From mental health industry to humane care : suggestions for an alternative systemic approach to distress

The article proposes a rough outline of an alternative systemic approach to mental health issues and of a more humane mental health care system. It suggests focusing on understanding mental distress as stemming from problems in living, using medications as agents facilitating psychotherapy, or as a last resort and short-term help, according to the principles of harm reduction. It argues that understanding drugs as psychoactive substances and studying the subjective effects they produce could lead to better utilization of medications and improvements in terms of conceptualizing and assessing treatment effects. Qualitative research could be particularly useful in that regard. It also advocates a radical departure from current diagnostic systems and proposes a synthesis of already existing alternatives to be used for both research and clinical purposes. Accordingly, a general idea for an alternative mental health care system, based on a combination of Open Dialogue Approach, Soteria houses, individual and group psychotherapy, cautious prescribing, services helping with drug discontinuation, peer-led services and social support is presented. The proposition could be seen as a first step towards developing a systemic alternative that could replace the currently dominating approach instead of focusing on implementing partial solutions that can be co-opted by the current one

The Soteria Project : a forerunner of "a third way" in psychiatry?

The article presents a somehow forgotten, yet largely controversial, experiment and therapeutic phenomenon known as Soteria Research Project. History, circumstances and main methodological assumptions of the experiment are briefly presented. Theoretical inspirations behind therapeutic model of Soteria are discussed and analyzed, and the results of the experiment are shortly described. The Soteria Research Project is placed in historical and contemporary context and compared to other theoretical propositions and practical solutions. A summary of critical arguments against Soteria is presented. Results of the Soteria Research Project suggest that therapeutic methods employed there were at least as effective as hospital treatment as usual, despite a radical reduction in, or even a complete lack of, pharmacotherapy. These results are still very important in the context of the debate concerning effective and ethical treatment of psychiatric disorders. It is claimed that Soteria was an attempt of restoring the importance of subjective experiences and subjectivity of a psychiatric patient in organized mental health care and a forerunner of contemporary postpsychiatric approaches, which postulate larger autonomy of patients, criticize sole reliance on pharmacotherapy and contemporary diagnostic systems, and underline the importance of psychotherapeutic interventions

Ciąża w bliźnie po cięciu cesarskim: Embolizacja tętnic macicznych połączona z histerektomią w 13 tygodniu ciąży – opis przypadku i przegląd piśmiennictwa

A cesarean scar pregnancy is a pregnancy located within the uterine muscle after previous cesarean sections. Recent years have shown a significant increase in the rate of CS and an improvement in the ultrasound diagnosis, and therefore a trend towards an increase in the rate of CSP cases has been reported in many countries. We report on a case of CSP diagnosed using ultrasound at 5/6 weeks’ gestation and confirmed by magnetic resonance imaging. The patient underwent surgical management at 13 weeks, combined with the chemioembolization of the uterine arteries. The current review aims to update the knowledge of the available treatment modalities.Ciąża w bliźnie po cięciu cesarskim jest ciążą zlokalizowaną w warstwie mięśniówki przedniej ściany macicy, w miejscu blizny po cięciu cesarskim. W ostatnich latach zaobserwowano znaczący wzrost odsetka cięć cesarskich oraz udoskonalenie diagnostyki ultrasonograficznej. W wielu krajach doprowadziło to do znacznego zwiększenia liczby rozpoznawanych przypadków ciąży w bliźnie po cięciu cesarskim. Opisywany przypadek przedstawia rozpoznanie ciąży w bliźnie po cięciu cesarskim w 5/6 tygodniu ciąży w badaniu ultrasonograficznym oraz jej potwierdzenie w rezonansie magnetycznym. W 13 tygodniu ciąży wykonano embolizację tętnic macicznych z następową histerektomią bez przydatków. Przedstawiono przegląd piśmiennictwa dotyczący aktualnych rodzajów postępowania klinicznego

Through acid psychiatry to acid communism. Psychedelic renaissance in psychiatry as a chance for a paradigm shift

Mark Fisher wrote „the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.” This paper attempts to develop this thought and show how the repoliticization of issues defined as mental illnesses that could have an emancipatory potential and undermine capitalist realism could look like and how it could be related to the contemporary phenomenon of „psychedelic renaissance”. This repoliticization could constitute the first step towards acid communism – a step that would enable a comprehensive formulation of the project, the imagining of both acid communism itself as well as the road towards it. Even though psychedelics could provide an impulse for the change of the dominant psychiatric paradigm and the reorganization of mental health services, the process of the interception of these substances by the alienating and commodificating orders of psychiatry and capitalism can already be observed, so that both of the intertwined and mutually supporting orders can in fact be strengthened. From this perspective the institution of psychiatry becomes a key element preserving the status quo, which makes the imagining of the end of capitalism impossible. Politicization of mental health, that could question capitalist realism, needs to be connected with the deconstruction of the ideology of psychiatry.Mark Fisher wrote „the task of repoliticizing mental illness is an urgent one if the left wants to challenge capitalist realism.” This paper attempts to develop this thought and show how the repoliticization of issues defined as mental illnesses that could have an emancipatory potential and undermine capitalist realism could look like and how it could be related to the contemporary phenomenon of „psychedelic renaissance”. This repoliticization could constitute the first step towards acid communism – a step that would enable a comprehensive formulation of the project, the imagining of both acid communism itself as well as the road towards it. Even though psychedelics could provide an impulse for the change of the dominant psychiatric paradigm and the reorganization of mental health services, the process of the interception of these substances by the alienating and commodificating orders of psychiatry and capitalism can already be observed, so that both of the intertwined and mutually supporting orders can in fact be strengthened. From this perspective the institution of psychiatry becomes a key element preserving the status quo, which makes the imagining of the end of capitalism impossible. Politicization of mental health, that could question capitalist realism, needs to be connected with the deconstruction of the ideology of psychiatry

Soteria Research Project. A critical historical analysis

Praca przedstawia, wcześniej nieznany szerzej w Polsce, Projekt Badawczego Soteria. W pierwszej jej części dość szczegółowo ukazane są inspiracje Projektu, jego założenia i wyniki. Opisano także podstawowe elementy modelu terapeutycznego Soterii. W drugiej części pracy Projekt Badawczy Soteria pokazano na tle innych teoretycznych i praktycznych rozwiązań związanych z leczeniem i badaniem schizofrenii. W pracy zarysowano dyskusje między przeciwnikami i zwolennikami Soterii. Zaprezentowano argumenty na rzecz twierdzenia, iż mimo że oficjalnie psychiatrzy przyznają, że schizofrenia to choroba, którą w kontekście badawczym i klinicznym najlepiej ujmować w ramach modelu biopsychospołecznego, to jednak w praktyce główny nacisk położony jest na poziom biologiczny. Wyniki Projektu Badawczego Soteria wskazują, że nie jest to najkorzystniejsze podejście, a interwencje terapeutyczne odnoszące się do innych poziomów ludzkiego funkcjonowania mogą mieć podobną, a nawet wyższą skuteczność. Jest to szczególnie istotne w obliczu doniesień o szkodliwych efektach długotrwałego przyjmowania neuroleptyków i ich wzrastającej sprzedaży, co wydaje się w prostej linii wynikać z dominacji modelu biomedycznego. Praca, nie roszcząc sobie oczywiście pretensji do ostatecznych konkluzji, zwraca uwagę na istnienie tego niemal całkowicie zapoznanego fenomenu terapeutycznego oraz wskazuje jego kluczowe wady i zalety.The paper describes inspirations, aims and results of Soteria Research Project which is not widely known in Poland. It also describes main compononents of Soteria therapeutic approach. Second part of the paper compares Soteria with other theoretical and practical solutions related to treatment and study of schizophrenia. The paper outlines the debate between opponents and supporters of Soteria. It presents arguments for the claim that although psychiatrists agree that schizophrenia is a disease that is best understood according to the biopsychosocial model, in practice the emphasis is on the biological level. Soteria Research Project results indicate that therapeutic interventions related to other levels of human functioning may be of similar or even higher efficiency. This is particularly important in the face of reports of harmful effects of long-term medication with neuroleptic drugs. The paper draws attention to the existence of Soteria, an almost completely forgotten therapeutic phenomenon

Postpsychiatry and postmodern psychotherapy : theoretical and ethical issues in mental health care in a Polish context

The article reconstructs postpsychiatry’s core propositions and briefly describes its theoretical background and assumptions. It also presents chosen aspects of postmodern psychotherapy, which seem to be in many ways similar to postpsychiatry’s ideas. Although they are drawn from different inspiration, postpsychiatry and postmodern psychotherapy seem to come to similar conclusions, especially regarding the role of the patient in the therapeutic process, the meaning of psychiatric diagnosis, and the importance of the institutional, cultural, and social contexts in mental health practice and research. The paper also aims to place postpsychiatry and postmodern psychotherapy in a Polish context, focusing on the ethical challenges faced by psychiatry and showing that some of postpsychiatry’s ideas and solutions to contemporary problems were already present in the Polish psychiatric literature of the 20th century. It also contains a brief description of the Polish social and historical context of psychiatry, as well as key aspects of the Polish legal system that relate to mental health and seem to reflect the nature of biomedical explanations of mental distress. It concludes that the model of psychiatric care postulated by "postmodern" approaches seems more ethical and scientifically and philosophically grounded and promises better treatment results than the "traditional" biomedical model

Comparative Analysis of the Placental Microbiome in Pregnancies with Late Fetal Growth Restriction versus Physiological Pregnancies

A comparative analysis of the placental microbiome in pregnancies with late fetal growth restriction (FGR) was performed with normal pregnancies to assess the impact of bacteria on placental development and function. The presence of microorganisms in the placenta, amniotic fluid, fetal membranes and umbilical cord blood throughout pregnancy disproves the theory of the “sterile uterus”. FGR occurs when the fetus is unable to follow a biophysically determined growth path. Bacterial infections have been linked to maternal overproduction of pro-inflammatory cytokines, as well as various short- and long-term problems. Proteomics and bioinformatics studies of placental biomass allowed the development of new diagnostic options. In this study, the microbiome of normal and FGR placentas was analyzed by LC-ESI-MS/MS mass spectrometry, and the bacteria present in both placentas were identified by analysis of a set of bacterial proteins. Thirty-six pregnant Caucasian women participated in the study, including 18 women with normal pregnancy and eutrophic fetuses (EFW > 10th percentile) and 18 women with late FGR diagnosed after 32 weeks of gestation. Based on the analysis of the proteinogram, 166 bacterial proteins were detected in the material taken from the placentas in the study group. Of these, 21 proteins had an exponentially modified protein abundance index (emPAI) value of 0 and were not included in further analysis. Of the remaining 145 proteins, 52 were also present in the material from the control group. The remaining 93 proteins were present only in the material collected from the study group. Based on the proteinogram analysis, 732 bacterial proteins were detected in the material taken from the control group. Of these, 104 proteins had an emPAI value of 0 and were not included in further analysis. Of the remaining 628 proteins, 52 were also present in the material from the study group. The remaining 576 proteins were present only in the material taken from the control group. In both groups, we considered the result of ns prot ≥ 60 as the cut-off value for the agreement of the detected protein with its theoretical counterpart. Our study found significantly higher emPAI values of proteins representative of the following bacteria: Actinopolyspora erythraea, Listeria costaricensis, E. coli, Methylobacterium, Acidobacteria bacterium, Bacteroidetes bacterium, Paenisporsarcina sp., Thiodiazotropha endol oripes and Clostridiales bacterium. On the other hand, in the control group statistically more frequently, based on proteomic data, the following were found: Flavobacterial bacterium, Aureimonas sp. and Bacillus cereus. Our study showed that placental dysbiosis may be an important factor in the etiology of FGR. The presence of numerous bacterial proteins present in the control material may indicate their protective role, while the presence of bacterial proteins detected only in the material taken from the placentas of the study group may indicate their potentially pathogenic nature. This phenomenon is probably important in the development of the immune system in early life, and the placental microbiota and its metabolites may have great potential in the screening, prevention, diagnosis and treatment of FGR