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Chapter 2 Stigma revisited and lay representations of mental health problems Chapter overview While the previous chapter dealt with expert, or disciplinary, knowledge about mental health and illness, this one extends a sociological understanding of the processes of stereotyping, stigmatization and social exclusion of people with mental health problems. Approaches to these topics have varied from a social psychological emphasis on prejudice to structural critiques emphasizing a social disability model. Not all cultures identify these differences in exactly the same way, nor do they use identical terms. Equally, however, no culture is indifferent to those who are sad, frightened or unintelligible in their conduct (Horwitz 1983). It is a well-rehearsed argument that in Europe, from the seventeenth to the twentieth century, such differences were accounted for decreasingly by demonic possession and increasingly by medical notions. With or without an expertise in the field of mental abnormality, most people know madness when they see it. This has become more salient with individualism and resonates with the discussion on self surveillance which is seen as intrinsic to the psy complex (see discussion in Chapter 1) Any of us might be directly involved in invoking a medical diagnosis for a friend, a relative or even a stranger in the street acting in a way we find perplexing or distressing. Any of us might reach a point where we decide that our own distress warrants a visit to the doctor or other expert for help. A problem with this term is that it alludes only to the pain of the patient and it gives no notion that they can be distressing, frustrating or frightening to others at times. Indeed, from the lay but non-patient perspective, the latter is often the preoccupying concern. There is considerable overlap between lay and psychiatric notions of mental health and illness. For example, in psychiatric disease categories, such as anorexia nervosa, where there is uncertainty about the cause and a large cultural component to the diagnosis, lay and psychiatric epistemologies have been found to be similar (Lees 1997). However, there are also differences between lay perspectives and disciplinary and formal knowledge. Notions about antisocial behaviour sometimes appear to be less readily accommodated within the lay discourse of distress and oddity. Two examples of this appeared in Britain in the early 1980s when juries were asked to consider the states of mind of two mass murderers and rejected expert psychiatric views that the men were mentally disordered.
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The mice corneas of control group exhibited high intensity transient signals due to regular arrangement of corneal collagen fibers (Fig. Phosphorylation of Smad2 was hard to detect in control group mice corneas whereas was upinj regulated 4. Quiescent keratocytes become activated fibroblasts, and keratocytes proteins such as cystallins and keratin sulfate proteoglycans are down-regulated [18]. Proteoglycans in fibrotic extracellular matrix is characterized with altered glycosaminoglycans, which contribute to the reduced transparency of scarred tissue [24]. Allogeneic transplantation often results in graft versus host response or host rejection. In this experiment, the transplanted animals did not see significant immunological rejection, the eye showed normal corneal transparency, no corneal neovascularization, clear pupil and iris texture, no ocular reaction, such as uveal reaction. However, further studies should be established to explore the in-depth mechanism 15 underlying mesenchymal stem cells regulation in corneal fibrosis for new therapies. All procedures used in this study were approved by Henan Provincial Eye Hospital Ethics Committe in compliance with the National Institutes of Health guidelines. Consent for publication Not applicable Availability of data and material All the data supporting the findings was contained within the manuscript. Funding this study was supported by the National Natural Science Foundation of China (No. The funding organization had no role in the study design, conduct of this research, data analysis, decision to publish, or preparation of the manuscript. We thank all the faculty of Henan Key Laboratory of Ophthalmology and Visual Science for the support they provided in this study. Cui Z, Zeng Q, Liu S, Zhang Y, Zhu D, Guo Y, Xie M, Mathew S, Cai D, Zhang J et al: Cell-laden and orthogonal-multilayer tissue-engineered corneal stroma induced by a mechanical collagen microenvironment and transplantation in a rabbit model. Moroncini G, Paolini C, Orlando F, Capelli C, Grieco A, Tonnini C, Agarbati S, Mondini E, Saccomanno S, Goteri G et al: Mesenchymal stromal cells from human umbilical cord prevent the development of lung fibrosis in immunocompetent mice. Zhang H, Wang L, Li Z, Liu S, Xie Y, He S, Deng X, Yang B, Liu H, Chen G et al: A novel murine model of Fusarium solani keratitis utilizing fluorescent labeled fungi. He S, Zhang H, Liu S, Liu H, Chen G, Xie Y, Zhang J, Sun S, Li Z, Wang L: gammadelta T cells regulate the expression of cytokines but not the manifestation of fungal keratitis. Zhang H, Wang L, Liu S, Xie Y, Deng X, He S, Zhang J, Sun S, Li X, Li Z: Two-photon imaging of the cornea visualized in the living mouse using vital dyes. Translational research: the journal of laboratory and clinical medicine 2014, 163(3):200-210.
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Such a neurological theory might be supported further by the experience and behaviour of people with temporal lobe epilepsy, who may present with anxiety and sometimes fiorid psychotic states. The induction of abnormal mental states by brain lesions, drugs, toxins, low blood sugar and fever might all point to the sense in regarding mental illness as a predominantly biological condition. Perspectives on mental health and illness 3 the question begged is: what has medicine to do with that wide range of mental problems that elude a biological explanationfi These illnesses include anxiety neuroses, reactive depression and functional psychoses (the schizophrenias and the affective conditions of mania and severe or endogenous depression). While there is some evidence that we may inherit a vague predisposition to nervousness or madness, there are no clear-cut laws evident to biological researchers as yet. Both broad dispositions run in families, but not in such a way as to satisfy us that they are biologically caused. Upbringing in such families might equally point to learned behaviour and the genetic evidence from twin studies remains contested (Marshall 1990). However, this may not follow: thieving can be prevented quite effectively by chopping off the hands of perpetrators, but hands do not cause theft. Likewise, a person shocked following a car crash may feel better by taking a minor tranquillizer, but their state is clearly environmentally induced. Thus, effective biological treatments cannot be invoked as necessary proof of biological causation. A fundamental problem with the illness framework in psychiatry is that it deals, in the main, with symptoms, not signs. This is certainly the case in the diagnosis of neurosis and the functional psychoses. Even in organic conditions, such as dementia, brain damage is not always detectable post-mortem (see Chapter 6). In the diagnosis of physical illness the diagnosis can often be confirmed using physical signs of changes in the body. However, it is possible to overdraw the distinctions between physical and mental illness. For example, an internal critic of psychiatry, Thomas Szasz (1961), has argued that mental illness is a myth. He says that only bodies can be ill in a literal sense and that minds can only be sick metaphorically (like economies).
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This helps to miniGastroesophageal Reflux mise the fibrosis and thus prevents stricture this is yet another condition where there is formation. Besides corrosive burns of the oesophagus, However, once established the resultant reflux other important causes of the oesophageal causes progressive oesophageal fibrosis strictures include trauma by foreign body or resulting in the shortening of the oesophagus. It is a disease of unknown aetiology affecting men more frequently than women, usually Complications Associated with between the age group of 30 and 60 years. Pulmonary complications because of peristalsis occurs in the oesophagus and the frequent regurgitation and aspiration of lower oesophageal sphincter fails to relax in food material. Clinical Features Treatment of Oesophageal Stricture There is long-standing history of epigastric Bougies of increasing size are passed down discomfort which progresses to dysphagia, the lumen to dilate it. The procedure needs more for liquids than solids as the solid food frequent repetition. If bouginage fails, external can pass down the sphincter because of its operation is required wherein the stenosed weight. Swallowed foods and liquids In this operation, the obstruction at the lower associated with mucous usually foul smelling, end is relieved by cutting through the are regurgitated. Through the left-sided thoracotomy, the lower part of Diagnosis oesophagus is exposed. An anterior longituBarium X-ray shows a spindle-shaped narrowdinal incision is made in the muscular wall of ing of the cardiac end through which little or the oesophagus at the cardio-oesophageal no barium passes down. However, the narjunction down to the mucosa but not through rowing is smooth and regular unlike in the mucous membrane. The mucosa is object which is retained in the pharynx or hyperaemic and at places ulcerated. Complications Foreign Bodies in Pharynx these include nutritional deficiencies and Small fish or meat bones are the commonly pulmonary complications because of frequent encountered foreign bodies in the pharynx. The chances of developing oesothese may get lodged in the tonsils, valecullae, phageal malignancy are around 20 per cent. Treatment Diagnosis Conservative management includes administhe history is suggestive. Diagnosis is confirmed Proper examination of the throat should be using oesophageal manometry. Laparoscopic done and a detailed mirror examination cardiomyotomy has shown results comparable usually reveals the site of lodgement of the to open cardiomyotomy minus the attendant foreign body.
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