Richard Warner

An evaluation of the impact of clubhouse membership on quality of life and treatment utilization.

A group of clubhouse users matched with similar patients (not clubhouse users) in a neighbouring area were compared in terms of quality of life (Lancashire Quality of Life Profile), service utilization and treatment costs over a two year period. The clubhouse group achieved a reasonable employment status and good social relationships, and advantages in subjective well-being favoured the clubhouse group. Over two years the pattern of service utilization and costs also favoured the clubhouse group. When the two groups were disaggregated for employment status the group with least treatment utilization and lowest costs was the employed clubhouse group.

Deception and Self-Deception in Shamanism and Psychiatry

The author argues that both shaman and psychiatrist are obliged to use a degree of self- deception in assuming their roles. The shaman must rationalize his use of trickery to impress his patients, and the psychiatrist deceives himself that his psychotherapeutic techniques have specific healing properties in the face of evidence which suggests that he often merely mobilizes the general effects of placebo and suggestion. Shaman and psychiatrist appear to use the same mental mechanisms in deceiving themselves. Inadequate method and theory may be supported by reference to personal experience and unrelated data or defended by circular reasoning or comparison with an even more inadequate system. The practitioner may also allow his perception of his abilities to be moulded by social consensus.

The roots of hospital alternative care

British hospital alternatives inherit some of their most valuable features, such as the use of small, domestic environments and the avoidance of coercion and confinement, from the early 19th-century moral management movement. The North American experience illustrates that these advantages can be lost if clinical benefits are overridden by cost and other practical concerns.

Invited commentary on . . . Ethnic variations in pathways into early intervention services for psychosis

Advocates of early intervention in psychosis choose to treat the association between long duration of untreated psychosis (DUP) and poor outcome as evidence that reducing DUP will improve outcomes. I question this view and argue that DUP does not predict outcome but rather that mode of onset of psychosis predicts DUP and outcome.