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Does fMRI Have A Role in Personalized Health Care for Psychiatric Patients?

Alex Fornito and Edward T. Bullmore

in Integrative Neuroscience and Personalized Medicine

Functional magnetic resonance imaging (fMRI) has rapidly emerged as an important tool for understanding the neural correlates of myriad cognitive and emotional processes. By offering a direct window ... More

Functional magnetic resonance imaging (fMRI) has rapidly emerged as an important tool for understanding the neural correlates of myriad cognitive and emotional processes. By offering a direct window into brain activity, fMRI promised to usher in a new era of psychiatry, in which clinical decisions would be based on objective neurobiological measures rather than often-contentious symptom classifications. However, research conducted over the past two decades has failed to realise this goal, and fMRI remains an unutilized tool in the psychiatric clinic. In this chapter, we consider reasons why fMRI has failed to fulfill its promise as a clinically useful tool for psychiatrists and consider recent progress towards this goal in three key clinical domains: diagnosis, prediction and treatment monitoring. In particular, we focus on moving away from using traditional case-control comparisons of mean differences in brain activation to more sophisticated statistical techniques using brain activity patterns to classify individual participants to key clinical outcome variables, such as diagnosis or treatment response.Less

Psychopathologies and Theories of Consciousness: An Overview

Rocco J. Gennaro

in Disturbed Consciousness: New Essays on Psychopathology and Theories of Consciousness

This is the first and introductory chapter to the volume entitled Disturbed Consciousness: New Essays on Psychopathology and Theories of Consciousness. Rocco J. Gennaro presents an overview of ... More

This is the first and introductory chapter to the volume entitled Disturbed Consciousness: New Essays on Psychopathology and Theories of Consciousness. Rocco J. Gennaro presents an overview of philosophical psychopathology, specific disorders of consciousness, and philosophical theories of consciousness. Some background on key terminology and a summary of the essays to follow is also included. Some of the theories of consciousness described are the higher-order thought theory, self-representationalism, and the global workspace theory. A fairly lengthy list of disorders, along with their definitions, is also provided.Less

Therapeutic work and mental illness in America, c. 1830–1970

Ben Harris

in Work, Psychiatry and Society, C. 1750-2015

This chapter shows the key role played by patient labour in the birth, development, and decline of the hospital treatment of the mentally ill in the United States. Patient labour was present at the ... More

This chapter shows the key role played by patient labour in the birth, development, and decline of the hospital treatment of the mentally ill in the United States. Patient labour was present at the birth of the asylum, as a key feature of both theory and practice. In the late nineteenth century, its change to non-therapeutic drudgery corresponded with the ascendance of custodial pessimism and the warehousing of the chronically ill poor. Its revival at the start of the twentieth century was engineered by an optimistic alliance of psychotherapists, clergy and physicians, reflecting the national mood of expansionism and financial promise. Soon, however, both Freudians and harried hospital bureaucrats put an end to the idea that work would help individuals overcome their symptoms and re-direct their inner resources. In public asylums it was succeeded by non-therapeutic labour that hospitals relied upon for economic survival. When the asylums were dismantled in the 1970s and 1980s, legal attacks on unpaid patient work played a key role.Less

Travails of madness: New Jersey, 1800–70

James Moran

in Work, Psychiatry and Society, C. 1750-2015

Focusing on the evidence provided by civil trials in lunacy in the American state of New Jersey, this chapter first examines how work was considered in its relationship to madness in everyday life ... More

Focusing on the evidence provided by civil trials in lunacy in the American state of New Jersey, this chapter first examines how work was considered in its relationship to madness in everyday life outside of an institutional setting. There was a strong link made between work and madness in a society that considered success in work as essential to success in the social organization of the family and the community. Next, this chapter explores how New Jersey’s first lunatic asylum superintendent understood the value of patient labour within his institution. Although asylum work was closely connected to mental health and to varying states of madness the work/madness relationship operated very differently in the new psychiatric settingLess

The Shift to Mechanistic Explanation and Classification

Kelso Cratsley

in Extraordinary Science and Psychiatry: Responses to the Crisis in Mental Health Research

Despite widespread recognition that psychiatry would be better served by a classificatory system based on etiology rather than mere description, it goes without saying that much of the necessary work ... More

Despite widespread recognition that psychiatry would be better served by a classificatory system based on etiology rather than mere description, it goes without saying that much of the necessary work is yet to be done. Most of it will be empirical, but there are also conceptual issues that need to be addressed. In this chapter I take up the increasingly important question of how mechanistic explanation fits into the larger effort to build a scientifically sound etiological and nosological framework for psychiatry. I sketch a rough picture of what mechanistic explanation should look like in the context of psychiatric research, with a focus on several potential challenges posed by the special features of many psychiatric conditions. These include the role of social and environmental factors, the relatively transient nature of symptoms, the presumably complex organization of underlying systems, and the likelihood that many disorders are the product of a nonstandard developmental course. I suggest that these explanatory challenges can be met with a sufficiently broad notion of mechanism, one that allows for something less than the flawless execution of internal operations, attends to organizational relations both within the mechanism itself and across the wider cognitive system, and appeals to the influence of contextual factors.Less

Introduction: Entering a Landscape of Mindfulness

J. L. Cassaniti

in Remembering the Present: Mindfulness in Buddhist Asia

This chapter introduces the landscape of mindfulness practices in the regions of South and Southeast Asia, where people overwhelmingly follow the kind of Theravāda Buddhism from which the modern ... More

This chapter introduces the landscape of mindfulness practices in the regions of South and Southeast Asia, where people overwhelmingly follow the kind of Theravāda Buddhism from which the modern mindfulness movement emerged. The chapter begins with a question: what kind of mindfulness-based therapeutic interventions are and could be used in a Thai psychiatric hospital, as part of a broader Buddhist cultural environment? It answers this question by introducing the methodological and theoretical project of Remembering the Present, including an overview of the interview and survey-based ethnographic research into sati with over 600 psychiatrists, monks, students, and villagers in Thailand, Burma, and Sri Lanka. It also previews some of the central findings of the book, in relation to what the author calls the TAPES of mindfulness: the ways that people frame mindfulness culturally around issues of Temporality, Affect, Power, Ethics, and Selfhood.Less

Two Trauma Communities: A Philosophical Archaeology of Cultural and Clinical Trauma Theories

Vincenzo Di Nicola

in Trauma and Transcendence: Suffering and the Limits of Theory

While the goal of both clinical work and cultural research generally is the transformation and transcendence of trauma, these communities struggle to characterize trauma as a unified discourse even ... More

While the goal of both clinical work and cultural research generally is the transformation and transcendence of trauma, these communities struggle to characterize trauma as a unified discourse even within one discipline. This chapter makes three proposals that provide order for the concept of trauma through conceptual dichotomies that divide their discourses: first, the term has accrued a supplementarity or excess, which helps explain the variation between the clinical use of trauma and its cultural avatar; second, theorists must separate the ways the word trauma deployed within the trauma process; third, trauma must be separated radically from Event, which is the subtext of a cultural trauma theory. This philosophical archaeology offers keys of translation between these competing cultural and psychiatric trauma theories, calls to deactivate the desubjectivation associated with trauma, and opens new prospects for interdisciplinary research in these intersecting fields based on the possibilities of the Event.Less

Below the Bar: The U.S. Army and Limited Service Manpower

Sanders Marble

in Scraping the Barrel: The Military Use of Substandard Manpower, 1860–1960

During World War I, the US had to quickly mobilize an army. Rather than demanding full physical fitness, it started accepting men with job skills, and tacitly accepted that the army was an industrial ... More

During World War I, the US had to quickly mobilize an army. Rather than demanding full physical fitness, it started accepting men with job skills, and tacitly accepted that the army was an industrial organization. WWI ended too quickly for the full implications to be felt, and the system was kept ‘on the shelf’ between the world wars. During WWII the system failed. It had only two categories (General Service and Limited Service) that did not reflect all the gradations of jobs. The US Army replaced Limited Service with a graded system based on physical ability.Less

Contested Boundaries: Psychiatry, Disease, and Diagnosis

Charles E. Rosenberg

in Applied Ethics in Mental Health Care: An Interdisciplinary Reader

Since the 19th century, we have come to think of disease in terms of specific entities--entities defined and legitimated in terms of characteristic somatic mechanisms. Since the last third of that ... More

Since the 19th century, we have come to think of disease in terms of specific entities--entities defined and legitimated in terms of characteristic somatic mechanisms. Since the last third of that century, we have expanded would-be disease categories to include an ever-broader variety of emotional pain, idiosyncrasy, and culturally unsettling behaviors. Psychiatry has been the residuary legatee of these developments, developments that have always been contested at the ever-shifting boundary between disease and deviance, feeling and symptom, the random and the determined, the stigmatized and the value-free. Even in our era of reductionist hopes, psychopharmaceutical practice, and corporate strategies, the legitimacy of many putative disease categories will remain contested. The use of the specific disease entity model will always be a reductionist means to achieve necessarily holistic ends, both in terms of cultural norms and the needs of suffering individuals. Bureaucratic rigidities and stakeholder conflicts structure and intensify such boundary conflicts, as do the interests and activism of an interested lay public.Less

Moot Questions in Psychiatric Ethics

Ralph B. Little and Edward A. Strecker

in Applied Ethics in Mental Health Care: An Interdisciplinary Reader

This paper presents an early example of empirical applied ethics in which the authors survey psychiatrists about their views on an array of array of common ethical issues.

The Ethics of Psychotherapy

Toksoz B. Karasu

in Applied Ethics in Mental Health Care: An Interdisciplinary Reader

The author addresses the ethics of psychotherapy in terms of the interface between science and ethics, the goals of treatment, the therapeutic relationship, and special issues of confidentiality and ... More

The author addresses the ethics of psychotherapy in terms of the interface between science and ethics, the goals of treatment, the therapeutic relationship, and special issues of confidentiality and therapist-patient sex. He considers the problems of multiple therapeutic modalities, dual allegiance of the therapist, the therapeutic use (and abuse) of power, and issues of dependency and suggests ways to maximize the clinician’s exercise of ethical choices. Ethical dilemmas in psychotherapy are not entirely soluble; ultimately, the therapist, guided by his or her profession as a group, still be able to find answers to the complex problems that inevitably arise.Less

Character Virtues in Psychiatric Practice

Jennifer Radden and John Z. Sadler

in Applied Ethics in Mental Health Care: An Interdisciplinary Reader

In this discussion by a clinician and a philosopher, clinical scenarios using exchanges and inner monologue illustrate key aspects of virtues. Virtues are acquired through habituation; they are ... More

In this discussion by a clinician and a philosopher, clinical scenarios using exchanges and inner monologue illustrate key aspects of virtues. Virtues are acquired through habituation; they are habits of mind as much as behavior; they are as a group heterogeneous, and individually composite; they involve affective responses; they are not impartial; they are compatible with the “role morality” required of professionals; they are responses to particular temptations and weaknesses; and they include, in the capacity for practical judgment known as phronesis, a way of resolving many of the conflicts and dilemmas that arise in practice. The virtue approach to ethics will likely be most useful in the educational setting where practitioners are learning clinical skills and socialized into the broad ethos of professional practice. Aspects of this educational effort are briefly reviewed, including whether it ought to be undertaken at all, whether the effort to teach virtues is possible, and, if so, how it can be achieved.Less

Psychiatric Advance Directives and the Treatment of Committed Patients

Paul S. Appelbaum

in Applied Ethics in Mental Health Care: An Interdisciplinary Reader

Advance directives have been one of the more promising innovations in recent years to give patients a greater voice in their psychiatric treatment. The author describes the clinical-legal ... More

Advance directives have been one of the more promising innovations in recent years to give patients a greater voice in their psychiatric treatment. The author describes the clinical-legal implications of the Hargrave vs. Vermont. Hargrave represents a continuation of the battle over the right of psychiatric patients to refuse treatment that began in the 1970s.Less

Denying Autonomy in Order to Create It: The Paradox of Forcing Treatment upon Addicts

Arthur L. Caplan

in Applied Ethics in Mental Health Care: An Interdisciplinary Reader

American bioethics affords extraordinary respect to the values of personal autonomy and patient self-determination. Many would argue that the most significant achievement deriving from bioethics in ... More

American bioethics affords extraordinary respect to the values of personal autonomy and patient self-determination. Many would argue that the most significant achievement deriving from bioethics in the past 40 years has been to replace a paternalistic model of health provider–patient relationships with one that sees patient self-determination as the normative foundation for practice. This shift away from paternalism towards respect for self-determination has been on going in behavioral and mental health as well, especially as it is reflected in the ‘recovery movement’. As a result of the emphasis placed on patient autonomy, arguments in favor of mandatory treatment are rare and often half-hearted. Can a case be made which acknowledges the centrality and importance of autonomy but which would still deem ethical mandatory treatment for addicts? I think it can.Less