The Goldwater Rule: a bastion of a bygone era?

In tandem with the changing political landscape in recent years, interest in the Goldwater Rule has re-emerged within psychiatric discourse. Initiated in 1973, the Goldwater Rule is an ethical code specific to psychiatry created by the American Psychiatric Association in response to events surrounding the USA presidential election of 1964, in which the integrity of the psychiatric profession was challenged. Current detractors view the rule as an antiquated entity which obfuscates psychiatric pragmatism and progression. Proponents underscore its role in maintaining both respectful objectivity and diagnostic integrity within the psychiatric assessment process. This essay aims to explore the origin of the rule, and critique its applicability to modern-day psychiatric practice.

The Emergence of Recovery: A Genealogical Exploration of the Forces of Power Shaping New Zealand's Mental Health Services in the 21st Century

<p>Recovery is a conceptual model that underpins New Zealand’s mental health service delivery in the 21st century. This thesis explores how recovery emerged historically as an influential philosophy and how representations of recovery have changed to meet the needs of different groups. An inquiry, based on Foucault’s genealogical method, investigates the historical and contemporary forces of power that have shaped the construction of mental illness, and the development of methods and techniques to support and manage persons labelled as mentally ill. The normalisation of knowledge developed during 19th century psychiatric practice provided a context for later critique and resistance from movements that highlighted the oppressive power of psychiatric discourse. Key to the critique were the antipsychiatry and service user movements, which provided the conditions for the possibility of the emergence of recovery as a dominant discourse. Since its emergence, recovery has moved through a number of representations as it was taken up by different groups. A significant shift in the 21st century has been the dominance of neo-liberal discourse based on consumerism, a rolling back of the state, and an emphasis on individual responsibility. The implications of this shift for users and providers of services and their effects on current representations of recovery conclude the inquiry.</p>

The Emergence of Recovery: A Genealogical Exploration of the Forces of Power Shaping New Zealand's Mental Health Services in the 21st Century

<p>Recovery is a conceptual model that underpins New Zealand’s mental health service delivery in the 21st century. This thesis explores how recovery emerged historically as an influential philosophy and how representations of recovery have changed to meet the needs of different groups. An inquiry, based on Foucault’s genealogical method, investigates the historical and contemporary forces of power that have shaped the construction of mental illness, and the development of methods and techniques to support and manage persons labelled as mentally ill. The normalisation of knowledge developed during 19th century psychiatric practice provided a context for later critique and resistance from movements that highlighted the oppressive power of psychiatric discourse. Key to the critique were the antipsychiatry and service user movements, which provided the conditions for the possibility of the emergence of recovery as a dominant discourse. Since its emergence, recovery has moved through a number of representations as it was taken up by different groups. A significant shift in the 21st century has been the dominance of neo-liberal discourse based on consumerism, a rolling back of the state, and an emphasis on individual responsibility. The implications of this shift for users and providers of services and their effects on current representations of recovery conclude the inquiry.</p>

Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

Strengthening the psychiatric advance directive system in New Zealand: Allowing the mentally ill to help themselves

<p>Psychiatric advance directives (PADs) are an emerging method for adults with serious and persistent mental illness to manage their treatment by documenting treatment preferences in advance of periods of incapacity. However, the application of PADs has largely been neglected by the legal and psychiatric discourse in New Zealand. This paper presents some of the key purposes and unrealised benefits of PADs, and explains why New Zealand’s law and policy surrounding advance directives in the mental health arena is unclear compared to other jurisdictions. Though interviews conducted with New Zealand clinicians and consumer advocates, key practical and legal dilemmas around forming, monitoring, and enforcing PADs were extracted and dissected. Interviews elucidated that, while attitudes were generally positive attitude towards PADs in the mental health system, the lack of a focused PAD strategy stifled its promulgation where it could most benefit service users. This paper proposes that PADs should be promoted, and articulates a normative PAD strategy for New Zealand.</p>

The ‘feminisation’ of psychiatric discourse: A Marxist analysis of women’s roles in neoliberal society

In analysing the increasing rates of female ‘mental illness’ in neoliberal society, this article draws on Marxist and feminist theory to conceptualise psychiatry as an institution of patriarchal and capitalist power, responsible for reinforcing traditional gender roles. Through outlining the changing circumstances of women, including the recent ‘feminisation’ of the labour force, we argue that there has been a more acute need for patriarchal capitalism to curtail the emancipatory potential of women through the heightened enforcement of sex-role ideology. This is demonstrated through a profile of ‘feminised’ mental disorders which have appeared in the Diagnostic and Statistical Manual of Mental Disorders ( DSM) since 1980 – including premenstrual dysphoric disorder and female sexual interest/arousal disorder – which we argue purposely reproduce a discourse which restricts women’s advancements in paid employment while reinforcing the cliché of ‘respectable femininity’ as still primarily associated with the family and the home. We conclude the article by suggesting that, under the conditions of neoliberalism, the mental health system is becoming an increasingly powerful institution for the social control of gender.

Structural Violence Education: A Critical Moment for Psychiatric Training

The mental health ramifications of structural violence are borne disproportionately by marginalized patient populations in North America, which includes Black, Indigenous, and 2SLGBTQIA+ communities and people who use drugs. Structural violence can comprise, for example, police or state violence, colonialism, and medical violence. We chronicle the history of psychiatric discourse around structural violence over the past 50 years and highlight the critical need for new formalized competencies to become incorporated into the training of medical students across Canada, specifically addressing the impacts of structural violence for the aforementioned populations. Finally, we offer a framework of learning objectives for designing educational sessions discussing structural violence and mental health for integration into pre-clerkship psychiatry curricula at medical schools across Canada.

Model of complex rehabilitation for patients with a simple form of schizophrenia

Psychosocial rehabilitation for patients with mental disorders is one of the priority areas of scientific research in modern psychiatric discourse. The key to solving this problem is a multidisciplinary approach, within which it becomes possible to select congruent rehabilitation and psychoeducational techniques, taking into account the clinical and psychopathological content of this nosological form. In this context endogenous procedural mental disorders deserve special attention, as they are characterized by the highest level of social and labor maladjustment. Aim. To investigate the effectiveness of the developed model of complex psychosocial rehabilitation for patients with schizophrenia. Materials and methods. On the basis of Municipal Non-Commercial Enterprise “Regional Clinical Institution for Provision of Psychiatric Care” of Zaporizhzhia Regional Council, 80 patients with a simple form of schizophrenia were selected at the outpatient stage of treatment for the purpose of further examination. Clinical diagnostics of the studied mental pathology was carried out in accordance with the differential diagnostic criteria of the International Classification of Diseases 10 revision (ICD-10). The inclusion criteria for the study contingent were: informed consent to participate in the study, the absence of severe somatic pathology and information about craniocerebral trauma. In order to analyze the effectiveness of the developed model, the study contingent was randomized into the study group (SG) – 40 patients who received complex therapy within the framework of the developed model of psychosocial rehabilitation, and the comparison group (CG) – 40 patients who received treatment in accordance with the current protocols. Results. Based on the formed principles of psychosocial rehabilitation for patients with a simple form of schizophrenia, a comprehensive model of psycho-rehabilitation support for this patient contingent was generated including four stages: psychopharmacological, family intervention, cognitive-behavioural and ergotherapeutic. Analysing the effectiveness of the developed model, statistically significant differences (P < 0.05) were established between the average indicators in the studied groups according to the criteria “socially useful activity, including work and study” (4.18 ± 0.25 and 3.33 ± 0.27 points in SG and CG, respectively) and “relationships with family and other social relations” (4.35 ± 0.24 and 3.60 ± 0.25 points in SG and CG, respectively) in the absence of statistically significant differences in the criteria for “self-care” and “bothering others and aggressive behaviour”. Conclusions. The effectiveness of the complex model of psychosocial rehabilitation for patients with a simple form of schizophrenia in the areas of socially useful activities (study and work) and social relations was developed and proved, which made it possible to increase the effectiveness of therapy for this contingent of patients.

El artista modernista y el discurso psiquiátrico: Los Raros de Rubén Darío y la mirada médica finisecular

This article focuses on the relationship between literary discourse and psychiatric discourse in the late 19th century; especially, in what refers to the establishment of knowledge about the abnormal and the configuration of artistic genius as a pathology. Furthermore, the work aims to examine the construction of a “rhetoric of the disease”, their strategies and functions, in Los Raros (1896-1905) by Rubén Darío, from the analysis of the normal/abnormal conceptual binomial and the emergence of psychiatric discourse as power of normalization in end-of-century artistic productions. The author proposes that the literary portraits that Darío draws in his work reveal a tension between two types of gaze on the normal and the pathological. On the one hand, the artistic gaze of end-of-century artists with an ambivalent discourse that informs about a use of a pathological genius as an artistic ideal; on the other, the psychiatric gaze, which establishes a series of diagnostic and classification devices for abnormal subjects. Darío will face this clinical gaze from the pages of his literary portraits through a discourse that dismantles the episteme of the medical-psychiatric discourse and questions the fluctuating place that modernist writers occupy in the incipient Buenos Aires consumer society.