The body as image: image as body

Pain consultations are often contested spaces where patient and clinician compete for the roles of speaker. Often patients are searching for mechanical explanations and clinicians for psychological ones - creating an impasse and causing distress to both parties. Meanwhile, as technology advances and we have increasing means of seeing inside a person’s body we seem to have less and less ability to see inside another’s world – to understand what it means to live with pain, the significance of that pain for that individual in their social context. In this paper we explore the potential for images of pain, co-created with patients, to intervene in this unproductive patient dynamic and bring the full experience of pain - social, emotional, physical - into focus. Narrative analysis is used on a series of transcripts of pain consultations

New Contexts: what art psychotherapy theory can bring to an understanding of using images to communicate the experience of pain in medical pain consultations

This paper looks at whether we can bring art psychotherapy theory to understanding the role of art in a new context; the medical pain consultation, as part of an experimental arts in health research project. The project studied the introduction of a set of art images into chronic pain consultations, to help patients and doctors communicate complex experiences of pain. The paper draws on different theoretical approaches from art psychotherapy, to provide ways to understand the meanings of an art object introduced between two people. Triangular relating, symbolisation and transactional uses of the image are explored (Isserow 2008, 2013, Schaverien 1991,1995, 2000). The image is also considered within a social frame and from an intersubjective viewpoint (Tipple 2003, 2011, Skaife 2008). The images were artistic depictions of pain, previously co-created by other pain patients with an artist as a communication resource. Videos of consultations where doctors and patients used these images were studied. The paper takes case examples of features observed in a thematic analysis and uses art psychotherapy theories to explore them further. Suggested implications are that using images in this setting may allow negotiation of unconscious dynamics between clinician and patient and have potential to aid communication and empower patients, suggesting avenues for future research. The potentials and limitations of bringing theory to this context are considered. The research took place within a multidisciplinary team

Images as catalysts for meaning-making in medical pain encounters: a multidisciplinary analysis

The challenge for those treating or witnessing pain is to find a way of crossing the chasm of meaning between them and the person living with pain. This paper proposes that images can strengthen agency in the person with pain, particularly but not only in the clinical setting, and can create a shared space within which to negotiate meaning. It draws on multidisciplinary analyses of unique material resulting from two fine art/medical collaborations in London, UK, in which the invisible experience of pain was made visible in the form of co-created photographic images, which were then made available to other patients as a resource to use in specialist consultations. In parallel with the pain encounters it describes, the paper weaves together the insights of specialists from a range of disciplines whose methodologies and priorities sometimes conflict and sometimes intersect to make sense of each other’s findings. A short section of video footage where images were used in a pain consultation is examined in fine detail from the perspective of each discipline. The analysis shows how the images function as ‘transactional objects’ and how their use coincides with an increase in the amount of talk and emotional disclosure on the part of the patient and greater non-verbal affiliative behaviour on the part of the doctor. These findings are interpreted from the different disciplinary perspectives, to build a complex picture of the multifaceted, contradictory and paradoxical nature of pain experience, the drive to communicate it and the potential role of visual images in clinical settings

A Democratic Licence to Operate: Report of the Independent Surveillance Review

The British population has been greatly affected by the rapid evolution in information and communications technology. In this digital society, we all leave extensive traces of our behaviour and interactions in the course of our normal, everyday lives. We have unprecedented opportunities to express ourselves, to connect and share knowledge, to be prosperous and inventive. At the same time, the digital society also presents new challenges, making citizens potential targets for fraudsters, criminals and possibly terrorists. The task for the police and SIAs has become more demanding as they try to stay abreast of rapid technological innovation and deal with threats that emanate from across the globe. It is important to ensure that the powers granted to these agencies to protect the public are explicit, comprehensible, and are seen to be both lawful and consistent with democratic values. The citizen’s right to privacy online as offline – and what constitutes a ‘justifiable’ level of intrusion by the state – has become a central topic of debate. As traditional notions of national security and public safety compete with the realities of digital society, it is necessary to periodically renew the licence of the police, security and intelligence agencies to operate. This report aims to enable the public at large to engage in a more informed way in the debate, so that a broad consensus can be achieved and a new, democratic licence to operate can be agreed

Cow's Milk Fat Obesity pRevention Trial (CoMFORT): a primary care embedded randomised controlled trial protocol to determine the effect of cow's milk fat on child adiposity.

INTRODUCTION: Cow's milk is a dietary staple for children in North America. Though clinical guidelines suggest children transition from whole (3.25% fat) milk to reduced (1% or 2%) fat milk at age 2 years, recent epidemiological evidence supports a link between whole milk consumption and lower adiposity in children. The purpose of this trial is to determine which milk fat recommendation minimises excess adiposity and optimises child nutrition and growth. METHODS AND ANALYSIS: Cow's Milk Fat Obesity pRevention Trial will be a pragmatic, superiority, parallel group randomised controlled trial involving children receiving routine healthcare aged 2 to 4-5 years who are participating in the TARGet Kids! practice-based research network in Toronto, Canada. Children (n=534) will be randomised to receive one of two interventions: (1) a recommendation to consume whole milk or (2) a recommendation to consume reduced (1%) fat milk. The primary outcome is adiposity measured by body mass index z-score and waist circumference z-score; secondary outcomes will be cognitive development (using the Ages and Stages Questionnaire), vitamin D stores, cardiometabolic health (glucose, high-sensitivity C-reactive protein, non-high density lipoprotein (non-HDL), low density lipoprotein (LDL), triglyceride, HDL and total cholesterol, insulin and diastolic and systolic blood pressure), sugary beverage and total energy intake (measured by 24 hours dietary recall) and cost effectiveness. Outcomes will be measured 24 months postrandomisation and compared using analysis of covariance (ANCOVA), adjusting for baseline measures. ETHICS AND DISSEMINATION: Ethics approval has been obtained from Unity Health Toronto and The Hospital for Sick Children. Results will be presented locally, nationally and internationally and published in a peer-reviewed journal. The findings may be helpful to nutrition guidelines for children in effort to reduce childhood obesity using a simple, inexpensive and scalable cow's milk fat intervention. TRIAL REGISTRATION NUMBER: NCT03914807; pre-results

Organizing to counter terrorism: sensemaking amidst dynamic complexity

publication-status: Acceptedtypes: ArticlePre-print draft (version 1). ‘The final, definitive version of this paper has been published in Human Relations September 2013 66(9): 1201–1223, by SAGE Publications Ltd, All rights reserved. © [The Author]Organizations increasingly find themselves contending with circumstances that are suffused with dynamic complexity. So how do they make sense of and contend with this? Using a sensemaking approach, our empirical case analysis of the shooting of Mr Jean Charles de Menezes shows how sensemaking is tested under such conditions. Through elaborating the relationship between the concepts of frames and cues, we find that the introduction of a new organizational routine to anticipate action in changing circumstances leads to discrepant sensemaking. This reveals how novel routines do not necessarily replace extant ones but instead, overlay each other and give rise to novel, dissonant identities which in turn can lead to an increase in equivocality rather than a reduction. This has important implications for sensemaking and organizing amidst unprecedented circumstances

Through a Glass, Darkly:The CIA and Oral History

This article broaches the thorny issue of how we may study the history of the CIA by utilizing oral history interviews. This article argues that while oral history interviews impose particular demands upon the researcher, they are particularly pronounced in relation to studying the history of intelligence services. This article, nevertheless, also argues that while intelligence history and oral history each harbour their own epistemological perils and biases, pitfalls which may in fact be pronounced when they are conjoined, the relationship between them may nevertheless be a productive one. Indeed, each field may enrich the other provided we have thought carefully about the linkages between them: this article's point of departure. The first part of this article outlines some of the problems encountered in studying the CIA by relating them to the author's own work. This involved researching the CIA's role in US foreign policy towards Afghanistan since a landmark year in the history of the late Cold War, 1979 (i.e. the year the Soviet Union invaded that country). The second part of this article then considers some of the issues historians must confront when applying oral history to the study of the CIA. To bring this within the sphere of cognition of the reader the author recounts some of his own experiences interviewing CIA officers in and around Washington DC. The third part then looks at some of the contributions oral history in particular can make towards a better understanding of the history of intelligence services and the CIA