La línea que divide la insanidad y la perversidad / The line that divide illness and perversity

La antiquísima pregunta sobre la maldad o la locura es re-explorada. Esto parece estar permanentemente justificado en el servicio de una sociedad humana y sensible que necesita estar siempre consciente de las motivaciones y tendencias para concretizar nuestras ideas en forma conveniente. Esta área del pensamiento es abordada con un enfoque influenciado por el pragmatismo social contenido en los últimos escritos de Wittgenstein. Conceptos como justicia, maldad, insanidad o locura y si mismo son inevitablemente conceptos de una sociedad humana, como también lo es la equidad. Sin embargo la paradoja se hace evidente en algunos casos que se discuten, especialmente relevantes para algunas personas que deben ser encarceladas

Sociobiología y psiquiatría / Sociobiology and psychiatry

Desde la perspectiva de nuestra vida intelectual, debemos intentar calzar dentro del patrón total de las cosas y por cierto, dentro del mundo material y biológico. La sociobiología es parte del intento por hacerlo, pero en un sentido de abajo hacia arriba. Toma la forma, en que actualmente vemos el mundo de la física y de la química y también de la biología, y espera encajar nuestra sociología en ellos. Lo que recuerda uno de los comentarios Wittgenstein, que si quieres abrir una puerta debes mantener las bisagras inmóviles. Los sociobiólogos sostienen sus principios físicos inmoviles y ajustan explicaciones de nosotros para calzarlas con ellos. Otra manera de aprender sobre las cosas y producir teoría es lo que podriamos llamar de arriba a abajo. (Top Down). Uno sostiene firme lo que uno ve que son las personas y las sociedades, conscientes, esquemáticas, aparentemente libres y contemplativas. Uno no espera ser capaz de producir una teoría totalmente consistente y coherente a costa de evitar correspondencia con lo que parece ser observado. Uno nota los errores que surgirían en algunas extrapolaciones de las visiones de Newton y Euclides y anticipa algo similar para Darwin. Como lo dijera Einstein, el mundo es más complicado de lo que creimos, y probablemente más de lo que pensamos. Debemos, sin embargo, dejar de pensar o continuar tratando de integrar nuestras ideas de manera, al menos, análoga a aquellas de los sociobiológos. Quizás podríamos administrar nuestras sociedades mejor si estuviéramos conscientes y fuéramos humildes a causa de nuestra ignorancia, pero no debemos quedarnos intelectualmente paralizados por el escepticismo

Users' satisfaction with mental health services.

The opinion and level of satisfaction of the users of three different mental health services are presented as a way of evaluating the outcome of institutional and community approaches to psychiatric services. The information was collected in the cities of Concepcion (Chile), Sheffield (England) and Trieste (Italy) interviewing a sample of the users of the psychiatric services using a questionnaire specifically designed to suit the study's aims. The patients in Sheffield tended to support an eventual move towards a more community based service while the relatives appeared more interested in a general improvement of the traditional institutional facilities. In Trieste, patients as well as relatives are fully supportive of the community based services and reasonably aware of the difficulties. They want to improve things in the community. Finally, Chilean users show a considerable adherence to the more traditional and institutionalised ways of offering services and the levels of satisfaction were very high considering the conditions in which the help was delivered.

Attitudes of professional mental health workers to psychiatry.

An attempt is presented to measure and compare attitudes to and ideas about psychiatry and mental health services in Concepcion, Sheffield and Trieste. These cities have in some respects comparable populations but very different mental health services. Questionnaires in English, Italian and Spanish were used to assess the views of professional workers in the field. The information collected showed that the Italian professionals had the highest level of satisfaction with their work, showed most tolerance of deviant behaviour in the community, the least acceptance of diminished responsibility in law and a non-traditional view of psychiatry. Clearly Chilean professionals held a very traditional view and medicalised approach to mental illness but an encouraging theoretical approval towards eventual changes in the services, along with the lowest level of satisfaction with their work. Professionals from Sheffield held an intermediate position coming closer to the theoretical view of the Chileans but nearer to the Italian praxis and therapeutic approach.

Mentally abnormal homicide--a review of a special hospital male population.

The clinical, criminological and demographic characteristics of a Special Hospital population of male patients convicted of homicide are described. The results confirm much previous work on mentally abnormal homicide. Typically the patients come from a disadvantaged social background with poor employment records, a prior history of aggressive behaviour and a diagnosis of schizophrenia. Victims were usually known to the patient and often came from within his circle of family and friends. Only 25% of the patients were receiving treatment at the time of the offence. These findings are discussed in the light of the current literature.

Patterns of benzodiazepine use in Great Britain as measured by a general population survey.

In a general population survey by Gallup in Great Britain of 4148 subjects, 7.7% had taken benzodiazepines within the last year (male:female ratio 106:212). Younger subjects tended to take anxiolytics for shorter periods compared with older subjects, who often took hypnotics chronically. This pattern was most marked among females. Dosage escalation, tolerance, high daily dose usage, and hoarding were not common. A substantial proportion of current users had experienced difficulty in stopping their medication. Withdrawal problems were associated with being older than 45 years and consuming benzodiazepines for over 12 months. This lends support to the idea of benzodiazepine dependency. However, the appropriateness of long-term therapy for chronic symptoms cannot be ruled out.

Castilla del Pino's contribution to a scientific psychopathology.

This paper attempts to express critically the basic concepts in the extensive writings on psychopathology of the Spanish author, Castilla del Pino. These are otherwise only available to the world in Castilian. His work offers a way in which the course and depth of psychotic disorders could be charted mathematically. It illustrates the fact that, what is apparently objective is still necessarily so within the confines of the conventions of our languages, from which we cannot ever escape. He nevertheless shows how psychopathology is not therefore fundamentally different from other sciences, even if its development remains rudimentary.

Literature on methadone maintenance clinics.

The literature on the impact of methadone maintenance clinics is presented and it is pointed out that only a very tentative evaluation can be made. The authors themselves, however, are opposed to these clinics based on the balance of the evidence available.

The use of naloxone during the withdrawal syndrome from heroin.

Attempts to repeat in human subjects animal studies in which naloxone stopped withdrawal symptoms after prolonged use of heroin failed. Nevertheless, suggestions for further studies are made, as the subjects' subsequent desire for opiates did seem attenuated.

Computerized axial tomographic studies following long-term use of benzodiazepines.

Computerized axial tomography was used to compare sex and age-matched groups of controls and long-term benzodiazepine users for evidence of cerebral atrophy. No statistically significant differences were found.

Electro-oculogram changes at the switch in a manic-depressive patient.

The correlations between eye movements on the EOG of a patient with a 48 hour cycle of manic-depressive type are described. They are used to confirm the fact that his switch from one state to another occurred at the same time of night whether he was awake or asleep.

A double-blind gluten-free/gluten-load controlled trial in a secure ward population.

A double-blind control trial of gluten-free versus a gluten-containing diet was carried out in a ward of maximum security hospital: 24 patients were studied for 14 weeks. Most suffered from psychotic disorders, particularly schizophrenia. Various dimensions of behaviour were rated on the Psychotic In-Patient profile (PIP) at different stages. There were beneficial changes in the whole group of patients between pre-trial and gluten-free period in five dimensions of the PIP, maintained during the gluten challenge period; these changes could be attributed to the attention the patients received. Two patients improved during the gluten-free period and relapsed when the gluten diet was reintroduced.