Gendering and schizophrenia: Negotiating power relations, gender understandings and experience in psychiatric/patient interactions

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University.This thesis uses a discursive approach to examine psychiatric understandings of gender and schizophrenia in clinical encounters between professionals and patients. Chief reasons for undertaking the research were an unease about the concept of schizophrenia and a lack of attention to interactive psychiatric contexts in feminist work on gender and madness. This study attempts to move beyond explanations of schizophrenia as a label or social product to analyse the intersections between femininity, masculinity, and schizophrenia accomplished within psychiatric/patient interactions. Drawing on case conference discussions in a British psychiatric unit, I argue that the interplay between locally accomplished power and the broader mandate of community care produces co-existing relations of benevolent psychiatry/responsible patient, and supervisory psychiatry/ untrustworthy patient, and considerable professional persuasion and patient resistance at this local level. Within these relations, understandings of femininity and (masculine) personhood produce a plurality of meanings of emotion, activity, and (in)dependence. The experiences of patients and their significant others are fluid and complex resources (re)configured in gendered relational terms to inform the restoration of lives and definitions of trouble. The central argument is that schizophrenia is not applied as a label but operates largely as a background understanding. Professional assumptions about schizophrenia, not gender, inform discourses of responsibility, consumerism and supervision, whereas professional discourses of femininity and (masculine) personhood intersect with understandings of schizophrenia to differentiate and delimit restoration to purpose and autonomy. But professionals' understandings of femininity and masculinity, not schizophrenia, inform definitions of trouble: negative understandings of femininity are associated with blame and change; those of masculinity with excusing and unchangeability. Contemporary psychiatry is more concerned with encouraging self-regulation and restoring lives than straightforward social control and gender conformity. But gender understandings remain salient to contemporary psychiatry and, in relation to schizophrenia, gender differentiations in local interactions run counter to schizophrenia's distributional gloss of gender neutrality

Methodology for taking a computer-aided breast cancer screening system from the laboratory to the marketplace

Breast cancer is one of the most common causes of death in women, and yet is one of the more 'curable' cancers if caught early. Since its inception in 1987, the Breast Screening Programme has been the principal tool in the National Health Service's fight to reduce the number of cancer related deaths in the UK. Breast screening using mammography is widely viewed as the most effective way of detecting early breast cancer, with the UK population of women over the age of 50 being invited to a screening session every three years. However, national shortages of clinical staff willing to enter and remain in this field mean that the NHS Breast Screening Programme is severely understaffed. This thesis discusses one way in which technology can assist in the screening programme; specifically, the use of a computer-aided cancer detection system. Here, we will present the design and analysis of a sequence of experiments used to develop and evaluate such a system. PROMAM (PROmpting for MAMmography) involved the scanning and digitising of mammograms, and the subsequent analysis of the digital image by a series of algorithms. Initial evaluation was done to ensure that the algorithms were performing satisfactorily at a technical level before being introduced into a clinical setting. Two large experiments with the algorithms were designed and evaluated: 1. offering radiologists three levels of algorithm prompting and, as a control, an unprompted level, on samples of mammographic films, with outcomes being their recall rate and subjective views at each prompting level, 2. a pre-clinical experiment, conducted under semi-clinical conditions, where two readers would see a batch of films seeded with higher than normal numbers of cancers, with readers allocated randomly to prompted and unprompted views of films. The first experiment was designed using a Graeco-Latin Square, with three 'nuisance' variables and the treatment factor of prompting levels (no prompts, low level of prompt¬ ing, medium and high). Four radiologists read at each level of prompting once, on dif¬ ferent sets of films. One of the more interesting results was that the recall rate did not increase as the prompting rate rose - contrary to prior expectations. Most of the differ¬ ences seen between the prompting rates could be explained as radiologist differences. Once these were taken into account, the level of prompting had little effect. Addition¬ ally, although the time taken to read a set of films increased as the prompting rate increased (as would be expected), it was only an increase of 26% from the unprompted set to the set with the highest number of prompts. Observational data suggested that the lowest level of prompting was not maintaining the interest of the radiologist, thus leading them to neglect the prompts. The following experiment moved the system a step closer to a true clinical demonstra¬ tion of the efficacy of PROMAM, being conducted under semi-clinical conditions. Using a method of minimisation, the number of cancers each radiologist viewed as first reader, second reader, prompted or unprompted were balanced. Preliminary exploratory anal¬ ysis indicated that the recall rate declined with the introduction of the prompting system, but more detailed, analysis indicated that much of this difference was due to a radiologist effect. Although cancer detection was slightly lower with the prompting system, examination of the 11 cancers missed by the prompted radiologist showed that six of these had been correctly prompted by the algorithms. This demonstrated scope to improve the cancer detection rate by nearly 5%. These experiments determined the 'production' version of the prompting system. A design to evaluate the system in a sample of 100,000 women in six centres was produced, but due to circumstances beyond the project team's control, it was not possible to take this work to the stage of a full 'trial' of the system. The design concept can, however, apply to the evaluation of any similar prompting system. The recommended design is therefore presented, together with an analysis of data from a simulated application of this design. This simulation has allowed recommendations to be made on the most appropriate ways to analyse the extensive and complicated dataset that will be obtained. In particular, it identified technical problems that can arise from the application on one candidate analytical method, and an explanation for the failure obtained It is quite clear from the evidence presented in this thesis that there is much scope for improvement in the cancer detection rate by the use of a prompting system, with¬ out a corresponding loss in the specificity. With the shortage of radiologists and ra¬ diographers, and the increasing demand placed on the Breast Screening Programme, technology could play a beneficial role in screening for breast cancer in the coming year

Using intervention mapping to develop and adapt a secondary stroke prevention program in Veterans Health Administration medical centers

Secondary stroke prevention is championed by the stroke guidelines; however, it is rarely systematically delivered. We sought to develop a locally tailored, evidence-based secondary stroke prevention program. The purpose of this paper was to apply intervention mapping (IM) to develop our locally tailored stroke prevention program and implementation plan. We completed a needs assessment and the five Steps of IM. The needs assessment included semi-structured interviews of 45 providers; 26 in Indianapolis and 19 in Houston. We queried frontline clinical providers of stroke care using structured interviews on the following topics: current provider practices in secondary stroke risk factor management; barriers and needs to support risk factor management; and suggestions on how to enhance secondary stroke risk factor management throughout the continuum of care. We then describe how we incorporated each of the five Steps of IM to develop locally tailored programs at two sites that will be evaluated through surveys for patient outcomes, and medical records chart abstraction for processes of care

Changing Attitudes About Being a Bystander to Violence: Translating an In-Person Sexual Violence Prevention Program to a New Campus

Bystander approaches to reducing sexual violence train community members in prosocial roles to interrupt situations with risk of sexual violence and be supportive community allies after an assault. This study employs a true experimental design to evaluate the effectiveness of Bringing in the Bystander™ through 1-year post-implementation with first-year students from two universities (one rural, primarily residential; one urban, heavily commuter). We found significant change in bystander attitudes for male and female student program participants compared with the control group on both campuses, although the pattern of change depended on the combination of gender and campus

Changing Attitudes About Being a Bystander to Violence: Translating an In-Person Sexual Violence Prevention Program to a New Campus

Bystander approaches to reducing sexual violence train community members in prosocial roles to interrupt situations with risk of sexual violence and be supportive community allies after an assault. This study employs a true experimental design to evaluate the effectiveness of Bringing in the Bystander™ through 1-year post-implementation with first-year students from two universities (one rural, primarily residential; one urban, heavily commuter). We found significant change in bystander attitudes for male and female student program participants compared with the control group on both campuses, although the pattern of change depended on the combination of gender and campus

The Ursinus Weekly, November 21, 1969

250,000 march on Washington to protest Nixon\u27s Viet War effort: 1965 Ursinus graduate leads Moratorium parade in US Air Force attire • 3 frosh injured in auto accident • Pre Med Convention tours Temple U. medical school • Ecumenism experiment now underway at U.C. • Editorials: The thrill of victory; When will it end? • Focus: Tom Branca • Liberate the nut • Letters to the editor: Campus Chest; Gripe; Never ending; Change; Mr. Faaet • Faculty portrait: F. Donald Zucker • Equality • Administration answers: Freedom of assembly • Coffee house conquers • Spotlight: Collegeville cop • I am curious (Morris) shocks Ursinus audience • Contemplations: Red neck kit • Security system • Hitch-hiking Bear Harriers victorious, finish dual meet season with 11-1 mark • Bearettes all make All-College • Gridders best since 1931 • Bears should be MAC champs • Dickinson edged by UC 21-20 • Centennial Football Day at Ursinushttps://digitalcommons.ursinus.edu/weekly/1152/thumbnail.jp

Six propositions on the sonics of pornography

Pornography (and all its contentious pleasures, contested politics and attendant problematics) is enjoying a fresh wave of academic attention. The overwhelming majority of these studies, however, focus on the visual discourses of sexually explicit material. This risks the sonic dimensions of pornography being overlooked entirely. Yet porn is anything but silent. This speculative article maps out some of the ways in which the sounds of pornography (and the pornography of sound) might be approached in the analytical context of gay male culture. Not only do the texts of porn contain assorted sounds (dialogue, soundtracks, non-verbal noises of participation, background and accidental audio), they also seek to prompt sounds (not least the non-verbal noises pornography seeks to elicit during the moments of its consumption) and sometimes depend on sound alone (telephone lines that allow access to recorded narratives or ‘live’ chat). Pornography speaks in particular accents, it mobilizes particular music, it dances to particular tunes and it relies on the pants we hear as much as the pants we see. If queer cultures have their own distinctive worlds of sound, then the sonic armouries of porn play a prominent role within them