It's better to connect and collaborate

In de media is recentelijk veel aandacht voor de schaduwzijde van de democratie en disfunctioneren van het openbaar bestuur. Bij veel mensen is immers sprake van een toenemend wantrouwen in de politiek. Ook wetenschappelijke publicaties signaleren een afnemend vertrouwen in politieke instituties en politici. In het publieke debat over democratie en politiek wordt derhalve regelmatig de vraag gesteld of we het democratisch bestel opnieuw moeten uitvinden. Het dichten van de (vertrouwens)kloof tussen burgers, hun politieke vertegenwoordigers en de ambtelijke uitvoering lijkt aldus een van de meest fundamentele uitdagingen voor alle westerse democratieën. In dit essay verkennen we een mogelijke oplossing voor deze kloof, gebaseerd op praktische ervaringen opgedaan in de gemeente Utrechtse Heuvelrug. Het essay is gebaseerd op de studie ”From competition and collusion to consent-based collaboration: a case study of local democracy”, recentelijk gepubliceerd in de International Journal of Public Administration.In de media is recentelijk veel aandacht voor de schaduwzijde van de democratie en het disfunctioneren van het openbaar bestuur. Bij veel mensen is immers sprake van een toenemend wantrouwen in de politiek, en ook veel wetenschappelijke publicaties signaleren een afnemend vertrouwen in politieke instituties en politici. Het dichten van de kloof tussen burgers, hun politieke vertegenwoordigers en de ambtelijke uitvoering lijkt aldus een van de meest fundamentele uitdagingen voor alle westerse democratieën. In dit essay verkennen we een mogelijke oplossing voor deze kloof, gebaseerd op ervaringen opgedaan in de gemeente Utrechtse Heuvelrug.<br/

Making sense of voices: a case series

The current evidence-base for the psychological treatment of distressing voices indicates the need for further clinical development. The Maastricht approach (also known as Making Sense of Voices) is popular within sections of the Hearing Voices Movement, but its clinical effectiveness has not been systematically evaluated. The aim of the approach is to develop a better understanding of the role of the voice, in part through opening a dialogue between the voice hearer and the voice. The current study was a (N=15) case series adopting a concurrent multiple baseline design. The Maastricht approach was offered for up to 9-months. The main outcome, weekly voice-related distress ratings, was not statistically significant during intervention or follow-up, although the effect size was in the moderate range. The PSYRATS Hallucination scale was associated with a large effect size both at the end of treatment, and after a 3-month follow-up period, although again the effect did not reach statistical significance. The results suggest further evaluation of the approach is warranted. However, given the large variance in individual participant outcome, it may be that a better understanding of response profiles is required before conducting a definitive randomised controlled trial

Madness decolonized?: Madness as transnational identity in Gail Hornstein’s Agnes’s Jacket

The US psychologist Gail Hornstein’s monograph Agnes’s Jacket: A Psychologist’s Search for the Meanings of Madness (2009) is an important intervention in the identity politics of the mad movement. Hornstein offers a resignified vision of mad identity that embroiders the central trope of an “anti-colonial” struggle to reclaim the experiential world “colonized” by psychiatry. A series of literal and figurative appeals make recourse to the inner world and (corresponding) cultural world of the mad, as well as to the ethno-symbolic cultural materials of dormant nationhood. This rhetoric is augmented by a model in which the mad comprise a diaspora without an origin, coalescing into a single transnational community. The mad are also depicted as persons displaced from their metaphorical homeland, the “inner” world “colonized” by the psychiatric regime. There are a number of difficulties with Hornstein’s rhetoric, however. Her “ethnicity-and-rights” response to the oppression of the mad is symptomatic of Western parochialism, while her proposed transmutation of putative psychopathology from limit upon identity to parameter of successful identity is open to contestation. Moreover, unless one accepts Hornstein’s porous vision of mad identity, her self-ascribed insider status in relation to the mad community may present a problematic “re-colonization” of mad experience

A controlled study of temporal lobe structure volumes and P300 responses in schizophrenic patients with persistent auditory hallucinations

Recent studies of cerebral pathology in patients with schizophrenia have focused on symptomatological and electrophysiological correlates of reduced temporal lobe structure volumes. Volume deficits of the left superior temporal gyrus have been correlated with auditory hallucinations as well as to left-sided P300 amplitude reduction. However, caution is needed to interpret correlational data as evidence of a specific relationship. Therefore, a controlled study was undertaken on schizophrenic patients with and without auditory hallucinations. MRI-defined volumes of the left superior temporal gyrus and other temporal lobe structures were quantified from 3-mm coronal slices in 15 schizophrenic patients with chronic auditory hallucinations (hallucinators), 15 schizophrenic patients without auditory hallucinations (nonhallucinators) and 17 healthy controls. In all subjects a simple oddball paradigm was used to elicit P300 responses at temporal and centro-parietal electrode sites. No evidence was found for volume reductions of temporal lobe structures in the combined patient group compared with controls, or in the hallucinators compared with the nonhallucinators. The patients did show left P300 amplitude reduction compared with controls, particularly in the hallucinator group. Correlations between volumes of left temporal lobe structures and left P300 amplitudes were low and not significant. The results of the present study do not indicate that auditory hallucinations and associated abnormal electrophysiological activity are the consequence of atrophy of localized temporal lobe structures. However, replication in a larger sample of subjects is needed before firm conclusions can be drawn

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’

Shame, social deprivation, and the quality of the voice-hearing relationship.

OBJECTIVES: Many individuals hold different beliefs about the voices that they hear and have distinct relationships with them, the nature of which may determine the distress experienced. Understanding what factors contribute to these beliefs and relationships and consequently the resulting distress is important. The current research examined whether shame and social deprivation, in a sample of adult voice-hearers, were related to the relationships that individuals had with their voices or the beliefs that they held about them. DESIGN: The study utilized a cross-sectional, Internet-based design. METHODS: Eighty-seven adult voice-hearers from England were recruited to the online survey. Participants completed measures regarding shame, beliefs about voices, and relationships with voices and provided demographic information and postcodes that were used to refer to Index of Multiple Deprivation data. RESULTS: Social deprivation and shame were not associated. Shame was positively associated with variables describing negative voice-hearing beliefs/relationships but not positive voice-hearing beliefs/relationships. Principal component analysis on the eight voice-hearing variables yielded two components related to positive and negative voice-hearing qualities. A multiple regression conducted on the two components identified that shame was only associated with negative voice-hearing qualities. CONCLUSIONS: The results suggest that therapies that target shame may be helpful when working with negative voice-hearing beliefs and relationships. Future research should utilize experimental or longitudinal designs to examine the direction of the relationship. PRACTITIONER POINTS: The results contribute to the limited research evidence available regarding the relationship between shame and voice-hearing. The results suggest the utility of psychological therapies that focus on shame such as compassion-focused therapy and that conceptualize voices interpersonally such as cognitive analytic therapy. No conclusions can be made regarding causation. The sample size was relatively small, and results cannot be generalized to other areas of the United Kingdom. Future research should utilize experimental and longitudinal designs to examine the impact of shame on voice-hearing experiences and to examine other factors that may predict shame

Aspen Recruitment in the Yellowstone Region Linked to Reduced Herbivory After Large Carnivore Restoration

Quaking aspen (Populus tremuloides) recruitment during the 1980s–90s was suppressed by Rocky Mountain elk (Cervus canadensis) herbivory on winter ranges in the Yellowstone region, and saplings (young aspen taller than 2 m) were rare. Following the 1995–96 reintroduction of gray wolves (Canis lupus), browsing decreased and sapling recruitment increased in Yellowstone National Park. We compared aspen data from inside the park to data collected in three winter ranges outside the park. For most areas, the percentage of young aspen browsed annually was 80–100% in 1997–98, decreasing to 30–60% in 2011–15. Sapling recruitment was inversely correlated with browsing intensity, and increased despite climate trends unfavorable for aspen. Browsing decreased with decreasing elk density, a relationship suggesting that densities greater than about 4 elk/km2 resulted in consistently strong browsing effects likely to suppress aspen recruitment. Changes in elk density and distribution were influenced by predators, as well as human hunters. Most evidence for trophic cascades involving large terrestrial mammals has been from protected areas within national parks. This study provides evidence of widespread changes in plant communities resulting from large carnivore restoration, extending outside a protected national park to areas with hunting, livestock grazing, and other human activities