Psychopolitics: Peter Sedgwick’s legacy for mental health movements

This paper re-considers the relevance of Peter Sedgwick's Psychopolitics (1982) for a politics of mental health. Psychopolitics offered an indictment of ‘anti-psychiatry’ the failure of which, Sedgwick argued, lay in its deconstruction of the category of ‘mental illness’, a gesture that resulted in a politics of nihilism. ‘The radical who is only a radical nihilist’, Sedgwick observed, ‘is for all practical purposes the most adamant of conservatives’. Sedgwick argued, rather, that the concept of ‘mental illness’ could be a truly critical concept if it was deployed ‘to make demands upon the health service facilities of the society in which we live’. The paper contextualizes Psychopolitics within the ‘crisis tendencies’ of its time, surveying the shifting welfare landscape of the subsequent 25 years alongside Sedgwick's continuing relevance. It considers the dilemma that the discourse of ‘mental illness’ – Sedgwick's critical concept – has fallen out of favour with radical mental health movements yet remains paradigmatic within psychiatry itself. Finally, the paper endorses a contemporary perspective that, while necessarily updating Psychopolitics, remains nonetheless ‘Sedgwickian’

A randomised controlled trial of the Neuro Emotional Technique (NET) for childhood Attention Deficit Hyperactivity Disorder (ADHD): a protocol

<p>Abstract</p> <p>Background</p> <p>An abundance of literature is dedicated to research for the treatment of Attention Deficit Hyperactivity Disorder (ADHD). Most, is in the area of pharmacological therapies with less emphasis in psychotherapy and psychosocial interventions and even less in the area of complementary and alternative medicine (CAM).</p> <p>The use of CAM has increased over the years, especially for developmental and behavioral disorders, such as ADHD. 60–65% of parents with children with ADHD have used CAM. Medical evidence supports a multidisciplinary approach (i.e. pharmacological and psychosocial) for the best clinical outcomes. The Neuro Emotional Technique (NET), a branch of Chiropractic, was designed to address the biopsychosocial aspects of acute and chronic conditions including non-musculoskeletal conditions. Anecdotally, it has been suggested that ADHD may be managed effectively by NET.</p> <p>Design/methods</p> <p>A placebo controlled, double blind randomised clinical trial was designed to assess the effectiveness of NET on a cohort of children with medically diagnosed ADHD.</p> <p>Children aged 5–12 years who met the inclusion criteria were randomised to one of three groups. The control group continued on their existing medical regimen and the intervention and placebo groups had the addition of the NET and sham NET protocols added to their regimen respectively. These two groups attended a clinical facility twice a week for the first month and then once a month for six months.</p> <p>The Conners' Parent and Teacher Rating Scales (CRS) were used at the start of the study to establish baseline data and then in one month and in seven months time, at the conclusion of the study. The primary outcome measures chosen were the Conners' ADHD Index and Conners' Global Index. The secondary outcome measures chosen were the DSM-IV: Inattentive, the DSM-IV:Hyperactive-Impulsive, and the DSM-IV:Total subscales from the Conners' Rating Scales, monitoring changes in inattention, hyperactivity and impulsivity.</p> <p>Calculations for the sample size were set with a significance level of 0.05 and the power of 80%, yielding a sample size of 93.</p> <p>Discussion</p> <p>The present study should provide information as to whether the addition of NET to an existing medical regimen can improve outcomes for children with ADHD.</p> <p>Trial registration</p> <p>Australian New Zealand Clinical Trial Registration Number: ANZCTRN 012606000332527</p

New Foundations: Pseudo-pacification and special liberty as potential cornerstones of a multi-level theory of homicide and serial murder

Over the past 30 years the industrialized West has witnessed a move towards space, heterogeneity and subjectivity in the criminological study of violence and homicide. Although large-scale quantitative studies of the temporal and spatial distribution of homicide continue to provide a broad empirical context, aetiological explanations tend to be based on analyses of the heterogeneous psychological interactions and experiences of individual subjects at the micro-level. However, mid-range studies of the temporal and spatial distribution of perpetrators and victims of homicide between unrelated adults have provided a useful link between the micro- and macro-levels. Focusing primarily on British homicide and serial murder, this article attempts to strengthen this link by combining contemporary micro-analyses of the subjective motives of perpetrators with mid-range analyses of space, which can therefore be seen as part of the structural tradition of theorizing about homicide and serial murder. Placing these analyses in a broad underlying context constituted by major historical shifts in political economy and the cultural forms of ‘pseudo-pacification’ and ‘special liberty’ will lay the initial cornerstones for an integrated multi-level theory. © The Author(s) 2014

Psychodynamik medikalisierter Beziehungen

Konsensuskonferenzen in der Medizin tragen das zu einem bestimmten Zeitpunkt verfügbare Wissen über eine Krankheit zusammen, um Empfehlungen zu formulieren, wie sie erfolgreich diagnostiziert und therapiert werden kann. Für die Aufmerksamkeits und/oder Hyperaktivitätsstörung bei Kindern und Jugendlichen haben entsprechende Bemühungen dazu geführt, einen aufwendigen Diagnoseprozess zu verlangen, der die gesamte Lebenswelt der auffälligen Kinder und Jugendlichen in die Beobachtung einbezieht und Vorsicht walten lässt, um Unaufmerksamkeit, Impulsivität und Hyperaktivität nicht vorschnell als Symptome einer psychischen Störung zu beurteilen (Remschmidt, 2005). Ein solcher Aufwand ist nicht zuletzt deshalb notwendig, weil die Symptomdiagnose einer AD(H)S auf Urteilen sozialer Wahrnehmung beruht, die immer Normalitätsvorstellungen enthalten, die unterschiedlich ausfallen können. Eine andere Möglichkeit der Objektivierung gibt es nicht. Was die Therapie der AD(H)S betrifft, so gilt es inzwischen als Behandlungsstandard, sich nicht auf die Verordnung von Medikamenten zu beschränken, weil eine solche Beschränkung die Ätiologie der Symptome ignoriert. Wenn eine Medikation nach sorgfältiger Prüfung indiziert erscheint, sollte sie gegebenenfalls von psychotherapeutischen, psychoedukativen, ergotherapeutischen, logopädischen, pädagogischen oder anderen geeigneten nichtmedikamentösen Unterstützungen flankiert werden. Ohne eine solche Flankierung wird den Betroffenen die Entwicklung eines angemessenen Selbstverständnisses vorenthalten

Attempting to stop antipsychotic medication: success, supports, and efforts to cope

Purpose To explore supports and coping strategies used during attempts to discontinue antipsychotic medication and test for associations with success. Method 144 people who were taking or had taken antipsychotics completed The Experiences of Antipsychotic Medication Survey. Among them, 105 people had made at least one discontinuation attempt and answered a series of questions about their most recent attempt to stop. Content analysis and Chi-square tests of independence were used to categorise the data and explore associations. Success was defined as stopping all AM use irrespective of the duration of the medication-free period or whether relapse occurred, which were explored separately. Results Among the 105 people who had attempted discontinuation, 61.9% described unwanted withdrawal effects and 27.6% of the group described psychotic or manic relapse during the withdrawal period. Within this group 55% described successfully stopping all AM for varying lengths of time, half reported no current use, and half described having some form of professional, family, friend, and/or service user or peer support for their attempt. Having support was positively associated with success and negatively associated with both current use, and relapse during withdrawal. A range of coping efforts were described, but having coping strategies failed to show significant associations with any of the dependent variables explored. Among those who described successfully stopping, some described returning to AM for short periods when needed, while others reported managing well with alternative methods alone. Conclusions Findings cannot be readily generalised due to sampling constraints, but results suggest a wide range of supports and coping strategies may be used when attempting to discontinue antipsychotics. Many people may attempt to discontinue antipsychotics without any support. Those who have support for their attempts may be significantly less likely to relapse during withdrawal and more likely to succeed in their attempt. There is a pressing need for further research in this area

Pharmaceutical Creep: U.S. Military Power and the Global and Transnational Mobility of Psychopharmaceuticals

In 2006, the United States Department of Defense developed for the first time official criteria for the use of psychopharmaceuticals “in theater”—in the physical and tactical spaces of military operations including active combat. Based on fieldwork with Army soldiers and veterans, this article explores the transnational and global dimensions of military psychopharmaceutical use in the post‐9/11 wars. I consider the spatial, material, and symbolic dimensions of what I call “pharmaceutical creep”—the slow drift of psychopharmaceuticals from the civilian world into theater and into the military corporate body. While pharmaceutical creep is managed by the U.S. military as a problem of gatekeeping and of supply and provisioning, medications can appear as the solution to recruitment and performance problems once in theater. Drawing on soldiers’ accounts of medication use, I illuminate the possibilities, but also the frictions, that arise when routine psychopharmaceuticals are remade into technologies of global counterinsurgency