Women's Voices in Psychiatry

Today's post was written by clinical psychiatrist, Gianetta Rands.

Women's Voices in Psychiatry was published in June 2018 by Oxford University Press. It is a collection of essays by women psychiatrists working, or who have worked, in the NHS. In addition, medical journalist Abi Rimmer writes on the history of women in British Medicine and Claire Murdoch, National Mental Health director at NHS England, reminisces about training as a registered mental nurse at Friern Hospital in the 1980s.

This anthology has had a momentum of its own from the very start. I was just in the right place, at the right time. With encouragement from Baroness Elaine Murphy, psychiatrist, researcher, senior manager and cross bench peer, and support from several individuals and committees at Oxford University Press this book was on its way.

In 2015, I retired from the NHS and presented an ‘exit seminar’ titled “Career Reflections of a 1970s Feminist” using my experiences of training and working in medicine and psychiatry from 1975 to 2015 to highlight women’s issues in general. Afterwards, I was surprised by comments from current women psychiatry trainees essentially saying that not much had changed over 40 years in terms of their work experiences. This seminar formed the basis of the first chapter of Women’s Voices.

I now work as an independent psychiatrist and my clinical practice focuses on dementias, brain injuries and mental capacity. A long-term preoccupation of mine has been post flight confusion. That is, air passengers being confused after flying. Many colleagues know about this and many of us have seen dozens of cases. It seems to mostly affect older people whose physiological autoregulation mechanisms may not be so good as those of younger people. And, of course, aviation and altitude medicine research is almost exclusively done on fit young men. I continue to rant about this because I think it is a public health scandal.

I have never aspired to write or edit a book but Women’s Voices was an important project and I had the energy, time and contacts needed to commit to it. For me it was essential to record, in real time, women’s experiences as professionals and as patients in mental health services. Too often women have been silenced and the gender publication gap in scientific publications is one example of this. There are many gender differences discussed in these essays. Whilst editing them I was constantly overwhelmed by their quality, integrity, and content, and so inspired by my wonderful colleagues. I can’t imagine that anyone won’t find every word fascinating.

The essays are a range of autobiographies, biographies, case based studies, reviews of clinical literature, and historical descriptions. For example, Fiona Subotsky scrutinizes the archives in her essay “The Entry of Women into Psychiatry”, and Jane Mounty, Anne Cremona and Rosalind Ramsey describe the more recent history of the Women’s Mental Health Special Interest Group.

Rosemary Lethem writes as psychiatrist and patient having suffered with bipolar affective disorder throughout her adult life. Her bravery and stamina are extraordinary and anyone doubting that they can manage their career and their mental illness will be inspired by her experiences and tips.

There are chapters about Perinatal Psychiatry (Jacqui Humphreys), The Role of Women in Intellectual Difficulties (Angela Hassiotis and Rupal Dave), Women in Forensic services (Jail Birds by Annie Bartlett), and a contemplation about whether or not women only mental health units are needed (Aoife Singh).

For the more psychodynamic essays, Jo O’Reilly considers the need for psychotherapist support in mental health units and proposes a model of the “Maternal Lap” with its changing concavities. An important update of our understanding of child sex abuse and complex trauma is presented by Joanne Stubley, Maria Eyres and Victoria Barker. Sandra Evans and Jane Garner write on “Old Age, Women, and Dynamic Psychotherapy” firmly refuting the belief that psychotherapy is only for the young.

There are chapters about Dementia and how to reduce its risks (Joanne Rodda), about difficult, life-and-death clinical decisions that have involved the Court of Protection (Clementine Maddock), and about the evolution of services - Claire Hilton’s biography of Barbara Robb, and Amanda Thomsell interviewing Nori Graham about Old Age Psychiatry and working with the Alzheimers Society UK and International.

A collection of essays by psychiatrists would not be complete without descriptions of our training (Philippa Greenfield and Georgina Fozard), and our experiences as trainers of psychiatrists (Hannah Fosker and Ann Boyle); but this time it’s women’s views. In addition, inspiring reflections from the Royal College of Psychiatrists President, Wendy Burn, and recent past president, Sue Bailey, give insights into their roads to success.

These essays are interspersed with short ‘profiles’ of pioneering colleagues such as Helen Boyle, Fiona Caldicott, Dora Black, Helen Green Allison, Eluned Woodford-Williams, and nurses Lisbeth Hockey and Annie Altschul. Poems by GP poet Emily Wills create pauses for reflection about women as doctors, as patients, and many aspects of women in general.

Sweeping vs. Creeping Reductionism in Addiction Research

Şerife Tekin is an Assistant Professor of Philosophy at the University of Texas at San Antonio. Her research program in philosophy of science and mind aims to enhance psychiatric epistemology by developing methods for supplementing the existing scientific literature with a philosophical study of the first-person accounts of those with mental illness. 

She draws on the scientific literature on mental illness, philosophical literature on the self, and the ethics literature on what contributes to human flourishing to facilitate the expansion of psychiatric knowledge that will ultimately yield to effective treatments of mental illness. Here she discusses her article, “Brain Mechanisms and the Disease Model of Addiction: Is it the Whole Story of the Addicted Self? A Philosophical-Skeptical Perspective,” which recently appeared in the Routledge Handbook of Philosophy and Science of Addiction.

In my chapter in this anthology, which brings together cutting-edge work on the scientific and clinical research on addiction and various philosophical puzzles pertaining to addiction, I take issue with the disease model of addiction that construes addiction merely as a problem of the “broken brain.” I defend that self or person models of addiction are more resourceful for enhancing research on the mechanisms of addiction and developing effective interventions.

A common debate among scientists and philosophers is whether human sciences, such as psychology and psychiatry, involve phenomena distinct from those targeted in the physical sciences. According to reductionism, target phenomena in human sciences are only prima facie distinct from those in the physical sciences, lending themselves to explanation or even replacement by phenomena in the physical and chemical sciences.

Reductionism exists on a spectrum (Schaffner 2013). On the one extreme, human phenomena “are nothing but aggregates of physicochemical entities,” a view labeled “sweeping reductionism” (Schaffner 2013: 1003). For “sweeping” reductionists, “there is a theory of everything” and “there is nothing but those basic elements—for example, a very powerful biological theory that explains all of psychology and psychiatry” (ibid). 

How We Understand Others

Today’s post was written by Shannon Spaulding, Assistant Professor of Philosophy at Oklahoma State University. Her general philosophical interests are in the philosophy of mind, philosophical psychology, and the philosophy of science. 

The principal goal of her research is to construct a philosophically and empirically plausible account of social cognition. She also has research interests in imagination, pretense, and action theory. Here she introduces her new book, “How We Understand Others: Philosophy and Social Cognition”.

A question that has long interested me is how we understand others – that is, what are the cognitive processes that underlie successful social understanding and interaction – and what happens when we misunderstand others. In philosophy and the cognitive sciences, the orthodox view is that understanding and interacting with others is partly underwritten by mindreading, the capacity to make sense of intentional behavior in terms of mental states. 

On this view, successful social interaction often involves understanding what others are thinking and what they are trying to achieve. In our ordinary social interactions, we attribute beliefs, desires, emotions, and intentions to people to make sense of their behavior, and on the basis of that we predict what they are likely to do next. 

In this book, I argue that mindreading is an important tool in our folk psychological toolkit. But, I argue, mindreading is not as simple, uniform, or accurate as the orthodox view portrays it to be. The philosophical literature on mindreading suggests that neurotypical adult humans rarely make mindreading mistakes, that competent mindreaders all pretty much agree on the mentalistic explanations and predictions we infer, and all there really is to mindreading is attributing a belief, desire, or intention and explaining and predicting behavior. 

I challenge each of these ideas. I argue that individuals differ with respect to informational input to mindreading, their goals in mindreading, the kind of mindreading strategies they adopt, and the kind of mindreading output they produce. My claim is not simply that individuals use their mindreading judgments differently. That much is uncontroversial. 

Rather, my claim is that the input, processing, and output of mindreading all vary along many dimensions, which makes constructing an empirically adequate account of mindreading significantly more challenging than typically recognized. The overarching theme of the book is that mindreading is much more complex, messy, interesting, and relevant to other debates than philosophers have acknowledged. 

There are two particularly important dimensions of complexity for mindreading: the input and output of mindreading. Philosophical accounts of mindreading for the most part do not discuss the input into mindreading mechanisms. Discussions of mindreading rarely concern how social categorization (rapidly, spontaneously classifying individuals by their age, race, gender, and other categories), stereotypes, social biases, and situational context influence how we interpret social behavior. 

These aspects of social interaction filter the available information that serves as input to mindreading and thus directly influence the mental representations mindreaders end up attributing. Thus, realistic and accurate accounts of mindreading must explain how these aspects of social interaction shape both the input and output of mindreading judgments. 

Most contemporary mindreading theories presuppose that our primary goal in mindreading is to attribute beliefs in order to accurately explain behavior. Although this is the case in certain conditions, this presupposition is wrongheaded in two ways. First, mindreading is not limited to belief-based explanations. Existing mindreading theories often narrowly focus on how we attribute beliefs to others. 

Although there is good reason to think that belief attribution is a significant cognitive achievement, and there’s an interesting history of how belief attribution came to dominate philosophical discussion of social cognition, the result of this fixation on belief is that philosophical discussions neglect other important aspects of social interaction, such as attributing various kinds of mental states in order to influence others (mindshaping), to enforce social and moral norms (regulative folk psychology), to confirm our worldview, protect in-group members, and, in cases of competition or threat, vilify an outgroup member. 

The Subjective Structure of Thought Insertion

Pablo López-Silva is a Reader in Philosophical Psychology at the Faculty of Medicine of the Universidad de Valparaíso in Chile. He is the leading researcher of the FONDECYT project ‘The Agentive Architecture of Human Thought’ granted by the National Commission for Scientific and Technological Research (CONICYT) of the Government of Chile. 

His current research focuses on cognitive phenomenology, attributions of mental agency, and delusions. In this post, he summarizes his new paper titled ‘Mapping the Psychotic Mind’ recently published in the Psychiatric Quarterly.

Thought insertion – TI henceforth – is regarded as one of the most complex symptoms of psychosis. People suffering from TI report that external human and non-human agents have inserted thoughts or ideas into their minds. Over the last years, the enigmatic nature of TI reports has become target of a number of phenomenological, empirical, and conceptual debates. In fact, TI has been used as a good excuse to debate about the nature of delusions, the nature of psychiatric reports, the nature of the self, self-consciousness, the adaptive role of beliefs, the principle of immunity to error through misidentification, among many other issues.

However, three problems underlie these discussions.

How to Feel Blue

Today's post is by Cheryl Wright.

In 1998 I gave birth to a beautiful baby girl who was missing part of her corpus callosum. She was quirky and didn’t learn to speak in a typical manner. She had echolalia for years and would only simultaneously repeat what was being said in seemingly stereo timing to what she heard. I had to spend years teaching her to answer, “I’m fine, thank you.” to the question, “How are you?” I walked around with her, and for years pointed to everything blue, telling her it was blue; hoping she would get the concept of color.

We had a blue and white checkered tile floor. I had every person that came in hop on the blue tiles and exclaim “BLUE!” At the age of seven, she finally got it. She said, “Mama, I walk blue!” and excitedly walked across the white tiles on the floor. She did understand blue and was able to demonstrate her understanding over the next week. The other colors came within the next six months.

Cheryl Wright

When she did start to share her observations of the world, I found out that she didn’t view things in the same way that I did. “Look! An airplane, Mama!” she called out to me one day as we were outside walking. Of course, I looked up. No airplanes. I looked down for a toy airplane. I even looked for a sticker of an aircraft.

Then I saw it. The shadow that made an airplane. I became observant of shadows and realized that they were very real to her. She avoided stepping on shiny tiles that reflected the ceiling. For to her, it looked like she was going to drop into a pool. She didn’t look at her reflection in mirrors, as she didn’t recognize it was a reflection of herself, only a disinterested other child. She avoided stepping on shadows as they were physical objects.

The 'plane'

Through my sincere desire to understand my daughter’s thought processes, I researched and studied. I obtained an advanced degree in Autism Spectrum Disorders and earned a Doctorate of Education. I’ve worked to advocate for individuals with disabilities and enjoy being an international educator, speaker, and author. I have worked as a life-skills coach for students with developmental disabilities in South Korea, Thailand, Kuwait, and the United States. In coordination with the wonderful educational leaders that I have met internationally, we have authored the Cultural Rainbow series of children's books about individuals with different abilities, acceptance, holidays, and cultures around the world.