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Anger and Forgiveness"Are You There Alone?"10 Good Questions about Life and DeathA Casebook of Ethical Challenges in NeuropsychologyA Companion to BioethicsA Companion to BioethicsA Companion to GenethicsA Companion to GenethicsA Companion to Muslim EthicsA Cooperative SpeciesA Critique of the Moral Defense of VegetarianismA Delicate BalanceA Fragile LifeA Life for a LifeA Life-Centered Approach to BioethicsA Matter of SecurityA Mirror Is for ReflectionA Mirror Is for ReflectionA Natural History of Human MoralityA Philosophical DiseaseA Practical Guide to Clinical Ethics ConsultingA Question of TrustA Sentimentalist Theory of the MindA Short Stay in SwitzerlandA Tapestry of ValuesA Very Bad WizardA World Without ValuesAction and ResponsibilityAction Theory, Rationality and CompulsionActs of ConscienceAddiction and ResponsibilityAddiction NeuroethicsAdvance Directives in Mental HealthAfter HarmAftermathAgainst AutonomyAgainst BioethicsAgainst HealthAgainst MarriageAgainst Moral 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Taking NamesDebating ProcreationDebating Same-Sex MarriageDecision Making, Personhood and DementiaDecoding the Ethics CodeDefining DifferenceDefining Right and Wrong in Brain ScienceDefining the Beginning and End of LifeDelusions of GenderDementiaDemocracy in What State?Demons of the Modern WorldDescriptions and PrescriptionsDesert and VirtueDesire, Practical Reason, and the GoodDestructive Trends in Mental HealthDeveloping the VirtuesDid My Neurons Make Me Do It?Difference and IdentityDigital HemlockDigital SoulDignityDignityDisability BioethicsDisability, Difference, DiscriminationDiscrimination against the Mentally IllDisordered Personalities and CrimeDisorders of VolitionDisorientation and Moral LifeDivided Minds and Successive SelvesDoes Feminism Discriminate against Men?Does Torture Work?Double Standards in Medical Research in Developing CountriesDown GirlDrugs and JusticeDworkin and His CriticsDying in the Twenty-First CenturyEarly WarningEconomics and Youth ViolenceEmbodied 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UnconsciousEthics and the Metaphysics of MedicineEthics at the CinemaEthics at the End of LifeEthics Case Book of the American Psychoanalytic AssociationEthics Done RightEthics ExpertiseEthics for EveryoneEthics for PsychologistsEthics for the New MillenniumEthics in CyberspaceEthics in Everyday PlacesEthics in Health CareEthics In Health Services ManagementEthics in Mental Health ResearchEthics in PracticeEthics in PsychiatryEthics in PsychologyEthics in Psychotherapy and CounselingEthics of PsychiatryEthics without OntologyEthics, Culture, and PsychiatryEthics, Sexual Orientation, and Choices about ChildrenEvaluating the Science and Ethics of Research on HumansEvilEvil GenesEvil in Modern ThoughtEvil in Modern ThoughtEvolution, Gender, and RapeEvolutionary Ethics and Contemporary BiologyEvolutionary Psychology and ViolenceEvolved MoralityExperiments in EthicsExploding the Gene MythExploiting ChildhoodFacing Human SufferingFact and ValueFacts and ValuesFaking ItFalse-Memory Creation in Children and AdultsFat ShameFatal FreedomFellow-Feeling and the Moral LifeFeminism and Its DiscontentsFeminist Ethics and Social and Political PhilosophyFeminist TheoryFinal ExamFirst Do No HarmFirst, Do No HarmFlashpointFlesh WoundsForced to CareForgivenessForgivenessForgiveness and LoveForgiveness and ReconciliationForgiveness and RetributionForgiveness is Really StrangeFoucault and the Government of DisabilityFoundational Issues in Human Brain MappingFoundations of Forensic Mental Health AssessmentFree WillFree Will And Moral ResponsibilityFree Will and Reactive AttitudesFree Will, Agency, and Meaning in LifeFree?Freedom and ValueFreedom vs. InterventionFriendshipFrom Darwin to HitlerFrom Disgust to HumanityFrom Enlightenment to ReceptivityFrom Morality to Mental HealthFrom Silence to VoiceFrom Valuing to ValueFrontiers of JusticeGender in the MirrorGenetic PoliticsGenetic ProspectsGenetic ProspectsGenetics of Original SinGenetics of Original SinGenocide's AftermathGetting 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DeliberationPatient Autonomy and the Ethics of ResponsibilityPC, M.D.Perfecting VirtuePersonal AutonomyPersonal Autonomy in SocietyPersonal Identity and EthicsPersonalities on the PlatePersonhood and Health CarePersons, Humanity, and the Definition of DeathPerspectives On Health And Human RightsPharmaceutical FreedomPharmacracyPharmageddonPhilosophy and This Actual WorldPhilosophy of BiologyPhilosophy of Technology: The Technological ConditionPhysician-Assisted DyingPicturing DisabilityPilgrim at Tinker CreekPlaying God?Playing God?Political EmotionsPornlandPowerful MedicinesPractical Autonomy and BioethicsPractical EthicsPractical Ethics for PsychologistsPractical RulesPragmatic BioethicsPragmatic BioethicsPragmatic NeuroethicsPraise and BlamePreferences and Well-BeingPrimates and PhilosophersPro-Life, Pro-ChoiceProcreation and ParenthoodProfits Before People?Progress in BioethicsProperty in the BodyProzac As a Way of LifeProzac on the CouchPsychiatric Aspects of Justification, Excuse 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CloningUnderstanding EmotionsUnderstanding EvilUnderstanding Kant's EthicsUnderstanding Moral ObligationUnderstanding Physician-Pharmaceutical Industry InteractionsUnderstanding TerrorismUnderstanding the GenomeUnderstanding the Stigma of Mental IllnessUnderstanding Treatment Without ConsentUnhingedUnprincipled VirtueUnsanctifying Human Life: Essays on EthicsUnspeakable Acts, Ordinary PeopleUp in FlamesUpheavals of ThoughtUsers and Abusers of PsychiatryValue-Free Science?Values and Psychiatric DiagnosisValues in ConflictVegetarianismViolence and Mental DisorderVirtue EthicsVirtue, Rules, and JusticeVirtue, Vice, and PersonalityVirtues and Their VicesVoracious Science and Vulnerable AnimalsVulnerability, Autonomy, and Applied EthicsWar Against the WeakWar, Torture and TerrorismWarrior's DishonourWeaknessWelfare and Rational CareWhat are you staring at?What Genes Can't DoWhat Have We DoneWhat Is a Human?What Is Good and WhyWhat Is Good and WhyWhat Is the Good Life?What Price Better Health?What Should I Do?What We Owe to Each OtherWhat Would Aristotle Do?What's Good on TVWhat's Normal?What's Wrong with Children's RightsWhat's Wrong with Homosexuality?What's Wrong With Morality?When Is Discrimination Wrong?Who Holds the Moral High Ground?Who Owns YouWho Qualifies for Rights?Whose America?Whose View of Life?Why Animals MatterWhy Animals MatterWhy Does Inequality Matter?Why I Burned My Book and Other Essays on DisabilityWhy Not Kill Them All?Why Punish? How Much?Why Some Things Should Not Be for SaleWisdom, Intuition and EthicsWithout ConscienceWomen and Borderline Personality DisorderWomen and MadnessWondergenesWould You Kill the Fat Man?Wrestling with Behavioral GeneticsWriting About PatientsYou Must Be DreamingYour Genetic DestinyYour Inner FishYouth Offending and Youth Justice Yuck!
When this tome first came through my letter box, I groaned. It felt weighty in every sense. A look at the contents page was no more reassuring. A list of papers with titles like "Twenty five years of WHO co-ordinated activities concerned with Schizophrenia" and "Long term mortality experience of international cohorts of persons with schizophrenia and related psychoses." These are followed by nearly seventy pages of tables and statistics--never my ideal reading. So I began to review this book with considerable trepidation. I started with the Introduction and was startled by the opening sentence. "Since the early 1980's a body of epidemiological evidence has taken shape... challenging the early Kraepelian view... that the long term prognosis for schizophrenia was uniformly poor." (p.xi) This surprised me and I realized that my own, unconscious assumption was that a diagnosis of schizophrenia was the psychic equivalent of terminal cancer. One had periods of recovery; palliative care was available but the eventual outcome was in no doubt. Psychic death followed schizophrenia as surely as physical death followed from terminal cancer. This optimism is continued in the introduction with this comment "In the judgment of three leading researchers, it may well be time for chronicity to give way to the expectation of 'slow uphill returns to health' with allowances for 'multiple levels of functioning in housing, occupational and social skills.' (Harding, Zubin and Strauss, 1992) I found this heartening. As a lecturer in Mental Health Nursing I have always found it a little difficult to present my students with an optimistic picture of schizophrenia. With this new perspective my optimism could be revived; thus giving more hope to my students who, in their turn, could offer more hope to their patients.
One of the fascinating aspects of this collection is its breadth of data. Individuals with a diagnosis of schizophrenia were studied across continents and in both rural and urban settings. Thus there are studies from the Germany; China; India; Prague; The Netherlands; The U.K.; Japan and Moscow. Definitions of schizophrenia were agreed along with methodology, outcome measures, and a host of other criteria. Another interesting and important aspect of this trial is the length of time over which it was run. Patients were followed up for between 12-26 years which gives added weight to the findings of this study. I am not aware of many comparable studies which combine length and depth of information in quite this way.
Another aspect of this study that surprised me was the fact that people in the developing world with a diagnosis of schizophrenia had better outcomes than individuals in the developed world. (I had assumed that the reverse would be true.) In their paper, Hopper et al comment "Whether using a strict (ICD 10) or a broad (spectrum) diagnostic classification, and whether considering overall clinical status, symptoms, disabilities, or social functioning (as indexed by work), subjects in the developing centers showed a more favorable picture." (p.33) The reasons given for this are to do with family support and attitudes; acceptance by the wider community and the increased possibility of finding meaningful work, which gives any individual a sense of self worth along with social contact. (This contrasts starkly with the developed world where employment for those with a long term mental health problem is very limited. Whenever I ask my students if they would declare a long term mental health problem to a potential employer, their answer is always a resounding "No way!")
There are many more "fascinating facts" that could be taken from these studies e.g. that in India there is still a 73% chance that a patient will be married compared to a 38% chance in the developed world. Or that one's health outcomes are better in a rural setting than in an urban one. As a source book for lecturers wanting interesting facts this book is a must have! But it has more value than this. It offers a breadth and depth of study that I have not previously seen in one place.
My reservations about volumes like this (costly) one are about who will read it or buy it? In my university we do still buy books--but they represent a small slice of our library budget. Most of the money is spent on journals with an on-line presence. I, too, am increasingly accustomed to doing a "Google scholar" search on a topic, highlighting some major papers and then searching for them on line. I do read books--my study is already overcrowded and we have moved house at least once to accommodate our library. My nursing students are increasingly of a one–click generation. This book would not be seen by them, which would be a great shame. I am very pleased to have seen this book. It has already changed some of my perceptions about schizophrenia and I. in my turn, will share these insights with successive generations of student nurses.
© 2009 Terry Burridge
Terry Burridge is a Senior Lecturer in Mental Health Nursing at Buckinghamshire New University. He has spent most of his professional life as a psychiatric nurse and now spends considerable time and energy trying to inspire future psychiatric nurses to be the best kinds of nurses that they can be! He is very much influenced by psychoanalytic thinking and sees analytic theory as offering a valuable critique to many other areas of human activity. He can be contacted at Terry@dancingbears.co.uk
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