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Die filmographische Dokumentation der dokumentarischen Arbeiten über psychiatrische Institutionen und die psychiatrische Behandlung der psychischen Krankheiten steckt noch ganz in den Anfängen. Die folgende Liste gibt einen ersten Eindruck über solche Lang-Filme, die mir bekannt wurden und die das Thema im Spektrum der Fragen behandeln, die für das dokumentarische Interesse am Thema Leitlinien der Darstellung gebildet haben. Die Texte stammen zum Teil von mir, zum Teil aus Presseunterlagen, zum Teil aus den Datenbanken des Internets. Sie sollen einen Eindruck über Thema, dokumentarische Methode und Argumentationsweise geben. Für Hinweise danke ich Christine Noll Brinckmann und Gesa Rautenberg.
The pathophysiology of schizophrenia is still poorly understood. Investigating the neurophysiological correlates of cognitive dysfunction with functional neuroimaging techniques such as electroencephalography (EEG) and functional magnetic resonance imaging (fMRI) is widely considered to be a possible solution for this problem. Working memory impairment is one of the most prominent cognitive impairments found in schizophrenia. Working memory can be divided into a number of component processes, encoding, maintenance and retrieval. They appear to be differentially affected in schizophrenia, but little is known about the neurophysiological disturbances which contribute to deficits in these component processes. The aim of this dissertation was to elucidate the neurophysiological underpinnings of the component processes of working memory and their disturbance in schizophrenia. In the first study the the neurophysiological substrates of visual working memory capacity limitations were investigated during encoding, maintenance and retrieval in 12 healthy subjects using event-related fMRI. Subjects had to encode up to four abstract visual shapes and maintain them in working memory for 12 seconds. Afterwards a test stimulus was presented, which matched one of the previously shown shapes in fifty percent of the trials. A bilateral inverted U-shape pattern of BOLD activity with increasing memory load in areas closely linked with selective attention, i.e. the frontal eye fields and areas around the intraparietal sulcus, was observed already during encoding. The increase of the number of stored items from memory load three to memory load four in these regions was negatively correlated with the increase of BOLD activity from memory load three to memory load four. These results point to a crucial role of attentional processes for the limited capacity of working memory. In the second study, the contribution of early perceptual processing deficits during encoding and retrieval to working memory dysfunction was investigated in 17 patients with schizophrenia and 17 healthy control subjects using EEG and event-related fMRI. A slightly modified version of the working memory task used in the fist study was employed. Participants only had to encode and maintain up to three items. In patients the amplitude of the P1 event-related potential was significantly reduced already during encoding in all memory load conditions. Similarly, BOLD activity in early visual areas known to generate the P1 was significantly reduced in patients. In controls, a stronger P1 amplitude increase with increasing memory load predicted better performance. These findings indicate that in addition to later memory related processing stages early visual processing is disturbed in schizophrenia and contributes to working memory dysfunction by impairing the encoding of information. In the third study, which was based on the same data set as the second study, cortical activity and functional connectivity in 17 patients with schizophrenia and 17 to healthy control subjects during the working memory encoding, maintenance and retrieval was investigated using event-related fMRI. Patients had reduced working memory capacity. During encoding activation in the left ventrolateral prefrontal cortex and extrastriate visual cortex was reduced in patients but positively correlated with working memory capacity in controls. During early maintenance patients switched from hyper- to hypoactivation with increasing memory load in a fronto-parietal network which included left dorsolateral prefrontal cortex. During retrieval right ventrolateral prefrontal hyperactivation was correlated with encoding-related hypoactivation of left ventrolateral prefrontal cortex in patients. Cortical dysfunction in patients during encoding and retrieval was accompanied by abnormal functional connectivity between fronto-parietal and visual areas. These findings indicate a primary encoding deficit in patients caused by a dysfunction of prefrontal and visual areas. The findings of these studies suggest that isolating the component processes of working memory leads to more specific markers of cortical dysfunction in schizophrenia, which had been obscured in previous studies. This approach may help to identify more reliable biomarkers and endophenotypes of schizophrenia.
Psychiatrie
(2016)
In der Psychiatrie hat die Prognose über den Verlauf und den Ausgang von Erkrankungen eine Schlüsselstellung inne. Sie verknüpft die Erkenntnis, welche Ursachen eine Erkrankung besitzt, und die Frage, welche Therapie geboten ist, mit einem Wissen, wie die Krankheit verlaufen und ausgehen wird. Jedoch stehen einer Vorhersage der Zukunft zahlreiche Hindernisse entgegen, die einerseits in der Kontingenz des Lebens selbst, der Individualität der Patienten oder auch der Ungewissheit, ob und wie Therapien anschlagen, liegen. Jedoch ist in der Psychiatrie eine Prognose schwierig, weil vielfach unklar ist, was eine Krankheit überhaupt ist, welche Ursachen sie besitzt und wie sie von anderen Krankheiten zu unterscheiden ist. Dennoch entsteht im 19. Jahrhundert ein unmittelbarerer Nexus von Diagnose und Prognose, der den epistemologischen Kern der Psychiatrie definiert. Im 20. Jahrhundert wird der Nexus von Diagnostik und Prognostik auf neue Weise gefasst. Die Psychiatrie wird zu einer Zukunftswissenschaft, die nicht mehr nur vorhersagt, wie eine Krankheit, Erkrankung oder Störung verlaufen und ausgehen wird. Vielmehr schafft sie ein neuartiges Verständnis dafür, was psychische Gesundheit sei und nimmt insbesondere das Verhältnis von manifester, akuter Erkrankung und zukünftiger, wahrscheinlicher Erkrankung in den Blick.
Structural anthropology remains a hidden influence in Frantz Fanon's theory of the 'sociogenesis' of mental illness. This chapter outlines how Fanon's belief in the therapeutic capacity of 'socialization' critically absorbs Claude Lévi-Strauss's examination of the link between 'madness' and the symbolic structure of society. These innovations, Chamberlin argues, pushed Fanon to institute 'semihospitalization' as a radically dialectical method of treatment in his final role as a clinician at the Neuropsychiatric Day Centre in Tunis (1958–60).
Inner world and milieu : art, madness, and Brazilian psychiatry in the work of Nise da Silveira
(2024)
This short essay focuses on the work of Brazilian doctor Nise da Silveira, a pioneer in psychiatry who introduced artistic tools to work with psychiatric patients, especially those diagnosed as psychotic. She founded the Museum of Images from the Unconscious in 1952 inside an asylum in Rio de Janeiro to assemble and exhibit the works produced by her patients. As an iconoclast who did not systematize her theory, she engaged with several European psychiatrists, psychoanalysts, and thinkers to produce a very innovative reflection and practical clinical work. Her work resonates in particular with French Institutional Psychotherapy, as well as with Frantz Fanon's psychiatric work in Algeria, but, differently from the former, places art at the core of its clinical method and proposes a radical positioning against every form of medicalized approach.