The Endurance of Uncertainty: Antisociality and Ontological Anarchy in British Psychiatry, 1950–2010

Stalling or oiling the engines of diagnosis? Shifting perspectives on the DSM and categorical diagnosis in psychiatry

Diagnosis in psychiatry and its precursors has long attracted debate and dissent. Attempts to discipline professional praxis are associated especially with the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM). In this article, I explore how social actors with the institutional power to contribute in important ways to shaping psychiatric contexts construct the problems with and purposes of the DSM and of diagnosis in psychiatry. I suggest that despite common assumptions that influential psychiatrists and related stakeholders uncritically adopt the DSM and other tools of categorical diagnosis, their relationship with these is rather more nuanced, ambivalent, and even fraught. However, I will also show that critiques can themselves be folded into particular styles of psychiatric thought in ways that do little to impact wider concerns about biomedicalisation and pharmaceuticalisation-and might even further accelerate these processes. Moreover, since professional critiques of the DSM often underscore its ubiquity and entrenchment, when positioned against implicit or explicit justifications of the ongoing use of this text they might inadvertently contribute to a 'discourse of inevitability'-acting to 'oil' rather than 'stall' what Annemarie Jutel terms the 'engines of diagnosis'.

Neuroscience Education Begins With Good Science: Communication About Phineas Gage (1823–1860), One of Neurology’s Most-Famous Patients, in Scientific Articles

Phineas Gage is one of the most famous neurological patients. His case is still described in psychology textbooks and in scientific journal articles. A controversy has been going on about the possible consequences of his accident, destroying part of his prefrontal cortex, particularly with respect to behavioral and personality changes. Earlier studies investigated the accuracy of descriptions in psychology textbooks. This is, to my knowledge, the first analysis of journal articles in this respect. These were investigated with regard to four criteria: Description of (1) personality changes, (2) psychopathy-like behavior, (3) alternative explanations besides the immediate brain damage, and (4) Gage’s recovery. 92% of articles described personality changes, 52% of a psychopathy-like kind; only 4% mentioned alternative explanations and 16% described Gage’s recovery. The results are discussed in the light of the available historical evidence. The article closes with several suggestions on improving science communication about the famous case.

Kinds of Replication: Examining the Meanings of "Conceptual Replication" and "Direct Replication"

Although psychology’s recent crisis has been attributed to various scientific practices, it has come to be called a “replication crisis,” prompting extensive appraisals of this putatively crucial scientific practice. These have yielded disagreements over what kind of replication is to be preferred and what phenomena are being explored, yet the proposals are all grounded in a conventional philosophy of science. This article proposes another avenue that invites moving beyond a discovery metaphor of science to rethink research as enabling realities and to consider how empirical findings enact or perform a reality. An enactment perspective appreciates multiple, dynamic realities and science as producing different entities, enactments that ever encounter differences, uncertainties, and precariousness. The axioms of an enactment perspective are described and employed to more fully understand the two kinds of replication that predominate in the crisis disputes. Although the enactment perspective described here is a relatively recent development in philosophy of science and science studies, some of its core axioms are not new to psychology, and the article concludes by revisiting psychologists’ previous calls to apprehend the dynamism of psychological reality to appreciate how scientific practices actively and unavoidably participate in performativity of reality.

Self-correction in science: The diagnostic and integrative motives for replication

A series of failed replications and frauds have raised questions regarding self-correction in science. Metascientific activists have advocated policies that incentivize replications and make them more diagnostically potent. We argue that current debates, as well as research in science and technology studies, have paid little heed to a key dimension of replication practice. Although it sometimes serves a diagnostic function, replication is commonly motivated by a practical desire to extend research interests. The resulting replication, which we label 'integrative', is characterized by a pragmatic flexibility toward protocols. The goal is to appropriate what is useful, not test for truth. Within many experimental cultures, however, integrative replications can produce replications of ambiguous diagnostic power. Based on interviews with 60 members of the Board of Reviewing Editors for the journal Science, we show how the interplay between the diagnostic and integrative motives for replication differs between fields and produces different cultures of replication. We offer six theses that aim to put science and technology studies and science activism into dialog to show why effective reforms will need to confront issues of disciplinary difference.

Access, accountability, and the proliferation of psychological therapy: On the introduction of the IAPT initiative and the transformation of mental healthcare

Psychological therapy today plays a key role in UK public mental health. In large part, this has been through the development of the (specifically English) Improving Access to Psychological Therapies (IAPT) programme. Through IAPT, millions of citizens have encountered interventions such as cognitive behaviour therapy, largely for the treatment of depression and anxiety. This article interrogates how this national response to problems of mental ill-health - and the problematization itself - was developed, accounted for, and sustained. By imbricating economic expertise with accounts of mental ill-health and mechanisms of treatment, IAPT has revivified psychological framings of pathology and therapy. However, it has done so in ways that are more familiar within biomedical contexts (e.g. through recourse to randomized controlled trial studies). Today, the initiative is a principal player in relation to which other services are increasingly developed. Indeed, in many respects IAPT has transformed from content to context within UK public mental health (in a process of what I term 'contextification'). By documenting these developments, this paper contributes to re-centring questions about the place and role of psychology in contemporary healthcare. Doing so helps to complicate assumptions about the dominance of linear forms of (de)biomedicalization in health-systems.

Failing, hacking, passing: Autism, entanglement, and the ethics of transformation

One of the most notable recent changes in autism science is the belief that autism is a heterogeneous condition with no singular essence. I argue that this notion of 'autistic heterogeneity' can be conceived as an 'agential cut' and traced to uncertainty work conducted by cognitive psychologists during the early 1990s. Researchers at this time overcame uncertainty in scientific theory by locating it within autism itself: epistemological uncertainty was interwoven with ontological indeterminacy and autism became heterogeneous and chance like, a condition determined by indeterminacy. This paper considers not only the conceptual significance of this move but also the impact upon forms of subjectivity. This analysis is undertaken by integrating the agential realism of Karen Barad with the historical ontology of Michel Foucault. I argue that these two approaches are, firstly, concerned with ontologies of emergence and, secondly, foreground the inherently ethical nature of change. As such these theories can be used to articulate an 'ethics of transformation'. I argue that the agential cut which brought about autistic heterogeneity is potentially problematic within an ethics of transformation, limiting the possibility of future change in subjectivity by imagining difference and resistance as properties of autism rather than the individual.

Provisionally pregnant: uncertainty and interpretive work in accounts of home pregnancy testing

Upon their availability for purchase in the 1970s, home pregnancy testing devices were hailed as a ‘revolution’ for women’s reproductive rights. Some authors, however, have described these technologies as further enabling the medicalisation of pregnancy and as contributing to the devaluing of women’s embodied knowledge. The home pregnancy test is one of many technological devices encountered by women experiencing pregnancy in the United Kingdom today. Existing literature has described how engagement with medical technologies during pregnancy might address uncertainties experienced at this time, providing women with reassurance and alleviating anxieties. Drawing on interviews with women living in Scotland, this article explores accounts of testing for a first pregnancy, and women’s descriptions of the impacts of home pregnancy testing upon experiences of early gestation. Participants engaged with pregnancy tests in varying ways, with uses shaping and shaped by their experiences of early pregnancy more broadly. Particular technical characteristics of the home pregnancy test led many participants to question their interpretation of a positive result, as well as the accuracy of the test itself. Rather than addressing the unknowns of early gestation by confirming a suspected pregnancy, a positive result could thus exacerbate uncertainty. Through participants’ accounts, this article shows how uncertainty is lived out by users of mundane techno-medical artefacts and sheds new light on women’s experiences of the first trimester of pregnancy.

Autistic Heterogeneity: Linking Uncertainties and Indeterminacies

Autism is a highly uncertain entity and little is said about it with any degree of certainty. Scientists must, and do, work through these uncertainties in the course of their work. Scientists explain uncertainty in autism research through discussion of epistemological uncertainties which suggest that diverse methods and techniques make results hard to reconcile, ontological uncertainties which suggest doubt over taxonomic coherence, but also through reference to autism's indeterminacy which suggests that the condition is inherently heterogeneous. Indeed, indeterminacy takes two forms-an inter-personal form which suggests that there are fundamental differences between individuals with autism and an intra-personal form which suggests that no one factor is able to explain all features of autism within a given individual. What is apparent in the case of autism is that scientists put uncertainty and indeterminacy into discussion with one another and, rather than a well-policed epistemic-ontic boundary, there is a movement between, and an entwinement of, the two. Understanding scientists' dialogue concerning uncertainty and indeterminacy is of importance for understanding autism and autistic heterogeneity but also for understanding uncertainty and 'uncertainty work' within science more generally.

Epistemic modesty, ostentatiousness and the uncertainties of epigenetics: on the knowledge machinery of (social) science

Epigenetic processes are garnering attention in the social sciences, where some scholars assert their importance for theorizing social life. I engage with such ideas here by drawing on interviews with leading bioscientists. To begin with, I underscore the (productive) uncertainties of those working in and around epigenetics; I describe these as a manifestation of ‘epistemic modesty’, and suggest that dissensus helps to propel biomedical innovation. Then, drawing on the concept of ‘alien science’, I detail some researchers’ ambivalences regarding the notion of ‘transgenerational inheritance’; their dissatisfaction with the (public) communication practices of other scientists (situated in what I term a regime of ‘epistemic ostentatiousness’); and the challenges faced when moderating societal discussion of epigenetics in ways that expand excitement whilst deflating (what researchers regard as) unrealistic expectations. The paper concludes with reflections on the knowledge machinery of the (social) sciences, and employs the study data to interrogate sociological engagements with epigenetics.