Reflections on the Use of Patient Records: Privacy, Ethics, and Reparations in the History of Psychiatry

One of the most common questions we get asked as historians of psychiatry is “do you have access to patient records?” Why are people so fascinated with the psychiatric patient record? Do people assume they are or should be available? Does access to the patient record actually tell us anything new about the history of psychiatry? And if we did have them, what can, or should we do with them? In the push to both decolonize and personalize the history of psychiatry, as well as make some kind of account or reparation for past mistakes, how can we proceed in an ethical manner that respects the privacy of people in the past who never imagined their intensely personal psychiatric encounter as subject for future historians? In this paper, we want to think through some of the issues that we deal with as white historians of psychiatry especially at the intersection of privacy, ethics, and racism. We present our thoughts as a conversation, structured around questions we have posed for ourselves, and building on discussions we have had together over the past few years. We hope that they act as a catalyst for further discussion in the field

Signal Disruption Leads to Changes in Bacterial Community Population

The disruption of bacterial signaling (quorum quenching) has been proven to be an innovative approach to influence the behavior of bacteria. In particular, lactonase enzymes that are capable of hydrolyzing the N-acyl homoserine lactone (AHL) molecules used by numerous bacteria, were reported to inhibit biofilm formation, including those of freshwater microbial communities. However, insights and tools are currently lacking to characterize, understand and explain the effects of signal disruption on complex microbial communities. Here, we produced silica capsules containing an engineered lactonase that exhibits quorum quenching activity. Capsules were used to design a filtration cartridge to selectively degrade AHLs from a recirculating bioreactor. The growth of a complex microbial community in the bioreactor, in the presence or absence of lactonase, was monitored over a 3-week period. Dynamic population analysis revealed that signal disruption using a quorum quenching lactonase can effectively reduce biofilm formation in the recirculating bioreactor system and that biofilm inhibition is concomitant to drastic changes in the composition, diversity and abundance of soil bacterial communities within these biofilms. Effects of the quorum quenching lactonase on the suspension community also affected the microbial composition, suggesting that effects of signal disruption are not limited to biofilm populations. This unexpected finding is evidence for the importance of signaling in the competition between bacteria within communities. This study provides foundational tools and data for the investigation of the importance of AHL-based signaling in the context of complex microbial communities

Fanon's Letter Between Psychiatry and Anticolonial Commitment

The name of Frantz Fanon has become a symbol of anticolonial militancy and the struggles of national emancipation against colonial rule. However, Fanon was also a psychiatrist, who never abandoned clinical practice even after resigning from his post in colonized Algeria in 1956. The coexistence, in Fanon, of medicine and political involvement represents one of the most productive and contradictory aspects of his life and work. Fanon was highly critical of colonial ethnopsychiatry, but never abandoned his commitment to improving the condition of psychiatric patients. After his escape from Algeria, he wrote extensively for El Moudjahid, the journal of the anticolonial resistance, but also practised in the hospital of Charles Nicolle in Tunis. In this essay I propose a new assessment of the relation between psychiatry and politics by addressing Fanon's influence on Franco Basaglia, leader of the anti-institutional movement in Italian psychiatry in the 1960s and 1970s. Basaglia was deeply inspired by the example of Fanon and the contradictions he had to confront. Rereading Fanon through the mirror of Italian anti-institutional psychiatry will define a new understanding of Fanon as committed intellectual. Indeed, this may suggest a new perspective on the function of intellectuals in contexts signed by the aftermath of colonial history, drawing on the example of two psychiatrists who never ceased to inhabit the borderline between the clinical and the critical, medicine and militancy, the necessity of cure and the exigency of freedom

An Uncertain Dominion: Irish Psychiatry, Methadone, and the Treatment of Opiate Abuse

This paper investigates some productive ambiguities around the medical administration of methadone in the Republic of Ireland. The tensions surrounding methadone maintenance therapy (MMT) are outlined, as well as the sociohistorical context in which a serious heroin addiction problem in Ireland developed. Irish psychiatry intervened in this situation, during a time of institutional change, debates concerning the nature of addiction, moral panics concerning heroin addiction in Irish society and the recent boom in the Irish economy, known popularly as the Celtic Tiger. A particular history of this sort illuminates how technologies like MMT become cosmopolitan, settling into, while changing, local contexts

The genetic architecture of the human cerebral cortex

The cerebral cortex underlies our complex cognitive capabilities, yet little is known about the specific genetic loci that influence human cortical structure. To identify genetic variants that affect cortical structure, we conducted a genome-wide association meta-analysis of brain magnetic resonance imaging data from 51,665 individuals. We analyzed the surface area and average thickness of the whole cortex and 34 regions with known functional specializations. We identified 199 significant loci and found significant enrichment for loci influencing total surface area within regulatory elements that are active during prenatal cortical development, supporting the radial unit hypothesis. Loci that affect regional surface area cluster near genes in Wnt signaling pathways, which influence progenitor expansion and areal identity. Variation in cortical structure is genetically correlated with cognitive function, Parkinson's disease, insomnia, depression, neuroticism, and attention deficit hyperactivity disorder

Imperial bedlam: institutions of madness in colonial southwest Nigeria

The colonial government of southern Nigeria began to use asylums to confine the allegedly insane in 1906. These asylums were administered by the British but confined Africans. Yet, as even many in the government recognized, insanity is a condition that shows cultural variation. Who decided the inmates were insane and how? This sophisticated historical study pursues these questions as it examines fascinating source material - writings by African patients in these institutions and the reports of officials, doctors, and others - to discuss the meaning of madness in Nigeria, the development of colonial psychiatry, and the connections between them. Jonathan Sadowsky's well-argued, concise study provides important new insights into the designation of madness across cultural and political frontiers. Imperial Bedlam follows the development of insane asylums from their origins in the nineteenth century to innovative treatment programs developed by Nigerian physicians during the transition to independence. Special attention is given to the writings of those considered "lunatics," a perspective relatively neglected in previous studies of psychiatric institutions in Africa and most other parts of the world. Imperial Bedlam shows how contradictions inherent in colonialism were articulated in both asylum policy and psychiatric theory. It argues that the processes of confinement, the labeling of insanity, and the symptoms of those so labeled reflected not only cultural difference but also political divides embedded in the colonial situation. Imperial Bedlam thus emphasizes not only the cultural background to madness but also its political and experiential dimensions

Rendering Tetrahedral Meshes with Higher-Order Attenuation Functions for Digital Radiograph Reconstruction

This paper presents a novel method for computing simulated x-ray images, or DRRs (digitally reconstructed radiographs), of tetrahedral meshes with higher-order attenuation functions. DRRs are commonly used in computer assisted surgery (CAS), with the attenuation function consisting of a voxelized CT study, which is viewed from different directions. Our application of DRRs is in intra-operative "2D-3D" registration, i.e., finding the pose of the CT dataset given a small number of patient radiographs. We register 2D patient images with a statistical tetrahedral model, which encodes the CT intensity numbers as Bernstein polynomials, and includes knowledge about typical shape variation modes. The unstructured grid is more suitable for applying deformations than a rectilinear grid, and the higher-order polynomials provide a better approximation of the actual density than constant or linear models. The intra