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Contributing to contemporary debates in phenomenological psychopathology and enactive psychiatry, this book argues that a comprehensive account of mental illness and its treatment requires engagement with subjectivity. It advances an enactive model of the mind that articulates the dynamics of lived experience and provides an integrative framework for psychiatric research and clinical practice. Recentering subjectivity, the book outlines a more unified and productive direction for the field aimed at psychiatrists, neuroscientists, and other mental health professionals Organized into two parts, Part I examines psychiatry's historical movement toward objectivity and the consequences of this shift, offering the conceptual resources needed to critically address-and move beyond—the concerns that motivated it. Part II develops a positive vision for an enactive psychiatry structured around the Nested States Model (NSM), demonstrating how the NSM can help guide both clinical practice and research towards a more comprehensive understanding of psychiatric disorders.
The psychological consequences of hospital admission for COVID-19, such as post-traumatic stress disorder (PTSD), are under-researched.
Aims
To describe the prevalence of, and risk factors for, psychological trauma symptoms in COVID-19 patients discharged from hospital.
Method
We used data from the Post-Hospitalisation COVID-19 (PHOSP-COVID) study of adults discharged from UK hospitals after COVID-19. Psychological trauma was assessed using the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5) 5 and 12 months after discharge. We used log binomial regression to identify risk factors for probable PTSD.
Results
We describe 1565 study participants discharged from hospital between February 2020 and March 2021 following an admission for COVID-19. Most were male (61.3%), White (77.4%) and from more deprived areas (62%). Of these, 15% had probable PTSD (PCL-5 ≥34) at 5 months which was associated with being 18 to 50 years old (risk ratio: 3.0 (2.1– 4.3), p < 0.001), lower income (e.g. <£19,001, risk ratio 2.1, 95% CI: 1.5 – 2.8, p < 0.001), longer admission and a history of depression or anxiety. Out of 236, 136 (57.6%) with probable PTSD at 5 months still had probable PTSD at 12 months. Persistence was associated with intensive care unit (ICU) admission (risk ratio 1.3, 95% CI 1.1–1.6, p < 0.001) and higher anxiety and PCL-5 scores at 5 months.
Conclusions
Probable PTSD was common 5 months after admission for COVID-19 and was associated with lower socioeconomic status, longer admission and previous depression or anxiety. Over half remained symptomatic at 12 months, associated with ICU admission and higher 5-month PCL-5 scores.
In this chapter, we outline the research conducted on vertebrates at the two sanctuaries. There are two main groups of vertebrate species in the sanctuary: those in situ at the Experiment’s outset (e.g., macropods, birds and herpetofauna) and reintroduced species (e.g., eastern quoll and New Holland mouse). Our research on macropods at the sanctuaries examines their grazing impacts on biodiversity and highlights management strategies, including the application of fertility control to maintain sustainable populations. Our research on herpetofauna, such as skinks and frogs, reveals the critical role of coarse woody debris (CWD) in enhancing reptile habitat and has highlighted frogs’ sensitivity to climate-driven droughts. Long-term bird monitoring in the experiment has shown significant declines in small woodland species, attributed in part to competition from the aggressive noisy miner. Reintroduction trials for the eastern quoll and New Holland mouse demonstrate the value of adaptive management and novel strategies such as Mini Safe Havens to promote population persistence of rare species.
This chapter presents the reintroduction biology of the eastern bettong (Bettongia gaimardi) at Mulligans Flat Woodland Sanctuary (MFWS), detailing strategies, tactics, and outcomes across establishment, growth and regulation phases. Adaptive management guided translocation planning, health monitoring and post-release assessments. Immediate-release tactics proved more effective than delayed-release, with high survival and reproductive success. Physiological stress, body condition and genetic diversity were tracked, revealing improved health and stable population dynamics. The population reached density dependence within six years, indicating successful regulation. Genetic monitoring confirmed retention of source diversity and highlighted the need for long-term sampling. A trial reintroduction beyond predator-proof fencing tested coexistence with invasive predators, introducing the ‘Goldilocks Zone’ concept for adaptive predator exposure. The chapter proposes ‘coexistence conservation’ as a long-term strategy to restore native species in landscapes where eradication of invasive predators is unfeasible, emphasising evolutionary adaptation and multi-stage trials.
Contention remains as to the impact of withdrawal of Early Intervention Services (EIS) on subsequent hospitalisation rates. The UK NICE guideline continues to state that such clinical gains of EIS are diminished following discharge and recommends further study at 5 years (accessed July 2025; https://www.nice.org.uk/Guidance/CG178).
Objectives
We aimed to explore hospitalisation rate by year in the UK Sussex First Episode Psychosis Cohort study (S1P).
Methods
We retrospectively recorded hospitalisations in the S1P cohort for those who had continued to receive secondary mental health care at 5 years from first psychotic episode, including 2 years following discharge from EIS. Data was collected between 2009 and 2017. Ethical conduct of the study was approved by the Sussex Partnership NHS Foundation Trust.
Results
184 patients received 5 years of care following a first episode of psychosis (52% of the original cohort enrolling with EIS). 69% had at least 1 hospitalisation episode between baseline and 5 years. Actual total new hospitalisations per year were 72 at baseline, then 59, 44, 49, 54 and 41 in subsequent years. Mean hospitalisations per person per year excluding the index admission when comparing the 0-3 (under EIS care) vs 4-5 years period was 0.275 [95% CI - 0.215 to 0.335] vs 0.219 [0.159 to 0.278] respectively (n = 183; p = 0.050).
No changes in external factors influencing overall bed availability were identified during the study period
Conclusions
The group of patients requiring care up to 5 years had initial declining hospitalisation rates but relative stability following the first year. The group not requiring 5 years of specialist mental health care, not studied here, likely had much lower hospitalisation. The hypothesis of rebound hospitalisation in the 2 years following EIS discharge is not supported.
Antibiotic overprescribing remains common in pediatric outpatient care. We evaluated Medicaid claims–based provider report cards as a scalable stewardship tool. Quarterly audit and feedback improved guideline concordance, diagnostic appropriateness, and reduced cefdinir use; highlighting claims-based electronic feedback as a sustainable outpatient antimicrobial stewardship strategy suitable for statewide implementation.
Chapter 4 considers how duties of international cooperation safeguard sovereign equality by reconciling the territorial sovereignty of coastal states with landlocked states’ rights to access the oceans through negotiation or binding arbitration.
Chapter 5 demonstrates that states have accepted obligations of mandatory cooperation with respect to a variety of other transboundary harms, including piracy, terrorism, and at least some cyberattacks.
Chapter 13 concludes by recapping the book’s key themes, considering potential obstacles to mandatory cooperation, and identifying other matters of international concern, such as pandemics, that are good candidates for mandatory cooperation under the equitable conception of sovereign equality.
Chapter 10 examines whether states bear duties of international cooperation with respect to forced migration, including the mass displacement caused by Myanmar’s campaign of ethnic cleansing against its Rohingya Muslim minority. It makes the case that the international community has accepted the protection of forced migrants as a common concern of humanity under the community’s joint stewardship.
Chapter 1 draws on the history of Russia’s military interventions in Ukraine to distinguish two conceptions of sovereign equality under international law. It argues that that international law in the twentieth century embraced a constitutional and equitable conception of sovereign equality, generating state obligations to cooperate with one another to resolve disputes over matters of common concern in accordance with equitable principles.
Chapter 3 shows how the international law of the sea moved away from state unilateralism in favor of the equitable model of sovereignty by requiring states to resolve disputes over international fisheries and maritime boundaries through cooperation in accordance with equitable principles.
Chapter 9 explains how duties of international cooperation apply to the international community’s collective responsibility to safeguard international peace, security, and human rights. With the establishment of the United Nations, the Grotian paradigm of states deciding when to use force for themselves shifted to a collective stewardship model whereby states must cooperate with one another to avoid armed conflict, punish atrocity crimes, and combat global poverty, including through collective consultation, negotiation, and peaceful dispute resolution.
Chapter 2 explains how international law governing rivers has evolved to establish a requirement that upstream and downstream sovereigns must consult and negotiate in good faith to determine mutually satisfactory solutions for the shared use of rivers.
Chapter 7 examines climate change as a transnational and existential threat to humanity generally, and to certain smaller and vulnerable states most dramatically. Since it poses an existential threat to low-lying coastal states and raises the frequency and intensity of extreme weather events, Chapter 7 makes the case that climate change should be understood to trigger duties of international cooperation.