This explores the phenomenon of auditory verbal hallucinations (AVHs) as an example of entanglements of spirituality and psychopathology, and looks at ‘spiritually significant voices’ (identified by those who hear them as having spiritual/religious significance). Some have proposed making a differential diagnosis between ‘genuine’ spiritual experiences and mental illness, but the criteria for making such distinctions can be controversial and misleading, based on a false presupposition that the two are mutually exclusive. Research shows that patients identify some experiences as both part of an illness and spiritually significant. Patients with a psychiatric diagnosis are often subjected to epistemic injustice, wherein their claim to know things (e.g. spiritually) is discredited owing to prejudice associated with their diagnosis. A case study explores entanglement of spirituality with AVHs and considers implications for assessment/treatment. Voices of this kind may be meaningful for those who hear them, whether or not associated with a diagnosis, and affirmation of this and patients’ positive spiritual coping, where possible, can be a positive factor in promoting recovery.

The perimenopause is an individual experience, influenced by life circumstances, cultural context, family history and narrative. The perimenopause can last many years and women, as well as health professionals, can be poorly prepared for this potentially challenging period. Most people know to expect hot flushes, and maybe genitourinary symptoms. However, if the emotional symptoms, such as, reduced ability to cope, irritability and sudden anger, arise first, years before the expected hot flushes, it can be difficult to understand and have a detrimental effect on a woman’s life. We explore widespread physical symptoms of perimenopause and highlight symptoms that are regulated in the brain: hot flushes, body temperature regulation, sleep disturbances, libido. We focus on emotional symptoms, such as mood changes, depression, anxiety, agitation, irritability, a sense of overwhelm and losing the ability to cope, and explore their impact on suicidality. We briefly look at cognitive symptoms and explore the influence of trauma and the differences in experience by ethnicity and cultural influence. Finally, we look at the experience of premature ovarian insufficiency.

The spirituality of the psychiatrist is important because of the way that it may impact the well-being of the psychiatrist, clinical practice and the understanding of psychiatry more widely. In some cases, it may influence a psychiatrist’s sense of vocation to be a psychiatrist. The case study in this chapter draws on the author’s own experience of the ways in which spirituality and formation as a psychiatrist were entangled during training. Three historical examples are offered of different ways in which religion and psychiatry might be entangled in the life, work and thought of psychiatrists: a pragmatic atheism (Maudsley), religion understood as pathology (Freud) and religion as beneficial to mental flourishing (Jung). Three more recent examples are then considered, one of a Christian attempt to integrate theology and psychiatry (Frank Lake), one of reflections on how Buddhism influences practice as a psychiatrist (Mark Epstein) and one of a personal encounter of a psychiatrist with shamanism (Olga Kharitidi).

Broader debates about possible ways of addressing the tensions between science and theology/religion have not often been applied to psychiatry, and yet it is to a large extent scientific research on spirituality and mental health over recent decades that has generated current interest in the importance of spirituality to psychiatry. The four models of relationship between science and religion, developed by Ian Barbour – conflict, independence, dialogue and integration – each have their correlates in the literature on spirituality and psychiatry. However, in clinical practice it is the ‘ordinary’ theology of patients that assumes greater importance than the formal, or academic, theology of philosophical debate. As an example of the importance of a kind of ordinary theology which has been subjected to scientific research, the concept of God images is explored. It is proposed that, in the course of assessment and treatment, a kind of ‘clinical theology’ is needed, in which psychiatrists take into account inner representations of God and other ordinary theological beliefs which inform understanding of a patient’s illness and spirituality.

Psychological therapies are another focus for entanglement with spirituality. Prayer has caused concern in the literature, particularly in respect of boundary issues arising when clinicians pray with patients, but the nature of prayer is explored here rather as a way of giving attention to things that are most desired. Scientific evidence suggests that prayer is a form of positive religious coping for patients. Mindfulness, with its roots in Buddhism, is widely applied as a secular spiritual intervention that is helpful in a range of mental health conditions. Silence has long been recognised as a significant and meaningful phenomenon within psychotherapy, but also has its place in contemplative spiritual practices. A theme running through these three practices is that of careful attentiveness, in which spiritual and psychological concerns become entangled. Good clinical practice requires careful attention-giving, so there is a sense in which treatment planning in psychiatry can be considered a kind of prayer, understood as careful attentiveness to what is most desired by patients. Examples are drawn from Christian, Islamic and Buddhist spirituality and practice.

Referring to the medical model of frenzy sketched out in the first two chapters, Chapter 3 explores the metaphysical problems which it caused. The model’s insistence on the total dependence of the mind on the brain, it argues, placed pressure on a Christian cosmology in which ‘flesh’ and ‘spirit’ were supposed to be fully separable. Frenzy forced contemporaries to ask how it was possible for the human mind – made in the ‘image of God’ – to be impaired by organic disease. For most early modern Christians, the mind was a part of the soul, and this soul was immaterial, incorruptible, and immortal. Frenzy gave the impression that it invaded every part of the person, but this impression was false. The soul had to be immune to brain disease. This chapter examines the ancient roots of this problem, and examines how early modern England’s preachers, physicians, and philosophers attempted to solve it.

The Conclusion draws together the book’s various thematic strands: the perceived primacy of the ‘reason’, the right of its possessors to rule, the exculpatory effect of a frenzy diagnosis, and the high cost paid by those who received one. It returns to the larger question posed at the outset: whether the organ of the brain and the faculties of the mind were seen as constitutive of ‘personhood’ in pre-1700s England. The responses to frenzy which we have encountered in this book suggests that they were. The operations of the mental faculties known as ‘reason’, ‘will’, and ‘memory’ (or simply the ‘wits’) were located in (and often colloquially identified with) the brain. The functionality and continuity of these faculties was integral to the maintenance of legal, social, and spiritual personhood. Yet what troubled frenzy’s witnesses the most, the Conclusion argues, was the way it disrupted its sufferers’ predictable ways of being in the world – the values they had once held dear, the ways they had once looked and spoken. It was a disease which had the power to change friends, neighbours, and loved ones beyond recognition.

Chapter 2 considers how the diagnosis of frenzy – in its standard definition, an inflammation of the brain or meninges – both shaped and was shaped by anatomical knowledge. Reading the work of the anatomist Thomas Willis (1621–1675) alongside his various sixteenth- and seventeenth-century interlocutors, it situates his anatomical work within a longer tradition of brain–mind cartography. The chapter argues that Willis’s determination to map the functions of the brain onto its structures was driven, in part, by his clinical experiences of frenzy. His explicit hope was that his anatomy would be the foundation stone on which a new, clinically useful ‘Pathologie of the Brain and nervous stock, might be built’. But not all of his hopes for the project were medical in nature, or even this-worldly. Willis also sought to shore up two vital truths, both of which frenzy seemed to undermine: first, that there was a categorical difference between the human soul and that of all other living beings, and second, that the human soul alone would survive the death of the body.

The Introduction situates the book’s contribution in relation to the historiographies of madness, medicine, emotion, selfhood, and personhood. While mania and melancholy have enjoyed perennial scholarly interest, the same cannot be said of early modern frenzy. The Introduction offers some thoughts as to why frenzy has been neglected, and reflects on some of the conceptual and methodological difficulties which accompany its study. It explains the book’s scope (and limits), and offers short summaries of its six chapters. Sketching out the book’s central claim – that frenzy had devastating effects on personhood, and that these effects drove its early modern observers to unpick the tangle of mind, soul, and brain – it engages with recent claims about the emergence of a distinctively modern ‘cerebral self’. It sets out to test the claim that the possession of certain ‘psychological features, such as memory, consciousness, and self-awareness’ was not constitutive of ‘personhood’ until the end of the seventeenth century.

Beyond Words is a book of big questions about language. What is language? Where did it come from? How do we learn our mother tongue? How do we learn other languages in addition to our mother tongue? How do we use and understand language? How do we lose language? Collectively, these topics fall under the umbrella of psycholinguistics. Psycholinguistics is the marriage of linguistics and psychology. It is a branch of language science that explores the relationship between language and the human mind. This is a book that takes us down many rabbit holes. It is filled with astonishing research and surprising discoveries. It is about fierce debate and contentious topics that have fascinated us since ancient times and continue to do so today. Language is weird, but also wonderful. Language is intricate and innovative, confusing and complex, mysterious and most of all, it is multifaceted. Language is beyond words.

Chapter 1 tracks frenzy’s trajectory as a medical diagnosis between 1500 and 1700. It offers an introduction to frenzy as it was understood by eight medical practitioners, four of whom came of age in a time of relative stability in English medicine (1560–1640) and four in a time of rapid change (1640–1700). It shows how, from the mid seventeenth century, the old humoral definition of frenzy was altered to fit new medical philosophies – chemical, mechanistic, and corpuscular – and new models of human physiology. Tracing the contours of the disease over two centuries, it highlights points of continuity as well as change. Throughout this period, it argues, theorists from diverse schools explained frenzy’s effects with reference both to the solid structures of the body and the fluids which flowed through them. This chapter argues that it was the devastating effects of brain disease which galvanized medical theorists to seek to explain disorders of the mind as disruptions of material ‘animal spirits’.

Since the discovery of the first Neandertal fossils, the neurocranium has been of particular interest to specialists and the general public, particularly in relation to the question of what cognitive abilities can be inferred from the braincase. Here we present a detailed description and analysis of the neurocranial morphology of Neandertals and compare it with that of living humans and the fossil hominins that likely represent our last common ancestor. Our analyses show that the Neandertal neurocranium provides relatively few clues about the structural and functional characteristics of the brain it once contained. The unique morphology of the Neandertal braincase is best understood as a compromise between the spatial demands of a large brain and the biomechanical demands of a large and evolutionarily derived face.

Chapter 7 begins with Kornblith’s attempt to resurrect a teleology of the mind or intellect. I countenance his semantic, desire and pragmatic arguments, maintaining that none of them shows truth or true belief to be an objective good. By contrast, Aristotle’s idea that the intellect is constitutively directed at truth does show this (in virtue of the Aristotelian functionalist schema: i.e. all functions are correlated with perfections or goods). And Aristotle’s idea is corroborated not only by ‘folk’ and theoretical psychology, but also by cognitive science. For the latter is wedded to the notion that the brain is a cognitive system, functionally directed at cognition (viz. true belief). I go on to address three critiques of this intellectual teleology – those put forward by William James, evolutionary biology and global scepticism respectively – and argue that none of them is cogent. Next, I unpack two alternative accounts of the relation between truth and goodness – those of Ayer and Davidson – and maintain that they, too, fall short. Last, I tackle intellectual goods beyond true belief – such as knowledge and understanding – asking whether they or their objects form discernible hierarchies.

A fundamental dilemma in both the radiology reading room as well as the courtroom is whether a potential abusive head or spinal injury may be mistaken for other entities – both pathological processes and also normal anatomical or physiological variants.

A number of differential diagnoses, or mimics, for abusive head trauma may be apparent radiologically, but many may not be. Striving to achieve a medical “diagnosis” of an abusive injury requires the interplay between the radiologist and numerous other clinical specialties. The wide differentials which we discuss include accidental trauma, coagulopathies – both congenital and acquired, metabolic disorders, sepsis and vascular malformations, with all needing to be excluded before reaching a conclusion of nonaccidental trauma.

The experienced radiologist and clinician working in the challenging field of child protection also recognises that it is not always possible to reach a clear-cut decision and learning to communicate levels of uncertainty is essential. Part of this process is to always be alert to diagnostic mimics that may mislead the inexperienced and unwary.

Abusive head trauma (AHT) is a leading cause of traumatic death in infants, often resulting in severe brain injuries with lifelong consequences. It can cause cognitive, sensory and behavioral impairments, which may not fully emerge until later in childhood. AHT injuries are typically classified as primary (direct mechanical damage, such as contusions and lacerations) or secondary (indirect effects like hypoxic-ischemic injury and cerebral edema).

Infants are particularly vulnerable due to factors like poor neck control, larger head size and incomplete brain development. Neuroimaging, especially MRI and diffusion-weighted imaging, is essential for diagnosing these injuries and tracking their evolution, as some manifestations develop over days or weeks. Mechanisms of cell death, including necrosis, apoptosis and autophagy, play a key role in the progression of brain damage.

Differentiating AHT from accidental trauma is challenging. Certain patterns, such as subdural hemorrhages with ischemic injury, strongly suggest abuse. Comprehensive imaging, clinical evaluation and follow-up are crucial for documenting injury progression and understanding its impact on the developing brain.