William Carpenter Research Articles

Genes and Schizophrenia: From a Festschrift Seminar Honoring William T. Carpenter Jr, MD

Recent data have begun to elucidate the genetic architecture of schizophrenia, as well as provide new insights into the relationships of specific genetic factors across diagnostic boundaries, with specific symptom domains, and in the prediction of antipsychotic treatment response. Not surprisingly, work conducted at the Maryland Psychiatric Research Center (MPRC), led by Dr William Carpenter, has helped to guide the thinking behind much of this work, as well as contributed valuable data toward these efforts. In this article, I will briefly summarize some of the major findings emerging from these lines of research and highlight the role of the Dr Carpenter and his colleagues at the MPRC in this area.

Patients’ Positive Regard for Psychotic Symptoms May Contribute to Nonadherence

Evaluation and treatment of patients with schizophrenia should include a focus on the patient’s subjective experience of symptoms and illness.

DSM-5Fine-Tunes Diagnostic Criteria for Psychosis, Bipolar Disorders

<i>DSM-5</i>Fine-Tunes Diagnostic Criteria for Psychosis, Bipolar Disorders

Understanding Subjective Experience of Patients Important to Treatment

Understanding Subjective Experience of Patients Important to Treatment

&lt;em&gt;Shock, Memory and the Unconscious in Victorian Fiction&lt;/em&gt;, by Jill L. Matus

Reviewed by: Shock, Memory and the Unconscious in Victorian Fiction Sally Shuttleworth (bio) Shock, Memory and the Unconscious in Victorian Fiction, by Jill L. Matus; pp. x + 247. Cambridge and New York: Cambridge University Press, 2009, £59.00, £29.99 paper, $93.00, $50.00 paper. At a time when claims for emotional damage echo through our law courts and the antics of celebrities appear designed to trivialise the very notion of trauma, it is instructive to note that it was that explicit engine of modernity, the stream train, that first brought together lawyers, insurance companies, and medics in the nineteenth century, as a new diagnosis of "railway shock" came into being (86). The fact that railway companies were initially only held liable for physical injuries opened the way for the development of theories of psychological injury. Jill L. Matus builds on earlier work on railway shock to offer a fine reading of Charles Dickens's story "The Signalman" (1866), which, [End Page 551] together with The Mystery of Edwin Drood (1870), she places in the broader context of theories of memories and their aftermath. Shock, Memory and the Unconscious in Victorian Fiction makes a major contribution to the growing body of literature on the interrelations of nineteenth-century psychology and the novel. In addition to the one on Dickens, it offers insightful chapters on North and South (1855), which is treated as a "condition of consciousness" novel (61), and psychic shock in George Eliot's "The Lifted Veil" (1859) and Daniel Deronda (1876), concluding with an analysis of dissociation and multiple selves in, perhaps inevitably, The Strange Case of Dr Jekyll and Mr Hyde (1886). As the foregoing list suggests, the texts explored are canonical, and it is to Matus's credit that with so much written on these works she can still produce readings that are fresh and interesting, although—as with virtually all critical works—there are gaps and omissions, alternate paths that might have been taken. Matus explores the ways in which many of her literary texts used the gothic language of haunting to articulate forms of unconscious experience and internal conflict. Her own text has in a sense its own double, being haunted by an alternate work that would have had a far snappier title, "Trauma in Victorian Fiction." Her adoption of the lengthier, more cumbersome form results from her decision to consider Victorian culture's treatment of emotional shock on its own terms and not according to ahistoric post-Freudian concepts of trauma. At issue is the theoretical model employed by Cathy Caruth and others, which emphasises "unprocessed memory as the key element of trauma" (60), a formulation about which Matus is perhaps rightly sceptical. Instead, she turns to a complex network of ideas regarding emotions, memory, and the unconscious that she sees as better explaining psychic shock in the Victorian period. At the heart of her work is the excitement generated by the new science of physiological psychology developed by Alexander Bain, William Carpenter, G. H. Lewes, and others, which brought into close union the workings of body and mind, generating new understandings of unconscious processes and the physiological impact of emotions. The text offers a welcome corrective to Ian Hacking's otherwise magisterial volume, Rewriting the Soul (1995). As Matus notes, in focusing on Jean-Martin Charcot and his formulations of trauma and multiple personality disorder, Hacking ignores the extensive sciences of memory to be found in English psychological discourse at that time. Matus opens up what she sees as a richer history in which emotions, memory, and the unconscious are closely interwoven. The text, however, remains to some degree trapped by the model it wishes to refute, returning constantly to the idea of trauma, whether to suggest, as in her analysis of Daniel Deronda, that the novel and surrounding discourse "helped to produce the way we understand trauma today" or to argue in conclusion that Victorian culture did not produce a fully formulated theory of trauma since it "neither wanted nor needed it" (143, 186). This preoccupation with trauma produces its own limitations. Matus notes that her focus is on ideas of emotional aftermath in ordinary, rather than pathologized, states of...

Shock, memory and the unconscious in Victorian fiction

Jill L. Matus, Shock, Memory and the Unconscious in Victorian Fiction. Cambridge: Cambridge University Press, 2009, pp.x + 254. Hardback £62.00, isbn 978-0- 521-76024-9. Paperback £18.99, isbn 978-0-521-31025-3.In introducing Embodied Selves: An Anthology of Psychological Texts 1830-1890 in 1998, Jenny Bourne Taylor and Sally Shuttleworth claimed that there had been little work done on the close connections between Victorian narrative and the wider concerns of the emerging materialist science of self. Since then, the reciprocal relationship between nineteenth-century fiction and 'mental physiology' has become a particularly rich field for scholars of Victorian literature and culture. Following the groundbreaking work of Bourne Taylor and Shuttleworth, a number of other significant monographs have appeared by such scholars as Nicholas Dames and Anne Stiles. Jill L. Matus's perceptive and wideranging book, Shock, Memory and the Unconscious in Victorian Fiction, which has now been released in paperback by Cambridge University Press, provides a further insightful contribution to this flourishing field. It takes the experience of 'shock' or 'psychic injury' as its subject, analysing this phenomenon in a number of psychological works as well as in important examples of the period's prose fiction. In a series of interlinked individual case studies, Matus explores writing by Gaskell, Dickens, Eliot and Stevenson in detail alongside the work of significant figures from the world of mental science, including William Carpenter, Alexander Bain and E.S. Dallas. This approach is a suitably interdisciplinary one, but with an interesting twist; as Matus asserts, her 'book aims to explore in particular the participation of fictive narrative in what has been assumed to be the province of emergent psychology and memory science' (p.9). Matus, as a result, makes fascinating close readings of literary texts a central part of her project here, allowing her to argue convincingly that Victorian fiction does not only 'follow' or 'reflect' medical science, but in some cases helps shape it (p.12).The book's first chapter, 'Historicizing Trauma', provides a firm historical and theoretical basis for the in-depth analysis that follows. As Matus explains, another aim of Shock, Memory and the Unconscious in Victorian Fiction is to reveal 'a genealogy of trauma that reaches back into the mid-nineteenth century' (p.43). Her book therefore not only deepens our understanding of the Victorian novel; it also contributes to recent discussions of the application of trauma theory to literature. In analysing Victorian texts in the light of pre-Freudian ideas about trauma and the 'wounded psyche', Matus is able to reveal 'the historical contingency of trauma theory' (p.183). What is most important in nineteenth-century psychological and fictional accounts of trauma is not 'memory loss and dysfunction', as in twentieth-century instances, but rather the influence of contemporary 'theories of emotion and states of consciousness' (p.183).These themes are considered in further detail in Matus's second chapter on Elizabeth Gaskell's North and South, part of which has already appeared in different form in her Cambridge Companion to Elizabeth Gaskell (2007). Wittily labelling the text 'a condition-of-consciousness novel' (p.62), she provides a rich account of the narrative's interest in 'the effect of very powerful feelings on psychic functioning' (p.61). Beginning with the novel's notoriously high death toll, she analyses how the novel's significant events, like the upheaval of the Hales from Helstone, the strike scene and psychically-disturbing proposals of marriage, 'produce emotional upheaval and provoke a response of shock and pain' (p.63). She notes intriguingly that 'the experience of and response to powerful emotion is not conventionally gendered in this novel' (p.63), affecting John Thornton as much as Margaret Hale. Matus also shows, with particularly effective use of textual evidence, how Gaskell 'draws heavily on the language of dream and trance' in order to portray such traumatic experiences (p. …

APA Disputes Critics of DSM-V Process

APA Disputes Critics of <i>DSM-V</i> Process

Schizophrenia Prognosis: Debate Rages On

Schizophrenia Prognosis: Debate Rages On

Data Refute Belief About Schizophrenia Outcomes

Data Refute Belief About Schizophrenia Outcomes

Schizophrenia Scientist Comes Full Circle

Schizophrenia Scientist Comes Full Circle

Compound Improves Cognition In Schizophrenia Patients

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessCompound Improves Cognition In Schizophrenia PatientsJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:21 Jul 2006https://doi.org/10.1176/pn.41.14.0023For over a decade, scientists have attempted to find new drugs for affective disorders by targeting specific nerve receptors known to be involved in those conditions. Now investigators are starting to use a similar tack to find valuable new drugs for treating schizophrenia (Psychiatric News, May 19).One of the more provocative dramas unfolding in this domain concerns the alpha-7 nicotinic acetylcholine receptor. Faulty alpha-7 receptors appear to be responsible for some of the neurocognitive deficits in schizophrenia, notably difficulty in paying attention. Moreover, nicotine has been found to enhance the action of the alpha-7 receptors and to lead to a modest improvement in neurocognition function, especially in concentration, in individuals with schizophrenia. Indeed, the reason why persons with schizophrenia often smoke heavily may be because nicotine helps them pay attention better and think more clearly.Robert Freedman, M.D., chair of psychiatry at the University of Colorado Health Science Center, Ann Olincy, M.D., associate professor of psychiatry there, and colleagues decided to search for an alpha-7 receptor agonist that is better than nicotine at enhancing the mental performance of individuals with schizophrenia. Freedman is also editor in chief of the American Journal of Psychiatry.The search led them to a compound derived from a marine worm and dubbed DMXB-A. After DMXB-A showed positive neurocognitive effects in both experimental animals and in healthy human volunteers, the researchers decided to conduct a small “proof-of-concept” study to see whether DMXB-A might also show promise as a mental enhancer in individuals with schizophrenia.Eleven persons with schizophrenia participated in the trial. Although none of them smoked, all were taking antipsychotic medications. On one day, they received DMXB-A, and immediately afterward their neurocognitive performances were measured with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). The RBANS measures attention, immediate memory, delayed memory, language proficiency, and visuospatial ability. On another day, the subjects received a placebo, and the RBANS was used to measure their neurocognitive performances right after. The mental performances of the subjects under the two conditions were then compared.DMXB-A led to significantly better mental performances than the placebo did, the researchers reported in the June Archives of General Psychiatry. And these superior performances were also greater than those produced by nicotine in another small study of schizophrenia subjects conducted by the same group. Thus DMXB-A might indeed enhance the neurocognition of individuals with schizophrenia and perhaps better than nicotine does, the group concluded.Moreover, “we were surprised by the marked effects that some of the patients experienced in terms of the clearing of their cognition and the decrease in their symptoms,” Freedman added in an interview with Psychiatric News. “We did not expect that much effect after a single-day administration [of DMXB-A]. Improvement in schizophrenia, even for a brief period, is always a heartening finding, because it suggests the possibility that the patients' disability can improve.”These results, however preliminary, are “very important,” William Carpenter Jr., M.D., told Psychiatric News. Carpenter is director of the Maryland Psychiatric Research Center and a schizophrenia authority. “Impaired cognition and primary negative symptoms are the critical unmet therapeutic needs for schizophrenia.” And even if DMXB-A per se does not pan out as a schizophrenia medication, it still adds to the growing body of evidence that “the alpha-7 nicotinic acetycholine receptor is the best molecular target for new drug discovery in schizophrenia.”Freedman and his colleagues are now conducting a phase 2 trial with DMXB-A, and 30 subjects are enrolled. “We expect results late this year,” he said.The proof-of-concept trial was funded by the Veterans Affairs Medical Research Service, the National Institutes of health, the National Alliance for Research on Schizophrenia and Depression, the Stanley Medical Research Institute, and the Institute for Children's Mental Disorders.An abstract of “Proof-of-Concept Trial of an Alpha 7 Nicotinic Agonist in Schizophrenia” is posted at<http://archpsyc.ama-assn.org/cgi/content/abstract/63/6/630>.▪ ISSUES NewArchived

Cerebral Automatism, the Brain, and the Soul in Bram Stoker’s Dracula

Neither literary critics nor historians of science have acknowledged the extent to which Bram Stoker’s Dracula (1897) is indebted to late-Victorian neurologists, particularly David Ferrier, John Burdon-Sanderson, Thomas Huxley, and William Carpenter. Stoker came from a family of distinguished Irish physicians and obtained an M.A. in mathematics from Trinity College, Dublin. His personal library contained volumes on physiology, and his composition notes for Dracula include typewritten pages on somnambulism, trance states, and cranial injuries. Stoker used his knowledge of neurology extensively in Dracula. The automatic behaviors practiced by Dracula and his vampiric minions, such as somnambulism and hypnotic trance states, reflect theories about reflex action postulated by Ferrier and other physiologists. These scientists traced such automatic behaviors to the brain stem and suggested that human behavior was “determined” through the reflex action of the body and brain—a position that threatened to undermine entrenched beliefs in free will and the immortal soul. I suggest that Stoker’s vampire protagonist dramatizes the pervasive late-nineteenth-century fear that human beings are soulless machines motivated solely by physiological factors.

Treatment Is Delicate Balance Between Efficacy, Side Effects

Treatment Is Delicate Balance Between Efficacy, Side Effects

Psychosis Rates Reflect Urban Life, Minority Status

Psychosis Rates Reflect Urban Life, Minority Status

The NIMH-MATRICS Consensus Statement on Negative Symptoms

The impairments now called negative symptoms have long been noted as common features of schizophrenia, and the concept of negative symptoms itself has a long history.1,2 Patients who exhibit significant negative symptoms have particularly poor function and quality of life,3–8 and this aspect of schizophrenia has been proposed as a separate domain with distinctive pathophysiological and therapeutic implications since at least 1974.9 Despite the attention these problems receive, no drug has received Food and Drug Administration (FDA) approval for an indication of negative symptoms, and available data indicate that second-generation antipsychotic medications have not met early hopes for a highly effective treatment for alleviation of negative symptoms.10 Because of limited progress in the development of effective treatments for negative symptoms, under the auspices of the National Institute of Mental Health (NIMH), Drs. Steve Marder, Wayne Fenton, William T. Carpenter, Jr, and Brian Kirkpatrick initiated a process to examine issues that may interfere with treatment development. The NIMH had previously focused attention on impaired cognition as a therapeutic target with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) project. The success of the MATRICS process suggested similar progress could be made in the area of negative symptoms and provided a possible model for proceeding in the area of negative symptoms. Marder, Fenton, Carpenter, and Kirkpatrick organized a consensus development conference, which was held at the NIMH Neuroscience Center in Rockville, Maryland, on January 26–27, 2005. Those attending are listed in the appendix. The mission statement of the meeting was: To review the data relating to the existence of separate domains within negative symptoms, as a prerequisite for choosing appropriate measures of these domains in clinical trials. To initiate a process for developing or identifying widely acceptable, evidence-based measures and methodologies needed to establish the efficacy of treatments that target negative symptoms. Prior to the meeting, the organizers asked experts to address a series of questions: What are the separate components of negative symptoms? Are they independent, or components of the same latent construct? Which aspect of each domain belongs to the negative symptom construct? Does this area need a separate assessment? What is the best assessment method for clinical trials? Since research has suggested that both negative symptoms and cognitive impairments were significant determinants of poor outcome in schizophrenia, an additional set of questions related to the relationship between these domains of psychopathology was also addressed at the conference: Which aspects of cognition are part of the negative symptom construct? Which are independent? Which are uncertain? Articles that more fully address the topics of these presentations can be found in this issue of Schizophrenia Bulletin. Those articles address regulatory issues and negative symptoms,11 negative symptoms as a therapeutic target,12 the factor structure of negative symptoms,13 restricted affect,14 anhedonia,15 and the relationship between negative symptoms and cognitive impairment.16 At the conference other presentations were also made: Wayne Fenton spoke on “Meeting Goals and Objectives: The NIMH Perspective,” Robert Buchanan on “Summary of the MATRICS Process,” William Carpenter, Jr, on “Study Design and the “Pseudospecificity' Problem,” Michael Green on “Social Cognition,” Nancy Andreasen on “Alogia,” and Jeffrey Cummings on “Apathy.”

An Apostle of the North: Memoirs of the Right Reverend William Carpenter Bompas (review)

An Apostle of the North: Memoirs of the Right Reverend William Carpenter Bompas (review)

Editorial--Modeling Negative Symptoms: What's Missing?

Editorial--Modeling Negative Symptoms: What's Missing?

An Apostle of the North: Memoirs of the Right Reverend William Carpenter Bompas (review)

An Apostle of the North: Memoirs of the Right Reverend William Carpenter Bompas (review)

Schizophrenia May Not Impair Decision-Making Ability

Schizophrenia May Not Impair Decision-Making Ability

Preparing for Fusion: Reforming the Nineteenth-Century Court of Chancery, Part I

In 1850, William Carpenter, a reform-minded journalist, called the court of Chancery “an instrument of oppression” and noted that “[t]he madhouses, the workhouses, and the gaols, in all parts of the kingdom, have within their walls the melancholy and heart-broken victims of the evil it does.” The image of the nineteenth-century Chancery as a ruinously expensive and slow court is familiar and was given its most famous expression in Charles Dickens's Bleak House. Yet the court was also a prime focus of attention for law reformers throughout the nineteenth century, until its incorporation into the Supreme Court of Judicature in the reforms of 1873–75. The process of reform was slow and complex, driven at different times by different parties, who had often divergent notions of the problems to be addressed.