Andrew Lakoff argues that a new 'pharmaceutical' way of thinking about and acting upon mental disorder is coming to reshape not only the field of psychiatry, but also our very notions of self. Drawing from a comprehensive ethnography of psychiatric practice in Argentina (a country which boasts the most psychoanalysts per capita in the world) Lakoff looks at new ways of understanding and intervening in human behaviour. He charts the globalization of pharmacology, particularily the global impact of US psychiatry and US models of illness, and further illustrates the clashes, conflicts, alliances and reformulations that take place when psychoanalytic and psychopharmacological models of illness and cure meet. Highlighting the social and political implications that these new forms of expertise about human behaviour and human thought bring, Lakoff presents an arresting case-study that will appeal to scholars and students alike.

Pharmaceutical Reason: Knowledge and Value in Global Psychiatry

In this classic of French cultural studies, Georges Didi-Huberman traces the intimate and reciprocal relationship between the disciplines of psychiatry and photography in the late nineteenth century. Focusing on the immense photographic output of the Salpetriere hospital, the notorious Parisian asylum for insane and incurable women, Didi-Huberman shows the crucial role played by photography in the invention of the category of hysteria. Under the direction of the medical teacher and clinician Jean-Martin Charcot, the inmates of Salpetriere identified as hysterics were methodically photographed, providing skeptical colleagues with visual proof of hysteria's specific form. These images, many of which appear in this book, provided the materials for the multivolume album Iconographie photographique de la Salpetriere. As Didi-Huberman shows, these photographs were far from simply objective documentation. The subjects were required to portray their hysterical "type" -- they performed their own hysteria. Bribed by the special status they enjoyed in the purgatory of experimentation and threatened with transfer back to the inferno of the incurables, the women patiently posed for the photographs and submitted to presentations of hysterical attacks before the crowds that gathered for Charcot's "Tuesday Lectures." Charcot did not stop at voyeuristic observation. Through techniques such as hypnosis, electroshock therapy, and genital manipulation, he instigated the hysterical symptoms in his patients, eventually giving rise to hatred and resistance on their part. Didi-Huberman follows this path from complicity to antipathy in one of Charcot's favorite "cases," that of Augustine, whose image crops up again and again in the Iconographie. Augustine's virtuosic performance of hysteria ultimately became one of self-sacrifice, seen in pictures of ecstasy, crucifixion, and silent cries.

Invention of hysteria : Charcot and the photographic iconography of the Salpêtrière

Nurses in psychiatric settings have an important role to play in the application of seclusion, a measure that continues to be a frequently used intervention for the management of disturbing patient behaviours. Albeit a controversial measure, isolating patients remains a common institutional practice that has received widespread attention from a political, ethical, legal, and clinical standpoint. Although there is an abundance of scientific work on the subject, few studies have examined the experience of patients being confined. In order to improve the quality of nursing care surrounding this measure it appeared essential to obtain data on patients' perspectives, information deemed valuable in orienting nursing interventions. This qualitative study, guided by a phenomenological research design, aimed at describing and gaining a better understanding of patients with a severe and persistent psychiatric disorder who were placed in a seclusion room while hospitalized on a closed psychiatric unit. Using a semi-structured, non-directive interview format, a total of six patients participated in this study. Content analysis of participants' narratives yielded three main themes that appeared to be central to their experience of seclusion: their experience of seclusion on an emotional level, their perception of this intervention, and how they coped during their stay in the seclusion room. Major findings emerging from this nursing study centred on the following dimensions: patients' perceptions of seclusion as a punitive measure and a modality for social control and, the experience of seclusion serving as an intensification of already existing feelings of exclusion, rejection, abandonment, and isolation. In addition the findings also suggest that it is not seclusion per se that impacts on their negative perception and negative emotional experience but rather the lack of nurse-patient contact during the seclusion experience. Furthermore, whether patients coped by regressing, acting out, or taking on a more compliant stance, they appeared to be motivated by a need to connect with staff. This points to the importance of the relational aspects of nursing care when applying this restrictive measure. A need for modifying the institutional culture surrounding seclusion and transforming nursing practices are discussed as are future research endeavours.

The mentally ill and social exclusion: a critical examination of the use of seclusion from the patient's perspective

This paper offers a conceptual and historical analysis of descriptive psychopathology. The first section defines it as a cognitive system constituted by terms, assumptions and rules for its application. It traces the conceptual implications of this definition and relates them to clinical practice. The second section contains an up-to-date assessment of current historical work on descriptive psychopathology and offers a new hypothesis to account for its development during the nineteenth century. It is suggested that the work involved in the testing of the hypothesis should be carried out by psychiatrists with historical training and as a separate speciality. It is concluded that the historical calibration of psychiatric symptoms must be considered as an essential stage in the construction of a viable descriptive psychopathology.

Descriptive psychopathology: conceptual and historical aspects.

One of the assumptions made when mental problems are defined as a medical problem is that certain problems, certain diagnoses, are chronic. Nevertheless, a substantial number of follow-up studies h ...

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Gladys Swain

Papers

La pratique de l'esprit humain : l'institution asilaire et la révolution démocratique

Le sujet de la folie : naissance de la psychiatrie

Des passions : considérées comme causes, symptômes et moyens curatifs de l'aliénation mentale

Le vrai Charcot : les chemins imprévus de l'inconscient

Dialogue avec l'insensé : essais d'histoire de la psychiatrie