ʿAṣfūriyyeh: A History of Madness, Modernity, and War in the Middle East

My book, published in 2020, reconstructs the history of ʿAṣfūriyyeh, one of the first ‘modern’ mental hospitals in the Middle East. It uses the rise and fall of this institution as a lens through which to examine the development of modern psychiatric theory and practice in the region as well as the socio-political history of modern Lebanon. ʿAṣfūriyyeh becomes a window into social-policy questions relating to dependency and welfare, definitions of deviance, the relation of mission to empire, state-building processes, and the relation of medical authority to religion. The book also examines the impact of war on health and healthcare infrastructures. Reflecting on the afterlife of this and other institutions, the book calls for a new ‘ethics of memory.’

From fighting animals to the biosocial mechanisms of the human mind: A comparison of Selten’s social defeat and Mead’s symbolic interaction

Social defeat is a psychiatric theory accounting for the role of social environment in the aetiology of psychosis via the mechanism of stress. Social defeat stems from animal studies of stress, whereby a small rat is introduced into a larger rat’s cage and is subsequently attacked and defeated by its larger foe. The defeated rat is subjected to behavioural and hormonal analyses to explore its stress levels. The idea is that social defeat leads to social stress which may cause psychoses. In this article, we draw on the work of Jean-Paul Selten to critique the epistemics that are bound up with social defeat research. For comparative analysis, we use Mead’s Mind, Self and Society to tease out the problems of social defeat and suggest potential remedies. We contend that, in seeking to equate animal and human sociality, social defeat portrays human interaction as hostile and pathological, and minority groups as inevitably defeated. In contrast, Mead’s symbolic interaction presents human sociality as progressively organizational. Mead’s account is grounded in human exceptionalism and lacking attention to structural inequalities. Nevertheless, symbolic interaction has much to offer contemporary social defeat research, albeit whilst echoing some of its thin sociology.

Diagnostic Dissent: Experiences of Perceived Misdiagnosis and Stigma in Persons Diagnosed With Schizophrenia

It is not uncommon for individuals to disagree with their psychiatric diagnosis. The experience of perceived misdiagnosis can be challenging for service users, as mainstream psychiatric theory often views this disagreement as an indication of “poor insight” into their putative illness. Some researchers have suggested that labeling a service user as lacking insight can be detrimental to the service user’s recovery. Regardless of whether a person agrees with his or her diagnosis, persons labeled with “mental illness” sometimes internalize the discrimination and stigma that they encounter. However, few studies have examined the lived experience of disagreeing with a diagnosis. The present study investigated the first-person experiences of three individuals who believed that they were misdiagnosed with a psychotic disorder. As part of a larger study, participants completed in-depth interviews about their life history and experiences in psychiatric hospitals. Data were analyzed using phenomenological methods. Participants felt that their clinicians assigned an erroneous and stigmatizing label that did not match their self-experience. Diagnostic dissent, a form of perceived misdiagnosis, was a way for individuals to assert their self-experience against perceived invalidation and stigmatizing labels.

A knight’s Life Between Love and Duty As Seen in Sir Walter Scott’s Ivanhoe

The problem in this thesis is the life of a knight who has to choose between duty and love. Dif analysis on the main task because on one side must perform his duties as a knight, and on the other side must follow his conscience to get his love. The problem of duty and love does not fit in the story. The purpose of this study is to evaluate the duties and responsibilities of the knight in performing his duty to the country where the knight is also confronted with his feelings and love, be a confrontation between the duty and responsibility to the knight. In this writing, literature research is taken as a method of data. As for the method of data analysis, the authors perform comparative procedures with the understanding of novels, figures, and also psychiatric theory. Technical techniques data data research results relevant to the research. In data analysis techniques, the author uses the technique of genetic structuralism by analyzing the knight in the Ivanhoe novel through psychic theory, the writer must see the confrontation that the knight must enter in choosing a task or love. The findings in this thesis are: 1) the knight prefers the task to fullness and prefers love in the end, 2) at the beginning of the story, the knight prefers to give priority to his duty to the king so that he is carried away Rowena, his beloved girl 3) At the end of the story, the knight returns to give priority to his love for Rowena.

Embodiment and Enactment in Cultural Psychiatry

Cultural psychiatry is concerned with understanding the implications of human cultural diversity for psychopathology, illness experience, and intervention. The emerging paradigms of embodiment and enactment in cognitive science provide ways to approach this diversity in terms of variations in bodily and intersubjective experience, narrative practices, and discursive formations. This chapter will outline an approach to cultural neurophenomenology and psychopathology through metaphor theory, which examines the interplay of culturally shaped developmental processes of embodied experience and narrative practices structured by ideologies of personhood and social positioning. The new paradigm has broad implications for psychiatric theory, research, and practice, which will be illustrated with examples from the cross-cultural study of delusions.

Remembering the West End: social science, mental health and the American urban environment, 1939–1968

ABSTRACT:Analysing the urban renewal of Boston's West End during the 1950s, we examine how psychiatrists, social scientists and urban planners understood the relationship between the urban environment and mental health. For psychiatrist Erich Lindemann, the West End offered a unique opportunity to study how acute stress and loss affected populations, thus contributing to social psychiatry, which sought to prevent mental illness by addressing factors in the social and physical environment. While Lindemann's project provided a sophisticated response to the often simplistic arguments about the cities and mental health, it also highlighted the challenges of applying social psychiatric theory in practice.

‘You feel like your whole world is caving in’: A qualitative study of primary care patients’ conceptualisations of emotional distress

General practitioners are tasked with determining the nature of patients’ emotional distress and providing appropriate care. For patients whose symptoms appear to fall near the ‘boundaries’ of psychiatric disorder, this can be difficult with important implications for treatment. There is a lack of qualitative research among patients with symptoms severe enough to warrant consultation, but where general practitioners have refrained from diagnosis. We aimed to explore how patients in this potentially large group conceptualise their symptoms and consequently investigate lay understandings of complex distinctions between emotional distress and psychiatric disorder. Interviews were conducted with 20 primary care patients whom general practitioners had identified as experiencing emotional distress, but had not diagnosed with major depressive disorder. Participants described severe emotional experiences with substantial impact on their lives. The term ‘depression’ was used in many different ways; however, despite severity, they often considered their emotional experience to be different to their perceived notions of ‘actual’ depression or mental illness. Where anxiety was mentioned, use appeared to refer to an underlying generalised state. Participants drew on complex, sometimes fluid and often theoretically coherent conceptualisations of their emotional distress, as related to, but distinct from, mental disorder. These conceptualisations differ from those frequently drawn on in research and treatment guidelines, compounding the difficulty for general practitioners. Developing models of psychological symptoms that draw on patient experience and integrate psychological/psychiatric theory may help patients understand the nature of their experience and, critically, provide the basis for a broader range of primary care interventions.

Psychiatry of Old Age

This chapter of practice exam questions aims to put you, albeit briefly, in the seat of an old age psychiatrist dealing with important aspects of psychiatric disease in older adults. Our population is ageing and this, in addition to wider public understanding and earlier diagnoses of dementia, is leading to an increasing burden of disease. Furthermore it is acknowledged that the incidence of affective and psychotic disorders unexpectedly peaks again as we reach old age and can be devastating if not recognized and managed effectively. The unique challenge of psychiatry of old age is the need for a sound grasp of general medicine and neurology to tackle unusual presentations of illness and possible multiple co-morbidities, in addition to a ground­ing in psychiatric theory. There remains a great need for lateral think­ing, particularly in liaison work on the medical and surgical wards where delirium is rife and can masquerade as everything psychiatric. Within the specialty, true collaboration exists as allied health professionals and psy­chiatrists work together at problem solving to improve patients’ quality of life beyond simply offering medication. An understanding of the pathology, epidemiology, diagnosis, and treat­ment of mental illness and dementia in older adults is an essential skill for any doctor at the coalface. Working with older adults is incredibly rewarding and never stops being educational to the clinician. These patients and their carers will continue to challenge and impress you throughout your career. As you manage to feel more confident with the facts, the practicalities and benefits of talking to and helping older adults become clearer. There is nothing that surpasses learning on the job, with many opportunities through attachments in psychiatry, GPs, ED, and geriatric wards. There are excellent resources available with regard to dementia, including NICE guidelines and the Alzheimer’s Society website. The aim of the following questions is to touch on a range of areas throughout the subject, taking us from first principles to practical applica­tion, through effective management, and support of older adults’ mental health and wellbeing.