The World Health Organization estimates that neurological disorders currently affect one billion people worldwide, a number which is predicted to increase considerably as a result of an ageing population. The need to further understand the brain and make progress in the field of neurology has therefore never been greater. However, with over 100 million neurons each making over 1000 synapses, the human brain is undoubtedly the most complex organ in the human body, and it is this complexity that has meant that advances in neuroscience have been comparatively slow.
In 1979, Nobel laureate Francis Crick published a paper discussing progress in neuroscience. Describing the subject as “profoundly mysterious”, he speculated on new methods of investigating the brain, including the ability to inactivate one type of neuron whilst leaving the others “more or less unaltered” . Crick is not alone; for years the mammalian brain has dumbfounded researchers [1,2]. In the human, a hundred billion neuronal parts and myriad connections lead to an interconnected system of a level of unparalleled complexity .
A 14 year old girl was seen in clinic after an injury whilst playing rugby. Although her description was vague, she intimated that a valgus stress had been put on her left leg and described being tackled in rugby practice. She fell on her left knee and heard an audible cracking or ‘pop’ sound, experiencing immediate pain and swelling of the joint. She had no significant past medical history and was taking no regular medication.
Phèdre is a tragedy which explores the relationship between moral culpability and responsibility for one’s actions by examining the incestuous love of a queen for her step-son, a passion that is apparently imputed to her by a vengeful deity. What is fascinating for the purposes of our discussion is the dynamic interplay between the portrayals of Phèdre’s infatuation both as an illness and simultaneously as a crime, for this is essentially the same question we must consider in deciding to what extent a malady excuses behaviour that contravenes society’s judicial expectations. While this was doubtless an intriguing consideration for a seventeenth century French dramatist, it is all the more pertinent for us today given the extent of medicalisation that has occurred in recent decades across many spheres of society. In terms of psychiatry, this may be illustrated merely with reference to the DSM, which between its first edition in 1952 and the fourth revision fifty-two years later has more than tripled the number of conditions it identifies, taking the total from 112 to more than 370 today . This inexorable rise has led certain commentators to question the extent to which this phenomenon is justified, particularly where it impinges on the realm of moral accountability. This is exemplified in an article by the sociologist Frank Furedi entitled The seven deadly personality disorders, in which he describes how all of those vices that the Catholic Church once taught to be mortal sins are now considered by Western culture to be addictive illnesses, with the sole exception of pride, which is thought to be a virtue, the helpful antidote to low self-esteem . This issue is one of eminent importance to the forensic psychiatrist, who may be obliged to stand as an expert witness and give evidence on a defendant’s mental state, potentially obviating the accusation that they had the mens rea for a crime. This is particularly the case in homicide, where mental illness can reduce a verdict from murder to manslaughter, but it is of more general significance in the verdict of ‘not guilty by reason of insanity’. Thus, this essay shall concern itself with a consideration of the current theories on which medico-legal practice seems to be predicated, before examining a possible alternative to this model and the congruence of this with a broader philosophical perspective, concluding with some speculation as to the implications of this concept for clinical practice and for society.
Mental health in pregnancy remains a significant issue, with 7-13%  of women experiencing depressive symptoms during pregnancy. ‘Confidential Enquiries into Maternal Deaths in the United Kingdom’  have highlighted suicide in pregnancy and during the first postnatal year as a leading cause of maternal death. SSRIs are known to cross the placental barrier, however the safety of these drugs in pregnancy is not well understood .