Chapter 1 examines what mental illness stigma is and analyzes the components of mental illness stigma to show how people with mental illness experience stigma in their daily lives. These components include labeling, stereotyping, prejudice, moral distancing, social exclusion, status loss, dehumanization, microaggressions, discrimination, and epistemic injustice. In each case, I use empirical evidence from the social psychology literature on stigma to show ways in which people with mental illness experience these forms of stigma. Next, I look at factors that affect the kind, degree, and scope of stigma associated with mental illness, including beliefs, political values, cultural values, socioeconomic status, education, and gender. Finally, I examine how many people experience compounding stigmas that come from multiple sources.

The introduction motivates the book’s arguments by showing how mental illness stigma remains pervasive despite greater awareness of mental health issues and more resources directed at mental health treatment and destigmatization. The forms of mental illness stigma most commonly expressed are stigma against people with severe mental illness who are perceived as homeless, and internalized stigma that people with mental illness project onto themselves. Mental illness stigma arises as a reaction to the violation of social norms of what a human being should be in the Western world in the twenty-first century. I give an account of stigma as the devaluing and discrediting of a person based on possessing a social trait that is seen as violating social norms, constituting a relationship of power. Components of stigma include labeling, stereotyping, prejudice, moral distancing, social exclusion, status loss, dehumanization, microaggressions, discrimination, and epistemic injustice. The chapter ends with a description of the book’s scope, methodology, and chapter outline.

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 menstrual history is a key feature of a psychiatric assessment and must be approached with sensitivity, recognising that cultural beliefs surrounding menstruation and menopause may pose barriers to open discussion. A structured framework is outlined, including suggested questions, designed to simplify the process and support identification of links between hormonal fluctuations and psychiatric symptoms and to glean information about the practical management of menstruation. We suggest a culturally sensitive, trauma-informed approach to enquiring about female genital mutilation (FGM) and its psychological impact. By adopting a life-course approach and routinely incorporating menstrual history into psychiatric assessment, clinicians can provide more holistic, personalised care.

The seven decades of Allen Ginsberg’s life and poetic work coincided with major changes in societies’ approaches to the mentally ill. Mid century, near rock-bottom in this difficult evolution, Allen burst onto the scene with “Howl” and then “Kaddish”. Allen’s shocking and monumental works said we need to face mental illness and madness, stop seeing them as apart from ourselves, find spiritual meaning, take risks, and make major changes to humanize our approaches. With the approval of Allen and later his estate, I could conduct new research to bring us closer to Allen and Naomi’s lifelong involvement with madness and mental illness and why it matters in relation to his poetry. The result was Best Minds: How Allen Ginsberg Made Revolutionary Poetry from Madness (2023). Allen’s radical acceptance of madness as a basic and potentially beneficial human capacity was far ahead of his time in inviting readers to change how we understand and engage with madness and mental illness.

In the Netherlands, compulsory care of patients with mental disorders such as schizophrenia is regulated by the Law on Compulsory Mental Healthcare (Wet verplichte geestelijke gezondheidszorg or Wvggz). This law replaces its predecessor, the Law on Special Admissions to Psychiatric Hospitals (Wet bijzondere opnemingen in psychiatrische ziekenhuizen or Bopz). The legislative process for this new law took over a decade. Discussions in parliament, with clinicians and in civil society focused much on the complexity of the relevant legal procedures and on the autonomy and legal position of the patients. In this paper, we discuss the Wvggz, its background and the central procedures for the judicial authorization of compulsory care. We also discuss which forms of compulsory care the Wvggz allows – as the Wvggz provides options for compulsory care in mental health clinics, but also at home and in community settings. While the Wvggz is a complex law with many elements, in this paper we focus on various ways the Wvggz is purportedly aimed at enhancing autonomy of patients with severe mental illness. In conclusion, we show how Dutch regulations aimed at enhancing autonomy also create more complexity and bureaucracy for patients.

This chapter takes a relatively broad approach to defences, covering a range of factors that might serve to exculpate a defendant who might otherwise appear to have committed an offence. The defences examined here are arranged into two, imperfectly realised, categories. The first group have been termed ‘mental state defences’ and the second ‘self-help defences’. The group titled ‘mental state defences’ are so categorised because they depend to a greater or lesser extent on the contention that the accused did not possess the requisite mens rea to commit the offence. In assessing whether an accused may be able to rely on a defence a number of subjective and objective elements have to be applied and analysed. It is important to understand that the considerations informing the development of each of the defences are often very different and sometimes controversial. The groupings are far from perfectly realised and the rationales and doctrines of each of the defences may manifest as many dissimilarities as they do similarities. It is hoped that the arrangement of the material in this chapter will aid understanding by drawing comparisons across different aspects of the criminal law.

Postpartum psychosis is a condition of great clinical and public health importance. Severe episodes of mental illness in the perinatal period can result in significant distress, may disrupt the developing relationship between mother and child, and have long-term implications for the well-being of the woman, her baby, family and wider society.

In this chapter we will discuss what we know about this condition and its relationship to bipolar disorder, how it might best be defined, what we still need to find out, and consider how it should be managed.

Suicide remains a leading cause of maternal death in the UK and in other high-income countries. While there are clear risks in severe mental disorder, those who die have experienced a range of mental illnesses and often come from more deprived communities. The Confidential Enquiries highlight the distinctive patterns of occurrence and progression in perinatal mental illness and the need for improvements in clinical evaluation of risk, effective risk management and the availability of high-quality perinatal mental healthcare as important factors in helping reduce progression to suicide.

As discussed in Chapter 1, the primary focus of this book is on the potential of neurotechnology to support the rehabilitation of convicted persons by improving risk assessment and risk management – rather than on its potential for diagnosing and treating mental or brain disorders. Still, in some cases, neurorehabilitation might well become conducive or even crucial to the improvement of mental health in forensic populations. Brain stimulation to attenuate aggressive impulses might serve to reduce the mental distress experienced by some persons subject to these impulses. Furthermore, aggression can be a symptom of a recognised mental illness, such as a psychotic disorder, or may be a core feature of a disorder, as in intermittent explosive disorder. Diminishing aggression using neurotechnology could in such cases be relevant to the person’s mental health, which appears to be an interest protected by human rights law. For example, Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) recognises a “right to the highest attainable standard of physical and mental health”.

This chapter begins with reference to the veneration and obscurity that characterises Webb’s reputation. It relates the early Webb’s mentoring by Norman Lindsay and his subsequent rejection of Lindsay’s secular aesthetics and anti-Semitism. Webb’s expatriate years in Canada and then England are discussed as a search for creative independence, although England was the place of his first hospitalisation for mental illness. The chapter observes that some of Webb’s most resonant poems are responses to the East Anglia landscape. It traces Webb’s return to Australia, his continued hospitalisation, and his Catholic devotion. The chapter explores the concept of schizophrenia as a pathology of language to understand Webb’s poetic language, particularly its metaphorical aspects. Lastly, the chapter focuses on Webb’s ‘explorer’ poems, their metaphorics of journeying, and their relationship to Australia’s cultural history, or national mythology, in the late 1950s and 1960s.