The Australian and New Zealand journal of psychiatry
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Aust N Z J Psychiatry · Dec 1988
Historical ArticleThe history and present status of moral insanity.
Psychiatric taxonomies, always a little uncertain, are most confused and illogical when they endeavour to encompass the moral and legal aspects of human behaviour. The concept of moral insanity represented a step backwards when it came into being, but it has persisted for a century and a half, changing only its title. Its creation and its subsequent history exemplify some of the common errors in psychiatric theorising.
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There is widespread criticism of medicine which contrasts with its manifest success in biotechnology. Medicine's failure to convince stems partly from the fact that its successful biotechnology distracts it from the mundane task of responding appropriately to components of commonplace sicknesses which do not stem from disease (things) or illness (symptoms) but from predicaments. Predicaments are painful social situations or circumstances, complex, unstable, morally charged and varying in their import in time and place, which are readily discernible from a good history. ⋯ The model is capable of broader application in psychiatry and medicine. Doctors should be more concerned to know about the context and background of their patients' sickness, as patients give this information very freely if asked. If patients' complaints are misunderstood then medical responses, made in good faith, may be seen as dangerous intrusions leading to a loss of trust, anger, and litigiousness.
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Aust N Z J Psychiatry · Mar 1985
Comparative StudyParasuicide and depression: a comparison of clinical and questionnaire diagnoses.
The frequency with which depressive disorder is diagnosed in parasuicide varies. It has been suggested that when observer bias is removed and a depression questionnaire employed, a greater number of young women who attempt suicide will be designated as depressed than would be expected on the basis of previous clinical reports. Our study compared clinical diagnoses made according to Feighner's research diagnostic criteria or DSM III with the categorisations obtained by the Levine-Pilowsky Depression questionnaire (LPD). ⋯ The LPD categorised 72.5% as depressed. Comparison of the clinical diagnoses with questionnaire data suggests that the LPD is overinclusive and not as specific as clinical diagnosis. Alcohol and substance abuse disorders accounted for almost one-third of the diagnoses and are therefore an important concomitant of parasuicide.