Psycho-colonialism: colonisation in mental health

This thesis develops and contributes to an emerging field of postcolonial critique in the mental health field. Colonisation has been described as an issue for the Global South through the activities of western disciplines alongside business interests like ‘Big Pharma’. I argue that psychiatric practices are also colonising processes in the Global North: what I call psycho-colonisation. This thesis begins by outlining a rationale for interdisciplinary engagement with psycho-colonisation which includes drawing on postcolonial theory and activism, and examining colonisation processes through literature. I then review literature in two areas: Firstly, I assess the status and use of postcolonial thinking in the mental health arena. Secondly, I review (counter) canonical postcolonial thinkers selected on the basis of their engagement in resistance. In doing so, I establish a thematic scheme for assessing colonising processes. Humanities have a central role in both the colonisation process and resistance, and so I turn to a critical analysis of two writers’ work and what they tell about madness and psycho-colonisation. First, I critique Sebastian Faulks’ Human Traces (2005) as an exemplar of a traditional psychiatric discourse. I argue that Faulks’ novels aim to present a literary, historically authentic picture that inducts the reader into psychiatric orthodoxy. Colonisation exists in his writing at the level of producing a cultural power/knowledge effect. Secondly, I examine the works of Toni Morrison, specifically The Bluest Eye (1970) and God help the Child (2015), as examples of how madness is written about without recourse to traditional psychiatry, but with reference to socio-psychological and political contexts. For the most part, Morrison avoids psycho-colonisation. I conclude that there is a rationale for the use of postcolonial scholarship as a critical discourse in the mental health field. In addition, I show how the processes of colonisation through novels can be evident in the literatures of the Global North, and argue that the effect is one of a subtle induction of readers to psychiatric thinking and practices

Psy-science and the colonial relationship in the mental health field

Purpose The purpose of this paper is to critically discuss how the psy-sciences have been, and continue to be, typified by some critics, as colonizers and are credited with Imperialistic motivations. However, rarely are these critiques developed beyond a pejorative characterisation. Design/methodology/approach This paper reviews the criticisms of psychiatry as colonial and outlines the tensions in taking different frames of reference in the mental health field, before going on to suggest theoretical and research perspectives arising from postcolonial theory that might advance these critical positions more coherently and the implications of doing so. Findings This study suggests an engagement with humanities-based methods and fields such as postcolonial scholarship. Social implications This argument is timely, especially given recent controversies over the publication of DSM5, the scaling up agenda for mental health in the Global South and increased attention to the agenda of Big Pharma. Originality/value Postcolonial intersections with psy-science remains a relatively undeveloped area in the critical literatur

Multi-institutional Validation of the CAPRA-S Score to Predict Disease Recurrence and Mortality After Radical Prostatectomy

BackgroundThe University of California, San Francisco, Cancer of the Prostate Risk Assessment Postsurgical (CAPRA-S) score uses pathologic data from radical prostatectomy (RP) to predict prostate cancer recurrence and mortality. However, this clinical tool has never been validated externally.ObjectiveTo validate CAPRA-S in a large, multi-institutional, external database.Design, setting, and participantsThe Shared Equal Access Regional Cancer Hospital (SEARCH) database consists of 2892 men who underwent RP from 2001 to 2011. With a median follow-up of 58 mo, 2670 men (92%) had complete data to calculate a CAPRA-S score.InterventionRP.Outcome measurements and statistical analysisThe main outcome was biochemical recurrence. Performance of CAPRA-S in detecting recurrence was assessed and compared with a validated postoperative nomogram by concordance index (c-index), calibration plots, and decision curve analysis. Prediction of cancer-specific mortality was assessed by Kaplan-Meier analysis and the c-index.Results and limitationsThe mean age was 62 yr (standard deviation: 6.3), and 34.3% of men had recurrence. The 5-yr progression-free probability for those patients with a CAPRA-S score of 0-2, 3-5, and 6-10 (defining low, intermediate, and high risk) was 72%, 39%, and 17%, respectively. The CAPRA-S c-index was 0.73 in this validation set, compared with a c-index of 0.72 for the Stephenson nomogram. Although CAPRA-S was optimistic in predicting the likelihood of being free of recurrence at 5 yr, it outperformed the Stephenson nomogram on both calibration plots and decision curve analysis. The c-index for predicting cancer-specific mortality was 0.85, with the caveat that this number is based on only 61 events.ConclusionsIn this external validation, the CAPRA-S score predicted recurrence and mortality after RP with a c-index >0.70. The score is an effective prognostic tool that may aid in determining the need for adjuvant therapy

Ofranergene Obadenovec (Ofra-Vec, VB-111) With Weekly Paclitaxel for Platinum-Resistant Ovarian Cancer: Randomized Controlled Phase III Trial (OVAL Study/GOG 3018)

PURPOSE To evaluate the addition of ofranergene obadenovec (ofra-vec, VB-111), a novel gene-based anticancer targeted therapy, to once a week paclitaxel in patients with recurrent platinum-resistant ovarian cancer (PROC). METHODS This placebo-controlled, double-blind, phase III trial (ClinicalTrials.gov identifier: NCT03398655 ) randomly assigned patients with PROC 1:1 to receive intravenous ofra-vec every 8 weeks with once a week IV paclitaxel or placebo with paclitaxel until disease progression. The dual primary end points were overall survival (OS) and progression-free survival (PFS) as assessed by Blinded Independent Central Review. RESULTS Between December 2017 and March 2022, 409 patients were randomly assigned. The median PFS was 5.29 months in the ofra-vec arm and 5.36 months in the control arm, hazard ratio (HR) 1.03 (CI, 0.83 to 1.29; P = .7823). The median OS with ofra-vec was 13.37 months versus 13.14 months, HR 0.97 (CI, 0.75 to 1.27; P = .8440). Objective response rates (ORRs) per RECIST 1.1 were similar in both arms: 28.9% with ofra-vec versus 29.6% with control. In both treatment arms, response to CA-125 was a substantial prognostic factor for both PFS and OS. In the ofra-vec arm, the HR in CA-125 responders compared with that in nonresponders for PFS was 0.2428 (CI, 0.1642 to 0.3588), and for OS, the HR was 0.3343 (CI, 0.2134 to 0.5238). Safety profile was characterized by common transient flu–like symptoms such as fever and chills. CONCLUSION The addition of ofra-vec to paclitaxel did not improve PFS or OS. The PFS and ORR in the control arm exceeded the results that were anticipated on the basis of the AURELIA chemotherapy control arm. CA-125 response was a substantial prognostic biomarker for PFS and OS in patients with PROC treated with paclitaxel