After geneticization

The concept of geneticization belongs to a style of thinking within the social sciences that refers to wide-ranging processes and consequences of genetic knowledge. Lippman’s original use of the term was political, anticipating the onerous consequences of genetic reductionism and determinism, while more recent engagements emphasise the productivity and heterogeneity of genetic concepts, practices and technologies. This paper reconstructs the geneticization concept, tracing it back to early political critiques of medicine. The argument is made that geneticization belongs to a style of constructionist thinking that obscures and exaggerates the essentializing effects of genetic knowledge. Following Hacking’s advice, we need a more literal sense of construction in terms of ‘assembly’ to give a clearer account of the relationship between processes and products. Using the ‘assemblage’ concept to explore the social ontology of genetics, the paper reviews three areas of the empirical literature on geneticization – disease classification, clinical practice and biosociality – to show that a new style of thinking has appeared within the social sciences. In the final assessment, the conditions that gave rise to geneticization are now obsolete. While it may serve as a useful ritual of debate, conceptually geneticization offers a limited account of the heterogeneity of socio-technical change

Beyond pessimism: the dialectic of promise and complexity in genomic research

How should we reflect upon the last 10 years since the completion of the human genome? One dominant response from within the humanities and the social sciences is to cast these events within a dialectic of promise and disappointment. Indeed, this contrast would seem to hold if we take Clinton’s historic announcement as our point of departure. I choose an alternative departure: not in the rhetoric of press releases but from scientists’ ambivalent accounts of complexity. Perhaps a dialectic of promise and complexity is a less pessimistic (but no less sceptical) way of reflecting on what has happened in the last 10 years. In this paper, I focus on two aspects of societal change within the ‘urban zone’: the rise of population-based biobanking and the marketisation of genetic susceptibility testing. Both developments are driven by the promise that genomic research will lead to new ways to ‘prevent, diagnose, treat and cure disease’. However, genomic knowledge also reveals a level of complexity that has led to unprecedented scale in the production of granular information. In the last 10 years we have seen that traditional bioethics has struggled to cope with this scale. In the era of high-throughput sequencing and personal genomics, we have also seen that translating complexity into benefits for the health consumer is controversial. Arguably, ethical principles do not capture the subtle differences between predictive and susceptibility testing, and that more empirical research is needed to understand how people perceive and communicate complex risk information

Caring through things at a distance: intimacy and presence in teletherapy assemblages

The COVID‐19 crisis in the UK precipitated a sharp rise in the use of remote technologies to provide therapy during the lockdown. With mental health care services migrating to devices and video‐conferencing platforms, nearly all forms of therapy had become ‘teletherapy’. Drawing on interviews with UK‐based practitioners, this paper explores how existing ideas of intimacy and presence are challenged when care is practiced at a distance. Against the background of concerns that remote technologies erode intimacy and degrade physical presence, the argument is made that presence, distance, intimacy and control are reconfigured within mediated therapy. Analysis of practitioners’ experiences of teletherapy examines the material and expressive components of ‘assemblages’ characterised by their stable and fluid properties. Two assemblages are identified and discussed: emergency care assemblages and assemblages of intimacy, both of which are aligned with specific sectors of mental health care. Evidence that therapeutic encounters are constrained by technologies are considered alongside the material conditions and inequalities of vulnerable groups, while assemblages with relatively stable properties are generative of new ways of relating to clients online. These findings highlight the material and expressive components of human and nonhuman assemblages that create new kinds of affective relations in distanced care

On the medicalisation of welfare : towards a genealogy of dependency

The thesis combines genealogical investigation with an 'analytics of government' to diagnose present reforms of Australian Social Security. The Australian example poses a new diagram of knowledge/power relations linked to early nineteenth century debates on pauperism and poor policy. Characteristic of 'advanced' liberal government, social welfare is transformed from an income redistribution scheme to a behaviour modification regime. This raises serious implications for contemporary citizenship, subjectification and the apparent flexibility of wage-labour. By re-tracing modern welfare's conditions of possibility, the present is reconstructed to breach the naturalness and self-evidence with which we accept the current crisis of welfare as problems of 'community', 'dependency' and 'participation'. The case is made that present control strategies rapidly recycle clients into flexible wage-labour via human technologies that seek the ethical and moral reconstruction of the poor. But diagnosis is a limited enterprise if it fails to consult the experiences of those to which these reforms are applied. A discursive analysis of 12 interview participants deemed 'at risk' of welfare dependency explores themes of labour market activity, welfare regulation and practices of freedom to understand how welfare subjects manage and transform their lives. Interviews confirm the existence of discourses that reinscribe distinctions between the deserving and undeserving poor, intensify stigma of welfare receipt, and increase ambivalence about labour market security. Furthermore, a psychological subject emerges as one of two positions: it reactivates the pathologies of abject sectors of the population, while shoring-up capacities for rational self- management. Arguably, psychology has become a key technology for the ethical reconstruction of conduct and the calculated management of risk. Discourses of poverty are now recast as problems of 'the excluded' as welfare rationalities monitor and prevent behaviours that lead to market passivity. Like early nineteenth century statements on poverty, citizenship is now conditional upon moral improvement. And while neo-classical solutions have succeeded in moving the welfare debate away from contradictions of political economy, welfare reform risks producing a sector of the population that is low paid, casualised, under-protected from risk, insecure and desocialised

Ambient intelligence:a narrative in search of users (discussion paper)

The vision of Ambient Intelligence (AmI) was first developed in the late 1990s. It describes new worlds, economies and paradigms that emphasize the centrality of human experience, however, distinguished from related visions such as ubiquitous and pervasive computing. A key feature of the AmI vision are the seamless intelligent environments and gadgets, capable of anticipating people’s needs and motivations, and acting autonomously on their behalf. So what can be gleaned from exploring the conditions under which this innovation domain evolves over time and how it adapts to various criticisms and technical challenges? The AmI vision not only represents possible futures but actively creates the worlds in which AmI applications appear to be possible. Visionaries and research leaders build expectations, marshal resources and align key stakeholders. Promises and progressions toward realizing AmI have performative and generative features but the original promise of intelligence has largely failed. This outcome points to a two-sided problem. The definitional looseness of intelligence is permissive of what can be expected of the role and scope of artificial reasoning in AmI interaction paradigms, while ordinary human reasoning and knowing what people actually want and need remains persistently elusive. Grappling still with the problem of what the intelligence in Ambient Intelligence can stand for, research and development has shifted its focus toward the design of practical win-win solutions, coined synergetic prosperity

Professionals’ accounts of genetic testing in adoption: a qualitative study

Objective To explore social workers’ and medical advisors’ accounts of genetic testing in adoption. Methods A qualitative study using semi-structured interviews to gather in-depth accounts of retrospective cases. Data were analysed thematically to identify professionals’ knowledge and expectations. Results Twenty professionals working in adoption services (including 8 medical advisors and 12 social workers) participated in this study. Social workers adopted an essentialist (single-gene) model to discuss genetic testing in relation to past cases. They assumed that testing was a generic procedure for detecting the presence or absence of a specific aetiology, the results of which were believed to be definitive and mutually exclusive. By contrast, medical advisors were circumspect and agnostic about the meaning of results, especially in relation to chromosomal microarray testing. Whereas social workers believed that genetic testing provided clarity in assessment and therefore assisted adoption, medical advisors emphasised the uncertainties of testing and the possibility that prospective adopters might be misled. Medical advisors also reported inappropriate requests to test children where there was a family history of a genetic condition, or to confirm or exclude a diagnosis of fetal alcohol spectrum disorder in children presenting with non-specific dysmorphic features. Conclusion Recent advances in genetic technologies are changing the ways in which professionals understand and tolerate uncertainty in adoption. Social workers and medical advisors have different understandings and expectations about the clinical utility of genetic testing. These findings have implications for social work training about genetic testing and enabling effective communication between professional groups

Can genomics remove uncertainty from adoption? Social workers' and medical advisors' accounts of genetic testing

Genetic testing is controversial in adoption with professionals taking different positions on whether children should be protected from genetic information or whether it can be used to assist adoption. In this article, we argue that advances in ‘genome-wide’ testing add further complications to these debates. Although next-generation sequencing (NGS) and microarray-based technologies can offer high-quality molecular diagnoses for a variety of conditions, they also increase the burden of interpretation. For these reasons, adoption professionals will need to understand the relevance and complexity of biomedical information. Our study explores the accounts of social workers’ and medical advisors’ knowledge and reasoning about genetic testing in adoption. Twenty participants, including social workers, managers, medical advisors and paediatricians, were recruited from adoption services in England and Wales. A key finding revealed that medical professionals reported increasing pressure to test children prior to adoption, whilst social workers justified testing on the basis that it reduced uncertainty and therefore assisted adoption. Professionals’ accounts of genetic testing suggest that social workers may not be aware of the potential indeterminacy of microarray and NGS technologies. This has important implications for adoption because increases in genomic uncertainty can stigmatise children and disadvantage their prospects for adoption

Complexity and accountability: The witches' brew of psychiatric genetics

This paper examines the role of complexity in descriptions of the aetiology of common psychiatric disorders. While scientists attest to the discovery of an underlying reality of complex inheritance — the so-called ‘witches’ brew’ of genetic and non-genetic factors — we argue that ‘complexity’ also performs rhetorical work. In our analysis of scientific review papers (1999—2008), we find a relatively stable genre of accountability in which descriptions of complexity appear to neutralize past failures by incorporating different and sometimes competing methodological perspectives. We identify two temporal strategies: retrospective accounting, which reconstructs a history of psychiatric genetics that deals with the recent failures, citing earlier twin studies as proof of the heritability of common psychiatric disorders; and prospective accounting, which engages in the careful reconstruction of expectations by balancing methodological limitations with moderated optimism. Together, these strategies produce a simple-to-complex narrative that belies the ambivalent nature of complexity. We show that the rhetorical construction of complexity in scientific review papers is oriented to bridging disciplinary boundaries, marshalling new resources and reconstructing expectations that justify delays in gene discovery and risk prediction

Out of time: theorising family in social work practice

This paper draws on a British Academy (BA) funded study exploring social workers' conceptions of family using a vignette and focus groups. The policy context is discussed and the data from the BA study are then compared and contrasted with families' accounts of their own situations using the data from a separate qualitative study about child protection social work. The paper discusses the themes emerging and argues for a renewed focus on theorizing family in children's social work and the implications for practice