Felicity Callard

Biology's gift: interrogating the turn to affect

This article investigates how the turn to affect within the humanities and social sciences re-imagines the relationship between cultural theory and science. We focus on how the writings of two neuroscientists (Antonio Damasio and Joseph LeDoux) and one developmental psychologist (Daniel Stern) are used in order to ground certain claims about affect within cultural theory. We examine the motifs at play in cultural theories of affect, the models of (neuro)biology with which they work, and some fascinating missteps characterizing the taking up of scientific literature. While neuroscience frames the affective as part of a system of regulation that makes both self and social coherence possible, in cultural theory’s narratives, by contrast, affectivity becomes a placeholder for the inherent dynamism and mutability of matter. The article interrogates the consequences of cultural theory’s strange borrowings from neuroscience and developmental psychology in their institution of a model of subjectivity preoccupied with a lived present in excess of the hold of habit and embodied history.

Social science and neuroscience beyond interdisciplinarity: experimental entanglements

This article is an account of the dynamics of interaction across the social sciences and neurosciences. Against an arid rhetoric of ‘interdisciplinarity’, it calls for a more expansive imaginary of what experiment – as practice and ethos – might offer in this space. Arguing that opportunities for collaboration between social scientists and neuroscientists need to be taken seriously, the article situates itself against existing conceptualizations of these dynamics, grouping them under three rubrics: ‘critique’, ‘ebullience’ and ‘interaction’. Despite their differences, each insists on a distinction between sociocultural and neurobiological knowledge, or does not show how a more entangled field might be realized. The article links this absence to the ‘regime of the inter-’, an ethic of interdisciplinarity that guides interaction between disciplines on the understanding of their pre-existing separateness. The argument of the paper is thus twofold: (1) that, contra the ‘regime of the inter-’, it is no longer practicable to maintain a hygienic separation between sociocultural webs and neurobiological architecture; (2) that the cognitive neuroscientific experiment, as a space of epistemological and ontological excess, offers an opportunity to researchers, from all disciplines, to explore and register this realization.

Development and evaluation of a de-identification procedure for a case register sourced from mental health electronic records

BackgroundElectronic health records (EHRs) provide enormous potential for health research but also present data governance challenges. Ensuring de-identification is a pre-requisite for use of EHR data without prior consent. The South London and Maudsley NHS Trust (SLaM), one of the largest secondary mental healthcare providers in Europe, has developed, from its EHRs, a de-identified psychiatric case register, the Clinical Record Interactive Search (CRIS), for secondary research.MethodsWe describe development, implementation and evaluation of a bespoke de-identification algorithm used to create the register. It is designed to create dictionaries using patient identifiers (PIs) entered into dedicated source fields and then identify, match and mask them (with ZZZZZ) when they appear in medical texts. We deemed this approach would be effective, given high coverage of PI in the dedicated fields and the effectiveness of the masking combined with elements of a security model. We conducted two separate performance tests i) to test performance of the algorithm in masking individual true PIs entered in dedicated fields and then found in text (using 500 patient notes) and ii) to compare the performance of the CRIS pattern matching algorithm with a machine learning algorithm, called the MITRE Identification Scrubber Toolkit – MIST (using 70 patient notes – 50 notes to train, 20 notes to test on). We also report any incidences of potential breaches, defined by occurrences of 3 or more true or apparent PIs in the same patient’s notes (and in an additional set of longitudinal notes for 50 patients); and we consider the possibility of inferring information despite de-identification.ResultsTrue PIs were masked with 98.8% precision and 97.6% recall. As anticipated, potential PIs did appear, owing to misspellings entered within the EHRs. We found one potential breach. In a separate performance test, with a different set of notes, CRIS yielded 100% precision and 88.5% recall, while MIST yielded a 95.1% and 78.1%, respectively. We discuss how we overcome the realistic possibility – albeit of low probability – of potential breaches through implementation of the security model.ConclusionCRIS is a de-identified psychiatric database sourced from EHRs, which protects patient anonymity and maximises data available for research. CRIS demonstrates the advantage of combining an effective de-identification algorithm with a carefully designed security model. The paper advances much needed discussion of EHR de-identification – particularly in relation to criteria to assess de-identification, and considering the contexts of de-identified research databases when assessing the risk of breaches of confidential patient information.

Cohort profile of the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register : current status and recent enhancement of an Electronic Mental Health Record-derived data resource.

Purpose The South London and Maudsley National Health Service (NHS) Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register and its Clinical Record Interactive Search (CRIS) application were developed in 2008, generating a research repository of real-time, anonymised, structured and open-text data derived from the electronic health record system used by SLaM, a large mental healthcare provider in southeast London. In this paper, we update this registers descriptive data, and describe the substantial expansion and extension of the data resource since its original development. Participants Descriptive data were generated from the SLaM BRC Case Register on 31 December 2014. Currently, there are over 250 000 patient records accessed through CRIS. Findings to date Since 2008, the most significant developments in the SLaM BRC Case Register have been the introduction of natural language processing to extract structured data from open-text fields, linkages to external sources of data, and the addition of a parallel relational database (Structured Query Language) output. Natural language processing applications to date have brought in new and hitherto inaccessible data on cognitive function, education, social care receipt, smoking, diagnostic statements and pharmacotherapy. In addition, through external data linkages, large volumes of supplementary information have been accessed on mortality, hospital attendances and cancer registrations. Future plans Coupled with robust data security and governance structures, electronic health records provide potentially transformative information on mental disorders and outcomes in routine clinical care. The SLaM BRC Case Register continues to grow as a database, with approximately 20 000 new cases added each year, in addition to extension of follow-up for existing cases. Data linkages and natural language processing present important opportunities to enhance this type of research resource further, achieving both volume and depth of data. However, research projects still need to be carefully tailored, so that they take into account the nature and quality of the source information.

The Body in Theory

Geographers are now taking the problematic of corporeality seriously. ‘The body’ is becoming a preoccupation in the geographical literature, and is a central figure around which to base political demands, social analyses, and theoretical investigations. In this paper I describe some of the trajectories through which the body has been installed in academia and claim that this installation has necessitated the uptake of certain theoretical legacies and the disavowal or forgetting of others. In particular, I trace two related developments. First, I point to the sometimes haphazard agglomeration of disparate theoretical interventions that lie under the name of postmodernism and observe how this has led to the foregrounding of bodily tropes of fragmentation, fluidity, and ‘the cyborg‘. Second, I examine the treatment of the body as a conduit which enables political agency to be thought of in terms of transgression and resistance. I stage my argument by looking at how on the one hand Marxist and on the other queer theory have commonly conceived of the body, and propose that the legacies of materialist modes of analysis have much to offer current work focusing on how bodies are shaped by their encapsulation within the sphere of the social. I conclude by examining the presentation of corporeality that appears in the first volume of Marxs Capital. I do so to suggest that geographers working on questions of subjectivity could profit from thinking further about the relation between so-called ‘new’ and ‘fluid’ configurations of bodies, technologies, and subjectivities in the late 20th-century world, and the corporeal configurations of industrial capitalism lying behind and before them.

Experiences of hearing voices: analysis of a novel phenomenological survey

Summary Background Auditory hallucinations—or voices—are a common feature of many psychiatric disorders and are also experienced by individuals with no psychiatric history. Understanding of the variation in subjective experiences of hallucination is central to psychiatry, yet systematic empirical research on the phenomenology of auditory hallucinations remains scarce. We aimed to record a detailed and diverse collection of experiences, in the words of the people who hear voices themselves. Methods We made a 13 item questionnaire available online for 3 months. To elicit phenomenologically rich data, we designed a combination of open-ended and closed-ended questions, which drew on service-user perspectives and approaches from phenomenological psychiatry, psychology, and medical humanities. We invited people aged 16–84 years with experience of voice-hearing to take part via an advertisement circulated through clinical networks, hearing voices groups, and other mental health forums. We combined qualitative and quantitative methods, and used inductive thematic analysis to code the data and χ2 tests to test additional associations of selected codes. Findings Between Sept 9 and Nov 29, 2013, 153 participants completed the study. Most participants described hearing multiple voices (124 [81%] of 153 individuals) with characterful qualities (106 [69%] individuals). Less than half of the participants reported hearing literally auditory voices—70 (46%) individuals reported either thought-like or mixed experiences. 101 (66%) participants reported bodily sensations while they heard voices, and these sensations were significantly associated with experiences of abusive or violent voices (p=0·024). Although fear, anxiety, depression, and stress were often associated with voices, 48 (31%) participants reported positive emotions and 49 (32%) reported neutral emotions. Our statistical analysis showed that mixed voices were more likely to have changed over time (p=0·030), be internally located (p=0·010), and be conversational in nature (p=0·010). Interpretation This study is, to our knowledge, the largest mixed-methods investigation of auditory hallucination phenomenology so far. Our survey was completed by a diverse sample of people who hear voices with various diagnoses and clinical histories. Our findings both overlap with past large-sample investigations of auditory hallucination and suggest potentially important new findings about the association between acoustic perception and thought, somatic and multisensorial features of auditory hallucinations, and the link between auditory hallucinations and characterological entities. Funding Wellcome Trust.

Life expectancy at birth and all-cause mortality among people with personality disorder

OBJECTIVE It is well established that serious mental illness is associated with raised mortality, yet few studies have looked at the life expectancy of people with personality disorder (PD). This study aims to examine the life expectancy and relative mortality in people with PD within secondary mental health care. METHODS We set out to examine this using a large psychiatric case register in southeast London, UK. Mortality was obtained through national mortality tracing procedures. In a cohort of patients with a primary diagnosis of PD (n=1836), standardised mortality ratios (SMRs) and life expectancies at birth were calculated, using general population mortality statistics as the comparator. RESULTS Life expectancy at birth was 63.3 years for women and 59.1 years for men with PD-18.7 years and 17.7 years shorter than females and males respectively in the general population in England and Wales. The SMR was 4.2 (95% CI: 3.03-5.64) overall; 5.0 (95% CI: 3.15-7.45) for females and 3.5 (95% CI: 2.17-5.47) for males. The highest SMRs were found in the younger age groups for both genders. CONCLUSION People with PD using mental health services have a substantially reduced life expectancy, highlighting the significant public health burden of the disorder.

Close to the bench as well as at the bedside: involving service users in all phases of translational research

Aim  The paper aims to develop a model of translational research in which service user and other stakeholder involvement are central to each phase.

The era of the wandering mind? Twenty-first century research on self-generated mental activity

The first decade of the twenty-first century was characterized by renewed scientific interest in self-generated mental activity (activity largely generated by the individual, rather than in direct response to experimenters’ instructions or specific external sensory inputs). To understand this renewal of interest, we interrogated the peer-reviewed literature from 2003 to 2012 (i) to explore recent changes in use of terms for self-generated mental activity; (ii) to investigate changes in the topics on which mind wandering research, specifically, focuses; and (iii) to visualize co-citation communities amongst researchers working on self-generated mental activity. Our analyses demonstrated that there has been a dramatic increase in the term “mind wandering” from 2006, and a significant crossing-over of psychological investigations of mind wandering into cognitive neuroscience (particularly in relation to research on the default mode and default mode network). If our article concludes that this might, indeed, be the “era of the wandering mind,” it also calls for more explicit reflection to be given by researchers in this field to the terms they use, the topics and brain regions they focus on, and the research literatures that they implicitly foreground or ignore.

Diagnosis, diagnosis, diagnosis: towards DSM-5

The allocation of diagnoses in psychiatry has always been controversial. Diagnoses usually indicate possible treatments, as well as determining who will receive support from health and social services. Some regard the formulation and sharing of a psychiatric diagnosis as itself therapeutic, in that psychological symptoms can be given meaning and effectively discussed with the patient (e.g., Brody & Waters, 1980). However, detractors also comment on how diagnosis can medicalize patterns of behaviour (Conrad, 2007) as well as the human condition itself (Chodoff, 2002), compound stigma (Sartorius, 2002), pre-determine which interventions are deemed appropriate, and also narrowly define the frameworks through which mental health problems might be addressed. The production of an updated diagnostic manual exposes these controversies, and this has certainly been the case in recent discussions of the forthcoming fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association. Initially, we were led to believe that there would be sweeping changes that would include an increased ‘‘dimensional’’ rather than categorical approach to disorders that would better describe phenomena that are continuous and lacking clear boundaries, and would allow clinicians a rating of severity. However, this emphasis has decreased over time. Along the way, there have been critics of the confidentiality agreements that have to be signed by the working group members (see Collier, 2010), the rush to field trials before the end of the process, and also the likelihood that sub-syndromal diagnoses will be introduced. The initial drafts of the diagnostic system are now available for public review and comment (www.dsm5.org), with the expectation of version five of the manual (known as DSM–5) being published in May 2013. It is important to stress that changes in the manual are backed up by informed opinion, complex negotiations between committee members, as well as clear research evidence, and that there is usually a force of conservatism that prevents major changes. This is clear in looking at the current release. However, even small changes can have unintended consequences. Changes to the previous version seem to have contributed to three false positive ‘‘epidemics’’ (Frances, 2010) – high rates of attention deficit hyperactivity disorder, autistic disorder, and childhood bipolar disorders. Clearly, there were other factors that also contributed, in particular drug companies marketing drugs for these diagnoses directed not only at doctors