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There is increasing recognition that perinatal anxiety disorders are both common and potentially serious for mother and child. Obsessive–compulsive disorder (OCD) can be triggered or exacerbated in the postpartum period, with mothers reporting significant effects on parenting tasks. However, there is little evidence concerning their effective treatment or the impact of successful treatment on parenting.
A total of 34 mothers with OCD and a baby of 6 months old were randomized into either time-intensive cognitive–behaviour therapy (iCBT) or treatment as usual (TAU). iCBT took place after randomization at 6 months postpartum and was completed by 9 months. Maternal symptomatology, sensitivity in mother–infant interactions and parenting were assessed at baseline and reassessed at 12 months postpartum. At 12 months attachment was also assessed using Ainsworth's Strange Situation Procedure. A healthy control group of mothers and infants (n = 37) underwent the same assessments as a benchmark.
iCBT was successful in ameliorating maternal symptoms of OCD (controlled effect size = 1.31–1.90). However, mother–infant interactions were unchanged by treatment and remained less sensitive in both OCD groups than a healthy control group. The distribution of attachment categories was similar across both clinical groups and healthy controls with approximately 72% classified as secure in each group.
iCBT is an effective intervention for postpartum OCD. Sensitive parenting interactions are affected by the presence of postpartum OCD and this is not improved by successful treatment of OCD symptoms. However, the overall attachment bond appears to be unaffected. Longitudinal studies are needed to explore the impact of postpartum OCD as the child develops.
This volume has grown out of a conference on ‘The Prelate in Late Medieval and Reformation England’, held at the University of Liverpool in September 2011. All the papers delivered at that conference are published below, apart from those given by Natalia Nowakowska and Brigitte Resl. The volume also includes a chapter by Cédric Michon, offered subsequent to the Liverpool conference. I would like to thank the contributors to both the conference and to the volume, all of whom have been stimulating and good-humoured collaborators throughout this project.
I would also like to acknowledge gratefully the work and expert guidance of all those at Boydell & Brewer and York Medieval Press who have been involved with this volume and especially Caroline Palmer, Rohais Haughton and Professor Peter Biller. The Liverpool conference was funded partly by a British Academy Research Development Award, and partly by financial contributions from the department of History of the University of Liverpool and the Liverpool Centre for Medieval and Renaissance Studies, without all of whose generous support the event could not have taken place. This publication has also been made possible by a grant from the Scouloudi Foundation in association with the Institute of Historical Research, acknowledged here with gratitude.
The years between the early fourteenth and the mid sixteenth century are of considerable interest in the history of the prelate. In some respects, this era might be regarded as a golden age of prelacy, culminating in the appearance of great ecclesiastical dignitaries across much of Europe, such as Wolsey, d'Amboise, Cisneros, Lang and Jagiellon. In terms of their political weight, their grandeur and their wide-ranging cultural patronage, these early sixteenth-century ‘cardinal-ministers’ arguably represented a high point in prelatical influence. Nor should they be regarded as wholly distinct from their clerical contemporaries: recent studies of Renaissance cardinals and the early Tudor episcopate indicate that the next rank of senior churchmen were no less concerned to express the importance and dignity of their office. However, the period c. 1300–c. 1560 also witnessed a developing critique of prelacy – not unconnected with these eye-catching assertions of ecclesiastical status and power – with complaints about senior members of the Church hierarchy a commonplace in the literature and preaching of the day. To these criticisms were added attacks on the very concept of the prelate, which was rejected as unscriptural by John Wyclif and his followers: a critique which would be taken up enthusiastically by sixteenth-century reformers in England and Europe.
High ecclesiastical office in the Middle Ages inevitably brought power, wealth and patronage. The essays in this volume examine how late medieval and Renaissance prelates deployed the income and influence of their offices, how they understood their role, and how they were viewed by others. Focusing primarily on but not exclusively confined to England, this collection explores the considerable common ground between cardinals, bishops and monastic superiors. Leading authorities on the late medieval and sixteenth-century Church analyse the political, cultural and pastoral activities of high-ranking churchmen, and consider how episcopal and abbatial expenditure was directed, justified and perceived. Overall, the collection enhances our understanding of ecclesiastical wealth and power in an era when the concept and role of the prelate were increasingly contested. Dr Martin Heale is Senior Lecturer in Late Medieval History, University of Liverpool. Contributors: Martin Heale, Michael Carter, James G. Clark, Gwilym Dodd, Felicity Heal, Anne Hudson, Emilia Jamroziak, Cédric Michon, Elizabeth A. New, Wendy Scase, Benjamin Thompson, C.M. Woolgar.