How and why to use 'vulnerability': an interdisciplinary analysis of disease risk, indeterminacy and normality.

In recent years, 'vulnerability' has been getting more traction in theoretical, professional and popular spaces as an alternative or complement to the concept of risk. As a group of science and technology studies scholars with different disciplinary orientations yet a shared concern with biomedicine, self and society, we investigate how vulnerability has become a salient and even dominant idiom for discussing disease and disease risk. We argue that this is at least partly due to an inherent indeterminacy in what 'vulnerability' means and does, both within and across different discourses. Through a review of feminist and disability theory, and a discussion of how vulnerability and disease both get recruited into a binary conceptualisation of normal versus abnormal, we argue that vulnerability's indeterminacy is, in fact, its strength, and that it should be used differently than risk. Using COVID-19 management in the UK as an illustration of the current ambivalence and ambiguity in how vulnerability versus risk is applied, we suggest that instead of being codified or quantified, as it has started to be in some biomedical and public health applications, vulnerability and its remedies should be determined in conjunction with affected communities and in ways that are polyvalent, flexible and nuanced. The concept of vulnerability encapsulates an important precept: we must recognise inequality as undesirable while not attempting to 'solve' it in deterministic ways. Rather than becoming fixed into labels, unidirectional causalities or top-down universalising metrics, vulnerability could be used to insist on relational, context-specific understandings of disease and disease risk-in line with contemporary social justice movements that require non-hierarchical and non-universal approaches to problems and solutions.

Troubling Neurobiological Vulnerability: Psychiatric Risk and the Adverse Milieu in Environmental Epigenetics Research.

In post-genomic science, the development of etiological models of neurobiological vulnerability to psychiatric risk has expanded exponentially in recent decades, particularly since the neuromolecular and biosocial turns in basic research. Among this research is that of McGill Group for Suicide Studies (MGSS) whose work centers on the identification of major risk factors and epigenetic traits that help to identify a specific profile of vulnerability to psychiatric conditions (e.g., depression) and predict high-risk behaviors (e.g., suicidality). Although the MGSS has attracted attention for its environmental epigenetic models of suicide risk over the years and the translation of findings from rodent studies into human populations, its overall agenda includes multiple research axes, ranging from retrospective studies to clinical and epidemiological research. Common to these research axes is a concern with the long-term effects of adverse experiences on maladaptive trajectories and negative mental health outcomes. As these findings converge with post-genomic understandings of health and also translate into new orientations in global public health, our article queries the ways in which neurobiological vulnerability is traced, measured, and profiled in environmental epigenetics and in the MGSS research. Inspired by the philosophy of Georges Canguilhem and by literature from the social studies of risk and critical public health, we explore how the epigenetic models of neurobiological vulnerability tie into a particular way of thinking about the normal, the pathological, and the milieu in terms of risk. Through this exploration, we examine how early life adversity (ELA) and neurobiological vulnerability are localized and materialized in those emerging models while also considering their broader conceptual and translational implications in the contexts of mental health and global public health interventions. In particular, we consider how narratives of maladaptive trajectories and vulnerable selves who are at risk of harm might stand in as a "new pathological" with healthy trajectories and resilient selves being potentially equated with a "new normal" way of living in the face of adversity. By troubling neurobiological vulnerability as a universal biosocial condition, we suggest that an ecosocial perspective may help us to think differently about the dynamics of mental health and distress in the adverse milieu.

Towards a feminist philosophy of engagements in health-related research.

Engagement with publics, patients, and stakeholders is an important part of the health research environment today,and different modalities of 'engaged' health research have proliferated in recent years. Yet, th ere is no consensus on what, exactly, 'engaging' means, what it should look like, and what the aims, justifications, or motivations for it should be. In this paper, we set out what we see as important, outstanding challenges around the practice and theory of engaging and consider the tensions and possibilities that the diverse landscape of engaging evokes. We examine the roots, present modalities and institutional frameworks that have been erected around engaging, including how they shape and delimit how engagements are framed, enacted, and justified. We inspect the related issue of knowledge production within and through engagements, addressing whether engagements can, or should, be framed as knowledge producing activities. We then unpack the question of how engagements are or could be valued and evaluated, emphasising the plural ways in which 'value' can be conceptualised and generated. We conclude by calling for a philosophy of engagements that can capture the diversity of related practices, concepts and justifications around engagements, and account for the plurality of knowledges and value that engagements engender, while remaining flexible and attentive to the structural conditions under which engagements occur. Such philosophy should be a feminist one, informed by feminist epistemological and methodological approaches to equitable modes of research participation, knowledge production, and valuing. Especially, translating feminist tools of reflexivity and positionalityinto the sphere of engagements can enable a synergy of empirical, epistemic and normative considerations in developing accounts of engaging in both theory and praxis. Modestly, here, we hope to carve out the starting points for this work.

[Situating atention deficit and hyperactivity in Portugal: social, historical, and ethical dimensions of an emerging global health issue]. / Situar a hiperatividade e déficit de atenção em Portugal: dimensões sociais, históricas e éticas de um tema emergente na saúde global.

Attention deficit and hyperactivity disorder (ADHD) is considered one of the most frequent behavioral and neurodevelopmental problems in school-age children and adolescents, both in Portugal and worldwide. The diagnostic categorization of ADHD and the prescription of psychostimulants as its first-line treatment have been the object not only of scientific research and clinical validation, but also of controversy and social critique, especially in light of the concept of medicalization. Despite its high profile and salience in such diverse fields as education, pharmaceuticals, mental health, and public policy, a significant gap remains in the characterization of social-historical, ethical, and institutional dimensions of ADHD outside English-speaking countries. Combining historical and ethnographic research with document and media analysis, the article addresses that challenge by tracing the social trajectory of ADHD in Portugal, from the emergence of "hyperactivity" in the 1970s and 1980s to the current public and political debates on psychostimulant treatments and prescribing trends. From this interdisciplinary perspective and based on the Portuguese case study, the aim of this article is to contextualize the definition, validation, and expansion of ADHD as part of a dynamic and socially situated process in which global diagnostic and pharmaceutical systems intersect with institutional and socioeconomic contingencies, as well as local specificities and needs. More broadly, the article discusses how the case study of ADHD contributes to the development of interdisciplinary research that helps rethinking the social scope of mental health across local and global health contexts.

A perturbação de hiperatividade e déficit de atenção (PHDA) é considerada um dos problemas de comportamento e neurodesenvolvimento mais frequentes nas crianças e adolescentes em idade escolar, tanto em Portugal como a nível mundial. Além disso, a categorização diagnóstica da PHDA e a prescrição de psicoestimulantes como tratamento de primeira linha têm sido não só objeto de pesquisa científica e validação clínica, mas também alvo de polêmica e crítica social, sobretudo à luz do conceito de medicalização. Apesar do seu aspecto midiático e relevância em domínios tão diversos quanto os da educação, do medicamento, da saúde mental e dos apoios psicossociais, existe uma lacuna profunda na caracterização das dimensões históricas, socioéticas e institucionais da PHDA em Portugal. Aliando dados historiográficos e etnográficos à análise documental e da mídia, este artigo procura responder a esse desafio, traçando a trajetória social da PHDA neste país - desde a emergência da "hiperatividade" nos anos 1970/1980 ao debate público e político sobre a prescrição de psicoestimulantes. Dessa perspectiva interdisciplinar e por meio do estudo do caso português, procura contextualizar-se a definição, validação e ampliação da PHDA como parte de um processo dinâmico e socialmente situado na interseção de sistemas diagnósticos e farmacêuticos globais, contingências institucionais e socioeconômicas e, ainda, políticas públicas e especificidades locais. Discute-se, por fim, a forma como o caso da PHDA em Portugal contribui para o desenvolvimento de novas linhas de reflexão e de pesquisa interdisciplinar que permitem repensar o escopo social da saúde mental e da saúde global.

El trastorno de hiperactividad y déficit de atención (THDA) está considerado uno de los problemas de comportamiento y neurodesarrollo más frecuentes en niños y adolescentes en edad escolar, tanto en Portugal, como a nivel mundial. Asimismo, la categorización diagnóstica del THDA y la prescripción de psicoestimulantes como tratamiento de primera línea ha sido no sólo objeto de investigación científica y validación clínica, sino también objeto de polémica y crítica social, sobre todo a la luz del concepto de medicalización. A pesar de su cariz mediático y relevancia en dominios tan diversos como son los de la educación, del medicamento, de la salud mental y de los apoyos psicosociales, existe una laguna profunda en la caracterización de las dimensiones históricas, socio-éticas e institucionales del THDA en Portugal. Aunando datos historiográficos y etnográficos y al análisis documental, y de los medios de comunicación, este artículo procura responder a este desafío, trazando la trayectoria social del THDA en este país - desde la emergencia de la "hiperactividad" en los años 1970/1980 al debate público y político sobre la prescripción de psicoestimulantes. Desde esta perspectiva interdisciplinar, y a través del estudio del caso portugués, se intenta contextualizar la definición, validación y ampliación del THDA como parte de un proceso dinámico y socialmente situado, que atraviesa sistemas diagnósticos y farmacéuticos globales, contingencias institucionales y socioeconómicas e, incluso, políticas públicas y especificidades locales. Se discute, finalmente, la forma en la que el caso del THDA en Portugal contribuye al desarrollo de nuevas líneas de reflexión y de investigación interdisciplinaria que permiten repensar el campo social de la salud mental y de la salud global.

Situar a hiperatividade e déficit de atenção em Portugal: dimensões sociais, históricas e éticas de um tema emergente na saúde global / Situating attention deficit and hyperactivity in Portugal: social, historical, and ethical dimensions of an emerging global health issue / Situar la hiperactividad y déficit de atención en Portugal: dimensiones sociales, históricas y éticas de un tema emergente en la salud global

A perturbação de hiperatividade e déficit de atenção (PHDA) é considerada um dos problemas de comportamento e neurodesenvolvimento mais frequentes nas crianças e adolescentes em idade escolar, tanto em Portugal como a nível mundial. Além disso, a categorização diagnóstica da PHDA e a prescrição de psicoestimulantes como tratamento de primeira linha têm sido não só objeto de pesquisa científica e validação clínica, mas também alvo de polêmica e crítica social, sobretudo à luz do conceito de medicalização. Apesar do seu aspecto midiático e relevância em domínios tão diversos quanto os da educação, do medicamento, da saúde mental e dos apoios psicossociais, existe uma lacuna profunda na caracterização das dimensões históricas, socioéticas e institucionais da PHDA em Portugal. Aliando dados historiográficos e etnográficos à análise documental e da mídia, este artigo procura responder a esse desafio, traçando a trajetória social da PHDA neste país - desde a emergência da "hiperatividade" nos anos 1970/1980 ao debate público e político sobre a prescrição de psicoestimulantes. Dessa perspectiva interdisciplinar e por meio do estudo do caso português, procura contextualizar-se a definição, validação e ampliação da PHDA como parte de um processo dinâmico e socialmente situado na interseção de sistemas diagnósticos e farmacêuticos globais, contingências institucionais e socioeconômicas e, ainda, políticas públicas e especificidades locais. Discute-se, por fim, a forma como o caso da PHDA em Portugal contribui para o desenvolvimento de novas linhas de reflexão e de pesquisa interdisciplinar que permitem repensar o escopo social da saúde mental e da saúde global.

Attention deficit and hyperactivity disorder (ADHD) is considered one of the most frequent behavioral and neurodevelopmental problems in school-age children and adolescents, both in Portugal and worldwide. The diagnostic categorization of ADHD and the prescription of psychostimulants as its first-line treatment have been the object not only of scientific research and clinical validation, but also of controversy and social critique, especially in light of the concept of medicalization. Despite its high profile and salience in such diverse fields as education, pharmaceuticals, mental health, and public policy, a significant gap remains in the characterization of social-historical, ethical, and institutional dimensions of ADHD outside English-speaking countries. Combining historical and ethnographic research with document and media analysis, the article addresses that challenge by tracing the social trajectory of ADHD in Portugal, from the emergence of "hyperactivity" in the 1970s and 1980s to the current public and political debates on psychostimulant treatments and prescribing trends. From this interdisciplinary perspective and based on the Portuguese case study, the aim of this article is to contextualize the definition, validation, and expansion of ADHD as part of a dynamic and socially situated process in which global diagnostic and pharmaceutical systems intersect with institutional and socioeconomic contingencies, as well as local specificities and needs. More broadly, the article discusses how the case study of ADHD contributes to the development of interdisciplinary research that helps rethinking the social scope of mental health across local and global health contexts.

El trastorno de hiperactividad y déficit de atención (THDA) está considerado uno de los problemas de comportamiento y neurodesarrollo más frecuentes en niños y adolescentes en edad escolar, tanto en Portugal, como a nivel mundial. Asimismo, la categorización diagnóstica del THDA y la prescripción de psicoestimulantes como tratamiento de primera línea ha sido no sólo objeto de investigación científica y validación clínica, sino también objeto de polémica y crítica social, sobre todo a la luz del concepto de medicalización. A pesar de su cariz mediático y relevancia en dominios tan diversos como son los de la educación, del medicamento, de la salud mental y de los apoyos psicosociales, existe una laguna profunda en la caracterización de las dimensiones históricas, socio-éticas e institucionales del THDA en Portugal. Aunando datos historiográficos y etnográficos y al análisis documental, y de los medios de comunicación, este artículo procura responder a este desafío, trazando la trayectoria social del THDA en este país - desde la emergencia de la "hiperactividad" en los años 1970/1980 al debate público y político sobre la prescripción de psicoestimulantes. Desde esta perspectiva interdisciplinar, y a través del estudio del caso portugués, se intenta contextualizar la definición, validación y ampliación del THDA como parte de un proceso dinámico y socialmente situado, que atraviesa sistemas diagnósticos y farmacéuticos globales, contingencias institucionales y socioeconómicas e, incluso, políticas públicas y especificidades locales. Se discute, finalmente, la forma en la que el caso del THDA en Portugal contribuye al desarrollo de nuevas líneas de reflexión y de investigación interdisciplinaria que permiten repensar el campo social de la salud mental y de la salud global.