Madness and Literature

Mental illness has been a favourite topic for authors throughout the history of literature, and, conversely, psychologists and psychiatrists like Sigmund Freud and Karl Jaspers have been interested in and influenced by literature. Pioneers within philosophy, psychiatry and literature share the endeavour to explore and explain the human mind and behaviour, including what a society deems as being outside perceived normality. This volume engages with literature’s multifarious ways of probing minds and bodies in a state of ill mental health. To encompass this diversity, the theoretical approach is eclectic and transdisciplinary. The cases and the theory are in dialogue with a clinical approach, addressing issues and diagnoses such as trauma, psychosis, bipolar disorder, eating disorders, self-harm, hoarding disorder, PTSD and Digital Sexual Assault. The volume has three parts. Chapters in Part I address literary representations of madness with a historical awareness, outlining the socio-political potentials of madness literature. Part II investigates how representations of mental illness can provide a different way of understanding what it is like to experience alternative states of mind, as well as how theoretical concepts from studies in literature can supplement the language of psychopathology. The chapters in Part III explore ways to apply literary cases in clinical practice. Throughout the book, the contributors explore and explain how the language and discourses of literature (stylistically and theoretically) can teach us something new about what it means to be in ill mental health.

Depressive Symptoms among Self-Harming Adolescents

Self-harm is a common form of high-risk behaviour in adolescents. It is often linked to depression; however, the correlation between these two variables has scarcely been studied. The presented study on a sample of 1,117 adolescents aged from 11 to 19 (mean age 15.56) compares the occurrence of depressive symptoms (measured by the CDI questionnaire) in individuals who self-harm versus those who do not self-harm, it investigates whether there is a correlation between the intensity of self-harm (measured by a modified SHI questionnaire) and depressive symptoms on a sample of self-harming adolescents, as well as explores the specificities of the correlation in terms of the age and sex of the subjects. The results showed that the occurrence of depressive symptoms: 1/ is statistically significantly higher (p = 0.000) among self-harming individuals compared to non-self-harmers, particularly in female subjects, 2/ significantly correlates with the intensity of self-harming behaviour in the group of self-harmers (p = 0.000), and 3/ it decreases with age among self-harming female subjects. The conclusions point to a need for the clarification of the relationship between depressive symptoms and self-harming behaviour (presence and direction of causality) and to the consequences in clinical practice.

Clinical and behavioral correlates in adult methamphetamine users with childhood exposure to household drug and alcohol use

Aims: To describe and compare methamphetamine (MA) users with and without a family history of alcohol or drug () use in the household. Design: A total of 1144 Thai-speaking MA users in Thailand were recruited for a cohort study. Cross-sectional baseline data were analyzed according to their exposure to FAOD use (FAOD+/FAOD-). The Semi-Structured Assessment for Drug Dependence and Alcoholism (SSADDA) was utilized to collect baseline socio-demographic information and variables known to be associated with the impact of FAOD use. Findings: FAOD+ participants had lower average years of education (p<0.01), fewer average months of employment in the past year (p<0.01) and reported higher rates of self-harm experience (p<0.001), gambling (p=0.018) and antisocial personality disorder (p=0.015). FAOD+ participants had more severe clinical, adverse consequences. FAOD+ significantly predicted episodes of lifetime MA use (R2 =0.004, p=0.032), the largest number of drinks ever had in a 24-hour period (R2 =0.01, p=0.001), paranoid experiences ([OR]=1.090, p=0.004), alcohol dependence ([OR]=1.112, p=0.001) and antisocial personality disorder ([OR]=1.139, p=0.015). FAOD+ participants who were exposed to alcohol only were more likely to report a significantly higher number of drinks ever had in a 24-hour periods (p<0.005). Similarly, FAOD+ participants who were exposed to MA use only were significantly more likely to report more frequent use of MA (p<0.005). Conclusions: FAOD+ participants were characterized by a generally more severe clinical presentation than FAOD- participants. Moreover, we show the specificity of drug type mattered, with family exposure of alcohol and MA associated with greater subsequent use of the respective drugs.

A systematic review of evidence-based aftercare for older adults following self-harm

Objective: Self-harm is closely associated with suicide in older adults and may provide opportunity to intervene to prevent suicide. This study aimed to systematically review recent evidence for three components of aftercare for older adults: (1) referral pathways, (2) assessment tools and safety planning approaches and (3) engagement and intervention strategies. Methods: Databases PubMed, Medline, PsychINFO, Embase and CINAHL were searched from January 2010 to 10 July 2021 by two reviewers. Empirical studies reporting aftercare interventions for older adults (aged 60+) following self-harm (including with suicidal intent) were included. Full text of articles with abstracts meeting inclusion criteria were obtained and independently reviewed by three authors to determine final studies for review. Two reviewers extracted data and assessed level of evidence (Oxford) and quality ratings (Alberta Heritage Foundation for Medical Research Standard Quality Assessment Criteria for quantitative and Attree and Milton checklist for qualitative studies), working independently. Results: Twenty studies were reviewed (15 quantitative; 5 qualitative). Levels of evidence were low (3, 4), and quality ratings of quantitative studies variable, although qualitative studies rated highly. Most studies of referral pathways were observational and demonstrated marked variation with no clear guidelines or imperatives for community psychiatric follow-up. Of four screening tools evaluated, three were suicide-specific and one screened for depression. An evidence-informed approach to safety planning was described using cases. Strategies for aftercare engagement and intervention included two multifaceted approaches, psychotherapy and qualitative insights from older people who self-harmed, carers and clinicians. The qualitative studies identified targets for improved aftercare engagement, focused on individual context, experiences and needs. Conclusion: Dedicated older-adult aftercare interventions with a multifaceted, assertive follow-up approach accompanied by systemic change show promise but require further evaluation. Research is needed to explore the utility of needs assessment compared to screening and evaluate efficacy of safety planning and psychotherapeutic approaches.