socio-economic status 476–7
sociotropy 253, 533
Socrates 349
SoCRATES trial 508
source monitoring 365–8, 375, 394–5, 482–3
current perceptions 370–74
definition 533
memories 368–9
speech
blocking 385
circumstantiality 103, 385
clanging 383, 385
cohesive ties 390–92
derailment 102–3, 383, 384
distractible 384
illogicality 383, 385
incoherent/psychotic see thought disorder
inner 196, 197–8, 239, 360–64, 524–5
loss of goal 102–3, 385
and mania 276
planning 363–4, 392, 394
poverty 383, 384
poverty of content 383, 384
pressure of 103, 384
private 196–7, 482–3, 524–5
self-monitoring 394–5
social 196
stilted 385
tangentiality 103, 383, 384
and thought 196
see also language
Sperber, Dan 131, 132
Sperry, Roger 163
spiritual experiences and delusional beliefs 99–100
Spitzer, Manfred 398–9
Spitzer, Robert 53, 55, 56, 57, 58, 59, 60, 62, 63, 64, 105–6, 116
Spohn, Herbert 180
SRD events 288–9
stable attributions 241, 243–4, 247
Standard Classified Nomenclature of Disease45–6
Stanton, Alfred 505
Startup, Mike 243, 249, 283, 285
state-dependent memory 272–3, 533–4
states 415–17
Stengel, Erwin 47
Stephens, G. Lynn 364, 375, 376
sterilization, compulsory 76
Strauman, Tim 251–2, 332
Strauss, John 83–4, 353
Strauss, Milton 180
stress 127
and expressed emotion 426–7
in relationships 420–28
sensitivity to 418–19
stress-vulnerability model 241, 415, 484–5, 534
Stroop, J. R. 281
Stroop effect 281–2, 283, 284, 313–14, 315, 333–4, 335, 534
substance-induced psychotic disorder 69
subvocalization 198, 198n, 360, 534
suicide 247
Sullivan, Harry Stack 505
superego 250n Susser, Ezra 129
sustained attention/vigilance 184–5, 514
Swarbrick, Rebecca 327
Sweeny, Paul 243
symptoms 149
active 164–5
as basis of psychiatry 140–45, 405–6
clustering 72–5
and cognitive deficits 187–8
cross-cultural differences 130–31
first-rank 30–35, 65, 96, 97, 99, 100, 351
fluctuations in 414–20
functional relationships 411, 412
genetics 440–44, 451–2
incidence 96–104
of mania 273–6
negative xii, 73–4, 73n, 219–29, 526
origins of 488
positive 73–4, 73n, 187, 528
prodromal 206, 420, 529
reliability 144–5
synapses 167
Szasz, Thomas 117, 151–4, 151n, 174, 177
Szechtman, Henry 374, 377
Szulecka, Krystyna 314
Tai, Sara 388
tardive dyskinesia 500, 534–5
Tarrier, Nick 331, 425, 506, 507, 508
Taylor, Eric 456
Taylor, M. A. 65
Taylor, Michael 81
Teasdale, John 240–41, 243, 245, 250
Tellegren, Auke 215–18
Temple–Wisconsin Cognitive Vulnerability to Depression Project 245–6, 246n, 253, 261–2, 473
temporal lobes 190
Tennen, Howard 247
test-retest reliability 531
Teuton, Joanna 118–20, 134
theory of mind 192–3, 192n, 395, 535
and attachment 468, 472
deficits in 315–18, 342–3, 411
second-order tests 316n
third-order tests 316n Third Reich 14
Thomas, Justin 270n, 290
Thomas, Phil 354, 360, 375
Thompson, Michelle 281
thought
audible 32
diffusion 33
intrusive/obsessional 351, 376
and speech 196
withdrawal 32
thought disorder 24, 101–3, 276, 378–401
definition 535
functional relationships 411, 412
genetic studies 441–3
thought insertion 350–51, 375
thought, language and communication disorder 383–5, 535
threshold theory 370
Tien, Allen 97–8, 98n Tienari, Pekka 443, 467, 471
TLC Scale 101–2, 145, 383–5, 388, 395, 396
token economy 4–5
Topping, Gillian 421
Torrey, E. F. 81, 459
traditional healers 118–20, 134–6
traits 415–17
trauma 477–83
Trower, Peter 297, 339, 490
Tsuang, Michael 86
Turkington, Douglas 507–8
Turpin, Graham 425
twin studies 77, 78, 79, 81, 83, 519
discordance rates 79n pairwise concordance rate 78
probandwise concordance rate 78–9
thought disorder 443
twins
dizygotic 76–7, 520–21
monozygotic 77, 77n, 526
UCLA Family Project 471–2
Uganda, traditional healers 118–20, 121, 134
Ullman, Leonard 313
United States, concept of schizophrenia 50–51
ununderstandibility of psychoses 28–9
urban environment 477
US–UK Diagnostic Project 50–51, 55, 65
USSR, concept of schizophrenia 52–3, 544
validity 67–8, 535–6
Valium 89
van Duyl, Marjolein 118–19
van Os, Jim 65, 94, 98, 100
Vaughn, Christine 424
verbal community 536
Virchow, Rudolf 152
visual association cortex 363
Voltaire 296
von Economo, Constantin 39
Vygotsky, L. S. 195–6, 197, 380
Wald, D. 500n Walker, Elaine 454
Wanderling, Joseph 129
Warner, Richard 7, 221
Watson, David 215–18, 219
Watson, J. B. 45, 45n, 197–8, 516
Webster, Donna 326
Weeks, David 102–3
Wehr, Thomas 288, 289
weight gain, drug-induced 500, 501
Weinberger, Daniel 165–6, 396
Weingartner, Howard 272
were 135
Wernicke, Karl 362
Wernicke’s aphasia 362
Wernicke’s area 362
WHO see World Health Organization
Whybrow, Peter 417
Williams, J. Mark 253, 283
Wing, John 34, 221
Winters, Ken 279–80
Wisconsin Card Sort Task 165–6, 180
witiko psychosis 130, 131, 519–20
Wittgenstein, Ludwig 96, 212, 364
Wittson, Cecil 48
Wong, Grace 290
Woodnut, Tom 282
Woodruff, Guy 192n
word approximations 385
word associations 398
word salad 23–4, 378, 384, 535
working memory 186–7, 395–6, 536
World Health Organization (WHO) 42
and classification 46
study of international discrepancies in diagnosis 51–3, 54
Wundt, Wilhelm 10, 11, 293
Wykes, Til 391
Wynne, Lyman 441–2, 44
3
Yolken, Robert 459
Young, Andy 310–11, 314
Young, Heather 324, 325, 326, 357
Yung, Alison 509
Zajonc, Robert 207 zeitgeber 266, 536
Zigler, Philip 344
Zimbardo, Philip 309
Zubin, Joseph 55
* Rob Buckman, doctor and humorist, has characterized the difference between psychologists and psychiatrists in the following way: ‘According to psychologists, a psychologist is a scientist who has trained in various aspects of experimental psychology, neurophysiology, operant conditioning and interpersonal dynamics, whereas a psychiatrist is a doctor who couldn’t keep up the payments on his stethoscope. Psychiatrists, on the other hand, tend to view the schism in a more allegorical style. Thus, according to a very senior psychiatrist, “neurotics are people who build castles in the air, psychotics are people who live in them, while psychiatrists are people who charge the rent, and psychologists are like Men from the Council who come round once in a blue moon, talk incomprehensible crap, and do damn all” (Medicineballs II. London: Papermac, 1988, pp. 78–9).
As this quotation suggests, the training of clinical psychologists and psychiatrists is quite different. For short accounts of these differences, see the Appendix, (pp. 513–26), which also contains brief definitions of many of the technical terms included in the text.
* Of course, in Kraepelin’s time, cars were owned only by the very rich.
* For a brief but interesting account of this lay misunderstanding of the concept of schizophrenia see T. Turner (1995) ‘Schizophrenia’, in G. E. Berrios and R. Porter (eds.), A History of Clinical Psychiatry. London: Athlone Press. According to Turner, the earliest recorded misrepresentation of this sort occurs in an essay on literary criticism written by T. S. Eliot in 1933.
* This theory anticipated recent philosophical discussions, for example by Dan Dennett, about the relationship between ‘folk’ psychology and scientific explanations of human behaviour. See note 16, p. 51.
* The role of German psychiatry in promoting Nazi eugenic policies is not widely known but has been well documented. Foremost among those who played a role was Alfred Hoche (the man criticized by Jaspers as ‘intelligent, yet unproductive’ and prone to ‘elegant sounding phrases of gentlemanly superiority’), who, together with the philosopher and jurist Karl Binding, in 1920 published a pamphlet entitled ‘Permission to destroy life unworthy of living’, advocating compulsory euthanasia for the inmates of ‘idiot institutes’. It was supporters of the National Socialist Movement, notably Rüdin, who pioneered genetic studies of schizophrenia while at the same time advocating the most extreme eugenic measures. Their work is considered in more detail in Chapter 4.
* In 1913 Watson coined the term ‘behaviourism’ (roughly, the idea that human behaviour should be studied objectively, using the same techniques that had been successfully used to study animal behaviour). Behaviourism became the most influential approach in psychology between the 1930s and the 1960s.
* For the statistically unafraid, the formula for kappa is as follows:
where PO is the proportion of observed agreement between clinicians and Pc is the level of agreement expected by chance.
* The concept of positive and negative symptoms can be traced to the British neurologist Hughlings Jackson. Writing at the end of the nineteenth century, Jackson assumed a hierarchical-evolutionary model of the nervous system, in which the most evolved regions of the brain were not only responsible for the highest forms of mental functioning, but also regulated the expression of more primitive functions. On this view, negative symptoms were the consequence of the loss of higher functions whereas the release of lower functions was responsible for positive symptoms. Jackson’s use of metaphor reveals the cultural origins of this theory: ‘If the governing body of this country were destroyed suddenly, we should have two causes of lamentation: 1. The loss of services of eminent men; 2. the anarchy of the now uncontrolled people’ (quoted in J. Miller (1978) The Body in Question. London: Jonathan Cape).
* Kallman, who became one of the most influential of the early psychiatric geneticists, believed that the gene for schizophrenia was recessive and therefore would be carried by many of the healthy relatives of schizophrenia patients. He therefore held that the spread of schizophrenia genes into successive generations could only be checked if both patients and their healthy relatives were prevented from breeding. In their book Not in Our Genes, Steven Rose, Leon Kamin and Richard Lewontin (Harmondsworth: Penguin, 1985) have noted a curious rewriting of history by some contemporary American writers, who have argued that Kallman was motivated to believe that schizophrenia was a recessive disorder precisely because he knew that this would make eugenic measures impractical.
* Identical twins are not always identical in the uterus. Very rarely, genetic mutations may affect one foetus and not the other. More commonly, one foetus receives a better blood supply than the other, and is born heavier as a consequence. Also, infectious or toxic agents may have differential effects on twins. One twin may be affected by a virus whereas the other is not (a study of six pairs of twins born to HIV-positive mothers found that only one of the twins was affected in three of the pairs). Similarly, drugs taken by the mother may have a greater effect on one twin than on the other.
One way of estimating the influence of such factors on the development of twins is by the study of congenital abnormalities that are present at birth. Identical twins are often discordant for such abnormalities, and the degree of concordance or discordance varies according to the organ system affected. For example, concordance rates for clubfoot have been estimated at approximately 75 per cent whereas those for brain abnormalities are much lower, leading some researchers to conclude that non-genetic factors are the main cause of the latter. (For discussions of these and other factors complicating twin studies, see E. F. Torrey, A. E. Bowler, E. H. Taylor and I. I. Gottesman (1994) Schizophrenia and Manic-Depressive Disorder. New York: Basic Books, and also L. Wright (1997) Twins: Genes, Environment and the Mystery of Identity. London: Weidenfeld & Nicolson.)
* In an essay that is highly critical of the quality of genetic research in psychiatry, the late J. Richard Marshall showed that the same logic could be used to inflate estimates of dis cordance. For example, in the above example the pairwise discordance rate is 70 per cent. However, if we calculate a probandwise discordance rate for the sample by counting separately each member of the discordant pairs, we arrive at a discordance rate of 82 per cent, so that, ‘It could then be argued that the concordance rate is negligible’ (‘The genetics of schizophrenia: axiom or hypothesis?’ in R. P. Bentall (ed.) (1990) Reconstructing Schizophrenia. London: Routledge).
* Confusingly, drugs are given two names. The generic name (for example, chlor-promazine) refers to the active compound, whereas the trade name (for example, Largactil) isused by the drug company when marketing the compound. I will follow convention and begin generic names inlower case and trade names inupper case.
* The 13.0 per cent figure was based on data from the first interview, whereas the 11.1 per cent figure was based on data collected at the follow-up interviews one year later.
* There is evidence of both cross-cultural and historical variation in the extent to which visual hallucinations are reported by psychiatric patients, which I review in later chapters. Modern psychiatric patients in the West appear to report fewer visual hallucinations than patients in Kraepelin’s time. This difference between Tien’s findings and the earlier British findings may therefore reflect a genuine historical trend.
* A normal distribution, as defined by statisticians and epidemiologists, is characterized by the familiar ‘bell curve’ when values of a trait are plotted on the x-axis of a graph, and the proportion of the population having different values of the trait are plotted on the y-axis (see Figure 5.1).
* I am indebted to Joanna Teuton for her helpful advice about the contents of this chapter.
* There have been,
of course, some notable researchers who have straddled both camps, for example Horacio Fabrega and Arthur Kleinman in the United States, and Roland Littlewood and Maurice Lipsedge in the UK.
* We will see in a later chapter that the stresses associated with racial discrimination may play a role in the excess of psychotic breakdowns in British Afro-Caribbeans. It is therefore of some interest to note that Dr Hickling was stopped by the police for no apparent reason when driving in his hire car from his hotel to the Institute of Psychiatry. On being unable to prove his identity, he was arrested (Robin Murray, personal communication).
* According to Kleinman’s distinction between illness and disease (as discussed in the last chapter), Szasz’s argument is against the concept of mental disease. However, I will stick with Szasz’s terminology here.
* In an attempt to make this point humorously, I once wrote an article entitled ‘A proposal to classify happiness as a psychiatric disorder’ (Journal of Medical Ethics, 18: 94–8, 1992). In the article I was able to point to evidence that happiness often leads to irrational or reckless behaviour; that some people are genetically disposed to be happier than others; and that states of happiness are accompanied by abnormal activity in the right cerebral hemisphere of the brain. Of course, my proposal was not a serious one, and was meant to illustrate the problems involved in discriminating between disease and health. Unfortunately, the joke was lost on a number of British journalists who were alerted to the article by a press release from the publisher of the journal. The magazine New Scientist devoted a whole page to suggesting that I was making poor use of the salary at that time paid to me by the University of Liverpool. However, my favourite headline from this period was from the Daily Star, which said, TOP DOC TALKS THROUGH HIS HAT! From this I could at least take some comfort that I was a top doc.
* These tests are devised by finding out how different types of brain damage affect the ability to solve different kinds of problems. Not all psychological tests can be used to identify a specific locus of brain damage in this way.
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