This track explores the use of biotechnologies in psychiatry or clinical psychology and analyses the social, ethical, political and legal dimensions. It aims at mapping out the practices and effects of the biologization, geneticization and the proclaimed personalization of psychiatry.
New genetics and biotechnologies innovations have revolutionized medical practices as well as our understanding of health and illness in the past 3 decades. Novel genetic tools, biological tests and (neuro-)imaging technologies promise better diagnosis and treatment of diseases. The manifold consequences of emerging biotechnologies in the medicine have been described by social scientists in various fields and highly interesting case studies. Theoretically, they have been captured with concepts such as biomedicalization, geneticization, neurochemical selves, biosociality, personalization of medicine or biological citizenship.
Interestingly, emerging biotechnologies are only rarely used in psychiatric practise. Despite claims that have been made since the decade of the brain in the 1990s, that is to say the aim that the 5th revision of the DSM would be entirely based on neurobiological markers, the diagnosis of mental disorders still relies on questionnaires and supposedly subjective assessments by mental health professionals. The treatment with psychiatric medications still mostly follows the principal of trial and error.
This panel invites papers that explore the use of biotechnologies in psychiatry or clinical psychology and analyse the social, ethical, political and legal dimensions. It aims at mapping out the practices and effects of the biologization, geneticization and the proclaimed personalization of psychiatry and clinical psychology. Proposals could address the historical development of these technologies, specific research settings and uses in psychiatry and clinical psychology as well as the implications of the application of biomedical knowledge in these fields.
This track is closed to new paper proposals.
From Pharmacogenetics to Post-Genomic Revolution? Competing Narratives of Personalized Psychiatry
In recent years, personalized psychiatry has become an influential vision that increasingly guides psychiatric research and practice. Based on a document analysis, I will reconstruct the competing narratives on this notion and how the foundations of psychiatry are renegotiated.
Since the completion of the Human Genome Project, personalized psychiatry has become an influential vision that increasingly guides psychiatric research and practice. The notion has been a matter of scientific controversies ever since and experienced significant transformations. In the early 2000s, it was mostly identified with pharmacogenetics and its suggested potential to improve both drug safety and drug efficacy. Since then its meaning has changed. Personalized psychiatry has turned out to be a theoretical umbrella that incorporates (pharmaco-)genomics as well as proteomics and neurosciences. According to this narrative, personalized psychiatry will be realized by means of a systemic integration of various biomarkers and a consistent re-classification of mental illness. The objective of its advocates is not only an improvement of drug treatment but rather a post-genomic revolution of psychiatry itself - its way of knowing, diagnosing and intervening. This narrative is currently challenged by some psychiatrists, who conversely describe the targeted biomarkerization as a kind of depersonalization. Instead of biomarker research, they ask for new bio-psycho-social approaches to realize their vision of personalized psychiatry.
Based on an analysis of psychiatric journals and documents with a focus on the period from 2000 to 2015, I will reconstruct these competing narratives of personalized psychiatry and outline how the very foundations of psychiatry are renegotiated in this discourse.
From adaptation to neural regeneration: Neuroscientific views of depression beyond the serotonin hypothesis
I discuss two models of neurobiology of depression from a Canguilhemian perspective: first, a stress response model of depression by Peter Whybrow, focused on adaptation of the brain; second, Eero Castrén's interpretation of antidepressant effects, emphasizing neural regeneration and plasticity.
The idea of depression as a brain disorder with specific biological features has become predominant in professional and lay understandings in the West during the past a quarter of a century. In my paper, I approach two concepts of neurobiology of depression from a Canguilhemian perspective. First one is a 'stress response' model of depression (which seems to return in fashion in neuropsychiatry and in wider discourse of mental health care). I focus on Peter Whybrow's 'psychobiological' synthesis of depressive and other mood disorders which dates back 20 years. In particular, the notion of adaptation of the brain is particularly relevant. To illustrate a change in neuroscientific reasoning, I look into a present discussion in which depression is related to diminished neural regeneration. This concept is exemplified Eero Castrén, a prominent Finnish neuroscientist, and his animal experiments on antidepressant effects in the brain. A core feature in Castren's discussion is an emphasis of neural regeneration and plasticity.
I analyse these concepts of depression with the help of Georges Canguilhem's concepts of adaptation, and vital and social norms. In particular, Castren's discussion implies that psychopharmaceuticals entangle social and biological elements, processes and norms. Consequently, I consider antidepressant medication both as 'biotechnology' enabling modification of neurobiological processes in order to manage or repair impaired 'stress response' or 'adaptive failure' and as social technology allowing individuals to adjust social norms and expectations. Therefore, I suggest that Canguilhemian dimensions of 'the social' and 'the vital' should be amended by 'the technological'.
Subjective technologies and biosubjectivities: The entanglement of questionnaires and molecular genetics in the ontology of autism
Here I discuss a shift in understandings of autism and argue that autism is providing a language through which to understand all humans rather than demarcate a clinical population. I argue that this shift can be understood as a response to the reliance upon both mundane and emerging technologies.
In this talk I argue there has been a significant and recent shift in understandings of autism. In decades past autism signified an absence; a qualitatively distinct state characterised by empathetic and social dysfunction. Today autism increasing marks a presence; a normally distributed and quantifiable trait applicable, in varying degrees, to all individuals within the general population. I argue that this contemporary understanding of autism is facilitated by the ready availability of questionnaires assessing the number of 'autistic traits' exhibited by any individual. These questionnaires were frequently developed for studies in molecular genetics; the inability to find genetic markers for autism in the 1990s meant that studies in the new millennium increasingly relied upon parents and other relatives in order to examine 'endophenotypes'; traits far below the clinical threshold but which could, it was hoped, be mapped onto specific parts of the genome and taken back to the clinic. After development, however, these quick and easy to administer questionnaires have been used to understand the social behaviours of those with no relationship to autism - for example, the loneliness of college students - and, thus, facilitate a striking and novel 'ontology of the self'. This talk, therefore, discusses and historicizes the boundary between 'normal' and 'abnormal' in psychiatry and clinical psychology as well as the boundary between 'developed' and 'emerging' technologies arguing that, in the case of autism at least, these technologies are better understood as part of a single, contemporary, apparatus.
The neuroscience of psychopathy between medicalization and criminalization
In this paper, I analyze neuroscientific investigations in psychopathy and show that there are two distinct research approaches that either frame psychopathy as a mental disorder or a predictor or criminal behavior.
Since the 1990s, neuroscientists have made fundamental progress in the study of psychopathy. Advances in neuroscience and the development of new biotechnologies have helped to elucidate genetic variations and neural correlates of psychopathy such as polymorphisms in the MAOA gene, alterations in serotonin activity, or dysfunctions in the neural circuitry of emotion regulation.
This paper provides a comprehensive overview and critical analysis of the neuroscience of psychopathy from a sociological perspective. I analyze how psychopathy is studied in neuroscience, and outline the social implications associated with this research. I show that there are to distinct research approaches that either frame psychopathy as a mental disorder or a predictor or criminal behavior. Depending on the respective theoretical framework and assumption psychopathy is studied significantly differently, both with regards to the methods used and the interventions suggested. Theoretically, the paper contributes to the analysis of processes of biomedicalization and criminalization in society as well as the concept of genetic risk and genetic susceptibility. The argument is based on an extensive literature and document analysis as well as fieldwork in two neuroscience laboratories in the USA.
Inconsistencies and multiple understandings: An analysis of culture-related aspects in DSM-5
This paper examines how culture is conceptualized and linked to psychopathology in DSM-5.
In order to be applicable worldwide and in ethnically heterogeneous populations, Diagnostic and Statistical Manual of Mental Disorders (DSM-5) addresses culture-related aspects of diagnostic criteria and procedures. This paper examines how culture is conceptualised in the manual. Through a content analysis of the manual's main chapter (section II) that lists criteria of all disorders, the paper maps out the different ways culture is linked to psychopathology. The analysis reveals that cultural aspects in DSM-5 rarely tie into current bio-discourses (i.e. neurobiology, genetics or brain scanning), but rather focus on presentation and interpretation of symptoms. However, the way culture is addressed is neither consistent nor systematic. For instance, culture is interchangeably used as both identity and as a system of meaning, and similarly is it unclear if culture changes the symptoms, explains the symptoms or hides the symptoms (or the disease). The paper concludes by discussing the possible effects of such multiple understandings (Mol 2002) of the link between culture and psychopathology.
This track is closed to new paper proposals.