An ideal in mental health care is user participation. This implies inclusion and facilitation by clinicians to enable users to participate in decisions about themselves and in the design of suitable treatment. However, much of the work of clinicians consists of handovers and other meetings where patients are not present. It is therefore interesting to study how the patient perspective is handled in such meetings and whether it forms a basis for user participation. We conducted fieldwork in three different inpatient (...) wards in Norwegian District Psychiatric Centres. We used an interactional perspective in our analysis, where speech acts, framing and footing were key concepts. The findings show that the talk in the handovers and meetings contained five main themes and that there was a clear correlation between what was said and how it was said, and whether clinicians related to the content in a decisive, person‐centred or indecisive manner. We discuss potential participation statuses for patients and their limited opportunity to influence the talk and possible decisions about themselves. Our conclusion is that handover meetings primarily function as an aid in organising clinicians' work and could ultimately be seen as counteracting user participation. (shrink)

The purpose of this study was to investigate some factors which may influence moral decision-making in psychiatric nursing practice. The Moral Sensitivity Questionnaire, a 30-item, seven-point Likert scale, measures six dimensions that are assumed to be related to moral sensitivity. In scoring, the test is divided into six categories: interpersonal orientation, structuring moral meaning, expressing benevolence, modifying autonomy, experiencing conflict, and reliance on medical authority. Seventy-nine nurses, employed in the same psychiatric district, were included in the sample. Significant differences (...) were found for some items in five of the six categories regarding gender, post-basic nursing education, experience as a mental care worker and type of clinical setting. Le but de cette étude était d'investiguer quelques éléments qui pourraient influencer les décisions morales dans la pratique infirmière psychiatrique. Le Questionnaire de Sensibilité Morale de 30 questions, sept points échelle Likert, mesure six dimensions qu'on assume d'être lié à la sensibilité morale. En marquant les points, le test est divisé entre les six catégories: orientation interpersonnelle, structurant un sens moral, l'expression de bénévolence, la modification de l'autonomie, l'expérience de conflit et dépendance de l'autorité médicale. Soixante-dix neuf infirmiers/ères, employé(e)s dans le même rayon de psychiatrie, ont participé dans l'étude. On a trouvé des différences considérables pour quelques questions dans cinq des six catégories en ce qui concerne le genre, l'éducation avancée, l'expérience d'infirmier/ère psychiatrique et type de cadre clinique. Das Ziel dieser Studie war die Untersuchung einiger Faktoren, die Einfluss haben auf die moralische Entscheidungsfindung in der psychiatrischen Krankenpflege. Der Fragebogen zur 'Moralischen Einfühlsamkeit' ist eine sieben-Punk Likert Skala für 30 Sachaspekte und misst sechs Dimensionen, von denen man annimmt, daß sie zur moralischer Einfühlsamkeit gehören. Für die Auswertung ist der Test in sechs Kategorien eingeteilt: Orientierung zu andem Personen, das Strukturieren moralischer Bedeutungselemente, Wohlwollen ausdrücken, Modifizierung von Selbstbestimmung. (shrink)

Emotions and bodily feelings -- Existential feelings -- The phenomenology of touch -- Body and world -- Feeling and belief in the Capgras delusion -- Feelings of deadness and depersonalization -- Existential feeling in schizophrenia -- What William James really said -- Stance, feeling, and belief -- Pathologies of existential feeling.

The need for a model -- Currently available models in psychiatry -- Introduction to enactivism -- Body and mind - and world -- The existential dimension and its role in psychiatry -- Enriched enactivism : existential sense-making, values, and socio-cultural worlds -- Enactive psychiatry : psychiatric disorders are disorders of sense-making -- An enactive approach to causes, diagnosis and treatment of psychiatric disorders.

Extended Reality (XR) systems, such as Virtual Reality (VR) and Augmented Reality (AR), provide a digital simulation either of a complete environment, or of particular objects within the real world. Today, XR is used in a wide variety of settings, including gaming, design, engineering, and the military. In addition, XR has been introduced into psychology, cognitive sciences and biomedicine for both basic research as well as diagnosing or treating neurological and psychiatric disorders. In the context of XR, the simulated ‘reality’ (...) can be controlled and people may safely learn to cope with their feelings and behavior. XR also enables to simulate environments that cannot easily be accessed or created otherwise. Therefore, Extended Reality systems are thought to be a promising tool in the resocialization of criminal offenders, more specifically for purposes of risk assessment and treatment of forensic patients. Employing XR in forensic settings raises ethical and legal intricacies which are not raised in case of most other healthcare applications. Whereas a variety of normative issues of XR have been discussed in the context of medicine and consumer usage, the debate on XR in forensic settings is, as yet, straggling. By discussing two general arguments in favor of employing XR in criminal justice, and two arguments calling for caution in this regard, the present paper aims to broaden the current ethical and legal debate on XR applications to their use in the resocialization of criminal offenders, mainly focusing on forensic patients. (shrink)

Background: The magnitude of bullying and harassment among psychiatrists is reportedly high, yet no peer-review published studies addressing this issue could be found. Therefore, it was decided to conduct a pilot study to assess the degree of the problem, the types of bullying/harassment and to provide some insights into the situation.Methods and Principal Findings: Following multiple focus group meetings, a yes/no response type questionnaire was developed to assess the degree and type of bullying and harassment experienced by psychiatrists. Over a (...) 3-month period the questionnaire was administered to a random sample of 60 psychiatrists. 57 out of the 60 psychiatrists reported harassment and bullying. Frequencies of the following response variables are presented in descending order: rumours 40% ; defamation 20% ; passing remarks 20% ; false accusations 15% ; threats 13.3% ; verbal abuse 13.3% ; unjustified complaints 13.3% ; promotion blocked 13.3% ; humiliation 13% ; bad reference given 10% ; credentials questioned 8.3% ; physical attacks 5% ; termination 5% ; derogatory remarks 1.7% and 1.7% were subjected to personal work. As a result of being subjected to harassment, 66.7% of the psychiatrists did not take any action, whereas 33.3% confronted the person they believed responsible. Asked whether the bullying and harassment caused distress, 18.3% of the psychiatrists did not report any effect, 30% reported mild distress, 40% moderate distress and severe distress was reported by 11.7%.Conclusions: It was concluded that the magnitude of bullying and harassment among psychiatrists may be quite high, as evidenced by this pilot study. There is a need for extensive systematic studies on this subject and to establish strategies to prevent and address this issue at a national and regulatory level. (shrink)

Some critics argue that the types of psychiatric diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders and International Classification of Disease are superfluous and should be abandoned. These are known as categorical polythetic psychiatric diagnoses. To receive a categorical polythetic psychiatric diagnosis an individual need only exhibit some, rather than all, of the symptoms on the diagnostic criteria. Consequently, categorical polythetic psychiatric diagnoses only associate an individual with a range of symptoms rather than specify which symptoms they (...) have. Drawing on Giere’s account of scientific models, I portray categorical polythetic psychiatric diagnoses as abstract models that guide the building of less abstract models. These models can specify which symptoms a particular individual has. Additionally, categorical polythetic psychiatric diagnoses can guide investigation of symptoms towards difficult to spot symptoms, guide investigation towards changing symptoms, and guide investigation towards how symptoms manifest. These important roles mean categorical polythetic psychiatric diagnoses should not be abandoned. (shrink)

There are three lines of argument in defence of coercive treatment of patients with mental disorders: arguments regarding (1) societal interests to protect others, (2) the patients' own health interests, and (3) patient autonomy. In this paper, we analyse these arguments in relation to an idealized case, where a person with a mental disorder claims not to want medical treatment for religious reasons. We also discuss who should decide what in situations where patients with mental disorders deny treatment on seemingly (...) rational grounds.We conclude that, in principle, coercive treatment cannot be defended for the sake of protecting others. While coercive actions can be acceptable in order to protect close family and others, medical treatment is not justified for such reasons but should be given only in the interest of patients. Coercive treatment may be required in order to promote the patient's health interests, but health interests have to waive if they go against the autonomous interests of the patient. We argue that non-autonomous patients can have reasons, rooted in their deeply-set values, to renounce compulsory institutional treatment, and that such reasons should be respected unless it can be assumed that their new predicaments have caused them to change their views. (shrink)

The notion of epistemic injustice was first applied to cases of discrimination against women and people of color but has since come to refer to wider issues related to social justice. This paper applies the concept of epistemic injustice to problems in the therapeutic relationship between psychiatrists and psychiatric patients. To this end, it is necessary to acknowledge psychiatrists as professionals with expertise in treating mental disorders, which impair the patient’s rationality, sometimes leading to false beliefs, such as delusions. This (...) paper classifies the characteristic features of the therapeutic relationship in psychiatry into three stages: those of a professional–client relationship, those of a doctor–patient relationship, and those of a psychiatrist–psychiatric patient relationship. Epistemic injustice is prevalent in psychiatric care owing to prejudice against patients with mental disorders. However, it is also predisposed by the roles that psychiatrists play in relation to psychiatric patients. This paper suggests some ameliorative measures based on the analysis. (shrink)

In this landmark volume, editor Jaak Panksepp assembles the perspectives of top scientists and clinicians who apply contemporary neuroscience to psychiatric ...

This paper focuses on one of the original moments of the development of the “phenomenological” current of psychiatry, namely, the psychopathological research of Ludwig Binswanger. By means of the clinical and conceptual problem of schizophrenia as it was conceived and developed at the beginning of the twentieth century, I will try to outline and analyze Binswanger’s perspective from a both historical and epistemological point of view. Binswanger’s own way means of approaching and conceiving schizophrenia within the scientific, medical, and (...) psychiatric context of that time will lead us to grasp the epistemological stakes at the origins of his project of reforming psychiatry by means of phenomenology. I will finally attempt to upgrade and update Binswanger’s project in light of the current reappraisal of phenomenology within the ongoing debate on psychopathology engaged by studies in the field of science and philosophy of mind. (shrink)

Philosophy has always been concerned with mental health and mental disorder, and many prominent historical figures have held views that have drawn attention to these issues. In recent years, however, there has been a surge of interest in philosophical issues surrounding psychiatry. As a result, the philosophy of psychiatry has emerged as a distinct, well-established field of inquiry.

_NeuroAnalysis _investigates using the neural network and neural computation models to bridge the divide between psychology, psychoanalysis, and neuroscience when diagnosing mental health disorders and prescribing treatment. Avi Peled builds on Freud's early attempts to explain the neural basis of mental health by introducing neural computation as a bridging science to explain psychiatric disorders. Peled describes the brain as a complex system of interconnected units and goes on to suggest that conscious experience, feelings, and mood are emergent properties arising from (...) these complex organisations. This model describes mental health disorders in terms of perturbation to the optimal brain organisation, and demonstrates how particular disorders can be identified through a specific breakdown pattern of the brain’s organisation. This fresh approach to the diagnosis of psychiatric disorders will interest students, professors, and researchers of psychoanalysis, neuroscience, and their related fields. (shrink)

‘Deliberate self-harm’, ‘self-mutilation’ and ‘self-injury’ are just some of the terms used to describe one of the most prominent issues in British mental health policy in recent years. This article demonstrates that contemporary literature on ‘self-harm’ produces this phenomenon (to varying extents) around two key characteristics. First, this behaviour is predominantly performed by those identified as female. Second, this behaviour primarily involves cutting the skin. These constitutive characteristics are traced back to a corpus of literature produced in the 1960s and (...) 1970s in North American psychiatric inpatient institutions; analysis shows how pre-1960 works were substantially different. Finally, these gendered and behavioural assertions are shown to be the result of historically specific processes of exclusion and emphasis. (shrink)

This book considers coercion within the healing and ethical framework of therapeutic relationships and partnerships at all levels, and addresses the universal ...

La vie, le travail et l’œuvre médicale de Constance Pascal (1877-1937), psychiatre qui fut la première à diriger un asile, sont à la fois exceptionnels et exemplaires du parcours d’une femme exerçant une profession réservée aux hommes dans une Troisième République bien peu démocratique. Alternant avec finesse le récit de la vie privée et professionnelle de cette femme, le livre de Felicia Gordon, senior member du Wolfson college de Cambridge, est une biographie bien documentée ancrée à la foi...

In recent years, phenomenologically informed philosophers, psychologists and psychiatrists have attempted to import philosophical notions associated with the self into the empirical study of pathological experience. In particular, so-called ipseity disturbances have been put forward as generative of symptoms of schizophrenia, and several attempts have been made to operationalize and measure kinds and degrees of ipseity disturbances in schizophrenia. However, we find that this work faces challenges caused by the fact that the notion of ipseity is used ambiguously, both in (...) the philosophical and in the empirical discussion, and the methods employed to operationalize ipseity often portray a rather different understanding of the notion from that found in the literature that is cited as providing the philosophical foundation for the studies in question. In particular, according to the definitions found in the philosophical literature, while being phenomenologically available, the self is not represented in ipseity. However, when it comes to the empirical study of ipseity and its disturbances, the object of investigation is often a kind of explicit self-representation. As a result, it is unclear whether different researchers are really talking about the same thing. Future progress in this area will require more careful conceptual distinctions; the present article aims to contribute to this task. (shrink)

The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of (...) dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice. (shrink)

Nurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is widespread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a poststructuralist perspective to reexamine (...) this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these settings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings. (shrink)

This chapter argues that the modernist agenda, currently dominant in mainstream psychiatry, serves as a disempowering force for service users. By structuring the world of mental health according to a technological logic, this agenda is usually seen as promoting a liberation from "myths" about mental illness that led to stigma and oppression in the past. However, it is argued that this approach systematically separates mental distress from background contextual issues and sidelines non-technological aspects of mental health such as relationships, (...) values, and meanings. This move privileges the gaze of the expert doctor who is trained to understand distress in terms of psychopathology. But, as this move empowers the doctor, it disempowers the service user. In part this is because the priorities of modernist psychiatry are generally at odds with the interests and concerns of services users, particularly those who see themselves as survivors of the mental health system. The chapter examines the implications of this for the psychiatrist's role in working with survivors towards recovery. (shrink)

In a recent Editorial, Kious et al. (2023) put forward the claim that psychiatrists should resist calls to integrate concerns about epistemic injustice into their practice as this concept not only fails to add significantly to the current professional standards but would also lead to deleterious clinical outcomes. We believe their claim is mistaken, as it arises from several misconceptions about both the nature of epistemic injustice, and its clinical relevance. First, epistemic justice is conflated with what the authors term (...) ‘a quest for social justice’ that could ‘sideline principles of good clinical reasoning’ (Kious at al 2023: 4). Second, the claim about the impracticality and/or counterproductivity of epistemic injustice as a critical tool within psychiatric practice reflects a series of misconceptions about the normative framework from which this concept derives, so the standards they evaluate it against are ill-chosen. Pace Kious at al., fostering epistemic justice in any area of knowledge and inquiry could not – unwittingly or otherwise – inhibit the consideration of relevant evidence, restrict sound argument or facilitate the casual treatment of testimonies at face value. Third and final, this claim obfuscates some immediate ways in which a focus on epistemic justice as an integral goal will strengthen psychiatric practice according to its own internal standards. (shrink)