Blame or discovery? Walter Benjamin's Jetztzeit, Purdue Pharma LP and 'our values and our historical understanding of psychiatrists'.

This commentary explores issues of professional identity, fairness and discovery in the history of psychiatry in the light of Walter Benjamin's (1892-1940) philosophy of history, especially his concept of Jetztzeit (now-time) and the profession's relationship with the founder and owners of Purdue Pharma LP.

European madness 1910-1980: lessons for today from Alastair Morgan's Continental Philosophy of Psychiatry: The Lure of Madness.

In Continental Philosophy of Psychiatry: The Lure of Madness Alastair Morgan surveys the contributions of a loosely conceived school of psychiatrists, philosophers and social theorists to understanding and responding to madness during the years 1910-1980. Taking my cue from him, I highlight some of the contributors discussed in Morgan's book and reflect that although madness may be difficult or even impossible to articulate effectively in discourse it remains a 'limit experience' which demarcates and illuminates the contours of other thinking and being, including reason and activism. I discuss social and cultural factors that have dulled clinicians' sensitivities to the sounds of madness in recent decades and advocate the need for a reappraisal of our expertise and for a new activism today. What may at first appear as a failed clinical-philosophical tradition remains of professional relevance in today's rapidly transforming circumstances of practice both as inspiration and as cautionary tale.

Not doomed: sociology and psychiatry, and ignorance and expertise.

This paper presents and responds to On the Heels of Ignorance, a sociological study which identifies five fundamental epistemological paradigm changes in American psychiatry in the service of its survival and details several tactics that have been employed to facilitate these professional reinventions. Issues raised in this presentation include the relationship between psychiatry, society and the state, and the nature and significance of psychiatric expertise. The dynamic of these relationships and the complexities of the required expertise create their own challenges for the advancement and professional accountability of the specialty. The conclusion suggests some future imperatives.

Madness and society in Britain.

The fiftieth anniversary of the Royal College of Psychiatrists, and the publication of a detailed multidisciplinary social history of British psychiatry and mental health in recent decades have offered an opportunity to take a helicopter view and reflect on the relation between psychiatry and changing British society. We argue that the time has come to move on from the rhetoric of deinstitutionalisation and community mental healthcare to lead public debate and advocacy for the needs of the mentally ill in the new era of 'meta-community psychiatry and mental healthcare'. We need to respond effectively to the increasing awareness of mental health problems across society, aiming for a pluralist, integrated and well-funded reform led by joint professional and patient interests which could be unstoppable if we all work together.

Images of depression in Charles Baudelaire: clinical understanding in the context of poetry and social history.

There is increasing recognition of the importance of the humanities and arts in medical and psychiatric training. We explore the poetry of Charles Baudelaire (1821-1867) and its evocations of depression through themes of mood, time and self-consciousness and discuss their relation to images of 'spleen', the 'snuffling clock' and the 'sinister mirror'. Following the literary critical commentaries of Walter Benjamin (1892-1940) and Jean Starobinski (1920-2019) we identify some of their roots in the poet's experience of the rapid and alienating urbanisation of 19th-century Paris. Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the 'social' as part of the biopsychosocial constellation.

History of psychiatry in the curriculum? History is part of life and life is part of history: why psychiatrists need to understand it better.

The General Medical Council has introduced a generic professional capabilities framework. It includes the need to develop the professional values, actions and aspirations fundamental to becoming a 'dedicated doctor'. The history of psychiatry has potential to facilitate this learning, both by an understanding of content and the ability to think historically.

From Community to Meta-Community Mental Health Care.

Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.

The Stanmore Nursing Assessment of Psychological Status (SNAPS): not just for spinal cord injury rehabilitation?

Spinal cord injury is an uncommon condition, potentially causing a wide range of consequences and requiring specialist rehabilitation to optimize health, activity and participation. Early psychological response to injury and relations with staff, as well as family, may set the foundations for long-term emotional adjustment, healthcare utilization and quality of life. The Stanmore Nursing Assessment of Psychological Status has been developed at the London Spinal Cord Injury Centre to empower nurses to adopt a consistently empathic approach to patient care, as part of a comprehensive range of rehabilitation team skills. Its use in other spinal cord injury centers and a broader range of clinical environments (hospital and community) should therefore be considered.

The Stanmore Nursing Assessment of Psychological Status: Understanding the emotions of patients with spinal cord injury.

CONTEXT: Research has shown that individuals who have sustained a spinal cord injury can experience strong and abrupt variations in their emotional state; however no instrument for nurses has been developed to assess these patients' psychological status. OBJECTIVE: To develop a brief, reliable instrument to enable nurses to accurately assess, record and respond to spinal cord injury patients' psychological status. METHODS: In Phase 1, semi-structured interviews were conducted with spinal cord injury patients (n = 10) and nurses (n = 10) which were audio recorded, transcribed and thematically analysed to develop the instrument. The instrument's content validity was then ensured via independent expert review. In Phase 2, the instrument was trialled on 80 spinal cord injury patients to determine inter-rater reliability, internal consistency and test-retest reliability. RESULTS: In Phase 1, four core themes (emotional impact, coping, relationships and assessment) were identified together with a number of related sub-themes. In Phase 2, the instrument was shown to have excellent inter-rater reliability, acceptable internal consistency and satisfactory test re-test reliability. Subsequently a rating sheet, user manual and prompt card were produced. CONCLUSION: The new instrument, the Stanmore Nursing Assessment of Psychological Status, was shown to be valid and reliable. It is anticipated that training nurses to use this instrument may help to enhance good emotional care of patients.