How to think about the social in psychiatric research? On language games and styles of social thought.

Over the last 20 years, the importance of 'the social' has again become a crucial theme within psychiatric research, as evidenced for example by the recent focus on the social determinants of mental health. However, what is less clear is what is meant, in this kind of research, by the very idea of the social-and what consequences those ideas have. The key purpose of the article is therefore to discuss what is often meant by the concept of 'the social'; what different ideas of the social do; and what can be at stake in the different, explicit and implicit, understandings of social life that proliferate in contemporary psychiatric research. We propose that there are, roughly, three widespread styles of social thought, wherein (a) the social is seen as structural, (b) the social is seen as individual, and (c) the social is seen as relational/processual. We exemplify these by discussing examples of 'social defeat' and 'therapeutic communities', focused on what might be at stake in different understandings of social life. Lastly, we draw on the philosopher Ludwig Wittgenstein to argue that a singular understanding of 'the social' is not achievable.

The social underpinnings of mental distress in the time of COVID-19 - time for urgent action.

We argue that predictions of a 'tsunami' of mental health problems as a consequence of the pandemic of coronavirus disease 2019 (COVID-19) and the lockdown are overstated; feelings of anxiety and sadness are entirely normal reactions to difficult circumstances, not symptoms of poor mental health.  Some people will need specialised mental health support, especially those already leading tough lives; we need immediate reversal of years of underfunding of community mental health services.  However, the disproportionate effects of COVID-19 on the most disadvantaged, especially BAME people placed at risk by their social and economic conditions, were entirely predictable. Mental health is best ensured by urgently rebuilding the social and economic supports stripped away over the last decade. Governments must pump funds into local authorities to rebuild community services, peer support, mutual aid and local community and voluntary sector organisations.  Health care organisations must tackle racism and discrimination to ensure genuine equal access to universal health care.  Government must replace highly conditional benefit systems by something like a universal basic income. All economic and social policies must be subjected to a legally binding mental health audit. This may sound unfeasibly expensive, but the social and economic costs, not to mention the costs in personal and community suffering, though often invisible, are far greater.

Digging deeper in Shanghai: towards a 'mechanism-rich' epidemiology.

BACKGROUND: There are very few close-up sociological or anthropological data informing epidemiological and psychiatric research design and/or contributing to our understanding of the relationship between mental health and specific forms of urban life. Furthermore, research on the relationships between urbanicity and mental disorder has paid little attention to the global diversity of urban experience, such as in cities in China, India and Brazil. METHODS: Two innovative methods can be employed to unveil the diversified urban experience of migrants in China, i.e. an ethnography-informed sociological deep surveying instrument and an ecological momentary assessment with a smartphone app. This article introduces the design and pilot survey of these new instruments towards a 'mechanism-rich' epidemiology. RESULTS: The ethnography-informed survey instrument enabled us to include some of the issues from the ethnography and successfully 'dig deeper' into respondents' social experience. The pilot of the smartphone app serves as 'proof of principle' that we can recruit respondents in Shanghai, and that we can receive and use the data. CONCLUSIONS: Both of these pilots have demonstrated good feasibility for studying mobility, urban life and mental health. Our next steps will be to extend the Shanghai sample, to use the app in Sao Paulo and Toronto and then hopefully in India and Africa.

Genealogies of recovery: The framing of therapeutic ambitions.

The notion of recovery has become prominent in mental healthcare discourse in the UK, but it is often considered as if it were a relatively novel notion, and as if it represented an alternative to conventional treatment and intervention. In this paper, we explore some of the origins of the notion of recovery in the early 20th century in movements such as Alcoholics Anonymous and Recovery Inc. Whilst these phenomena are not entirely continuous with recovery in the present day, some important antecedents of the contemporary notion can be detected. These include the focus on the sufferers' interior space as a key theatre of operations and the reinforcement and consolidation of medical ways of seeing the condition without any immediate medical supervision of the actors being necessary. This has resonance with many contemporary examples of recovery in practice where the art of living with a mental health condition is emphasised without the nature of the psychopathological condition itself being challenged.

An analysis of the Research Team-Service User relationship from the Service User perspective: a consideration of 'The Three Rs' (Roles, Relations, and Responsibilities) for healthcare research organisations.

BACKGROUND: This article debates interview data from service users who engaged with the work of a Collaboration for Leadership in Applied Health Research and Care (CLAHRC). The evidence base, to date, concerning the nature of CLAHRC work at the frontline (i.e. What is it actually like to do CLAHRC work?) is meagre; thus, this article represents an original contribution to that literature. Further, this article analyses service users' participation in research - as members of the research team - and so contributes to the body of developing literature regarding involvement too. OBJECTIVE: This article explores the nature of the Research Team-Service User relationship, plus associated roles, relations and responsibilities of collaborative health research. DESIGN: Qualitative social science research was undertaken in a health-care research organization utilizing interview method and a medical sociology and organizational sociology theoretical framework for analysis. Data utilized originate from a larger evaluation study that focuses on the CLAHRC as an iterative organization and explores members' experiences. RESULTS: There can be a disparity between initial expectations and actual experiences of involvement for service users. Therefore, as structured via 'The Three Rs' (Roles, Relations and Responsibilities), aspects of the relationship are evaluated (e.g. motivation, altruism, satisfaction, transparency, scope, feedback, communication, time). Regarding the inclusion of service users in health research teams, a careful consideration of 'The Three Rs' is required to ensure expectations match experiences.

DSM-IV and dangerous and severe personality disorder--an essay.

In this essay some reflections are offered on the nature of psychiatric classification, on how these diagnostic categories have evolved in the Diagnostic and Statistical Manuals of Mental Disorders (DSM) system and on the development of services based on them. These are described, and then analysed from the perspective of the sociology of knowledge, using 'personality disorder' as an example. Conditions that underlie the stabilisation of such categories, and the policy and political consequences of basing services on them, are reviewed.

A culture of enquiry: research evidence and the therapeutic community.

This paper presents data from a systematic review and meta-analysis of 29 published studies of therapeutic community effectiveness using controls, including 8 randomised control trials. Meta-regressions suggest that the two types of therapeutic community, democratic and concept-based, and the age of the study, are the key sources of heterogeneity in the collection of studies analysed. Otherwise, heterogeneity is low and the meta-analysis confirms the effectiveness of therapeutic community treatment with overall summary log odds ratio for the 29 studies of 0.512 (95% ci -0.598 to -0.426).