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In the 1980s the traditional Hippocratic term excited delirium was transplanted from the bedsides of febrile, agitated and disoriented patients to the streets of Miami. Deaths in custody of young men who were intoxicated with cocaine and who were restrained by the police because of their erratic or violent behaviour were attributed to excited delirium. The blood concentrations of cocaine in these subjects were approximately ten times lower than the lethal level and other factors which might have contributed to the fatal outcome, such as the police use of neck-holds, choke-holds or 'hog-tying', were relegated to a minor role compared with the reframed 'diagnosis' of excited delirium. Over the course of the next few decades 'excited delirium' might be applied to virtually any highly agitated person behaving violently in a public place and who subsequently died in custody while being restrained or shortly afterwards. Expert witnesses, mainly forensic pathologists, testified that the deceased's death was probably inevitable given the perilous nature of excited delirium, even though this diagnostic entity lacked any consistent neuropathological basis and depended entirely on observed behaviour. This history of the rise and fall of this disputed diagnosis is a partial response to the sociologist Phil Brown's 1995 paper asking who benefits, or at least avoids trouble, by the identification and use of a diagnosis. [ABSTRACT FROM AUTHOR]

This study explores how psychological distress is identified and explained among Zulu people, examines how traditional healers understand their role and treatment methods and investigates the interaction between traditional and Western approaches to health care. Zulu people consult traditional healers namely diviners, faith healers or herbalists, as well as Western doctors to treat mental illness and distress. Whilst Western biomedicine is seen as useful in providing treatment, diviners and faith healers are particularly valued for their skills in identifying the cause of illness. Patients and their families tend to shop around for a practitioner who gives advice in keeping with their own beliefs. Psychological distress is usually explained in terms of sorcery, displeasure from the ancestors or social causes. Traditional healers use treatments aimed at harmonizing the patient with their environment through neutralizing sorcery, appeasing ancestors or directly manipulating the environment. [ABSTRACT FROM AUTHOR]

Jonathan Martin was a fundamentalist itinerant Christian preacher. Outraged by the laxity of Church of England clergy and inspired by prophetic dreams, he set fire to York Minster in 1829. At his trial for this capital offence, medical expert witnesses argued that Jonathan Martin was suffering from monomania and he was incarcerated for the rest of his life in Bethlem Hospital. This paper reviews the medico-legal use of the insanity defence in cases of religious motives for grave offences from the early 19th Century, and describes the millenarian climate of the period as well as the phenomenon of biblical exegesis and prophecy. Finally, the case of a contemporary bible-inspired arsonist is reviewed and his medical mitigation and 'disposal' is compared with that of Jonathan Martin. [ABSTRACT FROM AUTHOR]

The present study analyses the phenomenon of the migration to London of Italian intravenous drug users. Using structured questionnaires and prevalence data it was estimated that a significant number of Italian intravenous drug users (at least 1000) were living in London at the time of the study (1990), of whom 30% were HIV positive. Risk-taking behaviour was disturbingly high. The reasons for migrating were identified, and the implications of recent Italian legislation are briefly discussed. The data indicated that the living conditions of these immigrants in London were precarious and that these vulnerable individuals had little access to services. As the barriers to travel within the European Community disappear, the public health problems represented by the migration of problem-drug users are likely to become more acute. [ABSTRACT FROM AUTHOR]

The renewed research on religious experience and psychiatric illness requires a short and accessible measure of religious background, experience, belief and practice among patients and their families. The fourth edition of an unpublished questionnaire, previously used in clinical practice and research, is presented along with its scoring notes and its limitations. [ABSTRACT FROM AUTHOR]

Examines the prevalence of psychiatric illness among Afro-Caribbean migrants in Great Britain. Reasons for the high rate of mental illness among migrants; Comments regarding the figures of hospital admissions; Comparison of the admission rates for psychiatric illness between the children and parents of Afro-Caribbean migrants.

The English National Service Framework for Mental Health stipulates that the highest quality of health care should be provided for mental health service users in the most efficient and effective manner. Incidents of aggression and violence militate against achieving that goal, yet such incidents are frequently reported in inpatient settings.Traditionally, research in this area has focused on the extent of the phenomenon, the individual characteristics of those involved and precursors to the incident. For the most part the literature reflects a dualistic, perpetrator/victim conceptualisation of incidents. This study aimed to address the lack of research undertaken from a more systemic perspective by examining how all those involved understood and attributed meaning to violent or aggressive situations and how these attributions justified individual perceptions, reactions and actions.Working from the position that all behaviour, including violent behaviour, has meaning to those involved and can be understood, 16 semi-structured interviews were carried out in one mental health unit. Because only one client was both willing and able to give a full account of an incident, we focus here on two incidents in which that client was involved. Discourse analytic techniques were used to examine her account of the two incidents and those of the staff members involved.Participants discussed key themes from the interviews in terms of several dilemmas: whether the violent or aggressive behaviour was ‘mad’ or ‘bad’; predictable or unpredictable; and had resulted from ‘personality’ or ‘ mental illness’. The client and staff discourses were strikingly similar and in each case the central concern was with the attribution of blame.The findings have implications for the professional discourse of mental health care, including the discourse of the current policy agenda, a discourse itself constructed with the primary function of exoneration from and attribution of blame. [Copyright &y& Elsevier]

Presents several correspondence on medicine. Treatment of cerebral abscess; Immunization for polio during pregnancy; Plight of Maltese medical students; Deficiency in vitamin B[sub 12] among children.

Focuses on health related issues. Description of lethal osteogenesis imperfecta and a gene deletion; Occurrence of psychosis following cannabis abuse; Factors associated with the intellectual ability of children born to women with high risk pregnancies.