Is 'another' psychiatry possible?

In this paper, we examine a number of approaches that propose new models for psychiatric theory and practices: in the way that they incorporate 'social' dimensions, in the way they involve 'communities' in treatment, in the ways that they engage mental health service users, and in the ways that they try to shift the power relations within the psychiatric encounter. We examine the extent to which 'alternatives' - including 'Postpsychiatry', 'Open Dialogue', the 'Power, Threat and Meaning Framework' and Service User Involvement in Research - really do depart from mainstream models in terms of theory, practice and empirical research and identify some shortcomings in each. We propose an approach which seeks more firmly to ground mental distress within the lifeworld of those who experience it, with a particular focus on the biopsychosocial niches within which we make our lives, and the impact of systematic disadvantage, structural violence and other toxic exposures within the spaces and places that constitute and constrain many everyday lives. Further, we argue that a truly alternative psychiatry requires psychiatric professionals to go beyond simply listening to the voices of service users: to overcome epistemic injustice requires professionals to recognise that those who have experience of mental health services have their own expertise in accounting for their distress and in evaluating alternative forms of treatment. Finally we suggest that, if 'another psychiatry' is possible, this requires a radical reimagination of the role and responsibilities of the medically trained psychiatrist within and outside the clinical encounter.

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.

Urban social exclusion and mental health of China's rural-urban migrants - A review and call for research.

China's internal rural-urban migrants experience social exclusion that may have significant mental health implications. This has historically been exacerbated by the hukou system. Echoing recent calls for interdisciplinary research on the interdependencies of urbanization and mental health, this review examines evidence of rural-urban migrants' mental health status in comparison with nonmigrants and its association with various dimensions of social exclusion. We found conflicting evidence on the mental health status of migrants in comparison with nonmigrants, but strong evidence that social exclusion is negatively associated with migrants' mental health: limited access to full labour rights and experience of social stigma, discrimination and inequity were the most significant factors. We discuss the limitations of current social epidemiological research and call for an attempt to use close-up, street-level ethnographic data on the daily experience of being a migrant in the mega-city, and describe our aim to produce a new sociological deep surveying instrument to understand migration, urban living, and mental health.

Living well in the Neuropolis.

This paper is about the relationship between cities and brains: it charts the back-and-forth between the hectic, stressful lives of urban citizens, and a psychological and neurobiological literature that claims to make such stress both visible and knowable. But beyond such genealogical labour, the paper also asks: what can a sociology concerned with the effects of 'biosocial' agencies take from a scientific literature on the urban brain? What might sociology even contribute to that literature, in its turn? To investigate these possibilities, the paper centres on the emergence and description of what it calls 'the Neuropolis' - a term it deploys to hold together both an intellectual and scientific figure and a real, physical enclosure. The Neuropolis is an image of the city embedded in neuropsychological concepts and histories, but it also describes an embodied set of (sometimes pathological) relations and effects that take places between cities and the people who live in them. At the heart of the paper is an argument that finding a way to thread these phenomena together might open up new paths for thinking about 'good' life in the contemporary city. Pushing at this claim, the paper argues that mapping the relations, histories, spaces, and people held together by this term is a vital task for the future of urban sociology.

Revitalizing sociology: urban life and mental illness between history and the present.

This paper proposes a re-thinking of the relationship between sociology and the biological sciences. Tracing lines of connection between the history of sociology and the contemporary landscape of biology, the paper argues for a reconfiguration of this relationship beyond popular rhetorics of 'biologization' or 'medicalization'. At the heart of the paper is a claim that, today, there are some potent new frames for re-imagining the traffic between sociological and biological research - even for 'revitalizing' the sociological enterprise as such. The paper threads this argument through one empirical case: the relationship between urban life and mental illness. In its first section, it shows how this relationship enlivened both early psychiatric epidemiology, and some forms of the new discipline of sociology; it then traces the historical division of these sciences, as the sociological investment in psychiatric questions waned, and 'the social' become marginalized within an increasingly 'biological' psychiatry. In its third section, however, the paper shows how this relationship has lately been revivified, but now by a nuanced epigenetic and neurobiological attention to the links between mental health and urban life. What role can sociology play here? In its final section, the paper shows how this older sociology, with its lively interest in the psychiatric and neurobiological vicissitudes of urban social life, can be our guide in helping to identify intersections between sociological and biological attention. With a new century now underway, the paper concludes by suggesting that the relationship between urban life and mental illness may prove a core testing-ground for a 'revitalized' sociology.

The Human Brain Project: social and ethical challenges.

Focusing on the Human Brain Project, I discuss some social and ethical challenges raised by such programs of research: the possibility of a unified knowledge of "the brain," balancing privacy and the public good, dilemmas of "dual use," brain-computer interfaces, and "responsible research and innovation" in governance of emerging technologies.

As ciências humanas em uma era biológica / The human science in a biological age / Las ciencias humanas en una era biologica

Vivemos, de acordo com alguns, no século da biologia, onde agora entendemos a nós mesmos em formas radicalmente novas, visto que os conhecimentos da ciência genômica e neurociência tornaram acessíveis os funcionamentos de nossos corpos e nossas mentes para novos tipos de conhecimento e intervenção. Uma nova figura do humano e do social está tomando forma no século XXI? Com quais consequências atualmente para as políticas da vida? E com quais implicações, se existem, para as ciências sociais, culturais e humanas? Essas são as questões discutidas neste artigo, o qual argumenta que uma nova relação com as ciências da vida é requerida, para além do comentário e da crítica, se as ciências sociais e humanas estão a se revitalizar para o século XXI. (AU)

We live, according to some, in the century of biology, where we now understand ourselves in radically new ways as the insights of genomics and neuroscience have opened up the workings of our bodies and our minds to new kinds of knowledge and intervention. Is a new figure of the human, and of the social, taking shape in the 21st century? With what consequences for the politics of life today? And with what implications, if any, for the social, cultural and human sciences? These are the issues that are discussed in this article, which argues that a new relation is required with the life sciences, beyond commentary and critique, if the social and human sciences are to revitalize themselves for the 21st century. (AU)

Vivimos, según algunos, en el siglo de la biología, donde ahora entendemos a nosotros mismos en formas radicalmente nuevas como las ideas de la genómica y la neurociencia han abierto el funcionamiento de nuestros cuerpos y nuestras mentes a nuevos tipos de conocimiento e intervención. ¿Es una nueva figura del ser humano, y de lo social, tomando forma en el siglo 21? ¿Con qué consecuencias para la política de la vida hoy? ¿Y con qué consecuencias, si lo hay, por las ciencias sociales, culturales y humanas? Estos son los temas que se tratan en este artículo, que sostiene que una nueva relación é necesario con las ciencias de la vida, más allá de comentarios y críticas, si las ciencias sociales y humanas han de revitalizarse para el siglo XXI. (AU)

As ciências humanas em uma era biológica / The human science in a biological age / Las ciencias humanas en una era biologica

Vivemos, de acordo com alguns, no século da biologia, onde agora entendemos a nós mesmos em formas radicalmente novas, visto que os conhecimentos da ciência genômica e neurociência tornaram acessíveis os funcionamentos de nossos corpos e nossas mentes para novos tipos de conhecimento e intervenção. Uma nova figura do humano e do social está tomando forma no século XXI? Com quais consequências atualmente para as políticas da vida? E com quais implicações, se existem, para as ciências sociais, culturais e humanas? Essas são as questões discutidas neste artigo, o qual argumenta que uma nova relação com as ciências da vida é requerida, para além do comentário e da crítica, se as ciências sociais e humanas estão a se revitalizar para o século XXI.

We live, according to some, in the century of biology, where we now understand ourselves in radically new ways as the insights of genomics and neuroscience have opened up the workings of our bodies and our minds to new kinds of knowledge and intervention. Is a new figure of the human, and of the social, taking shape in the 21st century? With what consequences for the politics of life today? And with what implications, if any, for the social, cultural and human sciences? These are the issues that are discussed in this article, which argues that a new relation is required with the life sciences, beyond commentary and critique, if the social and human sciences are to revitalize themselves for the 21st century.

Vivimos, según algunos, en el siglo de la biología, donde ahora entendemos a nosotros mismos en formas radicalmente nuevas como las ideas de la genómica y la neurociencia han abierto el funcionamiento de nuestros cuerpos y nuestras mentes a nuevos tipos de conocimiento e intervención. ¿Es una nueva figura del ser humano, y de lo social, tomando forma en el siglo 21? ¿Con qué consecuencias para la política de la vida hoy? ¿Y con qué consecuencias, si lo hay, por las ciencias sociales, culturales y humanas? Estos son los temas que se tratan en este artículo, que sostiene que una nueva relación é necesario con las ciencias de la vida, más allá de comentarios y críticas, si las ciencias sociales y humanas han de revitalizarse para el siglo XXI.

From global bioethics to ethical governance of biomedical research collaborations.

One of the features of advanced life sciences research in recent years has been its internationalisation, with countries such as China and South Korea considered 'emerging biotech' locations. As a result, cross-continental collaborations are becoming common generating moves towards ethical and legal standardisation under the rubric of 'global bioethics'. Such a 'global', 'Western' or 'universal' bioethics has in turn been critiqued as an imposition upon resource-poor, non-Western or local medical settings. In this article, we propose that a different tack is necessary if we are to come to grips with the ethical challenges that inter-continental biomedical research collaborations generate. In particular we ask how national systems of ethical governance of life science research might cope with increasingly global research collaborations with a focus on Sino-European collaboration. We propose four 'spheres' - deliberation, regulation, oversight and interaction - as a helpful way to conceptualise national systems of ethical governance. Using a workshop-based mapping methodology (workshops held in Beijing, Shanghai, Changsha, Xian, Shenzen and London) we identified three specific ethical challenges arising from cross-continental research collaborations: (1) ambiguity as to which regulations are applicable; (2) lack of ethical review capacity not only among ethical review board members but also collaborating scientists; (3) already complex, researcher-research subject interaction is further complicated when many nationalities are involved.

Risk assessment in mental health care: values and costs.

Risk assessment has assumed increasing salience in mental health care in a number of countries. The frequency of serious violent incidents perpetrated by people with a mental illness is an insufficient explanation. Understandings of mental illness and of the role of those charged with their care (or control) play a key role. "Moral outrage", associated with an implied culpability when certain types of tragedy occur, is very significant. This leads to tensions concerning the role of post-incident inquiries, and contributes to a flawed conception of what such inquiries can offer. At the same time, understanding of probability and prediction is generally very poor, among both professionals and the public. Unrealistic expectations for risk assessment and management in general psychiatric practice carry a variety of significant costs, taking a number forms, to those with a mental illness, to mental health professionals and to services. Especially important are changes in professional practice and accountabilities that are significantly divorced from traditional practice, implications for trust in patient-clinician relationships and the organisations in which mental health professionals work, and practices that often breach the ethical principle of justice (or fairness) and heighten discrimination against people with mental illness.

The birth of the neuromolecular gaze.

The aim of this article is (1) to investigate the "neurosciences" as an object of study for historical and genealogical approaches and (2) to characterize what we identify as a particular "style of thought" that consolidated with the birth of this new thought community and that we term the "neuromolecular gaze." This article argues that while there is a long history of research on the brain, the neurosciences formed in the 1960s, in a socio-historical context characterized by political change, faith in scientific and technological progress, and the rise of a molecular gaze in the life sciences. They flourished in part because these epistemological and technological developments were accompanied by multiple projects of institution-building. An array of stakeholders was mobilized around the belief that breakthroughs in understanding the brain were not only crucial, they were possible by means of collaborative efforts, cross-disciplinary approaches and the use of a predominantly reductionist neuromolecular method. The first part of the article considers some of the different approaches that have been adopted to writing the history of the brain sciences. After a brief outline of our own approach, the second part of the article uses this in a preliminary exploration of the birth of the neurosciences in three contexts. We conclude by arguing that the 1960s constitute an important "break" in the long path of the history of the brain sciences that needs further analysis. We believe this epistemological shift we term the "neuromolecular gaze" will shape the future intellectual development and social role of the neurosciences.

"Screen and intervene": governing risky brains.

This article argues that a new diagram is emerging in the criminal justice system as it encounters developments in the neurosciences. This does not take the form that concerns many "neuroethicists" -- it does not entail a challenge to doctrines of free will and the notion of the autonomous legal subject -- but is developing around the themes of susceptibility, risk, pre-emption and precaution. I term this diagram "screen and intervene" and in this article I attempt to trace out this new configuration and consider some of the consequences.