I shadow two free clinics in London, using documentary film and cinema and Kashmir to frame the challenge of treating populations who are trapped in or displaced by perpetual war. The two initiatives include an intercultural therapy center and a gardening project, both in London, and each of these interventions is studied for method, techniques, and outcomes.

Introduction to the research claims and objectives of the work as a whole, paying attention to the fraught relationship between psychoanalysis, race, and poverty. A historical outline of the Freudian free clinic movement is used to examine the viability of an adapted psychoanalysis, with its components of free or low-fee therapy, community outreach, lay counselors, etc.

This chapter begins with vigilante activists who have strained to introduce therapeutic dimensions to traditional psychiatric treatment. The case studies include torture victims at Bellevue Hospital, who have sought asylum in the US after enduring political atrocities in their homeland; homeless persons being sheltered and made capable of securing independent housing; and children in a therapeutic nursery whose abuse at the hands of their carers points to the depredations of slavery and racism.

This chapter looks at free clinics in three Indian cities, namely Benguluru, Chennai, and Kolkata, looking at the training and deployment of “barefoot researchers” drawn from the community and sent back to the community. I examine the case studies in detail to weigh the benefits and disadvantages of these free clinic initiatives.

A summation of the themes of the entire book, description of a psychoanalysis of the poor, and a counteracting of “Unseen City” with what Du Bois called “Second Sight.”

Cognitive impairment or dementia is increasing in prevalence worldwide and may be an unrecognised and early complication of a number of endocrine conditions, including diabetes mellitus and thyroid disease. In addition, these conditions may be predisposing factors towards developing dementia. In this chapter, we will discuss these issues with reference to diabetes in particular, being the endocrine disorder with the strongest association with cognitive impairment. Identifying cognitive impairments among people with endocrine disorders is important, as is identifying endocrine conditions in people living with dementia, as this may require adjustment of therapeutic targets and of treatment. There are particular challenges in certain clinical groups, including depressive pseudodementia, behavioural and psychological symptoms of dementia, frailty and mild cognitive impairment. Targets for glycaemic control may need to be relaxed in this group of patients, and this is supported by international best practice guidelines.

Depression is a common mental illness that is receiving increasing clinical, academic and even political attention. The World Health Organization (WHO) stated in its report of 2004 that depression is one of the most significant health challenges of the twenty-first century in terms of its effect on disability and loss of function, and it ranked depression as the third leading cause of burden of disease worldwide, as measured by disease-adjusted life-years. It is the leading cause of disease burden in the Americas, and is projected to be the leading cause of disease burden worldwide by 2030. In addition to being an important condition in its own right, it is increasingly being recognised as a condition that, when comorbid with physical illness, has a significant effect on recovery and even mortality. Comorbid mental disorders with endocrine conditions may present challenges both for the patient and for their healthcare providers. The evidence for effective joint interventions is at an early stage, and individuals with psychiatric disorders often experience inequalities in accessing routine physical healthcare.

The assessment and treatment of paraphilias and sex offenders are highly complex. The limited evidence base for treatment extends to both psychological and talking therapy interventions, as well as biological and medication-based interventions. Biological interventions and medical management of sexual offending are particularly challenging areas. Evidence is at the emerging stage only in this area, and Cochrane reviews have advised that further research is required. Nonetheless, given the serious outcomes of potential risks to the patient, such as prolonged stays in secure settings, and to the public in the event of recidivism, medication can be considered in the highest-risk groups. Such treatment regimens require careful assessment, consideration and ongoing management. Consent and motivation for treatment in the individual patient are key to the success or failure of an intervention with such anti-libidinal medications, as the patient will need to voluntarily comply with this treatment in the community in the medium or long term. Patients who find their intrusive sexual thoughts ego-dystonic are probably the most suitable candidates for consideration for such treatment. It is therefore appropriate that such treatments are offered to the highest-risk offenders only.

Eating disorders, while relatively rare, have the highest mortality rates of all mental disorders. When combined with diabetes, they have poor outcomes in terms of recurrent diabetic ketoacidosis, premature development of microvascular complications and mortality. Eating disorders are common in diabetes and, where present, are associated with a much higher incidence of diabetic complications and a sevenfold increase in mortality. The term ‘diabulimia’ is increasingly used by patient groups and in the general (and social) media. However, it is not a diagnostic term; there has been no professional agreement regarding what constitutes ‘diabulimia’ or what may constitute a minimum set of criteria for diagnosis. It is important for endocrinologists to have a high index of suspicion for eating disorders in patients with diabetes (especially young women with type 1 diabetes). Psychiatrists need to consider and treat insulin omission as a form of purging in eating disorders.

Over 650 million people live with obesity worldwide, and almost all countries are affected by what is considered a global obesity pandemic. It is one of the factors that contribute to excess premature mortality in patients with severe mental illness, who die 15–20 years younger than the general population. Both obesity and mental health disorders are highly prevalent and frequently occur in the same individual. While weight loss is typically associated with improvements in psychological functioning, a certain proportion of patients will develop new psychological issues or experience a relapse of pre-existing conditions. Further work is needed to clarify the underlying biological mechanisms explaining the relationship between obesity and mental health. In the interim, people with obesity should receive care in a multidisciplinary setting with access to mental healthcare integrated with their obesity care.

Modern developments in research and in the development of services have demonstrated the need for the better integration of mental and physical healthcare in various areas of medicine, including endocrinology. Years of research into the aetiology of depression and other mental disorders have demonstrated the importance of the stress response and the hypothalamic–pituitary axis in the aetiology of many common mental disorders. Where collaborative care or integrated care systems or interventions have been implemented, they have shown improved outcomes across the domains. There is a need for more naturalistic research in the management of complex comorbidities.