Mental health and legal landscapes

When it was established early in the twentieth century, Tokanui became part of a network of mental hospitals that were responsible for the care and confinement of the insane and the mentally deficient. At the time of its construction Tokanui was the first new mental hospital commissioned in over 20 years and the first to be built in the central North Island. Of those mental hospitals operating in 1912 all, except Ashburn Hall (the country's only private institution), were government controlled and funded. State dominance in the management of mental abnormality was the result of an unofficial policy which followed English precedent, favouring government intervention in the belief that it produced beneficial results and which endorsed the conviction that government responsibility for such matters could not be divested to a third party. This position was strengthened by the paucity of a prosperous philanthropic class who would otherwise have bridged the gulf between demand and supply under the auspices of charity. The essence of this philosophy was reflected in the early nineteenth and twentieth-century legislation which governed the development and management of New Zealand's mental hospitals

Narratives from the Mind's Eye: The Significance of Mental Health Pathography in New Zealand, 1980-2008.

Medical narratives have dominated historical accounts of suffering, patients have also played a role in their own illness experiences. Efforts to elucidate their perspective have necessarily focused on deconstructionist readings of material produced by the medical profession. However, in recent years historians have been aided in their task by sufferers, who have begun to publish their own narratives of affliction. These accounts, called 'pathographies', are particularly significant for histories of mental health, where comprehension outside experience remains tenuous. This thesis investigates sufferers' experiences of mental illness through an examination of fourteen New Zealand mental health pathographies, published between 1980 and 2008. It considers, not just what pathographies say, but how the way in which they say it, including the myths, language and media used, conveys the desired meaning and reflects the purpose of the narrative. Sufferers' narratives inform readers about what it is like to be ill, including what was thought, felt and done. In describing their experiences sufferers invariably discuss the illness relationships which comprise their support network. Most especially they highlight the importance of the role which family and friends play in recovery. Despite pathography's restoration of the patient's voice through the provision of a legitimate, therapeutic narrative, silences remain. Whether the result of selectivity, concealment, or forgetfulness, pathographers' silences are far from meaningless, powerfully conveying the pain, anger, embarrassment, and hurt which eludes articulation. In spite of the presence of silence this thesis argues that pathographies are a rich source of information about the position of mental illness sufferers. Yet to be fully utilised, I argue that pathographies testify to the way in which the chaotic can be ordered in a therapeutic plot which communicates the individual truth wrought by memory

Mental health at Tokanui in the early years

Tokanui was the first hospital to be built entirely to the villa design, and as such, its physically separate wards presented considerable opportunity for the classification and treatment of patients. Piecing together information contained in the remaining records, this chapter describes the formative years at Tokanui, during which not only a hospital, but also a community was established. The narrative which follows tells of buildings erected, land broken, cultivated and beautified, of hard physical labour and trying conditions. Above all, it is a narrative of the people who worked and lived, however fleetingly, at Tokanui and without whom the hospital would not have had a purpose. As the first new hospital to be built after provincial time, Tokanui, in many respects, led the way in developments made in the accommodation and treatment of the psychiatrically ill and those with intellectual disability

Author Correction: Genetic meta-analysis of diagnosed Alzheimer’s disease identifies new risk loci and implicates Aβ, tau, immunity and lipid processing (Nature Genetics, (2019), 51, 3, (414-430), 10.1038/s41588-019-0358-2)

An amendment to this paper has been published and can be accessed via a link at the top of the paper

Author Correction: Genetic meta-analysis of diagnosed Alzheimer\u27s disease identifies new risk loci and implicates Aβ, tau, immunity and lipid processing.

An amendment to this paper has been published and can be accessed via a link at the top of the paper

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

New insights into the genetic etiology of Alzheimer’s disease and related dementias

Characterization of the genetic landscape of Alzheimer’s disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/‘proxy’ AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele