Special Issue: The Death of the Clinic? Emerging Biotechnologies and the Reconfiguration of Mental Health

The July 2019 issue of Science, Technology, & Human Values may interest AHP readers. The special issue is dedicated to “The Death of the Clinic? Emerging Biotechnologies and the Reconfiguration of Mental Health.” Full details below.

“The Death of the Clinic? Emerging Biotechnologies and the Reconfiguration of Mental Health,” by Jonas Rüppel, Torsten H. Voigt. Abstract:

This guest editorial opens with a brief overview of the transformations of medicine and mental health that can be observed since the second half of the twentieth century. New genetics and biotechnologies hold out the promise of overcoming presumed limitations in the field of mental health care, that is, the fact that diagnostic procedures in psychiatry and clinical psychology still largely rely on the narratives of patients and questionnaires, supposedly subjective assessments by physicians and psychologists. It is envisioned that innovative genetic and proteomic tools, (neuro)imaging technologies, and objective laboratory tests for blood biomarkers will enable better diagnosis and treatment of mental diseases. We argue that emerging biotechnologies do not revolutionize mental health, despite their promise to do so. Instead, we observe a pluralization of research and treatment approaches in the domain of mental health. The second part of this editorial discusses the contributions to this special issue on emerging biotechnologies and mental health and outlines how they address some of the gaps in social studies of psychiatry and mental health in the twenty-first century.

““Now Is a Time for Optimism”: The Politics of Personalized Medicine in Mental Health Research,” by Jonas Rüppel. Abstract:

Since the completion of the Human Genome Project, personalized medicine has become one of the most influential visions guiding medical research. This paper focuses on the politics of personalized medicine in psychiatry as a medical specialty, which has rarely been investigated by social science scholars. I examine how this vision is being sustained and even increasingly institutionalized within the mental health arena, even though related research has repeatedly failed. Based on a document analysis and expert interviews, this article identifies discursive strategies that help to sustain this vision and its promises: “complexity talk,” “extension,” and “boundary work.” These practices secure its plausibility, protect it from criticism, and maintain stakeholder support.

“Psychiatry and the Sociology of Novelty: Negotiating the US National Institute of Mental Health “Research Domain Criteria” (RDoC),” by Martyn Pickersgill. Abstract:

In the United States, the National Institute of Mental Health (NIMH) is seeking to encourage researchers to move away from diagnostic tools like the Diagnostic and Statistical Manual of Mental Disorders (the DSM). A key mechanism for this is the “Research Domain Criteria” (RDoC) initiative, closely associated with former NIMH Director Thomas Insel. This article examines how key figures in US (and UK) psychiatry construct the purpose, nature, and implications of the ambiguous RDoC project; that is, how its novelty is constituted through discourse. In this paper, I explore and analyze these actors’ accounts of what is new, important, or (un)desirable about RDoC, demonstrating how they are constituted through institutional context and personal affects. In my interviews with mental health opinion leaders, RDoC is presented as overly reliant on neurobiological epistemologies, distant from clinical imaginaries and imperatives, and introduced in a top-down manner inconsistent with the professional norms of scientific research. Ultimately, the article aims to add empirical depth to current understandings about the epistemological and ontological politics of contemporary (US) psychiatry and to contribute to science and technology studies (STS) debates about “the new” in technoscience. Accordingly, I use discussions about RDoC as a case study in the sociology of novelty.

“From the Profound to the Mundane: Questionnaires as Emerging Technologies in Autism Genetics,” by Gregory Hollin. Abstract:

It is widely argued that the final decades of the twentieth century saw a fundamental change, marked by terms such as biomedicalization and geneticization, within the biomedical sciences. What unites these concepts is the assertion that a vast array of emerging technologies—in genomics, bioengineering, information technology, and so forth—are transforming understandings of disease, diagnosis, therapeutics, and working practices. While clearly important, these analyses have been accused of perpetuating theoretical trends that attribute primacy to the new over the old, discontinuity over continuity, and the laboratory over the field. In this paper, I show that in the case of autism, the effects of genomic technologies can only be understood by simultaneously examining the role of questionnaires. Due to shortcomings in clinical diagnoses, genomic analyses could only progress once questionnaires had been developed to address a “reverse salient” within the “technological system.” Furthermore, I argue that questionnaires such as the Autism Quotient have a significance that surpasses the genomic classifications they were designed to undergird. I argue that to neglect the role of mundane technologies such as questionnaires in contemporary biomedicine is to miss complexity, bifurcate old and new, and do a disservice to innovation.

“Neurobiologically Poor? Brain Phenotypes, Inequality, and Biosocial Determinism,” by Victoria Pitts-Taylor. Abstract:

The rise of neuroplasticity has led to new fields of study about the relation between social inequalities and neurobiology, including investigations into the “neuroscience of poverty.” The neural phenotype of poverty proposed in recent neuroscientific research emerges out of classed, gendered, and racialized inequalities that not only affect bodies in material ways but also shape scientific understandings of difference. An intersectional, sociomaterial approach is needed to grasp the implications of neuroscientific research that aims to both produce and repair neurobiological difference. Following Benjamin’s critique of the “carceral imagination” of technoscience, this article considers how such research may fix in terms of helping, or in contrast, fix by classifying and reifying, vulnerable subjects. I address the potential for biosocial determinism in linking neural phenotypes and social problems. I use an intersectional approach to consider the presence and absence of race in this body of research and explore how some methodological and conceptual framings of the “brain on poverty” mark poor and minority children for intervention in concert with neoliberal approaches to poverty.

Psychology’s own mindfulness: Ellen Langer and the social politics of scientific interest in “active noticing”

AHP readers are sure to be interested in a forthcoming piece in the Journal of the History of the Behavioral Sciences from AHP contributor Shayna Fox Lee: “Psychology’s own mindfulness: Ellen Langer and the social politics of scientific interest in “active noticing”. Abstract:

Ellen Langer’s mindfulness construct is presented as “indigenous” to disciplinary psychology. Langer’s early work laid the foundations for the research program she would come to call the psychology of possibility. Studying inattentive behavior (mindlessness) and intentionally reflective cognition (mindfulness) placed her work directly in line with the theoretical priorities of the 1970s and influenced the direction of research in several subdisciplines related to social cognition. Positioning Langer’s work at an intersection crossed by various discourse communities in psychology explains much of its influence within the discipline. However, its relevance is additionally related to a broader field of research and application also employing the terminology of mindfulness. While superficially synonymous, the majority of mindfulness research is distinguished from Langer’s due to differences in origination, definition, and goals. Comparative assessments are used as a lens through which to interrogate the social politics of mindfulness theories’ burgeoning success over the past half century.

The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness

AHP readers will be interested in a forthcoming book exploring David Rosenhan’s “On being sane in insane places.” Susannah Cahalan’s The Great Pretender: The Undercover Mission That Changed Our Understanding of Madness will be released in November 2019. The book is described as follows:

For centuries, doctors have struggled to define mental illness-how do you diagnose it, how do you treat it, how do you even know what it is? In search of an answer, in the 1970s a Stanford psychologist named David Rosenhan and seven other people — sane, normal, well-adjusted members of society — went undercover into asylums around America to test the legitimacy of psychiatry’s labels. Forced to remain inside until they’d “proven” themselves sane, all eight emerged with alarming diagnoses and even more troubling stories of their treatment. Rosenhan’s watershed study broke open the field of psychiatry, closing down institutions and changing mental health diagnosis forever. 

But, as Cahalan’s explosive new research shows, very little in this saga is exactly as it seems. What really happened behind those closed asylum doors, and what does it mean for our understanding of mental illness today?

Queer Ink: A Blotted History Towards Liberation

Forthcoming from Routledge is Katherine Hubbard’s Queer Ink: A Blotted History Towards Liberation. The book is described as follows:

This historical interdisciplinary book contextualises the Rorschach ink blot test and embeds it within feminist action and queer liberation.

What do you see when you look at an ink blot? The Rorschach ink blot test is one of the most famous psychological tests and it has a surprisingly queer history. In mapping this history, this book explores how this test, once used to detect and diagnose ‘homosexuality’, was later used by some psychologists and activists to fight for gay liberation. In this book the author uses the test in yet another way, as a lens through which we can reveal a queer feminist history of Psychology. By looking closely at the lives and work of some women psychologists and activists it becomes clear that their work was influenced by their own, often queer, lives. By tracing the lives and actions of women who used, were tested with, or influenced by, the Rorschach, a new kind of understanding of gay and lesbian history in Britain is revealed.

Pushing at the borders between Psychology, Sociology, and activism, the book utilises the Rorschach to show how influential the social world is on scientific practice. This is fascinating reading for anyone interested in the history of sexuality and Psychology.