–standing and distinct taboo regarding incorporating religious and spiritual aspects of life experience into treatment unless it is to frame most of these discussions within the context of psychosis. This stems from the advent of psychoanalysis in which religion was deemed a neurosis and atheism became the goal. Some still hold to that belief and there certainly remains controversy regarding the incorporation of prayer into routine outpatient or inpatient care. The essential starting point is the determination of accurate differential diagnosis, which can often be a lengthy process. The clinician must be careful about distinguishing between religious experiences and religious delusions, and often this takes time to sort out. The determination of the etiology of hearing the voice of God or the devil or demons must be carefully parsed and framed within the context of the situation and culture the patient describes. If the clinician denies the existence of God or the devil or demons or the practice of witchcraft, the patient’s descriptions of such experiences will be quickly [End Page 206] labeled psychotic. The patient may then experience a lengthy hospitalization and treatment with psychotropic medications that can have an extremely negative effect on the possibility of recovery. Once I witnessed the level of healing that occurs with carefully administered spiritual interventions that are related to specific spiritual experiences that are based on the patient’s belief system, there was no going back to using only allopathic medication and non–spiritual psychosocial interventions, even in spite of the criticisms from others. The key is to understand and respect the patient’s belief system, if this is not congruent with the practitioner’s belief system, then practitioner must refer out.In the United States, an increasing persecution of Christianity and a devaluing of the Judeo–Christian heritage of our Constitution are creating a climate of intolerance to the expression of religious values resulting in an expectation that Christians should compromise their beliefs for the sake of political correctness. As a doctorally prepared psychiatric–mental health advanced practice nurse I experienced a profound born–again Christian experience that ultimately led to study of the Hebrew roots of Christianity and I now worship in a Messianic Jewish synagogue. It is impossible for me to not include the concept of spirituality into... (shrink)

By first analysing the arguments of psychiatry's critics and the philosophical ideas of such thinkers as Freud, Eysenck, Laing, Szasz, Sedgwick and Foucault and by then providing answers to the many contentious and diverse questions raised, Dr. Reznek aims to establish a philosophical defence of the theory and practice of psychiatry. As both a qualified philosopher and psychiatrist, the author is exceptionally p[laced to undertake the examination of a subject which has hitherto remained untackled. It will be easily (...) accessible to a wide variety of non-specialists as well. It will be of specific interest to those involved in the practice of philosophy, psychiatry, clinical psychology, social work and psychiatric nursing. (shrink)

In psychiatry there is no sharp boundary between the normal and the pathological. Although clear cases abound, it is often indeterminate whether a particular condition does or does not qualify as a mental disorder. For example, definitions of ‘subthreshold disorders’ and of the ‘prodromal stages’ of diseases are notoriously contentious. Philosophers and linguists call concepts that lack sharp boundaries, and thus admit of borderline cases, ‘vague’. This overview chapter reviews current debates about demarcation in psychiatry against the backdrop (...) of key issues within the philosophical discussion of vagueness: Are there various kinds of vagueness? Is all vagueness representational? How does vagueness relate to epistemic uncertainty? What is the value of vagueness? Given the immense social, moral, and legal importance of demarcating the normal from the pathological in psychiatry, what are the pros and cons of gradualist approaches to mental disorders, that is, of construing boundaries as matters of degree? (shrink)

Psychiatry is enormously complex. One of its main difficulties is how to connect the wide diversity of factors that may cause or contribute to the problems at hand, factors ranging from traumatic experiences, dysfunctional neurotransmitters, existential worries, economic deprivation, and social exclusion, to genetic bad luck. Interventions are also diverse, with options including chemical or electrical treatment, therapies aimed at behavior change and those promoting insight. Much is still unknown: what are the causal pathways, which interventions work best (...) for which patients and why?In practice, many mental health care professionals work holistically in a pragmatic and eclectic way. Without using any explicit... (shrink)

This paper challenges the exclusion of patients from epistemic practices in psychiatry by examining the creation and revision processes of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a document produced by the American Psychiatric Association that identifies the properties of mental disorders and thereby guides research, diagnosis, treatment, and various administrative tasks. It argues there are epistemic—rather than exclusively social/political—reasons for including patients in the DSM revision process. Individuals with mental disorders are indispensable resources to enhance (...) psychiatric epistemology, especially in the context of the crisis, controversy, and uncertainty surrounding mental health research and treatment. (shrink)

Linda Morrison brings the voices and issues of a little-known, complex social movement to the attention of sociologists, mental health professionals, and the general public. The members of this social movement work to gain voice for their own experience, to raise consciousness of injustice and inequality, to expose the darker side of psychiatry, and to promote alternatives for people in emotional distress. Talking Back to Psychiatry explores the movement's history, its complex membership, its strategies and goals, (...) and the varied response it has received from psychiatry, policy makers, and the public at large. (shrink)

This is a comprehensive resource of original essays by leading thinkers exploring the newly emerging interdisciplinary field of the philosophy of psychiatry. The contributors aim to define this exciting field and to highlight the philosophical assumptions and issues that underlie psychiatric theory and practice, the category of mental disorder, and rationales for its social, clinical, and legal treatment.

Discrimination and inequalities in healthcare can be experienced by many patients due to many characteristics ranging from the obviously visible to the more subtly noticeable, such as race and ethnicity, legal status, social class, linguistic fluency, health literacy, age, gender and weight. Discrimination can take a number of forms including overt racist statement, stereotyping or explicit and implicit attitudes and biases. This paper presents the case study of a complex transcultural clinical encounter between the mother of a young (...) infant in a highly vulnerable social situation and a hospital healthcare team. In this clinical setting, both parties experienced difficulties, generating explicit and implicit negative attitudes that heightened into reciprocal mistrust, conflict and distress. The different factors influencing their conscious and unconscious biases will be analysed and discussed to offer understanding of the complicated nature of human interactions when faced with vulnerability in clinical practice. This case vignette also illustrates how, even in institutions with long-standing experience and many internal resources to address diversity and vulnerability, cultural competence remains a constant challenge. (shrink)

According to many researchers, it is inevitable and obvious that psychiatric illnesses are biological in nature, and that this is the rationale behind the numerous neuroimaging studies of individuals diagnosed with mental disorders. Scholars looking at the history of psychiatry have pointed out that in the past, the origins and motivations behind the search for biological causes, correlates, and cures for mental disorders are thoroughly social and historically rooted, particularly when the diagnostic category in question is the subject (...) of controversy within psychiatry. This is obscured by neuroimaging studies that drive researchers to proclaim 'revolutions' in psychiatry, namely in the DSM. Providing neuroimaging evidence to support the contention that a condition is 'real' is likely to be extremely influential, as has been extensively discussed in the neuroethics literature. This type of evidence will also reinforce the pre-existing beliefs of those researchers or clinicians who are already expecting a biological description. The uncritical credence given to neuroimaging research is an ethical issue, not in its potential for contributing to misdiagnosis per se but because of the motivations that often drive this research. My claim is that this research should proceed with an awareness of presumptions and motivations underlying the field as a whole, in addition to an explicit focus on the past and potential future consequences of classification and diagnosis on the groups of individuals under study. (shrink)

The biopsychosocial (BPS) model in psychiatry has come under fire for being too vague to be of any practical use in the clinic. For many, its central flaw consists in lack of scientific validity and philosophical coherence: the model never specified how biological, psychological and social factors causally integrate with one another. Recently, advances in the cognitive sciences have made great strides towards meeting this very ‘integration challenge.’ The paper begins by illustrating how enactivist and predictive processing frameworks (...) propose converging accounts of biopsychosocial integration that are far superior to those of previous theories. It argues, however, that the main problem of implementing the BPS model has less to do with integration than with the lack of a social etiology. Psychiatric practice leans heavily towards ‘bio’ and ‘psycho’ approaches, without an equally developed set of explanatory and therapeutic resources for dealing with the ‘social’ dimension of illness. This leaves psychiatry essentially internalist in orientation. As illustrated most poignantly by conditions such as functional neurological disorders, internalism comes with the risks of stigma and the curtailment of therapeutic possibilities. The paper argues that the answer to the failings of the BPS model lies in combining the integration challenge with the development of an ‘externalist psychiatry,’ which casts both causes and treatment of psychiatric illness onto the social environment. The following two papers explore the conditions that might make this idea a reality. (shrink)

Philosophical speculation about how psychiatric externalism might function in practice has yet to fully consider the multitude of externalist psychiatric systems that exist beyond the bounds of modern psychiatry. Believing that anthropology can inform philosophical debate on the matter, the paper illustrates one such case. The discussion is based on 19 months of first-hand ethnographic fieldwork among Akha, a group of swidden farmers living in highland Laos and neighboring borderlands. First, the paper describes the Akha set of medicinal, ritual, (...) and shamanic practices, analyzing issues of stigma and medical pluralism within it. Second, it makes the case that the Akha realize a functioning biopsychosocial system which comes with a well-developed set of resources for treating the social dimension of illness. Externalism among the Akha re-frames psychiatric illness as a ‘problem in living,’ which becomes manageable as such. The paper claims that, in so doing, the Akha system succeeds in many of the areas where modern internalist psychiatry falls short, and that it does so because Akha society is structured in such a way so that its practitioners can shift the social environment around the patient. As a takeaway for philosophers, it suggests that the development of an externalist psychiatry must begin from questioning the accepted ontology of the social causes of psychiatric illness. (shrink)

Elaborating decolonial and intersectional methods, aesthetics has developed rich tools for tackling power differences. A philosophical question arises about the nature of gendered embodied experience and materiality: How to comprehend the cultural field if it is at once a site of heinous expropriation and violence and one of vital social and political possibility? This essay explores this question through a reading of Claudia Llosa's film The Milk of Sorrow ( La teta asustada ) (2009). The film, we show, reworks (...) racial, gendered, and colonial logics and supplants a model of transculturation, magical realism, and syncretism and its attendant figuration of resistance by a cultural vision of a web of multivalent, pluri-directional aesthetic promises and threats. Thus it presents a young Indigenous woman as a contemporary decolonial actor who, in encounter with popular culture and the global marketplace, renders memory livable and opens up unforeseen futures for her young town and country. We signal the implications for the positioning of the decolonial feminist spectator or culture maker and for a decolonial aesthetics. Aesthetic existence at the intersection of oppression and liberation, although impure and troubled, functions as a bountiful font of feminist energy and sustenance and a site of communal caring and imagination. (shrink)

It is common to note that social environment and cultural formation shape mental disorders. The details of this claim are, however, not well understood. The paper takes a look at the claim that culture has an impact on psychiatry from the perspective of metaphysics and the philosophy of science. Its aim is to offer, in a general fashion, partial explications of some significant versions of the thesis that culture and social environment shape mental disorders and to highlight (...) some of the consequences social constructionism about psychiatry has for psychiatric explanation. In particular, it will be argued that the alleged dependence of facts about particular mental disorders and about the second order property of being a mental disorder on social facts amounts to a robust form of constructivism, whereas the view that clinician–patient interaction is influenced by cultural facts is perfectly compatible with an anti-constructivist stance. (shrink)

The anti-psychiatry movement of the 20th century has notably denounced the role of values and social norms in the shaping of psychiatric categories. Recent activist movements also recognize that psychiatry is value-laden, however, they do not fight for a value-free psychiatry. On the contrary, some activist movements of the 21st century advocate for self-advocacy in sciences of mental health in order to reach a more accurate understanding of psychiatric categories/mental distress. By aiming at such epistemic gain, (...) they depart from the anti-psychiatry movement. Through the analysis of the epistemic and political influence of two of these movements – Neurodiversity and the Mad Studies, we show how this new activism has taken a scientific turn compatible with current philosophical scientific frameworks, while still developing a critical approach on psychiatry. (shrink)

Within psychiatric research, the field of 'technotherapy' has been centred primarily on attempts to assess the computer as a treatment tool. The situation of daily clinical usage is, however, often ignored within such research, as for instance in controlled clinical trials. Our empirical study illustrates how health professionals and clients use different concepts of science and health in the attempts of formulating standards for using computers in psychiatric practice. The psychiatrists at a major psychiatric hospital decided and justified clients' use (...) of computers on the basis of a 'techno-medical' quality assurance. At the same hospital the occupational therapists stressed the improvement of social relations as a treatment goal. And, at a psychiatric outside clinic the clients used concepts of 'normality' for articulating quality in computer use. Our study exemplifies how the use of computers is a multifaceted 'performance'. What is called for is a kind of research not limited by artificial borders of 'the context' and the 'user-perspective'. In much humanistic research as well as in action research concepts of 'context' and 'user-perspective' imply a somehow romantic view on practice as pure and uncontaminated by the outside world contrasted to a 'general' or an 'objective' way of knowing the world. These sharp distinctions were however difficult to maintain in our study, where health professionals and clients took local contingencies into account when they interpreted computer use, while they simultaneously drew on a socio-historical reservoir of resources. (shrink)

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