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Lesbianism and mental health Kristian Aleman and Ronald Doctor Print Publication Year: Published Online: Jul 2011 ISBN: 9780199214365 eISBN: 9780199640454 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780199214365.003.0006
Etymologically the adjective ‘lesbian’ is traced back to 1591 from‘Lesbius’, emanating from the Greek conception ‘lesbios of Lesbos’. Lesbos is an island in the north-eastern Aegean Sea in Greece and was the great lyric poet Sappho's home (born sometime between 630 and 612 BC). Sappho is famous for her erotic and romantic verses and is associated with homosexual relationships between women. Adrienne Rich (1980), a feminist poet in the late 20th century, outlined a continuum of lesbian intimacy ranging from sexual to platonic relationships. In the broadest definition of lesbianism, Rich proposed that the female who sidestepped traditional married life in order to combat male tyranny might be seen at one end of the continuum, usually connected with feminism. In the 1970s the radical lesbians declared, ‘A lesbian is the rage of all women condensed to the point of explosion’ (McCoy and Hicks 1979). Henri de Toulouse-Lautrec, the prominent 19th century French post-impressionist painter, injured as a young boy, became short, midget-like, and suffered from a sense of being an outsider. He empathized with prostitutes and represented them in his art. He became acquainted with lesbians and noted that these women often protectively turned to each other for love. His artistic inspiration emerged from their intense intimacy. When ToulouseLautrec observed two women sleeping entwined on a couch, he pronounced: ‘This is superior to everything. Nothing can compare to something so simple.’ Being a lesbian most often involves both romantic feelings and sexual attraction toward other women. Today the prevalence of female and male homosexuals plus bisexuals is estimated by the Stonewall organization to be between 5–7% among people in the United Kingdom. One crucial research observation of homosexual people relating to mental health seems to be whether they can openly stand for their homosexual identity or not. The identity process of ‘coming out’ is associated with healthier self-acceptance and self-esteem.
Depression in women Jona Lewin Print Publication Year: Published Online: Jul 2011 ISBN: 9780199214365 eISBN: 9780199640454 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780199214365.003.0011
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Depression in women is common and has attracted increasing interest. It affects women disproportionately and besides the emotional suffering, it has a major impact on their ability to function in their various roles. An analysis of the effect of depression on disability adjusted life years (DALYs) by Murray and Lopez (1996) showed that depression was the second leading cause of disease burden after ischaemic heart disease. However, depression proved to be the leading cause of disability for women worldwide. The most likely reasons are the disproportionate prevalence of depression and the severity of its impact on a woman's life course. Possible reasons for the gender difference in depression prevalence could include a greater number of first-onset episodes, longer duration of depressive episodes, a greater recurrence of depression in women than in men, or a combination of these factors. This question was addressed by three large epidemiological studies conducted in the United States, which showed that the greater number of first-onset depressive episodes in women and not gender differences in the duration or recurrence of depression is responsible for the gender difference (Eaton et al. 1997; Keller and Shapiro 1981; Kessler et al. 1993). It can therefore be concluded that women have greater rates of first-onset depression than men, but once they are depressed, both have episodes of similar duration and are equally likely to have recurrent depressive episodes. The subsequent question arises why do women have greater rates of first-onset depression than men? This is most likely based on the fact that there are significant biological- and socialization-related differences between women and men. Women experience certain stressors more frequently than men and women may also react differently to these stressors, either due to different biological or socialization factors. In the rest of this chapter I will describe epidemiological evidence about the difference in prevalence of depression, examine the phases in the life cycle of a woman, and consider social, psychological, and biological aetiological factors.
Anxiety disorders including post traumatic stress disorder (PTSD) Catherine F. Lewis Print Publication Year: 2015 Published Online: May 2015 Publisher: Oxford University Press ISBN: 9780199360574 eISBN: 9780190224042 DOI: 10.1093/med/9780199360574.003.0035 Item type: chapter
Increasing numbers of studies of correctional populations have emphasized diagnosis with structured clinical instruments over the past two decades. These studies have primarily focused on serious mental illness (i.e., psychotic and mood disorders), substance use disorders, and personality disorders. The focus has made sense because of the need to identify the severely mentally ill who are incarcerated and to identify the most common disorders. Anxiety disorders include generalized anxiety disorder, social anxiety disorder, panic disorder, and specific phobias. One anxiety disorder that stands apart from others is PTSD, which is prevalent at much higher rates in both incarcerated men and women than in the community. Despite this fact, other anxiety disorders are often co-morbid and add to overall disease burden and impair ability to function. Individuals with a greater disease burden (i.e., number of diagnoses, symptom counts) have worse outcomes than those with uncomplicated disorders. These impaired outcomes include a deteriorating trajectory of illness, increased health service utilization, poor prognosis, and increased likelihood of morbidity and mortality. Thus, while anxiety disorders may not be the primary Page 2 of 6 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 29 January 2017
focus of the correctional system, they must be recognized as important. Unrecognized anxiety disorders can result in behavior that is disruptive and may appear to be volitional. They can also lead to overutilization of health services that are already facing substantial demands. Appropriate, available, and consistent assessment, diagnosis, and treatment that are well integrated can successfully intervene in the range of anxiety disorders that present in correctional settings.
Women and alcohol John Roche, Eilish Gilvarry, and Ed Day Print Publication Year: Published Online: Jul 2011 ISBN: 9780199214365 eISBN: 9780199640454 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780199214365.003.0022
The second half of the 20th century saw an enormous change in the role of women in society, and with this came a shift in their relationship with alcohol. The number of women in paid employment has steadily risen in the developed world since the 1960s, and this has increased access to alcohol. More opportunities to drink have coincided with an increase in social acceptability of alcohol consumption and drunkenness in women. In the United Kingdom (UK) cheap alcohol and targeted advertising have combined with a rise in the number of women in their 20s and 30s with few family responsibilities and high disposable income to fuel an increase in consumption (Plant and Plant 2006). For example, female undergraduate students may feel pressured to drink as much as men to be socially accepted (Young et al. 2005). These issues are significant, as there appear to be gender differences in alcohol-related morbidity, with women tending to drink less than men though they are more prone to alcohol-related problems. In addition there are specific problems that only occur in women, for example, issues around pregnancy. In this chapter the epidemiology of the problem is summarized and areas of specific consideration with regard to women and alcohol are explored.
General medical disorders with psychiatric implications Erik J. Garcia and Warren J. Ferguson Print Publication Year: 2015 Published Online: May 2015 Publisher: Oxford University Press ISBN: 9780199360574 eISBN: 9780190224042 DOI: 10.1093/med/9780199360574.003.0038 Item type: chapter
Traditionally the domain of consultation/ liaison psychiatry, the challenge of recognizing and then appropriately treating the psychiatric complications of general medical disorders requires thoughtful planning and attention in corrections. Medical conditions that have psychiatric symptoms represent a significant diagnostic dilemma, particularly in the correctional health setting. Over half of the inmates in the United States have symptoms of a major mental illness, but the pervasiveness of substance use disorders, the increasing prevalence of elderly inmates, and limited access to a patient’s past medical and psychiatric records all contribute to the challenge of discerning when a psychiatric presentation results Page 3 of 6 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 29 January 2017
from an underlying medical condition. One early study underscored this challenge, noting that 46% of the patients admitted to community psychiatric wards had an unrecognized medical illness that either caused or exacerbated their psychiatric illness. A more recent study observed that 2.8% of admissions to inpatient psychiatry were due to unrecognized medical conditions. Emergency room medical clearance of patients presenting for psychiatric admission has revealed an increased risk for such underlying medical conditions among patients with any of five characteristics: elderly, a history of substance abuse, no prior history of mental illness, lower socioeconomic status, or significant preexisting medical illnesses. This chapter examines several of these risk groups and focuses on the presenting symptoms of delirium, mood disorders, and psychosis and the underlying medical conditions that can mimic or exacerbate them.
Psychoanalytic theories of suicideHistorical overview and empirical evidence Elsa Ronningstam, Igor Weinberg, and John T Maltsberger Print Publication Year: 2009 Published Online: Jul 2011 ISBN: 9780198570059 eISBN: 9780199640461 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780198570059.003.0024
Psychoanalytic theories and studies have influenced the explorations of suicide over the past hundred years. Freud’s first observations of self-objectification in melancholic depression were followed by contributions from object relation theorists and self-psychologists, highlighting foremost the role of narcissistic rage and structural vulnerability. Several of the central clinical concepts that unfolded have more recently been subject to empirical testing. This chapter provides an overview and discussion of the different psychoanalytic formulations applied to suicide. Empirical studies of several assumptions and constructs related to emotions, defences, and structural deficits and vulnerabilities verify their association to or explanation of chronic and acute suicidality. Further conceptualizations and research, especially on subtypes of suicide and individual experiences leading up to and dominating suicidal states, are called for.
Lesbian, gay, bisexual, and transgendered inmates Randi Kaufman, and Kevin Kapila Kenneth L. Appelbaum (ed.) Print Publication Year: 2015 Published Online: May 2015 Publisher: Oxford University Press ISBN: 9780199360574 eISBN: 9780190224042 DOI: 10.1093/med/9780199360574.003.0055 Item type: chapter
The lesbian, gay, bisexual, and transgender (LGBT) population has been, and remains, disenfranchised in many ways. Despite increasing acceptance of sexual orientation, evidenced by recent strides in legalizing gay marriage in several states, LGBT people continue to have a higher prevalence of mental illness due to minority stress than heterosexuals. Factors such as stigma, prejudice, and discrimination lead to increased incidence of mental suffering as a result of stressful, hostile, and often unsafe environments. Prejudice within the LGBT community around race, gender, disability, or mental illness Page 4 of 6 PRINTED FROM OXFORD MEDICINE ONLINE (www.oxfordmedicine.com). © Oxford University Press, 2015. All Rights Reserved. Under the terms of the licence agreement, an individual user may print out a PDF of a single chapter of a title in Oxford Medicine Online for personal use (for details see Privacy Policy). date: 29 January 2017
also exists. Transgender individuals have a high risk of being targeted for violence and hate crimes, harassment and discrimination, unemployment and underemployment, poverty, homelessness, substance abuse, suicide, and self-harm. The stressors that LGBT individuals face likely contribute to their disproportionate risk of contact with the criminal justice system beginning in adolescence and extending into adulthood. Transgender individuals in particular have a risk for incarceration, for reasons ranging from imprisonment based on gender identity expression alone to the need to earn money through the underground economy due to difficulty finding employment. In addition to homophobia and transphobia, LGBT individuals with mental illness experience further stigmatization. Clinicians need to understand the multiple stigmas that may affect an individual’s willingness to seek mental health care. The unique needs of incarcerated LGBT individuals with mental illness are often invisible, and generally misunderstood and underserved. This chapter seeks to add to the clinical knowledge of practitioners working with this population, to clarify legal precedent, and to establish best practices.
Medication treatment for anxiety, depression, schizophrenia, and bipolar disorder in the community setting Jonathan Shaywitz and Stephen Marder Print Publication Year: 2011 Published Online: Jul 2011 ISBN: 9780199565498 eISBN: 9780199640478 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780199565498.003.0109
In the community setting, four of the most common mental health syndromes affecting individuals include anxiety, depression, psychosis, and bipolar disorder. While the disorders can be quite debilitating, fortunately recent advances in both behavioural therapy as well as pharmacotherapy have helped improve the lives of countless individuals. In this chapter we will focus our discussion on pharmacotherapy with an emphasis on providing practical information that will be particularly useful to the community psychiatrist in selecting the most optimal therapeutic agents for his/her patient. Specifically, we first briefly introduce each clinical syndrome, and the classes of medications used in treatment; then we go on to discuss in detail each disorder within the general syndrome with the current pharmacological treatments variable for each entity, including both their short term and long term efficacy and then discuss the current pharmacological treatments available for each entity, including both their short-term and long-term efficacy. The potential adverse (side) effects associated with each of these medications will also be discussed. Our goal is for this chapter to serve as a clinical tool box providing the reader with a practical and effective approach to these very common psychiatric disorders.
Representations of suicide in cinema Gérard Camy Print Publication Year: 2009 Published Online: Jul 2011 ISBN: 9780198570059 eISBN: 9780199640461 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780198570059.003.0071
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In this chapter, representations of suicide in fiction film from the United States, Europe and South East Asia will be presented. Cinematic representations are helpful in addressing discourses on suicide worldwide. Typically, the sufferings of the characters that consider suicide or take their lives occupy a minor part of the plot in scenarios that highlight action, cultural and social reflection, or existential interrogations. In typical Hollywood dramas, redemption, punishment, lost love and solitude are the prime reasons for suicides; often as a consequence of genuine injustice. In the European films discussed, suicides on screen often attempt to open the screenplay to comments and reflections on the various tragic circumstances that bring the protagonists to such extremities. Refusal to recognize oneself in and by society appears to be an important reason for suicide. Another recurring theme is the wish to understand the motives behind the voluntary death of a peer. Much South East Asian cinema reflects the malaise of a society, its interiorized violence, fascination with death and the distress of a youth lacking excitement.
Epidemiology of dementia Laura Fratiglioni and Chengxuan Qiu Print Publication Year: 2013 Published Online: Oct 2013 ISBN: 9780199644957 eISBN: 9780191772085 Item type: chapter
Publisher: Oxford University Press DOI: 10.1093/med/9780199644957.003.0031
This chapter deals with the occurrence, determinants and primary prevention of dementia. Dementia is one of the major causes of functional dependence, poor quality of life, institutionalisation and mortality among elderly people. The risk of dementia increases almost exponentially with advancing age. As the population ages, dementia poses a serious threat to public health and social welfare system of our society. Accumulating evidence suggests that cardiovascular risk factors significantly contribute to the development and expression of dementia. Thus, adequate management of vascular risk factors and related disorders can be one of the preventative strategies against cognitive ageing and dementia. In addition, psychosocial factors such as educational achievement, socially-integrated and mentally-stimulating lifestyles are critical for delaying the onset of dementia by increasing cognitive reserve. Taken together, maintaining vascular health and adopting a healthy cognitive lifestyle from a life-course perspective may be the most promising strategy to achieve late-life cognitive health.
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