Psychiatry Day Quotes

Nicotine, in fact, is an unusual drug because it does very little except trigger compulsive use. According to researcher Roland R. Griffiths, PhD, professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine, “When you give people nicotine for the first time, most people don’t like it. It’s different from many other addictive drugs, for which most people say they enjoy the first experience and would try it again.” Nicotine doesn’t make you high like marijuana or intoxicated like alcohol or wired up like speed. Some people say it makes them feel more relaxed or more alert, but really, the main thing it does is relieve cravings for itself. It’s the perfect circle. The only point of smoking cigarettes is to get addicted so one can experience the pleasure of relieving the unpleasant feeling of craving, like a man who carries around a rock all day because it feels so good when he puts it down.

Shamefully, human beings are the only mammals to separate mothers from their infants. Dr. John Krystal, Professor of Psychiatry and Neurobiology at the Yale School of Medicine, described the impact of maternal separation on the infant as 'profound', citing the recent discovery that the autonomic activity (heart rate and other involuntary nervous system activity) of two-day-old sleeping babies is 176 per cent higher during maternal separation.

Throughout the human life span there remains a constant two-way interaction between psychological states and the neurochemistry of the frontal lobes, a fact that many doctors do not pay enough attention to. One result is the overreliance on medications in the treatment of mental disorders. Modern psychiatry is doing too much listening to Prozac and not enough listening to human beings; people’s life histories should be given at least as much importance as the chemistry of their brains. The dominant tendency is to explain mental conditions by deficiencies of the brain’s chemical messengers, the neurotransmitters. As Daniel J. Siegel has sharply remarked, “We hear it said everywhere these days that the experience of human beings comes from their chemicals.” Depression, according to the simple biochemical model, is due to a lack of serotonin — and, it is said, so is excessive aggression. The answer is Prozac, which increases serotonin levels in the brain. Attention deficit is thought to be due in part to an undersupply of dopamine, one of the brain’s most important neurotransmitters, crucial to attention and to experiencing reward states. The answer is Ritalin. Just as Prozac elevates serotonin levels, Ritalin or other psychostimulants are thought to increase the availability of dopamine in the brain’s prefrontal areas. This is believed to increase motivation and attention by improving the functioning of areas in the prefrontal cortex. Although they carry some truth, such biochemical explanations of complex mental states are dangerous oversimplifications — as the neurologist Antonio Damasio cautions: "When it comes to explaining behavior and mind, it is not enough to mention neurochemistry... The problem is that it is not the absence or low amount of serotonin per se that “causes” certain manifestations. Serotonin is part of an exceedingly complicated mechanism which operates at the level of molecules, synapses, local circuits, and systems, and in which sociocultural factors, past and present, also intervene powerfully. The deficiencies and imbalances of brain chemicals are as much effect as cause. They are greatly influenced by emotional experiences. Some experiences deplete the supply of neurotransmitters; other experiences enhance them. In turn, the availability — or lack of availability — of brain chemicals can promote certain behaviors and emotional responses and inhibit others. Once more we see that the relationship between behavior and biology is not a one-way street.

Environmental influences also affect dopamine. From animal studies, we know that social stimulation is necessary for the growth of the nerve endings that release dopamine and for the growth of receptors that dopamine needs to bind to in order to do its work. In four-month-old monkeys, major alterations of dopamine and other neurotransmitter systems were found after only six days of separation from their mothers. “In these experiments,” writes Steven Dubovsky, Professor of Psychiatry and Medicine at the University of Colorado, “loss of an important attachment appears to lead to less of an important neurotransmitter in the brain. Once these circuits stop functioning normally, it becomes more and more difficult to activate the mind.” A neuroscientific study published in 1998 showed that adult rats whose mothers had given them more licking, grooming and other physical-emotional contact during infancy had more efficient brain circuitry for reducing anxiety, as well as more receptors on nerve cells for the brain’s own natural tranquilizing chemicals. In other words, early interactions with the mother shaped the adult rat’s neurophysiological capacity to respond to stress. In another study, newborn animals reared in isolation had reduced dopamine activity in their prefrontal cortex — but not in other areas of the brain. That is, emotional stress particularly affects the chemistry of the prefrontal cortex, the center for selective attention, motivation and self-regulation. Given the relative complexity of human emotional interactions, the influence of the infant-parent relationship on human neurochemistry is bound to be even stronger. In the human infant, the growth of dopamine-rich nerve terminals and the development of dopamine receptors is stimulated by chemicals released in the brain during the experience of joy, the ecstatic joy that comes from the perfectly attuned mother-child mutual gaze interaction. Happy interactions between mother and infant generate motivation and arousal by activating cells in the midbrain that release endorphins, thereby inducing in the infant a joyful, exhilarated state. They also trigger the release of dopamine. Both endorphins and dopamine promote the development of new connections in the prefrontal cortex. Dopamine released from the midbrain also triggers the growth of nerve cells and blood vessels in the right prefrontal cortex and promotes the growth of dopamine receptors. A relative scarcity of such receptors and blood supply is thought to be one of the major physiological dimensions of ADD. The letters ADD may equally well stand for Attunement Deficit Disorder.

Philosophers and psychiatrists should explain why it is that we mathematicians are in the habit of systematically erasing our footsteps. Scientists have always looked askance at this strange habit of mathematicians, which has changed little from Pythagoras to our day.

I can no longer hide the truth: I have AADD, or Artist Attention Diversion Disorder. You won’t find this disorder in a psychiatry reference guide, but it exists. AADD is the curse of anyone whose mantra is, “So many supplies, so little time . . . oh look, there’s something new I have to try!

I can remember the days when people talked about the conflict between science and religion. But no more. The newest of all sciences—psychiatry—is teaching what Jesus taught. Why? Because psychiatrists realize that prayer and a strong religious faith will banish the worries, the anxieties, the strains and fears that cause more than half of all our ills. They know, as one of their leaders, Dr. A. A. Brill, said: “Anyone who is truly religious does not develop a neurosis.” If religion isn’t true, then life is meaningless. It is a tragic farce.

Scientists have found that the amount of time spent milkshake-multitasking among American young people has increased by 120 percent in the last ten years. According to a report in the Archives of General Psychiatry, simultaneous exposure to electronic media during the teenage years—such as playing a computer game while watching television—appears to be associated with increased depression and anxiety in young adulthood, especially among men.[1] Considering that teens are exposed to an average of eight and a half hours of multitasking electronic media per day, we need to change something quickly.[2] Social Media Enthusiast or Addict? Another concern this raises is whether you are or your teen is a social media enthusiast or simply a

People may be constrained in two basic ways: physically, by confining them in jails, mental hospitals, and so forth; and symbolically, by confining them in occupations, social roles, and so forth. Actually, confinement of the second type is more common and pervasive in the day-to-day conduct of society’s business; as a rule, only when the symbolic, or socially informal, confinement of conduct fails or proves inadequate, is recourse taken to physical, or socially formal, confinement…. When people perform their social roles properly – in other words, when social expectations are adequately met – their behavior is considered normal. Though obvious, this deserves emphasis: a waiter must wait on tables; a secretary must type; a father must earn a living; a mother must cook and sew and take care of her children. Classic systems of psychiatric nosology had nothing to say about these people, so long as they remained neatly imprisoned in their respective social cells; or, as we say about the Negroes, so long as they “knew their place.” But when such persons broke out of “jail” and asserted their liberty, they became of interest to the psychiatrist.

Through most of human history, our ancestors had children shortly after puberty, just as the members of all nonhuman species do to this day. Whether we like the idea or not, our young ancestors must have been capable of providing for their offspring, defending their families from predators, cooperating with others, and in most other respects functioning fully as adults. If they couldn't function as adults, their young could not have survived, which would have meant the swift demise of the human race. The fact that we're still here suggests that most young people are probably far more capable than we think they are. Somewhere along the line, we lost sight of – and buried – the potential of our teens.

My other client, whom I will call Teresa, thought Lorraine had MPD and hoped I could help her. Almost no one recognized this condition in those days. Lorraine was forty years old and had been in and out of psychiatric hospitals since she was thirteen. She had had various diagnoses, mainly severe depression, and she had made quite a few serious suicide attempts before I even met her. She had been given many courses of electric shock therapy, which would confuse her so much that she could not get together a coherent suicide plan for quite a while. Lorraine’s psychiatrist was initially opposed to my seeing her, as her friend Teresa had been stigmatized with the "borderline personality disorder" diagnosis when in hospital, so was seen as a bad influence on her. But after Lorraine spent a couple of months in hospital calling herself Susie and acting consistently like a child, he was humble enough to acknowledge that perhaps he could learn some new things, and someone else’s help might be a good idea.

In 1949, neurologist Egas Moniz (1874-1955) received a Nobel Prize for his discovery of ‘the therapeutic value of leucotomy in certain psychoses’. Today, prefrontal leucotomy is derided as a barbaric treatment from a much darker age, and it is to be hoped that, one day, so too might antipsychotic drugs.

Imagine a psychiatrist sitting down with a broken human being saying, I am here for you, I am committed to your care, I want to make you feel better, I want to return your joy to you, I don't know how I will do it but I will find out and then I will apply one hundred percent of my abilities, my training, my compassion and my curiosity to your health -- to your well-being, to your joy. I am here for you and I will work very hard to help you. I promise. If I fail it will me my failure, not yours. I am the professional. I am the expert. You are experiencing great pain right now and it is my job and my mission to cure you from your pain. I am absolutely committed to your care... I know you are suffering. I know you are afraid, I love you. I want to cure you and I won't stop trying to help you. You are my patient. I am your doctor. You are my patient. Imagine a doctor phoning you at all hours of the day and night to tell you that he or she had been reading some new stuff on the subject of whatever and was really excited about how it might help you. Imagine a doctor calling you in an important meeting and saying listen, I'm so sorry to bother you but I"ve been thinking really hard about your problems and I'd like to try something completely new. I need to see you immediately! I"m absolutely committed to your care! I think this might help you. I won't give up on you.

CUNNINGHAM: Defense calls Sigmund Freud, Your Honor. BAILIFF: Name! SIGMUND FREUD: Doctor Sigmund Shlomo Freud. CUNNINGHAM: Doctor Freud, would it be accurate to say you qualify as an expert in the field of modern psychiatry? SIGMUND FREUD: Fräulein—I AM modern psychiatry. EL-FAYOUMY: Objection, Your Honor!—the witness is boasting! JUDGE LITTLEFIELD: Overruled!

Liber Novus thus presents a series of active imaginations together with Jung's attempt to understand their significance. This work of understanding encompasses a number of interlinked threads: an attempt to understand himself and to integrate and develop the various components of his personality; an attempt to understand the structure of the human personality in general; an attempt to understand the relation of the individual to present-day society and to the community of the dead; an attempt to understand the psychological and historical effects of Christianity; and an attempt to grasp the future religious development of the West. Jung discusses many other themes in the work, including the nature of self-knowledge; the nature of the soul; the relations of thinking and feeling and the psychological types; the relation of inner and outer masculinity and femininity; the uniting of opposites; solitude; the value of scholarship and learning; the status of science; the significance of symbols and how they are to be understood; the meaning of the war; madness, divine madness, and psychiatry; how the Imitation of Christ is to be understood today; the death of God; the historical significance of Nietzsche; and the relation of magic and reason.

The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

Much, much later. when I am back home and being treated for Post Traumatic Stress Disorder (PTSD). I will be enabled to see what was going on in my mind immediately after 11 August. I am still capable of operating mechanically as a soldier in these following days. But operating mechanically as a soldier is now all I am capable of. Martin says he is worried about me. He says I have the thousand-yard stare'. Of course, I cannot see this stare. But by now we both have more than an idea what it means. So, among all the soldiers here, this is nothing to be ashamed of. But as it really does just go with the territory we find ourselves in. it is just as equally not a badge of honour. Martin is seasoned enough to never even think this. but I know of young men back home, sitting in front of war films and war games, who idolise this condition as some kind of mark of a true warrior. But from where I sit, if indeed I do have this stare, this pathetically naive thinking is a crock of shit. Because only some pathetically naive soul who had never felt this nothingness would say something so fucking dumb. You are no longer human, with all those depths and highs and nuances of emotion that define you as a person. There is no feeling any more, because to feel any emotion would also be to beckon the overwhelming blackness from you. My mind has now locked all this down. And without any control of this self-defence mechanism my subconscious has operated. I do not feel any more. But when I close my eyes. I see the dead Taliban looking into this blackness. And I see the Afghan soldier's face staring into it, singing gently as he slips into another world. And I see Dave Hicks's face. shaking gently as he tries to stay awake in this one. With this, I lift myself up, sitting foetal and hugging my knees on my sleeping mat.

As the pumping engines for the circulatory system, ventricles must have a particular ovoid, lemonlike shape for strong, swift ejection of blood. If the end of the left ventricle balloons out, as it does in takotsubo hearts, the firm, healthy contractions are reduced to inefficient spasms—floppy and unpredictable. But what’s remarkable about takotsubo is what causes the bulge. Seeing a loved one die. Being left at the altar or losing your life savings with a bad roll of the dice. Intense, painful emotions in the brain can set off alarming, life-threatening physical changes in the heart. This new diagnosis was proof of the powerful connection between heart and mind. Takotsubo cardiomyopathy confirmed a relationship many doctors had considered more metaphoric than diagnostic. As a clinical cardiologist, I needed to know how to recognize and treat takotsubo cardiomyopathy. But years before pursuing cardiology, I had completed a residency in psychiatry at the UCLA Neuropsychiatric Institute. Having also trained as a psychiatrist, I was captivated by this syndrome, which lay at the intersection of my two professional passions. That background put me in a unique position that day at the zoo. I reflexively placed the human phenomenon side by side with the animal one. Emotional trigger … surge of stress hormones … failing heart muscle … possible death. An unexpected “aha!” suddenly hit me. Takotsubo in humans and the heart effects of capture myopathy in animals were almost certainly related—perhaps even the same syndrome with different names.

Meanwhile, scientists are studying certain drugs that may erase traumatic memories that continue to haunt and disturb us. In 2009, Dutch scientists, led by Dr. Merel Kindt, announced that they had found new uses for an old drug called propranolol, which could act like a “miracle” drug to ease the pain associated with traumatic memories. The drug did not induce amnesia that begins at a specific point in time, but it did make the pain more manageable—and in just three days, the study claimed. The discovery caused a flurry of headlines, in light of the thousands of victims who suffer from PTSD (post-traumatic stress disorder). Everyone from war veterans to victims of sexual abuse and horrific accidents could apparently find relief from their symptoms. But it also seemed to fly in the face of brain research, which shows that long-term memories are encoded not electrically, but at the level of protein molecules. Recent experiments, however, suggest that recalling memories requires both the retrieval and then the reassembly of the memory, so that the protein structure might actually be rearranged in the process. In other words, recalling a memory actually changes it. This may be the reason why the drug works: propranolol is known to interfere with adrenaline absorption, a key in creating the long-lasting, vivid memories that often result from traumatic events. “Propranolol sits on that nerve cell and blocks it. So adrenaline can be present, but it can’t do its job,” says Dr. James McGaugh of the University of California at Irvine. In other words, without adrenaline, the memory fades. Controlled tests done on individuals with traumatic memories showed very promising results. But the drug hit a brick wall when it came to the ethics of erasing memory. Some ethicists did not dispute its effectiveness, but they frowned on the very idea of a forgetfulness drug, since memories are there for a purpose: to teach us the lessons of life. Even unpleasant memories, they said, serve some larger purpose. The drug got a thumbs-down from the President’s Council on Bioethics. Its report concluded that “dulling our memory of terrible things [would] make us too comfortable with the world, unmoved by suffering, wrongdoing, or cruelty.… Can we become numb to life’s sharpest sorrows without also becoming numb to its greatest joys?” Dr. David Magus of Stanford University’s Center for Biomedical Ethics says, “Our breakups, our relationships, as painful as they are, we learn from some of those painful experiences. They make us better people.” Others disagree. Dr. Roger Pitman of Harvard University says that if a doctor encounters an accident victim who is in intense pain, “should we deprive them of morphine because we might be taking away the full emotional experience? Who would ever argue with that? Why should psychiatry be different? I think that somehow behind this argument lurks the notion that mental disorders are not the same as physical disorders.

Of course. A new consciousness - I that that is the word,' said the old man after he had thought a moment. 'That is what I hope it is. You and your African and Colombian, you are speaking the same language now, you know the same ideas. You are conscious that life on earth is flux. Men are better educated. They are more disciplined than in the past - their schedules are harder, their lives move faster, efficiency digs into them. Men are more sophisticated -every day they have more alternatives to choose among than they can possibly exhaust. Through psychiatry they know their strengths and weaknesses. They know the risks of every choice. This is what I mean by consciousness. Men know so much about everything they do. It was much simpler when they didn't know, when they simply acted out of instinct, believed from instinct, loved from instinct, brought up children by their instincts. Perhaps people were even happier. But now we are more conscious. We have got to live with our greater knowledge. We have got to live with our greater freedom.

While I was doing my fellowship in child and adolescent psychiatry, my family and I lived in Hawaii. When my son was seven years old, I took him to a marine life educational and entertainment park for the day. We went to the killer whale show, the dolphin show, and finally the penguin show. The penguin’s name was Fat Freddie. He did amazing things: He jumped off a twenty-foot diving board; he bowled with his nose; he counted with his flippers; he even jumped through a hoop of fire. I had my arm around my son, enjoying the show, when the trainer asked Freddie to get something. Freddie went and got it, and he brought it right back. I thought, “Whoa, I ask this kid to get something for me, and he wants to have a discussion with me for twenty minutes, and then he doesn’t want to do it!” I knew my son was smarter than this penguin. I went up to the trainer afterward and asked, “How did you get Freddie to do all these really neat things?” The trainer looked at my son, and then she looked at me and said, “Unlike parents, whenever Freddie does anything like what I want him to do, I notice him! I give him a hug, and I give him a fish.” The light went on in my head. Whenever my son did what I wanted him to do, I paid little attention to him, because I was a busy guy, like my own father. However, when he didn’t do what I wanted him to do, I gave him a lot of attention because I didn’t want to raise a bad kid! I was inadvertently teaching him to be a little monster in order to get my attention. Since that day, I have tried hard to notice my son’s good acts and fair attempts (although I don’t toss him a fish, since he doesn’t care for them) and to downplay his mistakes. We’re both better people for it. I collect penguins as a way to remind myself to notice the good things about the people in my life a lot more than the bad things. This has been so helpful for me as well as for many of my patients. It is often necessary to have something that reminds us of this prescription. It’s not natural for most of us to notice what we like about our life or what we like about others, especially if we unconsciously use turmoil to stimulate our prefrontal cortex. Focusing on the negative aspects of others or of your own life makes you more vulnerable to depression and can damage your relationships.

After a 20-year-old female college student had recovered from her schizophrenic breakdown, she wrote the following description of her experiences during the oneiroid phase: (...) There are no days; no nights; sometimes it's darker than other times—that's all. It's never quite black, just dark gray. There is no such thing as time—there is only eternity. There is no such thing as death—nor heaven and hell—there is only a timeless—hateful—spaceless—worsening of things. You can never go forward; you must always regress into this horrific mess...

The dosage range of carbamazepine used to facilitate withdrawal is 400 to 500 mg a day. Some clinicians report particular difficulty in tapering and discontinuing alprazolam, especially in persons who have been receiving high dosages for long periods. There have been reports of successful discontinuation of alprazolam by switching to clonazepam, which is then gradually withdrawn.

Because insomnia may be a symptom of a physical or psychiatric disorder, hypnotics should not be used for more than 7 to 10 consecutive days without a thorough investigation of the cause of the insomnia.

Triazolam has received significant attention in the media because of an alleged association with serious aggressive behavioral manifestations. Therefore, the manufacturer recommends that the drug be used for no more than 10 days for treatment of insomnia and that physicians carefully evaluate the emergence of any abnormal thinking or behavioral changes in persons treated with triazolam, giving appropriate consideration to all potential causes. Triazolam was banned in Great Britain in 1991.

The benzodiazepine hypnotics differ principally in their half-lives; flurazepam has the longest half-life, and triazolam has the shortest. Flurazepam may be associated with minor cognitive impairment on the day after its administration, and triazolam may be associated with mild rebound anxiety and anterograde

In the abstinence state, patients will have been depleted of catecholamines and will want to sleep all day and night, sometimes for the first several days on the unit.

she was counting the brushstrokes when she brushed her teeth — on the rare days that she did brush her teeth.

Leftists shrieked like happy hamsters at a recent Canadian (of course) study linking “prejudice” and “right-wing” ideology to “lower cognitive ability.” They also squealed like shiny baby piglets at another recent study that purported to show that liberals and conservatives (whatever that means) have different brain structures. And though they claim to celebrate the rainbow of differences that Goddess has bequeathed us, somehow they find room in their wide-open minds to cheer for the day when we breed all of those differences into extinction. Neither will these diversicrats tolerate any true diversity of thought—they’re lurching toward Soviet-style political psychiatry by suggesting that ideological disagreement on racial matters is a mental disorder requiring medication. Sound paranoid? I’m sure they’re working on a pill for that, too. Sanity is in many ways a social construct, one that varies widely from society to society. In a pragmatic sense I’ll admit it’s crazy to go against the crowd, however abjectly deluded and brainwashed that crowd may be. If you don’t run with them, they’ll stomp right over you like wild buffalo. Despite the soul-blotting excesses of Soviet and Maoist totalitarianism, many neo-Marxists still appear to believe that the control freaks and power psychos are confined to the right.

No wonder phenomenology could be exciting. It could also be perplexing, and often it was a bit of both. A mixture of excitement and puzzlement was evident in the response of one young German who discovered phenomenology in its early days: Karl Jaspers. In 1913, he was working as a researcher at the Heidelberg Clinic of Psychiatry, having chosen psychology over philosophy because he liked its concrete, applied approach. Philosophy seemed to him to have lost its way, whereas psychology produced definite results with its experimental methods. But then he found that psychology was too workmanlike: it lacked philosophy’s grand ambition. Jaspers was not satisfied by either. Then he heard about phenomenology, which offered the best from both: an applied method, combined with the soaring philosophical aim of understanding the whole of life and experience. He wrote a fan letter to Husserl, but in it admitted that he was not yet quite sure what phenomenology was. Husserl wrote back to him, ‘You are using the method perfectly. Just keep it up. You don’t need to know what it is; that’s indeed a difficult matter.’ In a letter to his parents, Jaspers speculated that Husserl did not know what phenomenology was either. Yet none of this uncertainty could dim the excitement. Like all philosophy, phenomenology made great demands on its practitioners. It required ‘a different thinking’, Jaspers wrote; ‘a thinking that, in knowing, reminds me, awakens me, brings me to myself, transforms me’. It could do all that, and also give results.

Ten minutes of meditation a day, keeps the psychiatrist away.

Voices are often heard at random moments.

My thoughts were my own until I discovered that the universe had access to them.

I’m not interested in psychiatry as a career. Definitely not.” I would take anything else. Surgery, internal medicine, OB/GYN. I’ll even be that kind of doctor who does nothing but look at rectums all day, because that’s an important job and I could do that. But I can’t treat people with psychiatric disorders. It’s the one thing I’ll never do. “I

Among Individuals with a History of Military Service,” JAMA Psychiatry 71, no. 9 (2014): 1041–48.

Imagine anything at all, for after all one is free to do it here. That is the purpose of this place; it was made for you to be mad in. And when you give in and have a real fine bout, they have won. And then they have their evidence as well. But the temptation in the long hours is hard to resist, and it comes over you like the drowsiness of the powders. . . . The moments of clarity are the worst. You burn in humiliation remembering yesterday's folderol, your own foolish thoughts. Not the boredom of here, the passive futility of reality, but the flights of fancy, which would convict you, are the evidence that you merit your fate and are here for a purpose. The crime of the imaginary. The lure of madness as illness. And you crumble day by day and admit your guilt. Induced madness. Refuse a pill and you will be tied down and given a hypodermic by force. Enforced irrationality. With all the force of the state behind it, pharmaceutical corporations, and an entrenched bureaucratic psychiatry. Unassailable social beliefs, general throughout the culture. And all the scientific prestige of medicine. Locks, bars, buildings, cops. A massive system.

Emotional Labour: The f Word, by Jane Caro and Catherine Fox "Work inside the home is not always about chores. One of the most onerous roles is managing the dynamics of the home. The running of the schedule, the attention to details about band practice and sports training, the purchase of presents for next Saturday’s birthday party, the check up at the dentist, all usually fall on one person's shoulders. Woody Allen, in the much-publicised custody case for his children with Mia Farrow, eventually lost, in part because unlike Farrow, he could not name the children’s dentist or paediatrician. It’s a guardianship role and it is not only physically time consuming but demands enormous intellectual and emotional attention. Sociologists call it kin work. It involves: 'keeping in touch with relations, preparing holiday celebrations and remembering birthdays. Another aspect of family work is being attentive to the emotions within a family - what sociologists call ‘emotion work.’ This means being attentive to the emotional tone among family members, troubleshooting and facing problems in a constructive way. In our society, women do a disproportionate amount of this important work. If any one of these activities is performed outside the home, it is called work - management work, psychiatry, event planning, advance works - and often highly remunerated. The key point here is that most adults do two important kinds of work: market work and family work, and that both kinds of work are required to make the world go round.' (Interview with Joan Williams, mothersandmore.org, 2000) This pressure culminates at Christmas. Like many women, Jane remembers loving Christmas as a child and young woman. As a mother, she hates it. Suddenly on top of all the usual paid and unpaid labour, there is the additional mountain of shopping, cooking, cleaning, decorating, card writing, present wrapping, ritual phone calls, peacekeeping and emotional care taking. And then on bloody Boxing Day it all has to be cleaned up. If you want to give your mother a fabulous Christmas present just cancel the whole thing. Bah humbug!

The main evolutionary explanation for the obesity epidemic is obvious; the mechanism that regulate body weight are poorly suited for our modern environments. Taking your body into a modern grocery store is like taking your computed into the summer sun. The environment is outside the range that the control mechanisms can cope with. Our environment is so different from the one we evolved in that it’s remarkable that anyone eats normally. Our hunter-gatherer ancestors walked miles each day gathering food and hunting game, eager to satisfy hunger with whatever they could find. The food they found was mainly high-fiber fruits and vegetables and lean fish and meat. That was only a few thousand years ago, less for many populations.

Although we may not know it, we have, in our day, witnessed the birth of the Therapeutic State. This is perhaps the major implication of psychiatry as an institution of social control.

The standard model of schooling in which 20 or more young people of the same age are taught in classrooms for about 5 hours a day on most days of the year for 10 years certainly runs counter some of our evolved behavioral strategies.

Such is the magnitude of our evolved psychological dependence on social interaction that, even when surrounded by individuals who have committed the most heinous crimes, solitary confinement for more than 15 days is considered psychological torture by the United Nations.

There are a range of useful and illuminating analyses of the media construction of organised abuse as it became front-page news in the 1980s and 1990s (Kitzinger 2004, Atmore 1997, Kelly 1998), but this book is focused on organised abuse as a criminal practice; as well as a discursive object of study, debate and disagreement. These two dimensions of this topic are inextricably linked because precisely where and how organised abuse is reported to take place is an important determinant of how it is understood. Prior to the 1980s, the predominant view of the police, psychiatrists and other authoritative professionals was that organised abuse occurred primarily outside the family where it was committed by extra-familial ‘paedophiles’. This conceptualisation; of organised abuse has received enduring community support to the present day, where concerns over children’s safety is often framed in terms of their vulnerability to manipulation by ‘paedophiles’ and ‘sex rings’. This view dovetails more generally with the medico-legal and media construction of the ‘paedophile as an external threat to the sanctity of the family and community (Cowburn and Dominelli 2001) but it is confounded by evidence that organised abuse and other forms of serious sexual abuse often originates in the home or in institutions, such as schools and churches, where adults have socially legitimate authority over children.

As a society, however, we have become victim to the demands of insurers, who often require justification for every day (if not every hour) of hospitalization, and hospitals in turn encourage, reward, and publicize their ever-shrinking lengths of stay. By this standard, keeping a patient in a hospital for days or weeks longer than would be necessary if they could simply be forced to take medications is unacceptable.

When she woke up each day to go to the school that Fall, she was struck with the reality again of where she was and how trapped she was. She was physically trapped inside the dome and nobody was allowed to go out. She was mentally trapped in this society. She struggled with her emotions. Justina couldn't cry because people would look at her and judge her. All too easily people were medicated here and she had to try to avoid being put in the mental hospital again. She couldn't afford it.