“But What About Real Mental Illnesses?” Alternatives to the Disease Model Approach to “Schizophrenia”

The old dichotomy between “neurosis” and “psychosis” appears to be alive and well in the debate about psychiatric diagnosis. It is often suggested that while diagnostic alternatives may be appropriate for the relatively common forms of distress with which we can all identify such as anxiety and depression, psychiatric diagnoses remain vital for experiences such as hearing voices, holding beliefs that others find strange, or appearing out of touch with reality—experiences that are traditionally thought of as symptoms of psychosis. Such experiences are often assumed to be symptoms of underlying brain pathology or “real mental illnesses” that need to be diagnosed or “excluded” (in the medical sense of ruling out particular explanations of problems) before deciding on the appropriate intervention. This article argues that this belief is misguided, and that far from being essential, psychiatric diagnosis has the potential to be particularly damaging when applied to such experiences. It describes an alternative perspective outlined in a recent consensus report by the British Psychological Society Division of Clinical Psychology ( Understanding Psychosis and Schizophrenia), which has attracted significant attention in the United Kingdom and internationally. The report argues that even the most severe distress and the most puzzling behavior can often be understood psychologically, and that psychological approaches to helping can be very effective. It exhorts professionals not to insist that people accept any one particular framework of understanding, for example, that their experiences are symptoms of an illness. This article outlines that report’s main findings, together with their implications for how professionals can best help. </jats:p

“It allowed us to let our pain out”: perspectives from voice-hearers and their voices on the ‘talking with voices’ approach

The “Talking with Voices” (TwV) approach is a novel, formulation-driven approach to helping people who hear distressing voices. It is based on an understanding of voice-hearing as a relational phenomenon, often linked to trauma. Therapy involves facilitation of dialogical engagement between hearers and their voices. There are as yet few empirical studies of the approach

Exocytosis at the ribbon synapse of retinal bipolar cells studied in patches of presynaptic membrane

The distribution of exocytic sites and ion channels in the synaptic terminal of retinal bipolar cells was investigated by measuring capacitance and conductance changes in cell-attached patches of presynaptic membrane. Patch depolarization evoked capacitance and conductance increases that were inhibited by blocking Ca(2+) influx or loading the terminal with EGTA. The increase in capacitance declined as the depolarization approached the reversal potential for Ca(2+), indicating that it was a result of Ca(2+)-dependent exocytosis. The conductance increase was caused by K(Ca) channels that were also activated by Ca(2+) influx. Two observations indicated that sites of exocytosis and endocytosis colocalized with clusters of Ca(2+) channels and K(Ca) channels; the initial rate of exocytosis was correlated with the activation of K(Ca) channels, and exocytosis did not occur in the 41% of patches lacking this conductance. Electron microscopy demonstrated that there were approximately 16 vesicles docked to the plasma membrane at each active zone marked by a ribbon, but vesicles were also attached to the rest of the membrane at a density of 1.5/microm(2). The density of ribbons was 0.10 +/- 0.02/microm(2), predicting that approximately 43% of cell-attached patches would lack an active zone. The density of Ca(2+) channel clusters assayed by capacitance and conductance responses was therefore similar to the density of ribbons. These results are consistent with the idea that Ca(2+) channel clusters were colocalized with ribbons but do not exclude the possibility that calcium channels also occurred at other sites. The wide distribution of vesicles docked to the plasma membrane suggests that exocytosis might also be triggered by the spread of Ca(2+) from Ca(2+) channel clusters

Labour regimes and the labour problem in Asia

Our presentation is about work, employment and labour relations in the seven East/South-East Asian countries of Taiwan, the Philippines, Vietnam, Thailand, Malaysia, Indonesia, and Singapore, and in China. Following an account of the key features of the labour problem in each country, including the converging industrial relations of China and Vietnam, we conclude that the interface between industrial democracy and economic development remains a useful heuristic for understanding labour in the region

Industrial relations in South-East Asia: a cross-examination

Our presentation is based upon the Editorial exposé of a special issue on industrial relations in Asia recently published by the Chronique Internationale de l’IRES (Delahaie and Le Queux 2016). Contributions were drawing on original research work and covered up to seven countries from the South-East Asian region (Taiwan, The Philippines, Vietnam, Thailand, Malaysia, Indonesia, Singapore) plus China. Three streams were under scrutiny: 1) Low wages and decent work; 2) Migrant workers and informal labour; 3) Industrial conflict, and the way labour organisations (or the State) dealt with it. Contributions on Indonesia and Thailand touched upon decent work in low-wage economies, and the one on The Philippines on precarious employment more particularly; those on Singapore and Taiwan addressed the challenges and contradictions of maintaining a productivist agenda under tight corporatist regimes. The one on Malaysia focused on migrant labour and informal work. Contributions on China and Vietnam reflected on the nature and modality of industrial disputes and how these came to challenge established Communist labour institutions. China and Vietnam were given additional attention as they provided ground for a comparative analysis. Observations are congruent with the literature: States still play a dominant role of 'pacification' of industrial relations, with capitalist accumulation’ being the primary motive (Ford and Gillan 2016); international pressures are indispensable yet commitment to the enforcement of workers' rights remains problematic; echoing a long-lasting assessment (Deyo 1981; Leggett 1999), the overarching conclusion is that the interface between development and industrial democracy is a key determinant in the region

Caring for the older person with cognitive impairment in hospital: Qualitative analysis of nursing personnel reflections on fall events

Aims and objectives To explore nurse and nursing assistant reflections on the care of older patients with cognitive impairment who have experienced a fall. Background While there are evidence‐based clinical guidelines for the prevention and management of falls and for the care of older people with cognitive impairment, the falls rates for older people with cognitive impairment are three times as high as those without. Design Critical incident technique. Methods Eleven registered and two enrolled nurses and four assistants in nursing working in one subacute and two acute wards within two hospitals of a tertiary level health service in south‐east Queensland. Individual semistructured interviews focused on two past events when a patient with cognitive impairment had fallen in hospital: one when there was minimal harm and the second when there was significant harm. Thematic analysis was undertaken. The COREQ checklist was followed. Results Three themes emerged from 23 reflective accounts of fall events: “direct observation is confounded by multiple observers” and “knowing the person has cognitive impairment is not enough,” and “want to rely on the guideline but unsure how to enact it.” While participants were aware of the falls prevention policy and techniques available to prevent falls, the implementation of these was challenging due to the complexity of care required by the older person with cognitive impairment. Conclusions Falls prevention for older people with cognitive impairment is complex and belies the simple application of policy. Relevance to clinical practice To reduce falls, nurses can involve the family to support “knowing the patient” to enable prediction of impulsive actions; shift the focus of in‐service from lectures to specific case presentations, with collaborative analysis on person‐focused strategies to prevent falls in older people with cognitive impairment; and reconsider the sitter role from simple observer to assistant, focused on ambulation and supporting independence in activities of daily living.Full Tex

“My voices are just part of me, they don’t own me”: a qualitative investigation of Acceptance and Commitment Therapy groups for people experiencing psychosis

Background: This study aimed to generate a grounded theory of change processes as experienced by people with psychosis who engaged in an Acceptance and Commitment Therapy (ACT) group program. A secondary aim was to identify how participants described changes in their relationship to distress following the groups. Methods: The study used a qualitative research methodology, grounded theory. This was used to explore emergent themes in the participants’ subjective experiences of group ACT delivered in community mental health services. The experience of the ACT group process was investigated for nine participants. Semi-structured interviews were used to explore how the group experience and the exercises, metaphors and skills promoted by ACT were used by participants in their daily lives. Results: There were four main themes emerging from the interviews: awareness, relating differently, reconnection with life, leaning on others. Conclusions: The participants all described experiencing subjective benefits from being involved in the ACT groups, along with perspectives on processes of change. These reports of changes were consistent with the model and extend our understanding of the lived experience of engaging in ACT for psychosis group