Psychosis

With the publication of Wilfred Bion’s text 'Learning from Experience', psychoanalysis was afforded a new schema for understanding the processes and implications involved in an infant’s contact with their caregivers. As a result, our conception of some of the most fundamental phenomena of psychic life was significantly enriched. By proposing his theory of alpha-functioning, Bion mapped out how meaningful connections to the internal and external worlds become established in the mind. In contrast, and through working clinically with psychotic patients, Bion revealed how these ties can catastrophically come undone. It is with these ideas, as well as their links to a corresponding set of neuroscientific constructs relating to the Markov blanket and principally developed by Karl Friston, that this paper is concerned. Through an investigation of the psychic functioning originally dubbed ‘dream-work-alpha’, the paper’s first section focuses on how Bion conceived of the creation of a ‘contact-barrier’ that allows for the differentiation of consciousness from an unconscious mind. Casting the ramifications of this organisation in sharp relief, the psychotic disorganisation of the contact-barrier is then explored. The discussion subsequently broadens to incorporate contemporary theories from free energy neuroscience that bear significant and illuminating relations to the psychoanalytic ideas espoused by Bion over half a century ago. Finally, through posing a series of three questions with accompanying discussions, a superimposition of these theoretical schemas is attempted. These suggestions directly address 1. whether there is an intimate connection between the interoceptive contact-barrier and the exteroceptive Markov blanket, 2. whether a disobjectalising of the contact-barrier may be reflected as a tear in the functional fabric of the Markov blanket, and 3. what the clinical implications are of working at the level of the projected surface. Ultimately, the aim of the paper is to expose relevant points of contact within and between the varying conceptual frameworks; frameworks that ultimately derive from disciplines that are both concerned with examining the underlying mechanisms of the mind-brain.

This is the entire book.

"Why Are Our Pictures Puzzles?" is an attempt to understand why scholars have begun writing at such tremendous length on individual pictures. Before the 20th c., one of the longest texts on a single painting was Vasari's description of Leonardo's "Last Supper." In the last forty years it has become common for historians to write entire books on individual artworks.

Why have we started experiencing images as so complex? Why do they seem to us like puzzles, waiting to be solved? Why doesn't it concern us that previous generations did not think of writing at such length?

This book also has a couple of chapters on what I consider to be psychotic behavior about images: compulsive sighting of supposedly hidden images, and a crazy art historical book about a painting written by Dalí. So I have tagged the book with psychoanalytic terms.

The book itself is still in print and in copyright, but I found a full pdf of this on the internet (for example on scribd), so I decided to post it on here on academia.edu, where at least it can have the correct context and links.

This thesis explores Maurice Blanchot’s notion of the “limit-experience” through a close reading of Thomas the Obscure. I examine Blanchot’s notion of the limit-experience through Thomas’ symptoms of psychosis and melancholia. These symptoms are important for understanding the “limit-experience” because they show the corrosive force of language on identity. Blanchot emphasizes the limits to thought and knowledge that is outside of the lived experience. I argue that Thomas’ “limit-experience” depicts a missed experience that includes both self and the other relations. Further, I suggest that Blanchot provides a unique account of what it is to put being into question but that he does so in literature. His récit will be examined here accordingly in terms of the way it enacts a questioning of the “limit-experience”.

The notion of the “limit-experience” hinges upon the idea that language is a counter-world to the real. Language is portrayed as an absence and presence that conceals and reveals being. I trace this thought through the narration of Thomas’ presence that is pushed to the extreme limits of experience and knowledge. I approach Thomas’ series of “limit-experiences” through a twofold perspective as I investigate his relationship with “the image” and “the symbol”. I argue that these two relationships with the anterior link Thomas’ being-in and for-itself (consciousness) to culture/ presence/ “I”.

People diagnosed with schizophrenia and related psychotic disorders often have unmet needs around sexuality and intimacy issues. This can impact negatively upon a person's recovery and the need to lead a fulfilling and satisfying life. The aim of the current review was to explore the available qualitative literature that addressed sexuality and intimacy issues published between the years 2006 and 2016. Records were screened for eligibility. Finally, 56 studies that addressed the aims were included the review. The main themes that emerged are briefly discussed. The implications for clinical practice and future research are presented.

Background There is a growing number of studies showing interactions between genetic polymorphisms associated with dopaminergic neurotransmission and traumatic life events (TLEs) on a risk of psychotic-like experiences (PLEs). Anomalous self-experiences (ASEs) have been associated both with TLEs as well as with PLEs. However, it remains unknown what is the role of ASEs in the complexity of gene–environment interactions on the emergence of PLEs. Patients and methods We included 445 young adults—university students from three big cities in Poland. We used the Traumatic Events Checklist to assess TLEs, the Inventory of Psychotic-Like anomalous self-experiences in order to measure ASEs, and the Prodromal Questionnaire (PQ16) to record the level of PLEs. The following gene polymorphisms, related to dopaminergic neurotransmission, were determined: the catechol-O-methyltransferase (COMT) rs4680 polymorphism, the dopamine D2 receptor (DRD2) rs6277 polymorphism, and the dopamine transporter ...

RESUMEN.Reflexionamos sobre el debate que existe en la comunidad científica sobre los artículos de opinión que plantean valorar el posible uso terapéutico que puede tener el consumo regulado del Cannabis y por otra parte los estudios que muestran la relación entre el consumo de esta sustancia y el riesgo de enfermedad mental. Se diferencia entre "riesgo de enfermedad" y causalidad y se explica el concepto de estocasticidad en psiquiatría Debemos valorar así mismo "el coste de oportunidad que está suponiendo que el debate sobre el cannabis se siga planteando como un conflicto bélico entre partidarios y detractores del uso de esta sustancia milenaria y compleja".
Palabras clave: Cannabis, artículo de opinión, causalidad, riesgo de enfermedad, psicosis, enfermedad mental, consumo.
SUMMARY.We reflect on the debate that exists in the scientific community about the opinion articles that propose assessing the possible therapeutic use that the regulated cannabis consumption can have and on the other hand the studies that show the relationship between the consumption of this substance and the risk of mental illness. Differs between "risk of disease" and causality, and explain the concept of stochasticity in psychiatry. We must value "the loss of opportunity that is assuming that the debate on cannabis continues to arise as a war conflict between supporters and detractors of the uso of this ancient and complex substance. En las ciencias de la salud las cosas casi nunca son blancas o negras y la estructura empírica, el momento histórico, nos hace valorar debidamente

The World Health Organisation defines health promotion as “the processof enabling people to increase control over, and to improve, their health”. EIIP undertook activities aimed at raising awareness of psychosis and the help available. The Early Intervention in Psychosis's health promotion strategy reduced admission by 75% between 2009-2010. The service's caseload is 69% male and the reason for this seems to be explored further.

Background: Voice-hearing experiences can be distressing and impairing, and existing psychological treatments show modest effectiveness. Ecological momentary assessment and intervention (EMA/I) are two promising approaches which may be used as digital tools to support and enhance existing psychological therapies. The aim of this study was to investigate the potential clinical utility of smartphone-based EMA/I in a blended, coping focused therapy for voice-hearing experiences. Method: This pilot RCT focused on feasibility, acceptability and preliminary estimations of efficacy. Thirty-four participants with persisting and distressing voices were randomised to receive the four-session intervention alongside treatment-as-usual (TAU) or TAU-only. Results: Findings supported the feasibility and acceptability of the approach, with good engagement and satisfaction rates, and clinical outcomes showed the intervention holds promise for improving coping, overall severity of voices and to some degree their negative impact. Conclusion: This is the first examination of the use of EMA/I in a blended therapy for psychotic experiences, with findings suggesting these technologies show promise as clinical tools.

Most contemporary text books of neurology and of psychology pay little attention to the function of the cerebellum beyond noting it to be an organ of motor control. A historical overview of research on cerebellar function is presented, from pre-Sherrinton suggestions of sensory and motor function, through the post-Sherrinton and dominant 20 th . Century view of "motor" function, to the 21 st . century perspective of "sensorimotor" function. The intrinsic capability of the cerebellum is briefly considered in terms of: its size/complexity/capacity; its information representation/processing characteristics (with "a particular computational function"); its sensory information processing capability; and, its role in sensorimotor regulatory control. It is suggested that the cerebellum can process sensorimotor stimulus information in a statistical (connectionist type) manner and respond to in on the basis of its own learning based sensorimotor representations, albeit at a "level" that does not necessarily involve cerebral "awareness".

Early-onset schizophrenia is characterized by significant impairment in general intellectual ability, which seems to show a deteriorating course before but not after the onset of syndromal psychosis.  Against this background, there is a degree of differentiation with regards to the magnitude and longitudinal evolution of specific cognitive domains. Verbal memory and learning emerge as the most consistently and significantly affected domains in which patients show increased deviance both before and after the onset of syndromal psychosis.  In contrast, attentional resources seem to be initially preserved but show evidence of deterioration after syndromal onset. A common theme in cognitive changes observed after psychosis onset is that they seem to reflect both decline from baseline functioning and failure to show the age-related gains observed in healthy developing youth.

Background: We examined whether motor speed assessed by the finger tapping test predicts generalized and specific stable deficits because of a common pathogenic process in bipolar and schizophrenic patients. Methods: One hundred and two patients underwent a battery of neuropsychological tests. Patients with a score of less than one standard deviation from their siblings', sample in two assessments with an interval of one year were defined as suffering from stable deficits because of a common pathogenic process.

Background
Adequately understanding and measuring pathways to care is a prerequisite for early detection and effective treatment of first-episode psychosis.

Method
We conducted a systematic review of studies on pathways to care in first-episode psychosis to establish what measures currently exist to assess pathways in first-episode psychosis and to compare these measures.

Results
We identified 15 studies which had used six different measures of pathways to care. Differences in aims, methodology and lack of psychometric data did not allow a direct comparison of pathways measures but certain common themes emerged.

Discussion
Pathways to care in first-episode psychosis are diverse and varied. There is no measure with established psychometric properties that has been devised on a well-developed theoretical or conceptual framework and had its psychometric properties established. The conflict between exploring the patient's narrative and journey through the healthcare system and developing an empirical measure of pathways with optimal outcomes has hindered the development of such a measure.

Keywords:
Pathways to care; First-episode psychosis; Schizophrenia; Duration of untreated psychosis; Early intervention in psychosis

Background: Non-pharmacological treatment for schizophrenia includes educational, psychotherapeutic, social, and physical interventions. Despite growing importance of these interventions in the holistic treatment of individuals with schizophrenia, very little is known about their availability in SouthEast European countries (SEE). Objective: To explore mental health care experts' opinions of the availability of non-pharmacological treatment for people with schizophrenia in SEE. Methods: An online survey containing 11 questions was completed by one mental health expert from each of the following SEE countries: Albania, Bosnia and Herzegovina (B&H), Bulgaria, Croatia, Greece, Kosovo, Montenegro, Moldova, North Macedonia, Romania, Serbia, and Slovenia. Data were collected on estimated rates of received nonpharmacological interventions, type of services delivering these interventions, and expert views of availability barriers. Results: In eight countries, the estimated percentage of...

Many of the major neuropsychiatric illnesses, including schizophrenia, have a typical age of onset in late adolescence.
Late adolescence may reflect a critical period in brain development making it particularly vulnerable for the onset of psychopathology. Neuroimaging studies that focus on this age range may provide unique insights into the onset and course of psychosis. In this review, we examine the evidence from 2 unique longitudinal cohorts that span the ages from early childhood through young adulthood; a study of childhood-onset schizophrenia where patients and siblings are followed from ages 6 through to their early twenties, and an ultra-high risk study where subjects (mean age of 19 years) are studied before and after the onset of psychosis. From the available evidence, we make an argument that subtle, regionally specific, and genetically influenced alterations during developmental age windows influence the course of psychosis and the resultant brain phenotype. The importance of examining trajectories of development and the need for future combined approaches,
using multimodal imaging together with molecular studies
is discussed.

for anyone who wishes to extend their knowledge and develop services for OCD. As well as presenting the science behind OCD, the outcomes of various therapeutic interventions are also examined. My criticism of the book is that, as a multi-author work, it is in parts highly repetitive. For example, almost every chapter includes a description of the Yale-Brown Obsessive Compulsive Scale. This may be useful for the reader who uses the book as a reference work, but it is tedious for anyone reading it from beginning to end. Another criticism is that whereas a wealth of neuropsychiatric research is presented, cognitive-behavioural therapy (CBT) is rather sparsely covered. There is a relatively short chapter on psychological treatments but the general role of CBT, such as in treatment-refractory OCD, is not fully described. Despite my reservations I feel this is a useful addition to the literature and would recommend it to all adult and child psychiatrists who may wonder how to treat these patients.

Background
People with psychosis experience disruptions in personal identity that affect positive and negative symptoms, but the complexity of these phenomena needs to be addressed in an in-depth manner. Using the Personal Construct Theory, we examined whether distinct dimensions of personal identity, as measured with the Repertory Grid Technique along with other cognitive factors, might influence psychotic symptomatology.

Method
Eighty-five outpatients with schizophrenia-spectrum disorders completed a repertory grid, an observed-rated interview of psychotic symptoms, and measures of cognitive insight, depressive symptoms, neurocognition, and theory of mind.

Results
Structural equation models revealed that interpersonal dichotomous thinking directly affected positive symptoms. Self-discrepancies influenced positive symptoms by mediation of depressive symptoms. Interpersonal cognitive differentiation and interpersonal cognitive richness mediated the impact of self-reflectivity and neurocognitive deficits in negative symptomatology.

Conclusions
This study is the first of its kind to examine the structure of personal identity in relation to positive and negative symptoms of psychosis. Results suggest interventions targeted to improving interpersonal dichotomous thinking, self-discrepancies, interpersonal cognitive differentiation, and interpersonal cognitive richness may be useful in improving psychotic symptoms.

The present study aims to explore emotion recognition in people with intellectual disabilities. Emotion recognition is an important skill to generate adequate social interactions. Thus, the stimulation and development of these skills are essential to build new relationships , understand the environment in which the subject develops and acquire a positive knowledge through social learning. In this research , photography was used as a tool for expression and improvement of cognitive and social skills. The evaluation was carried out through a test previously created specifically for the Ecuadorian population. The purposes of this study attempt to confirm if: a. People with intellectual disabilities have more difficulties in recognizing emotions than the general population, and: b. Studying photography improves emotion recognition skills in people with intellectual disabilities. Regarding the method, this study uses a pre-experimental design with pre-post measurements, with an intervention of 4 months and a half through two-hour training aimed at fifty subjects with minor and moderate intellectual disabilities. The main results show that: a. There is a significant difference (X^2 = 37.29 P <0.001) in emotion recognition between the control group and people with intellectual disability. b. There is a significant improvement in emotion recognition, which at the same time allows concluding that photography is an alternative tool to stimulate emotion recognition skills in people with intellectual disability.

The aim of this paper is presentation of the comprehensive literature of the new therapeutic interventions based on mindfulness (Mindfulness-based Cognitive Therapy MBCT,  Acceptance and Commitment Therapy ACT and modifications) which appeared promising whilst their implementing among psychotic patients. MBCT and ACT are a contextual forms of Cognitive Behavioral Therapy that attempts to alter one’s relationship to symptoms of psychosis rather than attempting to reduce or control them (traditional approaches to the treatment of psychosis emphasize symptom reduction or elimination). Many clinical and empirical studies (qualitative and quantitative) shows that mindfulness meditation appears to ameliorate psychotic symptoms (improvements in psychotic symptom severity and frequency of hospitalization, general clinical and psychosocial functioning, ability to respond mindfully to distressing thoughts and images). The limits of the researches are discussed, especially in case of meditation-induced psychotic symptoms (low participant number, uncontrolled designs, a history of psychiatric illness of participants, exposition to intensive meditation practise - 18 hours of meditation per day with prolonged periods of fasting and silence). In summary the conceptual clinical applications of the theory are presented: mindfulness (adaptations of ACT and MBCT) in context of contemporary clinical practice is shown to improve delusion-related regulatory capacity and modify participant’s perception of psychotic experiences (centering in awareness of psychosis; allowing voices, thoughts, and images to come and go without reacting or struggle; and reclaiming power through acceptance of psychosis and the self).

IMPORTANCE Alterations in multiple neuroimaging phenotypes have been reported in psychotic disorders. However, neuroimaging measures can be influenced by factors that are not directly related to psychosis and may confound the interpretation of case-control differences. Therefore, a detailed characterization of the contribution of these factors to neuroimaging phenotypes in psychosis is warranted. OBJECTIVE To quantify the association between neuroimaging measures and behavioral, health, and demographic variables in psychosis using an integrated multivariate approach. DESIGN, SETTING, AND PARTICIPANTS This imaging study was conducted at a university research hospital from June 26, 2014, to March 9, 2017. High-resolution multimodal magnetic resonance imaging data were obtained from 100 patients with schizophrenia, 40 patients with bipolar disorder, and 50 healthy volunteers; computed were cortical thickness, subcortical volumes, white matter fractional anisotropy, task-related brain activation (during working memory and emotional recognition), and resting-state functional connectivity. Ascertained in all participants were nonimaging measures pertaining to clinical features, cognition, substance use, psychological trauma, physical activity, and body mass index. The association between imaging and nonimaging measures was modeled using sparse canonical correlation analysis with robust reliability testing. MAIN OUTCOMES AND MEASURES Multivariate patterns of the association between nonimaging and neuroimaging measures in patients with psychosis and healthy volunteers. RESULTS The analyses were performed in 92 patients with schizophrenia (23 female [25.0%]; mean [SD] age, 27.0 [7.6] years), 37 patients with bipolar disorder (12 female [32.4%]; mean [SD] age, 27.5 [8.1] years), and 48 healthy volunteers (20 female [41.7%]; mean [SD] age, 29.8 [8.5] years). The imaging and nonimaging data sets showed significant covariation (r = 0.63, P < .001), which was independent of diagnosis. Among the nonimaging variables examined, age (r = −0.53), IQ (r = 0.36), and body mass index (r = −0.25) were associated with multiple imaging phenotypes; cannabis use (r = 0.23) and other substance use (r = 0.33) were associated with subcortical volumes, and alcohol use was associated with white matter integrity (r = −0.15). Within the multivariate models, positive symptoms retained associations with the global neuroimaging (r = −0.13), the cortical thickness (r = −0.22), and the task-related activation variates (r = −0.18); negative symptoms were mostly associated with measures of subcortical volume (r = 0.23), and depression/anxiety was associated with measures of white matter integrity (r = 0.12). CONCLUSIONS AND RELEVANCE Multivariate analyses provide a more accurate characterization of the association between brain alterations and psychosis because they enable the modeling of other key factors that influence neuroimaging phenotypes.

Paris : Editions Michèle, collection « Je est un autre », janvier 2012. L'enjeu de cet ouvrage est d'approcher et de décrire la manière par laquelle le psychanalyste d'orientation lacanienne peut mener un travail auprès des personnes atteintes de psychoses. L'entreprise d'un travail sur la parole auprès d'un sujet psychotique présente des particularités que l'auteur déploie notamment à travers l'usage de vignettes cliniques plus ou moins détaillées. Loin de tenter d'élaborer un manuel, l'auteur souligne qu'aucune des réponses singulières qu'il a pu faire face à un sujet ne peut valoir pour règle. La direction du livre se trouve à l'inverse dans la description d'une position d'accueil de la parole, où tout savoir se maintient à l'horizon, sans retournement de la relation en rapport.

‫פלג-בנימיני‬ ‫תמר‬ ‫לשון:‬ ‫עריכת‬ www.resling.co.il 64736 ‫אביב‬ ‫תל‬ ,3 ‫בן-אבי‬ ‫איתמר‬ ‫רסלינג,‬ 03-6956704 ‫טל:‬ ‫אביב‬ ‫תל‬ ‫בע"מ,‬ ‫חדקל‬ ‫בדפוס‬ ‫נדפס‬ ‫רסלינג‬ ‫להוצאת‬ ‫שמורות‬ ‫הזכויות‬ ‫כל‬ © 2009 ‫בישראל,‬ ‫נדפס‬ ‫העניינים‬ ‫תוכן‬ 7 / ‫תודות‬ 9 / ‫השמימית‬ ‫וירושלים‬ ‫החיים‬ ‫הקדמה‬ ‫הקפיצה‬ -‫הסמלי‬ ‫הסדר‬ ‫והולדת‬ ‫הקלינית‬ ‫ההתנסות‬ ‫א‬ ‫פרק‬ 27 / ‫ב-3591‬ ‫לאקאן‬ ‫של‬ ‫התיאורטית‬ ‫החזרה‬ ‫של‬ ‫מוקדם‬ ‫דגם‬ -(1938) ‫משפחתיים'‬ ‫'תסביכים‬ ‫ב‬ ‫פרק‬ 69 / ‫האב‬ ‫הפשטת‬ ‫ושל‬ ‫לפרויד‬ 117 / ‫לאקסטימיות‬ ‫דואליזם‬ ‫בין‬ -‫ללוגוס‬ ‫החזרה‬ ‫ג‬ ‫פרק‬ 155 / ‫המאיימת‬ ‫הקרבה‬ -(1) ‫יונג‬ ‫עם‬ ‫לאקאן‬ ‫ד‬ ‫פרק‬ ‫היהודית-‬ ‫והמסורת‬ ‫ביניהם‬ ‫ההבדלה‬ -(2) ‫יונג‬ ‫עם‬ ‫לאקאן‬ ‫ה‬ ‫פרק‬ 199 / ‫נוצרית‬ ‫לא-מודע‬ ‫מהו‬ -‫וטאבו'‬ ‫'טוטם‬ ‫בעקבות‬ ‫ולאקאן‬ ‫לוי-שטראוס‬ ‫ו‬ ‫פרק‬ 241 / ‫קולקטיבי?‬ ‫והעמדה‬ ‫הגדול‬ ‫האחר‬ ‫שם-האב,‬ -‫אהיה'‬ ‫אשר‬ ‫'אהיה‬ ‫ז‬ ‫פרק‬ 271 / ‫המקראית‬ -‫הנצרות‬ ‫של‬ ‫היהדות,‬ ‫של‬ ‫הפסיכואנליזה,‬ ‫של‬ ‫האתיקה‬ ‫ח‬ ‫פרק‬ 335 / 7 ‫בסמינר‬ ‫קריאה‬ 383 / ‫המאוחר‬ ‫לאקאן‬ ‫על‬ ‫דבר‬ ‫אחרית‬ -‫הבארוק‬ ‫עינוגי‬ 397 / ‫מקום‬ ‫מראי‬ 425 / ‫אישים‬ ‫מפתח‬

This article analyzes the stages that Jacques Lacan's thought has dedicated to the theme of madness, starting from the forties, up to the seventies, to highlight the peculiar aspects of the decision of being, of the foreclosure of the Name of Father and the sinthome inside the substitute clinic. The purpose of this journey is to see whether, as far as madness is concerned, one can speak of origin or cause, or whether the question should be re-evaluated in other terms. Finally, the Freudian term Nachträglichkeit will be considered as an attempt to redefine the causality of madness itself.

This article posits that the DSM-5 and its psychiatric diagnoses are a monumental artifact of social power rather than a useful system for naming, describing, classifying, or understanding mental disorders. Two biographic documentaries, Crumb and Jupiter's Wife, are examined as alternative information about people with severe mental, behavioral, and emotional disturbances, which ordinarily would be diagnosed as schizophrenia or a related psychotic disorder. In contrast to the disease processes implied by psychiatric diagnoses, these detailed documentaries revealed particular social (e.g., lack of positive role models, bullying), environmental (e.g., poverty, homelessness), and historical (e.g., child abuse, failure in school) factors that might have brought about the individual's personal problems. Seeing people in the actual places where they live and hearing about their struggles first-hand can evoke sympathy and empathy in viewers, potentially freeing them from the technical abstractions and pathological attributions inherent in psychiatric diagnoses.

Background: Impaired insight into illness is common during early psychosis and has been associated with treatment delays and poorer long-term outcomes. The relationship between patients' insight into illness and their caregivers' knowledge about psychosis is putatively associated with treatment outcome but there is limited research about this. This pilot study was designed to test the hypothesis that caregivers' levels of insight into illness is associated with patients' insight into illness in early psychosis and would be related to caregivers' levels of critical, rejecting attitudes toward patients. Methods: Patients with schizophrenia or schizoaffective disorder within 5 years of psychosis onset (n= 14) and caregivers (n= 14) of the patients' choosing were studied. Insight into illness was assessed in patients using the Scale to assess Unawareness of Mental Disorder (SUMD). Caregiver insight into illness was assessed with a modified version of the SUMD with questions rephrased to probe caregivers' understanding of the patients' illness. Caregivers' critical attitudes toward patients were assessed with the Patient Rejection Scale (PRS). Results: Significant correlations were found between patients' and caregivers' awareness of need for treatment (r = .55, p = .02), awareness of symptoms (r = .48, p = .04) and between caregivers' awareness of illness and critical attitudes toward patients (r = .65, p = .01). Conclusions: These findings suggest that caregivers' emotional characteristics and levels of insight into illness may be related to insight into illness in patients. Implications for family psychoeducational approaches to impairments of insight into illness during early psychosis are discussed.

In this article I apply film theory as an analytic prism through which to examine the ritual mechanisms of a particular kind of Islamic exorcism (al-ruqya al-sharʿiyya). I show how these exorcisms operate as a ritual montage that conjures the absent presence of al-ghayb—a hidden world of power that only God can see in its totality and to which the possessed patients and the jinn spirits must succumb. These exorcisms thus provide healing, not in the sense of immediate "well-being" or "relief from pain" but in the sense of moral witnessing, an opportunity to testify to the limits of human seeing and action and to the ways in which invisible and divine forces give shape to the tangible world.