What are Mental Disorders? Exploring the Role of Culture in the Harmful Dysfunction Approach.

A shared problem in psychology, psychiatry, and philosophy is how to define mental disorders. Various theories have been proposed, ranging from naturalism to social constructionism. In this article, I first briefly introduce the current landscape of such theories, before concentrating on one of the most influential approaches today: The harmful dysfunction theory developed by Jerome Wakefield. It claims that mental disorders are hybrid phenomena since they have a natural basis in dysfunctional mental mechanisms, but also a cultural component in the harm experienced by human beings. Although the theory is well thought through, I will raise a critical question: Is it possible to isolate mental mechanisms as naturally evolved from cultural factors? I will argue that it is not, but that the theory could still be helpful in an understanding of mental disorders, albeit on a new footing that does not operate with a natural and a cultural component as two separate factors. I argue that we need to develop a "naturecultural" approach to psychopathology that avoids mentalism, based on the fact that human beings are irreducibly persons.

Is Another kind of Biologization Possible? On Biology and the psy Sciences.

The relationship between biology and the psy disciplines (psychology, psychiatry, and psychotherapy) is a complex one. Many scholars have criticized how these disciplines have been biologized in the 20th century, especially since the emergence of psychopharmacology, neuroscience, and genetic research. However, biology is not just a laboratory-based science of chemical compounds, scanners, and DNA sequencing, but also a field science based on observations of organisms in their milieus. In this paper, we draw a contrast between laboratory-based biology with a focus on brains and genes, and an ecology-based biology with a focus on lives and niches. Our argument is philosophical in nature - building partly on Wittgenstein as a "philosopher of life" - to the effect that the psy sciences need not just less biologization of the former kind, but also more biologization of the latter kind to avoid a prevalent mentalism. Not least when it comes to an understanding of psychological distress, which can favorably be viewed situationally and coupled to human lives in ecological niches.

Embodied relational research: How can researchers' competences in exploring existential aspects be enhanced?

BACKGROUND: This methodological essay discusses the following question: How can researchers' competences in exploring existential aspects related to healthcare be enhanced? Exploring this novel perspective on caring practice may help us better understand and communicate about experiences and issues that matter to others (e.g. patients/users). Two things are needed: firstly, a vocabulary mirroring an "aesthetic-holistic" research approach allowing us to capture the essence of "what it is like" and secondly, the development of skills and competences allowing us to understand complex aspects of caring that are embodied, ethically sensitive and sustainable. AIM: To identify personal competences and approaches underpinning research exploring "what it is like"-understanding human existence. DISCUSSION: The discussion addresses three questions: (A) What does human science exploring human existence search for? (B) Which researcher competences are required? (C) Which theoretical and practical approaches and dimensions may enhance the researchers' competences? We argue that we should find "ourselves" not only grasped through language and a qualitative research-methodological approach but also in what is reflected in the relation between self, language (dialogue) and the other. It is crucial to listen to the world in an ontological way. Emotions, feelings and bodily sensed understandings can, in some situations, bar us from stepping further into meta-physical listening and from adopting a being-in-the-world stance. In this relational perspective, the researcher may adopt an attentive pace and aesthetical attunement that transcend what cannot be reached through the language of logical, rigorous, precise and rational words, tuning into the ontological mood that exists as the tacit backdrop of our existence. This approach we dub "Embodied Relational Research." CONCLUSION: Researchers who explore humanity may benefit from cultivating awareness, sensitivity and understanding while displaying openness towards the other (the patients' or users' experiences). In this context, contemplative and creative dimensions are important to apply.

Influence at work is a key factor for mental health - but what do contemporary employees in knowledge and relational work mean by "influence at work"?

PURPOSE: Common mental health problems are a substantial burden in many western countries. Studies have pointed out that work related factors can both increase and decrease the risk of developing mental health problems. Influence at work is a key factor relating the psychosocial work environment to employees mental health. However, little is known regarding how contemporary employees experience and understand influence at work. The purpose of this study is to explore this in depth. METHODS: We conducted semi-structured interviews with 59 employees in knowledge and relational work and analysed the data using principles from Interpretative Phenomenological Analysis (IPA). FINDINGS: TWe identified three themes each consisting of two interrelated parts, where the second part describes the consequences of the identified type of influence for employees: 1) work tasks and performance, 2) relations and belonging, 3) identity and becoming. CONCLUSIONS: The interviewed employees had a multifaceted understanding of influence at work and that influence at work mattered to them in different but important ways. Our hope is that managers, employees and consultants will be inspired by the three themes when designing work tasks, organizations and interventions in order to increase the level of influence and thereby help enhance the mental well-being of employees.

Me and us: Cultivating presence and mental health through choir singing.

BACKGROUND: An increasing body of qualitative and quantitative research suggests that choir singing can improve mental and physical health and wellbeing. A recurring phenomenon is social agency and social and emotional competences. However, there is little consensus about the underlying impact mechanisms and the special nature of music as a medium for music-based social-emotional competence. AIM: This research was carried out to explore how the participants experienced engaging and singing in the choir A Song for the Mind in order to understand the social and emotional aspects in relation to choir singing and mental health. METHOD: Six women and two men were interviewed. The study involved open-ended interviews and applied Paul Ricoeur's phenomenological-hermeneutic theory of interpretation in processing the collected data. FINDINGS: Two themes emerged-The Singing Me and Cultivating Us. Joining the choir, singing and engaging with the lyrics, helped the participants get in contact with complex feelings and visualise and express challenges. This formed feelings of connecting to oneself and opening up to become aware of the world such as nature, the other person and the choir. Songs, melodies, tones, lyrics-singing together-formed a relation between the participants and the other and the group. This was a meaningful, and to some, a life-changing experience, and an important learning process to the professionals. As the participants are sensing and connecting to themselves, there is an opening for growing a nascent presence and awareness. CONCLUSION: Joining the initiative A Song for the Mind instils an attention to the other person(s). The singing process seems to evoke presence, leading to awareness towards relational aspects and solidarity. In a choir singing perspective, and health care practice in general, this can be seen as a budding and ground-breaking formation of cultural activities holding learning and empowering potentials instilling mental health.

Moving On Our Feet: For a Nomadic Psychology.

Zagaria, Andò and Zennaro have provided a useful analysis of the theoretical precariousness of psychology by looking at a number of its core concepts. They propose that evolutionary psychology could be a unifying approach for the otherwise fragmented discipline. In this response, I argue that although evolutionary psychology provides many interesting perspectives on the mental life of human beings, it is much too soon to jump to a unifying conclusion for psychology on its basis. Before beginning the work of explaining the functioning of the mind in evolutionary terms, we need illuminating descriptions of mental life as such. Phenomenological description should precede evolutionary explanation, and the former will reveal that mental life is intentional and normative - something that evolutionary and other explanatory perspectives have difficulties accommodating. When the subject matter is human mental life, it might be better to live with conceptual confusion than obtaining consensus on a misguided foundation. I agree with the authors that psychology stands on feet of clay, but instead of lamenting the "unsteady building" of the discipline, I suggest we embrace a more nomadic life for psychology - moving about on our feet - given the fact that humans perpetually and historically seem to reflect on their own lives, which is a process that should be kept open rather than terminated.

From Doxastic to Epistemic: A Typology and Critique of Qualitative Interview Styles.

Qualitative interview styles have been guided by precedent within academic disciplines. The nature of information sought, and the role of interviewer and interviewee are key determinants across styles, which range from doxastic (focused on understanding interviewees' experiences or behaviors) to epistemic (focused on co-constructing knowledge). In this article, we position common interview styles along a doxastic-epistemic continuum, and according to the role of the interviewee (from respondent to equal partner). Through our typology and critique of interview styles, we enhance epistemic interviewing by introducing "deliberative interviews," which are more debate oriented and closer to equality in the interviewee and interviewer relationship than existing interview styles. Deliberative interviews require a comprehensive, pre-interview briefing on the subject matter followed by interactive deliberation wherein complex issues are debated across viewpoints in an effort to devise solutions. The effectiveness of this interview style in generating new knowledge warrants empirical testing across academic disciplines.

"I´m the one who has written this": reciprocity in writing courses for older adults in Norway.

Purpose: The aim of this article is to explore, theoretically and empirically, the reciprocity of care afforded by writing courses as community interventions for older adults. Methods: We narratively analyzed 209 excerpts of the anthology "I´m the one who has written this" written by teachers and participants of courses organized by the Church City Mission in Norway. Results: The reciprocity that appeared in the writing courses is grounded in the sense of vulnerability that both teachers and participants embraced, and that is experienced in three main relational movements that these writing courses convey: self-exploration, otherness and togetherness. In addition, the data suggests that these courses promote affective processing and existential meaning-making, motivation, as well as improvements of memory and attention. However, more research is needed to confirm these preliminary findings, and their possible effects in older adults with and without symptoms of dementia. Conclusion: Even though these writing courses for older adults are not explicitly therapeutic, they can have therapeutic effects, given the reciprocity afforded in these cultural community interventions. A theoretical exploration upon reciprocity in eldercare is hereby provided. These findings could shape improvements in aging and health care policies that are person-centered and focus on reciprocity.

Qualitative Interview Studies of Working Mechanisms in Electronic Health: Tools to Enhance Study Quality.

Future development of electronic health (eHealth) programs (automated Web-based health interventions) will be furthered if program design can be based on the knowledge of eHealth's working mechanisms. A promising and pragmatic method for exploring potential working mechanisms is qualitative interview studies, in which eHealth working mechanisms can be explored through the perspective of the program user. Qualitative interview studies are promising as they are suited for exploring what is yet unknown, building new knowledge, and constructing theory. They are also pragmatic, as the development of eHealth programs often entails user interviews for applied purposes (eg, getting feedback for program improvement or identifying barriers for implementation). By capitalizing on these existing (applied) user interviews to also pursue (basic) research questions of how such programs work, the knowledge base of eHealth's working mechanisms can grow quickly. To be useful, such interview studies need to be of sufficient quality, which entails that the interviews should generate enough data of sufficient quality relevant to the research question (ie, rich data). However, getting rich interview data on eHealth working mechanisms can be surprisingly challenging, as several of the authors have experienced. Moreover, when encountering difficulties as we did, there are few places to turn to, there are currently no guidelines for conducting such interview studies in a way that ensure their quality. In this paper, we build on our experience as well as the qualitative literature to address this need, by describing 5 challenges that may arise in such interviews and presenting methodological tools to counteract each challenge. We hope the ideas we offer will spark methodological reflections and provide some options for researchers interested in using qualitative interview studies to explore eHealth's working mechanisms.

General Psychological Implications of the Human Capacity for Grief.

Much theorizing in psychology and related disciplines begins with a given model of the mind that is then applied in research projects to study concrete phenomena. Sometimes psychological research can be theory-driven in quite an explicit way, approaching the logic of the hypothetico-deductive method. Others reject this and prefer to work inductively, and, in the extreme case of positivism, perhaps try to avoid theorizing altogether. In this article I shall suggest another way to think of the relationship between psychological theories and psychological phenomena. My suggestion is not simply to replace the hypothetico-deductive model with an inductive one, but to argue that the most direct route to theories of the human mind that grasp its complexity is to begin with the Kantian question of transcendental philosophy: X exists - how is X possible? In the context of this article, I apply this questioning to the phenomenon of grief: Grief exists - what general psychological theory of the mind do we need in order to account for its possibility? I attempt to extract three general psychological points from the existence of grief, viz. (1) the deep relationality of the self, (2) the limitations of evolutionary accounts, and (3) the normativity of psychological phenomena. I shall argue that these are general psychological lessons to be learned from grief, although they could also be arrived at by considering several other significant psychological phenomena.

Perils and potentials in qualitative psychology.

Famously, Ebbinghaus declared that psychology has a long past, but only a short history. Psychology, as something implicit to human conduct, is as old as the human race, but the science, as an explicit investigative reflection upon that conduct, is a recent invention. Within the short history of psychology, we find an even shorter history of qualitative psychology specifically. Although most founding fathers (Freud, Piaget, Bartlett etc.) worked as "qualitative psychologists", they found no need to thematize their methods of inquiry in this manner. Since around 1980, however, a field has established itself that can be called qualitative psychology. In this paper, I discuss how this field can move sensibly into the future, and I highlight two perils and two potentials. The perils stem from neo-positivism and a threatening "McDonaldization" of qualitative research, while the potentials are related to proliferation of new forms of inquiry and a transcending of disciplinary boundaries.

How do workers with common mental disorders experience a multidisciplinary return-to-work intervention? A qualitative study.

PURPOSE: Long-term sick leave due to common mental disorders (CMD) is an increasing problem in many countries. Recent reviews indicate that return to work (RTW) interventions have limited effect on reducing sickness absence among this group of sick-listed. The aims of this study were to investigate how sick-listed persons with CMD experienced participating in an RTW intervention and how workability assessments and RTW activities influenced their RTW-process, and to examine the working mechanisms of the intervention. The gained knowledge can help improve future RTW intervention design and implementation. METHODS: In-depth interviews were conducted with 17 participants on sick leave due to CMD who participated in an RTW intervention. Interviews were conducted at three time points with each participant. Principles of interpretative phenomenological analyses guided the analysis. RESULTS: The workability assessment consultations and RTW activities such as psychoeducative group sessions and individual sessions with psychologist could result in both motivation and frustration depending on the extent to which the RTW professionals practiced what we have termed an individual approach to the sick-listed person. CONCLUSIONS: The individual approach seems necessary for the realization of the positive potential in the RTW intervention. However, the fact that RTW professionals are both the facilitators and the controllers of the sick-listed persons' RTW process is an inherent paradox in the intervention, which can impede the necessary establishment of a high-quality relationship between the sick-listed persons and RTW professionals.

Meta-synthesis of qualitative research on return to work among employees with common mental disorders.

OBJECTIVES: The purpose of this study was to investigate which opportunities and obstacles employees with common mental disorders (CMD) experience in relation to return to work (RTW) and how they perceive the process of returning to work. In addition, the study explores what characterizes an optimal RTW intervention and points to possible ways to improve future interventions for employees with CMD. METHODS: A systematic literature search was conducted, and eight qualitative studies of medium or high quality published between 1995-2011 were included in this systematic review. The eight studies were synthesized using the meta-ethnographic method. RESULTS: This meta-synthesis found that employees with CMD identify a number of obstacles to and facilitators of returning to work related to their own personality, social support at the workplace, and the social and rehabilitation systems. The employees found it difficult to decide when they were ready to resume work and experienced difficulties implementing RTW solutions at the workplace. CONCLUSIONS: This study reveals that the RTW process should be seen as a continuous and coherent one where experiences of the past and present and anticipation of the future are dynamically interrelated and affect the success or failure of RTW. The meta-synthesis also illuminates insufficient coordination between the social and rehabilitation systems and suggests how an optimal RTW intervention could be designed.

The mind as skills and dispositions: on normativity and mediation.

On the occasion of the critique of Alfredo Gaete and Carlos Cornejo, this article explains and extends the hybrid theory of the mind that I recently presented in this journal. Taking inspiration from Rom Harré's program for a hybrid psychology, the theory is supposed to be integrative and aims to broaden Harré's hybrid psychology by including not just the brain, but also the body, social practices, and technological artifacts as mediators of the mind. The mind is understood not as a substance of any kind, but as a set of skills and dispositions to act, think, and feel. This implies a normative view of the mind, according to which psychological phenomena do not simply happen, but are done, and can consequently be done more or less well. I provide arguments in favor of grounding psychology in normativity rather than conscious experience, and I explain why the emphasis on mediators does not represent a threat to the ontological primacy of the person in psychology.

Towards an expansive hybrid psychology: integrating theories of the mediated mind.

This article develops an integrative theory of the mind by examining how the mind, understood as a set of skills and dispositions, depends upon four sources of mediators. Harré's hybrid psychology is taken as a meta-theoretical starting point, but is expanded significantly by including the four sources of mediators that are the brain, the body, social practices and technological artefacts. It is argued that the mind is normative in the sense that mental processes do not simply happen, but can be done more or less well, and thus are subject to normative appraisal. The expanded hybrid psychology is meant to assist in integrating theoretical perspectives and research interests that are often thought of as incompatible, among them neuroscience, phenomenology of the body, social practice theory and technology studies. A main point of the article is that these perspectives each are necessary for an integrative approach to the human mind.