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This paper critically explores the research and development of 'digital phenotyping', which broadly refers to the idea that digital data can measure and predict people's mental health as well as their potential risk for mental ill health. Despite increasing research and efforts to digitally track and predict ill mental health, there has been little sociological and critical engagement with this field. This paper aims to fill this gap by introducing digital phenotyping to the social sciences. We explore the origins of digital phenotyping, the concept of the digital phenotype and its potential for benefit, linking these to broader developments within the field of 'mental health sensing'. We then critically discuss the technology, offering three critiques. First, that there may be assumptions of normality and bias present in the use of algorithms; second, we critique the idea that digital data can act as a proxy for social life; and third that the often biological language employed in this field risks reifying mental health problems. Our aim is not to discredit the scientific work in this area, but rather to call for scientists to remain reflexive in their work, and for more social science engagement in this area. [ABSTRACT FROM AUTHOR]

In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer's disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of 'implicit normativity' in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for 'synthesising certainty' in practice and for future research in this area. [ABSTRACT FROM AUTHOR]

Evidence is accumulating of the negative impact of the COVID‐19 pandemic and related public health measures on mental health. In this emergent field, there has been little research into the role of risk perception on depressive symptoms and the contribution of health‐care resources to model risk perception and mental health. The aim of this paper is to describe the relationship between individual‐level perception of risk and depression, controlling for a set of confounders and for country‐level heterogeneity. A cross‐sectional and observational online survey was conducted using a non‐probability snowball sampling technique. We use data on 11,340 respondents, living in six European countries (Italy, Sweden, United Kingdom, France, Poland, Czech Republic) who completed survey questionnaires during the first months of the pandemic. We used a fixed‐effect approach, which included individual and macro‐level variables. The findings suggest that a high proportion of people suffering from depression and heightened risk perception is positively associated with reporting depressive symptoms, even if this relationship varies significantly between countries. Moreover, the association is moderated by contextual factors including health‐care expenditure as a percentage of Gross Domestic Product, hospital beds for acute care, and number of medical specialists per head of population. Investment in health care offers a concrete means of protecting the mental health of a population living under pandemic restrictions. [ABSTRACT FROM AUTHOR]

Professional accounts of emotional distress originate from within mainstream mental illness discourses and are underpinned by largely conjectural biomedical, brain‐based conceptions of disorder. Alternative, formulation‐based approaches remain delimited by cultural norms and linguistic resources. Service users frequently declare the most ordinary aspects of therapy the most helpful: listening, understanding, and respectfulness; these are not contingent upon the presence of a mental health professional. This paper describes ameliorations in states of emotional distress amongst volunteer trainee mechanics in a bicycle workshop, which has little overtly to do with mental health. Possible explanations for these ameliorations, or 'recoveries', are presented. In an enabling setting that offers the social and material resources conducive to particular ways of being, an applied actor‐network approach is introduced as a practical way to disentangle the concomitant complexities of bicycles and everyday life. This approach to analysing states of distress—introduced here as 'actor‐network therapy'—combines notions of enactment and enhandedness in the appreciation of 'engrenage' – the intriguing intricacy of locally generated, provisional realities. [ABSTRACT FROM AUTHOR]

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio‐material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long‐standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time‐lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision‐making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research. [ABSTRACT FROM AUTHOR]

Across the UK, wide‐ranging efforts have been made to enhance citizen access to psychological therapy. Clinical psychologists are key providers of and gatekeepers for therapy. This article is concerned with how clinical psychologists foster access (or not) to psychological care. More specifically, it interrogates how psychologists manage, and make decisions around, patient referrals. Following a referral, psychologists must resolve an uncertain situation: should they accept a referral and continue with an assessment? Thereafter, they must decide whether a patient is suitable for their service – and for therapy more generally. Certainty is synthesised against a backdrop of sometimes powerful pressures to meet service targets. Taking cues from medical sociology and science and technology studies (STS), this article interrogates some of the uncertainties around access to psychological therapy, and how decisions made by clinical psychologists involve negotiations of patient, service and professional ontologies. To do so, it draws on interviews with 40 psychologists across England and Scotland. The paper spotlights a professional group that is often absent from or only dimly lit within sociological observation and analysis: clinical psychology. Through attending to the discourses of psychologists, I extend conversations about uncertainty through a distinctive case study. [ABSTRACT FROM AUTHOR]

Abstract: Biomedical research aimed at the development of therapies for chronic and late‐onset conditions increasingly concentrates on the early treatment of symptom‐less disease. This broad trend is evidenced in prominent shifts in contemporary dementia research. Revised diagnostic criteria and new approaches to clinical trials propose a focus on earlier stages of disease and prompt concerns about the implications of communicating test results associated with the risk of developing dementia when no effective treatments are available. This article examines expectations of the implications of learning test results related to dementia risk, based on focus group research conducted in the UK and Spain. It points to the extended social and temporal aspects of the dementia risk experience. Three key dimensions of this risk experience are elaborated: living ‘at risk’, represented in efforts to reduce risk and plan for the future; ‘with risk’, through vigilance towards cognitive health and earlier or prolonged contact with healthcare services; and finally, ‘beyond risk’ through a cessation of the self in its current social, legal and financial form. A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA [ABSTRACT FROM AUTHOR]

Abstract: Only some individuals who have the medically defined condition ‘infertility’ adopt a self‐definition as having a fertility problem, which has implications for social and behavioural responses, yet there is no clear consensus on why some people and not others adopt a medical label. We use interview data from 28 women and men who sought medical infertility treatment to understand variations in self‐identification. Results highlight the importance of identity disruption for understanding the dialectical relationship between medical contact and self‐identification, as well as how diagnosis acts both as a category and a process. Simultaneously integrating new medical knowledge from testing and treatment with previous fertility self‐perceptions created difficulty for settling on an infertility self‐perception. Four response categories emerged for adopting a self‐perception of having a fertility problem: (i) the non‐adopters – never adopting the self‐perception pre‐ or post‐medical contact; (ii) uncertain – not being fully committed to the self‐perception pre‐ or post‐medical contact; (iii) assuming the label – not having prior fertility concerns but adopting the self‐perception post‐medical contact; and (iv) solidifying a tentative identity – not being fully committed to a self‐perception pre‐medical contact, but fully committed post‐medical contact. (A virtual abstract of this paper can be viewed at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA). [ABSTRACT FROM AUTHOR]

Abstract: With increasing rates of obesity in the United States, attention to life chances and psychological consequences associated with weight stigma and weight‐based discrimination has also intensified. While research has demonstrated the negative effects of weight‐based discrimination on mental health, little is known about whether different social groups are disproportionately vulnerable to these experiences. Drawing on the modified labelling theory, the focus of this paper is to investigate the psychological correlates of body weight and self‐perceived weight‐based discrimination among American women at the intersection of race/ethnicity and socioeconomic status (SES). Analyses use data from the National Health Measurement Study (NHMS), a national multi‐stage probability sample of non‐institutional, English‐speaking adults, ages 35 to 89 in 2005–2006. Our findings demonstrate that the effect of weight‐based discrimination on psychological well‐being is highly contingent on social status. Specifically, the psychological consequences of discrimination on Hispanic women and women in the lowest household income group is significantly greater relative to White women and women with higher household income, controlling for obesity status and self‐rated health. These results suggest that higher social status has a buffering effect of weight stigma on psychological well‐being. [ABSTRACT FROM AUTHOR]

Research indicates that there is a high level of trust in health professionals but also a high level of non-disclosure of mental health issues to general practitioners (GPs). This paper explores the issue of patients’ willingness to disclose mental health problems to GPs through interviews with 33 patients from the lower half of the North Island of New Zealand. Patients’ willingness to disclose related to a range of factors but this paper focuses on fear and sense of control as these issues have received little attention in the extant literature and provide important discussion points for the conduct of consultations. Fear of the consequences of consultation warrants attention if general practice is to be promoted as the preferred point of contact for mental health consultations. The research reported here suggests that trust in a range of institutions and agencies, not just in the individual practitioner, would need to be achieved for the GP to be the preferred point of contact. [ABSTRACT FROM AUTHOR]

This paper examines the mental wellbeing of children of Australian migrants. Migration can be viewed as a natural experiment in which persons of one culture have their beliefs, values and behaviours challenged by the host culture. Such a process could be expected to lead to impaired mental health amongst migrants and their children. This paper investigates the relationship between migrants' region of origin, length of stay in Australia and indicators of impaired mental health. The data were taken from the Mater-University of Queensland Study of Pregnancy (MUSP), a longitudinal study of mothers and children which started in Brisbane, Australia, in 1981. The study comprises a cohort of over 5,000 women interviewed at their first ante-natal clinic visit and followed up at 3-5 days, six months, 5 and 14 years after the baby was born. Results showed no significant differences between the mental health of 'second generation' children and their Australian counterparts. Length of stay in Australia was not associated with internalising symptoms (anxiety and depression). There was a positive association, however, between the length of stay in Australia and increased externalising problems (aggression and delinquency) amongst the children at both 5- and 14-years follow-up. We conclude that children of migrants do not differ from comparable children of Australian-born parents in their mental health. Children of migrant parents have fewer symptoms of some behaviour problems in the years after their arrival in Australia, but these rates increase to the Australian level over time. [ABSTRACT FROM AUTHOR]

Sociologists appear to have abandoned the study of serious mental illness. This paper argues that the work of the disability theorists provides new directions for an analysis of the plight of people suffering from serious mental illness. Disability theory, revolving around a 'social approach to disability', redirects analysis from the individual to processes of social oppression, discrimination and exclusion. The application of the ideas of disability theorists to the study of mental ill health will orient research and theoretical development towards an analysis of the complexity and multiplicity of the social restrictions faced by people diagnosed as 'mentally ill', and the social disadvantage and oppression they face. A number of vigorous debates within the disability theory literature are examined. One debate addresses the political and theoretical implications of identifying the differences that exist between people with disabilities. A second debate examines the relative importance of including an analysis of impairment in the social approach to disability. Finally, the paper discusses the critique of medical sociology, linking illness with disability, which is advanced by some disability theorists. This debate is particularly concerned with the linking of illness with disability and the ideological and conceptual disadvantages of a focus on illness. [ABSTRACT FROM AUTHOR]

Taking as its starting point a series of traditional divisions and debates, this paper approaches issues of 'mental' health through the specific lens of the emotions. Key themes and organising principles here include the following: (i) reason versus emotion (ii) biology versus society (iii) the micro and the macro divide, and finally (iv) the medicalisation-demedicalisation of society. Each of these divisions is critically assessed and some 'new' ways forward provided through a commitment to the emotions, their relationship to 'mental' health and to rationality and, more generally, to their 'fate' in late 20th century Western society. The paper concludes with some further reflections on these and related emotional health matters, including a critique of the very notion of 'mental' health as a contradiction in terms. [ABSTRACT FROM AUTHOR]

The gender-based nature of suicide-related behaviour is largely accepted. However, studies that report exclusively on female suicides are rare. Here we demonstrate how female suicide has effectively been 'othered' and appears incidental in studies which compare female and male behaviour. We highlight how recent studies of suicide have tended to be dominated by male-only approaches, which increasingly link issues of masculinity with male death by suicide. Drawing on data collected from the general practitioner and coroner's office, we then apply the sociological autopsy approach to a cohort of 78 deaths recorded as suicides in the UK between 2007 and 2009. By focusing on females in isolation from males, we demonstrate that, as in male-only suicide studies, it is similarly possible to draw out issues associated with the feminine identity, which can be linked to death by suicide. We find that bereavement, sexual violence and motherhood could all be linked to the lives and help-seeking of the females who died. In closing, we suggest that a reorientation towards sociological analytic approaches of female suicide may help to produce further reductions in the rate of female death by suicide. A Virtual Abstract of this paper can be found at: [ABSTRACT FROM AUTHOR]

This paper contributes to the sociological study of humour in health care settings by analysing its use by community mental health team members dealing with referrals made by consultant psychiatrists. It is about humour and hierarchy, and specifically about humour as a strategy used by rank and file team members to resist or attenuate instructions coming from powerful professionals. The paper draws on tape-recorded data from meetings of community mental health teams and describes the ways in which humour is used by participants to subvert or challenge existing occupational hierarchies. [ABSTRACT FROM AUTHOR]

The paper begins by noting the absence of any sustained analysis of post-war mental health pressure groups and movements. This is deemed problematic because such movements and groups have had a strong presence during this period and because movements, as such, are afforded a central role in much contemporary sociology on account of their role in the process of social change. Next the paper considers how such analysis should be conducted, and suggests a three-phase model for periodising the activity of the groups and movements of the post-war era. The largest part of the paper is then devoted to an examination of one particular aspect of the first phase: the birth of the National Association For Mental Health and their activities in their first ten years of life. Much can be learned from the study of this group. [ABSTRACT FROM AUTHOR]

Abstract In modern society natural objects like spiders or snakes have a primary role as the loci of specific phobias. Drawing on interviews with members of the UK National Phobics Society (NPS) and associated service providers, this paper explores the implications of the increasingly significant role played by new media, particularly Virtual Reality technologies, in the treatment of these ‘bio-phobias’. While advanced technological approaches provide new possibilities for individual sufferers to experiment with and control their phobic responses they also exemplify certain aspects of those specifically modern social relations that are the media within which bio-phobic behaviours develop. From a critical sociological perspective the techno-philic move to the medium of cyber-space may actually exaggerate characteristically modern social relations that seek (but never convincingly manage) to assert complete ‘cultural’ control over the unpredictable ‘natural’ elements threatening our cultural integrity. [ABSTRACT FROM AUTHOR]

Study of the interaction of mental health and justice systems tends to focus on the ways that the respective realms inadvertently 'capture' each other's target populations. There has been little research into a system-level analysis that can answer questions about how styles, organising principles and institutional values of one system relate to and are sometimes incorporated by the other. This paper reconsiders juvenile de-institutionalisation in Massachusetts to document the emergence of a mental health ethos in the state's juvenile justice system of community-based treatment. The emergence of this ethos superficially bears out an influential thesis in the sociology of punishment that penal practice has now become charactised by an amoral actuarialism. A more sophisticated criminological awareness of developments in mental health and the sociology of medicine would show how a mental health ethos might instead be understood to challenge the actuarial thesis, by providing a framework that reconciles the traditional aims of retribution and rehabilitation in punishment. [ABSTRACT FROM AUTHOR]

Managed care represents a response to the wider institutional demand for technical rationality and efficiency. In the US, managed care exemplifies the commodification of health and is governed by a technocratic-rationality that often conflicts with the professionally governed value rationality of providers. Providers must negotiate between contradictory institutional demands for cost containment and quality care in their everyday work practices, and consequently experience a series of ethical dilemmas. This paper examines the effect the commodification of health care has had upon the work of mental health care providers, their loss of professional prerogative, their concrete experience of the ethical dilemmas which result from the commodification of care, and evidence of countervailing power. [ABSTRACT FROM AUTHOR]

This paper addresses a foundational issue at the interface of psychiatry and medical sociology; namely, how the judgement of pathology is made. In particular, it examines a debate over how the symptom of delusion is identified. The psychiatric approach is realist in orientation with delusions being commonly defined in the American Psychiatric Association's Diagnostic and Statistical Manual as 'incorrect inferences about external reality'. However, from a social constructionist perspective, delusions are reconceptualised as the product of a power relationship in which the views of a less powerful patient are pathologised. Reviewing this argument reveals a number of ways in which constructionist sociology is critical of the psychiatric approach. However, the 'debate' has a paradoxical quality in that, although the constructionist critique addresses psychiatry's foundations, it has been largely ignored. An ethnomethodological analysis of delusion is offered which attempts to account for, and move beyond, this paradox. This involves developing criticisms which are responsive to the sorts of phenomena that clinicians deal with. In other words, the argument points towards the development of a sub-discipline that deals with clinical phenomena and hence might be called 'clinical sociology'. [ABSTRACT FROM AUTHOR]

Why has there been a very rapid elaboration of the category of personality disorder within psychiatric classifications over the last 20 years? Personality disorder is the site of considerable psychiatric controversy. Its classification, diagnosis, and treatment are disputed not only within psychiatry, but also in closely related fields of forensic and psychological work. For severe cases, the Home Secretary in Britain has recently suggested that pre-emptive incarceration is justified, and many psychiatrists feel that personality disorder is not amenable to treatment. This paper seeks to make a contribution to the sociology of psychiatric knowledge, drawing both on recent work on the sociology of science and technology, and on the relationship between psychiatric practice and government in the late 20th century. [ABSTRACT FROM AUTHOR]

This paper focuses on the narrative of a Latvian countrywoman. In so doing it explores the unstable relationship between history, memory and the body. In particular, it looks at the way in which certain historical events have come to be annexed to the body and are used to explain the development of psychological and mental illness. This account describes state-perpetrated violence, and connects individual ills to a shared history and collective suffering. My informant offered her life story as testimony to the violence and injustice of past experience. The attempt to channel political discontent by the generous provision of medical diagnostic categories is unsuccessful. Rather, bodily experience plays a central role as a yardstick against which the unreasonableness of history is judged. [ABSTRACT FROM AUTHOR]

Medical dominance is not a transhistorical and invariant property of the medical profession. Rather it is a set of occupational privileges that can be invoked or revoked according to changing alignments of political, economic and cultural power, Using the example of British psychiatry in the context of the health service reforms of the 1980s, it is argued that medical dominance may be fracturing as a result of the policy switch towards community mental health care and the managerial reorganisation of the health services. Knowledge claims and medical procedures that have legitimated the dominant position of psychiatry within the mental health services - a medicoeclectic ideology, a view of doctor superiority over other mental health professionals and the extensive use of physical treatments - are outlined and contrasted with the conflicting ideas and authority structures of community care and health service management. Challenges to medical dominance in mental health, it is contended, are represented by the legislative empowerment of a range of previously subordinated groups of professionals and paraprofessionals. This paper draws primarily upon two sources of data; an ethnography and in-depth interview study of 40 psychiatrists and managers in the Bristol area in 1989-90 and an analysis of the writings of psychiatrists in the professional press. [ABSTRACT FROM AUTHOR]

A random allocation study of the effectiveness of day hospital treatment for acute psychiatric illness was carried out in two district general hospitals. During the study it became apparent that in one hospital numerous patients being randomised to the day hospital failed to become established in treatment. In-depth interviews were carried out with the day hospital staff in an attempt to elicit the reasons for this. It became clear that staff perceptions of the role of the day hospital is a potential source of bias in this type of study. A case study of one patient who was transferred from day to inpatient treatment during the study illustrates the dynamics of this bias. The paper demonstrates, once again, the value of concurrent qualitative research while performing a randomised controlled trial. In this particular case the qualitative interview indicates the reasons why the results of randomised controlled trials at one centre cannot necessarily be generalised to other centres. [ABSTRACT FROM AUTHOR]