SUMMARY ‘Formal thought disorder’ is commonly conceptualised as a singular underlying disruption in thinking. In this commentary, I argue that formal thought disorders are not homogeneous in nature and emphasise their importance as signs that add to a comprehensive assessment of mental state.

Abstract The term ‘self’ refers to a dynamic and evolving concept that is contrasted with our awareness of physical objects in the world and as such is the centre and focus of our internal experiences, as an awareness of ourselves as a centre of experience. This chapter deals with the philosophical accounts of John Locke, David Hume, Immanuel Kant and Derek Parfit. These varying accounts demonstrate that the concept of the self is not definitive but is situated in a shifting world of ideas. Karl Jaspers’ contribution was to set out formal characteristics of the self that developed out of encounters with patients and as such has clinical utility since it allows for a discussion of the abnormal phenomena that present to psychiatrists. Finally, our understanding of the neuroscience underpinning the self has advanced considerably to establish that there is no homunculus and the discovery of the default mode network confirms that at the very least the self is a distributed and dynamic network of structures that is most active when the mind is at rest and not focused on external tasks. It is involved in self-referential thinking, mind-wandering, autobiographical memory and social cognition. It is most active during daydreaming or letting the mind wander, when thinking about oneself or others, when recalling personal memories, imagining the future or engaging in moral reasoning and social understanding.

Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.

Empathy is the ability to fully understand and share the feelings, thoughts, and perspectives of another person. The process involves putting oneself in someone else’s shoes, seeing the world through their eyes, and experiencing their emotions. There are at least two aspects to empathy: cognitive and emotional. It is one of a family of terms that include compathy (shared feelings due to shared circumstances) and sympathy (intentionally reacting emotionally to another person’s situation). Empathic understanding is central to Karl Jaspers’ psychopathology and is the process of grasping another person’s abnormal subjective experience from one’s own perspective. It requires the ability to ‘enter into’ the experience of another individual while still maintaining a sense of self-distinction. When empathic understanding breaks down, the abnormal subjective experience becomes ‘un-understandable’ in Jaspers’ terms. This is a fundamental concept that points to a radical and elemental alteration in a person’s subjective life.

Empathy is a process as well as a trait. As a process, it involves automatic mechanisms as well as effortful perspective taking. As a trait, it is a stable, enduring pattern of behaviour, which is stable across time and consistent across situations. In this context, the empathy trait reflects a person’s consistent ability to identify what someone else is thinking or feeling, and to respond to their thoughts and feelings with an appropriate emotion. Assessment of empathy is rarely conducted in clinical practice, even though empathy is pivotal to social interactions and therefore central to the concern of psychiatrists. The role and place of empathy in determining clinical diagnosis is also rarely investigated or explored. Nonetheless, it is possible to propose potentially useful approaches to examining empathy in clinical practice. This chapter poses some systematic inquiries that can be made within the clinical interview.

John Thomas Perceval (1803-1876) was confined first to Dr Fox's private madhouse (asylum) in 1830 and transferred to Mr Newington's madhouse at Ticehurst, Sussex, in 1832 until his release in 1834. His account of his incarceration and treatment was published in two versions, the first in 1838 and the second in 1840. In this article I describe Perceval's psychosis, his treatment and management at Dr Fox's madhouse and his reforming and advocating contributions to psychiatry in the period following his release.

Ursula K. Le Guin (1929-2018) was an influential American writer who was a leading literary figure of the 20th century. She is known for her contributions to the science fiction and fantasy genres. She wrote numerous novels, short stories, poems, and essays throughout her career, exploring various themes and pushing the boundaries of speculative fiction. In this article, I discuss Le Guin's writings on the developmental tasks of adolescence. In Le Guin's fiction, she examines how different social and cultural contexts determine patterns of maturation and the acquisition of the roles and responsibilities of adulthood. This article focuses on two novels, A Wizard of Earthsea from the Books of Earthsea (Le Guin, 2018), and Coming of Age in Karhide (Le Guin, 2017).

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Abstract The clinical encounter can be conceived of as a functional, instrumental, and transactional process. It is an encounter between someone who is in distress and is in the role of a patient and another person who has expertise, makes inquiries, comes to judgements, and proffers assistance to the other, in the role of doctor. These roles have implicit and explicit expectations that determine how the encounter unfolds. In this chapter, the author will explore the characteristics of the aesthetic values that influence the patient’s actions, the patient’s narrative account, and the patient’s desire to be more than a patient. The author will then turn to the aesthetic values that underpin the clinical inquiry, how this shapes the possibility of attentive listening, and the notion of attunement to the patient’s dilemma. Finally, the author will consider the conjoint enterprise between the patient and the doctor to escape the limitations and constraints of role performance such that creativity and aesthetics determine what emerges within the clinical encounter.

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a six-episode series 'Is Psychiatry Working?' for BBC Radio 4 in early 2023.The series focused on six aspects of psychiatry, namely access to care in crisis, the role of mental health legislation and detention in psychiatric care, the place of diagnosis in clinical practice, medical treatments, psychological therapies and recovery.Our method was to have the lived experience of psychiatric patients centre stage and to augment this with interviews and conversations with practitioners and experts.I think what was distinctive about the series was that Horatio Clare and I then had an ongoing dialogue throughout which, on reflection, listeners found informative and enriching.The series itself grew out of Horatio Clare's personal experience of psychosis, which is wonderfully and openly described in his book Heavy Light [1], and the format of the series followed the clinical journey of Clare through what is commonly termed the psychiatric system.There is little doubt that there is much debate about, even disdain for, psychiatric practice, certainly in North America and Western Europe.The reasons for this are multifold, but probably most prominent is the widely held belief that psychiatric disorders are not like other medical diseases, as they have no readily identifiable independent markers and therefore ought not to be treated as medical conditions and not by doctors.This, I believe, is the central plank of the so-called antipsychiatry movement or critical psychiatry.In this article, I will follow the format of the series, discussing access to care in crisis, mental health legislation, diagnostic practice, medical treatment, psychological therapies and recovery.Gaining access to psychiatric care, the world over is difficult, determined as much by limited resources as by stigma and the associated reluctance to being identified as mentally ill.

The role of the humanities in medicine, especially mental health, is now well established. The importance of the subjective experience of people in the clinical encounter; the values and meanings that influence and determine how healthcare decisions are made and responded to; and the degree to which language pervades, structures, limits or enriches communication within the clinical space, are now explicit. This edited book extends, deepening our appreciation and understanding, the ways in which context, history, and politics impact on conceptional notions of madness. Furthermore, it demonstrates the capacity of literary theory to not only reflect but also to refract the realities that underlie behaviours and experiences termed madness. Finally, as if to make the point clear that the role of literature is not merely theoretical, it ends with a section on the instrumental uses of literature in clinical practice. One of the challenges of the postmodern world is the loss of the grand, monolithic narrative that disregards the emic, subsuming it within a supposed universalizing etic. Alan Weber’s chapter, “Layla and Majnun in Historical and Contemporary Conceptions of Madness in Islamic Psychology,” introduces the role of context, cultural as well as religious, in framing potential causes of inner turmoil, perhaps too, prescribing what emotions or beliefs arise in specific situations. Here then is a relativizing dialogue in which translations are inevitable with terms such as melancholia, delusionary disease, excessive love, and depression becoming the currencies that are exchanged to facilitate our cross-cultural understanding. Whether or not these terms cover the same semantic field in both Arabic and English is moot. Weber’s chapter makes it impossible to ignore the competing explanatory claims in mental health and, without saying so explicitly, centres psychiatry as a contested field. Sebastian Galbo’s chapter, “Apartheid’s Garden: Dismantling Madness in J.M. Coetzee’s Life & Times of Michael K,” develops this theme further by examining how politically oppressive systems such as apartheid South Africa can co-opt the power of diagnostic systems to disenfranchise political enemies by labelling them as mentally ill and thus fit for incarceration. In this reading, madness is not a medical condition, but a social construction perpetuated by racist and politically oppressive regimes. 1160111 TAP0010.1177/09593543231160111Theory & PsychologyReview review-article2023