It has been suggested that the medical profession contributes to the stigmatisation of those who experience mental health problems, through ‘iatrogenic’ stigma. This study…
It has been suggested that the medical profession contributes to the stigmatisation of those who experience mental health problems, through ‘iatrogenic’ stigma. This study explores how pharmaceutical companies and their advertising agencies think psychiatrists view people who suffer from mental health problems, as expressed through the design and content of advertisements for neuroleptic medication intended for the psychiatric profession. All pharmaceutical company advertisements appearing in the British Journal of Psychiatry in 1999 were analysed: quantitatively as to drug type, advertisement format and demographic characteristics of subjects portrayed in advertisements, and qualitatively as to content, accompanying text and the theme of the advertisement. Although adverts for neuroleptic drugs constitute a minority of all adverts appearing in the journal in 1999, they are larger than antidepressant adverts, use more pages, and are more likely to portray people suffering from schizophrenia as inactive, socially isolated, and leading empty, meaningless lives. Some of the images resonate with the popular mythology of schizophrenia as ‘other’ and ‘split personality’. From this we conclude that pharmaceutical company advertisements for neuroleptic drugs do indeed present stigmatising images of people suffering from schizophrenia. Editors of medical journals should scrutinise advertisements for potentially stigmatising content. It is time for a debate about the position of glossy advertisements in the pages of medical journals.Declaration of interest: Philip Thomas is co‐chair of the Critical Psychiatry Network and has written extensive critiques of the biomedical model.
Evidence of audit committee activity in the formative years of the Baltimore & Ohio (B&O) Railroad indicates that control and reporting activity developed long before the…
Evidence of audit committee activity in the formative years of the Baltimore & Ohio (B&O) Railroad indicates that control and reporting activity developed long before the existence of regulatory mandate or the external auditing function. This is the earliest example of such an organized and continuing activity in American business history. With no previous business experience to model this enterprise, the organizers of the corporation put in place an audit committee of directors as a control device to safeguard assets and ensure proper handling of cash receipts and disbursements. Research into primary materials establishes that the committee not only performed regular routine audits of the “treasurer’s report,” but also identified and addressed critical problems of control and payment weaknesses. The discovery of the function of value‐for‐money (VFM) auditing by a committee of directors establishes historical context for today’s audit process and audit committee. Because the B&O was such an important entity, it influenced other railroads; and the railroad industry, in turn, greatly influenced the development of modern American businesses during the Industrial Revolution.
Assuming BSE causes vCJD, the numbers and characteristics of the vCJD outbreak are re‐estimated using vCJD mortality data to the end of 2001. The results of the earlier analyses are confirmed. The mean mortality period is found to be less than ten years, with seven years the most likely figure; the number of human victims will be restricted to hundreds, even if the distribution turns out to be bimodal, and the most likely figure is calculated as 130. The effectiveness of the various countermeasures since 1988 is assessed in terms of lives saved, and the early countermeasures are found to be far and away the most effective. The implications for government policy are examined.
For over 100 years biomedical psychiatry has dominated the way people throughout the western world understand their sadness and distress, despite the lack of empirical…
For over 100 years biomedical psychiatry has dominated the way people throughout the western world understand their sadness and distress, despite the lack of empirical evidence that distress has a biological basis. Now, the interests of the global pharmaceutical industry and trans‐national professional elites such as the World Health Organisation and the World Psychiatric Association are extending these biomedical accounts across the globe. This paper briefly describes biomedical psychiatry and its origins before considering how this project is closely aligned to the interests of the pharmaceutical industry. It ends with a call for a new agenda in mental health, driven by the concerns and interests of ordinary people in local communities, and an outline of recent developments in Britain and elsewhere that illustrate this challenge to the biomedical hegemony.
Evidence‐based medicine (EBM) is a technical and scientific paradigm in clinical practice that has delivered major improvements in the outcome of care in medicine and…
Evidence‐based medicine (EBM) is a technical and scientific paradigm in clinical practice that has delivered major improvements in the outcome of care in medicine and surgery. However, its value in psychiatry is much less clear. The purpose of the paper is thus to examine its value by subjecting empirical evidence from EBM to a conceptual analysis using the philosophy of Thomas Kuhn.
The authors examine evidence drawn from meta‐analyses of RCTs investigating the efficacy of specific treatments for depression in the form of antidepressant drugs and CBT. This shows that the non‐specific aspects of treatment, the placebo effect and the quality of the therapeutic alliance as seen by the patient, are more important in determining outcome than the specific elements (active drug, specific therapeutic elements of CBT).
Using the philosophy of Thomas Kuhn, it is shown that these non‐specific and non‐technical elements are anomalies that indicate that the technological paradigm in the treatment of depression is fundamentally flawed.
Non‐specific elements of mental health care are essential in fostering hope, trust and meaning. They constitute non‐technical factors that are central to the concept of caring, and vital for recovery, and which resonate strongly with the growth of survivor and user‐led systems of support for people who experience distress and madness. As such they pose a major challenge to scientific psychiatry and mental health services based in this. The analysis has major implications for the primacy of the natural sciences in the education and training of those involved in mental health work, and demonstrates the importance of an open debate about the value of the scientific imagination in mental health work.
This paper is important because it supports user‐led self‐defined notions and understandings of recovery, and does so using a philosophical conceptual analysis.
This conceptual analysis is highly original. To the authors' knowledge no one has subjected EBM to a detailed conceptual analysis using the ideas of Thomas Kuhn.
This paper describes some findings from an evaluation of the effectiveness of a community development project that aimed to overcome inequalities in mental health care…
This paper describes some findings from an evaluation of the effectiveness of a community development project that aimed to overcome inequalities in mental health care experienced by members of the local black and minority ethnic (BME) communities. A participatory action research design was used, involving people from BME communities who had experienced mental health problems and external stakeholders. The study relied largely on qualitative methodology. Findings reported here indicate that participants in the project valued the culturally and spiritually relevant support they received, but felt that more opportunities were needed for training and employment, greater representation on the project's management committee, and greater awareness of the project in the community. External stakeholders felt that the project gained credibility from its community base and valued its ability to work across faith traditions and cultures. It was also seen as successful in acting as a bridge between the communities and statutory services, although there were concerns about the project's relationship with frontline services. The paper proposes two models of community development that primary care trusts may wish to adopt ‐ radical or consensus, or a mixture of both ‐ in order to address inequalities in mental health service provision.
The authors welcome the debate hosted by the British Food Journal on the likely size of the outbreak of New Variant CJD, if it is caused by eating BSE‐contaminated beef…
The authors welcome the debate hosted by the British Food Journal on the likely size of the outbreak of New Variant CJD, if it is caused by eating BSE‐contaminated beef. We are pleased that there is a substantial measure of agreement between our estimates and those of Ferguson et al., for the most likely number of deaths, even if there is disagreement on the upper bound. We note that our low predictions for vCJD deaths based on vCJD data to the end of 1997 continue to be borne out by figures available at the time of writing, one year later.
When Theodore Levitt discussed how firms respond to the question “what business are we in?”, he highlighted the myopic perceptions of some because they viewed their business as “running a railroad” or “making films” — rather than being “in the transport or entertainment market”.
The following is an annotated list of materials dealing with information literacy including instruction in the use of information resources, research, and computer skills related to retrieving, using, and evaluating information. This review, the nineteenth to be published in Reference Services Review, includes items in English published in 1992. A few are not annotated because the compiler could not obtain copies of them for this review.
By Mirowski's own description, this book is a collection of essays that dwell in the interstices of scientific disciplines and established fields of inquiry: “this book…
By Mirowski's own description, this book is a collection of essays that dwell in the interstices of scientific disciplines and established fields of inquiry: “this book sets out to explore that no-man's land at the borders of science and economics with attendant emotions pitched somewhere beyond the thrill of spelunking and the delectation of trespass” (p. 4). With his body armor and some extra clips for his rifle, he charges headfirst into this no-man's land with his sights set on what he calls “the twentieth century science-economy problematic” (p. 6). Some scholars often utilize economic principles (especially neoclassical ones) to characterize the structure and processes of science (ever heard of the “marketplace of ideas?”) while pulling out all the stops in claiming economics to be a rigorous scientific enterprise (on par with the pinnacle – physics, of course). In short, Mirowski is troubled that critical analysis of such academic pursuits seems to be verboten.