vi Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

The rest of the book is practice-based which is a strength. Chapter 18 has three clinical illustrations, were reflection and self-reflection is brought to fore. Especially so, as it pointed out that the 'clinical situation/encounter' introduces its own 'vagaries', or noise which can impact the 'quality of the bond between clinician and patient'. Rapport is the key. 

I was still missing 'complexity' and its dynamics, but I'm sure of the following:

If this was discussed - could be represented then the book would be theory-laden and I and other would-be readers would not be able to understand.

I still think Hodges' model can help, and in chapter 19 picked out 'manifold' (p.113), as if doing so, manifests something more esoteric. There is something here, the author noting the need to shift from individual to group perspectives. So, yes I think we can do more than embrace 'complexity' (p.114).

On page 116 there is discussion of the sometimes sudden path to recovery, 'probably common but often not comprehended'. Please pardon the naivety, but I scribbled 'hidden in complexity, what would (say) the three(?) equations be?'. For a book published in 2023 'artificial intelligence' is not indexed. This might be one area that AI could assist, given the progress in formal mathematics (but see below p.183!)? Algorithm is mentioned throughout the book. Further reading here, informed me that engaging with a reading group on 'Philosophical Counselling' is worthwhile. It is!

Part IX had me wondering if the debate about typical and complex cases, there is a slight of perspective going on? You can end up with paradoxes in terms of an individual's needs, criteria, risk, 'need for admission'. Which I must think about! Chapter 20 has three further reading texts on abductive reasoning. There's an appeal(?) on page 129 for an appropriate treatment model, well that is my take. Collaborative care and stepped care models are suggested. But with acknowledgement that:

'In truth, all models currently available may involve a defect in continuity within or between systems'. p.129.

I beg to differ. A role of Hodges' model is to help frame aspects of care through time, to facilitate and assure continuity.

Part X tackles the required precision in assessment, hence recourse to mathematics and statistics. The next two chapters may be useful for early career researchers and yet looking over our shoulders what is ai offering here? In Case 1 I was impressed by the suggestion of a health record that is over 70 years old. Not impossible of course, but I thought of the Lloyd George envelopes, their hospital equivalents, other paper sources and inevitable scanning this would entail here in the UK? Of interest to research is the creation and validation of complexity profiling inventories (tools) not just that, but their self-assessment form of delivery. And, yes in summary chapter 24:

'We are still left with the challenge of rating the patients' severely compromised health situations where "health" includes social, emotional, and financial well-being.' p.143.

'How do you factor this interpersonal situation into your complexity equation?' p.144.

Yes, how indeed? 

The realities of research of dealt with - funding for the development of tools a problem universally. The references here concern biopsychosocial complexity. Chapter 25 describes abstraction, and hiding detail, which is of great interest here. DSM-5 criteria for major depressive disorder are listed (DSM-6 may be released in 2029?). 

In chapter 25 the authors are once stymied by 'how to include (integrate? PJ) four dimensions, three time periods,and assorted assessment items in a single assessment.' 

As noted the four domains are here again (p.151): medical, psychological, social and care delivery and on page 153, introducing chapter 26, limitations of complexity assessment tools. Parity as in 'parity of esteem' is not indexed and I don't recall having read this, but this is well represented in later deliberations on variables #2. You will find psychosis, but not in depth or severity.

 In 'Creation of a New Model for Clinical Practice' (Chapter 31) identity is stressed, as a prompt to encompass those variables that contribute to preserving the person - what is humanistic. Allied with manifold, identity is a 'coi' for me, concept of interest - for this same reason. On page 172: the authors observe they 'are left with the question of whether there are acceptably accurate clinical models that are simpler and more straightforward than ours? We believe the answer is no!'. I believe there is a way, and a model to help 'keep the life in clinical work' - not take it out. There is a sense that Chapter 32 seeks what I was looking for above: as they explore random variable and 'sample spaces' descriptively - over a page.

Ah! 'Artificial intelligence' is found in text p.183. I'm surprised an editor, proofreader aloud the following sentence to go unchallenged?

'But, as will be discussed, these computer techniques have their limitations based on their lack of flexibility.' 

I was genuinely surprised to read this. Plus, again on ai on page 185: 'Making inferences is not reliably their domain.' I think I would look more at the human-ai interface. And the status of ai within psychiatry as opposed to medicine, but that is also another (parity - divide) debate. Things really are complex now on so many fronts: ethics especially.

Perhaps I am looking for the cookbook formula as introduced for chapter 35 clinical judgement. The further reading is combined with critical thinking. More detail on the empirical-collaborative method is welcome. When I read 'illustrated' I take this literally. Again I can disagree twice on page 220. I know Hodges' model is not validated, but it can - with practice(?) - do this light (simple) or heavy (complex) lifting. 

The warning about dogma needs to be repeated regularly. It is rather like the need for nurses to revisit their profession, role and work as relates to the law. Is Hodges' model an over-valued idea? Am I guilty of thinking I'm an expert? A problem with that view is that any assumed expertise is stretched across the whole model. So if anything there is a shallowness, but this means that I see my particular scope of practice, as other colleagues / professions see theirs. Here in the UK of late, this seems to have become rather blurred. 

In closing with this and achieving a "real-life" understanding of a case, with synthesis - path analysis diagram, the author's underline the value of their book which I have enjoyed and informed my preparation for WCCS26 (more to follow there). The authors can perhaps be reassured that all practitioners have a means to achieve their paradigm shift as described here - with added value and values.

There is a missed word: "of the situation ['with'?] him" on page 114. And revision needed re. text beginning with 'his boyish Paul McCartney "mop-top" ... on page 214. Spelling error on 216 'retu(r)ning'. 

Thanks again to Daniela and colleagues at SpringerNature for the review copy.

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

v Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

Chapter 11 held promise in the title 'Formalising the Clinical Field'.

If anyone is interested, formalisation is what I would like to focus upon - using Hodges' model - over the next several years (taking nothing for granted). If truth be told, I'd be stressed as if (true) formalisation was discovered here, I may find this is beyond me, but this is the course I have chosen.

There was nothing new, the 'clinical illustrations' continued. The reading is worthwhile, in trying to define complexity, or what constitutes a 'complex case', hence 'Each new entry expands the complexity and gravity of the case, moving it beyond "plain vanilla" of a single medical or socially based condition'. I was reminded here of the user personas used in developing online communities. And in health the way personalised detail gets lost as personal details - emotional content gets lost (necessarily) as data is aggregated. The chapter revists the definition of clinical complexity.

'So, how does this information fit with our tentative understanding of clinical complexity as "the potential for progress toward health recovery in the context of a particular set of diagnoses and available treatments" (Kathol et al. 2018)? The phrase "particular set of diagnoses" could be replaced by "clinical challenges?" After all, where do you fit cultural considerations or family disjunctions here? Neither are diagnoses per se. Both have typically been relegated to the periphery of diagnostic considerations. Instead, they are elements in a loose matrix of clinical influencers.' p.76. [My emphasis].

Well, Hodges' model provides an ideal place for cultural considerations and family disjunctions. But replacing 'particular set of diagnoses' with 'clinical challenges' will be met with a challenge itself. This serves my purpose in advocating for Hodges' model, if challenges across the model's four care/knowledge domains can be seen as 'clinical'.

Identity morphism

Part VI on Subjectivity and Intersubjectivity is an important lesson to look; then look again - beyond the (basic!) subjective-objective dichotomy. You want patients - clients to recover quickly. The clinical illustrations are helpfully carried forward, as per the longevity their being 'complex' portends. The fact that in a clinical conference, social aspects are barely mentioned is one rationale for use of Hodges' model in practice. What has not been discussed? For 'Seth' a case formulation is raised, (I sketched a 'simple'  triangle) and the limited conceptual scope acknowledged above (p.80). Reading, I did wonder what a new edition might look like given developments in the USA? Would it make a difference? There a question about to categorise one client. And I scribbled 'identity' in the summary for the subjectivity between client and clinician.

I've always liked archaic terms^ and here cussedness springs to mind as the authors seem compelled to return to the issue of a definition for complexity. You could say - they can't put it to bed! 'Lifestyle' is not indexed. But it is clear that the adopted lifestyle of many clients also compounds, contributes to the clinically complex presentation. Case, condition, set of sign/symptoms, state of affairs, situation - all may be simple or complex. On page 87 regards Mark: 'The management challenge of this situation is evident. The situation itself is not medically complex. However, managing it is.'

When I read the aforementioned formalisation (chapter 11), I thought logic might follow, a specific illustration? Abduction is a teaser introducing chapter 14. It is chapter 15 that inference including abduction is usefully discussed:

'Abduction goes further than obtaining general and specific logical conclusions. Abduction seeks explanations beyond logic. The clinician listens to the utterances of a patient and integrates word meanings and word referents with other gathered data. The clinician abductively decodes information and concocts potential explanations for the words of the patient that fit with aggregated clinical findings. This rational processing results in what the clinician considers the best explanation for the information at hand. However, other explanations remain as viable until and unless eliminated by subsequent data. The clinician using abductive reasoning always maintains an openness to changing explanations and an intention to expunge unsatisfactory conclusions as accumulating data dictate [1].' p.96.

The author's empirical-collaborative (E-C) approach spans the book. They might find that Hodges' model as a conceptual framework can seamlessly fit with E-C. A reference on Bayesian Statistics. Lee PM (2013), plus further reading is listed.

There is a spelling mistake p.73; 'contacted a disease'?

One more post to follow ... may add here also.

Thanks again to Daniela and colleagues at SpringerNature for the review copy. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948. 

Image:

https://krossovochkin.com/posts/2020_04_26_category_theory/ 

 

^Which is ok, I'm a grandad now. 

iv Book: 'Complexity in Health Care - A Paradigm Shift for Clinical Practice'

After a first mention on page 23, it is chapter 6 that discusses "awe" - the chapter's title. I wrote (in light pencil!) 'It keeps you going'. This is deeper than job satisfaction, but in healthcare is a contributing factor. And different again to (clinical) intution (with many mentions), which recurs, despite (or due to) its subjective nature.

Within its 3.5 pages you will find 'interpersonal awe', Piaget's 'accomodation', the neuroscience of awe, and humility. From a physiological and experiences with short-sightedness and vision, I have applied the concept of accommodation over the years. All this, quite rightly, places emphasis upon the therapeutic relationship. Even since the book's publication in 2023, this relationship has grown in importance.

'The sense of awe is an emotional reaction to events characterized as "vast" or to experienced stimuli outside the domain of the usual and prototypical. A sense of "awe" is often described by scientists who peer through telescopes (immensity) or who observe the uniqueness and expansiveness of the microscopic world. A similar emotional reaction can ocur with respect to the overwhelming experience of the clinician processing the complexity of intertwined variables experienced with a patient. When interpersonal awe occurs, it potentially opens the mind of the clinician to enhanced information gathering, cognitive processing, and empathic understanding.' p.49.

I often feel obliged to apologise that the spiritual does not have a concrete home in Hodges' model. Personally, it is INTRA- and interpersonal. Our religious beliefs, and committments were they apply. Unfortunately, the spiritual is often expressed politically: 'shock and awe'(?). Socially, the spiritual is manifest in the world's religions, our cultures and upbringing, recognition of others - in our communities, the media, ability to 'see' beauty, experience empathy, rapport and shared emotions. On twitter I've often written -

(SPIRITUAL [Intra- Interpersonal; Sciences; Political; Sociology] )

So, Hodges' model is embedded within - should be viewed as surrounded by the spiritual. 

Chapter 7, 'Clinical Decision-Making' utilises the thought of Daniel Kahneman. I like the use of ratiocinations here. I do try to bear in mind the 'traps' afforded by Hodges' model. To be clear, it is not the only clinical cognitive tool I have used. For some reason, against ratiocinations I scribbled 'running the axes, or the corridors of care'. Formal training brought to mind training to assure the marking of student's work (if still needed!), and mentoring student nurses. Case-based learning features here, and in the conclusion: CBL 'will be the central element of this book and will involve actual patients with pronounced biopsychosocial complexities.' p.56. How I wish there was an extra reference (a #16) here: clinical decision-making is fundamentally political; both reflectively and reflexively.

Part V then begins (p.59) on further technical considerations with chapter 8 Introduction to Clinical Complexity. A shift is flagged from a linear, logical-based approach to mix of logic and clinical content. At two pages I did hope for more: biological complexity and resolution left me hungry for more. There is however a key learning point on p.62, re. resolution; that of suffering. Connected to this and a well made point is priorities and what is clinically important and any contrast for the clinical team and the patient.

In a BASIC program from the 1980s on the 'Nursing Process' (essentially p.11 in the book, and somewhere on W2tQ?) I'd included a woman, medical ward with chest pain, who was agitated and couldn't explain herself that well. It wasn't delerium, but we eventually found out she was alone at home and worried about a cat. Attention and listening are not in the index, but should be in all clinical texts. An essential ingredient in the aforementioned reflective/reflexive aspect of interpersonal exchange. In the summary for C8 it was good to read of constellations. Our forebears joined the stars to provide meaning and explanation for what was life, being and experience for them, who had passed, and who was to follow. Without that political domain, the meaning is incomplete, may be repeatedly mistaken. How impoverished [we are / are we] as a result?

 Chapter 9 starts to present the clinical model, with clinical illustrations - case examples. The focus here is underrepresented factors. There is always an issue about granularity in how much data/information is needed for a comprehensive assessment/evaluation. A paragraph considers The problem of simplication. A question is raised:

'How can a clinician think of all the contributing factors on the spur of the moment, the point at which many if not most clinical decisions are made? Our guess is that your response, as a reader, may be to wipe your brow and decide to return to "treatment as usual." reverting to comfortable algorithms.' p.67.

This 'treatment as usual' is surely institutional in origin? Back to the 'political' again. Well I can think of a way to frame, apprehend all the contributing factors and on the spur of the moment. Healthcare is inherently situated. Healthcare professionals need to proceed with care, especially with constant reference to statistics and algorithms. Hodges' model can provide an anchorage, a safe harbour even if the visit is fleeting. These harbour fees, or dues, service charges are negligible.

 In Chapter 10 brings the complexcity of the clinical "field", once more through a case illustration, a woman with chronic schizophrenia, complexity based on clinical diagnosis. The process of diagnosis (and a medical matter) is largely a matter of data reduction, a means to simplify, and provide an avenue to aggregate and group. There is a history lesson in the development of hospitals, even as in the UK bed numbers have seen whole scale reductions. Interestingly (for further study), of course, diagnosis is also a way to abstract away details. The problem is that although this makes the unknown a known, it is binding when it comes to complexity. It ties down a flux, a dynamic that doesn't just want to be free it is constantly changing and may also achieve a more ordered state. The authors try to get to grips with this, they highlight housing, employment, comorbidity and how these may prevent recovery. All this as they seek to define complexity in clinical terms. No easy task: itself part of the problem.

In the summary for chapter 10 it was encouraging to see the cultural aspects for the person and group emphasised, plus how identical demographic factors can still result in disimilar prognoses, hence the importance to 'see' the person and their respective 'self-management'. 

More to follow ...

^Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311. 

Steven A. Frankel, Steven D. Thurber, James A. Bourgeois (2023) Complexity in Health Care: A Paradigm Shift for Clinical Practice. Cham. Switzerland: Springer. ISBN: 978303114948.

'Sociological Theory in Transition' (always ..?)

Conclusion: Sociology as a Skin Trade

In other writings (O'Neill, 1972, 1985) I have set out a rival conception of the embodied subject who suffers the hopes and defeats of what I have called 'sociology as a skin trade'. At the same time I began to renovate the imagery of society as a body-politic, to differentiate the levels of the bio-body, the productive body and the libidinal body as sites where human beings pursue the relevant knowledge and values of health, work and happiness. Each level of discourse requires he formulation of relevant technical knowledge (medicine, political economy, sociology and psychoanalysis) and each level has its own emancipatory discourse about health creativity and self-expression. Because each of these discursive interests is likely to be articulated by professional social scientists and therapists, it is necessary to require the institutionalization of mechanisms of political and ethical accountability to laypersons' common-sense knowledge and values regarding their bodies, their families, their work and their souls. Medical and sociological nemesis is not the result of a therapeutic conspiracy against society. It belongs to the radical technological a priori of Western knowledge whose ambition is fundamentally bio-technological. The sin of Adam and Eve was the best humankind could manage at the time. In today's laboratory Adam and Eve can be bypassed and life can be set in motion according to the best genetic formulas. Huge legal, ethical and sociological problems are simultaneously generated. And thus we step into a new 'crisis of opportunity` for which very few social scientists are prepared - whether by training or morals.' p.35.

INDIVIDUAL

|

     INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

psychoanalysis	body as a machine bio-technological body- bio-
sociology	-politic bio-politics of the population

'In concrete terms, starting in the seventeenth century, this power over life evolved in two basic forms ... One of these poles - the first to be formed, it seems - centered on the body as a machine: its disciplining, the optimisation of its capabilities, the extortion of its forces, the parallel increase of its usefulness and docility, its integration into systems of efficient and economic controls, all this was ensured by the procedures of power that characterised the disciplines: an anatomo-politics of the human body.
The second, formed somewhat later, focussed on the species body, the body imbued with the mechanics of life and serving as the basis of the biological processes: propagation, births and mortality, the level of health, life expectancy and longevity, with all the conditions that can cause them to vary. Their supervision was effected through an entire series of interventions and regulatory controls: a bio-politics of the  population. (Foucault, 1980a, p. 139; altered for my emphasis)' p.24.

'Bio-power regulates bodies individually, as in the clinical model. and collectively, as on the model of social medicine. The two strategies are combined to produce the most complete system of discipline ever known in the history of power. Disciplinary power works in hospitals. schools, prisons, armies, factories and bureaucracies. It is compatible with shifting vocabularies of rights, reform and welfare. It is intimate and collective; it is obeyed not because of its power over death but because of its power over life. It is this shift in emphasis that is the source of the expansion of bio-power whose corresponding apparatus we may call the therapeutic state.' p.25.

 

O’Neill, J. Sociological Nemesis: Parsons and Foucault on the Therapeutic Disciplines, Chapter 1 (pp.21-35). In. Wardell, M.L. and Turner, S. (Eds.). (1986) Sociological Theory in Transition. London: Allen & Unwin, Inc. https://digitalcommons.usf.edu/phi_facpub/86

Previously: 'sociology' : 'power' : 'body'

Definition: Individual and Group Counselling

INDIVIDUAL

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    INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

|

GROUP

"Counsellor"
	"Counsellor of state"

My source: Robert Wright, Starmer eyes succession law change for Andrew, FTWeekend, 21-22 February, 2026, p.2.

Previously: 'counselling' : 'therapy'

Primary & Secondary Health Care - How long...?

THE DAWSON REPORT

MINISTRY OF HEALTH.

CONSULTATIVE COUNCIL ON MEDICAL AND ALLIED SERVICES.

Presented to Parliament by Command of His Majesty. [... selected extracts]

3. The general availability of medical services can only be effected by new and extended organisation, distributed according to the needs of the community. This organisation is needed on grounds of efficiency and cost, and is necessary alike in the interest of the public and of the medical profession. Measures for dealing with health and disease become, with increasing knowledge, more complex, and, therefore, less within the power of the individual to provide, but rather require combined efforts. Such combined efforts to yield the best results must be located in the same institution. As complexity and cost of treatment increase, the number of people who can afford to pay for a full range of service diminishes. Moreover, enlightened public opinion is appreciating the fact that the home does not always offer the best hygienic conditions for dealing with serious illness, which requires special provision in order to give the patient a full chance of recovery.

4. In days gone by such conditions as appendicitis were treated with poultices and drugs in the patient’s home. Now they are treated by operation, which is more effective, but requires more equipment, a team of workers, and a larger expenditure. Such conditions as diseases of the lungs formerly received clinical examination and treatment by drugs. They now may require, in addition, the attention of the pathologist and the radiologist. This means greater efficiency, but more organisation and higher cost.

5. Preventive and curative medicine cannot be separated on any sound principle, and in any scheme of medical services must be brought together in close co-ordination. They must likewise be both brought within the sphere of the general practitioner, whose duties should embrace the work of communal as well as individual medicine. It appears that the present trend of the public health service towards the inclusion of certain special branches of curative work is tending to deprive both the medical student and the practitioner of the experience they need in these directions.

6. Any scheme of services must be available for all classes of the community, under conditions to be hereafter determined. In using the word “available,” we do not mean that the services are to be free; we exclude for the moment the question how they are to be paid for. Any scheme must further be such that it can grow and expand, and be adapted to varying local conditions. It must be capable of comprising all those medical services necessary to the health of the people.

7. The foregoing are some of the considerations which have guided us in drawing up the scheme outlined below.

The services maybe classified into-

Those which are Domiciliary as distinct from those which are Institutional.

Those which are Individual as distinct from those which are Communal.

1. We begin with the home, and the services, preventive and curative, which revolve round it, viz., those of the doctor, dentist, pharmacist, nurse, midwife, and health visitor. These we style domiciliary services, and they constitute the periphery of the scheme, the remainder of which is mainly institutional in character. A Health Centre is an institution wherein are brought together various medical services, preventive and curative, so as to form one organisation. Health Centres may be either Primary or Secondary, the former denoting a more simple, and the latter a more specialised service.

2. The domiciliary services of a given district would be based on a Primary Health Centre -an institution equipped for services of curative and preventive medicine to be conducted by the general practitioners of that district, in conjunction with an efficient nursing service and with the aid of visiting consultants and specialists. Primary Health Centres would vary in their size and complexity according to local needs, and as to their situation in town or country, but they would for the most part be staffed by the general practitioners of their district, the patients retaining the services of their own doctors.

3. A group of Primary Health Centres should in turn be based on a. Secondary Health Centre. Here cases of difficulty, or cases requiring special treatment, would be referred from Primary Centres, whether the latter were situated in the town itself or in the country round. The equipment of the Secondary Centres would be more extensive, and the medical personnel more specialised. Patients entering a Secondary Health Centre would pass from the hands of their own doctors under the care of the medical staff of that centre. Whereas a Primary Health Centre would be mainly staffed by general practitioners, a Secondary Health Centre would be mainly staffed by consultants and specialists. It would be a consultant service in function and would be carried out by specialists or by general practitioners acting in a consulting capacity.

4. Secondary Health Centres must of necessity be situated in towns, where alone an efficient consultant service and adequate equipment could be expected, and the necessary means of communication exist. The selection of these towns will need careful consideration, and full information will be required as to the extent of existing provision of hospital and allied facilities, and of its distribution in relation to population and means of public conveyance. In rural areas the natural currents of traffic and business and existing medical facilities will usually indicate the town or towns in which a Secondary Health Centre may best be placed. In this connection we would like to point out the importance of carrying out a “Hospital Survey” at an early date. The results of this survey would afford data for recognising the areas in which the existing provision is inadequate, and the degree of the inadequacy. The Secondary Health Centres would vary in size and elaboration according to circumstances.

5. Secondary Health Centres should in turn be brought into relation with a Teaching Hospital having a Medical School. This is desirable, first in the interest of the individual patient, that in difficult cases he may have the advantages of the highest skill available, and secondly in the interest of the medical men attached to the Primary and Secondary Centres, that they may have the opportunity to follow the later stages of an illness in which they have been concerned at the beginning, to make themselves acquainted with the treatment adopted, and to appreciate the needs of a patient after his return to his home. In those towns where Teaching Hospitals exist, Secondary Health Centres would sometimes be merged in them. 

Continued at: 

https://sochealth.co.uk/national-health-service/healthcare-generally/history-of-healthcare/interim-report-on-the-future-provision-of-medical-and-allied-services-1920-lord-dawson-of-penn/

LONDON PUBLISHED BY HIS MAJESTY'S STATIONERY OFFlCE

1920. Price 2s. Net. Cmd. 693

See also:
https://www.adph.org.uk/resources/175th-anniversary-timeline/ 

My emphasis.

In search of socio-political logics

'The logic of appropriateness refers to actions which members of an institution take to conform to its norms. For example, a head of state will perform ceremonial duties because it is an official obligation. By contrast, the logic of consequences denotes behaviour directed at achieving an individual goal such as promotion or re-election.' p.87.

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

'Institutions are far more than the theatre within which the political drama unfolds; they also shape the script (Peters, 1999). This emphasis within the institutional framework on the symbolic or ritual aspect of political behaviour contrasts with the view of politicians and bureaucrats as rational, instrumental actors who define their own goals independently of the organization they represent.' p.87.

'Further, institutions bring forth activity which takes place simply because it is expected, not because it has any deeper political motive. When a legislative committee holds hearings on a topic, it may be more concerned to be seen to be doing its job than to probe the topic itself. Much political action is best understood by reference to this logic of appropriateness rather than a logic of consequences. For instance, when a president visits an area devastated by floods, he is not necessarily seeking to direct relief operations or to achieve any purpose other than to be seen to be performing his duty of showing concern. In itself, the tour achieves the goal of meeting expectations arising from the actor's institutional position. "Don't just do something, stand there", said Ronald Reagan, a president with a fine grasp of the logic of appropriateness.' pp.86-87.

    

See also: 'drama' : 'bridges'

Hague, R., & Harrop, M. (2007). Comparative Government and Politics (7th ed.). New York, NY: Palgrave Macmillan.

Peters, B. Guy. (1999). Institutional theory in political science: the new institutionalism. London: Pinter.

Anti-Science countermeasures ...

'We are pleased to announce the winners for the 2025 Nature Awards for Standing Up For Science - The John Maddox Prize.

We are proud to announce that our Maddox Prize winner is Virginia Burkett, United States Geological Survey. Judges were impressed by her persistence, as a government adviser and an expert in coastal systems, in the face of opposition.' ...

https://www.nature.com/immersive/maddoxprize/winners/index.html

Virginia Burkett's five 'tips for resisting the anti-science lurch'

individual

|

INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

|

group-population

2. KEEP RECEIPTS (your memory) know your institution's scientific integrity policy	2. Never compromise on scientific integrity
3. Find allies 5. Be prepared for setbacks, e.g. relying on family and religious faith.	keep receipts (your defence) 4. KNOW YOUR INSTITUTION'S  SCIENTIFIC INTEGRITY POLICY

My source:

Anjana Ahuja, Tips for resisting the anti-science lurch, Opinion, Research. Financial Times, Wednesday 5 November, 2025, p.20.

Auction: Twenty-two photographs of psychiatric patients at the Surrey County Lunatic Asylum [1850s]

DIAMOND, Dr Hugh Welch (1808–1886)

Twenty-two photographs of psychiatric patients at the Surrey County Lunatic Asylum [1850s]

Estimate - GBP 100,000 – GBP 200,000

Christie's London - December 10th 2025

https://www.christies.com/en/lot/lot-6564110?ldp_breadcrumb=back

Asylum patient by Hugh Welch Diamond, c1850-58
Hugh Welch Diamond (English, 1808-1886)
Public domain, via Wikimedia Commons

'The women Iook out at us across 170 years of history with a variety of expressions - bold and shy, serene and distressed. Yet all of them were regarded at the time as "lunatics". These faces were the  subjects of a pioneering project by the 19th-century psychiatrist Hugh Welch Diamond, superintendent of the female division of an asylum in London and the world's first photographer to take pictures of patients for the purpose of diagnosis and therapy.

Twenty-two of Diamond's asylum portraits - the largest surviving group - will be put up for auction on December 10 at Christie's in London, as part of a sale of books, manuscripts and photographs from the library of The Royal Society of Medicine. If they achieve their estimated prices, RSM, a membership charity, will raise more than £2mn to invest in physical and digital infrastructure.' ...

'Diamond was working at a time when society's views of people suffering from mental illness were changing. The earlier practice of shutting patients away in secure "madhouses" was giving way to more humane treatment. Diamond seems to have believed that photography would help doctors both to diagnose and to treat patients. His diagnoses were based partly on the idea, popular in Victorian medical circles, that an individual's physiognomy - their physical features, particularly the face - could reveal their mental state.

"He wanted to make people better and put them back into the world," says Sharrona Pearl, a medical historian at Texas Christian University who has studied Diamond's work. "He also enjoyed experimenting and liked the idea of bridging his expertise in medicine and photography.' p.32.

individual

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INTERPERSONAL : SCIENCES

humanistic -------------------------------------------  mechanistic

SOCIOLOGY : POLITICAL

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group-population

Mental Illness PERSON - SUBJECT Patient's names not recorded Portrait - Consent?	Diagnosis and Treatment person - DATA - SUBJECT Photography as records Eagerness to classify - label
Social history Change in social attitudes Stigma and fear of mental illness Current relatives?	Confidentiality Institutional change Power imbalance Shift from 'custodial' to health care

My source:
Clive Cookson, Mind Hunter, FT Magazine, November 15, 2025, 1151, pp.30-34.

I have noticed Prof. Brendan Kelly is a regular FT respondent, as with this article:

'These photographs were likely to have been taken without meaningful consent and in the context of power imbalance. Yet publication can reclaim their individuality, address historical injustice and underscore our common humanity. Compassion, respect and humility should guide decisions. 

 Proceeds should support medical, educational, or justice-oriented programmes. Most importantly honouring forgotten patients of the past demands better care for people with mental illness today, who often languish, neglected, in homeless hostels or prisons. We can do better.'

Brendan Kelly Professor of Psychiatry, Trinity College, Dublin, Ireland.

Letters, FT Weekend. 22-23 November 2025, p.10.

See also: 'asylum' : 'photos'

'Un Caso Clinico' BUZZATI (I906-I972)

Reading The Theatre of the Absurd earlier this year was a very enjoyable and disconcerting experience. In acknowledgement: I have quoted from the book at length below. I do so to better convey the context, and in the hope other people may similarly obtain and enjoy this classic theatrical text.

Reading, I was reminded of starting my career as a nursing assistant and student nurse, and the 'lock-up' wards: male and female. Listening now to the current Reith Lectures I will post regards: 

Gwen Adshead - Four Questions about Violence

https://www.bbc.co.uk/sounds/play/m0025cmg

As a community mental health nurse in community mental health teams and nursing home liaison, residents on the ground floor (of two or three floors - with 'general') 'knew' there were very poorly people on the top floor. In summer, windows open, they could often be heard shouting and in the night. Inside, for staff, family members, friends became advocates expressing concern for a lack of access to fresh air and sunshine. Something, of course, we can all benefit from. For some residents there was an in-house understanding of NOT wanting to be moved 'upstairs'. At times I gather, if a resident 'played up' such re-location (displacement) was used as a threat: a cue for education.^

DINO BUZZATI (I906-I972)

'In Les Bátisseurs d'Empire the flight from death takes the form of trying to escape upwards. The same image appears in the opposite direction in a remarkable play by Dino Buzzati, the eminent Italian novelist and journalist on the staff of the Corriere della Sera in Milan. This play, first performed by the Piccolo Teatro, Milan, in 1953, and in Paris in an adaptation by Camus in 1955, is Un Caso Clinico. In two parts (thirteen scenes), it shows the death of a middle-aged businessman, Giovanni Corte. Busy, overworked, tyrannized but pampered as the family's breadwinner, whose health must be preserved, he is disturbed by hallucinations of a female voice calling him from the distance and by the spectre of a woman that seems to haunt his house. He is persuaded to consult a famous specialist, and goes to see him at his ultra-modern hospital. Before he knows what has happened, he is an inmate of the hospital, about to be operated on. Everybody reassures him - this hospital is organized in the most efficient modern manner; the people who are not really ill, or merely under observation, are on the top floor, the seventh. Those who are slightly less well are on the sixth; those who are ill, but not really badly, are on the fifth; and so on downwards in a descending order to the first floor, which is the antechamber of death.

In a terrifying sequence of scenes, Buzzati shows his hero's descent. At first he is moved to the sixth floor, merely to make room for someone who needs his private ward more than does. Further down, he still hopes that he is merely going down to be near some specialized medical facilities he needs, and before he has fully realized what has happened, he is so far down that there is no hope of escape. He is buried among the outcasts who have already been given up, the lowest class of human beings - the dying. Corte's mother comes to take him home, but it is too late.

Un Caso Clinico is a remarkable and highly original work, a modern miracle play in the tradition of Everyman. It dramatizes the death of a rich man - his delusion that somehow he is in a special class, exempt from the ravages of illness; his gradual loss of contact with reality; and, above all, the imperceptible manner of his descent and its sudden revelation to him. And in the hospital, with its rigid stratification, Buzzati has found a terrifying image of society itself - an impersonal organization that hustles the individual on his way to death, caring for him, providing services, but at the same time distant, rule-ridden, incomprehensible, and cruel.' 

Esslin, Martin. Parallels and Proselytes, The Theatre of the Absurd. London: Pelican, 1982. (3rd Ed.).pp.277-279.

The Bewitched Bourgeois

^Rest assured, there were and are excellent centers of care too.

Update: 11th January 2025: c/o John Self. Meet the forgotten maestro of the ultra-short story. Saturday Review, The Times, p.15.

'One of his most widely published stories, Seven Floors, is set in a hospital where they put the "mildest cases" on the seventh floor, and so on in increasing order of sickness down to the first floor, which is occupied by those who are "beyond hope"'.

Lawrence Venuti. (2025) The Bewitched Bourgeois, New York: NYRB Classics ISBN: 9781681378671.

Cover image: NYRB.

Book for review: v "Philosophy of Care - New Approaches to Vulnerability, Otherness and Therapy"

I think this is the final post for Philosophy of Care (think! There is so much more ...). There are other chapters more salient to me personally, but for Hodges' model and the collective human enterprise, I think chapter 5 by Virginia Held is the most important. There's not just a chapter, but three in Part II 'Care and Economy'. I appreciate the reminder of Kate Raworth's Doughnut Economics which challenges;"the dominant assumption of the economy as a machine". I notice on Twi/X Kate Rowarth reflects on the UK's election:

The book 'Doughnut Economics' opens with the story of Yuan Yang who, as a young economics student back in 2008, was challenging the outdated theory she was being taught. Last night she was elected as the first-ever MP for Earley & Woodley. Huge congratulations @YuanfenYang!

    https://x.com/KateRaworth/status/1809216007518507248

I gave Keir Starmer a copy of Doughnut Economics just 10 days before he became Labour Party Leader. So will the book make it onto his bookshelves in Number 10? More importantly: will policies for a regenerative & distributive UK become real under this government?...

     https://x.com/KateRaworth/status/1809235013403136029

While in Philosophy of Care, another three words stood out:

"'Big-picture thinkers'^, Raworth notes, have offered alternative visions, but they have been dismissed by the field of economics." p.102.

continued ... 

The Digital Collective (DC) a Symposium: Digitalisation, Subjectivities, and Care

Dear colleagues, 

We recognise that many people who wanted to join our symposium on Digitalisation, subjectivities, and care were unable to join in person. For this and other reasons we have moved our symposium to be fully online. Our intention is for the symposium to be accessible to all of our colleagues including those who are outside the NL. 

If this is you, we hope you will now consider submitting an abstract, and as such we have extended the deadline to 31 January 2024.

Decisions will be made by 14 February 2024.

Please find the amended call below.

CFP: Digitalisation, subjectivities, and care
7 March 2024, 9.30am – 6pm, online
Deadline abstract submission: 27 November

The Digital Collective (DC) at the University of Twente in the Netherlands is planning a symposium on digitalisation in care. More information below. Please consider submitting an abstract for a talk or poster presentation, deadline: 31 January 2024. 

Any questions to: dc-bms AT utwente.nl 

Introduction

Digitalisation is more than a technological phenomenon. It concerns an ever shifting relation between digital technologies and societal developments. Digital tools are increasingly common in care contexts, reshaping practices, institutions, relations, and social structures. Understanding digitalisation of care therefore requires a multidisciplinary approach to distinct yet related issues that cover the scale of technology innovation, societal impacts (benefits and drawbacks), as well as the pace of development and its ubiquitous nature. In this interdisciplinary symposium we will therefore explore the relation between digital tools and those who use them, willingly or otherwise. 

Topics of interest:

Possible topics related to digitalisation include, but are not limited to: 

• Digital users and digital tools
• Care institutions
• Data development / use in digital care contexts
• Epistemic injustice in digital care contexts 
• Perspectives on ‘users’ of digital care content
• Realities and subjectivities of ‘digital users’ 
• (Multi-)methodological approaches to digital care
• Care labour economies
• Global justice perspectives on care
• Human-technology relations
• Health economics 
• Health Technology Assessment of digital health technologies

The DC is a multidisciplinary platform and we welcome submissions from a broad range of disciplinary and interdisciplinary perspectives, including from outside academia.

Overview of the symposium:

Schedule and further information about the day to follow.

Submission deadlines:

• Extended abstract submission: Wednesday, 31 January 2024
• Notification of decisions: Wednesday, 14 February 2024

Please note:

• Extended abstracts should be between 500 and 1000 words. 
• Submissions should be sent by email to dc-bms AT utwente.nl 
• Poster proposals should be sent to the same email, and clearly labelled as such. 
• If you want your work to be considered for both a presentation and a poster, please make this clear in your submission. Abstracts not accepted for presentation may be invited to present a poster instead.
• Each submission will receive at least two reviews. 

Additional information:

The Digital Collective (DC) is an interdisciplinary research platform on digitalisation at the University of Twente in the Netherlands. DC consists of social scientists and philosophers specialised in digitalisation and with domain expertise in health, higher education, artificial intelligence, and related technologies. 

After the symposium the DC intends to build a consortium with a view to developing collaborative work, including for a Horizon Europe funding proposal.

 

Event and venue information:

 

The event will be free for all participants. It will be fully online. Further details to follow.

Symposium organisers and programme Committee:

Please send questions to: dc-bms AT utwente.nl 

Dr Y. J. Erden

Associate Professor in Philosophy
University of Twente
AISB Vice Chair 

My source:

Philos-L "The Liverpool List" is run by the Department of Philosophy, University of Liverpool https://www.liverpool.ac.uk/philosophy/philos-l/ 

Follow the list on Twitter @PhilosL. Follow the Department of Philosophy @LiverpoolPhilos 

n.b. With the event now including provision for online presentations I am submitting an abstract.

Paper: "How can we mainstream mental health in research engaging SDGs? -

A theory of change." i

This paper caught my eye on twitter, quite a while ago - the combination of mental health and SDGs:

Madill A, Bhola P, Colucci E, Croucher K, Evans A, et al. (2022) How can we mainstream mental health in research engaging the range of Sustainable Development Goals? A theory of change. PLOS Global Public Health 2(8): e0000837. https://doi.org/10.1371/journal.pgph.0000837

"The recently updated WHO Comprehensive Mental Health Action Plan 2013–2030 [1] concurs with this vision in that two of its six cross-cutting principles are: (i) a multi-sectoral approach, and (ii) action on social determinants. This acknowledges that “integrating mental health across wider sectors such as education, employment and social welfare helps address social determinants of mental health and ensures a comprehensive and holistic approach” [7 p12]. Shen, Eaton and Snowden [8] investigated mental health mainstreaming in 42 countries in terms of a shift towards providing mental health care from institutional to community settings. They concluded that “different countries have adapted deinstitutionalization in ways to meet idiosyncratic situations and population needs” [7 p313] and that more needs to be done with regard to management and implementation strategies. While the keyword for Shen, Eaton and Snowden [8] is ‘deinstitutionalisation’, for Gómez-Dantés and Frenk [9] it is ‘integration,’ and they provide a dimensional approach with regard to what is involved in mainstreaming mental health: “(i) incorporating mental disorders to the global and local agendas related to NCDs [non-communicable diseases]; ii) moving away both from the biological and sociological reductionisms around mental health prevalent in the past century; iii) addressing the whole range of conditions related to mental health; iv) migrating from the idea that mental diseases have to be treated in secluded clinical spaces; and v) expanding the use of a comprehensive approach in the treatment of these disorders, which includes medication, psychotherapy and other types of therapies” [9 p214]." p.2/23

Selected concepts are related to Hodges' model below. In addition to the 2x2 table below, it may be useful for visitors to consider the paper's figures against the model? There is no doubt an overlap across the care / knowledge domains of Hodges' model, but hopefully the 'holistic bandwidth' of the model and its potential as a generic conceptual framework will also be highlighted. 

Note for example the way mention of 'clinical' tends to attract care (understandably) to clinics, hospitals, institutions, controlled (mechanistic) spaces where resources can be controlled and concentrated. Additionally, to find appropriate concepts, we must appreciate how 'local' is applied not only geographically, regionally, but culturally also - within and across a community, or several.

Hodges' model provides several disciplinary bridges of relevance here:

• psycho-political
• psycho-social
• socio-economic
• socio-political
• bio-social

I will revisit the paper again soon ii.

INDIVIDUAL

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INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

intra-personal - mental health  (contribution to individual's overall health status) self advocacy qualitative evidence mental health practitioners psychotherapy, counselling individual health literacy/education "Implications for researchers include: recognising the potential of their projects to have psycho-	quantitative evidence time, environment, geography - locale treatment resources (time and physical - space) digital technologies 'clinical' seclusion spaces multiple locally-appropriate concepts 'clinical spaces' seclusion/isolation
-social wellbeing impact"* "collaborating with local communities, researchers, and service providers to effect change." "developing a more inclusive and flexible language around mental health that bridges cultures and disciplines ..." multiple locally-appropriate concepts resources  - social, family, community	LMICs - 'workforce gap' shift from institutionalised to community settings security - conflict advocacy resources $$$ income/welfare/micro-finances/ banking/digital access legislation, policies, strategies and services

*The paper also refers to "psychosocial disabilities".

My source (twitter):

https://twitter.com/PLOSGPH/status/1565066449798205440?s=20

Madill A, Bhola P, Colucci E, Croucher K, Evans A, et al. (2022) How can we mainstream mental health in research engaging the range of Sustainable Development Goals? A theory of change. PLOS Global Public Health 2(8): e0000837. https://doi.org/10.1371/journal.pgph.0000837

"Imagine dumping nearly 400,000 paper documents -

- into a dead drop
located discretely on the hard shoulder of a road."

INDIVIDUAL
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 INTERPERSONAL    :     SCIENCES               

HUMANISTIC --------------------------------------  MECHANISTIC      

SOCIOLOGY  :   POLITICAL 

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GROUP

"Third is the rise of new actors, 'super-empowered' individuals, capable of intervening in historical developments at a systemic level."	"First is a change in the materiality of communication. Communication becomes more extensive, more recorded and the records become more mobile."
"Finally, fourth is a structural transformation of the public sphere (through media consolidation at one pole, and the explosion of non-institutional publishers at the other), to an extent that rivals the one described by Habermas with the rise of mass media at the turn of the 20th century." p.31.	"Second is a crisis of institutions, particularly in western democracies, where moralistic rhetoric and the ugliness of daily practice are further diverging at the very moment when institutional personnel are being encouraged to think for themselves."

Image: Amazon

"In the wake of Wikileaks' recent headline-busting exposés, a very different news and informational landscape is emerging. Whilst acknowledgeing the structural leakiness of networked organisations. Felix Stadler finds deep-rooted reasons for the crisis of information security and the new distribution of investigative journalism." p.31.

Source: Stalder, F. (2011) Double Negative Feedback: CONTAIN THIS! LEAKS, WHISTLE-BLOWERS AND THE NETWORKED NEWS ECOLOGY. MUTE. Spring/Summer, Vol. 3, #1, pp.30-37.





https://www.metamute.org/editorial/magazine/mute-vol.-3-no.-1-double-negative-feedback