This thesis is a first biographical account of the German/Austrian psychiatrist Richard von Krafft-Ebing (1840 - 1902). It seeks to paint a more accurate picture than is so far available by bringing together new biographical data including background information on the institutional settings in which he worked. Above all, it explores the full range of Krafft-Ebing's written work and ideas over the whole period of his life. This shows Krafft-Ebing as a man of many interests and is intended to counteract our present, limited understanding of his work. Although Krafft-Ebing is, in fact, known to many, this knowledge is mainly based on the cursory reading of one book, the Psychopathia sexualis, 1886. This has led to a seriously one-sided view of Krafft-Ebing, particularly in Englishs-peaking countries. Part one is about Krafft-Ebing's outer life: a brief summary of known biographical data, followed by several chapters on those places where he lived and worked. Different points are highlighted according to their relevance for Krafft-Ebing's ideas: for example, chapter 2 emphasises the general atmosphere of the Illenau (one of the leading asylums at the time), which shaped his approach to psychiatry lastingly; the chapter on Graz centres around the very varied patients he treated during that period. Part two represents an intellectual biography. Exploiting the full range of published work (see appendix), chapter 5 gives an overview over the topics Krafft-Ebing wrote on, followed by more detailed analyses of specific areas: sexuality (including its important forensic aspect), hypnotism and neurology. Part three - the appendix - consists of a new and complete list of Krafft-Ebing's published works containing about 550 items; the few letters by Krafft-Ebing found so far have also been transcribed and reprinted here.

Bakgrund: Depression och ångestsyndrom var 2019 de mest förekommande psykiatriska tillstånden. Trots den låga prioriteringen i de nationella riktlinjerna finns det studier som visat positiv effekt av fysisk aktivitet och fysioterapi för depressions- och ångestsymtom. Studier visar ett begränsat förtroende och en bristande förståelse för fysioterapeuter inom psykiatrin. Därför är psykiatrikers uppfattning relevant för att fylla kunskapsluckorna. Syfte: Syftet med studien var att undersöka psykiatrikers uppfattning om fysisk aktivitet och fysioterapi som behandling vid depression och ångestsyndrom. Metod: Studien antog en kvalitativ deskriptiv design där semistrukturerade intervjuer genomfördes individuellt med fem psykiatriker. Data bearbetades genom en kvalitativ innehållsanalys. Resultatsammanfattning: Analysen resulterade i fem kategorier: Fördelar av fysisk aktivitet, Grad av sjukdom påverkar relevansen av fysisk aktivitet, Behov av tillgänglighet och integrering av fysisk aktivitet, Fysioterapi har en betydande roll i psykiatrin och Utmaningar och barriärer för fysioterapi. Slutsats: Psykiatrikernas uppfattning var att fysisk aktivitet har en positiv påverkan på fysisk och psykisk hälsa, för patienter med depression och ångest, men behöver anpassas efter sjukdomens svårighetsgrad. Vidare forskning behövs för att studera effekterna av fysisk aktivitet vid medelsvår till svår depression och ångestsyndrom. Resultatet påvisar informanternas önskan om fysioterapi som en integrerad del av behandlingen, men identifierar även hinder såsom bristande resurser och kunskap om fysioterapi inom organisationen. Ytterligare forskning och utbildning om fysioterapi föreslås. / Background: Depression and anxiety disorders were the most prevalent mental disorders in 2019. Despite their low prioritization in national guidelines, studies have shown a positive effect of physical activity and physiotherapy on depression and anxiety symptoms. Research indicates limited confidence and understanding of physiotherapists in psychiatry. Therefore, psychiatrists' perspectives are relevant to fill knowledge gaps. Objective: The aim of the study was to investigate psychiatrists' perceptions of physical activity and physiotherapy as treatments for depression and anxiety disorders. Method: The study adopted a qualitative descriptive design, where semi-structured interviews were conducted individually with five psychiatrists. Data were processed through qualitative content analysis. Summary of Results: The analysis resulted in five categories: Benefits of physical activity, Severity of illness affects the relevance of physical activity, Need for accessibility and integration of physical activity, Physiotherapy plays a significant role in psychiatry, and Challenges and barriers to physiotherapy. Conclusion: Psychiatrists' perception was that physical activity has a positive impact on both physical and mental health for patients with depression and anxiety but needs to be adapted to the severity of the illness. Further research is needed to study the effects of physical activity in moderate to severe depression and anxiety disorders. The results highlight the informants' desire for physiotherapy as an integrated part of treatment but also identify obstacles such as a lack of resources and knowledge about physiotherapy within the organization. Additional research and education on physiotherapy are suggested.

Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context. Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden. • Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors. • Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959. • Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality. Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals. Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate. Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%). Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy. Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations. / Kompletteras 2012-09

In this dissertation, I explore a quite unique legal situation, namely administrative court hearings relating to coercive interventions: the Care of Young Persons Act (LVU), Care of Abusers (Special Provisions) Act (LVM), and the Compulsory Psychiatric Care Act (LPT). There are three central participatory roles in the court hearings: The official party is the authority who files the application for coercive intervention – either a chief psychiatrist or a social welfare board (typically represented by a social worker or sometimes a lawyer assisted by a social worker), whereas the citizen party is the person about whom the application is brought. The citizen party is represented by a legal representative. The professionals represent two different logics: therapeutic and judicial. The purpose of this dissertation has been to study the tension between therapeutic and judicial logic in court hearings relating to compulsory care. With theoretical concepts from Scott (1995) and Wetherell & Potter (1998), it is possible to say that the therapeutic and judicial logics are built up by institutional elements that are communicated through interpretative repertoires. Three questions are central: 1. How do professional participators handle the different role expectations embedded in therapeutic and judicial logic? In this case, I am particularly interested in role conflicts faced by social workers and psychiatrists. 2. How do different institutional elements (regulative, normative/cognitive) play out in the court hearings? 3. To what extent can these court hearings be considered a scrutinizing order of discourse, where the arguments of official party are subjected to critical examination? In my analysis I am inspired by both critical discourse analysis and organizational theory, more precisely, new institutionalism. These two perspectives provide useful insights and make it possible to combine the micro- and macro levels in the analysis. Data for the analysis consist of 43 court hearings and 31 interviews, gathered from two different county administrative courts in Sweden. All written documents used and produced by the courts are also part of our data. The dissertation consists of five studies that indicate that the court hearings hardly can be described as a scrutinising order of discourse. In spite of this, the court constantly finds that the legal criteria for coercive intervention are satisfied. Neither the official party nor the legal representative argue according to a judicial logic. Instead, therapeutic logic dominates the order of discourse. When the arguments for compulsory care are therapeutic, they are not explicitly related to the criteria in the law. In my interpretation, the reason why the conflict between therapeutic and judicial logic is not realised can be found in the existence of a logic of normalisation. This ideological logic of normalisation can be found in most of the institutions in the Swedish society and are built on the idea of traditional welfare norms.

<p>In this dissertation, I explore a quite unique legal situation, namely administrative court hearings relating to coercive interventions: the Care of Young Persons Act (LVU), Care of Abusers (Special Provisions) Act (LVM), and the Compulsory Psychiatric Care Act (LPT). There are three central participatory roles in the court hearings: The official party is the authority who files the application for coercive intervention – either a chief psychiatrist or a social welfare board (typically represented by a social worker or sometimes a lawyer assisted by a social worker), whereas the citizen party is the person about whom the application is brought. The citizen party is represented by a legal representative. The professionals represent two different logics: therapeutic and judicial.</p><p>The purpose of this dissertation has been to study the tension between therapeutic and judicial logic in court hearings relating to compulsory care. With theoretical concepts from Scott (1995) and Wetherell & Potter (1998), it is possible to say that the therapeutic and judicial logics are built up by institutional elements that are communicated through interpretative repertoires. Three questions are central:</p><p>1. How do professional participators handle the different role expectations embedded in therapeutic and judicial logic? In this case, I am particularly interested in role conflicts faced by social workers and psychiatrists.</p><p>2. How do different institutional elements (regulative, normative/cognitive) play out in the court hearings?</p><p>3. To what extent can these court hearings be considered a scrutinizing order of discourse, where the arguments of official party are subjected to critical examination?</p><p>In my analysis I am inspired by both critical discourse analysis and organizational theory, more precisely, new institutionalism. These two perspectives provide useful insights and make it possible to combine the micro- and macro levels in the analysis. Data for the analysis consist of 43 court hearings and 31 interviews, gathered from two different county administrative courts in Sweden. All written documents used and produced by the courts are also part of our data.</p><p>The dissertation consists of five studies that indicate that the court hearings hardly can be described as a scrutinising order of discourse. In spite of this, the court constantly finds that the legal criteria for coercive intervention are satisfied. Neither the official party nor the legal representative argue according to a judicial logic. Instead, therapeutic logic dominates the order of discourse. When the arguments for compulsory care are therapeutic, they are not explicitly related to the criteria in the law. In my interpretation, the reason why the conflict between therapeutic and judicial logic is not realised can be found in the existence of a logic of normalisation. This ideological logic of normalisation can be found in most of the institutions in the Swedish society and are built on the idea of traditional welfare norms.</p>

The diploma thesis deals with the cooperation of health and social services in the field of mental health care with regard to the ongoing reform of psychiatric care in the Czech Republic. The theoretical part of this work consists of defining the concept of mental illness, also deals with social and health services in the field of psychiatric care, discusses the reform of psychiatric care and cooperation of services. The empirical part examines what the current situation in the field of cooperation of services looks like, collects suggestions and tools for better functioning of these services and defines the views of direct care workers on the situation. The empirical part is performed by the method of questionnaire survey. The aim of the diploma thesis is to find out what the current situation looks like and what tools would help to better cooperation of these services.

This thesis deals with a multidisciplinary approach to clients suffering from schizophrenia. The main aim is to reflex the multidisciplinary approach to schizophrenic clients, appealing to social work and having respect to ethical principles of participating branches. The work includes chapters that are necessarily coherent to this topic. These are mainly the social work in the context of schizophrenia, specifics of schizophrenia, the structure of the multidisciplinary team, team work and all ethical aspects arising out of team work and individual experts' work. This thesis tries to link up theoretical and practical knowledge, mainly by means of casuistry and practical observations.

Psykisk ohälsa är idag ett av de största folkhälsoproblemen i Sverige. Syftet med studien var att inom socialpsykiatrin undersöka samverkan, personcentrering och brukarinflytande för brukare med psykisk ohälsa. Syftet var också att kartlägga hur COVID-19 pandemin har påverkat organisationernas planerade insatser för brukarinflytande. Kvalitativ ansats användes för att intervjua olika professioner för att undersöka hur deras samverkan bidrog till brukarinflytande. Sammanlagt intervjuades 8 personer. Resultatet visade två kategorier: samverkan är nödvändig för arbete med brukarinflytande och personcentrering samt COVID-19 pandemin har begränsat organisationernas planerade insatser för brukarinflytande. Resultatet visade att brukarinflytande var en viktig del av arbetet som bidrog till att brukarna alltid var i centrum med att vara en del av utformningen av insatserna. Genom brukarnas delaktighet och inflytande kunde den psykiska ohälsan motverkas och bidra till välmående. De slutsatser som kan dras av studien var att samverkan var svår men samtidigt väldigt viktigt. Det behövdes samarbete med många aktörer för att samverkan skulle vara lyckat och naturlig del av arbetsprocessen för personcentrering och brukarinflytande.

Une attention de plus en plus importante est accordée à la santé mentale au travail en raison, entre autres de la perte de bien-être chez les personnes atteintes d’un trouble mental courant (ex. trouble anxieux, trouble dépressif), ainsi que des coûts associés à l’absentéisme. Quand il est question d’invalidité au travail, plusieurs acteurs sont normalement impliqués dont le médecin de famille et le psychiatre lorsque nécessaire. Dans le cadre de ce mémoire conçu sous le format d’articles, deux articles sont présentés. Le premier article aborde plusieurs dilemmes auxquels les médecins traitants sont confrontés lors de la gestion de la reprise professionnelle d’un patient avec un trouble mental courant. Ces dilemmes sont illustrés par trois vignettes cliniques et appuyés par la littérature scientifique. Les trois vignettes portent sur les dilemmes relatifs aux thèmes suivants: 1) l’évaluation du potentiel thérapeutique des arrêts de travail; 2) le rôle d’expert octroyé aux médecins traitants et au processus d’évaluation de la capacité à travailler; 3) les aspects administratifs liés à cette évaluation; 4) la relation thérapeutique médecin-patient. La littérature nous indique que ce sont des dilemmes récurrents chez les médecins traitants dans le contexte de la gestion de la reprise professionnelle à la suite d’un trouble mental courant. Dans une suite logique, le deuxième article présente une étude qualitative effectuée auprès de médecins de famille et de psychiatres. Les objectifs de cette étude sont de documenter les tâches de ces cliniciens liées à la gestion d’une invalidité en raison d’un trouble mental courant, d’identifier les éléments facilitants et entravants qu’ils perçoivent dans le processus d’arrêt de travail et de retour au travail. Il est par ailleurs question de dégager les besoins de formation et d’outils qui pourront éventuellement être mis en place pour les aider dans l’accomplissement de leurs tâches. La collecte de données a été faite via des groupes de discussion (focus groups) totalisant trois groupes de médecins de famille et deux groupes de psychiatres (N=28). Tous les enregistrements ont été retranscrits en verbatim et par la suite codifiés. Les réponses générées par les groupes de discussion ont fait émerger 180 unités thématiques réparties sur 4 grands thèmes, lesquels sont récurrents pour chaque objectif de recherche : 1) évaluer/documenter, 2) prescrire/traiter, 3) communiquer/collaborer/réseauter avec les autres acteurs et 4) arbitrer/défendre. Les unités thématiques démontrent l’importance de la collaboration entre les acteurs et d’une communication efficace entre ces derniers. Il ressort également que ces cliniciens aimeraient être mieux formés pour arrimer connaissances et pratiques. La santé mentale au travail est une thématique qui prend de plus en plus d’ampleur et de préoccupation au sein de notre société. La mise en place d’outils et de formation adaptés pour aider les médecins de famille et psychiatres à mieux exécuter leurs tâches ne pourrait qu’avoir un impact positif sur la pratique de ces cliniciens et leurs patients. / An increasing amount of attention is being given to mental health in the workplace, due in part to the loss of well-being for individuals with common mental disorders (ex. anxiety disorder, depressive disorder), as well as the costs associated with absenteeism. In the context of this paper-based master, two articles will be presented. The first article will address three clinical vignettes and the dilemmas physicians may encounter in managing the vocational rehabilitation of a patient struggling with a common mental disorder. The vignettes will be supported by literature. Three clinical cases address dilemmas related to the following themes: 1) the assessment of the therapeutic potential of work absence, 2) the expert role given to clinicians and the process of assessing work disability, 3) the administrative aspects related to this assessment and 4) the impact of this assessment on therapeutic alliance between the clinician and his/her patient with common mental disorders. The literature tells us that these are recurring dilemmas for clinicians when managing the return to work of their patients with common mental disorders. The second article will present a qualitative study carried out among family physicians and psychiatrists. The objectives of this study are to document the clinical tasks related to the management of a disability due to a common mental disorder, identify the facilitators and barriers perceived in this process and identify training needs which could potentially help these clinicians perform their tasks, thereby enabling sustainable recovery of the worker. This is a qualitative study which collects data through focus groups, including three groups of family physicians and two groups of psychiatrists (N=28). All recordings were transcribed as stated and coded. The responses generated by the focus groups identified 180 thematic units distributed over 4 main themes, which are recurring for each research objective: 1) assess/document; 2) prescribe/treat; 3) communicate/collaborate/network with other stakeholders and 4) arbitrate/defend. The thematic units demonstrate the importance of collaboration between stakeholders and having effective communication among them. It also emerges that these clinicians would like to be better trained to align knowledge and practice. Mental health in the workplace is a topic which is becoming increasingly important and of concern within our society. The implementation of adapted tools and training to help family physicians and psychiatrists to better perform their tasks can only have a positive impact on the practice of these clinicians and their patients.

Standardisation of professional work is a major policy concern to ensure quality and efficiency of services and a number of hospitals are now focusing on the use of clinical pathways as an important tool to standardise their work. This study sheds light on the processes set in motion when notions of standardisation meet local practice. In order to gain insight into what clinical pathways mean for professional work in mental health care, the focus of the study was to explore the contexts in which standardisation by “rule production” takes place. Two empirical cases from Norwegian mental health care show how dedicated professionals are in charge of carrying out the standardisation work, strongly influenced by a steering framework of defined governmental policies where employee involvement and responsibility ensured loyalty to the idea.  Along with a “package” of ideas, new bodies and techniques, clinical pathways contribute to the institutionalisation of prima facie knowledge in demonstrating that evidence basing is linked to steering and control of employees. Thus, professional autonomy is threatened in an insidious way: through the institutionalisation of evidence-based knowledge as ‘prima facie’ knowledge in combination with professionals who standardise and control their own work. The thesis therefore concludes that the control of professional work has now become a complex and sophisticated process where professional work is “controlled by knowledge”.