Vicente Navarro (born 1937 in Gironella, Spain) is a Spanish sociologist and political scientist. He has been a Professor of Health and Public Policy at Johns Hopkins University, US, for over 30 years. He is also emeritus professor in political and social science at the Pompeu Fabra University
in Barcelona, Spain, and is the director of the JHU-UPF Public Policy
Center in Barcelona, which is jointly sponsored by the two institutions.
He is also the director of the Observatorio Social de España, where he coordinates a research project on the welfare state.
Navarro has published 24 books which have been translated into several languages, the most recent being The Social Underdevelopment of Spain: Causes and Consequences (El Subdesarrollo Social de España: Causas y Consecuencias), Anagrama; There Are Alternatives: Proposals to Create Employment and Social Wellbeing in Spain
(Hay Alternativas. Propuestas para Crear Empleo y Bienestar Social en
España), Ed. Seguitur (With Juan Torres and Alberto Garzón); Neoliberalism,
Globalization and Inequalities, Baywood; and Attack on Democracy and
Wellbeing: A Critique of the Dominant Economic Thinking (Ataque a la
democracia y al bienestar. Crítica al pensamiento económico dominante),
Anagrama, 2015. He is also a regular contributor to the Spanish
newspaper Público, as well as Rebelion.org.
He received the essay prize of the publishing company Anagrama for his book Insufficient Wellbeing, Incomplete Democracy. On That Which is not Spoken About in our Country (Bienestar insuficiente, democracia incompleta. De lo que no se habla en nuestro país), which is the Spanish equivalent to the Pulitzer Prize. In 2014, Professor Navarro was awarded the Stebbins Medal from Johns Hopkins University. According to the Agency of International Scientific Information of the University of Pennsylvania
(Lauder Institute of Management and International Studies), professor
Navarro is one of the most quoted Hispanic scientists in the
international scientific literature in the social sciences.
Works
Dangerous to your health. Capitalism in health care, Monthly Review Press (1993)
The politics of Health Policy. The US reforms, 1980-1994, Blackwell (1994)
Neoliberalismo y Estado del Bienestar. Madrid, Ariel Económica, 3a edició ampliada (2000)
Globalización Económica, Poder Político y Estado del Bienestar. Madrid, Ariel Económica (2000)
Bienestar Insuficiente, Democracia Incompleta. De lo que no se habla en nuestro país. XXX Premi Anagrama d'Assaig, Barcelona, Anagrama (2002)
The Political Economy of Social Inequalities. Consequences for Health and Quality of Life (2002)
El estado de Bienestar en España (2003)
L'estat del Benestar a Catalunya (2003)
Political and Economic Determinants of Population Health and Well-Being, Baywood (with C. Muntaner) (2004)
The Political and Social Context of Health, Baywood (2004)
El subdesarrollo social de España: causas y consecuencias, Barcelona, Anagrama (2006)
Lo que España necesita. Una réplica con propuestas alternativas a la política de recortes del PP. Vicenç Navarro, Juan Torres y Alberto Garzón. Editorial Deusto (2012)
Los amos del mundo. Las armas del terrorismo financiero. Vicenç Navarro y Juan Torres López. Editorial Espasa (2012)
Lo que debes saber para que no te roben la pensión. Vicenç Navarro y Juan Torres López. Editorial Espasa (2013)
The financial and economic crises and their impact on health and social well-being. Baywood Publishing Company (2014)
Ataque a la democracia y al bienestar. Crítica al pensamiento económico dominante. Anagrama (2015)
Psychiatry
is, and has historically been, viewed as controversial by those under
its care, as well as sociologists and psychiatrists themselves. There
are a variety of reasons cited for this controversy, including the
subjectivity of diagnosis, the use of diagnosis and treatment for social and political control including detaining citizens and treating them without consent, the side effects of treatments such as electroconvulsive therapy, antipsychotics and historical procedures like the lobotomy and other forms of psychosurgery or insulin shock therapy, and the history of racism within the profession in the United States.
In addition, there are a number of groups who are either critical towards psychiatry or entirely hostile to the field. The Critical Psychiatry Network
is a group of psychiatrists who are critical of psychiatry.
Additionally, there are self-described psychiatric survivor groups such
as MindFreedom International and religious groups such as Scientologists that are critical towards psychiatry.
Challenges to conceptions of mental illness
Vienna's Narrenturm — German for "fools' tower" — was one of the earliest buildings specifically designed as a "madhouse". It was built in 1784.
Since the 1960s there have been challenges to the concept of mental illness. Sociologists Erving Goffman and Thomas Scheff argued that mental illness was merely another example of how society labels and controls non-conformists, behavioral psychologists challenged psychiatry's fundamental reliance on unchallengable or unfalsifiable concepts, and gay rights activists criticized the APA's inclusion of homosexuality as a mental disorder in the DSM. As societal views on homosexuality have changed in recent decades, it
is no longer considered a mental illness and is more widely accepted by
society. As another example that challenged conceptions of mental
illness, a widely publicized study by Professor David Rosenhan, known as the Rosenhan experiment, was viewed as an attack on the efficacy of psychiatric diagnosis.
Medicalization
Conversation between doctor and patient
Medicalization, a concept in medical sociology, is the process by which human conditions and problems come to be defined and treated as medical conditions, and thus become the subject of medical study, diagnosis, prevention,
or treatment. Medicalization can be driven by new evidence or
hypotheses about conditions, by changing social attitudes or economic
considerations, or by the development of new medications or treatments.
For many years, several psychiatrists, such as David Rosenhan, Peter Breggin, Paula Caplan, Thomas Szasz, Giorgio Antonucci and critics outside the field of psychiatry, such as Stuart A. Kirk, have "been accusing psychiatry of engaging in the systematic medicalization of normality". More recently these concerns have come from insiders who have worked for the APA themselves (e.g., Robert Spitzer, Allen Frances). For example, in 2013, Allen Frances said that "psychiatric diagnosis
still relies exclusively on fallible subjective judgments rather than
objective biological tests".
The concept of medicalization was devised by sociologists to
explain how medical knowledge is applied to behaviors which are not
self-evidently medical or biological. The term medicalization entered the sociology literature in the 1970s in the works of Irving Zola, Peter Conrad, and Thomas Szasz,
among others. These sociologists viewed medicalization as a form of
social control in which medical authority expanded into domains of
everyday existence, and they rejected medicalization in the name of
liberation. This critique was embodied in works such as Conrad's "The
discovery of hyperkinesis: notes on medicalization of deviance",
published in 1973 (hyperkinesis was the term then used to describe what we might now call ADHD), and Szasz's "The Myth of Mental Illness."
These sociologists did not believe medicalization to be a new
phenomenon, arguing that medical authorities had always been concerned
with social behavior and traditionally functioned as agents of social
control (Foucault, 1965; Szasz, 1970; Rosen). However, these authors
took the view that increasingly sophisticated technology had extended
the potential reach of medicalization as a form of social control,
especially in terms of "psychotechnology" (Chorover, 1973).
In the 1975 book Limits to medicine: Medical nemesis (1975), Ivan Illich
put forth one of the earliest uses of the term "medicalization".
Illich, a philosopher, argued that the medical profession harms people
through iatrogenesis,
a process in which illness and social problems increase due to medical
intervention. Illich saw iatrogenesis occurring on three levels: the clinical, involving serious side effects worse than the original condition; the social, whereby the general public is made docile and reliant on the medical profession to cope with life in their society; and the structural,
whereby the idea of aging and dying as medical illnesses effectively
"medicalized" human life and left individuals and societies less able to
deal with these natural processes.
Marxists such as Vicente Navarro (1980) linked medicalization to an oppressive capitalist society. They argued that medicine disguised the underlying causes of disease, such as social inequality
and poverty, and instead presented health as an individual issue.
Others examined the power and prestige of the medical profession,
including use of terminology to mystify and of professional rules to
exclude or subordinate others.
Some argue that in practice the process of medicalization tends
to strip subjects of their social context, so they come to be understood
in terms of the prevailing biomedical ideology, resulting in a disregard for overarching social causes such as unequal distribution of power and resources. A series of publications by Mens Sana Monographs have focused on medicine as a corporate capitalist enterprise.
In unstable countries, political prisoners are sometimes confined and abused in mental institutions. The diagnosis of mental illness allows the state to hold persons
against their will and insist upon therapy in their interest and in the
broader interests of society. In addition, receiving a psychiatric diagnosis can in and of itself be regarded as oppressive.
In a monolithic state, psychiatry can be used to bypass standard legal
procedures for establishing guilt or innocence and allow political
incarceration without the ordinary odium attaching to such political
trials. The use of hospitals instead of jails prevents the victims from
receiving legal aid before the courts, makes indefinite incarceration
possible, and discredits the individuals and their ideas. In that manner, whenever open trials are undesirable, they are avoided.
Examples of political abuse of the power, entrusted in physicians
and particularly psychiatrists, are abundant in history and seen during
the Nazi era and the Soviet rule when political dissenters were labeled as "mentally ill" and subjected to inhumane "treatments." In the period from the 1960s up to 1986, abuse of psychiatry for
political purposes was reported to be systematic in the Soviet Union,
and occasional in other Eastern European countries such as Romania, Hungary, Czechoslovakia, and Yugoslavia. The practice of incarceration of political dissidents in mental
hospitals in Eastern Europe and the former USSR damaged the credibility
of psychiatric practice in these states and entailed strong condemnation
from the international community. Political abuse of psychiatry also takes place in the People's Republic of China and in Russia. Psychiatric diagnoses such as the diagnosis of 'sluggish schizophrenia' in political dissidents in the USSR were used for political purposes.
History of racism in psychiatry in the United States
The
history of racism in psychiatry dates back to the days of slavery and
segregation in the United States. Such racism in psychiatry exemplifies
the concept of scientific racism, which falsely alleges that science and other empirical evidence supports racism and proves certain racial inferiorities.
Diagnosis
Psychiatric
diagnoses were influenced by Black people's status as free or enslaved.
Enslaved people were not considered civilized enough to be diagnosed
with insanity, while free Black people were over-diagnosed with
insanity, having much higher diagnosis rates than white people. Specific diagnoses in the 19th century were crafted specifically to fit Black people – drapetomania and dysesthesia aethiopica,
disorders meant to explain why slaves ran away and why they were lazy
or lacked a strong work ethic, respectively, and justify the institution
of slavery. Prominent political figures such as John C. Calhoun
used this supposed evidence to argue for slavery, arguing that free
Black people could not be entrusted with their lives and would
ultimately develop lunacy. All in all, throughout the 19th century, psychiatric diagnoses and
scientifically racist theories were used to medicalize Blackness and
uphold systems of slavery and racism, further constraining the rights,
freedom, and humanity of Black people.
Proponents of scientific racism have historically attempted to
"prove" that Black people are physiologically and cognitively inferior
to white people based on faulty assumptions and prejudices. Perpetuated
by the inaccurate application of biodeterminism, specialists in
neuroanatomy and psychiatry compared disproportionate numbers of brains
from Black and white individuals to support their racial agendas based
on "science."
The proportion of Black individuals confined in establishments for
"flawed and imbecile" patients increased throughout the late 19th and
early 20th century. Psychiatry contributed towards the inaccurate and racist belief that if
they were left to their respective means, they would not be able to
remain in decent condition. At the beginning of the 20th century, Black people were disproportionally sterilized in eugenics programs that compulsorarily sterilized those classed as feebleminded or who received welfare payments. The premise that the genes of those deemed mentally ill were
undesirable was used to justify sterilization which was frequently
supervised by physicians, including psychiatrists.
Hospitals
Segregation
within mental institutions and hospitals is another example of the
history of racism within psychiatry. Many psychiatric hospitals in the
19th century either excluded or segregated Black patients or admitted
Black slaves to work at the hospital in exchange for care. The founding fathers of psychiatry themselves supported the notion that
Black people were inferior, lower class citizens that must be treated
separately and differently from white patients. With time, racial segregation within hospitals became interspersed with
entirely separate hospitals for white and Black patients, each with
differential treatment and quality of care. Political figures in the
post-Civil War era argued that emancipation had led to a significant
increase in insanity cases amongst Black individuals, and they cited the
need to accommodate this increase via segregated and Black-only insane
asylums. Many hospitals, especially in the southern United States, did not admit
Black patients until they were eventually mandated to do so. The last segregated hospital opened in 1933. Popular arguments also circulated that Black patients were more
difficult to take care of in mental institutions, making psychiatric
care for them more difficult and justifying the need for segregated
facilities.
Until the late 1960s, many hospitals remained segregated. This affected the experiences of racial minorities accessing
psychiatric care in mental institutions and hospitals in the United
States. When Lyndon B. Johnson's administration stated that no
segregated hospital would receive federal Medicare funds, hospitals
began to integrate quickly in order to be able to continue to access
such funding. In January 1966, around two-thirds of Southern hospitals were
segregated facilities and many Northern facilities remain segregated
in-effect. One year later, by January 1967, there were very few hospitals in the
United States that remained segregated. Segregation within mental
institutions and hospitals is one example of the history of racism
within psychiatry.
In the profession
Black psychiatrists often experienced racism as practitioners within the field. Some of this history is detailed in Jeanne Spurlock's book titled Black Psychiatrists and American Psychiatry,
published in 1999, in which she profiles Black psychiatrists who were
influential in American psychiatry and their experiences in the
profession. During the Civil Rights Movement,
Black psychiatrists expressed concerns to the APA that the needs of
Black communities and Black psychiatrists were being ignored by the
professional organization. In 1969, a contingent of Black psychiatrists presented a list of 9
concerns to the APA Board of Trustees regarding experiences of
structural racism in the field. Their '9 points' represented a wide array of experiences of
discrimination, both from the experiences of practitioners and patients,
and on the institutional and individual level and the group demanded
change from within the APA. For example, they called for more Black leaders on APA committees as
well as the desegregation of all mental health facilities, both public
and private, in the United States.
As of 2020, within psychiatry, historically underrepresented
groups continue to be less represented as residents, faculty, and
practicing physicians in comparison to their proportion in the U.S.
population.
The act of diagnosis itself has been criticized for being arbitrary with some conditions being overdiagnosed. Individuals may be diagnosed with a mental disorder despite having been
perceived as having no issues with their behavior. In Virginia, U.S.,
it was found up to 33% of white boys are diagnosed with ADHD leading to
alarm in the medical community.
Thomas Szasz
argued that mental health diagnoses were used as a form of labelling
violations of societies norms. Bill Fullford, introduced the idea of
"value-laden" mental health diagnosis with mental health lying between
physical health and a moral judgment. Under this system personality disorders are seen as not very factual and very value-laden while delirium is quite factual and not very value-laden.
In 2013, psychiatrist Allen Frances
said that he believes that "psychiatric diagnosis still relies
exclusively on fallible subjective judgments rather than objective
biological tests".
Mary Boyle
argues that psychiatry is actually the study of behavior, but acts as
if it is the study of the brain based on a presumed connection between
patterns of behavior and the biological function of the brain. She
argues that in the case of schizophrenia it is the bizarre behavior of
individuals that justifies the presumption of a biological cause for
this behavior rather than the existence of any evidence.
She argues that the concept of schizophrenia and its biological
basis serves a social function for psychiatrists. She views the concept
of schizophrenia as necessary for psychiatry to be considered as a
medical field, that the claimed biological link gives psychiatrists
protection from accusations of social control, and that the belief in
the biological basis for schizophrenia is maintained through secondary source's
misrepresentation of underlying data. She argues that schizophrenia and
its biological basis also gives families, psychiatrists and society as a
whole the ability to avoid blame for the damage they cause individuals
and the ineffectiveness of treatment.
Underlying issues associated with schizophrenia would be better addressed as a spectrum of conditions or as individual dimensions along which everyone varies rather than by a
diagnostic category based on an arbitrary cut-off between normal and
ill. This approach appears consistent with research on schizotypy,
and with a relatively high prevalence of psychotic experiences, mostly
non-distressing delusional beliefs, among the general public. In concordance with this observation, psychologist Edgar Jones, and psychiatrists Tony David and Nassir Ghaemi,
surveying the existing literature on delusions, pointed out that the
consistency and completeness of the definition of delusion have been
found wanting by many; delusions are neither necessarily fixed nor
false, and need not involve the presence of incontrovertible evidence.
Nancy Andreasen has criticized the current DSM-IV and ICD-10 criteria for sacrificing diagnostic validity for the sake of artificially improving reliability. She argues that overemphasis on psychosis in the diagnostic criteria,
while improving diagnostic reliability, ignores more fundamental
cognitive impairments that are harder to assess due to large variations
in presentation. This view is supported by other psychiatrists. In the same vein, Ming Tsuang
and colleagues argue that psychotic symptoms may be a common end-state
in a variety of disorders, including schizophrenia, rather than a
reflection of the specific etiology of schizophrenia, and warn that
there is little basis for regarding DSM's operational definition as the
"true" construct of schizophrenia. Neuropsychologist Michael Foster Green went further in suggesting the presence of specific neurocognitive deficits may be used to construct phenotypes
that are alternatives to those that are purely symptom-based. These
deficits take the form of a reduction or impairment in basic
psychological functions such as memory, attention, executive function and problem solving.
The exclusion of affective components from the criteria for
schizophrenia, despite their ubiquity in clinical settings, has also
caused contention. This exclusion in the DSM has resulted in a "rather
convoluted" separate disorder—schizoaffective disorder. Citing poor interrater reliability, some psychiatrists have totally contested the concept of schizoaffective disorder as a separate entity.The categorical distinction between mood disorders and schizophrenia, known as the Kraepelinian dichotomy, has also been challenged by data from genetic epidemiology.
ADHD, its diagnosis, and its treatment have been controversial since the 1970s. The controversies involve clinicians, teachers, policymakers, parents,
and the media. Positions range from the view that ADHD is within the
normal range of behavior to the hypothesis that ADHD is a genetic condition. Other areas of controversy include the use of stimulant medications in children, the method of diagnosis, and the possibility of overdiagnosis. In 2012, the National Institute for Health and Care Excellence,
while acknowledging the controversy, states that the current treatments
and methods of diagnosis are based on the dominant view of the academic
literature. In 2014, Keith Conners, one of the early advocates for recognition of the disorder, spoke out against overdiagnosis in an article in The New York Times. In contrast, a 2014 peer-reviewed medical literature review indicated that ADHD is underdiagnosed in adults.
With widely differing rates of diagnosis across countries, states
within countries, races, and ethnicities, some suspect factors other
than the presence of the symptoms of ADHD are playing a role in
diagnosis. Some sociologists consider ADHD to be an example of the medicalization of deviant behavior, that is, the turning of the previously non-medical issue of school performance into a medical one. Most healthcare providers accept ADHD as a genuine disorder, at least in the small number of people with severe symptoms. Among healthcare providers the debate mainly centers on diagnosis and
treatment in the much larger number of people with less severe symptoms.
As of 2009, 8% of all United States Major League Baseball
players had been diagnosed with ADHD, making the disorder common among
this population. The increase coincided with the League's 2006 ban on stimulants,
which has raised concern that some players are mimicking or falsifying
the symptoms or history of ADHD to get around the ban on the use of
stimulants in sport.
Psychosurgery
is brain surgery with the aim of changing an individual's behavior or
psychological function. Historically, this was achieved through ablative
psychosurgery that removed or deliberately damaged (lesioning) a
section of the brain, but more recently deep brain stimulation is used to remotely stimulate sections of the brain.
One such practice was the lobotomy, that was used between the 1930s and 1950s, for which one its creators, António Egas Moniz, received a Nobel Prize in 1949. The lobotomy fell out of favor in by 1960s and 1970s. Other forms of ablative psychosurgery were in use in the UK in the late 1970s to treat psychotic and mood disorders. Bilateral cingulotomy was used to treat substance abuse disorder in Russia until 2002. Deep brain stimulation is used in China to treat substance abuse disorders.
In the US, the lobotomy, while initially received with positivity
in the late 1930s, came to be seen more negative in the late 1940s and
early 1950s. The New York Times discussed the personality changes of lobotomy in 1947, and in the same year the Science Digest reported on papers questioning the effects of lobotomy on personality and intelligence. The lobotomy was prominently depicted a means to control nonconformity in the 1962 book One Flew Over the Cuckoo's Nest.
Psychosurgery was criticized in the US in the late 1960s and 1970s by psychiatrist Peter Breggin.
He identified all psychosurgery with the lobotomy as a rhetorical
device to criticize the practice of psychosurgery more broadly.
He stated that "psychosurgery is a crime against humanity, a crime that
cannot be condoned on medical, ethical, or legal grounds".
Psycho-surgeons William Beecher Scoville and Petter Lindström said that Breggin's critique was emotional and not based on facts.
Psychosurgery was investigated by the US Senate in the 1973 by
the Health Subcommittee of the Senate's Committee on Labor and Public
Welfare chaired by Senator Edward Kennedy due to growing concern about
the ethical boundaries of science and medicine. At this committee
Breggin argued that newer forms of psychosurgery were the same as the
lobotomy since it had the same effects "emotional blunting, passivity,
reduced capacity to learn" and said that psycho-surgeons "represent the
greatest future threat that we are going to face for our traditional
American values", arguing that if the US became a totalitarian regime
lobotomy and psychosurgery would be the equivalent of the secret police.
The subcommittee published a report in 1977 suggesting that data should
be carefully collected about psychosurgery and that it should not be
performed upon children or prisoners.
Electroconvulsive therapy
Electroconvulsive therapy is a therapy method which was used widely between the 1930s and 1960s and is, in a modified form, still used today. Electroconvulsive therapy was one treatment that the anti-psychiatry
movement wanted to be eliminated from psychiatric practice. Their arguments were that ECT damages the brain, and was used as punishment or as a threat to keep the patients "in line". Since then, ECT has improved considerably, and is now performed under general anesthesia in a medically supervised environment.
The National Institute for Health and Care Excellence
recommends ECT for the short-term treatment of severe,
treatment-resistant depression, and advises against its use in
schizophrenia. According to the Canadian Network for Mood and Anxiety Treatments, ECT
is more efficacious for the treatment of depression than
antidepressants, with a response rate of 90% in first line treatment and
50-60% in treatment-resistant patients.
The most common side effects of ECT include headache, muscle soreness, confusion, and temporary loss of recent memory. Patients may also experience permanent amnesia.
Marketing of antipsychotic drugs
Psychiatry has greatly benefitted by advances in pharmacotherapy. However, the close relationship between those prescribing psychiatric
medication and pharmaceutical companies, and the risk of a conflict of
interest, is also a source of concern. This relationship is often described as being part of the medical-industrial complex. This marketing by the pharmaceutical industry has an influence on practicing psychiatrists, which affects prescription. Child psychiatry is one of the areas in which prescription of
psychotropic medication has grown massively. In the past, prescription
of these medications for children was rare, but nowadays child
psychiatrists prescribe psychotropic substances, such as Ritalin, on a regular basis to children.
Joanna Moncrieff has argued that antipsychotic drug treatment is
often undertaken as a means of control rather than to treat specific
symptoms experienced by the patient. Moncreiff has further argued, in the controversial and non-peer reviewed journal Medical Hypotheses,
that the evidence for antipsychotics from discontinuation-relapse
studies may be flawed, because they do not take into account that
antipsychotics may sensitize the brain and provoke psychosis if
discontinued, which may then be wrongly interpreted as a relapse of the
original condition.
Use of this class of drugs has a history of criticism in
residential care. As the drugs used can make patients calmer and more
compliant, critics claim that the drugs can be overused. Outside doctors
can feel pressure from care home staff. In an official review commissioned by UK government ministers it was
reported that the needless use of antipsychotic medication in dementia
care was widespread and was linked to 1800 deaths per year. In the US, the government has initiated legal action against the pharmaceutical company Johnson & Johnson for allegedly paying kickbacks to Omnicare to promote its antipsychotic risperidone (Risperdal) in nursing homes.
There has also been controversy about the role of pharmaceutical companies in marketing
and promoting antipsychotics, including allegations of downplaying or
covering up adverse effects, expanding the number of conditions or
illegally promoting off-label usage; influencing drug trials (or their
publication) to try to show that the expensive and profitable newer
atypicals were superior to the older cheaper typicals that were out of
patent. Following charges of illegal marketing, settlements by two large
pharmaceutical companies in the US set records for the largest criminal
fines ever imposed on corporations. One case involved Eli Lilly and Company's antipsychotic Zyprexa, and the other involved Bextra. In the Bextra case, the government also charged Pfizer with illegally marketing another antipsychotic, Geodon. In addition, Astrazeneca faces numerous personal-injury lawsuits from former users of Seroquel (quetiapine), amidst federal investigations of its marketing practices. By expanding the conditions for which they were indicated,
Astrazeneca's Seroquel and Eli Lilly's Zyprexa had become the biggest
selling antipsychotics in 2008 with global sales of $5.5 billion and
$5.4 billion respectively.
Harvard medical professor Joseph Biederman
conducted research on bipolar disorder in children that led to an
increase in such diagnoses. A 2008 Senate investigation found that
Biederman also received $1.6 million in speaking and consulting fees
between 2000 and 2007— some of them undisclosed to Harvard— from
companies including the makers of antipsychotic drugs prescribed for
children with bipolar disorder. Johnson & Johnson
gave more than $700,000 to a research center that was headed by
Biederman from 2002 to 2005, where research was conducted, in part, on Risperdal,
the company's antipsychotic drug. Biederman has responded saying that
the money did not influence him and that he did not promote a specific
diagnosis or treatment.
In 2004, University of Minnesota research participant Dan Markingson committed suicide while enrolled in an industry-sponsored pharmaceutical trial comparing three FDA-approved atypical antipsychotics: Seroquel (quetiapine), Zyprexa (olanzapine), and Risperdal (risperidone).
Writing on the circumstances surrounding Markingson's death in the
study, which was designed and funded by Seroquel manufacturer AstraZeneca, University of Minnesota Professor of Bioethics Carl Elliott
noted that Markingson was enrolled in the study against the wishes of
his mother, Mary Weiss, and that he was forced to choose between
enrolling in the study or being involuntarily committed to a state
mental institution. Further investigation revealed financial ties to AstraZeneca by
Markingson's psychiatrist, Dr. Stephen C. Olson, oversights and biases
in AstraZeneca's trial design, and the inadequacy of university Institutional Review Board (IRB) protections for research subjects. A 2005 FDA investigation cleared the university. Nonetheless, controversy around the case has continued. Mother Jones
resulted in a group of university faculty members sending a public
letter to the university Board of Regents urging an external
investigation into Markingson's death.
Pharmaceutical companies have also been accused of attempting to
set the mental health agenda through activities such as funding consumer advocacy groups.
In an effort to reduce the potential for hidden conflicts of
interest between researchers and pharmaceutical companies, the US
Government issued a mandate in 2012 requiring that drug manufacturers
receiving funds under the Medicare and Medicaid programs collect data,
and make public, all gifts to doctors and hospitals.
The term anti-psychiatry was coined by psychiatrist David Cooper in 1967 and is understood in current psychiatry to mean opposition to psychiatry's perceived role aspects of treatment. The anti-psychiatry message is that psychiatric treatments are
"ultimately more damaging than helpful to patients". Psychiatry is seen
to involve an "unequal power relationship between doctor and patient",
and advocates of anti-psychiatry claim a subjective diagnostic process,
leaving much room for opinions and interpretations. Every society, including liberal Western society, permits compulsory treatment of mental patients.[46]
The World Health Organization (WHO) recognizes that "poor quality
services and human rights violations in mental health and social care
facilities are still an everyday occurrence in many places", but has
recently taken steps to improve the situation globally.
Electroconvulsive therapy is a therapy method, which was used widely between the 1930s and 1960s and is, in a modified form, still in use today. Valium and other sedatives
have arguably been over-prescribed, leading to a claimed epidemic of
dependence. These are a few of the arguments that the anti-psychiatry
movement use to highlight the harms of psychiatric practice.
Divergence within psychiatry generated the anti-psychiatry
movement in the 1960s and 1970s, and is still present. Issues remaining
relevant in contemporary psychiatry are questions of; freedom versus
coercion, mind versus brain, nature versus nurture, and the right to be
different.
The psychiatric survivors movement arose out of the civil rights
ferment of the late 1960s and early 1970s and the personal histories of
psychiatric abuse experienced by some ex-patients rather than the
intradisciplinary discourse of antipsychiatry. The key text in the intellectual development of the survivor movement, at least in the US, was Judi Chamberlin's 1978 text, On Our Own: Patient Controlled Alternatives to the Mental Health System. Chamberlin was an ex-patient and co-founder of the Mental Patients' Liberation Front. Coalescing around the ex-patient newsletter Dendron, in late 1988 leaders from several of the main national and grassroots
psychiatric survivor groups felt that an independent, human rights
coalition focused on problems in the mental health system was needed.
That year the Support Coalition International (SCI) was formed. SCI's
first public action was to stage a counter-conference and protest in New York City, in May, 1990, at the same time as (and directly outside of) the American Psychiatric Association's annual meeting. In 2005 the SCI changed its name to Mind Freedom International with David W. Oaks as its director.
The sky is an unobstructed view upward from the surface of the Earth. It includes the atmosphere and outer space. It may also be considered a place between the ground and outer space, thus distinct from outer space.
Usually, the term sky informally refers to a perspective
from the Earth's surface; however, the meaning and usage can vary. An
observer on the surface of the Earth can see a small part of the sky,
which resembles a dome (sometimes called the sky bowl) appearing flatter during the day than at night. In some cases, such as in discussing the weather, the sky refers to only the lower, denser layers of the atmosphere.
The daytime sky appears blue because air molecules scatter shorter wavelengths of sunlight more than longer ones (redder light). The night sky
appears to be a mostly dark surface or region spangled with stars. The
Sun and sometimes the Moon are visible in the daytime sky unless
obscured by clouds. At night, the Moon, planets, and stars are similarly visible in the sky.
Some of the natural phenomena seen in the sky are clouds, rainbows, and aurorae. Lightning and precipitation are also visible in the sky. Certain birds and insects, as well as human inventions like aircraft and kites, can fly in the sky. Due to human activities, smog during the day and light pollution during the night are often seen above large cities.
Etymology
The word sky comes from the Old Norsesky, meaning 'cloud, abode of God'. The Norse term is also the source of the Old Englishscēo, which shares the same Indo-European base as the classical Latinobscūrus, meaning 'obscure'.
In Old English, the term heaven was used to describe the observable expanse above the earth. During the period of Middle English, "heaven" began shifting toward its current, religious meaning.
Sky during day timeEarth's atmosphere scatters a greater proportion of blue light than of red light.
Except for direct sunlight, most of the light in the daytime sky is caused by scattering, which is dominated by a small-particle limit called Rayleigh scattering. The scattering due to molecule-sized particles (as in air) is greater in the directions both toward and away from the source of light than it is in directions perpendicular to the incident path. Scattering is significant for light at all visible wavelengths, but is stronger at the shorter (bluer) end of the visible spectrum, meaning that the scattered light is bluer than its source: the Sun. The remaining direct sunlight, having lost some of its shorter-wavelength components, appears slightly less blue.
Scattering also occurs even more strongly in clouds. Individual water droplets refract white light into a set of colored rings.
If a cloud is thick enough, scattering from multiple water droplets
will wash out the set of colored rings and create a washed-out white
color.
The sky can turn a multitude of colors such as red, orange,
purple, and yellow (especially near sunset or sunrise) when the light
must travel a much longer path (or optical depth) through the atmosphere. Scattering effects also partially polarize
light from the sky and are most pronounced at an angle 90° from the
Sun. Scattered light from the horizon travels through as much as 38
times the air mass as does light from the zenith, causing a blue gradient looking vivid at the zenith and pale near the horizon. Red light is also scattered if there is enough air between the source and the observer, causing parts of the sky to change color as the Sun rises or sets. As the air mass nears infinity, scattered daylight appears whiter and whiter.
Apart from the Sun, distant clouds or snowy mountaintops may
appear yellow. The effect is not very obvious on clear days, but is very
pronounced when clouds cover the line of sight, reducing the blue hue
from scattered sunlight. At higher altitudes, the sky tends toward darker colors since scattering is reduced due to lower air density. An extreme example is the Moon, where no atmospheric scattering occurs, making the lunar sky black even when the Sun is visible.
Sky luminance distribution models have been recommended by the International Commission on Illumination (CIE) for the design of daylighting schemes. Recent developments relate to "all sky models" for modelling sky luminance under weather conditions ranging from clear to overcast.
The crescent Moon remains visible just moments before sunrise.Civil, nautical, and astronomical twilight. Dusk is the end of evening twilight.Dawn is the beginning of morning twilight.
The brightness and color of the sky vary greatly over the course of a
day, and the primary cause of these properties differs as well. When
the Sun is well above the horizon, direct scattering of sunlight (Rayleigh scattering) is the overwhelmingly dominant source of light. However, during twilight, the period between sunset and night or between night and sunrise, the situation is more complex.
Green flashes
and green rays are optical phenomena that occur shortly after sunset or
before sunrise, when a green spot is visible above the Sun, usually for
no more than a second or two, or it may resemble a green ray shooting
up from the sunset point. Green flashes are a group of phenomena that
stem from different causes, most of which occur when there is a temperature inversion
(when the temperature increases with altitude rather than the normal
decrease in temperature with altitude). Green flashes may be observed
from any altitude (even from an aircraft). They are usually seen above
an unobstructed horizon, such as over the ocean, but are also seen above
clouds and mountains. Green flashes may also be observed at the horizon
in association with the Moon and bright planets, including Venus and Jupiter.
Earth's shadow
is the shadow that the planet casts through its atmosphere and into
outer space. This atmospheric phenomenon is visible during civil
twilight (after sunset and before sunrise). When the weather conditions
and the observing site
permit a clear view of the horizon, the shadow's fringe appears as a
dark or dull bluish band just above the horizon, in the low part of the
sky opposite of the (setting or rising) Sun's direction. A related
phenomenon is the Belt of Venus
(or antitwilight arch), a pinkish band that is visible above the bluish
band of Earth's shadow in the same part of the sky. No defined line
divides Earth's shadow and the Belt of Venus; one colored band fades
into the other in the sky.
Twilight is divided into three stages according to the Sun's
depth below the horizon, measured in segments of 6°. After sunset, the civil twilight sets in; it ends when the Sun drops more than 6° below the horizon. This is followed by the nautical twilight, when the Sun is between 6° and 12° below the horizon (depth between −6° and −12°), after which comes the astronomical twilight,
defined as the period between −12° and −18°. When the Sun drops more
than 18° below the horizon, the sky generally attains its minimum
brightness.
Several sources can be identified as the source of the intrinsic brightness of the sky, namely airglow, indirect scattering of sunlight, scattering of starlight, and artificial light pollution.
The Milky Way can be seen as a large band across the night sky, and is distorted into an arch in this 360° panorama.
The term night sky refers to the sky as seen at night. The term is usually associated with skygazing and astronomy, with reference to views of celestial bodies
such as stars, the Moon, and planets that become visible on a clear
night after the Sun has set. Natural light sources in a night sky
include moonlight, starlight, and airglow, depending on location and
timing. The fact that the sky is not completely dark at night can be
easily observed. Were the sky (in the absence of moon and city lights)
absolutely dark, one would not be able to see the silhouette of an
object against the sky.
The night sky and studies of it have a historical place in both
ancient and modern cultures. In the past, for instance, farmers have
used the state of the night sky as a calendar to determine when to plant
crops. The ancient belief in astrology
is generally based on the belief that relationships between heavenly
bodies influence or convey information about events on Earth. The scientific study of the night sky and bodies observed within it, meanwhile, takes place in the science of astronomy.
Within visible-light astronomy, the visibility of celestial objects in the night sky is affected by light pollution. The presence of the Moon
in the night sky has historically hindered astronomical observation by
increasing the amount of ambient lighting. With the advent of artificial
light sources, however, light pollution has been a growing problem for
viewing the night sky. Special filters and modifications to light
fixtures can help to alleviate this problem, but for the best views,
both professional and amateur optical astronomers seek viewing sites
located far from major urban areas.
White cumulus clouds appeared over Dhaka, Bangladesh, when significant flooding was underway in many parts of the country.
Along with pressure tendency, the condition of the sky is one of the
more important parameters used to forecast weather in mountainous areas.
Thickening of cloud cover or the invasion of a higher cloud deck is
indicative of rain in the near future. At night, high thin cirrostratus clouds can lead to halos around the Moon, which indicate the approach of a warm front and its associated rain. Morning fog portends fair conditions and can be associated with a marine layer, an indication of a stable atmosphere. Rainy conditions are preceded by wind or clouds which prevent fog
formation. The approach of a line of thunderstorms could indicate the
approach of a cold front. Cloud-free skies are indicative of fair weather for the near future. The use of sky cover in weather prediction has led to various weather lore over the centuries.
Tropical cyclones
Picture of the sky in the eye of a tropical cyclone
Within 36 hours of the passage of a tropical cyclone's
center, the pressure begins to fall and a veil of white cirrus clouds
approaches from the cyclone's direction. Within 24 hours of the closest
approach to the center, low clouds begin to move in, also known as the bar
of a tropical cyclone, as the barometric pressure begins to fall more
rapidly and the winds begin to increase. Within 18 hours of the center's
approach, squally weather is common, with sudden increases in wind
accompanied by rain showers or thunderstorms. Within six hours of the
center's arrival, rain becomes continuous. Within an hour of the center,
the rain becomes very heavy and the highest winds within the tropical
cyclone are experienced. When the center arrives with a strong tropical
cyclone, weather conditions improve and the sun becomes visible as the eye
moves overhead. Once the system departs, winds reverse and, along with
the rain, suddenly increase. One day after the center's passage, the low
overcast is replaced with a higher overcast, and the rain becomes
intermittent. By 36 hours after the center's passage, the high overcast
breaks and the pressure begins to level off.
Flight is the process by which an object moves through or beyond the
sky (as in the case of spaceflight), whether by generating aerodynamic lift, propulsive thrust, aerostatically using buoyancy, or by ballistic movement, without any direct mechanical support from the ground. The engineering aspects of flight are studied in aerospace engineering which is subdivided into aeronautics, which is the study of vehicles that travel through the air, and astronautics, the study of vehicles that travel through space, and in ballistics, the study of the flight of projectiles. While human beings have been capable of flight via hot air balloons since 1783, other species have used flight for significantly longer. Animals, such as birds, bats, and insects are capable of flight. Spores and seeds from plants use flight, via use of the wind, as a method of propagating their species.
Many mythologies have deities especially associated with the sky. In Egyptian religion, the sky was deified as the goddess Nut and as the god Horus. Dyeus is reconstructed as the god of the sky, or the sky personified, in Proto-Indo-European religion, whence Zeus, the god of the sky and thunder in Greek mythology and the Roman god of sky and thunder Jupiter.
In Australian Aboriginal mythology, Altjira (or Arrernte) is the main sky god and also the creator god. In Iroquois mythology, Atahensic
was a sky goddess who fell down to the ground during the creation of
the Earth. Many cultures have drawn constellations between stars in the
sky, using them in association with legends and mythology about their
deities.
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