A qualitative emancipatory inquiry into relationships between people with mental disorders and health professionals

Introduction: A therapeutic alliance with people is essential for the efficacy of treatments. However, the traditional paternalistic values of the Mediterranean society may be incompatible with patient autonomy. Aim: To explore the therapeutic relationship from the perspective of people diagnosed with mental disorders with health professionals, including nurses. Methods: This emancipatory research was performed through focus groups, with people with mental disorders who had a variety of diagnoses and experiences of acute and community‐based mental health services and other healthcare services. Data were analysed using the content analysis method. Results: Four main themes emerged: stereotypes and prejudice; quality of interactions and treatment; emotional and behavioural impacts; and demands. Discussion: According to the participants' descriptions, health professionals are not exempt from prejudice against persons with psychiatric diagnoses. They reported experiencing abuse of power, malpractice, and overmedication. Thus, in the Mediterranean culture, professional attitudes may represent a barrier for an appropriate therapeutic alliance, and people with mental disorders do not feel involved in making decisions about their health. Implications for practice: Knowing how people with mental disorders perceive their interactions with health professionals and the effects is necessary to move the care model towards more symmetric relationships that facilitate a therapeutic alliance

Anthroposophic therapy for chronic depression: a four-year prospective cohort study

BACKGROUND: Depressive disorders are common, cause considerable disability, and do not always respond to standard therapy (psychotherapy, antidepressants). Anthroposophic treatment for depression differs from ordinary treatment in the use of artistic and physical therapies and special medication. We studied clinical outcomes of anthroposophic therapy for depression. METHODS: 97 outpatients from 42 medical practices in Germany participated in a prospective cohort study. Patients were aged 20–69 years and were referred to anthroposophic therapies (art, eurythmy movement exercises, or rhythmical massage) or started physician-provided anthroposophic therapy (counselling, medication) for depression: depressed mood, at least two of six further depressive symptoms, minimum duration six months, Center for Epidemiological Studies Depression Scale, German version (CES-D, range 0–60 points) of at least 24 points. Outcomes were CES-D (primary outcome) and SF-36 after 3, 6, 12, 18, 24, and 48 months. Data were collected from July 1998 to March 2005. RESULTS: Median number of art/eurythmy/massage sessions was 14 (interquartile range 12–22), median therapy duration was 137 (91–212) days. All outcomes improved significantly between baseline and all subsequent follow-ups. Improvements from baseline to 12 months were: CES-D from mean (standard deviation) 34.77 (8.21) to 19.55 (13.12) (p < 0.001), SF-36 Mental Component Summary from 26.11 (7.98) to 39.15 (12.08) (p < 0.001), and SF-36 Physical Component Summary from 43.78 (9.46) to 48.79 (9.00) (p < 0.001). All these improvements were maintained until last follow-up. At 12-month follow-up and later, 52%–56% of evaluable patients (35%–42% of all patients) were improved by at least 50% of baseline CES-D scores. CES-D improved similarly in patients not using antidepressants or psychotherapy during the first six study months (55% of patients). CONCLUSION: In outpatients with chronic depression, anthroposophic therapies were followed by long-term clinical improvement. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that the anthroposophic approach, with its recourse to non-verbal and artistic exercising therapies can be useful for patients motivated for such therapies

Scio Ergo Sum: Knowledge of the Self in a Nonhuman Primate

The pressures of developing and maintaining intricate social relationships may have led to the evolution of enhanced cognitive abilities in many social nonhuman species, particularly primates. Knowledge of the dominance ranks and social relationships of other individuals, for example, is important in evaluating one’s position in the prevailing affiliative and dominance networks within a primate society and could be acquired through direct or perceived experience. Our analysis of allogrooming supplants among wild bonnet macaques had revealed that individual females successfully evaluate social relationships among other group females and possess egotistical knowledge of their own positions, relative to those of others, in the social hierarchy. These individuals, therefore, appeared to have abstracted and mentally represented their own personal attributes as well as those of other members of the group. Bonnet macaques also seem to recognise that other individuals have beliefs that may be different from their own, manipulate another individual’s actions and beliefs in a variety of social situations, and selectively reveal or withhold information from others—capabilities displayed by certain individuals that became evident in the course of our earlier studies on tactical deception in the species. In conclusion, the ability to develop belief systems and form mental representations, generated by direct personal experience, suggests a rather early evolutionary origin for fairly sophisticated cognitive capabilities, characterised by an objectified self with limited regulatory control over more subjective levels of self-awareness, in cercopithecine primates, pre-dating those of the great apes. We, therefore, argue, in this review, that bonnet macaques might represent an intermediate stage in the evolution of self-awareness, a process which began with the subjective awareness that characterises most, if not all, higher animal species and culminates in the most sophisticated form of symbolic self-awareness, apparently the hallmark of the human species alone