Reframing Mental Health Ethics.

Mental health ethics has been classically focused on ethical concepts and problems in clinical mental health spaces. Psychiatric and psychotherapeutic ethics are main threads of analysis in this subfield of bioethics. However, ethical issues emerge around mental health and illness both within and beyond clinical settings. In particular, ethical quandaries arise in employment, education, family caregiving, and incarceration of people with mental health conditions outside of the clinical setting. Likewise, ethics are an important consideration within alternative care systems where mentally ill people seek support beyond biomedicine, psychotherapy, and case management. In this article, we argue that our understanding of "mental health ethics" should expand to be more inclusive of value questions and conflicts that arise in all areas of the lives of people with mental health conditions, rather than focusing more narrowly on how clinical practitioners and researchers should best respond to ethical quandaries in the delivery of mental healthcare. Community mental health is an ideal space in which to think about such ethical issues, as scholars and practitioners in the field strive to meet not only medical needs but the broader social needs of people with mental health conditions. We begin by providing an overview of psychiatric and psychotherapeutic ethics, and then describe broader applications of ethics in the lives of people experiencing mental illness. We encourage community mental health practitioners and researchers to reconceptualize disciplinary boundaries to consider the vast scope of ethical issues related to mental health in and out of the clinic.

Intraprofessionalism and Peer-to-Peer Learning in American Medical Education.

As previous research has observed, medical students and physicians alike confront vast amounts of knowledge in their education and practice, such that no one clinician can know everything there is to know about biomedicine. Even before clerkships, medical students learn to cope with this impossibility by prioritizing certain information based on its perceived utility for exams and clinical practice. Many factors can shape this process, including teamwork, wherein individual medical students rely on one another to address gaps in knowledge at the level of the group. This paper will draw on qualitative data from two allopathic medical schools in the American Midwest to demonstrate that peer-to-peer learning, a widely utilized pedagogical modality in North American medical schools, is amongst the earliest places where future physicians learn how to rely on their peers in the profession as they make choices about what to know and what not to know about biomedicine: cultivating a culture of "intraprofessionalism" between students with different knowledges and values, as they prepare to enter the same profession. The paper will also consider how differences in the student populations at two field sites impact intraprofessional development. Drawing on scholarship of peer-based learning strategies and the sociology and anthropology of medical education, the authors argue that peer-to-peer learning is a key site in the professional socialization of medical students toward the effective management of medical knowledge.

Dual Relationships in Mental Health Peer Support.

Mental health peer support is a growing care modality; yet, understanding is limited regarding the ethical complexities that distinguish it from clinical mental health services. In particular, clinicians in mental health care do not navigate boundaries in the same way as peer workers, whose relationships with clients are notably different and may include interactions with clients outside designated support programs ("dual relationships"). Drawing on data from ongoing qualitative research, two researchers with lived experience of serious mental illness highlight the implications of dual relationships for both peer practice and research.

Beyond Competence: Efficiency in American Biomedicine.

"Competence" is a longstanding value of American biomedicine. One underidentified corollary of competence is efficiency: at once a manifestation of competence, a challenge to competence, and a virtue in its own right. We will explore the social construction of efficiency in US undergraduate medical education through an analysis of its sociocultural and technological landscapes. We present qualitative data from two allopathic medical school field sites in the Midwestern United States, where medical students' careful selection of certain learning resources and overall perspectives on the curriculum underscore their focus on efficiency and pragmatic approaches to knowledge. In the discussion, we consider the ethical implications of physician efficiency, as well as future trajectories for the study of efficiency in the medical social sciences, bioethics, and medical education. We posit that efficiency is at the theoretical heart of US medical practice and education: a finding that has wide-reaching implications for how researchers conceptualize the enterprise of biomedicine across cultural contexts and interpret the lived experiences of physicians, medical students, and other clinicians.

Six hours to study: temporality and ignorance in medical education.

Individual scientists, clinicians, and other experts cannot have absolute knowledge of all of the theories, methods, models, and findings in their field of practice. Rather, these individuals make choices about the kind of information that will be most meaningful and impactful in their work, while choosing - or being compelled to choose - what knowledge to overlook or ignore: a process identified as sufficient knowledge. In biomedicine, medical students are socialized to deliberately decide what information matters most; so, too, do practicing physicians openly acknowledge that they make choices around knowledge in daily practice. Within this process, time is a critical factor that mediates epistemological decision-making. In other words, how does time bound or restrict what forms and depth of medical knowledge that physicians and future physicians prioritize? When would someone intentionally limit time in order to constrain the amount and types of information he, she, or they acquire? To answer these questions, this study draws upon interviews and participant observation conducted with students at a medical school in the American Midwest. This article seeks to answer the aforementioned questions and to provide a new framework for, and expand discussions of, agnotology in the anthropology of medicine.

When Physicians Don't Know.

Given the boundless amount of scientific information, clinical skills, and interventional techniques present in biomedicine today, it is impossible for individual physicians and clinicians to have absolute medical knowledge. Further, ambiguity in the interpretation and treatment of illness can lead to significant uncertainty. Despite the inevitability of not knowing in biomedicine, however, there is relatively little academic discussion about how physicians are socialized to address ignorance, how clinicians experience gaps in knowledge as practitioners, or the various forms that not knowing takes in professional health-care practice and education. This article seeks to invigorate new discussions on the role of ignorance and "non-knowledge" in biomedical practice and training. The article critically examines the predominant focus on medical knowledge in the sociological literature and presents a new anthropological framework for the relationship between knowing and not knowing in medicine, called "sufficient knowledge." The author posits that future social and humanistic examinations of biomedicine should seriously consider the ways that physicians navigate ignorance, uncertainty, and not knowing, and that scientists, clinicians, social scientists, and ethicists all have valuable disciplinary perspectives to bring to the conversation around medical ignorance.

Yields and Rabbit Holes: Medical Students' Typologies of Sufficient Knowledge.

Given the vastness of bioscientific knowledge and regular changes in evidence and protocol, how do individual clinicians make decisions about what to know and what to ignore? In this article I identify a process termed "sufficient knowledge:" the prioritizing of medical knowledge perceived as most important, while ignoring information that is not deemed essential or applicable. Drawing on 14 months of ethnographic fieldwork at an allopathic medical school in the American Midwest, I describe three typologies of sufficient knowledge that medical students devised to distinguish what to know and what to ignore or deemphasize: high yield knowledge, low yield knowledge and "rabbit holes." I aim here to contribute to a growing topical and theoretical discussion of ignorance by social scientists, especially to generate a more balanced picture of physician training and practice beyond depictions of knowledge and expertise.

Science, Technology, and Human Health: The Value of STS in Medical and Health Humanities Pedagogy.

As the number of medical and health humanities degree programs in the United States rapidly increases (Berry, Lamb and Jones 2016, 2017), it is especially timely to consider the range of specific disciplinary (and multidisciplinary) perspectives that might benefit students enrolled in these programs. This paper discusses the inclusion of one such perspective from the field of Science and Technology Studies (STS.) The author asserts that STS benefits students in the medical and health humanities in four particular ways, by: (1) challenging the "progress narrative" around the advancement of biomedicine as scientific practice, (2) evaluating the meaning of technology, especially in how technology orients us towards sickness and how health technology is in turn shaped by social and cultural values, (3) assessing the plurality of biomedical epistemologies, rather than assuming biomedicine is one, cohesive body of knowledge that does not differ across contexts, and (4) critiquing bias in biomedical practice and science, especially in the marginalization of women's voices and in the racial and postcolonial trajectories of contemporary biomedicine. The paper discusses the theoretical importance of these four trajectories to the medical and health humanities, as well as the venues for inclusion of STS within coursework and programming at Case Western Reserve University. The paper also comments on how programming at other institutions might be adapted to incorporate STS scholarship. By drawing on numerous examples of research in the anthropology, sociology, history, and the philosophy of science, this article seeks to open a conversation about the value of science and technology studies to health humanities pedagogy.