Chapter 4 PSYCHIATRY’S MATERIAL CULTURE

"Chapter 4: This chapter explores the ways historians can analyse museum collections to shed new light on psychiatric history. Focusing on the classic example of the straitjacket to illustrate the way psychiatric objects often function as symbols and practical items, it provides an introduction to material culture for the historian of psychiatry. First, it explores how and where we might find psychiatric objects, and how we can begin to analyse them. It examines what we can learn from observing the artefacts themselves, and what we might gain from placing them in the context of other sources. Reading objects alongside patient records, reports, publications, letters, and legal texts can shed new light on institutional life and practices. Objects may reveal the gap between rules and regulations and working practices and experiences within mental health care, and help to shed light on the hidden histories of psychiatric patients, especially women and working-class patients who were less likely to leave behind written accounts of their experiences. Finally, objects can help us as historians to confront our own assumptions. Acknowledging the symbolic meanings that historic items have often gained can help us to acknowledge the nuances of modern experiences of mental health care. Chapter 8: The disciplines of psychiatry and law are inextricably linked. Legal sources therefore provide invaluable material for understanding the history of psychiatry, but for historians unfamiliar with legal systems or legal history, there can be some barriers to their use. Focusing on the common law jurisdiction of England and Wales, this chapter describes three kinds of legal source – case law, court records, and legislation – and gives examples of the kind of information they contain, where they can be found, how they have been used by researchers, and what strategies can be applied to their interpretation. It concludes with an illustrative case study from the archives of the Court of Protection, and some final questions that these kinds of sources raise. Chapter 9: In the late 1960s, the first inquiries were held into claims of abuse and malpractice in certain NHS psychiatric and ‘mental handicap’ hospitals. As they continued through much of the 1970s, political indifference, failures in clinical leadership, poor management, and pernicious ingrained hospital cultures were revealed. Much of the vast repository of inquiry documentation that was generated at the time provides historians of today with immensely important insights into government interests, the impacts of NHS policy, and the cultural mechanisms that prevailed inside these large institutions. This article provides an overview of how the inquiries came about and were run, together with a summary of where to find sources today. It reflects on some of the epistemological and ethical questions that should be taken into account during the analysis and writing-up of the research, together with the potential challenges that come from working with such sensitive sources. Chapter 10: This chapter explores how our psychiatric histories can be enriched by engaging with the sources of mental health activism and the survivor movement. Beginning with a brief history of activism among patients and service users, it goes on to discuss the practical challenges associated with finding and working with a body of source material which is often ephemeral, uncatalogued, or hidden in private collections. While often difficult to access, activist materials can not only provide us with information on the history of the survivor movement, but open critical new perspectives on the wider history of psychiatry, and on the lives of service users past and present. The chapter concludes by reflecting on the historiographical and theoretical challenges which have been posed by mental health campaigners and survivor historians, to suggest how engaging with activist sources might change the ways we write the history of psychiatry. Chapter 13: Since the film camera was invented in the late nineteenth century, psychiatrists and their associates in allied disciplines have attempted to capture the symptomatology and treatment of mental illness in moving images. Film was used by 'psy' scientists for different ends over the course of the late nineteenth and twentieth century: as a diagnostic tool, as the means to create a visual archive of pathological gesture and expression, and as documentary and exposé. This chapter explores the opportunities and difficulties that face the historian of psychiatry when using film sources. It begins with a discussion of the parameters of psychiatric film and the expansion of its use in the mid-twentieth century. The following section explores the epistemological value of film within psychiatry and relevant implications for historical analysis. This extends into an examination of three salient issues facing the researcher: the fragmentary nature of film evidence, the ethical uncertainties surrounding the filming of patients, and the uses of empathy. The chapter ends with a list of major film archives and their holdings.

Chapter In Search of Sympathy

In this essay, I place in historical context the three themes identified as important for the image of nursing in the Nursing Mirror competition, using nursing textbooks, diaries, memoirs, institutional and committee records and oral histories of nurses who trained in the 1920s and 1930s, largely from the Royal College of Nursing Archive. I begin with “human sympathy,” a trait newly emphasized in nursing around the turn of the twentieth century (Chaney, 2020). As I have shown elsewhere, there were definite class overtones to this new framing of nursing care. The emphasis on “finer” feelings such as sympathy was linked to explicit efforts by some reformers—such as Ethel Bedford Fenwick—to turn nursing into a middle-class profession (Rafferty, 1993; Brooks, 2001). The professional status of nursing in Britain was even newer, solidified by the passing of the Nurses Registration Act in December 1919. I turn next, then, to “professional capacity.” The view of professional identity that followed the introduction of registration was heavily shaped by First World War nursing. As well as the hierarchical structure of military discipline, the Edith Cavell myth popularized the view that not to show strong emotion was the hallmark of the modern, professional nurse. Finally, I examine the third theme outlined by the Nursing Mirror—beauty of line—in relation to the expectations around femininity and appearance in the interwar period. The good nurse was also a good woman, something visible in both her appearance and her actions

Interchain disulfide bond reduction alters the structure and function of therapeutic monoclonal antibodies

Anti-TNF IgG biotherapeutics are used to treat immune disorders such as rheumatoid arthritis. They neutralise cytokine TNF-α to dampen the inflammatory response. These drugs are hugely successful, for instance Humira manufactured by AbbVie was the second bestselling drug of 2021 globally. However in approximately one-third of patients, the efficacy of anti-TNF treatment decreases with time. There are several proposed hypotheses, such as increased production of anti-drug antibodies (ADAs), however there is no definitive explanation. It is now proposed that elevated levels of the enzyme thioredoxin (Trx), which increases with inflammation, reduces IgG interchain disulfide bonds, therefore altering the drug structure and efficacy. Trx is known to reduce these disulfides during biotherapeutic manufacture, which can lead to product loss. Additionally, in vitro reduction of anti-TNF biotherapeutics by Trx increases potency to antigen TNF, but simultaneously abrogates Fc-mediated effector functions. These mysterious findings were postulated to result from the reduction causing increased flexibility around the IgG hinge, which could explain the observed decrease in efficacy in vivo. This project uses infliximab (IFX) as a model anti-TNF biotherapeutic to explore the altered drug structure following reduction. Hydrogen-deuterium exchange mass spectrometry (HDX-MS) shows the only structural change is in the IgG CH2 domain, a common destabilisation observed from many chemical modifications that explains knockout of Fc receptor binding. Transmission electron microscopy (TEM) proves increased flexibility of reduced IFX, with differing and more compact structures than native IFX. Importantly, a covalent interaction between reduced IFX and complement protein C1q is also identified in vitro. This is a novel finding of huge significance as it may have relevance for biotherapeutic mAbs in vivo. Overall this project contributes important structural information of reduced IgG1 mAbs and progresses the hypothesis for lack of efficacy of IgG biotherapeutics; Trx reduces interchain disulfides, causing immune complex formation with complement

The [in]significance of New Zealand wallpaper in the 1940s

This paper draws on research into the use, imaging and recording of wallpaper in New Zealand from 1850 to 1950, conducted as part of the Martin Hill Wallpaper research project. It tests New Zealand wallpaper as an industry, a craft, and as a design activity, comparing it to other applied wall surface treatments significant to the contemporary 1940s context, aiming to contextualise the value placed on wallpaper in the modern interior. To explore the content and context of wallpaper as it was recorded in 1940s New Zealand, this paper specifically draws on the definitive contemporary exhibition; The New Zealand Centennial Exhibition, and a definitive contemporary text; DE Barry Martin's Modern Decoration & Furnishing: The Complete Guide to Planning and Buying for all interiors, as sources to provide a framework within which to locate wallpaper and its perceived significance

The Pioneer of Santa Rosa Island

Santa Rosa Island which is part of the Channel Islands in California has a ranching history that goes as far back as the year 1843. While rich in history, the island is no longer “rich” in native plant populations due to the sheep, cattle and other livestock that once occupied the island. As a result of these grazers that the ranchers livelihood depended on, a great disturbance in the native plant population took place. It is up to plants such as Baccharis pilularis, commonly known as Coyote brush, to assist these endangered and threatened plants to once again flourish on Santa Rosa Island. In this study, a total of 200 cuttings were taken from the Coyote brush plant from different locations on the island. These cuttings were prepared with growth hormone and given time to grow their own roots in a humidity chamber for three-four weeks. The cuttings of Baccharis pilularis will be used as a pioneer plant to promote succession to shrub land on Santa Rosa Island. The Coyote brush will be planted on areas of the island that were devastated by the trampling and grazing of the cattle that once occupied the island and soil that has now been greatly affected by erosion. As a secondary succession plant, Coyote brush is utilized to reintroduce native plant species that were once prominent on Santa Rosa Island. Our goal and focus is to continue to collect and grow cuttings of this pioneer plant that has demonstrated success in the past in assisting the reintroduction of the various threatened and endangered plant species on Santa Rosa Island

Viral dynamics of acute SARS-CoV-2 infection and applications to diagnostic and public health strategies.

SARS-CoV-2 infections are characterized by viral proliferation and clearance phases and can be followed by low-level persistent viral RNA shedding. The dynamics of viral RNA concentration, particularly in the early stages of infection, can inform clinical measures and interventions such as test-based screening. We used prospective longitudinal quantitative reverse transcription PCR testing to measure the viral RNA trajectories for 68 individuals during the resumption of the 2019-2020 National Basketball Association season. For 46 individuals with acute infections, we inferred the peak viral concentration and the duration of the viral proliferation and clearance phases. According to our mathematical model, we found that viral RNA concentrations peaked an average of 3.3 days (95% credible interval [CI] 2.5, 4.2) after first possible detectability at a cycle threshold value of 22.3 (95% CI 20.5, 23.9). The viral clearance phase lasted longer for symptomatic individuals (10.9 days [95% CI 7.9, 14.4]) than for asymptomatic individuals (7.8 days [95% CI 6.1, 9.7]). A second test within 2 days after an initial positive PCR test substantially improves certainty about a patient's infection stage. The effective sensitivity of a test intended to identify infectious individuals declines substantially with test turnaround time. These findings indicate that SARS-CoV-2 viral concentrations peak rapidly regardless of symptoms. Sequential tests can help reveal a patient's progress through infection stages. Frequent, rapid-turnaround testing is needed to effectively screen individuals before they become infectious

Clinical, radiologic, pathologic, and molecular characteristics of long-term survivors of diffuse intrinsic pontine glioma (DIPG): a collaborative report from the International and European Society for Pediatric Oncology DIPG registries

Purpose Diffuse intrinsic pontine glioma (DIPG) is a brainstem malignancy with a median survival of < 1 year. The International and European Society for Pediatric Oncology DIPG Registries collaborated to compare clinical, radiologic, and histomolecular characteristics between short-term survivors (STSs) and long-term survivors (LTSs). Materials and Methods Data abstracted from registry databases included patients from North America, Australia, Germany, Austria, Switzerland, the Netherlands, Italy, France, the United Kingdom, and Croatia. Results Among 1,130 pediatric and young adults with radiographically confirmed DIPG, 122 (11%) were excluded. Of the 1,008 remaining patients, 101 (10%) were LTSs (survival ≥ 2 years). Median survival time was 11 months (interquartile range, 7.5 to 16 months), and 1-, 2-, 3-, 4-, and 5-year survival rates were 42.3% (95% CI, 38.1% to 44.1%), 9.6% (95% CI, 7.8% to 11.3%), 4.3% (95% CI, 3.2% to 5.8%), 3.2% (95% CI, 2.4% to 4.6%), and 2.2% (95% CI, 1.4% to 3.4%), respectively. LTSs, compared with STSs, more commonly presented at age < 3 or > 10 years (11% v 3% and 33% v 23%, respectively; P < .001) and with longer symptom duration ( P < .001). STSs, compared with LTSs, more commonly presented with cranial nerve palsy (83% v 73%, respectively; P = .008), ring enhancement (38% v 23%, respectively; P = .007), necrosis (42% v 26%, respectively; P = .009), and extrapontine extension (92% v 86%, respectively; P = .04). LTSs more commonly received systemic therapy at diagnosis (88% v 75% for STSs; P = .005). Biopsies and autopsies were performed in 299 patients (30%) and 77 patients (10%), respectively; 181 tumors (48%) were molecularly characterized. LTSs were more likely to harbor a HIST1H3B mutation (odds ratio, 1.28; 95% CI, 1.1 to 1.5; P = .002). Conclusion We report clinical, radiologic, and molecular factors that correlate with survival in children and young adults with DIPG, which are important for risk stratification in future clinical trials

Medulloblastoma therapy generates risk of a poorly-prognostic H3 wild-type subgroup of diffuse intrinsic pontine glioma: a report from the International DIPG Registry

Abstract With improved survivorship in medulloblastoma, there has been an increasing incidence of late complications. To date, no studies have specifically addressed the risk of radiation-associated diffuse intrinsic pontine glioma (DIPG) in medulloblastoma survivors. Query of the International DIPG Registry identified six cases of DIPG with a history of medulloblastoma treated with radiotherapy. All patients underwent central radiologic review that confirmed a diagnosis of DIPG. Six additional cases were identified in reports from recent cooperative group medulloblastoma trials (total n = 12; ages 7 to 21 years). From these cases, molecular subgrouping of primary medulloblastomas with available tissue (n = 5) revealed only non-WNT, non-SHH subgroups (group 3 or 4). The estimated cumulative incidence of DIPG after post-treatment medulloblastoma ranged from 0.3–3.9%. Posterior fossa radiation exposure (including brainstem) was greater than 53.0 Gy in all cases with available details. Tumor/germline exome sequencing of three radiation-associated DIPGs revealed an H3 wild-type status and mutational signature distinct from primary DIPG with evidence of radiation-induced DNA damage. Mutations identified in the radiation-associated DIPGs had significant molecular overlap with recurrent drivers of adult glioblastoma (e.g. NRAS, EGFR, and PTEN), as opposed to epigenetic dysregulation in H3-driven primary DIPGs. Patients with radiation-associated DIPG had a significantly worse median overall survival (median 8 months; range 4–17 months) compared to patients with primary DIPG. Here, it is demonstrated that DIPG occurs as a not infrequent complication of radiation therapy in survivors of pediatric medulloblastoma and that radiation-associated DIPGs may present as a poorly-prognostic distinct molecular subgroup of H3 wild-type DIPG. Given the abysmal survival of these cases, these findings provide a compelling argument for efforts to reduce exposure of the brainstem in the treatment of medulloblastoma. Additionally, patients with radiation-associated DIPG may benefit from future therapies targeted to the molecular features of adult glioblastoma rather than primary DIPG.https://deepblue.lib.umich.edu/bitstream/2027.42/145180/1/40478_2018_Article_570.pd