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The size of the field in which psychiatry claims expertise has expanded dramatically since the nineteenth century when alienists only dealt with madness (renamed psychosis after the 1860s), epilepsy and some organic disorders. Social history possesses methodologies apt for the exploration both of the world of concepts and values and of the dark forest of economic interests. This book may be pointing to another useful way of doing history of psychiatry. Its findings should add to the periodic documentation required by British psychiatry. There is a need to explore how values and economic interests affect neuroscientific research as well.
There remains a gap between needs, aspirations and delivery in psychiatry and mental health. To close this gap there is a need to attend more intensely to social science and mad studies, as well as neuroscience, in professional formation in psychiatry and mental health. Further strengthening of the nursing profession and greater engagement of action therapies will also help close the gap in practice. To be effective, such efforts must be underpinned by a commitment to pluralism.
The period 1960–2010 has been one of marked change in UK society and mental health services. Prominent changes have included deinstitutionalisation and community care in mental health. These have taken place in an evolving framework of liberalisation, marketisation and globalisation. The global financial crisis of 2008 and the increasing impact of information technology, social media and artificial intelligence have ushered in a new era of meta-community care, which is now affected by the shock of Covid-19. It is timely to look back over the half-century of 1960-2010 to study and learn the lessons from developments in mental health during what has been labelled the neoliberal era, now in retreat.
Mind, State and Society examines the reforms in psychiatry and mental health services in Britain during 1960–2010, when de-institutionalisation and community care coincided with the increasing dominance of ideologies of social liberalism, identity politics and neoliberal economics. Featuring contributions from leading academics, policymakers, mental health clinicians, service users and carers, it offers a rich and integrated picture of mental health, covering experiences from children to older people; employment to homelessness; women to LGBTQ+; refugees to black and minority ethnic groups; and faith communities and the military. It asks important questions such as: what happened to peoples' mental health? What was it like to receive mental health services? And how was it to work in or lead clinical care? Seeking answers to questions within the broader social-political context, this book considers the implications for modern society and future policy. This title is also available as Open Access on Cambridge Core.
The General Medical Council has introduced a generic professional capabilities framework. It includes the need to develop the professional values, actions and aspirations fundamental to becoming a ‘dedicated doctor’. The history of psychiatry has potential to facilitate this learning, both by an understanding of content and the ability to think historically.
The authors summarise the evolving understanding of the neuropsychophysiology of chronic pain, including the relevance of adverse childhood experiences in facilitating it and similarities between the central physiology of chronic pain and opioid addiction. Emerging understanding highlights the importance of dopamine-expressing GABAergic neurons in the nucleus accumbens and suggests that D1 expression is associated with a sense of pleasure and approach behaviour and D2 with a sense of punishment and behavioural inhibition. Regulation of D1 and D2 expression may be mediated by nigrostriatal and medial frontal striatal pathways within the increasingly understood brain as a ‘predictive’ organ. The distinction between the predictive brain and personal ‘expectations’ and the importance of the latter for clinical outcomes are emphasised. The relevance of findings for possible future psychopharmacological treatment avenues is also presented.