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  Mens Sana Monographs
A Monograph Series Devoted To The Understanding Of Medicine, Mental Health, Man, Mind, Music And Their Matrix
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   2014| January-December  | Volume 12 | Issue 1  
    Online since April 9, 2014

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The Task before Psychiatry Today Redux: STSPIR
Ajai R Singh
January-December 2014, 12(1):35-70
DOI:10.4103/0973-1229.130295  PMID:24891797
This paper outlines six important tasks for psychiatry today, which can be put in short as:
  1. Spread and scale up services;
  2. Talk;
  3. Science,
  4. Psychotherapy;
  5. Integrate; and
  6. Research excellence.
As an acronym, STSPIR.
  1. Spread and scale up services: Spreading mental health services to uncovered areas, and increasing facilities in covered areas:
    1. Mental disorders are leading cause of ill health but bottom of health agenda;
    2. Patients face widespread discrimination, human rights violations and lack of facilities;
    3. Need to stem the brain drain from developing countries;
    4. At any given point, 10% of the adult population report having some mental or behavioural disorder;
    5. In India, serious mental disorders affect nearly 80 million people, i.e. combined population of the northern top of India, including Punjab, Haryana, Jammu and Kashmir, Uttarakhand and Himachal Pradesh;
    6. Combating imbalance between burden of demand and supply of efficient psychiatric services in all countries, especially in developing ones like India, is the first task before psychiatry today. If ever a greater role for activism were needed, this is the field;
    7. The need is to scale up effective and cost-effective treatments and preventive interventions for mental disorders.
  2. Talk: Speaking to a wider audience about positive contributions of psychiatry:
    1. Being aware of, understanding, and countering, the massive anti-psychiatry propaganda online and elsewhere;
    2. Giving a firm answer to anti-psychiatry even while understanding its transformation into mental health consumerism and opposition to reckless medicalisation;
    3. Defining normality and abnormality;
    4. Bringing about greater precision in diagnosis and care;
    5. Motivating those helped by psychiatry to speak up;
    6. Setting up informative websites and organising programmes to reduce stigma and spread mental health awareness;
    7. Setting up regular columns in psychiatry journals around the globe, called 'Patients Speak', or something similar, wherein those who have been helped get a chance to voice their stories.
  3. Science: Shrugging ambivalence and disagreement and searching for commonalities in psychiatric phenomena;
    1. An idiographic orientation which stresses individuality cannot, and should not, preclude the nomothetic or norm laying thrust that is the crux of scientific progress.
    2. The major contribution of science has been to recognize such commonalities so they can be researched, categorized and used for human welfare.
    3. It is a mistake to stress individuality so much that commonalities are obliterated.
    4. While the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, therapeutic advancements and aetiologic understandings are going to result only from a scientific methodology.
    5. Just caring is not enough, if you have not mastered the methods of care, which only science can supply.
  4. Psychotherapy: Psychiatrists continuing to do psychotherapy:
    1. Psychotherapy must be clearly defined, its parameters and methods firmly delineated, its proof of effectiveness convincingly demonstrated by evidence based and controlled trials;
    2. Psychotherapy research suffers from neglect by the mainstream at present, because of the ascendancy of biological psychiatry;
    3. It suffers resource constraints as major sponsors like pharma not interested;
    4. Needs funding from some sincere researcher organisations and altruistic sponsors, as also professional societies and governments;
    5. Psychotherapy research will have to provide enough irrefutable evidence that it works, with replicable studies that prove it across geographical areas;
    6. It will not do for psychiatrists to hand over psychotherapy to clinical psychologists and others.
  5. Integrate approaches: Welcoming biological breakthroughs, while supplying psychosocial insights:
    1. Experimental breakthroughs, both in aetiology and therapeutics, will come mainly from biology, but the insights and leads can hopefully come from many other fields, especially the psychosocial and philosophical;
    2. The biological and the psychological are not exclusive but complementary approaches;
    3. Both integration and reductionism are valid. Integration is necessary as an attitude, reductionism is necessary as an approach. Both the biological and the psychosocial must co-exist in the individual psychiatrist, as much as the branch itself.
  6. Research excellence: Promoting genuine research alone, and working towards an Indian Nobel Laureate in psychiatry by 2020:
    1. To stop promoting poor quality research and researchers, and to stop encouraging sycophants and ladder climbers. To pick up and hone genuine research talent from among faculty and students;
    2. Developing consistent quality environs in departments and having Heads of Units who recognize, hone and nurture talent. And who never give in to pessimism and cynicism;
    3. Stop being satisfied with the money, power and prestige that comes by wheeling-dealing, groupism and politicking;
    4. Infinite vistas of opportunity wait in the wings to unfold and offer opportunities for unravelling the mysteries of the 'mind' to the earnest seeker. Provided he is ready to seek the valuable. Provided he stops holding on to the artificial and the superfluous.
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What Explains Consciousness? Or...What Consciousness Explains?
Donelson E Dulany
January-December 2014, 12(1):11-34
DOI:10.4103/0973-1229.130283  PMID:24891796
In this invited commentary I focus on the topic addressed in three papers: De Sousa's (2013 [16],[17] ) Toward an Integrative Theory of Consciousness, a monograph with Parts 1 & 2, as well as commentaries by Pereira (2013a [59] ) and Hirstein (2013 [42] ). All three are impressively scholarly and can stand-and shout-on their own. But theory of consciousness? My aim is to slice that topic into the two fundamentally different kinds of theories of consciousness, say what appears to be an ideology, out of behaviourism into cognitivism, now also influencing the quest for an "explanation of consciousness" in cognitive neuroscience. I will then say what can be expected given what we know of the complexity of brain structure, the richness of a conscious "vocabulary", and current technological limits of brain imaging. This will then turn to the strategy for examining "what consciousness explains"-metatheory, theories, mappings, and a methodology of competitive support, a methodology especially important where there are competing commitments. There are also increasingly common identifications of methodological bias in, along with failures to replicate, studies reporting unconscious controls in decision, social priming-as there have been in perception, learning, problem solving, etc. The literature critique has provided evidence taken as reducing, and in some cases eliminating, a role for conscious controls-a position consistent with that ideology out of behaviourism into cognitivism. It is an ideological position that fails to recognize the fundamental distinction between theoretical and metaphysical assertions.
  4,642 170 -
Stress and its expression according to contemporary science and ancient indian wisdom: perseverative cognition and the Pañca kośas
Sasidharan K Rajesh, Judu V Ilavarasu, TM Srinivasan, HR Nagendra
January-December 2014, 12(1):139-152
DOI:10.4103/0973-1229.130323  PMID:24891803
Stress is recognised as the most challenging issue of modern times. Contemporary science has understood this phenomenon from one aspect and Indian philosophy gives its traditional reasons based on classical texts. Modern science has recently proposed a concept of perseverative cognition (PC) as an important reason for chronic stress. This has shown how constant rumination on an unpalatable event, object or person leads to various lifestyle disorders. Similarly classical yoga texts like the Taittiriya Upanishad, the Bhagavad Gita, and the Yoga Vashistha describe stress in their unique ways. We have here attempted a detailed classification, description, manifestation, and development of a disease and its management through these models. This paper in a nutshell projects these two models of stress and shows how they could be used in future for harmonious management of lifestyle disorders.
  3,464 85 -
Medicine and mind-body dualism: a reply to mehta's critique
Callie Joubert
January-December 2014, 12(1):104-126
DOI:10.4103/0973-1229.130318  PMID:24891801
Neeta Mehta recently advanced the thesis that medical practice is facing a crisis today. In her paper "Mind-body dualism: a critique from a health perspective" she attributes the crisis to the philosophy of Descartes and set out to understand why this dualism is still alive despite its disavowal from philosophers, health practitioners and lay people. The aim of my reply to her critique is three-fold. First, I draw attention to a more fundamental problem and show that dualism is inescapable-scientifically and commonsensically. I then focus on the self-conscious emotions of shame, guilt and remorse, and argue that the self is not identical with a brain. The third section draws attention to the crisis in psychiatry and stipulates some of the main reasons why this is so. Contrary to Mehta's thesis, the health profession faces a crisis because of physicalism and biological reductionism.
  3,354 83 -
Shrug ambivalence and disagreement; search commonalities in psychiatric phenomena
Ajai R Singh
January-December 2014, 12(1):92-103
DOI:10.4103/0973-1229.130316  PMID:24891800
Holistic understanding is necessary to study intimate nuances of psychological/psychopathological processes; also, individual manifestations and individual approach are laudable goals in treatment and approach. But we cannot forget that major therapeutic advances result when we are able to delineate commonalities and stable symptom clusters that cut across geo-cultural boundaries and are amenable to study and intervention. Even though the purpose and approach of psychiatry, as of all medicine, has to be humane and caring, major therapeutic advancements and aetiologic understandings result only from a scientific methodology that stresses and figures out the commonalities of psychopathological phenomena. It is a mistake to stress individuality so much that commonalities are obliterated. Although stress on the individual's needs has helped psychiatry at times become more humane, it has hurt the task enormously by making some very bright minds question the very scientific basis of psychiatry and its status as a medical discipline. Hence, even as it is necessary to promote holistic and individualistic caring, it is equally necessary to shrug ambivalence and crippling disagreements that can result if individualism in therapy is carried beyond limits. Psychiatry's tradition, and field, will always allow for diversity in its practice, even in its theorising. For, psychopathology has both a personal, deep inner dimension - due to biogenetic and personality factors - and social, manifest/unmanifest, outer dimension - due to the environment. And the practice, and theory, of both are likely to be different, although we do try to amalgamate them in our 'bio-psycho-social' model. Such differences are only manifestations of an intricate network of influences that make for the human condition in health and disease. Psychiatry is the one branch which realises this diversity the most, but equally important for it is to stress its unity:
  1. Of purpose - that of reducing individual and social psychopathology;
  2. Of goals - that of unravelling the aetiopathology of psychiatric disorders; finding precision in diagnostics and investigative tests; finding biomarkers; and finding precise therapies for precise disorders that control such disorders; and not just control, but finally cure them; finding methods of primary prevention; of moving from mental disorder to mental health; and, further, of progress to individual actualisation and personal and collective well-being with longevity;
  3. Of practice - a) in therapy: By synergising psychopharmacology/somatic therapies with psychotherapy/therapies, social therapies and pharmacogenetics; b) in diagnostics: By identifying the phenotype-genotype-endophenotype axis; and (c) by promoting such therapy and diagnostics as brings about control, and finally, cure/primary prevention of psychiatric disorders.
The future course for psychiatry involves a goal oriented forward movement - while allowing for diversity in practice and theory, stressing on unity of purpose, goals, and practice.
  2,774 60 -
Speaking to a wider audience about the positive contributions of Psychiatry
UC Garg, Kabir Garg
January-December 2014, 12(1):71-78
DOI:10.4103/0973-1229.130297  PMID:24891798
We live in a world that is increasingly complex, intense, and stressful. Most people, at some time or other in their lives, can make good use of psychiatry as they map their course and steer their way through it. While this holds true, there also exists a very disturbing trend. No other branch of medicine suffers a similar, constant criticism, scrutiny and quite often downright vehement protest. Even the service users, who have been greatly benefitted, choose to stay mum for fear of stigmatization that may follow if they admit to have undergone therapy. The onus lies on both, the service users and providers alike, to take the positive contributions of psychiatry to the masses at large. All of us, especially medical professionals, need to consider our own attitudes and awareness. The recognition that anyone will break down if mental stress is high enough should help free us from a 'them and us' attitude. Reading about people's own experience of mental illness can promote understanding: Examples include a successful actress and a prize-winning author. For mental health practitioners, enabling service users to influence service development is another strong anti-stigma move. A cognitive behavior therapy approach can help individuals overcome the stigma felt and also cope better with discrimination. Also, we need to stand up against mental health discrimination wherever it is encountered.
  2,698 66 -
Welcome biological breakthroughs, supply psychosocial insights
Bheemsain Tekkalaki, Adarsh Tripathi, JK Trivedi
January-December 2014, 12(1):79-91
DOI:10.4103/0973-1229.130315  PMID:24891799
Human behaviour, emotions, and cognition are complex to understand and explain. It is even more difficult to understand the basis for abnormal behaviour, disturbed emotions, and impaired cognitions, something mental health professionals are trying for long. In these pursuits, psychiatry has traversed through eras of humours, witchcraft, spirits, psychoanalysis, and gradually deviated from other medical specialities. Now, with recent biological breakthroughs like advances in psychopharmacology, neuroimaging and genetics, increasingly more emphasis is being given to the biological model of psychiatric disorders. These new biological models have given a more scientific appearance to the speciality. It has also revolutionised the management strategies and outcome of many psychiatric disorders. However, this rapid development in biological understanding of psychiatry also leads to a new wave of reductionism. In an attempt to deduce everything in terms of neurons, neurochemicals, and genes, can we neglect psychosocial aspects of mental health? Patients' personality, expectations, motives, family background, sociocultural backgrounds continue to affect mental health no matter how much 'biological' psychiatry gets. Biological and psychosocial approaches are not mutually exclusive but complementary. Integrating them harmoniously is the skill psychiatry demands for comprehensive understanding of mental and behavioural disorders.
  2,584 69 -
Revised Template for MSM Submissions 2014
Ajai R Singh
January-December 2014, 12(1):194-199
DOI:10.4103/0973-1229.130363  PMID:24891808
  2,202 86 -
Natural evolution and human consciousness
Jan Holmgren
January-December 2014, 12(1):127-138
DOI:10.4103/0973-1229.130322  PMID:24891802
A visual conscious experience is my empirical basis. All that we know comes to us through conscious experiences. Thanks to natural evolution, we have nearly direct perception, and can largely trust the information we attain. There is full integration, with no gaps, of organisms in the continuous world. Human conscious experiences, on the other hand, are discrete. Consciousness has certain limits for its resolution. This is illustrated by the so-called light-cone, with consequences for foundations in physics. Traditional universals are replaced by feels and distributions. Conscious experiences can be ordered within a framework of conceptual spaces. Triple Aspect Monism (TAM) can represent the dynamics of conscious systems. However, to fully represent the creative power of human consciousness, an all-inclusive view is suggested: Multi Aspect Monism (MAM).
  2,195 76 -
Late J. K. Trivedi: A noble soul and a great human being
Roy Abraham Kallivayalil
January-December 2014, 12(1):4-7
DOI:10.4103/0973-1229.130281  PMID:24891794
  1,926 62 -
Late Prof. J. K. Trivedi: A teacher affects eternity
Adarsh Tripathi
January-December 2014, 12(1):1-3
DOI:10.4103/0973-1229.130280  PMID:24891793
  1,768 76 -
MSM book review: The unity of mind, brain and world (current perspectives on a science of consciousness)
Avinash De Sousa
January-December 2014, 12(1):163-167
  1,666 62 -
Ganesh Singh
January-December 2014, 12(1):161-162
DOI:10.4103/0973-1229.130330  PMID:24891805
  1,640 83 -
Total Reference List MSM 2014

January-December 2014, 12(1):170-187
  1,656 59 -
Preface MSM 2014

January-December 2014, 12(1):8-10
  1,630 60 -
Instructions to Contributors

January-December 2014, 12(1):188-193
  1,474 87 -
Corrections to my paper: John Locke on personal identity
Namita Nimbalkar
January-December 2014, 12(1):168-169
DOI:10.4103/0973-1229.130333  PMID:24891806
  1,445 61 -
Peer Reviewers for MSM 2014

January-December 2014, 12(1):169-169
  1,192 62 -
From here and now to infinity and eternity: A message to new medical doctors
José Florencio F Lapeña
January-December 2014, 12(1):153-160
DOI:10.4103/0973-1229.130328  PMID:24891804
Commencement means both an end and a beginning; the end of the academic year and the beginning of the rest of your life as new physicians. For such a beginning, it is useful to view it in retrospect, from the point of view of the end, by conducting a pre-mortem on your life. Taking the existentialist (ex sistere, to stand forth) stance, each of us can be classified into one of four basic types of person, based on our characteristic space and time (or spatio-temporal) context or horizon. Our space can be limited to the "here" and our time to the "now;" or our space may extend to "infinity" and our time embark on "eternity." In-between these poles, most have space contexts rooted in their home and work "turf" and time involving their "lifetime," while some expand their space to include the "world" and their time to encompass "history." From the "here and now" and "turf and lifetime" contexts, the horizons of "world and history," and "infinity and eternity" are examined, challenging new medical doctors to realize their full potential. The new physician is exhorted not to wait for a post-mortem to define (des finitus, to set limits) his or her life. He or she should stand forth, to live, and give life. The new medical doctor is encouraged to look to the sunrise, draw strength from the sunshine, to be brave, and strong and true.
  733 40 -
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