The journal of the American Academy of Psychiatry and the Law, 2014
In this commentary, I reflect on the narratives of offending that are generated in the courtroom ... more In this commentary, I reflect on the narratives of offending that are generated in the courtroom and those that are generated in the therapeutic space between an offender patient and his or her therapist. I discuss the similarities and differences between these different stories and explore the role of the psychiatrist in both cases.
Abstract 1. This chapter is set in a forensic psychiatric hospital and is concerned with group th... more Abstract 1. This chapter is set in a forensic psychiatric hospital and is concerned with group therapy for patients who have murdered. The authors argue that all homicides occur within the context of a group (ie more than two people), be it the family, the gang, the community, ...
The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa,... more The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa, Thomas Fuchs and Till Grohmann. Summa argues that even though it is true that there is a distinction and a discontinuity between reality and fiction, reality shapes fiction and the experience of fiction too acts to reconfigure our sense of reality. This chapter does not deal directly with the discontinuities between 'psychotic' reality and everyday reality, but it is clear that much of what is explored is relevant to an understanding of how patients traverse the differing worlds and may also help to illustrate the interpenetration of psychotic reality and everyday experiences. Fuchs focuses on what he terms the 'as-if ' function; this is the human cognitive function that allows us 'to suspend the force and validity of the immediate experience and to enter a parallel world of imagination, daydreaming, hypothetical thought, fiction, pretence, role play or theatre'. Fuchs' case is that impairment of this cognitive function underlies the concrete attitude, delusions and what he terms 'transitivism' (the threat of loss-of-self that is posed by the presence of others) in schizophrenia. I am not persuaded by his arguments but nonetheless his is a novel approach. Finally, Grohmann disputes the role of the disturbance of Theory of Mind in schizophrenia and autism and argues for an account based on the phenomenology of intersubjectivity. There's no doubting the fact that the case being put forward is not persuasive but it illustrates that, even in a condition such as autism where certain empirical facts are settled and established, alternative accounts are still possible. This is a densely written book that has a lot to offer, but it is not for a general audience. Matters that have a central place in psychiatric thought are treated with seriousness and rigour alongside approaches that will surprise many psychiatrists whilst at the same making the subject seem fresh and vital.
Introduction, Gwen Adshead, Broadmoor Hospital and Christine Brown, University of Exeter. 1. Do y... more Introduction, Gwen Adshead, Broadmoor Hospital and Christine Brown, University of Exeter. 1. Do you feel lucky? Assessing capacity to consent to research in forensic mental health practice, Gwen Adshead, Broadmoor Hospital. 2. In whose best interest: Consent by adolescence to research participation. Justine Rothwell, Mental Health Services of Salford and Carley Smith. 3. Dangerous stories: Consent and confidentiality in health and social care research, Christine Brown, University of Exeter. 4. User views and ethical issues in qualitative methods, Annie Bartlett, St George's Hospital Medical School and Krysia Canvin. 5. Ethical issues from risk assessment research, Caroline Logan, University of Liverpool. 6. Multidisciplinary aspects of forensic mental health research, Tom Mason, South Wales Forensic Services. 7. Research ethics committees and research in forensic psychiatry, Gwen Adshead, Broadmoor Hospital and Christine Brown, University of Exeter. 8.Gender sexuality in research, Jean Ruane, University of Sheffield. Conclusion. Index.
International Journal of Mental Health and Capacity Law, 2014
The only freedom which deserves the name is that of pursuing our own good in our own way, so long... more The only freedom which deserves the name is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs or impede their efforts to obtain it. Each is the proper guardian of his own health, whether bodily or mental and spiritual"
is too modest. He describes this collection of articles (previously published in the Guardian new... more is too modest. He describes this collection of articles (previously published in the Guardian newspaper and elsewhere) as a kind of 'statistic toilet book' , and says he is a 'student of wrongness' , a self-deprecating 'nerd evangelist' . Do not be taken in. Goldacre has a beguiling facility with numbers, but he is no trainspotter. He is not interested in data for their own sake; his interest is in what that information reveals. Insight backed by facts is a powerful position, especially when delivered in Goldacre's vividly iconoclastic prose: he writes with the fervour of a buccaneering moralist. What does it feel like to be so engaged? Goldacre writes: 'You might well view my work as pointless: like Sisyphus in an anorak, fighting my way up a greasy waterslide, defeated by the torrent of sewage, desperately trying to scratch one grumpy correction into yesterday's chip wrapper. But journalism like this is a genuine public health problem.' If you share his outrage at the Daily Mail's 'ongoing project to divide all the inanimate objects in the world into the ones that either cause or prevent cancer', and are exasperated by unpersuasive efforts to make 'Ka-Boom!' science 'FUN!' then these articles will evoke a strange feeling: an excited pride at seeing statistics being deployed in anger, mixed with despair at the folly and corruption in public life that Goldacre exposes. His targets include politicians' mendacious indifference to facts, and the irrationality of public policy. In a piece entitled 'Andrew Lansley and his Imaginary Evidence' , he directs his anger at the erstwhile Secretary of State for Health in England: 'There's no need to hide behind a cloak of scientific authority, murmuring the word ''evidence'' into microphones. If your reforms are a matter of ideology, legacy, whim and faith, then like many of your predecessors you could simply say so, and leave ''evidence'' to people who mean it.' Goldacre exposes the venality of vested interests, especially in bad Pharma, bad journalism, and a clutch of outrageous quacks. But he also criticises the 'real scientists, who can behave as badly as anyone else'. A word to ourselves: no one is immune to complacency and bias. If we are to practise a 'good' psychiatry rather than a 'bad' one, we need to inoculate our profession with Goldacre antibodies. We might usefully share his admiration for the motto of the Royal Society: Nullius in verba -'on the word of nobody'.
Current Issues in Assessment, Treatment and Research, 2001
Ethics in medicine and child abuse are both topics that generate passionate emotions. The study o... more Ethics in medicine and child abuse are both topics that generate passionate emotions. The study of bioethics particularly addresses those dilemmas which occur when clinicians interact intimately with vulnerable people, who are dependent on them. Doctor-patient ...
In 'The Book-Bag', Somerset Maugham is characteristically waspish about book readers: 'Some peopl... more In 'The Book-Bag', Somerset Maugham is characteristically waspish about book readers: 'Some people read for instruction, which is praiseworthy, and some for pleasure, which is innocent, but not a few read from habit, and I suppose that this is neither innocent nor praiseworthy'. 1
In this chapter I will argue that the two notions of an ethic of justice and an ethic of care hav... more In this chapter I will argue that the two notions of an ethic of justice and an ethic of care have particular relevance for ethical reasoning in psychiatry. Therapeutic relationships in psychiatry are based on relationships that endure over time, and are affected by the ...
aetiology and treatment in a diagnosis, aetiology and treatment in a multimodal way. Treatment re... more aetiology and treatment in a diagnosis, aetiology and treatment in a multimodal way. Treatment resistance is multimodal way. Treatment resistance is included. Single authors usually avoid included. Single authors usually avoid straying from their disciplinary base (psy-straying from their disciplinary base (psychopharmacology or psychological ther-chopharmacology or psychological therapy) and so leave the tricky business of apy) and so leave the tricky business of integration to the generalist reader. The integration to the generalist reader. The strength of this book is that the author has strength of this book is that the author has done the work of integration. Another done the work of integration. Another strength that will appeal particularly to strength that will appeal particularly to candidates about to write the essay paper candidates about to write the essay paper for Part II of the MRCPsych examination is for Part II of the MRCPsych examination is the developmental approach that the the developmental approach that the author takes. Despite its title, the book is author takes. Despite its title, the book is not restricted to an adult perspective and not restricted to an adult perspective and so, for example, the relationship between so, for example, the relationship between childhood separation disorder and later life childhood separation disorder and later life problems is explored. problems is explored. The weakness of a textbook like this is The weakness of a textbook like this is that parts of it will rapidly fall out of date, that parts of it will rapidly fall out of date, but this is not my main criticism here. I but this is not my main criticism here. I welcome many aspects of this book -the welcome many aspects of this book -the integration, the developmental viewpoint integration, the developmental viewpoint and the guide to treatment resistance -but and the guide to treatment resistance -but an opportunity to go further and to take a an opportunity to go further and to take a critical stance has been missed. The book critical stance has been missed. The book fairly reflects the debates that exist between fairly reflects the debates that exist between believers, but the critical voice is missing: believers, but the critical voice is missing: the voice that questions why there is so the voice that questions why there is so much evidence for some forms of treatment much evidence for some forms of treatment and not others, and that challenges the and not others, and that challenges the assumptions underlying the diagnostic assumptions underlying the diagnostic systems that constrain our thinking. systems that constrain our thinking.
Abstract Edited by John Gunn and Pamela J. Taylor. Butterworth Heinemann. Oxford, 1993; 1151 pp.;... more Abstract Edited by John Gunn and Pamela J. Taylor. Butterworth Heinemann. Oxford, 1993; 1151 pp.; recommended retail price $350; ISBN 0 7506 0349 6.
Psychopaths have emotional impairments that can be expressed in persistent criminal behavior. UK ... more Psychopaths have emotional impairments that can be expressed in persistent criminal behavior. UK and US law has traditionally excused disordered individuals for their crimes citing these emotional impairments as a cause for their criminal behaviour. The discussion of whether psychopaths are morally responsible for their behaviour has long taken place in the realm of philosophy. However, in recent years, this has moved into scientific and psychiatric investigation, fundamentally so with the development of Robert Hare's diagnostic tool, the ...
In this commentary, I reflect on the narratives of offending that are generated in the courtroom ... more In this commentary, I reflect on the narratives of offending that are generated in the courtroom and those that are generated in the therapeutic space between an offender patient and his or her therapist. I discuss the similarities and differences between these different stories and explore the role of the psychiatrist in both cases.
History, Philosophy and Theory of the Life Sciences
Discourses are social conversations which use words and images to apply meaning to human social e... more Discourses are social conversations which use words and images to apply meaning to human social experience. As such, they may be highly influential in terms of defining and regulating ideas of what is 'normal' socially, and also what is 'good' in moral terms. In this chapter I will argue that the concept of psychopathy, like that of gender, acts as a regulatory discourse that shapes ideas about what is 'normal' and 'abnormal' in terms of violence to others. I will discuss this argument in relation to women who commit acts of serious violence.
The journal of the American Academy of Psychiatry and the Law, 2014
In this commentary, I reflect on the narratives of offending that are generated in the courtroom ... more In this commentary, I reflect on the narratives of offending that are generated in the courtroom and those that are generated in the therapeutic space between an offender patient and his or her therapist. I discuss the similarities and differences between these different stories and explore the role of the psychiatrist in both cases.
The journal of the American Academy of Psychiatry and the Law, 2017
In this commentary, I explore two questions raised by Angelotta and Appelbaum's study. First,... more In this commentary, I explore two questions raised by Angelotta and Appelbaum's study. First, I offer an English legal perspective on the protection of children from their mothers, looking at both civil (family) and criminal law. Second, I discuss the idealization of motherhood that is implied by the prosecution of pregnant women; the denigration of those who fail this ideal; and the way that idealization and denigration contribute to injustice for women. I conclude by offering comments on the implications for those assessing women accused of harming their unborn child.
Mindfulness-based cognitive therapy (MBCT) is an area of modern psychology that provides a succes... more Mindfulness-based cognitive therapy (MBCT) is an area of modern psychology that provides a successful method for preventing the recurrence of depression. The standard theory of MBCT may be interpreted in terms of a simple theoretical model that employs incompatible variables as its fundamental observable quantities. Although the MBCT theory is not related to or derived from quantum theory, the existence of incompatible variables results in “quantal” phenomena, such as interference and the uncertainty principle, which have been widely believed to occur only as a consequence of the laws of quantum mechanics. The predictions of the model are subject to experimental testing and at present the model agrees with all published clinical data. To our knowledge, this work is the first quantitative theoretical treatment of a natural non-quantal system possessing incompatible variables. It confirms the intuition of Bohr and Heisenberg that incompatible variables may exist in human psychology.
The journal of the American Academy of Psychiatry and the Law, 2014
In this commentary, I reflect on the narratives of offending that are generated in the courtroom ... more In this commentary, I reflect on the narratives of offending that are generated in the courtroom and those that are generated in the therapeutic space between an offender patient and his or her therapist. I discuss the similarities and differences between these different stories and explore the role of the psychiatrist in both cases.
Abstract 1. This chapter is set in a forensic psychiatric hospital and is concerned with group th... more Abstract 1. This chapter is set in a forensic psychiatric hospital and is concerned with group therapy for patients who have murdered. The authors argue that all homicides occur within the context of a group (ie more than two people), be it the family, the gang, the community, ...
The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa,... more The most relevant chapters for psychiatrists in this fascinating book are those by Michela Summa, Thomas Fuchs and Till Grohmann. Summa argues that even though it is true that there is a distinction and a discontinuity between reality and fiction, reality shapes fiction and the experience of fiction too acts to reconfigure our sense of reality. This chapter does not deal directly with the discontinuities between 'psychotic' reality and everyday reality, but it is clear that much of what is explored is relevant to an understanding of how patients traverse the differing worlds and may also help to illustrate the interpenetration of psychotic reality and everyday experiences. Fuchs focuses on what he terms the 'as-if ' function; this is the human cognitive function that allows us 'to suspend the force and validity of the immediate experience and to enter a parallel world of imagination, daydreaming, hypothetical thought, fiction, pretence, role play or theatre'. Fuchs' case is that impairment of this cognitive function underlies the concrete attitude, delusions and what he terms 'transitivism' (the threat of loss-of-self that is posed by the presence of others) in schizophrenia. I am not persuaded by his arguments but nonetheless his is a novel approach. Finally, Grohmann disputes the role of the disturbance of Theory of Mind in schizophrenia and autism and argues for an account based on the phenomenology of intersubjectivity. There's no doubting the fact that the case being put forward is not persuasive but it illustrates that, even in a condition such as autism where certain empirical facts are settled and established, alternative accounts are still possible. This is a densely written book that has a lot to offer, but it is not for a general audience. Matters that have a central place in psychiatric thought are treated with seriousness and rigour alongside approaches that will surprise many psychiatrists whilst at the same making the subject seem fresh and vital.
Introduction, Gwen Adshead, Broadmoor Hospital and Christine Brown, University of Exeter. 1. Do y... more Introduction, Gwen Adshead, Broadmoor Hospital and Christine Brown, University of Exeter. 1. Do you feel lucky? Assessing capacity to consent to research in forensic mental health practice, Gwen Adshead, Broadmoor Hospital. 2. In whose best interest: Consent by adolescence to research participation. Justine Rothwell, Mental Health Services of Salford and Carley Smith. 3. Dangerous stories: Consent and confidentiality in health and social care research, Christine Brown, University of Exeter. 4. User views and ethical issues in qualitative methods, Annie Bartlett, St George's Hospital Medical School and Krysia Canvin. 5. Ethical issues from risk assessment research, Caroline Logan, University of Liverpool. 6. Multidisciplinary aspects of forensic mental health research, Tom Mason, South Wales Forensic Services. 7. Research ethics committees and research in forensic psychiatry, Gwen Adshead, Broadmoor Hospital and Christine Brown, University of Exeter. 8.Gender sexuality in research, Jean Ruane, University of Sheffield. Conclusion. Index.
International Journal of Mental Health and Capacity Law, 2014
The only freedom which deserves the name is that of pursuing our own good in our own way, so long... more The only freedom which deserves the name is that of pursuing our own good in our own way, so long as we do not attempt to deprive others of theirs or impede their efforts to obtain it. Each is the proper guardian of his own health, whether bodily or mental and spiritual"
is too modest. He describes this collection of articles (previously published in the Guardian new... more is too modest. He describes this collection of articles (previously published in the Guardian newspaper and elsewhere) as a kind of 'statistic toilet book' , and says he is a 'student of wrongness' , a self-deprecating 'nerd evangelist' . Do not be taken in. Goldacre has a beguiling facility with numbers, but he is no trainspotter. He is not interested in data for their own sake; his interest is in what that information reveals. Insight backed by facts is a powerful position, especially when delivered in Goldacre's vividly iconoclastic prose: he writes with the fervour of a buccaneering moralist. What does it feel like to be so engaged? Goldacre writes: 'You might well view my work as pointless: like Sisyphus in an anorak, fighting my way up a greasy waterslide, defeated by the torrent of sewage, desperately trying to scratch one grumpy correction into yesterday's chip wrapper. But journalism like this is a genuine public health problem.' If you share his outrage at the Daily Mail's 'ongoing project to divide all the inanimate objects in the world into the ones that either cause or prevent cancer', and are exasperated by unpersuasive efforts to make 'Ka-Boom!' science 'FUN!' then these articles will evoke a strange feeling: an excited pride at seeing statistics being deployed in anger, mixed with despair at the folly and corruption in public life that Goldacre exposes. His targets include politicians' mendacious indifference to facts, and the irrationality of public policy. In a piece entitled 'Andrew Lansley and his Imaginary Evidence' , he directs his anger at the erstwhile Secretary of State for Health in England: 'There's no need to hide behind a cloak of scientific authority, murmuring the word ''evidence'' into microphones. If your reforms are a matter of ideology, legacy, whim and faith, then like many of your predecessors you could simply say so, and leave ''evidence'' to people who mean it.' Goldacre exposes the venality of vested interests, especially in bad Pharma, bad journalism, and a clutch of outrageous quacks. But he also criticises the 'real scientists, who can behave as badly as anyone else'. A word to ourselves: no one is immune to complacency and bias. If we are to practise a 'good' psychiatry rather than a 'bad' one, we need to inoculate our profession with Goldacre antibodies. We might usefully share his admiration for the motto of the Royal Society: Nullius in verba -'on the word of nobody'.
Current Issues in Assessment, Treatment and Research, 2001
Ethics in medicine and child abuse are both topics that generate passionate emotions. The study o... more Ethics in medicine and child abuse are both topics that generate passionate emotions. The study of bioethics particularly addresses those dilemmas which occur when clinicians interact intimately with vulnerable people, who are dependent on them. Doctor-patient ...
In 'The Book-Bag', Somerset Maugham is characteristically waspish about book readers: 'Some peopl... more In 'The Book-Bag', Somerset Maugham is characteristically waspish about book readers: 'Some people read for instruction, which is praiseworthy, and some for pleasure, which is innocent, but not a few read from habit, and I suppose that this is neither innocent nor praiseworthy'. 1
In this chapter I will argue that the two notions of an ethic of justice and an ethic of care hav... more In this chapter I will argue that the two notions of an ethic of justice and an ethic of care have particular relevance for ethical reasoning in psychiatry. Therapeutic relationships in psychiatry are based on relationships that endure over time, and are affected by the ...
aetiology and treatment in a diagnosis, aetiology and treatment in a multimodal way. Treatment re... more aetiology and treatment in a diagnosis, aetiology and treatment in a multimodal way. Treatment resistance is multimodal way. Treatment resistance is included. Single authors usually avoid included. Single authors usually avoid straying from their disciplinary base (psy-straying from their disciplinary base (psychopharmacology or psychological ther-chopharmacology or psychological therapy) and so leave the tricky business of apy) and so leave the tricky business of integration to the generalist reader. The integration to the generalist reader. The strength of this book is that the author has strength of this book is that the author has done the work of integration. Another done the work of integration. Another strength that will appeal particularly to strength that will appeal particularly to candidates about to write the essay paper candidates about to write the essay paper for Part II of the MRCPsych examination is for Part II of the MRCPsych examination is the developmental approach that the the developmental approach that the author takes. Despite its title, the book is author takes. Despite its title, the book is not restricted to an adult perspective and not restricted to an adult perspective and so, for example, the relationship between so, for example, the relationship between childhood separation disorder and later life childhood separation disorder and later life problems is explored. problems is explored. The weakness of a textbook like this is The weakness of a textbook like this is that parts of it will rapidly fall out of date, that parts of it will rapidly fall out of date, but this is not my main criticism here. I but this is not my main criticism here. I welcome many aspects of this book -the welcome many aspects of this book -the integration, the developmental viewpoint integration, the developmental viewpoint and the guide to treatment resistance -but and the guide to treatment resistance -but an opportunity to go further and to take a an opportunity to go further and to take a critical stance has been missed. The book critical stance has been missed. The book fairly reflects the debates that exist between fairly reflects the debates that exist between believers, but the critical voice is missing: believers, but the critical voice is missing: the voice that questions why there is so the voice that questions why there is so much evidence for some forms of treatment much evidence for some forms of treatment and not others, and that challenges the and not others, and that challenges the assumptions underlying the diagnostic assumptions underlying the diagnostic systems that constrain our thinking. systems that constrain our thinking.
Abstract Edited by John Gunn and Pamela J. Taylor. Butterworth Heinemann. Oxford, 1993; 1151 pp.;... more Abstract Edited by John Gunn and Pamela J. Taylor. Butterworth Heinemann. Oxford, 1993; 1151 pp.; recommended retail price $350; ISBN 0 7506 0349 6.
Psychopaths have emotional impairments that can be expressed in persistent criminal behavior. UK ... more Psychopaths have emotional impairments that can be expressed in persistent criminal behavior. UK and US law has traditionally excused disordered individuals for their crimes citing these emotional impairments as a cause for their criminal behaviour. The discussion of whether psychopaths are morally responsible for their behaviour has long taken place in the realm of philosophy. However, in recent years, this has moved into scientific and psychiatric investigation, fundamentally so with the development of Robert Hare's diagnostic tool, the ...
In this commentary, I reflect on the narratives of offending that are generated in the courtroom ... more In this commentary, I reflect on the narratives of offending that are generated in the courtroom and those that are generated in the therapeutic space between an offender patient and his or her therapist. I discuss the similarities and differences between these different stories and explore the role of the psychiatrist in both cases.
History, Philosophy and Theory of the Life Sciences
Discourses are social conversations which use words and images to apply meaning to human social e... more Discourses are social conversations which use words and images to apply meaning to human social experience. As such, they may be highly influential in terms of defining and regulating ideas of what is 'normal' socially, and also what is 'good' in moral terms. In this chapter I will argue that the concept of psychopathy, like that of gender, acts as a regulatory discourse that shapes ideas about what is 'normal' and 'abnormal' in terms of violence to others. I will discuss this argument in relation to women who commit acts of serious violence.
The journal of the American Academy of Psychiatry and the Law, 2014
In this commentary, I reflect on the narratives of offending that are generated in the courtroom ... more In this commentary, I reflect on the narratives of offending that are generated in the courtroom and those that are generated in the therapeutic space between an offender patient and his or her therapist. I discuss the similarities and differences between these different stories and explore the role of the psychiatrist in both cases.
The journal of the American Academy of Psychiatry and the Law, 2017
In this commentary, I explore two questions raised by Angelotta and Appelbaum's study. First,... more In this commentary, I explore two questions raised by Angelotta and Appelbaum's study. First, I offer an English legal perspective on the protection of children from their mothers, looking at both civil (family) and criminal law. Second, I discuss the idealization of motherhood that is implied by the prosecution of pregnant women; the denigration of those who fail this ideal; and the way that idealization and denigration contribute to injustice for women. I conclude by offering comments on the implications for those assessing women accused of harming their unborn child.
Mindfulness-based cognitive therapy (MBCT) is an area of modern psychology that provides a succes... more Mindfulness-based cognitive therapy (MBCT) is an area of modern psychology that provides a successful method for preventing the recurrence of depression. The standard theory of MBCT may be interpreted in terms of a simple theoretical model that employs incompatible variables as its fundamental observable quantities. Although the MBCT theory is not related to or derived from quantum theory, the existence of incompatible variables results in “quantal” phenomena, such as interference and the uncertainty principle, which have been widely believed to occur only as a consequence of the laws of quantum mechanics. The predictions of the model are subject to experimental testing and at present the model agrees with all published clinical data. To our knowledge, this work is the first quantitative theoretical treatment of a natural non-quantal system possessing incompatible variables. It confirms the intuition of Bohr and Heisenberg that incompatible variables may exist in human psychology.
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