Carl Jung’s relationship with Sabina Spielrein: A reassessment

The aim of this article is to give an accurate account of the relationship between Sabina Spielrein and Carl Gustav Jung, based on a close reading of the available documentary evidence. I challenge many of the commonly held assumptions about their relationship. These include the belief that Spielrein was Jung’s first analytic patient, that they had a long and mutually passionate affair, and that Spielrein was the inspiration behind Jung’s conception of the ‘anima’. I argue that there is little evidence for these and a number of other beliefs that have been passed down through successive cultural iterations without careful documentary analysis

Macrophages come to mind as keys to cognitive decline

Cognitive impairment, an underappreciated consequence of hypertension, is linked to cerebral arteriolar disease through poorly defined mechanisms. A study by Faraco et al. in this issue of the JCI points to perturbations of neurovascular unit coupling caused by perivascular macrophages (PVMs) as a cause of hypertension-related cognitive impairment. Angiotensin II (Ang II) was shown to activate PVMs, causing them to produce superoxide and thereby alter the proper functioning of the adjacent arterioles. Faraco and colleagues also show that disruption of the blood-brain barrier occurs in hypertension, allowing circulating Ang II to access PVMs. This study provides important new insight into the role of inflammatory cells in the genesis of vascular dementia

What would an ideal mental health service for primary care look like?

Key messages: In order to commission an ideal mental health service for primary care, GP commissioners should challenge accepted distinctions and divisions. These include the division between mental health clinics and the GP surgery, and between short GP consultations and extended mental health ones. They also include the division between mental and physical illness, between severe and enduring mental illness and other difficulties, and between the individual and the family. GPs should also call into question the divisions between the mental, social and economic domains, between all the different mental health disciplines and ideologies, and between neighbouring localities or boroughs. Finally, they should challenge the distinctions between offering a diagnosis and treatment, and having a therapeutic conversation; and between the patient's voice and the doctor's decision-making. Why this matters to me: As a GP who is also a part-time consultant in a mental health trust, I have spent the last 15 years trying to promote innovative thinking and ways of working at the interface between primary and secondary care. In spite of all the obvious risks and constraints that will accompany GP commissioning consortia, I believe they may offer an opportunity to challenge some or all of the false divisions and distinctions that currently bedevil mental health services and often lead to fragmented, inflexible, inappropriate or poor care for patients. Mounting such challenges could lead to mental health services that were more attuned to the realities of primary care and served patients far better. The creation of GP commissioning consortia offers potential opportunities for GPs to challenge a number of divisions and distinctions that are currently taken for granted in mental health services, but may be neither necessary nor logical. I examine a range of these and suggest what GPs and patients might reasonably expect if we challenged them in order to imagine and commission an ideal mental health service for primary care. Among its features, an ideal service would cross the boundaries of mental and physical care, individual and family care, and the mental, social and economic domains. It would also transcend mental health ideologies, geographical borders and the artificial distinction between making a diagnosis, offering treatment and holding a therapeutic conversation