Thesis (D.N.S.)--Boston University

Thesis (M.S.)--Boston University

My dissertation focuses on literary and photographic representations of female madness as a means of exposing the material violence that notions of normality and of national identity produced in Italian society during the fin-de-siècle. Although many studies explore the exclusion of minorities in the project of nation-making, the mentally ill have rarely been discussed. Those studies that focus on literary representations of madness usually treat it as a metaphor or literary expedient and leave unexplored the material violence that psychiatric institutions inflicted on the mentally ill body. I aim to connect cultural realities and their representations, exploring the ways in which psychiatric and state power constructed and used the mentally ill body in the quest to create national identity. This quest was rooted in the widespread image of Italians as effeminate southerners from a backward, pre-modern part of Europe, an image that led to a crisis of masculinity. In my study I consider the crisis of masculinity vis-à-vis practices of asexualization of the body conducted inside the asylum. Through a parallel analysis of psychiatric photography and literary representations of female madness in Giovanni Verga, Luigi Capuana, Gabriele D'Annunzio, and Futurist avant-garde writers, my study shows how these practices actively contributed to social constructions of madness. Chapter I is an introduction to the development of modern psychiatry vis-à-vis the project of national identity formation in post-unification Italy. Chapter II analyzes first literary representations of female madness and psychiatric portraits of female patients to argue that the asexualization of patients' bodies was used to offer an ontological weight to national manhood. Chapter III explores the phenomenon of hysteria to show how the body of the hysterical woman functioned as apparatus used to produce normalization. Chapter IV examines how the futurist avant-garde overturned the madness apparatus at the beginning of the twentieth century. The conclusion I draw is that the mentally ill body functioned as an abjected or excluded other whose alterity was key to the construction of Italian identity.

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D.Cur. / Please refer to full text to view abstract

D.Cur. ( Psychiatric Nursing Science) / The aim of this study was to develop a selection model for prospective candidates in advanced psychiatric nursing, based on a whole person approach. In her interaction with patients, the nurse is confronted by the unusual realities of death, birth, pain and suffering of her patients, and the concomitant dependency and intimacy needs of these patients. This reality activates intense and complex feelings in the nurse's internal world, against which she develops a system of defense mechanisms which enable her to control her feelings and effect distance between her and her patient. These defense mechanisms protect her in general nursing practice, but become stumbling blocks for those nurses who wish to specialize in psychiatric nursing. It is contingent upon her as an advanced practitioner in psychiatric nursing to expose herself by casting off these defense mechanisms, building up intimate relationships with her patients, and to be open in terms of her own feelings. This process is intensely painful, anxiety provoking and stressful, and all are not equal to this task. The research question which arises is: To what extent can candidates who are not equal to the task of a course in, and the practice of, advanced psychiatric nursing, be protected by an effective selection procedure? A theory generational approach was used in the design and description of a selection model for prospective candidates in advanced psychiatric nursing. The methodology of Chinn & Jacobs (1987) was combined with that of Dickofj, James & Wiedenbach (1968) in this process. The 5 steps in this combined approach included: * The identification, definition and classification of concepts central to the model. Concepts were identified by utilizing four different methods: A literature survey of the characteristics of the mature person (ideal candidate). A survey of existing selection methods and techniques.

Class of 2014 Abstract / Specific Aims: It has been demonstrated through numerous studies that pharmacists have the ability to significantly impact patient outcomes. It is especially important to measure the effect that pharmacists have on psychiatric patient care as this is a population that is often underserved and can potentially benefit from pharmacist intervention. To date, there has been little research on pharmacist led patient medication education groups for patients with psychiatric diagnoses. Therefore, the purpose of this study was to assess the effectiveness of a pharmacist led medication education group in reducing adult psychiatric hospital readmission rates due to medication non-adherence. Methods: Patients admitted to an acute adult inpatient psychiatric unit at an academic medical center between September 1, 2011 and July 31, 2012 were included. A random sample of 100 patients that attended the medication education group (intervention group) and 100 patients that did not attend the group were selected (control group). The following data were collected: patient age, gender, ethnicity, insurance benefits, primary diagnosis, substance abuse history, number of medications at first discharge, length of stay on initial admission, time to first readmission, length of stay on first readmission, and reason for readmission (medication non-adherence versus other). A chi square analysis was conducted to determine if admission rates as well as reason for readmission were different between the two groups. An independent t test was conducted to determine if time to first readmission or length of stay on first readmission was different between the two groups. Main Results: There were 28 psychiatric hospital readmissions in the intervention group and 28 readmissions in the control group. Although these numbers were similar, there was a statistically significant difference in the number readmitted due to medication non-adherence, 11 in the intervention group vs. 19 in the control group (p=0.032). There was also a clinically significant difference in the time to readmission between the two groups (an average of 94.43 days in the intervention group vs. 60.70 days in the control group.) Conclusion: The pharmacist-led medication education group did not have an impact on readmission rate. However, the group did reduce the number of readmissions for medication non-adherence. There is a clinically significant increase in the time to readmission in patients that attended the medication education group. The data in this study support the implementation of pharmacist-led medication education groups to improve outcomes in adults admitted to acute inpatient psychiatry units.

M.Cur. (Nursing Sciences) / Please refer to full text to view abstract

M.Cur. / Please refer to full text to view abstract

Since the seminal work of Brown and Birley, the potential link between life events and psychosis has been the focus of research and speculation. However, to date, there have been few studies of life events prior to the onset of psychosis; making it impossible to disentangle whether a higher prevalence is a cause or consequence of the disorder. Furthermore, studies have neglected important characteristics, such as severity and type, and rarely considered potential psychological mechanisms. The primary aims of this study were to extend the current literature by investigating the impact of life events and difficulties on the onset of psychosis, and investigate potential synergistic effects and mediating factors. Data on 253 first-presentation cases and 301 population-based controls were drawn from the Childhood Adversity and Psychosis study. Life events and difficulties experienced one year prior to onset (cases) or interview (controls) were assessed with the Life Events and Difficulties Schedule. Potential causal partners included negative schematic beliefs (assessed using the Brief Core Schema Scales) and potential mediators included symptoms of anxiety and depression (assessed using the Hamilton Anxiety and Depression Questionnaires). There was strong evidence that severe and intrusive experiences were particularly associated with psychosis, showing a three- to twelve-fold increase in odds. The impact of severe experiences was found to be cumulative. There was also tentative evidence that low social class and negative self-schemas combined synergistically with these experiences to increase the odds of psychosis. However, there was no evidence of mediation via affective symptoms. The one year period before the initial onset of psychosis is likely to be a time of serious psychosocial stress, potentially characterised by threatening and intrusive experiences. Research must continue to examine potentially modifiable mechanisms that may link such stressors and psychosis in order to improve our understanding and treatment of these disorders.