Psychopolitics: Peter Sedgwick’s legacy for mental health movements

This paper re-considers the relevance of Peter Sedgwick's Psychopolitics (1982) for a politics of mental health. Psychopolitics offered an indictment of ‘anti-psychiatry’ the failure of which, Sedgwick argued, lay in its deconstruction of the category of ‘mental illness’, a gesture that resulted in a politics of nihilism. ‘The radical who is only a radical nihilist’, Sedgwick observed, ‘is for all practical purposes the most adamant of conservatives’. Sedgwick argued, rather, that the concept of ‘mental illness’ could be a truly critical concept if it was deployed ‘to make demands upon the health service facilities of the society in which we live’. The paper contextualizes Psychopolitics within the ‘crisis tendencies’ of its time, surveying the shifting welfare landscape of the subsequent 25 years alongside Sedgwick's continuing relevance. It considers the dilemma that the discourse of ‘mental illness’ – Sedgwick's critical concept – has fallen out of favour with radical mental health movements yet remains paradigmatic within psychiatry itself. Finally, the paper endorses a contemporary perspective that, while necessarily updating Psychopolitics, remains nonetheless ‘Sedgwickian’

Narrative, identity, and recovery from serious mental illness: A life history of a runner

In recent years, researchers have investigated the psychological effects of exercise for people with mental health problems, often by focusing on how exercise may alleviate symptoms of mental illness. In this article I take a different tack to explore the ways in which exercise contributed a sense of meaning, purpose, and identity to the life of one individual named Ben, a runner diagnosed with schizophrenia. Drawing on life history data, I conducted an analysis of narrative to explore the narrative types that underlie Ben's stories of mental illness and exercise. For Ben, serious mental illness profoundly disrupted a pre-existing athletic identity removing agency, continuity, and coherence from his life story. By returning to exercise several years later, Ben reclaimed his athletic identity and reinstated some degree of narrative agency, continuity, and coherence. While the relationships between narrative, identity, and mental health are undoubtedly complex, Ben's story suggests that exercise can contribute to recovery by being a personally meaningful activity which reinforces identity and sense of self

Examiner training: A study of examiners making sense of norm-referenced feedback

PURPOSE: Examiner training has an inconsistent impact on subsequent performance. To understand this variation, we explored how examiners think about changing the way they assess. METHOD: We provided comparative data to 17 experienced examiners about their assessments, captured their sense-making processes using a modified think-aloud protocol, and identified patterns by inductive thematic analysis. RESULTS: We observed five sense-making processes: (1) testing personal relevance (2) interpretation (3) attribution (4) considering the need for change, and (5) considering the nature of change. Three observed meta-themes describe the manner of examiners' thinking: Guarded curiosity - where examiners expressed curiosity over how their judgments compared with others', but they also expressed guardedness about the relevance of the comparisons; Dysfunctional assimilation - where examiners' interpretation and attribution exhibited cognitive anchoring, personalization, and affective bias; Moderated conservatism - where examiners expressed openness to change, but also loyalty to their judgment-framing values and aphorisms. CONCLUSIONS: Our examiners engaged in complex processes as they considered changing their assessments. The 'stabilising' mechanisms some used resembled learners assimilating educational feedback. If these are typical examiner responses, they may well explain the variable impact of examiner training, and have significant implications for the pursuit of meaningful and defensible judgment-based assessment

How often should we monitor for reliable detection of atrial fibrillation recurrence? Efficiency considerations and implications for study design

OBJECTIVE: Although atrial fibrillation (AF) recurrence is unpredictable in terms of onset and duration, current intermittent rhythm monitoring (IRM) diagnostic modalities are short-termed and discontinuous. The aim of the present study was to investigate the necessary IRM frequency required to reliably detect recurrence of various AF recurrence patterns. METHODS: The rhythm histories of 647 patients (mean AF burden: 12±22% of monitored time; 687 patient-years) with implantable continuous monitoring devices were reconstructed and analyzed. With the use of computationally intensive simulation, we evaluated the necessary IRM frequency to reliably detect AF recurrence of various AF phenotypes using IRM of various durations. RESULTS: The IRM frequency required for reliable AF detection depends on the amount and temporal aggregation of the AF recurrence (p<0.0001) as well as the duration of the IRM (p<0.001). Reliable detection (>95% sensitivity) of AF recurrence required higher IRM frequencies (>12 24-hour; >6 7-day; >4 14-day; >3 30-day IRM per year; p<0.0001) than currently recommended. Lower IRM frequencies will under-detect AF recurrence and introduce significant bias in the evaluation of therapeutic interventions. More frequent but of shorter duration, IRMs (24-hour) are significantly more time effective (sensitivity per monitored time) than a fewer number of longer IRM durations (p<0.0001). CONCLUSIONS: Reliable AF recurrence detection requires higher IRM frequencies than currently recommended. Current IRM frequency recommendations will fail to diagnose a significant proportion of patients. Shorter duration but more frequent IRM strategies are significantly more efficient than longer IRM durations. CLINICAL TRIAL REGISTRATION URL: Unique identifier: NCT00806689

Harmonic BRST Quantization of Systems with Irreducible Holomorphic Boson and Fermion Constraints

We show that the harmonic Becchi-Rouet-Stora-Tyutin method of quantizing bosonic systems with second-class constraints or first-class holomorphic constraints extends to systems having both bosonic and fermionic second-class or first-class holomorphic constraints. Using a limit argument, we show that the harmonic BRST modified path integral reproduces the correct Senjanovic measure.Comment: 11 pages, phyzz

Trauma as counter-revolutionary colonisation: narratives from (post)revolutionary Egypt

We argue that multiple levels of trauma were present in Egypt before, during and after the 2011 revolution. Individual, social and political trauma constitute a triangle of traumatisation which was strategically employed by the Egyptian counter-revolutionary forces – primarily the army and the leadership of the Muslim Brotherhood – to maintain their political and economic power over and above the social, economic and political interests of others. Through the destruction of physical bodies, the fragmentation and polarisation of social relations and the violent closure of the newly emerged political public sphere, these actors actively repressed the potential for creative and revolutionary transformation. To better understand this multi-layered notion of trauma, we turn to Habermas’ ‘colonisation of the lifeworld’ thesis which offers a critical lens through which to examine the wider political and economic structures and context in which trauma occurred as well as its effects on the personal, social and political realms. In doing so, we develop a novel conception of trauma that acknowledges individual, social and political dimensions. We apply this conceptual framing to empirical narratives of trauma in Egypt’s pre- and post-revolutionary phases, thus both developing a non-Western application of Habermas’ framework and revealing ethnographic accounts of the revolution by activists in Cairo

The construction of identities in narratives about serious leisure occupations

Engagement in occupation contributes to the shaping of identity throughout the human life. The act of telling about such engagement involves interaction based on symbolic meaning; the speaker constructing an identity by conveying how the occupation is personally meaningful. This study explored meaning in narratives told by people who engage in serious leisure occupations. A total of 78 narratives were extracted from interviews with 17 people who invest considerable time and other resources into their leisure. Analysis focused on the content, structure and performance of each narrative in order to explore meaning. The meanings were organised into a framework based around three dimensions: the located self, the active self and the changing self. Each dimension has facets that the individual might emphasise, constructing a unique identity. The framework offers a structured basis for conceptualising how occupation contributes to the shaping of the internalised self and the socially situated identity

Phase Space Reduction and Vortex Statistics: An Anyon Quantization Ambiguity

We examine the quantization of the motion of two charged vortices in a Ginzburg--Landau theory for the fractional quantum Hall effect recently proposed by the first two authors. The system has two second-class constraints which can be implemented either in the reduced phase space or Dirac-Gupta-Bleuler formalism. Using the intrinsic formulation of statistics, we show that these two ways of implementing the constraints are inequivalent unless the vortices are quantized with conventional statistics; either fermionic or bosonic.Comment: 14 pages, PHYZZ