Mens sana monographs最新文献

Mumbai and its suburbs constitute a huge population. There are limited services here in the field of psychiatry, mainly located in major hospitals and teaching centres. There is a need to decentralize services. Psychiatrists themselves have limited resources to plan out community-based services, or set up centres, which would cater to all the requirements of the local population. Hence, it is necessary that a group like the Bombay Psychiatric Society make collective efforts to urge government and municipal authorities to create such facilities at different centres in the city and suburbs.

Psychiatry and crime are linked in certain ways. On one hand, we have criminal offenders with serious psychopathology; and on the other hand, we have psychiatric patients who may commit criminal offences during the influence of a psychiatric disorder. The psychiatrist in practice has to come in contact with the criminal justice system at some point of time in his career. Forensic psychiatry under whose realm these issues reside is a branch yet underdeveloped in India. The present paper reviews the inter-relationship between crime and psychiatry and the factors involved therein.

Psychiatric Societies and Associations have variegated roles and functions. They provide their members an academic resource and a place for social networking. They also have responsibilities to the profession and to the community they serve. The nature of work they conduct should be aligned to the needs of all stakeholders. Only when there is such harmonious working will the community respect the fraternity and the Association. We, therefore, need to respond to the need of the hour, which in the current time is prevention of suicide in children and adolescents and facilitation of continuing professional development for our members.

This paper talks of support systems for mental health professionals wherein the Bombay Psychiatric Society (BPS) should devote some meetings exclusively to problems pertaining to the profession, e.g., long and odd working hours leading to potentially hazardous practice schedules, unhealthy competitive attitudes and culture. A crash course in self-defence against potentially psychotic patients and drug addicts is advocated as also awareness of the potential hazards in dealing with the litigious paranoid patients, erotomaniacs and some of the difficult hysterical patients. Potential medicolegal problems arise in treating an uncooperative patient without his knowledge and consent on an outpatient department basis, admitting such an uncooperative patient to a nursing home or a hospital, administering electroconvulsive therapies, maintaining detailed clinical records of patients, and legal issues involving smaller psychiatric private nursing homes. This paper stresses on the use of Yoga as a recognised psycho-physiological therapy. Furthermore, it suggests on the need for BPS, as a professional body, to have a cell to guide and help aspiring young professionals in setting up private practice. It points out the need to evolve some concrete programmes that in the long run should help alleviate stresses and strains and promote positive comprehensive health amongst mental health professionals.

The significance of mental health in the entire health scenario has increased. However, the representation of psychiatry in the current MBBS curriculum for undergraduate students in India still remains much less than desirable. Further, stigmatising attitudes lessen these future doctors' ability to detect and manage patients with psychological problems despite adequate knowledge about psychiatry. Students believe that psychiatrically ill patients are unpredictable and can be dangerous to others. Some feel that psychiatry is unscientific, imprecise and treatment is not effective. Traditional teaching methods are directed more towards imparting knowledge than changing the attitudes of students. Newer teaching and assessment techniques should be used to bring about attitudinal changes and develop interest among medical students. Case based and problem based learning, small group teaching, simulated patients, using movies, multidisciplinary seminars, integrated teaching, attitude questionnaires, objective structured clinical examinations etc., could be introduced in the curriculum to achieve this objective.

Stress is recognised as the most challenging issue of modern times. Contemporary science has understood this phenomenon from one aspect and Indian philosophy gives its traditional reasons based on classical texts. Modern science has recently proposed a concept of perseverative cognition (PC) as an important reason for chronic stress. This has shown how constant rumination on an unpalatable event, object or person leads to various lifestyle disorders. Similarly classical yoga texts like the Taittiriya Upanishad, the Bhagavad Gita, and the Yoga Vashistha describe stress in their unique ways. We have here attempted a detailed classification, description, manifestation, and development of a disease and its management through these models. This paper in a nutshell projects these two models of stress and shows how they could be used in future for harmonious management of lifestyle disorders.

This paper outlines six important tasks for psychiatry today, which can be put in short as: Spread and scale up services;Talk;Science,Psychotherapy;Integrate; andResearch excellence. As an acronym, STSPIR. Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:Mental disorders are leading cause of ill health but bottom of health agenda;Patients face widespread discrimination, human rights violations and lack of facilities;Need to stem the brain drain from developing countries;At any given point, 10% of the adult population report having some mental or behavioural disorder;In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.TALK: Speaking to a wider audience about positive contributions of psychiatry:Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;Defining normality and abnormality;Bringing about greater precision in diagnosis and care;Motivating those helped by psychiatry to speak up;Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;Setting up regular columns in psychiatry journals around the globe, called 'Patients Speak', or something similar, wherein those who have been helped get a chance to voice their stories.SCIENCE: Shrugging ambivalence and disagreement and searching for commonalities in psychiatric phenomena;An idiographic orientation which stresses individuality cannot, and should not, preclude the nomothetic or norm laying thrust that is the crux of scientific progress.The major contribution of science has been to recognize such commonalities so they can be researched, categorized and used for human welfare.It is a mistake to stress individuality so much that commonalities are obliterated.While the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, therapeutic advancements and aetiologic understandings are going to result only from a scientific methodology.Just caring is not enough, if you have not mastered the methods of care, which only science can supply.PSYCHOTHERAPY: Psychiatrists continuing to do psychotherapy:Psychotherapy must be clearly defined, its parameters and methods firmly delineated, its proof of effectiveness convincingly de

Neeta Mehta recently advanced the thesis that medical practice is facing a crisis today. In her paper "Mind-body dualism: a critique from a health perspective" she attributes the crisis to the philosophy of Descartes and set out to understand why this dualism is still alive despite its disavowal from philosophers, health practitioners and lay people. The aim of my reply to her critique is three-fold. First, I draw attention to a more fundamental problem and show that dualism is inescapable-scientifically and commonsensically. I then focus on the self-conscious emotions of shame, guilt and remorse, and argue that the self is not identical with a brain. The third section draws attention to the crisis in psychiatry and stipulates some of the main reasons why this is so. Contrary to Mehta's thesis, the health profession faces a crisis because of physicalism and biological reductionism.

Holistic understanding is necessary to study intimate nuances of psychological/psychopathological processes; also, individual manifestations and individual approach are laudable goals in treatment and approach. But we cannot forget that major therapeutic advances result when we are able to delineate commonalities and stable symptom clusters that cut across geo-cultural boundaries and are amenable to study and intervention. Even though the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, major therapeutic advancements and aetiologic understandings result only from a scientific methodology that stresses and figures out the commonalities of psychopathological phenomena. It is a mistake to stress individuality so much that commonalities are obliterated. Although stress on the individual's needs has helped psychiatry at times become more humane, it has hurt the task enormously by making some very bright minds question the very scientific basis of psychiatry and its status as a medical discipline. Hence, even as it is necessary to promote holistic and individualistic caring, it is equally necessary to shrug ambivalence and crippling disagreements that can result if individualism in therapy is carried beyond limits. Psychiatry's tradition, and field, will always allow for diversity in its practice, even in its theorising. For, psychopathology has both a personal, deep inner dimension - due to biogenetic and personality factors - and social, manifest/unmanifest, outer dimension - due to the environment. And the practice, and theory, of both are likely to be different, although we do try to amalgamate them in our 'bio-psycho-social' model. Such differences are only manifestations of an intricate network of influences that make for the human condition in health and disease. Psychiatry is the one branch which realises this diversity the most, but equally important for it is to stress its unity: Of purpose - that of reducing individual and social psychopathology;Of goals - that of unravelling the aetiopathology of psychiatric disorders; finding precision in diagnostics and investigative tests; finding biomarkers; and finding precise therapies for precise disorders that control such disorders; and not just control, but finally cure them; finding methods of primary prevention; of moving from mental disorder to mental health; and, further, of progress to individual actualisation and personal and collective well-being with longevity;Of practice - a) in therapy: By synergising psychopharmacology/somatic therapies with psychotherapy/therapies, social therapies and pharmacogenetics; b) in diagnostics: By identifying the phenotype-genotype-endophenotype axis; and (c) by promoting such therapy and diagnostics as brings about control, and finally, cure/primary prevention of psychiatric disorders.The future course for psychiatry involves a goal oriented forward movement - while allowing for diversity in practice and theory, str