The dementias are illnesses which have significant cultural prominence and feature in a wide range of contemporary writing, often as a trope for old age. This thesis examines how stories of dementia are told in fiction and in the clinic. To do this, the work uses Arthur Frank's socio-narratology to examine twelve selected texts in which a key protagonist has dementia. Three of the selected texts have been written by authors with direct experience of dementia within their family and form a subset of texts, memoir fiction. How stories of dementia are told is considered by examining the clinic as a storytelling venue, the creation of faux medical notes from information in the texts and a Triple Analysis of the memoir fiction using three reading templates. The templates have been created from clinical practice, using the questions posed by Frank's socio-narratological practice of Dialogical Narrative Analysis, and using the parameters of Rita Charon's version of Close Reading drill in Narrative Medicine. The work is informed by autoethnography which uses my position as a clinician and reader to examine how fiction has been used in my clinical practice and how it informs my reading of the selected texts.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Esta dissertaÃÃo objetivou analisar os sentidos construÃdos sobre saÃde-doenÃa mental por participantes de um grupo terapÃutico do CAPS e suas implicaÃÃes ao processo de desinstitucionalizaÃÃo da loucura. Para tanto, esteve referenciada nos aportes da SaÃde Coletiva, no tocante a produÃÃo social do processo saÃde-doenÃa e ainda nas contribuiÃÃes teÃricas do campo da SaÃde Mental sobre a proposta de desinstitucionalizaÃÃo da loucura no cotidiano das prÃticas de cuidado e atenÃÃo aos usuÃrios. AlÃm dessas bases, o estudo conta tambÃm com o referencial da Teoria HistÃrico-Cultural da Mente, no que se refere Ãs suas elaboraÃÃes em torno da temÃtica dos sentidos. Metodologicamente, a pesquisa se configurou como uma investigaÃÃo de carÃter qualitativo. A pesquisa foi realizado no CAPS Geral da SER II de Fortaleza, por meio do contato com um dos grupos terapÃuticos dessa instituiÃÃo, o Grupo de Florescimento Humano. O contato com esse grupo iniciou-se em julho de 2010, primeiramente, por meio da metodologia da ObservaÃÃo Participante, com intuito de conhecer o modo de funcionamento dessa proposta terapÃutica. Posteriormente, foi realizada uma Entrevista Individual Semi-Estruturada com uma das participantes. Por fim, foi aplicado um questionÃrio escrito com doze pessoas do grupo, as quais tambÃm participaram de um CÃrculo de Cultura sobre o tema desta pesquisa. O material oriundo desses procedimentos foi registrado com o auxÃlio de um gravador de voz, em seguida, foi transcrito e analisado com base na metodologia da AnÃlise TemÃtica. Como resultado de tal proposta de anÃlise, foram categorizados trÃs temas que mais se destacaram do discurso dos participantes, quais sejam: a conceituaÃÃo da loucura e do processo saÃde-doenÃa mental; as histÃrias e âestÃriasâ que explicam as existÃncias-sofrimento e a produÃÃo da saÃde mental; a construÃÃo de sentidos e desinstitucionalizaÃÃo. Os achados desta pesquisa apontam que a loucura e o processo saÃde-doenÃa mental encontram-se imersos em um quadro de grande indefiniÃÃo cientÃfica, que gera muitas possibilidades de significaÃÃes em torno da questÃo. Os sentidos de saÃde e doenÃa mental produzidos com os participantes circularam em torno de adjetivos antagÃnicos que indicaram a presenÃa marcante de uma noÃÃo de saÃde mental como algo inalcanÃÃvel, por significar a ausÃncia de doenÃas. JÃ a doenÃa mental foi percebida como desajuste, erro, desequilÃbrio e acÃmulo de problemas. Por outro lado, os participantes tambÃm destacaram a existÃncia de diferentes modos de ser e existir no mundo como marcas de singularidades, que, frequentemente sÃo diagnosticadas como loucura. Eles apontaram apara a necessidade de convivÃncia com essas diferenÃas e com seu processo de sofrimento. Como mais um resultado do estudo, foi discutida a importÃncia da categoria sentido, como ferramenta essencial a ser valorizada e trabalhada na proposta de desinstitucionalizaÃÃo da loucura no cotidiano dos serviÃos de saÃde mental. / This paper aimed to analyze the constructed meanings of health-mental illness participating in a therapeutic group of CAPS and its implications to the process of institutionalization of madness. To do so, was referenced in the contributions of Public Health, regarding the social production of health-disease process and also on the theoretical contributions of the field of Mental Health on the proposal of de-institutionalization of madness in the daily practice of care and attention to users. In addition to these bases, the study also has the frame of the Cultural-Historical Theory of Mind, with regard to their elaborations around the theme of the senses. Methodologically, the research was configured as a qualitative research. The study was conducted at the General CAPS II, Fortaleza-Ce, through contact with an institution of the therapy groups, the group of human flourishing. Contact with this group began in July 2010, primarily through the methodology of participant observation, in order to understand the mode of operation of the proposed therapy. Subsequently, we performed an Individual Semi-Structured Interview with one of the participants. Finally, a questionnaire was written in twelve people in the group, which also participated in a Culture Circle on the subject of this research. Material from these methodologies was recorded by audio-recorded, transcribed and analyzed using thematic analysis. As a result of this proposed analysis, three themes were categorized that stood out the speech of the participants, namely: the concept of madness and mental health-disease process, the stories and "stories" that explain the stock-suffering and production mental health, the construction of meanings and deinstitutionalization. The findings of this survey indicate that the madness and the health-mental illness find themselves immersed in a framework of great scientific uncertainty, which generates many possible meanings around the issue. The meanings of health and mental illness produced with participants circulated around opposing adjectives that indicated the presence of a remarkable notion of mental health as something unattainable, because it signifies the absence of disease. Since mental illness was perceived as a misfit, error, imbalance and accumulation of problems. On the other hand, participants also highlighted the existence of different modes of being and existence in the world as marks of singularities, which are often diagnosed as insane. They pointed out the need to trim live with these differences and their grieving process. As a result of the study, it is pointed towards the category as an essential tool to be valued and worked in the proposed institutionalization of madness in everyday mental health services.

The thesis looks firstly at creativity and the creative process, approaching the subject from a whole range of different viewpoints, such as the psychological, philosophical, biographical and anthropological angles. Following from this there is an exploration of the ways in which creativity way be awakened and unfolded. Special attention is given to the conditions and situations that are likely to encourage creative development and to the blocks and difficulties that inhibit its expression. Particular reference is made, on the one hand, to art education and to the art, leisure, and teaching student, and on the other hand, to art therapy and the psychiatric patient. The themes of the individual and the community are explored in a complementary way in the final two chapters. The thesis emphasizes the viewpoint of the student and the patient, but since these people do not exist in a vacuum, this involves looking also at the teacher, the therapist and society. With reference to the psychiatric field, other specific questions arise, for example: How may creative opportunities assist the healing process? What are the reciprocal influences of art and mental illness? Throughout the thesis the term 'art' is used in the visual sense, but references are made to creativity in other fields where parallel conclusions apply. The emphasis has been placed on the adult, but the subject of 'Creativity and the Teaching Student' involves some references to child art and 'Creativity and the Community' involves all ages.

The purpose of this study was to investigate the self- rated mental health of social services clients and see what affects it. A comparison was made against the other respondents regarding mental health. The study investigated the link between mental health and some different variables, such as gender, country of origin and whether they have emplyment or not. In addition, it was also examined how clients experienced the meeting with the social services and whether there was connection between their mental health and contact with social services. The material that formed the basis for the study was PART-studien (Mental health-Employment-Relations) and was collected by three researchers; Forsell and Lavebratt from Karolinska Institutet (KI) and Lundberg of Uppsala University, and concerned individuals' living conditions and mental health. To analyze the use Goffman's theory (2011) of psychological and social stigma and Ahmed Anis theory analysis on stigma and its three levels of stigma; social stigma, self-stigma and professionals stigma against clients. Previous research in this field has also helped in the interpretation of the results, as previous research reinforced the image of the individual's self- rated mental health varies between different groups in society, and that mental illness is linked to stigma. The result shows that self- rated mental health was adversely affected if they were a client of social services, if they were a woman, if they were born abroad, if they dint´t had employment and if they had a negative experience of the encounter with the social services. It also revealed that those who were in contact with social service felt worst in general, regardless of the other variables influence such as gender, birth country or employment. / Syftet med uppsatsen har varit att undersöka den självskattade psykiska hälsan hos socialtjänstens klienter och vad som kan påverka den. En jämförelse gjordes mellan socialtjänstens klienter och övriga respondenter i undersökningsmaterialet. Studien undersökte samband mellan psykisk hälsa och olika variabler, så som kön, ursprungsland samt om man har sysselsättning eller ej. Utöver det undersöktes även hur klienterna upplevde mötet med socialtjänsten och om det fanns samband mellan deras psykiska hälsa och kontakten med socialtjänsten. Materialet som låg till grund för studien var PART-studien (Psykisk hälsa-Arbete-Relationer), som är insamlat av tre forskare; Forsell och Lavebratt från Karolinska Institutet (KI), samt Lundberg från Uppsala universitet, och rörde individers levnadsvillkor och psykiska hälsa. För att analysera användes Goffmans (2011) teori om psykiska och sociala stigman och Ahmedanis (2011) teorianalys om stigmatisering och dess tre olika nivåer av stigma; socialt stigma, självstigma och yrkesverksammas stigma mot klienter. Även tidigare forskning på området har använts för att tolka resultatet, då det förstärkte bilden av hur individers självskattade psykiska hälsa varierar mellan olika grupper i samhället och att psykisk ohälsa är kopplat till stigmatisering. Resultatet visar att den självskattade psykiska hälsan var sämre hos dem som var i kontakt med socialtjänsten, om de var kvinnor, om de var födda utomlands, om de saknade sysselsättning och om de hade en negativ erfarenhet av mötet med socialtjänsten, samt att rollen som klient hos socialtjänsten hade störst påverkan på den psykiska hälsan jämfört med övriga variabler. Det framkom även att de som var i kontakt med socialtjänsten mådde sämst, oberoende av de andra variablernas påverkan så som kön, födelseland eller sysselsättning.

This is a study of military psychiatry in the Second World War. Focusing on the British Army, it recounts how the military came to employ psychiatrists to revise recruitment procedures and to treat psychiatric casualties. The research has shown that psychiatry was a valued specialty and that psychiatrists were given considerable power and independence. For example, psychiatrists reformed personnel selection and placed intelligence testing at the centre of the military selection of personnel. Psychiatrists argued that by eliminating the 'dull and backward' the tests would help improve efficiency, hygiene, discipline and morale, reduce psychiatric casualties and establish that the Army was run in a meritocratic way. However, it is probable that intelligence testing made it less likely that working-class men would receive commissions. Still, the Army had no consistent military doctrine about what the psychiatrists should be aiming for -to return as many psychiatric casualties to combatant duties as was possible or to discharge men who had found it impossible to adapt to military life. In the initial stages of the war, the majority of casualties were treated in civilian hospitals in Britain, where most were discharged. This was partly because the majority were regarded as constitutional neurotics. When psychiatrists treated soldiers near the front line most were retained in some capacity. The decision on whether to evacuate patients was influenced by multiple factors including the patients' military experience and the doctors' commitment to treatment or selection. Back in Britain, service patients were increasingly more likely to be treated in military hospitals such as Northfield -famous for the 'Northfield experiments'. These provided an alternative model of military psychiatry in which psychiatric intervention refocused away from individuals and their histories and onto social relationships, and where the psychiatrists' values were realigned with the military rather than with civilian general medicine.

Syftet är att studera hur män med små barn upplever att deras möjligheter till församlingsengagemang i Equmeniaförsamlingar i Göteborgsområdet påverkar deras psykiska hälsa och på vilket sätt dessa män menar att församlingen kan bidra till ökad psykisk hälsa. Det är en deduktiv, kvalitativ studie med semistrukturerade intervjuer. De frågeställningar som är aktuella berör informanternas upplevelse av församlingen i förhållande till psykisk hälsa. Det teoretiska perspektiv som i huvudsak används är Aaron Antonovskys KASAM (känsla av sammanhang), där de tre komponenterna begriplighet, hanterbarhet och meningsfullhet används för analys av det empiriska materialet. Det finns även en genusaspekt i studien där R.W Connells konstruktivistiska synsätt på maskulinitet används i analys av materialet.Resultat och analys visar att informanterna upplever att församlingen bidrar till en högre KASAM. Informanterna varnar dock för att församlingen kan vara en riskfaktor som riskerar ett lägre KASAM, inte minst vad gäller känslan av hanterbarhet. Även om informanterna upplever att församlingen bidrar till ett högre KASAM beskriver de att samtalet om psykisk hälsa knappt existerar samt att det finns ett stort behov av samtalet. Detta leder i sin tur till att församlingen i ännu högre utsträckning kan bidra till en högre KASAM. Vad gäller genus finns det en del hegemonier i församlingarna, men dessa är enligt en av informanterna under förhandling.

In Canada mental health related concerns are estimated to cost the economy $20-$50 billion annually. 500,000 Canadian each week have to take time off of work because of a mental health disability. This study explores the experiences of people living with a mental health disability in the workplace. The goal is to provide an opportunity to highlight many of the obstacles they face every day. This study relies on qualitative methodologies, using semi-structured interviews to get a more detailed understanding of their experiences. This study not only highlights the perceptions, experience and challenges of people living with a mental health disability, it highlights coping strategies and suggestions for building mentally health workplaces. The participant’s personal narratives can help by providing a chance for a community to build and be used to challenge the stigma and discrimination associated with mental health. / October 2016

The transition to parenthood involves psychological and social adjustments for men and women, with evidence of possible declines in mental health and close relationships. This thesis examined the relationship between parents' mental health (depression, anxiety, PTSD), the parent-infant relationship, couple's relationship and infant development. The five articles in this thesis were part of a prospective multi-method investigation of first-time parents. Parents completed questionnaires in late pregnancy, 3 months and 15 months postpartum (Article 3 & 4), detailed observations of parent-infant interactions 3 months postpartum (CARE-index; Article 4), in-depth interviews (Birmingham Interview of Maternal Mental Health) 5 months postpartum (Article 1 and 2), and infant development (Bayley Scales III) was examined at 17 months postpartum (Article 5). Results showed that a proportion of men and women suffered from poor mental health. Mental health problems were more common in pregnancy than postpartum. Women experienced worse mental health than men, but few other gender or within couple differences were found (Articles 2 & 3). A relatively high rate of poor parent-infant interactions was found (Article 4) and many parents reported feelings of anger towards their infant (Articles 1 & 2). Parents' perceptions of their infant's characteristics were important for the parent-infant relationship (Article 3) and infant's cognitive, language and motor development (Article 5). Additionally, women's postpartum PTSD and prenatal depression were associated with poor infant development (Article 5). Men's mental health was associated with poor interaction with their infants (Article 4), negative perceptions of the father-infant and couple's relationship (Article 3). These findings suggest that both men and women should be included in early mental health and family relationship interventions. However, the small low-risk sample limits generalizability of results. Future research would benefit from exploring the links between parental, infant and family relationship variables further, over time in larger more representative samples.

Personality disorder has been and continues to be a contested diagnosis. Those who attract this form of diagnosis have been particularly vulnerable to the effects of stigma and have tended to be excluded from service provision. This thesis provides an examination of how recent developments in law, policy and practice have impacted upon the status of personality disorder as a diagnosis of exclusion in Scotland. The theoretical framework that provides this thesis with its structure is derived from the post-empiricist approach proposed by Derek Layder. This approach seeks to contextualise emergent inductive findings within a broader historical and contemporary analysis. In the case of this research the broader context consists of the interplay between mental health law, policy and practice in the field of mental health and the diagnosis of personality disorder more specifically. The empirical enquiry at the core of this thesis is based upon an analysis of the views, beliefs and expectations of front-line staff (psychiatrists and social workers qualified as mental health officers) involved in the process of assessment and service provision. In addition to front-line staff (n = 27) a range of key informants who were in a position to shed light on the strategic imperatives underpinning recent developments in law and policy were also interviewed. This analysis is contextualised within a review of key developments in law and policy that have particular significance for anyone who may attract a diagnosis of personality disorder. Despite the ostensibly inclusive approach towards those who may attract a diagnosis of personality disorder evident within the Mental Health (Care and Treatment) (Scotland) Act 2003, the reality is a highly selective and very limited inclusion of those who attract this form of diagnosis. The effective inclusion of those who may attract a diagnosis of personality disorder has been obstructed by several key impediments: 1: an insufficiently robust policy framework to drive forward the process of inclusion; 2: residual ambivalence towards the legitimacy of the diagnosis of personality disorder itself and the legitimacy of the claims made upon services by those who may attract a diagnosis of personality disorder; 3: insufficient and inadequately focused resources; 4: service structures that have not been redesigned sufficiently to engage successfully with service users who may attract a diagnosis of personality disorder. As a consequence of these impediments to inclusion, the majority of those who may attract a diagnosis of personality disorder in Scotland are likely to continue to face high levels of marginalisation and exclusion.

O estudo investigou a visão de adolescentes e seus cuidadores sobre saúde/doença mental, estereótipos e acessibilidade aos serviços de saúde, bem como as principais redes de apoio e estratégias de cuidado utilizadas pelos adolescentes. Participaram do estudo 30 adolescentes de ambos os sexos da periferia de Porto Alegre com idades entre 14 a 18 anos e 28 cuidadores destes, 10 do sexo masculino com idade entre 27 a 55 anos e 18 do sexo feminino com idade entre 31 a 67 anos. Da amostra total dos adolescentes foram entrevistadas 20 famílias de variada configuração. Como instrumentos foram utilizados: diário de campo, roteiro de entrevista da família e questionários auto-aplicáveis. Os resultados dos questionários foram analisados através do SPSS 13.0, sendo levantadas estatísticas descritivas. Para os diários de campo e roteiro de entrevista utilizou-se a análise de conteúdo. Os resultados destes dois instrumentos mostraram a implicação dos aspectos socioeconômicos e dos acontecimentos estressantes da história de vida familiar na saúde mental dos adolescentes e membros da família. Os resultados dos questionários revelaram que a visão de saúde mental dos adolescentes estava associada à capacidade de pensar de forma crítica e relacionar-se bem com os outros. Da doença mental, os adolescentes apresentaram uma visão integradora entre corpo-mente. Os profissionais de saúde, os pais e amigos constaram como as principais redes de apoio. Foram encontradas mais barreiras ideológicas do que estruturais para o acesso aos serviços de saúde. As estratégias de cuidado variaram entre comportamentos em busca de mudança e fuga do problema. Na visão dos cuidadores, saúde mental esteve associada com o bom funcionamento físico, cognitivo e com a satisfação pessoal, apresentando algumas diferenças entre a visão do cuidador e da cuidadora. Da doença mental, identificou-se uma visão integradora corpo-mente e associação com problemas de concentração. A escola, o profissional de saúde e a mídia foram os principais formadores de opinião sobre a visão de saúde/doença mental. Dos estereótipos, foram identificadas mais barreiras ideológicas do que estruturais. Acerca da busca de ajuda e rede de apoio, a mãe, o pai e profissionais de saúde foram citados. Das estratégias de cuidado incentivadas aos adolescentes, a busca de mudança foi mais freqüente. Intervenções sociais e meios de melhorar a prestação de serviços em saúde mental aos adolescentes são discutidos. / The aim of this study was to investigate adolescents' and their caregivers' perspective about mental health and illness, stereotypes and accessibility to mental health services, as well as the main support networks and strategies used by adolescen ts to look after themselves. 30 female and male adolescents living in the suburb of Porto Alegre aged 14 to 18; and 28 caregivers, 10 male aged 27 to 55 and 18 female aged 31 to 67 participated in the study. 20 out of 30 adolescents' families were intervie wed during home visits. Families showed different configuration. Field diary, family interview, self-applicable questionnaires on mental health and illness were applied. Questionnaires results were analyzed with SPSS 13.0 and descriptive statistics was mad e for all items. Content analysis was adopted to analyze qualitative data in field diary and family interview. Results from those two instruments showed the implication of socioeconomic aspects and stressful occurrences of family history on adolescents and other family members' mental health. Questionnaire results unveil that adolescents' mental health was associated to the ability of thinking critically and getting along well with others. Adolescents presented an integrated view of health and body. Health professionals, parents and friends formed the main support networks for adolescents. Ideological barrier with regard to access to health services were found more than structural. Adolescents presented care strategies that varied from behaviors in search of change and scape from the problem. Caregivers' mental health perspective was associated with good physical and cognitive functioning and personal satisfaction, presenting some difference between male and female caregivers' perspective. About mental illnes s, caregivers presented an integrated view of body and mind and associated with concentration problems. School, health professional and media are the main opinion boosters about mental health and illness. About stereotypes was found more ideological barriers than structural. Mother, father and health professionals were the main help - seeking. Care strategies motivated to adolescents' indicates search of change when feeling mentally sick. Social interventions and ways to improve health services for adolescents were discussed.