"Modest doubt is called the beacon of the wise"-Incorporating uncertainty in risk analysis from Shakespeare to today.

"Modest doubt is call'd the beacon of the wise."-William Shakespeare, Troilus and Cressida. Although the character Hector warns his fellow Trojans with this line not to engage in war against the Greeks, Shakespeare's works are replete with characters who do not incorporate modest doubt, or any consideration of uncertainty, in their risk decisions. Perhaps Shakespeare was simply a keen observer of human nature. Although risk science has developed tremendously over the last five decades (and scientific inquiry over five centuries), the human mind still frequently defaults to conviction about certain beliefs, absent sufficient scientific evidence-which has effects not just on individual lives, but on policy decisions that affect many. This perspective provides background on the Shakespearean quote in its literary and historical context. Then, as this quote is the theme of the 2023 Society for Risk Analysis Annual Meeting, we describe how "modest doubt"-incorporating the notion of uncertainty into risk analysis for individual and policy decisions-is still the "beacon of the wise" today.

Stroke care in 1960 and now-the case of René Maugras.

BACKGROUND/OBJECTIVE: Georges Simenon accurately describes, in a novel called Les Anneaux de Bicêtre, the clinical picture and course, and the hospital procedures and treatment of a patient with a large left hemispheric stroke, presumably ischemic. METHODS: I here summarize these features and use them as a basis to discuss the marked changes in stroke evaluation and care in the last 60 years. RESULTS/CASE REPORT: A 54-year old Newspaper director was admitted shortly after an acute stroke leading to temporary loss of consciousness, to motor aphasia and right hemiplegia and hypoesthesia. Risk factors included hypertension, a sedentary life, smoking, and a previous episode of cardiac arrhythmia possibly related to congenital heart disease. Evaluation included electroencephalography, cerebral arteriography and cerebrospinal fluid analysis. The acute treatment involved prolonged bed rest in a private room, prophylactic antibiotics, and oral anticoagulation. Smoking was allowed. Prolonged in-hospital rehabilitation followed initial passive physical therapy provided by nurses. After many months, the patient was released with persistent motor problems and a marked psychological change. CONCLUSION: The entire field of acute stroke care has been revolutionized in the last 60 years. Big data management, telemedicine, software, new brain and vascular imaging techniques, biomarkers, robotics etc., are currently in development and again should lead to new and surprising changes during the next decades.

Accounting for Dignity in the Iliad, Ajax, Electra, and the Clinical Encounter: Debating the "End" of Life.

This essay explores as "dignity-denuding" case studies Greek tragic protagonists in order to discuss the ethical problematics involved in "accounting for" such figures: i.e. both diagnosing them and constructing (broken) narratives into which they are fitted. Starting with epic's positive constructions of "aidos" (shame), it contrasts Ajax and Phaedra-each deprived of their dignity by what one psychiatrist called a "violent storm"-as seeking to construct a restorative story of self after trauma. Finally, it argues that Sophocles's Electra's presentation of her "shameful" state has been misread, by both psychiatrists and dramaturgs seeking, perhaps needing?, to impose an inappropriate closure on both her and the play. It is suggestive and significant that this so-called "hysteric" should attract accounts which so impose a diagnosis, impose an "end." The essay concludes that such imposition on anyone who has had their dignity taken away, whether protagonist or patient, is the final indignity.

Hamlet and psychiatry intertwined.

OBJECTIVES:: This article considers selected landmarks in the history of psychiatry and their impact on Hamlet productions, including Burton's Anatomy of Melancholia, Emil Kraepelin's manic-depression, Freud's oedipal complex and R.D. Laing's 'divided self'. Additionally, this article considers the way Shakespeare's Hamlet has influenced the course of psychiatry. CONCLUSION:: The linkages between psychiatry and Hamlet have existed since the 17th century, and perhaps Shakespeare's Hamlet should have a place on every psychiatrist's shelf.

Representations of epilepsy on the stage: From the Greeks to the 20th century.

Epilepsy is a disorder that has been used by dramatists in various ways over the ages and therefore highlights the views of the disorder as people saw it at the time the plays were written and performed. In the 6th century BC, links between tragedy and epilepsy were developed by Greek playwrights, especially Euripides, in Iphigenia among the Taureans and Heracles where epilepsy and madness associated with extreme violence occur together. Both Heracles and Orestes have episodes after a long period of physical exhaustion and nutritional deprivation. During the Renaissance, Shakespeare wrote plays featuring different neurological disorders, including epilepsy. Epilepsy plays a crucial part in the stories of Julius Caesar and Othello. Julius Caesar is a play about politics, and Caesar's epilepsy is used to illustrate his weakness and vulnerability which stigmatizes him and leads to his assassination. Othello is a play about jealousy, and Othello, an outsider, is stigmatized by his color, his weakness, and his 'seizures' as a form of demonic possession. In modern times, Night Mother portrays the hard life of Jessie, who lives with her mother. Jessie has no friends, her father has abandoned the family, and she has no privacy and is ashamed. Stigma and social pressures lead her to commit suicide. Henry James' novella, The Turn of the Screw, portrays a governess with dream-like states, déjà vu, and loss of temporal awareness who has been sent to the country to look after two small children and ends up killing one. This novella was turned into an opera by Benjamin Britten. Most recently, performance art has been portraying epilepsy as the reality of a personally provoked seizure. Both Allan Sutherland and Rita Marcalo have purposely provoked themselves to have a seizure in front of an audience. They do this to show that seizures are just one disability. Whether this provokes stigma in audiences is unknown. Whether the performance artists understand the potential for status epilepticus has not been discussed. This article is part of a Special Issue entitled "Epilepsy, Art, and Creativity".

[Production of accentuated personality traits in baroque opera : Opera buffa Arcifanfano-Re dei matti (1749)]. / Inszenierung von akzentuierten Persönlichkeitszügen in der Barockoper : Opera buffa Arcifanfano - Re dei matti (1749).

BACKGROUND: Madness served primarily as a form of amusement for the spectators in operas of the seventeenth century. This representation was far removed from clinical reality. This circumstance changed in the eighteenth century at the time when tragic madness emerged in numerous operas. MATERIAL AND METHODS: The opera buffa Arcifanfano-Re dei matti (Arcifanfano-King of fools, premiered in 1749 in Venice, text by Carlo Goldoni 1707-1793 and music by Baldassare Galuppi 1706-1785), which continuously enacts a realm of fools and is meant to appear amusing, is riddled with psychopathological abnormalities for which a retrospective diagnosis is methodologically rejected. However, the opera presents many subjects for working out a typology of fools based on outlasting personality traits of the protagonists. The libretto is investigated. A musical analysis is spared. RESULTS: The conceptualized typology of fools in the opera, which is oriented towards the seven main vices or deadly sins serves, in the tradition of moral satire, to critically hold up a mirror to the audience to reflect their own vices by an amusing characterization of the latter. Historically classified, the treatment of fools by means of isolation, custody, locking up in cages as well as authoritarian measures of submission reflects the custom in those days before humanizing the treatment of people with mental illness in the course of the Enlightenment and the French Revolution. CONCLUSION: The opera Arcifanfano is essentially characterized by continuous madness. A typology of the fools can be worked out from the precise depiction of the personalities. A mirror is held up to the spectators in terms of vices, in the tradition of the contemporary baroque opera. At the same time, the opera can be classified psychiatrically and historically as a seismograph of its time when in the seventeenth and eighteenth centuries people with mental illness were isolated and incarcerated.

[Psychological and psychoanalytical issues in Schreker's opera "Die Gezeichneten"]. / Psychologische und psychoanalytische Grundlagen in Schrekers Musikdrama "Die Gezeichneten".

Franz Schrekers opera "Die Gezeichneten" is the artistically answer to Sigmund Freud's psychoanalysis. The proceedings in this drama discuss some principles of psychoanalyses. The figures show typical psychological mechanisms like repression, sublimation or regression and also the typical symptoms of neurosis. During the date of origin of the opera, Freud's method of psychoanalysis becomes well known and a lot of physicians and psychologists begin with their education in it. Themes like the theory of sexuality by Freud were discussed in the Vienna society. The story contains all mechanisms of psychoanalysis and discloses the psychopathology of the society of "fín de siègle" on the end of the 19th century. Franz Schreker's opera is like a forecasting of the nemesis, which in Europe occurs two decades later. The figures of the opera show the central facts of psychoanalysis and their artificial expression in music and performance.

Towards a structure of feeling: abjection and allegories of disease in science fiction 'mutation' films.

This article considers differences between the representation of mutation in science fiction films from the 1950s and the present, and identifies distinctive changes over this time period, both in relation to the narrative causes of genetic disruption and in the aesthetics of its visual display. Discerning an increasingly abject quality to science fiction mutations from the 1970s onwards-as a progressive tendency to view the physically opened body, one that has a seemingly fluid interior-exterior reversal, or one that is almost beyond recognition as humanoid-the article connects a propensity for disgust to the corresponding socio-cultural and political zeitgeist. Specifically, it suggests that such imagery is tied to a more expansive 'structure of feeling', proposed by Raymond Williams and emergent since the 1970s, but gathering momentum in later decades, that reflects an 'opening up' of society in all its visual, socio-cultural and political configurations. Expressly, it parallels a change from a repressive, patriarchal society that constructed medicine as infallible and male doctors as omnipotent to one that is generally more liberated, transparent and equitable. Engaging theoretically with the concept of a 'structure of feeling', and critically with scientific, cinematic and cultural discourses, two post-1970s' 'mutation' films, The Fly (1986) and District 9 (2009), are considered in relation to their pre-1970s' predecessors, and their aesthetics related to the perceptions and articulations of the medical profession at their respective historic moments, locating such instances within a broader medico-political canvas.

A commentary of in Plaute Cappadox in his Curculio by Dr. J. A. Vander Linden.

In 1656, some Selecta medica of Dr Johannes A. Vander Linden (1609-1664) were published in Leiden. Among these miscellaneous, it was quite unexpected to come on a medical commentary on a fictional character from Plautus' theatre : Cappadox hepaticus, or the Bilious. Today unknown, full of erudite quotations, this scholarly doctor's commentary is both philological and medical, on twenty densely printed pages in Latin. Every term used by Plautus is analized, weighed up, and confronted with texts or contemporary situations, thereby drawing knowlegde for his everyday work, how to define a bilious, hydropical affection.

Richard's back: death, scoliosis and myth making.

The body of a mediaeval monarch was always under scrutiny, and Richard III's was no exception. In death, however, his body became subject to new forms of examination and interpretation: stripped naked after the battle of Bosworth, his corpse was carried to Leicester and exhibited before being buried. In 2012, it was rediscovered. The revelation that Richard suffered from scoliosis prompts this article to re-evaluate the historical sources about Richard's physique and his posthumous reputation. This article argues that Richard's death and his myth as 'crookback' are inextricably linked and traces attitudes to spinal curvature in the early modern period. It also considers how Shakespeare represented Richard as deformed, and aspects of performance history which suggest physical vulnerability. It then considers Richard's scoliosis from the perspective of medical history, reviewing classical accounts of scoliosis and arguing that Richard was probably treated with a mixture of axial traction and pressure. It demonstrates from the evidence of Richard's medical household that he was well placed to receive hands-on therapies and considers in particular the role of his physician and surgeon, William Hobbes. Finally, it shows how the case of Richard III demonstrates the close relationship between politics and medicine in the period and the contorted process of historical myth making.

[Two French pioneers of plastic surgery: François Dubois and Raymond Passot]. / Deux pionniers français de la chirurgie esthétique: François Dubois et Raymond Passot.

After World War, especially during the interwar years, new plastic surgical techniques were highly developed by I two French surgeons: Dr Raymond Passot, a pupil of Pr Hippolyte Morestin, Head of surgery department in Val-de-Grâce military hospital, Father of the Gueules cassées and Dr François Dubois, a pupil of Pr Sébileau, head of ear nose throat disorders department at Lariboisière Hospital in Paris. By the way of papers, publications and interviews to media, they described new French cosmetic techniques (rhitidectomy, sutures, liposuccion) and extensively developed this outpatient surgery. They used to renove famous actresse's and actors' face and nose and those of hundreds of patients. They participate to French societies of plastic surgery meetings and publications. Their enthusiastic dare largely participated to the current success of cosmetic surgery in France.

[In truth could nothing on earth help? Kleist's suicide from a psychiatric perspective]. / In Wahrheit auf Erden nicht zu helfen? Kleists Suizid aus psychiatrischer Sicht.

Heinrich von Kleist (1777-1811) was a German poet and dramatist. During the celebrations marking the 200th anniversary of his death in November 2011, his double suicide with Henriette Vogel on the shores of the Kleine Wannsee near Berlin was extensively and publicly debated in Germany. The meticulous reconstruction of his suicidal condition demonstrates that often only a few aspects of this condition are highlighted in German-speaking feuilleton or biographies. Contrasting the popular stylization of Kleist's suicide as a "well-defended deliberate self-killing" or a "romantic double suicide" it is argued that: (a) retrospective psychiatric diagnosis or psychological models of explanation are necessarily questionable (so-called pitfall of pathography), (b) Kleist's mental narrowness regarding suicide as a behavioral option was multifactorially motivated and (c) his sentence "The truth is that on earth no help was possible for me" clearly expresses his desperation but delivers no justification for his suicide. On the contrary, from a clinical ethical point of view suicide can only be justified if no improvement of the condition is objectively possible. Even if this would have been the case in Kleist's time, nowadays modern psychotherapeutic and pharmacological means are reliably and easily able to help people in comparable situations. With a discussion and meticulous reconstruction this paper increases the understanding of Kleist's suicide and opens a clear view on his life and works.

Two scripts of madness.

OBJECTIVE: The purpose of this article is to illustrate the concept of transient mental illness (TMI) as defined by Ian Hacking by way of two texts: Sybil by Flora Rhetta Schreiber and The Adventures of Don Quixote by Miguel de Cervantes. CONCLUSIONS: Psychiatric symptoms tend to follow, in varying degrees, a pre-determined script resulting from a collaborative effort between patient and therapist. They both work in a historical and cultural environment that supports and supplies the background and general lines of the script. Charcot's hysterics and the multiple personality disorder epidemic provide good examples of this phenomenon. Most recently, the controversy around DSM5 suggests that there is growing concern that diagnostic manuals might be used as "scripts" that could lead to the creation of a string of new disorders. The concept of TMI helps explain the genesis and protean nature of psychiatric symptoms, while acknowledging the pain and disability of the sufferer.