Psychiatric Discourse Research Articles

An order of distinction (or, how to tell a collection from a hoard)

What is the difference between a collection and a hoard? This article draws upon an array of sources – from the DSM-V and current psychiatric research on hoarding, to recent media stories and artist Song Dong’s Waste Not (2009), to the author’s own participant observation with the Toronto Hoarding Coalition and the 21 ethnographic interviews she conducted with professional home organizers in the Greater Toronto Area between 2014 and 2015 – to examine how popular and psychiatric discourses that distinguish collecting and hoarding reveal a complex set of rules about what constitutes the healthy and moral ordering, organization and arrangement of one’s material possessions in contemporary life. In an age of seemingly limitless possibilities for accumulation, the author argues that it is not just the fact of having things that stands as a matter of distinction. One must also demonstrate an active engagement in practices related to the curation and management of one’s object world.

Removing the Mask of Sanity: McCarthyism and the Psychiatric–Confessional Foundations of the Cold War National Security State

In the early Cold War, the US government institutionalized a national security program, centered on the investigation into the political beliefs of federal employees, to safeguard the nation from Communist subversion. Often interpreted as the result of a partisan battle between New Deal Democrats and conservative Republicans, the national security program had deeper origins, reflecting the influence of psychiatric discourse on public understandings of deviancy. Framed by a metonymical logic that linked radical political beliefs, deviant sexual behaviors, and other illicit behaviors under the category of psychopathology, the security program sought to guard against the threat posed by potentially dangerous individuals, a form of protection that necessitated the public disclosure by those deemed security risks of all aspects of their personal lives.

Survivor research in Canada: ‘talking’ recovery, resisting psychiatry, and reclaiming madness

Beginning with discussion of what constitutes survivor research in Canada, this paper presents the findings of a critical discourse analysis of published accounts of survivor research over the last twenty-five years. Though they are varied, these texts demonstrate a rhetorical shift from a focus on the individual mind/body out to the social world experienced by psychiatric consumer/survivors. Findings indicate that survivor research engages with recovery discourse in numerous, sometimes problematic ways, in order to push back against dominant biomedical and psychiatric discourses. Further, new language is being generated for understanding madness and distress, rooted in a survivor perspective.

Clinical judgment, moral anxiety, and the limits of psychiatry

It is common for clinicians working in psychiatry and related clinical disciplines to be called on to make diagnostic clinical judgments concerning moral anxiety, which is a kind of anxiety that is closely bound up with decisions individuals face as moral agents. To make such a judgment, it is necessary to make a moral judgment. Although it has been common to acknowledge that there are ways in which moral and clinical judgment interact, this type of interaction has remained unacknowledged. This raises questions as to the nature and limits of psychiatry-particularly concerning the extent to which psychiatric discourse ought to incorporate moral discourse, and the role of the clinician as an expert in identifying problematic anxiety.

E. T. A. Hoffmann and the Development of Trauma 1

This essay reads E.T.A. Hoffmann’s gothic novel Die Elixiere des Teufels as a trauma narrative, arguing that it anticipates the scientific discovery of psychic trauma. It demonstrates that childhood trauma and transgenerational trauma deeply inform the novel’s plot, and that the text’s narration structurally performs traumatic processes such as repetition compulsion and dissociation with astonishing clinical accuracy. Hoffmann’s poetic knowledge of traumatic mechanisms, of the connection between incisive events and their deferred psychopathological effects, I argue, is unparalleled in the contemporary psychiatric discourse on mental illness that Hoffmann consulted. Hoffmann’s poetics of trauma indicate that psychic wounds formed a constitutive part of modern subjectivity as it emerged around 1800, suggesting that German Romanticism played an important role in the development of our current paradigm of trauma.

Polish Romanticism and the Discourses of Madness and the Mental Asylum

Summary This article deals with the problem of representation of psychiatric discourse and the mental asylum in the literature of Polish Romanticism. I am interested in both sides of the argument, i.e. the attempts to legitimize confinement in psychiatric institutions as well as the reasoning of the critics of that policy. My analyses, which draw on texts ranging from literary classics like Juliusz Słowacki’s Kordian to popular fiction (e.g. Ludwik Sztyrmer’s psychological thriller Phrenophagos and Phrenolestes and Józef Ignacy Kraszewski’s short story Bedlam), suggest that the psychiatric discourse in 19th-century literature employed three basic strategies of representation, i.e. legitimation, subversion and functionalization. If a fresh interest in institutionalized psychiatry was one of the key characteristics of the rise of modern society, the literature of Polish Romanticism was certainly part of it, even if its approach was dominated by ideas and attitudes that were hardly novel.

『高慢と偏見』にみる感受性 : 錯誤と精神医学言説

『高慢と偏見』にみる感受性 : 錯誤と精神医学言説

Crime and madness at the opposite shores of the Adriatic: moral insanity in Italian and Croatian psychiatric discourses

In the 19th century, fervid debates arose in the young psychiatric science about how to deal with and to scientifically categorize human behaviour which was perceived as dangerous to society, and as criminal. There were two concepts that stood out in these transnationally held discussions; namely moral insanity and later on, psychopathy. Following recent approaches in the cultural and social history of psychiatry, we understand moral insanity and psychopathy as social constructs, which are determined by the evolution in psychiatric knowledge, and also by laws, codes and social norms of particular historical timeframes. Our task is to discuss the evolution and adoption of these concepts in two linguistically different, but still historically profoundly entangled regions, namely in Italian and Croatian psychiatric discourses at the turn from the 19th to the 20th century. Our analysis of two of the most important medical and psychiatric journals of the time shows that psychiatric debates on antisocial and criminal behaviour were in numerous ways entangled and shaped by the way the two societies scientifically, legally, and institutionally struggled over the question of how to detect and control the mentally incapacitated criminal offender.

Travel and professional networks in the origins of Spanish psychiatry.

This article examines the importance of travel and professional networks in the origins of Spanish psychiatry. After reviewing the early alienists' Enlightenment predecessors and their therapeutic and professional trajectories, it describes the trips to foreign psychiatric institutions made during the second third of the nineteenth century by a group of exiled Spanish doctors, commissioners and pioneers. Later, as they became more socially, institutionally and professionally established, some figures of Spanish psychological medicine cultivated their connections and international profile by organizing or attending conferences and other scientific events. This case illustrates the important role of international relations and scientific and professional networks in the spread of psychiatric discourses and practices.

Lack of Insight in Psychiatric Illness: A Critical Appraisal.

Byline: M. Reddy Setting the Stage for Discussion: Evolution of The Concept and Importance The concept of insight in psychiatric discourse has evolved through various stages. Psychiatrists or 'the doctors of the soul' have sincetimes immemorial been curious about the attitudes and perspectives of persons with mental illness towards their disturbed minds/selves. Though discussed by alienists in the mid-19th century and few psychopathologists in the early 20th century, the concept has seen a great progress in its understanding over the last 25 years. The concept has progressed through the following stages: *Insight into illness as present or absent dichotomy (e.g., IPSS)[sup][1],[2] *One dimensional grading of Insight[sup][3] from Complete Denial (grade 1) to True Emotional Insight (grade 6). This model incorporated understanding of causation as due to internal or external factors. *Multidimensional models[sup][4],[5] which are referred to as 'biomedical models' by their anthropological critics. *The socio-cultural modifications of multidimensional models[sup][6] and the concept of Narrative Insight.[sup][7] The reason so much of global discussion and research is going into this one topic is its clinical, administrative and legal importance. The clinical practice of covert (or surreptitious) medication and involuntary admission into a psychiatric health facility are very difficult things to come to terms with. Not only is the practice of involuntary treatment/admission a clinical concern, it is also an administrative concern for the psychiatric health facility. Issues like use of physical restraints and involuntary treatment/admission usually go against the liberal understanding of Human Rights. Apart from the clinical and administrative concerns, even the legal concerns of criminal responsibility, capacity for informed consent and validity of a will depend upon the understanding of the concept of insight (or the related issues of personal, social and moral judgment) of the person suffering with a mental illness. So, the establishment of the lack of insight in a person suffering from mental illness is of utmost importance for the clinical, administrative and legal reasons. Difficulty in The Clarity and Utility of The Concept of Insight The concept of lack of insight, because of its importance needs clear conceptualization. Clarity in its conceptualization and its utility remain as major problems for four reasons: *Lack of insight means different things in different psychiatric conditions. For example lack of insight means various things in the following conditions: psychosis, depression, obsessive-compulsive disorder, personality disorder, paraphiliac disorders, substance addictions etc. *Criteria or definitions used even for a particular condition like Schizophrenia are different when used by different researchers. Some of which seem very utopian and almost unachievable when applied in routine clinical practice (example: Karl Jaspers' need for a 'completely objective attitude'[sup][8] or Amador & David's need for meeting the five criteria in a fullest sense).[sup][5] Some like Aubrey Lewis' definition[sup][9] are broad and vague. *Different schools of psychiatry ascribe different etiological reasons or reformulations of the concept of lack of insight. The understanding of causation and treatment vary among various schools of psychiatry whereby if one school considers that the person who takes western medical treatment is the one with optimal insight, the other school thinks that use of non-medical treatment is also a correct attitude towards treatment. Cultural psychiatrists[sup][7],[10],[11] discuss the lack of insight as only a coping strategy (or as just a way of explaining the disorder to oneself) without taking neurobiology of disorder into consideration. *The ontological nature of the Human Insight into subjective experiences or lack of it is very complex. …

Schizophrenia: pars pro toto for psychiatry? : A historical essay on the status of schizophrenia in psychiatric discourse

In the history of psychiatry, "schizophrenia" has often been portrayed as the discipline's pars pro toto, which prototypically represents mental illness as such and which draws together the fundamental questions concerning psychiatric epistemology and practice. Taking a conceptual history approach, this essay examines how "schizophrenia" is represented in psychiatric discourse and what aspects of its representation account for the pars pro toto status. Three such aspects are identified: a pragmatic, an existential and a justificatory aspect. Following up these aspects in present day psychiatric discourse, it is concluded that "schizophrenia" is losing its special status as the representations of psychiatry and of mental illness have changed and become more diverse. Tentative conclusions regarding current debates about the abolition of "schizophrenia" are drawn.

The DSM and learning difficulties: formulating a genealogy of the learning-disabled subject.

The article examines the manner in which the learning-disabled subject is created as an object within contemporary psychiatric discourse by means of a genealogical analysis of the learning-disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). It investigates how this pathology was formed historically in the text, what metamorphoses it underwent, and their epistemic significance. First, the theoretical underpinnings of the sociological discourse on DSM are presented, giving a brief background of the DSM status in the Israeli context. Many problematic characteristics in the text are unveiled, by means of critiques from sociology, anthropology and discourse studies. Second, the changing definitions and conceptualizations of learning-disorders in the seven editions of the Manual and the accompanying case studies (1952-2013) are examined. It becomes apparent that the disorders have undergone changes that have enabled the biomedical paradigm to triumph. The implications of these transformations are addressed.

Women, madness and psychiatry: Insane or persuaded?

During the nineteenth and early twentieth century, feminist movements proliferated in Europe and USA in order to vindicate the rights of women both in the workplace and political issues, such as women's suffrage and birth policies, among others. At the same time, psychiatry tried to gain a foothold as a medical specialty, which created a positivist discourse where it was important to measure and quantify mental disorders and their possible causes. As many feminist writers have argued (Chesler, Showalter, Jordanova, and others) this occurs at the same historical moment that a “feminization of madness” was taking place in several ways: madness begins to be described in feminine terms, Freud was developing his research on hysteria; diagnostics, such as puerperal and involution psychosis were taking hold; the interest about the influence of hormones in women's mood were raising, and gynaecology was thought as the organic etiology of female madness. The hegemonic psychiatric discourse appeared to have been a catalyst for logical social inclusion and exclusion, notably influencing the design of a new feminity, distant from the danger of feminism that began to gain prominence. The boundaries between insanity and mental health were really diffuse in case of women. The aim of my work is to highlight how attitudes and attributes of women were transformed into psychiatric symptoms, as the feminist theorist support. I will make a retrospective about clinical women reports of the public asylum of Malaga from the beginning of twenty century.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Cuerpo y discurso psiquiátrico a comienzos delsiglo XX en Uruguay: Insuficiencia, debilidad y adaptación

This study analyzes the psychiatric medical discourse and experimental psychology during the twentieth century in Uruguay, as expert knowledge on children and as referents of the pedagogic discourse of that period. As an introduction some key elements of psychiatry in the country are presented; from them, it is stuyed how the dysfunction of the body became the focus of analysis that led to a series of school children´s classifications. The relationship of the dysfunctional body with school learning is at the core of the reflection, and indiscipline and mental weaknesses are taken as elements articulating the psychiatric and psychological discourses with the pedagogical one, through the notion of adjustment disorder.

THE “SICK” RACIST

AbstractSince the early 1960s, there has been a movement among activists, scholars, and policymakers to redefine racism as a psychopathological condition, identifiable and treatable through psychotherapeutic and pharmacological interventions. This development reflects, and is reflected by, the popular framing among mass media and ordinary social actors of racism and racist events as individual pathology rather than as a social problem. This shifting perspective on racism, from a social problem and a system to an individual pathology, has increasingly become a part of academic and psychiatric discourse since Jim Crow. In this article, we have two aims: first, to trace the emergence of “psychopathological racism”; second, to illustrate the relationship between “psychopathological racism” and “colorblind racism” in the post-Civil Rights era. We argue that the psychopathological view of racism compliments colorblindness in that larger structural issues are dismissed in favor of individual pathos. Furthermore, psychopathological explanations for racism dismiss socio-political contexts, eschewing the contributions of well over fifty years of social scientific research in the process.

The Unjustified Emotions: Child Suicide in Finnish Psychiatry from the 1930s until the 1970s

This article examines the psychiatric discourse on child suicide in Finland from the 1930s until the 1970s. The studies on suicides committed by children reflect a clear change in the psychiatric notion of normalcy as well as in the predominant social attitudes of the era. The changes in the conception of child suicide, it is argued, were due to transformations in how the emotional lives of children have been understood in the society in general. Child psychiatry has, therefore, played a dual role as the producer of knowledge and as the mirror reflecting the changing social understanding of a complex and taboo subject.

International Society for Nutritional Psychiatry Research consensus position statement: nutritional medicine in modern psychiatry

<scp>I</scp>nternational <scp>S</scp>ociety for <scp>N</scp>utritional <scp>P</scp>sychiatry <scp>R</scp>esearch consensus position statement: nutritional medicine in modern psychiatry

Improving quality of a rural CAMHS service using the Choice and Partnership Approach.

This study outlines the service issues and adjustments associated with the implementation of Choice and Partnership Approach (CAPA) into a rural Child and Adolescent Mental Health Service (CAMHS). A mixed-methods approach examined the impacts of the CAPA implementation. A qualitative review of the minutes from team and implementation group meetings illustrated themes according to 11 key CAPA components. Quantitative internal audit data illustrated waiting list times. Findings showed that inclusive language has replaced the traditional, pathology-driven psychiatric discourse, though this has been met with mixed response from CAMHS clinicians, service users and referrers. Data also showed that a waiting list for clinician allocation has been eliminated, and the waiting time between the referral date and the first face-to-face contact has decreased from 63.9 days to 10.7 days. A modified CAPA Choice appointment system has allowed quick access without a waiting list, in line with government guidelines. A full-booking system and focussed, goal-oriented interventions has led to lower caseloads and optimum use of CAMHS clinician skillsets.

Treating without diagnosis: Psychoanalysis in medical settings in Argentina.

This article is part of a larger research project, the aim of which is to understand the discursive conditions of access and adherence to an outpatient mental health service at a public hospital in Buenos Aires, Argentina. The focus is on the historical conflict between medical discourse and psychoanalytical discourse as it emerges in the negotiation of treatment and diagnostic sequences at first consultations. It can be seen that patients who are socialized in medical discourse--and even in psychiatric discourse--expect the usual procedure in which a diagnosis, however transitory, is offered first and then followed by a treatment recommendation. However, psychoanalysts, in contrast, tend to reject diagnostic labels and offer treatment without further justification. This has an impact on the adherence of patients, and we can argue for the need to negotiate with medical discourse in order to guarantee engagement and continuity in treatment.

Writing Prozāk Diaries in Tehran: Generational Anomie and Psychiatric Subjectivities.

I explore the historical and cultural shifts that underlie the normalization of the term dépréshen and the emergence of public psychiatric discourses in 1990s Iran. I do this by investigating the cultural sensibilities of a particular generation, the self-identified 1980s generation, and the ways they situate what is perceived as dépréshen in social anomie and the memories of the Iran-Iraq war. I argue that psychiatrization of psychological distress in Iran was not simply a de-politicizing hegemonic biomedical discourse, but that the contemporary Iranian discourses of psychological pathology and social loss evolved in public, hand-in-hand, through the medicalization of post-war loss. Psychiatric subjectivity describes conditions where individuals internalize psychiatry as a mode of thinking, and performatively articulate not only their desires, hopes, and anxieties, but also historical losses as embodied in individual and collective brains. I underscore my interlocutors' simultaneous historicization and medicalization of their dépréshen, arguing that psychiatrically medicalized individuals are performative actors in the discursive formation of both biomedical and social truth. Dépréshen, in the larger sense of the word, has become one way to navigate ruptured pasts, slippery presents, and uncertain futures.