Monday, July 23, 2012

Global Mental Health and its Discontents

Global Mental Health and its Discontents | Somatosphere

The ASI workshop and conference entitled “Global Mental Health: Bridging the Perspectives of Cultural Psychiatry and Public Health.”, was chaired by Laurence Kirmayer and Duncan Pedersen, and was animated with ...

Global Mental Health and its Discontents

The field of Global Mental Health (GMH) is an emerging formation of knowledge and practice seeking to address mental illness on a global scale. A growing body of research has established mental illness as one of the most pressing “burdens of disease” (Lancet series, 2007). Recently, an article in Nature entitled “Grand Challenges in Global Mental Health” (2011) identified mental health priorities for research in the next 10 years, sparking controversy and debate about the appropriate methods for establishing priorities, research themes, and interventions in GMH. This year’s annual Advanced Study Institute (ASI) and Conference, hosted by McGill’s Division of Social & Transcultural Psychiatry (July 5-7 2012) in Montreal, Canada, sought to address these concerns and focused on ways to generate critique of the GMH movement to ensure that its goals and methods are responsive to diverse cultural contexts. The ASI workshop and conference entitled “Global Mental Health: Bridging the Perspectives of Cultural Psychiatry and Public Health.”, was chaired by Laurence Kirmayer and Duncan Pedersen, and was animated with intense discussions about various themes related to the GMH endeavour. The three-day ASI series sought to address ongoing controversies and tensions between a public health approach to mental health (grounded in current evidence-based practices largely produced by high-income countries and exported and adapted to local situations) and a culturally-based approach (which emphasizes local priorities and community-based resources and solutions). The first two days took the form of a workshop bringing together experts in cultural psychiatry, public health and medical anthropology for a consideration of ways to bridge various perspectives on GMH.
In an attempt to convey the essence of the ASI meeting, we report on the proceedings of the workshop and conference in the form of a debate, giving voice to those in attendance.

Understanding Global Mental Health
“I am confused. From what I’ve learned over the last days of discussion, it is not ‘global’, not about ‘mental’, and not about ‘health’. So why don’t we call it ‘local political recovery’?” Suman Fernando (closing statement to the ASI conference)
Discussion about the nature and vision of the GMH agenda oscillated between two antagonistic poles. One described it as a bottom-up, public health movement driven by local knowledge and priorities, with the aim of providing access to mental health care for everyone. On the other end of the spectrum, GMH was seen as a top-down, imperial project exporting Western illness categories and treatments that would ultimately replace diverse cultural environments for interpreting mental health.
Vikram Patel, a psychiatrist at the London School of Hygiene & Tropical Medicine, and a major proponent of the field of GMH, described current mental health treatment conditions as a fundamental human rights crisis. In contrast to other humanitarian crises, he argues, there has been no global outrage about the dramatic treatment gap in mental health care, partially because some people “perpetuate the myth that mental illness does not exist”. He suggested that unlike its colonial predecessors “tropical medicine” and “international health”, GMH was shaped by a postcolonial framework which asks “what can we do collaboratively?” rather than “what can we [the West] do for you?”. According to Patel, the GMH movement was grounded in the belief that mental healthcare interventions should be driven by local knowledge and that such knowledge should flow in both directions between the global south and the global north. In this vision of GMH, he described a shifting of power from “places like Montreal to places like Delhi”.
An alternative perspective on the GMH movement was voiced by Derek Summerfield and Suman Fernando, who both suggested that GMH is becoming a predominantly Western scientific endeavour driven by psychiatry and the pharmaceutical industry. Summerfield, an honorary senior lecturer at London’s Institute of Psychiatry, pointed to the limited explanatory power and relevance of Western mental health concepts in many parts of the world and questioned the existence of a “hidden burden of mental illness” which only becomes conceivable when Western psychiatric categories and measures are assumed to be universal. It was purported that evidence of efficacy for many psychiatric treatments is still contested in the West and was thus not robust enough to be scaled up in the South. Similarly, Fernando argued that the Western notion of the individual has become the universal subject in mental health care and although the GMH’s program is tweaked with culturally sensitive language, it does not include the voices of the service users and the poor. He further pointed out that economic interest and funding structures will always be a political issue as they create an unequal relationship between donors and recipients and determine what kind of system emerges in a particular context.

Who is setting the GMH agenda? Whose knowledge counts?
Many of those attending the ASI meeting questioned the selection of the Delphi panel[1] in strategizing the agenda of the GMH movement that informed the formulation of the “Grand Challenges in Global Mental Health” (Nature, 2011). In response, Patel described the Delphi process as one of the most transparent attempts of agenda setting since it included researchers from low-and-middle-income countries (LMICs) and because a third of the respondents were women. He also stressed that Western psychiatric nosologies, such as the DSM or the ICD were not the driving force behind the agenda, but that the basis was the World Health Organization’s (WHO) mental health intervention guide mhGAP (WHO 2008), which aims at scaling up services for a small selection of mental, neurological and substance use disorders in LMICs.
In response to this, many panellists questioned the ways in which access to the process of agenda setting is distributed. One of the central dichotomies dominating the discussion on agenda setting was the divide between a powerful global North and a receiving global South. William Sax drew attention to the fact that although this division reflected a political argument, it did not capture the epistemological dimensions as to whose knowledge actually counts in the GMH discourse. He pointed out that Western psychiatry and traditional healing practices engage in an asymmetrical relationship in which traditional local practices have “less resources, social capital, and power because they are the traditions of poor people”. Furthermore, he highlighted the failure of the North-South divide in addressing the implicit hierarchy of scientific knowledge which is negotiated within different, not locally specific networks and their practices of validation (peer review, evidence, RCT’s). This argument was taken up and exemplified by Frederick Hickling, a Jamaican psychiatrist, who, over many decades created an immensely successful community-based mental healthcare system in Jamaica. However, he recounted that his attempts to publish his work in scientific journals was continually met with rejection based on the requirements of an imperial knowledge production:
“When we try now to get to the Western world to say ‘this is what we have done, this is what we have achieved’ we have to go through journals. They then tell us about equipoise… with the journal saying, ‘we can’t take your naturalistic perspective; we need to get an ethical randomized controlled trial’. So they still put us into this conundrum of the enslaved and marginalized people”
Laurence Kirmayer added to this that not all interventions lend themselves to RCTs – especially psychosocial interventions may be difficult to standardize, randomize, and blind. According to him, the challenge of integrating evidence-based medicine and cultural psychiatry raises the question of methodological, epistemological and political pluralism. He identified the need to recognize different types of knowledge, e.g. outcome should be measured not only in terms of symptom reduction, behavioural change, or level of instrumental functioning, but in terms of individuals’ ability to pursue culturally relevant goals, including the impact on the family and community.

Political dimensions of the Global Mental Health Agenda
The GMH discourse was also addressed as a political instrument creating legitimacy and avenues to care, particularly in the context of refugee health. Charles Watters, professor of childhood studies at Rutgers University, analyzed such “epistemologies of care” in the context of European asylum practices. Using his work on European asylum practices as an example, he showed how the medical model (i.e. the emphasis on one’s sick body and mind) provided refugees with access to care, while also denying them other avenues of legitimacy. In other words, mental health was described as a parameter of legitimacy that people employed strategically in order to navigate the legal system while other factors, such as aspiring a new life and future were excluded since they undercut the Western concept of asylum, in which refugees are conceptualized as merely fleeing to the first available safe country. Laurence Kirmayer added that if refugees’ life aspirations invalidate their medical claims, an important source of resilience is denied to them, which could be critical to the individual’s mental health. Pierre Bastin, a psychiatrist working for Médecins Sans Frontières (MSF), noted that in this context, practitioners on the ground are very aware of the strategic and political power of diagnosis (i.e., PTSD) to aid in claims. Yet, speaking from his own experience in refugee camps in Somalia, Bastin described that diagnostic labels did not always provide access to care and/or asylum, and they could also, in many cases, become a barrier. He gave the example of refugees with the double label of being Muslim and having a mental health diagnosis, who were systematically denied access to certain countries.

What are we treating in Global Mental Health?
An integral part of the struggle to define the GMH agenda was the disagreement over the targets and objectives of the GMH field. This discussion was characterized by shifting frameworks, terms and concepts, the main argument of which concerned whether mental illnesses have a universal, biological foundation or whether they must be understood as culturally contingent expressions (with the DSM understood as a Euro-American cultural framework). Vikram Patel acknowledged that with the lack of biomarkers for mental illness, we must rely on currently existing knowledge as well as patients’ accounts. However, he also believes that a shared biology underlies culturally diverse descriptions of mental illness. He gave the example of Alzheimer’s Disease, which in the 1960s was simply described as “growing old badly” until it was confirmed as a disease entity through advances in biology and neuroscience. In terms of cultural variation and meaning of mental illness, Patel claimed that mental health, regardless of name or classification system (i.e., Chinese medicine, Ayurveda, the DSM) was experienced worldwide, stating that “a rose remains a rose, no matter how you call it”.
Gilles Bibeau, a medical anthropologist from the University of Montréal responded to this phenomenological perspective by stating that every illness experience must be framed in its own context, as “each of those terms is a prisoner to their own history”. Derek Summerfield took this critique further by challenging his colleagues to explain the difference between depression and sadness. He argued that validity remains a key issue in psychiatry, and if all we have are ways of validating illness categories which we ourselves constructed [in the West], “most of it can be thrown out because it fails validity; it fails the reality of these people”. Using the example of depression, Summerfield stated that illness classifications should not be brought to places where there has been no such thing. Teaching concepts such as “mental health literacy” represents a unidirectional transfer of knowledge with unclear gains for the people who (are at the receiving end of this knowledge):
“We cannot gather all distressed people in the world and put them into the category ‘depression’. I don’t think there is such a thing as depression, as a universal category. I think that’s a myth. At the end of the day it’s like saying peoples’ worlds are like colourful garments that you can strip away.”
While he acknowledged that the more severe spectrum of mental illness, like psychosis, would stand on firmer grounds of evidence than common mental illnesses, Summerfield insisted that even in these cases the question of cross-cultural validity must still be asked.
Debates as to what could be regarded as a mental illness erupted frequently throughout the ASI discussion, particularly in regards to suicide. Summerfield asked: “Does an Indian farmer commit suicide because of a mental illness, or because farming broke down and left him with no income?” Fred Hickling also spoke to the issue of suicide stating that Jamaica has the lowest suicide rates worldwide, but that its homicide rates are amongst the highest. If suicide is considered a mental illness, is homicide a mental illness category as well?
Interestingly, the role of social determinants of mental health was relatively underrepresented in this debate. Duncan Pedersen pointed out that the questions of social determinants transcend the nature-culture divide dominating the current debate over definitions of mental illness. According to Pedersen, the GMH agenda should be driven by questions of social inequity. Reflecting on his work with the Trauma and Global Health program at McGill, he stated that war and trauma, and ongoing forms of structural violence are extreme contributors to mental health which could not be ignored, and “are not going to be solved in the biological-cultural dilemma.”

How do we treat mental health problems?
Since there was little consensus on what constituted the objects of Global Mental Health, perspectives on how to implement GMH interventions were similarly diverse. There were a few central themes which revolved around practical strategies: Is it possible to scale up mental health treatments and is it the right approach? And if yes, what is it that we are scaling up? What constitutes evidence, valid instruments and measures? How much standardization does GMH bring about?
Patel pointed out that GMH is about universal healthcare, equity and scaling up public healthcare systems. Thus, the integration of mental healthcare into the primary healthcare system is a major goal of the GMH movement. In this context, it is inevitable that GMH strives to remove variability to ensure that everyone gets the same outcome. Patel stressed that although Global Health advocates a certain function (i.e. healthcare has to be affordable and follow a set of values and aspirations), the form can take many different shapes. Joop de Jong’s concern was that the function of GMH remains unclear since it is lacking a (meta-) theory to guide its action. Without such theory, there is an impediment to developing testable models related to cooperation, and to solving major preoccupations related to access to care or stigma.
On the topic of standardization and scaling up services, William Sax highlighted the importance of preserving medical pluralism, especially traditional healing. He reflected on the possibility of integrating healers into the mental health care system and concluded that it would be impossible for the following reasons: 1) the individualistic notion of the person used in psychiatry is incompatible with most forms of traditional healing; 2) there is a considerable social distance between health workers and healers, who are often perceived as backward, uneducated quacks by medically trained health workers; 3) ritual healing defines the boundary of the scientific episteme and can hence not be easily integrated into it; 4) the strength of locally contingent forms of healing is in fact their diversity. Health care systems on the other hand regulate, monitor and normalize traditional healing services– and would hence destroy the very characteristics that make traditional healing work: their local particularity. Patel responded to this by stating that traditional healers always have and will continue to co-exist with the medical standard to health care. Yet, Joop de Jong cautioned that although this may be a reality, there are always hierarchies of health seeking, since people “want to belong to the dominant class” of treatment, which is often associated with Western biomedicine or NGOs.
Marc Laporta, the director of the WHO Collaboration Center in Montreal, urged practitioners to focus on the variables that are “meaningful on the ground”. From his perspective, outcomes are not just about what works best, but that increasing the participation of mental health patients in society might be more important than saving a government money. Drawing on a project which aimed at integrating mental health services into primary care settings in South East Asia, he outlined the problems they experienced on the ground. For example, one of the major limitations of mhGAP is the difficulty to match the goals with the average 15 minute time frame allotted for patient visits in primary care settings.
Hilary Robertson-Hickling, a behavioural scientist at the University of the West Indies in Jamaica, questioned whether mental health work should actually be taken out of a medical framework, pointing out that “psychiatry does not do humanity work due to its obsession with pathologies” – a focus which distracts from social processes and the question of “what can we do together?” Frederick Hickling emphasized that over the past 50 years, mental health institutions in Jamaica have been dramatically transformed into community-based programs and integrated into primary health facilities. With a 500-year history of enslavement and imperial oppression, he emphasized that today, in countries like Jamaica, medical imperialism must be avoided by all means, and that philosophies and instruments of Western psychiatry that have been “forced upon” their local ways of dealing with mental health are no longer valuable in local practice.

So, again, what is Global Mental Health?
Joop de Jong described GMH as a fashion trend, comparing it to new pop music: “it is nothing entirely new, but there are a lot of new components, a lot of new evidence”. It also comes with the aura of the new and the kind of energy and verve urgently needed to move things forward. On the other hand, Gilles Bibeau suggested that the construction of GMH could have real structural effects and should thus be used and deconstructed with critical distance. He explained that individuals live today in a “fluid, uncertain and floating space that gives birth to more pluralistic societies… and to multiple identities in the construction of self”. He emphasized the point that in interrogating mental health in the context of a globalized world, one must search for a ground of articulation between modern psychiatric systems and the knowledge of people. This means that the only possible ethics for a “dia-logue of cultures” is through translation. He stated that societies must be understood in their own terms using the language/ customs of those societies. He cautioned that the term “Global Mental Health” could invite new – and often inappropriate – interpretations of what sort of identity we produce. Thus, one has to be careful as to how this language will map our minds and shape our thinking. As an example, Bibeau described how the GMH grant proposals he has reviewed already suggest the problematic ways in which these labels will be used and appropriated in the future.
Going back to his initial perspective of the state of mental health care as a fundamental humanitarian crisis, Vikram Patel defended the often strong language of the GMH movement, as a means of getting policy makers’ attention and convincing people to take action: “These are the kind of figures we have to use to shock policy makers. Shock the world into action.” He stressed that GMH’s main audience is not academics, but policy makers and health ministers. Hence, in this context the language of standardization, feasibility, and affordability become the main contenders for scaling up services. He acknowledged that GMH is a public health endeavour supported by the academic community, but vital differences exist on how to address the problem in academia and which strategies should be used on the ground. Kwame McKenzie, a psychiatrist based at the Centre of Addiction and Mental Health in Toronto, agreed with this point suggesting that in order to move forward and make progress in advancing the GMH endeavour, one should focus on agreements within the field and move past the controversies. In response, a number of panel members took the position that critical insight and controversy are in fact at the core of scientific progress and should be valued over consensus. In the words of Gilles Bibeau: “I am not afraid of controversies, I am more afraid of consensus”. Controversy gives a chance to correct and eventually to improve things. This perspective of needing a system of checks and balances was shared by Jamaican psychiatrist Geoffrey Walcott who remembered the “dark times in history” in which disagreement was not possible.

What is still missing in the GMH discourse?
One of the major omissions from the GMH discourse in the three day ASI series was the topic of ethics. Research ethics were briefly mentioned by a few of the discussants in regard to carrying out studies in LMICs. For example, Mónica Ruiz-Casares, an assistant professor in McGill’s Division of Social and Transcultural Psychiatry, was mainly concerned with research ethics that would avoid moral imperialism. She said it would be necessary to advance culturally-responsive mental health research designs and consent policies (e.g., visual consent forms). Yet, the overall ethical standards of the GMH movement were widely ignored for the major portion of the discussion. Duncan Pedersen acknowledged this “deficit” in the GMH discourse saying that “there is a need for more research- more robust and scientific base of GMH and a need to make explicit the ethical foundations of GMH”. According to Pedersen, a balanced global health research agenda for the future in GMH should focus not only on the global burden of illness as outlined in the Lancet (2007) series, but also on the social, political, environmental and economic determinants within which these illnesses and diseases occur. He expressed his concern that issues of global equity and social justice were missing from the conversation and were essential to the GMH agenda
To this end, medical anthropologist Hanna Kienzler, from the Department of Social Science, Health and Medicine at King’s College London, asked for more curiosity about the emergent social forms in the context of GMH. She said, “it might be helpful to learn more about how cultural and social differences play out as worldly encounters in a global arena instead of reiterating static dichotomies (north, south, west, HIC, LMIC, global, local). If we would look at these social encounters we would start to see interesting frictions – a term taken from anthropologist Anna Tsing – which produce new realities that can be instructive for our work. Such phenomena might be new and truly surprising, and not unfold along the same divisions and terms we have at the moment”.
This desire to move the discussion beyond the impasse of culture versus biology and medicine versus politics by paying closer attention to how GHM actually plays out in concrete terms was shared by many younger scholars and interventionists. A number of younger conference participants took the opportunity and stimulation provided by the ASI meetings to form a new group that is currently formulating a position paper aiming to add vital perspectives from the ground to the more conceptual discussion of the senior scholars. This call for new lenses to interpret the hopes or dangers of a newly emerging endeavour like GMH was also supported by Jaswant Guzder, a child psychiatrist at the Department of Psychiatry at McGill, and Rachel Tribe, a counselling psychologist from the University of East London, both of whom highlighted the need to engage the younger generation of researchers and practitioners into this discussion.

Further reading and resources:
Collins, P.Y., Patel, V., Joestl, S.S., March, D., Insel, T.R., Daar, A.S., et al. (2011). Grand challenges in global mental health. Nature, 475(7354), 27-30.
Fernando, S. (2005). Mental health services in low-income countries: Challenges and innovations. International Journal of Migration, Health & Social Care, 1(1), 13-18.
Grand Challenges in Global Mental Health website
Kirmayer, L.J. (2012). Cultural competence and evidence-based practice in mental health: Epistemic communities and the politics of pluralism. Social Science & Medicine, 75, 249-256.doi: 10.1016/j.socscimed.2012.03.018
Kleinman, A. (2009). Global mental health: A failure of humanity. [News]. Lancet, 374(9690), 603-604.
Patel, V., Garrison, P., de Jesus Mari, J., Minas, H., Prince, M., & Saxena, S. (2008). The Lancet’s series on global mental health : One year on. Lancet, 372(9646), 1354-1357.
Salie, M., Shatrugna, V., Fernando, S., & Timimi, S. (2011). A Reply to “Grand Challenges in Mental Health”. Somatosphere.
Summerfield, D. (2012). The exaggerated claims of the mental health industry. British Medical Journal, 344, e1791
Summerfield, D. (2008). How scientifically valid is the knowledge base of global mental health? British Medical Journal, 337, 992-994.

Dörte Bemme is a PhD student in the Department of Social Studies of Medicine and Anthropology at McGill University. She has conducted research on the topic of “Mental Health and Stigma” in Quebec, with particular emphasis on the implementation of the recovery model in community care settings. Building on this work, her doctoral research focuses on the recovery model as a product of Western epistemic cultures, which, when taken into different contexts through GMH interventions becomes a technology with its own social life and global trajectory. Contact:
Nicole D’souza is a graduate student in the Division of Social & Transcultural Psychiatry at McGill University. Her Master’s research explored the topic of trauma, resilience and mental illness in indigenous populations of the Peruvian highlands. She will be continuing her doctoral studies in the Division, with a focus on understanding how accessibility to mental health care intersects with issues of social justice, equity and social determinants of health. Contact:

[1] The Delphi method is a structured communication technique, which relies on a panel of experts. In Delphi decision groups, a series of questionnaires, surveys, etc. are sent to selected respondents (the Delphi group) through a facilitator who oversees responses of their panel of experts. The group does not meet face-to-face. All communication is normally in writing (letters or email). Members of the groups are selected because they are experts or they have relevant information. (source:

2 Responses to Global Mental Health and its Discontents

  1. Pingback: Is mental health a smoke screen for society’s ills? « Mind Hacks

Leave a Reply

Your email address will not be published. Required fields are marked *
You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>

Mike Nova's starred items - 7/23/12

Mike Nova's starred items - 7/23/12

via prisons - Google News on 7/22/12

Rash of suicides alarm Pa. prison officials
PHILADELPHIA — Three suicides and one attempted suicide by Philadelphia prison inmates since Wednesday has prompted the corrections system to take stepped-up preventive measures, officials said. A 25-year-old man was found hanging from an air ...
Prisons step up preventive efforts amid rash of suicidesPhiladelphia Inquirer

all 7 news articles »

via prisons - Google News on 7/22/12

The News International

Lost boys of Bagram in prison's shadow
The News International
"Sometimes I feel like I'm still in prison," said Khan, who, like all foreign prisoners at Bagram, was never charged with a crime. "They put me in jail for six years. No proof, nothing. I spent my youth behind bars," he said, adding that he and other ...
Lost boys of Bagram still live in prison's

all 17 news articles »

Mid East and World News. Worldwide News Syndication. Homepage ... Dubai: Police Wednesday announced that a new forensic science and criminology department will be set up within two years, which will feature specialised areas related to chemistry, biology and nuclear science. Speaking at a ... There will also be a new section at the department to investigate traffic accidents, as well as psychiatrists to evaluate the mental state of suspects,” said Lt Gen Dahi.

via forensic psychiatry international - Google Blog Search by Karen Franklin, Ph.D. on 7/22/12
While that ethics rule applies only to psychiatrists, the American Psychological Association has a very similar one. ... Consider this commentary by high-profile forensic psychiatrist Michael Welner on a Washington Post blog: ... One could even argue that we as professionals have an affirmative duty to help offset the inane speculation that pours in to fill any vacuum in the cutthroat world of daily journalism: Portrayals of Holmes as a "recluse" and a "loner" because he ...

via prisons - Google Blog Search by Elsa on 7/20/12
Nigerians, who were recently repatriated from the crises-torn Libya relay their ordeal after they were caught in-between two feuding camps. Their appearances tell the story of the ordeals they went through in their host country.

via prisons - Google Blog Search by Nyasa Times on 7/22/12
President Joyce Banda has said prisons should not be “hell on earth” but places where inmates may be rehabilitated and reformed to become productive and useful citizens. She was speaking on Sunday after attending ...

Rash of suicides alarm Pa. prison officials
"All inmates housed in the affected areas are being seen by behavioral health staff to assess their current mental state," Giorla said. He also said a regularly scheduled review by an independent prisons monitor of behavioral health services, set to ...

and more »

via Prison News on 7/22/12
One of Cuba's best-known dissidents, Oswaldo Paya, leader of the Christian Liberation Movement, died on Sunday in a car crash, religious and dissident sources said.

Sydney Morning Herald

Breivik failed to change Norway: PM
Sydney Morning Herald
Prime Minister Jens Stoltenberg says right-wing extremist Anders Behring Breivik, who massacred 77 people a year ago, has failed in his attempt to change Norwegian society. "The bomb and bullets were aimed at changing Norway. The Norwegian people ...

Mike Nova's starred items - 8:24 AM 7/23/2012

CBS News

Norway remembers victims on massacre anniversary
CBS News
Anders Behring Breivik, a 33-year-old far-right fanatic, has admitted to the July 22, 2011, attacks: a bombing of the government district in Oslo, killing eight, and a shooting rampage that left 69 dead at the left-wing Labor Party's youth camp on ...

Families, educators and medical professionals need to be aware of the behavior that might signal psychotic breaks of the kind that tormented Loughner. In the case of Breivik, simple evil seems to suffice as an explanation. (See Sohrab Ahmari's account of his trial nearby.) A civilized modern society is paradoxically more vulnerable to an act of individual malevolence than it is to a terror plot that at least its law enforcers are watching for. There may be no real defense ...

via Behavior and Law - Google Blog Search by David on 7/22/12
Law enforcement is taking to social media because criminals are changing their behavior and using social media to facilitate crime. In response, law enforcement officials are using it to track down criminals and as a predictive ...

Norway marks year since Breivik massacred 77 in Oslo, Utoeya island
The Australian
NORWEGIANS have marked a year since right-wing extremist Anders Behring Breivik massacred 77 people, at a poignant memorial ceremony on the island of Utoeya where most of his mainly teenage victims fell. "Let us honour the dead by celebrating life," ...

Hindustan Times

Norway marks anniversary of Breivik massacre
Hindustan Times
Some 50000 people attended a concert in Oslo on Sunday evening to mark the first anniversary of the gun and bomb rampage by Norwegian right-wing extremist Anders Behring Breivik, which claimed 77 lives. Prime Minister Jens Stoltenberg had earlier led ...

Norway commemorates anniversary of Breivik bloodbath
The News International
UTOEYA, Norway: Norwegians on Sunday marked a year since right-wing extremist Anders Behring Breivik massacred 77 people with a poignant memorial ceremony on the island of Utoeya where most of his mainly teenage victims fell. “Even though we ...

Christian Science Monitor

A year after Breivik's massacre, Norway tightens antiterror laws
Christian Science Monitor
The proposed laws would have made Anders Behring Breivik, the Norwegian man behind the July 22 attacks that claimed 77 lives, criminally responsible in the planning phase had he been caught with his home-made bombs and arsenal of weapons meant ...

The Guardian

Norway remembers the 77 people killed by Anders Behring Breivik
The Guardian
Thousands of Norwegians gathered on Sunday at sombre memorials to the 77 people killed a year ago by Anders Behring Breivik to show his rampage had done nothing to alter their belief in an open society. Norway's prime minister, Jens Stoltenberg, told ...

via forensic psychiatry - Google Blog Search by midnightinchicago on 7/22/12
Professor Thomas Fahy has published articles in Acta Psychiatrica Scandinavica; British Journal of Psychiatry; European Psychiatry; Comprehensive Psychiatry; International Journal of Clinical Practice; Journal of Forensic ...

via forensic psychiatry - Google Blog Search by unknown on 7/19/12
It is piloting a new collaborative approach for clinicians and service users to use when developing care and treatment options for patients in forensic mental health settings. Dr MacInnes said: “We are delighted that our project ...

via prisons - Google News on 7/23/12

Nyasa Times

Tackle prison congestion problem
The Times Group (blog)
One of government's top obligations is to maintain law and order among its citizens. This is achieved through the promulgation and strict enforcement of laws, which are formulated to protect people and their property. The government, through the ...
JB says Malawi prisons should not be 'hell on earth'Nyasa Times
Reverend's imprisonment was a blessing in disguiseallvoices

all 6 news articles »

via prisons - Google News on 7/23/12

The Express Tribune

Lost boys of Bagram still live in prison's shadow
The Express Tribune
KARACHI: During some sleepless nights when his stark bedroom walls remind him too much of his old prison cell in Afghanistan, Jan Sher Khan scans Internet dating sites he'd heard about from U.S. soldiers who once guarded him. The 24-year-old Pakistani ...
Lost boys of Bagram in prison's shadowThe News International

all 19 news articles »

via Prison News on 7/23/12
Two prominent Canadian doctors have joined an international campaign calling on world leaders to stop the spread of AIDS by ending the so called war on drugs.

via Behavior and Law - Google Blog Search by Tim McMahon on 7/23/12
takes into account the expectations of stakeholders; • is in compliance with applicable law and consistent with international norms of behavior; and • is integrated throughout the organization and practiced in its relationships.” ...

via Behavior and Law - Google Blog Search by admin on 7/23/12
After I had mentioned that he verbally threatened to do harm to both of these DJ's, they finally relented and said that yes he could exhibit violent behavior without medication. However, both the doctors and law enforcement ...

Irish Times

Norwegians reaffirm tolerance as they commemorate Breivik victims
Irish Times
NORWEGIANS BY the thousands gathered yesterday at sombre memorials to the 77 people killed a year ago by far-right gunman Anders Behring Breivik to show his bloody rampage had done nothing to change their dedication to an open society. “The bomb ...

via addiction - Google Blog Search by writinggomer on 7/21/12
An addiction is horrible; it is like dragging a lead weight around that you cannot be rid of. Even if you want to be rid of your addiction, you find that you are drawn right back to it again. Often though, people are addicted to things ...

via addiction - Google Blog Search by Kristen.NewCreation on 7/21/12
12 Steps to Victory over Sexual Addiction Based on the 12 Steps of Alcoholics Anonymous Step 1: Admitted I am powerless over my compulsiveness and.

via addiction - Google Blog Search by John Shore on 7/20/12
Occasioned by two comments he left on my blog, we last time discussed Chad Holtz's recent return from Pure Life Ministries, where he had gone to live for seven.

via addiction - Google News on 7/21/12

New gateways to addiction
The Westerly Sun
Astrid Meijer, a paid campaigner against nicotine addiction, faces some stiff competition in the battle for the hearts, minds and lungs of today's teenager. It comes in the form of products and marketing that package nicotine in candies, gum, and ...

via addiction - Google Blog Search by TMZ Staff on 7/22/12
The Situation was supposed to be the face of some anti-fat cream, but instead he ended up in rehab and never did a thing ... so says the company who hired…

via addiction - Google News on 7/22/12

Smokeless treatment centers make recovery difficult for addicts
Benavidez, who is in her first attempt of overcoming a longtime addiction to "booze, pills and meth," said she hopes that the additional challenge of giving up smoking does not become too onerous. "I understand we have to climb a mountain to get clean.

via addiction - Google Blog Search by duckblind405 on 7/22/12
I've been clean from any kind of narcotics for over a year now, but here recently I've found myself at the local bar more often than I probaly should.

via addiction - Google News on 7/22/12

Heroin use growing nationwide
Evansville Courier & Press
With addicts desperate for a cheaper high than prescription drugs or seeking a more powerful fix, experts are seeing heroin addiction treatment admissions, overdoses and fatalities rising in nearly every region, including areas where the drug has ...
Reporter knows that life is possible after heroin addictionPeoria Journal Star

all 4 news articles »

via The American Journal of Psychiatry Current Issue by Ly M, Motzkin JC, Philippi CL, et al. on 6/30/12
Psychopathy is a personality disorder associated with severely antisocial behavior and a host of cognitive and affective deficits. The neuropathological basis of the disorder has not been clearly established. Cortical thickness is a sensitive measure of brain structure that has been used to identify neurobiological abnormalities in a number of psychiatric disorders. The authors assessed cortical thickness and corresponding functional connectivity in psychopathic prison inmates.
Using T1 MRI data, the authors computed cortical thickness maps in a sample of adult male prison inmates selected on the basis of psychopathy diagnosis (21 psychopathic inmates and 31 nonpsychopathic inmates). Using resting-state functional MRI data from a subset of these inmates (20 psychopathic inmates and 20 nonpsychopathic inmates), the authors then computed functional connectivity within networks exhibiting significant thinning among psychopaths.
Relative to nonpsychopaths, psychopaths had significantly thinner cortex in a number of regions, including the left insula and dorsal anterior cingulate cortex, the left and right precentral gyri, the left and right anterior temporal cortices, and the right inferior frontal gyrus. These neurostructural differences were not due to differences in age, IQ, or substance use. Psychopaths also exhibited a corresponding reduction in functional connectivity between the left insula and the left dorsal anterior cingulate cortex.
Psychopathy is associated with a distinct pattern of cortical thinning and reduced functional connectivity.

via The American Journal of Psychiatry Current Issue by Appelbaum PS, Lothane H. on 6/30/12
To the Editor: The Images in Psychiatry feature on Sabina Spielrein in the January 2012 issue of the Journal (+1) unfortunately mischaracterized the circumstances of her death, inadvertently reinforcing a nearly simultaneous effort at the scene of her murder to alter the facts of history. Dr. Fusar-Poli's essay noted, “The Wehrmacht murdered [Spielrein] and her two daughters in 1941.” Although the 1941 date is reported in some earlier works on Spielrein (+2), recent records have indicated—as the sources cited in the essay and later ones—that she died with thousands of other Jews in Rostov-on-Don in August 1942 (+3++5). Under the direction of the SS Einsatzgruppe charged with exterminating Rostov's Jews, she was last seen being herded toward the Zmiyevskaya Balka, a ravine outside town, where she and her daughters were almost certainly shot to death. The error in the date of her death might be a small thing in other circumstances, but along with the omission of any mention of the reason she was killed—because she was a Jew—it eerily echoes an attempt in Russia to erase precisely that memory. At almost the same time the essay appeared, the world press reported that the plaque at the site of the massacre, which read “On 11/12 August 1942 there had been destroyed [here] by the Nazis more than 27,000 Jews,” had been replaced by one marking the death site of many “peaceful citizens of Rostov-on-Don and Soviet prisoners-of-war” (+6, +7). Thus, we write to preserve the memory of the thousands of Jews of Rostov-on-Don who died at the Zmiyevskaya Balka in August 1942 only because they were Jews, including Sabina Spielrein and her two daughters.

The following books are presented here as a service to our readership to alert them of new titles and as a courtesy to those who have sent copies of these books to the Journal office.

No psychiatrist since Freud and Jung has gained as much public recognition as Ronald David Laing. After the publication of The Divided Self in 1960, he became a darling of the British New Left and was treated as a guru by young people across the English-speaking world. “Two chicks who dig Coltrane, the [Grateful] Dead and R.D. Laing” advertised in New York's Village Voice in 1971 for compatible guests to join them at a party, and bumper stickers during Laing's 1972 U.S. college lecture tour read “I'm mad about R.D. Laing” (+1, p. 67). A generation of practicing psychiatrists was influenced by his view that the symptoms of psychosis could be seen as meaningful and appropriate to a patient's circumstances. This book will appeal to many of those psychiatrists as well as to others who admire Laing's intellectual achievements. The book addresses the following questions: How did it come about that a middle-class youth from Glasgow wrote a book about madness that rocked the world? How did he produce a work based on existential thinking and the ideas of European philosophers, such as Kierkegaard, Nietzsche, and Heidegger, within 5 years of graduating from medical school, a work that was nearly in complete form when he arrived at the Tavistock Clinic in London in 1956?

The choice of editors for this second edition of the Textbook of Psychoanalysis, just 7 years after the first, speaks volumes about contemporary broadening changes in the field that are manifest in daily practice as well as encouraged institutionally in the various teaching psychoanalytic institutes and centers throughout the United States. The coeditors of both the first and previous edition (published in 2005) were all psychiatrists. Two of the three editors of the first edition, to whom the second edition is dedicated—the late Arnold Cooper, of Weill Cornell Medical College, and Ethel Person, of Columbia University—came of age in the “golden era” of the 1950s and 1960s when psychoanalysis was popular in the United States and the theory was more unified and centered on Freud's ideas. Glen Gabbard (who is incidentally coeditor, along with Robert E. Hales and Stuart C. Yudofsky, of The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition) has remained a coeditor of the textbook for the second edition. Gabbard, Cooper, and Person are well known to the readership of the Journal, and their work continues to be taught in psychiatry residency departments. The first volume did a fine, orderly job of describing the many changing aspects of clinical treatment in the second century of psychoanalysis.

via Psychology Today Blogs by Paul Raeburn on 7/22/12
Nothing it seems, will be enough to end gun more

via Medicine JournalFeeds » Psychiatry by admin on 7/21/12
Related Articles
Cocaine dependence: a fast-track for brain ageing?
Mol Psychiatry. 2012 Apr 24;
Authors: Ersche KD, Jones PS, Williams GB, Robbins TW, Bullmore ET
PMID: 22525488 [PubMed - as supplied by publisher]

via Medicine JournalFeeds » Psychiatry by admin on 7/21/12
Related Articles
The neuroprogressive nature of major depressive disorder: pathways to disease evolution and resistance, and therapeutic implications.
Mol Psychiatry. 2012 Apr 24;
Authors: Moylan S, Maes M, Wray NR, Berk M

In some patients with major depressive disorder (MDD), individual illness characteristics appear consistent with those of a neuroprogressive illness. Features of neuroprogression include poorer symptomatic, treatment and functional outcomes in patients with earlier disease onset and increased number and length of depressive episodes. In such patients, longer and more frequent depressive episodes appear to increase vulnerability for further episodes, precipitating an accelerating and progressive illness course leading to functional decline. Evidence from clinical, biochemical and neuroimaging studies appear to support this model and are informing novel therapeutic approaches. This paper reviews current knowledge of the neuroprogressive processes that may occur in MDD, including structural brain consequences and potential molecular mechanisms including the role of neurotransmitter systems, inflammatory, oxidative and nitrosative stress pathways, neurotrophins and regulation of neurogenesis, cortisol and the hypothalamic-pituitary-adrenal axis modulation, mitochondrial dysfunction and epigenetic and dietary influences. Evidence-based novel treatments informed by this knowledge are discussed.Molecular Psychiatry advance online publication, 24 April 2012; doi:10.1038/mp.2012.33.
PMID: 22525486 [PubMed - as supplied by publisher]

via Medicine JournalFeeds » Psychiatry by admin on 7/21/12
Related Articles
Preliminary report of biological basis of sensitivity to the effects of cannabis on psychosis: AKT1 and DAT1 genotype modulates the effects of δ-9-tetrahydrocannabinol on midbrain and striatal function.
Mol Psychiatry. 2012 Jan 31;
Authors: Bhattacharyya S, Atakan Z, Martin-Santos R, Crippa JA, Kambeitz J, Prata D, Williams S, Brammer M, Collier DA, McGuire PK
PMID: 22290123 [PubMed - as supplied by publisher]

L’influence de la pensée de Claude Lévi-Strauss sur l’œuvre de Jacques Lacan n’est plus à démontrer. Le début coïncide avec la conférence du psychanalyste intitulée « Le mythe individuel du névrosé ». Dans cette conférence, il était question de démontrer en quoi le cas cli...

via psychiatry - Google News on 7/21/12

Psychiatrists: Colo. Shooting Witnesses With Past Trauma, Anxiety Face Added ...
Twelve people have been killed and dozens more were injured. "All the witnesses to this horror will be faced with the reliving of this event," says Dr. Victor Fornari, director of child/adolescent psychiatry at North Shore-LIJ Health System in New Hyde ...

and more »

via psychiatry - Google Blog Search by D Bunker on 7/21/12
FierceHealthcare has; Hospitals Report Only 1% Of Patient Harm Events July 20, 2012 | By Alicia Caramenico Although about 60 percent of patient harm events occurred at hospitals in states with reporting systems, only 12 ...

via psychiatry - Google Blog Search by George Dawson, MD, DFAPA on 7/21/12
I have been watching the media coverage of the mass shooting incident today - Interviews of family members, medical personnel and officials. I saw a trauma surgeon at one of the receiving hospitals describe the current ...

In their recent paper, Natalie Banner and Tim Thornton evaluate seven volumes of the Oxford University Press series “International Perspectives in Philosophy and Psychiatry,” an international book series begun in 2003 focusing on the ...

How Therapeutic Communities Work. Research from England explores the unique capacities of therapeutic communities (TCs) in an article published online July 20, 2012 by the International Journal of Social Psychiatry.

via psychiatry - Google News on 7/21/12

Daily Mail

Study shows child's behavior is linked to father-infant interactions
In a study which has been published today in the 'Journal of Child Psychology and Psychiatry' researchers at the University of Oxford studied 192 families to see whether there was a link between father-child interactions in the early postnatal period ...
Father And Infant Interactions Affect Behavior Later OnRedOrbit
Child's Behavior Linked to Father-Infant Interactions, Study ShowsScience Daily (press release)
Fathers influence babies' behaviourToronto Star
Counsel & Heal
all 36 news articles »

via psychiatry - Google News on 7/21/12


James Holmes was set to lecture on psychiatric and neuroscience disorders at ...
dailybeast: The professor who ran his course on the biological basis of psychiatric and neurological disorders is a prominent member of the medical school's department of psychiatry. The two student-led seminars scheduled immediately after Holmes's ...
Q&A: Understanding the Mindset of a Shooter's ParentsTIME
I was 'The Joker', says 'The Dark Knight Rises' premier gunman killerNewstrack India
Police beef up patrols in wake of movie shootingRochester Democrat and Chronicle
USA TODAY -Detroit Free Press
all 22,764 news articles »

via psychiatry - Google Blog Search by rkennedy on 7/20/12
Next year the International Congress on Neuropsychopharmacology (CINP) is holding a thematic meeting in April 2013 entitled “Pharmacogenomics and Personalized Medicine in Psychiatry.” An 'All Star' plenary faculty, who ...

via psychiatry - Google Blog Search by unknown on 7/21/12
The group Speak Out Against Psychiatry I had in fact not heard of before but they had seen my very basic website and felt strongly about holding such a protest as this hospital is well known to some people who they are aware ...

The nation's psychiatric establishment is wrestling with questions on proper treatment of transgender people as it works to overhaul its diagnostic manual for the first time in almost two decades. Advocates have spent years ...

via psychiatric diagnosis - Google Blog Search by diychica on 7/21/12
Explaining the misunderstood art of diagnosis Source: e/2012/07/how-thoughts-become-a-psychiat ric-diagnosis/260012/

via international psychiatry - Google Blog Search by Pamela Spiro Wagner on 7/21/12
Once in the ER, I was taken directly to the so called “purple pod” — the psychiatric section, and shifted onto a gurney in a curtained-off cubicle, told to change into hospital garb, which I did under duress but before I was forcibly changed by the guards, as was the threat, and was told to lie down and be quiet. I did. I submitted to a physical by an APRN .... She also won an international poetry competition sponsored by the BBC in 2001/2. Her art is currently on display in a ...

Patients with autism spectrum disorders (ASDs) are at an increased risk for many diseases. However, little has been published about the dental health of patients with ASDs. Here, we describe the clinical presentations in a 28-year-old woman with autistic disorder. The most striking finding was th...

via psychiatry - Google Blog Search by Kermit Cole on 7/20/12
Trailblazing psychiatrist Peter R. Breggin, MD in his first of the series: Simple Truths About Psychiatry: Do You Have A Biochemical Imbalance? Dr. Breggin debunks the myth of biochemical imbalance and examines what is known about ...

Transgender advocates seek new diagnostic terms
Longview News-Journal
Advocates have spent years lobbying the American Psychiatric Association to rewrite or even remove the categories typically used to diagnose transgender people, arguing that terms like Gender Identity Disorder and Transvestic Fetishism promote ... 6 ...

via psychiatric diagnosis - Google Blog Search by Jeanette Bartha on 7/21/12
Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every ...

Behind-The-Scenes "Vocal Opposition" by Psychiatrist Against MindFreedom International Protest in Philadelphia of American Psychiatric Association's Labeling. Dr. Allen Frances: "Vocal Opposition" to MindFreedom Protest ...

Behind-The-Scenes "Vocal Opposition" by Psychiatrist Against MindFreedom International Protest in Philadelphia of American Psychiatric Association's Labeling. Dr. Allen Frances: "Vocal Opposition" to MindFreedom Protest ...

via Involuntary Transformation by Becky on 7/22/12
via MindFreedom:

Surprising Secret Opposition to MFI's Successful Peaceful Protest of Psychiatry on 5 May 2012

When 200 people, mainly psychiatric survivors, protested in front of the American Psychiatric Association... there was something missing. A surprising footnote to the 5 May 2012 protest in Philadelphia reveals that Dr. Allen Frances "vocally opposed" support for the event, behind the scenes.

MindFreedom International News Investigation


Behind-The-Scenes "Vocal Opposition" by Psychiatrist Against MindFreedom International Protest in Philadelphia of American Psychiatric Association's Labeling

Dr. Allen Frances: "Vocal Opposition" to MindFreedom ProtestMindFreedom's historic national protest of the harm done by psychiatric labeling revealed some surprisingly "vocal opposition" to us psychiatric survivors, behind the scenes:
Dr. Allen Frances (photo on right), supposedly a key critic of the psychiatry's proposed newest label bible, acted to squash support from key allies for the protest.

Dr. Allen Frances vs. Psychiatric Survivor Activism

There we were, enthusiastically preparing to protest peacefully directly in front of the American Psychiatric Association Annual Meeting in Philadelphia on 5 May 2012.
Two hundred of us, mainly psychiatric survivors, came from all over the USA and Canada, listened to speeches, marched in the streets and even tore up our labels directly in front of this gathering of thousands of psychiatrists, to protest their planned new "label bible," their upcoming revised Diagnostic and Statistical Manual - DSM 5.
But something surprising was revealed by the protest. Or more accurately, something surprising was missing at the protest. Looking back, it seemed we were mainly psychiatric survivors and family members, with only a few psychologists and psychiatrists allies (thank you!).
It turns out a committee of psychologists opposing psychiatry's new label bible - behind the scenes - pulled announced support for our protest, due to private pressure by that psychiatrist who claims to be a lead critic, Dr. Allen Frances. read David Oak's report here
hat tip: TallaTrialogue

There have been 22 international drug regulatory warnings issued on psychiatric drugs causing violence, mania, hostility, aggression, psychosis, and other violent type reactions. These warnings have been issued in the ...

Mike Nova's starred items

via psychiatry - Google Blog Search by Stephany on 7/22/12
I see myself as protecting mainstream psychiatry from the dangers of DSM 5- I am not at all a critic of psychiatry done well and within its competence. I don't want to be identified with any group that has a broader agenda of ...

via NYT > Health by By JANE E. BRODY on 7/22/12
Some dispute the message that "breast is best" and cite concerns for the pressure and guilt it heaps on working mothers.

via NYT > Health by By CAROL POGASH on 7/22/12
Nearly two dozen people were injured during the first night of a seminar led by the motivational speaker Tony Robbins, called “Unleash the Power Within,” which included a fire walk.

The present study constructed empirically derived subtypes of adolescent offenders based on general traits and examined their associations with psychopathology and psychopathic traits. The sample included 342 detained minors (172 boys and 17 girls; mean age 15.85 years, SD = 1.7) recruited in var...

via international psychiatry journals - Google Blog Search by midnightinchicago on 7/22/12
Professor Thomas Fahy has published articles in Acta Psychiatrica Scandinavica; British Journal of Psychiatry; European Psychiatry; Comprehensive Psychiatry; International Journal of Clinical Practice; Journal of Forensic ...

However, in psychiatric populations, studying alterations in decision-making can provide insights into the neurobiology underlying real world functional impairments. Dr. Sharp commented that neuroeconomics provides an ...

Transgender advocates seek new diagnostic terms in rewriting of psychiatric ...
Lubbock Online | Lubbock Avalanche-Journal. Site Web. Web Search powered by YAHOO! Search. Home · News ... Advocates have spent years lobbying the American Psychiatric Association to rewrite or even remove the categories typically used to diagnose ...

via psychiatry research - Google Blog Search by Alana S. on 7/22/12
I found out about Grindr through my sound engineer whose girlfriend works in psychiatry research and is currently interviewing people who are at high risk for contracting HIV. She said many of the gay men she interviewed ...

Psychiatry and Philosophy - Sources

Last Update: 5:41 PM 7/22/2012

  • Philosophy of Psychiatry - Stanford
  • General Psychopathology, Volume 2 - By Karl Jaspers, J. Hoenig, Marian W. Hamilton

  • psychiatry and philosophy

    psychiatry and philosophy of science


    Psychiatry and Philosophy

    Continuous Topic Update

    "Psychiatry and Philosophy" bundle created by Mike Nova


    International Perspectives in Philosophy and Psychiatry

    You are here: Home > Academic, Professional, & General > Series > Medicine & Health Series > International Perspectives in Philosophy & Psychiatry

    International Perspectives in Philosophy & Psychiatry
    International Perspectives in Philosophy and Psychiatry is an international book series focusing on the emerging interdisciplinary field at the interface of philosophy and psychiatry.

    Volumes in the series will continue the broad theme of 'nature' (for causes/explanations) and 'narrative' (for meanings/understandings), building links between the sciences and humanities in psychiatry, but focusing on more narrowly defined topics.