The loss of reason, a sense of alienation from the commonsense world we all like to imagine we inhabit, the shattering emotional turmoil that seizes hold and won't let go-these are some of the traits ...we associate with madness. Today, mental disturbance is most commonly viewed through a medical lens, but societies have also sought to make sense of it through religion or the supernatural, or by constructing psychological or social explanations in an effort to tame the demons of unreason.Madness in Civilizationtraces the long and complex history of this affliction and our attempts to treat it.
Beautifully illustrated throughout,Madness in Civilizationtakes readers from antiquity to today, painting a vivid and often harrowing portrait of the different ways that cultures around the world have interpreted and responded to the seemingly irrational, psychotic, and insane. From the Bible to Sigmund Freud, from exorcism to mesmerism, from Bedlam to Victorian asylums, from the theory of humors to modern pharmacology, the book explores the manifestations and meanings of madness, its challenges and consequences, and our varied responses to it. It also looks at how insanity has haunted the imaginations of artists and writers and describes the profound influence it has had on the arts, from drama, opera, and the novel to drawing, painting, and sculpture.
Written by one of the world's preeminent historians of psychiatry,Madness in Civilizationis a panoramic history of the human encounter with unreason.
The meanings and causes of hearing voices that others cannot hear (auditory verbal hallucinations, in psychiatric parlance) have been debated for thousands of years. Voice-hearing has been both ...revered and condemned, understood as a symptom of disease as well as a source of otherworldly communication. Those hearing voices have been viewed as mystics, potential psychiatric patients or simply just people with unusual experiences, and have been beatified, esteemed or accepted, as well as drugged, burnt or gassed. This book travels from voice-hearing in the ancient world through to contemporary experience, examining how power, politics, gender, medicine and religion have shaped the meaning of hearing voices. Who hears voices today, what these voices are like and their potential impact are comprehensively examined. Cutting edge neuroscience is integrated with current psychological theories to consider what may cause voices and the future of research in voice-hearing is explored.
Phrenitis is ubiquitous in ancient medicine and philosophy. Galen mentions the disease innumerable times, patristic authors take it as a favourite allegory of human flaws, and no ancient doctor fails ...to diagnose it and attempt its cure. Yet the nature of this once famous disease has not been understood properly by scholars. This book provides the first full history of phrenitis. In doing so, it surveys ancient ideas about the interactions between body and soul, both in health and in disease. It also addresses ancient ideas about bodily health, mental soundness and moral 'goodness', and their heritage in contemporary psychiatric ideas. Readers will encounter an exciting narrative about health, illness and care as embedded in ancient 'life', but will also be forced to reflect critically on our contemporary ideas of what it means to be 'insane'. This title is also available as open access on Cambridge Core.
Abstract Our goal is to highlight challenges clinicians encounter in achieving valid psychiatric diagnoses in linguistically and culturally diverse patients. These challenges often arise from ...language barriers, misinterpretation of nuanced expressions of distress, and a lack of consideration for the patient’s unique experiences and perspectives regarding their illness, leading to potential misdiagnoses. In this context, we explore the strategies to address these diagnostic issues. To illustrate these challenges, clinical examples of culturally diverse patients are presented. These cases offer insights into the cultural nuances of expressing distress and attributing illness to the external factors such as cosmic influences and spiritual afflictions, often employed as a way to conceal underlying causes. To achieve culturally appropriate diagnoses, clinicians need to be mindful of their patients’ cultural and spiritual beliefs, establish trust and rapport, and approach patient narratives with empathy. This empathetic approach allows clinicians to gain a deeper understanding of the patient’s cultural expressions of distress and their perspectives on illness attribution, often tied to supernatural influences. Importantly, effective communication is a key to uncovering the concealed causes of the patient’s condition.
Noribogaine (noribo) is the primary metabolite from ibogaine, an atypical psychedelic alkaloid isolated from the root bark of the African shrub Tabernanthe iboga. The main objective of this study was ...to test the hypothesis that molecular, electrophysiological, and behavioral responses of noribo are mediated by the 5-HTsub.2A receptor (5-HTsub.2AR) in mice. In that regard, we used male and female, 5-HTsub.2AR knockout (KO) and wild type (WT) mice injected with a single noribo dose (10 or 40 mg/kg; i.p.). After 30 min., locomotor activity was recorded followed by mRNA measurements by qPCR (immediate early genes; IEG, glutamate receptors, and 5-HTsub.2AR levels) and electrophysiology recordings of layer V pyramidal neurons from the medial prefrontal cortex. Noribo 40 decreased locomotion in male, but not female WT. Sex and genotype differences were observed for IEG and glutamate receptor expression. Expression of 5-HTsub.2AR mRNA increased in the mPFC of WT mice following Noribo 10 (males) or Noribo 40 (females). Patch-clamp recordings showed that Noribo 40 reduced the NMDA-mediated postsynaptic current density in mPFC pyramidal neurons only in male WT mice, but no effects were found for either KO males or females. Our results highlight that noribo produces sexually dimorphic effects while the genetic removal of 5HTsub.2AR blunted noribo-mediated responses to NMDA synaptic transmission.
Humanizing Mental Illness demonstrates that we need to challenge our explicit and implicit biases and learn to interact with mental illness in more intentional, supportive, and inclusive ways. While ...most philosophical accounts of the matter are concerned with the question of how much agency a person with mental illness has, this book asks how we can enhance the agency of people with mental illness.
A growing body of evidence indicates that poor health early in life can leave lasting scars on adult health and economic outcomes. While much of this literature focuses on childhood experiences, ...mechanisms generating these lasting effects-recurrence of illness and interruption of human capital accumulation-are not limited to childhood. In this study, we examine how an episode of depression experienced in early adulthood affects subsequent labor market outcomes. We find that, at age 50, people who had met diagnostic criteria for depression when surveyed at ages 27-35 earn 10% lower hourly wages (conditional on occupation), work 120-180 fewer hours annually, and earn 24% lower annual wage incomes. A portion of this income penalty (21%-39%) occurs because depression is often a chronic condition, recurring later in life. But a substantial share (25%-55%) occurs because depression in early adulthood disrupts human capital accumulation, by reducing work experience and by influencing selection into occupations with skill distributions that offer lower potential for wage growth. These lingering effects of early depression reinforce the importance of early and multifaceted intervention to address depression and its follow-on effects in the workplace.
Objective: "Serious mental illness" (SMI) is a priority population within mental health treatment and policy. However, there is no standard operational definition across research, clinical, and ...policy contexts. The use of the label has also not been evaluated regarding its association with stigma among the general public. This mixed-method study compared community members' stigma toward "SMI" with other psychiatric labels and examined community understanding and perceptions of the SMI label. Method: Two hundred forty-six participants recruited via Prolific read randomly manipulated vignettes describing an individual diagnosed with depression, schizophrenia, or "SMI" and completed measures of stigma and qualitative questions regarding familiarity, understanding, and perceived utility of SMI. Quantitative analyses evaluated stigma across vignettes, and qualitative analyses identified common themes across responses. Results: Stigma was relatively high across vignettes, with more negative views reported toward SMI and schizophrenia compared with depression. Quantitative differences in stigma by vignette were not significant after controlling for participants' age and gender. Qualitative responses were split regarding the perceived utility of the SMI term, with noted concerns including its broadness and potential for stigma. Most participants described functional impairment or disability as characteristic of "SMI," and approximately 70% associated schizophrenia and psychotic disorders with "SMI" compared with 45% for depression. Conclusions and Implications for Practice: Person-level factors were more strongly associated with stigma than psychiatric labels. However, our sample described concerns that the SMI term is vague and may exacerbate stigma. Community education and antistigma efforts should move beyond diagnostic labels in characterizing mental illness to facilitate change in attitudes.
Impact and Implications
This study evaluated community attitudes regarding the term "serious mental illness" (SMI). Stigma was high toward a described individual with mental illness regardless of the diagnostic label (SMI, schizophrenia, or depression). However, community members reported broad conceptualizations of "SMI" and mixed, mostly negative, attitudes regarding its utility. Community education and antistigma efforts should move beyond diagnostic labels in characterizing mental illness to facilitate attitudinal change.
Background: Low dopamine D.sub.2/3 receptor availability in the nucleus accumbens shell is associated with highly impulsive behavior in rats as measured by premature responses in a cued attentional ...task. However, it is unclear whether dopamine D.sub.2/3 receptor availability in the nucleus accumbens is equally linked to intolerance for delayed rewards, a related form of impulsivity. Methods: We investigated the relationship between D.sub.2/3 receptor availability in the nucleus accumbens and impulsivity in a delay-discounting task where animals must choose between immediate, small-magnitude rewards and delayed, largermagnitude rewards. Corticostriatal D.sub.2/3 receptor availability was measured in rats stratified for high and low impulsivity using in vivo .sup.18Ffallypride positron emission tomography and ex vivo .sup.3Hraclopride autoradiography. Resting-state functional connectivity in limbic corticostriatal networks was also assessed using fMRI. Results: Delay-discounting task impulsivity was inversely related to D.sub.2/3 receptor availability in the nucleus accumbens core but not the dorsal striatum, with higher D.sub.2/3 binding in the nucleus accumbens shell of high-impulsive rats compared with low-impulsive rats. D.sub.2/3 receptor availability was associated with stronger connectivity between the cingulate cortex and hippocampus of high- vs low-impulsive rats. Conclusions: We conclude that delay-discounting task impulsivity is associated with low D.sub.2/3 receptor binding in the nucleus accumbens core. Thus, two related forms of waiting impulsivity--premature responding and delay intolerance in a delay-of-reward task--implicate an involvement of D.sub.2/3 receptor availability in the nucleus accumbens shell and core, respectively. This dissociation may be causal or consequential to enhanced functional connectivity of limbic brain circuitry and hold relevance for attention-deficit/hyperactivity disorder, drug addiction, and other psychiatric disorders. Keywords: delay discounting, dopamine D.sub.2/3 receptor, impulsivity, nucleus accumbens, resting-state fMRI, functional connectivity
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