Conceptualisations of agoraphobia: implications for mental health promotion

Agoraphobia emerged as a named disorder in the 1870s. Since then a wide variety of models ‐ both clinical and non‐clinical ‐ have been devised to explain it. This paper describes four of these models to demonstrate and explore the significance for mental health promotion of their different conceptualisations of agoraphobia in relation to the city, to public space and to the individual. Of particular interest is the shift in the gendering of agoraphobia: while late 19th century accounts tended to feature men, by the mid 20th century the archetype of someone who experiences agoraphobia had become female. The implications of this variance and subsequent decisions about intervention and cure, it is argued, demonstrate the importance of conceptualisation in debates about mental health promotion

Building a sexological concept through fictional narrative: The case of 'frigidity' in late nineteenth-century France

This paper raises a question about the role of literary texts in intellectual and cultural history, taking the particular example of middle-brow novels published by a set of Parisian publishers during the last decades of the nineteenth century and the first decade of the twentieth. It locates those novels with respect to medical writing about sexual pathology, with a particular focus on the notion of female frigidity, which was something of a new topic at that time. The Parisian publishers' catalogues contained a range of texts from popular medical `libraries' to outright pornography, but the greater part of the books they offered for sale were more or less respectable novels with some intellectual pretensions. The paper identifies some commonplaces about frigidity that emerged at the time, and shows that middle-brow novels sometimes led medical writing in the production of those commonplaces, notably by their construction and rehearsal of typical narratives about women characters

Overvalued ideas and their impact on treatment outcome Idéias supervalorizadas e seu impacto no resultado do tratamento

BACKGROUND: The presence of overvalued ideas (OVI) in patients with obsessive-compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome. However, to date there have not been any quantitative measures of overvalued ideas. Therefore, the relationship between OVI and outcome has been primarily hypothetical. Rudimentary assessments have been attempted by asking patients to rate their strength of belief from 1 to 10, clinically rating the fixity of beliefs from 1 to 5, and rating patients on item 11 (insight) on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The purpose of this study was to determine the relationship between OVI, degree of severity of OCD symptoms, and improvement. METHOD: Twenty patients with OCD participated in the study. All patients were treated with six days a week of 90 minutes of exposure and response prevention (ERP) and selective serotonin re-uptake inhibitors. No changes in medication were made during the course of treatment and all patients had been on their respective medications for at least three months prior to entering the study. Assessment scales consisted of the Overvalued Ideas Scale (OVIS), Y-BOCS, Beck Depression Inventory, and the Beck Anxiety Inventory. RESULTS: The results indicated that overvalued ideas did not necessarily correlate with severity of symptoms on the Y-BOCS. The higher the score on the OVIS, the less change on the Y-BOCS score. CONCLUSION: Overvalued ideas appear to be an important predictor of poor outcome.<br>INTRODUÇÃO: A existência de idéias superestimadas (IS) em pacientes com transtorno obsessivo-compulsivo (TOC) vem sendo teoricamente relacionada a resultado insatisfatório do tratamento. Como até o momento não existem medidas quantitativas das idéias superestimadas, a relação entre IS e resultado fica restrita ao campo hipotético. Houve algumas tentativas de avaliações simples. Era pedido aos pacientes que avaliassem a intensidade de suas convicções, em uma escala de 1 a 10. A seguir, fazia-se a avaliação clínica da fixidez das convicções de 1 a 5, e os pacientes eram classificados segundo o item 11 (insight) da Escala Yale-Brown de Sintomas Obsessivo-compulsivos (Y-BOCS). A proposta deste estudo era determinar a relação existente entre IS, gravidade dos sintomas do TOC e melhora. MÉTODO: Vinte pacientes com DOC participaram do estudo. Todos eles foram submetidos ao tratamento de prevenção de exposição e reação (PER), durante seis dias por semana, com sessões de 90 minutos, e medicados com inibidores seletivos de recaptação de serotonina. Os medicamentos não foram alterados durante o curso do tratamento. Antes de entrar no estudo, todos os pacientes já recebiam tratamento medicamentoso há, pelo menos, três meses. As escalas de avaliação usadas foram Escala de Idéias Superestimadas (OVIS), Y-BOCS, Inventário Beck para Depressão e Inventário Beck para Ansiedade. RESULTADOS: Os resultados indicaram que idéias superestimadas não se correlacionavam necessariamente com a gravidade dos sintomas, medidos pela Y-BOCS. Quanto maior o grau medido pela OVIS, menor era a variação na Y-BOCS. CONCLUSÃO: Idéias superestimadas parecem ser um importante fator de predição de um resultado insatisfatório para o tratamento