The importance of art and humanities in mental health is widely recognised, and consumption and creation of poetry, prose, drama and the plastic arts are now considered to be relevant knowledge-generating and therapeutic activities. However, literary and art criticism remain at the margins. By contrast, in his two ‘Logics of Discovery’ papers, psychiatrist, psychopathologist and psychotherapist Giovanni Stanghellini brings to bear on clinical discovery and the healing alliance cultural historian Aby Warburg's approach to images (specifically, his Atlas of Mnemosyne) and philosopher Giorgio Agamben's analysis of the linguistic phenomenon of parataxis in Friedrich Hölderlin's poetry. Both Warburg and Hölderlin experienced severe mental disorders, and Stanghellini's analysis is notable for its potential to contribute to co-creation in a wide range of clinical settings. We suggest that this work may help to address some key sources of dissatisfaction among mental health patients and thus improve patient experience and clinical outcomes. We also comment on issues regarding implementation of Stanghellini's proposals and conclude with discussion of an example of the severe loosening of associations originally reported by Eugen Bleuler.

The Mental Health Gap Action Programme (mhGAP) was launched by the World Health Organization (WHO) in 2008 to scale up services for mental, neurological and substance use disorders for low- and lower-middle-income countries. Subsequently, an updated mhGAP intervention Guide (mhGAP-IG 2.0) was released in 2016. This study explores the use and effectiveness of mhGAP-IG 2.0 by mental health volunteers of two South Asian charities in the UK. Semi-structured interviews were carried out with eight volunteers. The core themes identified were mental health awareness, mental health education, empathy and care, social perception and bias within the South Asian community, and personal development. The study identified mhGAP as a tool with transformative potential. Although the WHO originally planned the mgGAP-IG as a tool for low- and middle-income countries with limited mental health resources, this study demonstrates its usefulness even in high-income countries, as a foundation to educate volunteers working in mental health.

Promethazine, a sedating antihistamine, is widely and increasingly prescribed for patients reporting problems sleeping. In this Against the Stream article, the case is made that promethazine is not suitable as a sleep aid for people using mental health services, because it has no good evidence base, impedes with psychological and behavioural techniques that do improve sleep in the medium-long term, has underappreciated addictive and recreational-use potential, and an unacceptable side-effect profile. Alternatives to promethazine are described, notably the NICE first-line recommendation, cognitive–behavioural therapy for insomnia.

There is evidence that social contagion plays a role in shaping the clinical presentation of some psychiatric symptoms, particularly affecting features that vary over time and culture. Some symptoms can increase so rapidly in prevalence that they become ‘epidemic’. The mechanism involves a spread through peers and/or the media. Within broader domains of psychopathology, this process draws from a ‘symptom pool’ that can determine which specific symptoms will appear. This article illustrates these mechanisms by focusing on non-suicidal self-injury (NSSI), a syndrome that has been subject to social contagion and whose prevalence may have increased among adolescents.

Past experiences of mental healthcare which have been perceived as harmful can present significant barriers to accessing treatment again. This article draws upon research and lived experience to consider the ways in which conceptualisations of ‘trauma-informed care’ may better incorporate the role of iatrogenic harm, thus providing more acceptable and equitable treatment for those who have previously found treatment to be harmful. A more restorative approach is offered, founded in shared responsibility and compassionate relationships, to help minimise harms and create a more healing system for patients and clinicians alike.

The royal charter of the Royal College of Psychiatrists is generally taken to enhance its status. However, the concept of a hereditary monarchy is intellectually indefensible and the realities of the British monarchy exacerbate inequalities in the UK. The connection is particularly problematic for psychiatrists because of their role in the compulsory detention and treatment of patients. The Royal affiliation can only serve to emphasise the power inequalities in society associated with these activities. College members should feel free to discuss whether this situation should continue or whether we should be British rather than Royal.

Cultural sensitivity, competence and curiosity are essential for clinicians. To promote these, we developed an elective module in cultural psychiatry for medical students, consisting of eight seminars. In seminar eight, we used film clips to teach mental state examination. We comment on the development and delivery of the module, and offer a selection of student feedback. Cultural psychiatry could be better integrated into core medical school curricula, and we call for research to explore this.

Soper's ‘pain and brain’ evolutionary theory of suicide has significant explanatory power and deserves wider consideration and scrutiny in the mainstream psychiatric literature. It provides a novel framework for thinking about the problem of suicide and could have an important impact on research as well as clinical practice. However, we raise questions and concerns regarding the prediction the theory makes regarding common mental disorders being anti-suicide adaptations.

We challenge a prevalent belief that depression causes suicide and propose that certain symptoms of depression and other psychopathologies may function to prevent lethal self-injury. Theoretical and empirical evidence supports this position. As suicide posed an extreme fitness hazard throughout human evolution, our species evolved special-purpose psychological defences that continuously monitor and manage this danger. Last-ditch protections may present as diverse psychiatric phenomena. Mobilising in adolescence and adulthood in response to chronic distress, these usually stop suicidal thoughts from escalating into deadly actions. The theory is testable. We point to important implications for the clinical management of suicide and psychopathology.