Tag: mental disorders

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Sex and gender. New findings, new controversy

pdf‘Patients who had undergone sex reassignment surgery at his hospital, stated that the problems presented by patients before the surgery had not been resolved, at either human relationship, work or emotional level.

Introduction

Sex and gender. Dr. Lawrence S. Mayer, an epidemiologist specialising in Psychiatry, and Dr. Paul R. McHugh, said to be the most important American psychiatrist of the last half century, have recently published a study entitled “Sexuality and Gender” in the journal The New Atlantis (see HERE), which offers an exhaustive review of more than five hundred scientific articles related with this matter. “I was alarmed to learn that the LGBT community bears a disproportionate rate of mental health problems compared to the population as a whole”, says Dr. Mayer, one of the authors of the article. 1

Background

In November 2014, Dr. McHugh had already published a report on the website First Things2, in which he explained his decision as head of the Psychiatry Department at John Hopkins hospital in Baltimore, US, to no longer propose any sex reassignment surgery, in view of the negative findings that he obtained after a retrospective examination of patients who had undergone the procedure.

In the current article, the authors looked at studies published in recent years, in an attempt to establish statistically significant, well-proven evidence. Compared to other related studies, which often offer contradictory results on the topic, this one is distinguished by the large amount of data from many different sources, which gives it special credibility, as well as the backing of its indisputably eminent authors.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Transsexuality diagnosis and treatment

PDF version

‘The only thing that has been achieved so far is to try to adapt the body to the mind, instead of trying to alleviate the cerebral problem’

Diagnosis

The diagnosis of transsexualism is based on both medical and psychiatric findings, criteria that have been enshrined in medical guidelines, such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), drawn up by the American Psychiatric Association, or the tenth edition of the International Statistical Classification of Diseases and Related Health Problems (ICD-10).2

However, before attempting to determine the existence of transsexuality and its possible immediate consequence, gender dysphoria, karyotyping should be performed to try to rule out a chromosome disorder, the result of an enzyme defect, that could lead to sexual ambiguity, as occurs in Turner’s or Klinefelter syndrome.3

According to the DSM-5, in order to diagnose gender dysphoria, there has to be objective incongruity between the sex assigned at birth and the one the individual desires, i.e. a marked difference between the gender that one feels and the one assigned at birth, and this disharmony must persist for at least 6 months.

In the case of children, gender dysphoria can manifest between two and four years old, when affected children can start to express preferences or social attitudes of the sex opposite to the gender to which they biologically belong, but this desire must be determined objectively.

According to World Professional Association for Transgender Health (WPATH) guidelines, the diagnosis of gender dysphoria is an essential condition in order for a person to be able to request sex reassignment surgery.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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"American Horror Story" in Real Life: Understanding Racialized Views of Mental Illness and Stigma

By Sunidhi Ramesh
Racial and ethnic discrimination has taken various forms in the
United States since its formation as a nation. The sign in the image
reads: “Deport all Iranians. Get the hell out of my country.”
Image courtesy of Wikipedia.
From 245 years of slavery to indirect racism in police sanctioning and force, minority belittlement has remained rampant in American society (1). There is no doubt that this history has left minorities in the United States with a differential understanding of what it means to be American and, more importantly, what it means to be an individual in a larger humankind.

Generally, our day-to-day experiences shape the values, beliefs, and attitudes that allow us to navigate the real world (2). And so, with regards to minorities, consistent exposure to these subjective experiences (of belittlement and discrimination, for example) can begin to shape subjective perceptions that, in turn, can mold larger perspectives and viewpoints.

Last spring, I conducted a project for a class to address the reception (3) of white and non-white, or persons of color (POC), students to part of an episode from American Horror Story: Freak Show. The video I asked them to watch portrays a mentally incapacitated woman, Pepper, who is wrongfully framed for the murder of her sister’s child. The character’s blatant scapegoating is shocking not only for the lack of humanity it portrays but also for the reality of being a human being in society while not being viewed as human.
Although the episode remains to be somewhat of an exaggeration, the opinions of the interview respondents in my project ultimately suggested that there exists a racial basis of perceiving the mental disabilities of Pepper—a racial basis that may indeed be deeply rooted in the racial history of the United States.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – October 2016 by Livia Garofalo

Here is our “In the Journals” roundup for October. In addition to a rich selection of abstracts, also of interest this month are a Special Issue of Osiris on the “History of Science and Emotions” and two recent articles by Fernando Vidal on brains in literature and cinema (linked below). Enjoy!

 

Theory & Psychology 

Desire, indefinite lifespan, and transgenerational brains in literature and film

Fernando Vidal 

Even before the brain’s deterioration became a health problem of pandemic proportions, literature and film rehearsed the fiction of brain transplantations that would allow an aging person to inhabit a younger body, so that successive surgeries may result in that person’s immortality. Such fiction makes the brain operate like an immaterial soul that does not undergo physical decline. This article examines that fiction as elaborated in Hanif Kureishi’s The Body and several films in connection with older fantasies that articulate desire, eternal youth, and personal immortality, with philosophical discussions about brain and personhood, and with people’s assimilation of neuroscientific idioms into their views and practices of personal identity. In conclusion it discusses how, in contrast to philosophical approaches that tend to focus on self-consciousness, first-person perspectives, and individual autonomy, fiction may contribute to direct attention to relationality as constitutive of personhood.

SubStance 

Frankenstein’s Brain: “The Final Touch”

Fernando Vidal 

 

Critical Public Health

A critical examination of representations of context within research on population health interventions

Jean Shoveller, Sarah Viehbeck, Erica Di Ruggiero, Devon Greyson, Kim Thomson and Rodney Knight

Research that fulsomely characterizes context improves our understanding of the processes of implementation and the effectiveness of interventions to improve the health of populations and reduce health inequalities.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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A Gene That Could Help Explain Why Lithium Stabilizes Mood

October 20, 2016

(The Atlantic) – While the description of bipolar disorder in the various editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM)—the American Psychiatric Association’s sometimes maligned guide to psychiatric diagnosis—has changed over the years, lithium has remained a standby treatment. “It’s still arguably one of the best medications,” even if it’s not completely understood, says Ben Cheyette, a professor of psychiatry at the University of California, San Francisco. Now, a new study published on Tuesday by Cheyette’s group in Molecular Psychiatry sheds some light on lithium’s effects on the brain.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Conference Report: “Biopolitics and Psychosomatics: Participating Bodies” by Alev Sen

Biopolitics and Psychosomatics: Participating Bodies

8 July 2016, University of Cambridge

Conveners:
Darin Weinberg, University of Cambridge
Monica Greco, Goldsmiths, University of London
Robbie Duschinsky, University of Cambridge
Michael Schillmeier, University of Exeter

Introduction

Can we think of our living bodies as involving forms of social intelligence, agency, and power? And if so, how might this proposition transform the ways in which we consider the possibilities and politics of patient participation? These were the questions at the core of the intellectual agenda of the conference “Biopolitics and Psychosomatics: Participating Bodies”, held on 8 July 2016 at the Centre for Research in the Arts, Social Sciences and Humanities (CRASSH) at the University of Cambridge. The event—co-convened by Monica Greco (Goldsmiths), Darin Weinberg and Robbie Duschinsky (University of Cambridge) and Michael Schillmeier (University of Exeter)—aimed to reclaim the term ‘psychosomatic’ from the reductive and polemical forms of engagement in which it is often caught, and use it as a springboard for reframing questions of agency, embodiment, responsibility, power and choice in the context of current challenges facing state-sponsored service provision in Europe and the US.[1] The spirit of the conference was explicitly exploratory, more concerned with creating space for a new type of conversation than to provide direct answers to the many questions raised. Despite a last-minute cancellation by Laurence Kirmayer, who was scheduled to deliver the closing keynote, the conference proved successful, stimulating discussion and debate about these important and timely questions, on practical, political and intellectual levels.

After Darin Weinberg’s welcome address Monica Greco’s introduction outlined the multiple connotations of the term ‘psychosomatic’ and the striking contrast between them.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Neuroimaging in Predicting and Detecting Neurodegenerative Diseases and Mental Disorders

By Anayelly Medina

This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

Anayelly is a Senior at Emory University majoring in Neuroscience and Behavioral Biology. 

If your doctor told you they could determine whether or not you would develop a neurodegenerative disease or mental disorder in the future through a brain scan, would you undergo the process? Detecting the predisposition to or possible development of disorders or diseases not only in adults but also in fetuses through genetic testing (i.e. preimplantation genetics) has been a topic of continued discussion and debate [2]. Furthermore, questions regarding the ethical implications of predictive genetic testing have been addressed by many over the past years [4,8]. However, more recently, neuroimaging and its possible use in detecting predispositions to neurodegenerative diseases as well as mental disorders has come to light. The ethical questions raised by the use of predictive neuroimaging technologies are similar to those posed by predictive genetic testing; nevertheless, given that the brain is the main structure analyzed and affected by these neurodegenerative and mental disorders, different questions (from those posed by predictive genetic testing) have also surfaced.

Computerized Axial Tomography (CAT), Positron Emission Tomography (PET) and radioactive tracers, Magnetic Resonance Imaging (MRI), and Functional Magnetic Resonance Imaging (fMRI) are all current neuroimaging technologies used in the field of neuroscience. While each of these technologies function differently, they ultimately all provide information on brain functioning or structure. Furthermore, these neuroscientific instruments have, in recent years, been used to explore the brain in order to determine predictive markers for neurodegenerative diseases and mental disorders, such as Parkinson’s disease, Schizophrenia, Huntington’s disease, and Alzheimer’s disease [1,9,11,12].

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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Placebo as Therapy: Context, Ethics, and Recommendations

By Somnath Das
This post was written as part of a class assignment from students who took a neuroethics course with Dr. Rommelfanger in Paris of Summer 2016.

I am a Senior at Emory University and am currently pursuing a double major in Neuroscience and Chemistry. Currently, I am applying to medical school. My interest in healthcare lies primarily in understanding the behavioral motivations of patients as they navigate through various healthcare systems. I also wish to study how to effectively translate innovations powered by biomedical research into accurate health information for patients and optimized healthcare delivery. Neuroethics allows me to focus these interests onto patient dignity and rights when considering the role novel therapeutics and interventions in treatment. Studying this fascinating field has given me a perspective on the role deontological considerations play in both neuroscience and medicine as a whole. It is with this perspective that I hope to approach my patients with a balanced worldview, taking into account both individual rights as well as stakeholders and developers participating in a rapidly changing field. 
Placebo therapy is broadly characterized as the administration of an agent that possesses a physiologically inert effect. However, current research suggests that placebo in fact has observable therapeutic outcomes across a wide spectrum of disorders. Thus, placebo’s efficacy should be investigated thoroughly by researchers, ethicists, and physicians in order to evaluate and develop protocols to implement placebo therapy in an effective manner. It is necessary that researchers communicate to physicians and clinicians about the efficacy and rigor by which research has quantified placebo’s effect.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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An Ethical Argument for Regulated Cognitive Enhancement in Adults: The Case of Transcranial Direct Current Stimulation (tDCS)

by Selin Isguven

Introduction: Human Enhancement, Enhancement vs. Treatment

Human enhancement consists of methods to surpass natural and biological limitations, usually with the aid of technology. Treatment and enhancement are considered to be different in that treatment aims to cure an existing medical condition and restore the patient to a normal, healthy, or species-typical state whereas enhancement aims to improve individuals beyond such a state.  However, the line between treatment and enhancement remains debatable. There is no one agreed-upon definition of the normal human condition; this definition depends on factors such as time period and location, among many. In fact, the debate stems from discussions about the scope of medicine and the definition of ‘healthy.’  For some, like Norman Daniels, a healthy state is the absence of disease whereas for others, such as the World Health Organization (WHO), it is “a state of complete physical, mental and social well-being.”[1] These two definitions of a healthy state are clearly not identical and there exist similarly differing opinions on what is considered ‘beyond’ healthy, as well.[1]

This article aims to demonstrate the case in favor of the regulated use of cognitive enhancement by examining a technique called Transcranial Direct Current Stimulation (tDCS), while addressing common ethical arguments against cognitive enhancers as well as the ethical obligation for proper regulation. The case for regulated use is primarily articulated through a lens of safety and a comparison is drawn between enhancement and treatment in terms of cost-benefit analysis. Although the aim is to extend regulated use to other similar cognitive enhancers by showing tDCS as a case example, it would be wise to evaluate each technique individually.[

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.

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In the Journals – August 2016 by Anna Zogas

Here are some of the articles published in the journals in August 2016. This post includes the abstracts from a special issue of Anthropology & Medicine, “Medical Pluralism and Beyond.” Enjoy!

American Ethnologist

The postneoliberal fabulation of power: On statecraft, precarious infrastructures, and public mobilization in Brazil
João Biehl

In Brazil’s hybrid government of social protection and market expansion, there is under way a fabulation of power, which ultimately serves to “de-poor” people seeking care, working infrastructures, and justice while also shoring up state politics as usual. This process became evident through the failure of a collaborative research project that I coordinated on right-to-health litigation. In rethinking that failure as an experiment in public ethnography, I draw on core disagreements with public officials over the interpretation of our findings from a legal database. Analyzing these disagreements provides an entry point into the mechanisms of veridiction and falsification at work in Brazil, whose government sees itself as providing public goods beyond the minimum neoliberal state. Countering state mythology, public ethnography thus illuminates the improvised quality of postneoliberal democratic institutions and opens up new avenues for theorizing power and the political field.

Royal pharmaceuticals: Bioprospecting, rights, and traditional authority in South Africa
Christopher Morris

The translation of international biogenetic resource rights to a former apartheid homeland is fostering business partnerships between South African traditional leaders and multinational pharmaceutical companies. In the case of one contentious resource, these partnerships are entrenching, and in some instances expanding, apartheid-associated boundaries and configurations of power. The state and corporate task of producing communities amenable to biodiversity commercialization and conservation is entangled with segregationist laws and spatial planning.

The views, opinions and positions expressed by these authors and blogs are theirs and do not necessarily represent that of the Bioethics Research Library and Kennedy Institute of Ethics or Georgetown University.