Background: Homicide-suicides are rare events in which an individual commits a homicide and then takes his or her own life. Despite extensive media coverage and a recent increase in research in this field, our understanding of these events is limited as most studies are descriptive. There is little reliable evidence regarding mental illness in individuals who commit homicide-suicide. Aims: The central aim of this study was to examine the role of mental illness in cases of homicide-suicide. The objectives were to: (1) determine the prevalence of mental illness; (2) describe the characteristics of perpetrators and victims, and the circumstances of the offence; (3) examine the psychopathology of perpetrators prior to the offence. Method: The research design was a mixed methods study of homicide-suicide. Quantitative and qualitative techniques were used to examine a national consecutive case series, in England and Wales, between 1st January 2006 and 31st December 2008. The sample contained 60 cases. Descriptive statistical analysis and a thematic framework analysis were undertaken on documents obtained from coroners, the police, GP medical records, records of mental health services contact and newspaper articles. The social, behavioural, offence and clinical characteristics of these incidents were reported. Results: Most of these offences were committed by men (53, 88%). The average age of perpetrators was 44 years (range 18-85). The overwhelming majority of these incidents involved close family members, mainly current or former intimate partners and/or the children of the perpetrator. Over half of the perpetrators had previously been diagnosed with mental health problems by a GP, most commonly depression. The incident was, in most cases, preceded by an actual separation from an intimate partner, or the perpetrator perceived separation to be imminent. The emotional responses to the loss of the relationship included: anger; frustration; humiliation; jealousy; desire for revenge; hopelessness, guilt and remorse. Poor coping strategies were observed, with many having a history of previous self-harm or suicide attempts, and difficulty controlling their aggression. Despite the high proportion of lifetime mental illness, few had been in recent contact with their GP for psychological problems prior to the incident. In the majority of cases, incidents involving mentally ill perpetrators were reported responsibly in newspapers. However, there were instances in which journalists sensationalised the incidents and provided stereotypical portrayals of the perpetrator. Conclusion: The findings from this study add valuable empirical qualitative data to the literature. These incidents occur in the context of existing and challenging common social issues, such as intimate partner violence, child custody disputes, an ageing population, and mental disorder. The evidence from this study shows that these perpetrators had an extreme reaction to an interpersonal crisis resulting in severe emotional distress. Perpetrators from vulnerable groups had complex needs and exhibited previous poor coping strategies that may put them at increased risk. However, prevention is difficult as these are rare events and though under distress, these individuals were less likely to seek help from services. More research is required to identify risk factors in targeted sub-groups of homicide-suicide, such as intimate partner, filicide-suicide and elderly homicide-suicide, in the context of social, economic and clinical problems.

This thesis investigated the experiences of children who have a parent with a mental illness, using qualitative methods. It is divided into three separate sections, the first two written as standalone journal papers. Paper 1 is a systematic review and synthesis of qualitative studies exploring children's experiences of having a parent with a mental illness. The review used specific databases, a search of qualitative journals and a general internet search to identify relevant studies, and the subsequent application of inclusion/exclusion criteria and a quality appraisal assessment. 14 studies meeting inclusion and quality criteria were identified exploring the experiences of 163 children and young people aged between 5 and 22 years, from a range of countries, with a variety of parental mental health diagnoses. The review then involved synthesising the findings of these studies to generate five overarching themes which were found to influence children's experiences. Children who had some knowledge and understanding of their parent's mental illness were more likely to use effective coping strategies, have a more positive relationship with their parent, and experience fewer negative effects on them as a child. Paper 2 is an original research study which explored the experiences of children who have a parent with bipolar disorder, to see how this might impact on the child's emotional wellbeing. This qualitative study used 'In My Shoes', a computer assisted interview tool, to explore the experiences of ten children from England aged between 4 and 10 years. Subsequent comparison with their parent's accounts enabled greater insight into family life. Child and parent interview data was analysed using thematic and content analyses. The four main themes that emerged from the child interviews were: knowledge and awareness of bipolar disorder; perception of parents; managing family life with a 'bipolar' parent; and living in a family with bipolar disorder. The study concluded that further research was needed to understand children's perspectives, which should be taken into account when developing appropriate services and interventions to support children and parents with mental illness, including bipolar disorder. Finally the third section of the thesis was a critical appraisal of the literature review, research study and research process as a whole, including methodological reflections, implications for future research and clinical practice, and the researcher's personal reflections in undertaking the research. The findings were deemed vitally important for the future of families in which a parent has bipolar disorder.

My thesis is divided into 4 major sections. The first section is devoted in part to a description of the biochemical abnormalities in the metabolism of homocarnosine (y-aminobutyryl-L-histidine, HCarn) occurring in a patient with homocarnosinosis. The patient studied and two of her siblings have a progressive neurological disorder with grossly elevated concentrations of HCarn in their CSF. HCarn content was four times higher in a biopsy from the patient's frontal cortex than in biopsied cortex from a large group of control subjects. Using new techniques for the measurement of the HCarn synthesizing and catabolizing enzymes, it was found that the activity of HCarn-Carn synthetase was not increased in the patient's biopsy whereas homocarnosinase activity was undetectable. It is concluded that the elevated HCarn in brain and CSF in the homocarnosinosis patient is due to a deficiency of brain homocarnosinase activity. The first description of the regional distribution of the two HCarn metabolizing enzymes in human brain was also obtained. The remainder of the first section deals with a description of the neuropharmacological properties of HCarn. Intraventricular injection of HCarn in the rat produced hyperexcitability and in high doses, convulsions, whereas unilateral intra-striatal injection of HCarn resulted in contralateral myoclonus. The results of these experiments are consistent with the possibility that HCarn may be involved in the neuronal excitability of brain. The second section describes experiments which test the hypothesis that the content of the inhibitory neurotransmitter GABA is altered in the autopsied brains of some patients dying with schizophrenia. The mean content of GABA was reduced by 20-25% in nucleus accumbens, caudate nucleus, frontal cortex and thalamus of the schizophrenic patients as compared to a control group. However, the differences were found to be statistically significant for only the caudate and thalamus. Extraneous factors such as age of patient at death and prolonged drug treatment did not readily explain the observed reduction in GABA content. The results of the investigation suggest an association between a deficiency of GABAergic function in certain brain areas with some forms of schizophrenia. The third section describes experiments which test the hypothesis that a deficiency of aspartate found in the cerebellar cortex of some patients with dominantly inherited cerebellar disorders might be due to reduced activity of two enzymes involved in the synthesis of aspartate, namely, aspartate aminotransferase and pyruvate carboxylase. No deficiency of either enzyme was observed in the cerebellar specimens studied. The results of this investigation suggest that the aspartate deficiency in cerebellar cortex found in some dominantly inherited cerebellar disorders does not result from a deficiency of either of these two brain enzymes. In the final section, experiments are described which study the effects of chronic administration of Y-vinyl GABA and of hydrazine on the contents of GABA and other amino compounds in rat brain. Both of these compounds are presently under consideration for use in clinical trials on patients with disorders involving a brain GABA deficiency. Chronic administration of either y-vinyl GABA or of hydrazine markedly increased brain GABA content in the rat. Prolonged treatment with y-vinyl GABA, but not hydrazine, produced a decrease in the activity of glutamic acid decarboxylase (GAD) in rat brain. Since GAD is localized to a large extent in nerve endings, the possibility exists that y-vinyl GABA might reduce the amount of GABA available for release at synapses, a potentially undesirable effect. The contents of many brain amino compounds other than GABA were markedly altered by both drugs. Since the potential harmful effects of these unexpected biochemical alterations in brain are unknown, the nonspecific effects of Y-vinyl GABA and hydrazine are disturbing. / Medicine, Faculty of / Anesthesiology, Pharmacology and Therapeutics, Department of / Graduate

Michel Foucault's archaeology of the silence of madness in the age of reason circumvents the discipline of psychiatry by refusing to contest the latter on its own terms. The success of Foucault's project of giving voice to the mad is achieved, however, at the expense of neglecting a long history of resistance to the silencing of madness, to which autobiographical writings by people said to be mad have contributed. The first phase of my dissertation focuses on mind-problem memoirs published since the late 1960s, a period in which an international psychiatric survivor movement has emerged. My readings of these memoirs examine how they elaborate ways of negotiating encounters with psychiatry in everyday life, and how they reveal the contingency of naturalized psychiatric practices. The second phase begins with the identification of certain questions that are not prominent among the concerns of political activists struggling to displace the psychiatric system. In the course of articulating a critique of narrative, I introduce the phrase "order of making sense" to describe a moral injunction—to respond and contribute to narrative reason—that acts as a regulative ideal. The third phase consists of fragmentary writing about personal experiences that, in spite of being framed by competing theoretical perspectives, destabilize boundaries. My increasing emphasis on the body, understood as a multiplicity of forces that are not amenable to the formation of coherent subjectivity, opens up the possibility of a revaluation of non-knowledge and the absence of work. The fourth phase concludes a dissertation whose unanticipated discontinuities are both caused by, and a mode of expression of, persistent mind problems. With the delineation of a post-Nietzschean aesthetic of the materialist sublime, the political strategies of psychiatric survivors, including my critique of narrative, are surpassed by the intensities of unproductive expenditure. Until mind problems are no longer pathologized as troubled being that stands in need of direction, the project of overcoming the condition of internal exile remains imperative. Yet it is the anti-project of exceeding sense—through an affirmation of being troubled by eternal recurrence—that most exposes the limits of the age of reason. / Graduate and Postdoctoral Studies / Graduate

The aim of the study was to explore the constructions and meanings around madness/mental illness among a group of young professionals in order to broaden the dialogue around mental illness to include the voices of a certain section of the community. The current dialogue around mental illness is dominated by the view that madness/mental illness is the domain of scientifically trained professionals. The aim of the study was to explore the constructions of those not part of a mental health profession and those not suffering from mental illness and how these constructions may influence their behaviour towards those suffering from mental illness. The epistemological framework of the study falls into a social constructionist perspective. This epistemological approach allows for the exploration of previously taken for granted truths. When adhering to this approach the function of research is to explore a particular version of reality in an embedded context and language seen as the structuring aspect of social reality. From this approach a discourse analysis was done using the transcripts of audiotaped interviews with the participants. The four participants chosen for the study fell into the 23-26 years age group brackets, had finished tertiary education and have started working on a professional career. None of the participants have had any formal contact with mental health services or professionals or those suffering from mental illness. In the process of analysing the texts five discourses were identified and discussed. The first of these discourses was the scientific discourse around mental illness in which madness is constructed mostly as an illness with genetic, chemical or emotional causes. The knowledge and expertise of mental health professionals is seen as important to the general public as they seem to have little knowledge on the meaning of mental illness themselves. The second discourse that was identified was mental illness as the domain of professionals and mental institutions. Most of the respondents seemed comfortable with this idea and used distancing strategies in order to explain their non-involvement in the care of the mentally ill. Mental illness as individual experience was discussed next and in this discourse mental illness was seen as an exclusive experience to which few except the sufferer has access. The fourth discourse discussed was the mental illness as unknown discourse. In this discourse madness/mental illness, those suffering from it and the treatment thereof, is a mystery to those who are not part of these experiences. The final discourse discussed was the mental illness as bad discourse where those suffering from mental illness were constructed as dangerous, possibly violent, unpredictable and damaging. During the analysis of the data it was found that the majority of the respondents used techniques to distance themselves from involvement of the mentally ill and ascribed to the discourse that madness/mental illness is the domain of mental health professionals only. / Dissertation (MA)--University of Pretoria, 2008. / Psychology / unrestricted

No description available.

In today’s society 67% of women in the age of 16-29 doesn’t experience happiness in life. Even though people talk more freely of mental illness today there are still a shame and taboo about feeling unhappy and reach out for help to get better. The purpose of this study is to examine what motivates women with mental illness to search for help within the primary health care. To get an additional view of the work three sociologic theories and conceptions have been used to showcase the phenomenon. Ervin Goffmans theory about stigma, Thomas J Scheffs conception shame and Axel Honneths theory about confession. This study issued from a qualitative method in the shape of interviews with eight different women, where their vision of what motivates them, their experience and in what way it has been meaningful for them to seek help for their mental illness was showcased. The result established that family and friends is a motivator to seek help but also that the experience of seeking help was defective. The conclusion explained that it has been meaningful for them to get help and that the majority feels better today, but that they still have rough periods that in some cases won’t meet the requirements from the primary health care.

AbstractThe following work is driven foremost by the confounding fact that so few men are seekinghelp concerning mental illness, even though men, by far, are the dominating gender instatistics regarding suicide. Upon reflection a line of questions arose mainly regardingwhether gender based differences could play a role in the way men and women expressmental illness and especially whether, and to what extent, gender affects treatment thereof.Since interviewing people with mental illness would demand quite a lot of ethicalconsideration, and with regards to the extent of work a study of this sort would require, otheroptions had to be considered. Therefore, in order to investigate the subject further fourseparate interviews were conducted with therapists whose methods are based on a variety ofpsychological theories and methods. The interviews were based on semi-structuredinterview-guides containing questions about gender differentials in patients, gender basedapproaches to, as well as gender based expressions of, mental illness. The empirical materialwas later divided into relevant themes to create a basis for analysis. The analysis was formedby theories and research concerning gender constructivism, hegemonic masculinity andgender in therapy. The findings showed that gender and gender roles do play a part in how thetherapist conceive the patient and her problems. The informants expressed experiences oftraditional gender roles affecting the patient's ability to engage in therapy in an ideal way - theideal being comparable to characteristics associated with traditional femininity. Among theinformant was a consensus that the male gender role is undergoing reform, and thus becomingmore inclusive to gender identities unconform with traditional masculinity. Furthermore twomain experiences of gender differences was identified, both comparable to normative genderdiscourse regarding male and female characteristics. Finally a third theme lead to discussionconcerning therapist-patient dynamics in light of respectively gender-based or feministnarrative therapy.

Bostad Först, en intervention som syftar till att lösa kronisk hemlöshet, har visat sig vara ett framgångsrikt och ekonomiskt hållbart alternativ under de senaste tre decennierna. Men i utvärderingarna nämns sällan erfarenheterna från boende inom Bostad Först och främst påverkan på deras återhämtningsprocess. Tidigare forskning visar att erfarenheterna är mångfacetterade, i varierande grad beroende på ämne och att de ofta motsäger varandra. Detta gäller också för detta forskningsprojekt. De olika upplevelserna berättar om en intervention med medkänsla, sociala interaktioner, en säker och stödjande miljö och en utgångspunkt för förändring, men också en av osäkerhet, kampen mot att hålla sig nykter och hur svårt det är att gå från ett liv på gatorna. Så länge organisationer som utövar Bostad Först kontinuerligt undersöker behoven hos sina boende och ordnar sina servicelager i enlighet med dessa uppfyller interventionen till synes delar av en återhämtningsprocess. / Housing First, an intervention aimed at ending chronic homelessness, has shown itself to be a successful and financially viable alternative during the past three decades. But evaluations seldom mention the experiences from residents of Housing First and the impact it has on their process of recovery. Earlier research shows the experiences to be multifaceted, with varying degrees depending on topic and that they, more often than not, contradict one another. This holds true for this research project as well. The different experiences tell a story of residency of Housing First to be one of compassion, social interactions, a safe and supportive environment and a starting point for change, but also one of insecurity, struggles with staying abstinent and how hard it is to transition from a life on the streets. As long as organizations practicing Housing First continually investigate their residential needs and ranson their service inventory accordingly, the intervention seemingly fulfills the elements of recovery.

PTSD Symptoms and Military-Specific Stigma in United States Veterans