Monthly Archives: June 2012

An Introduction to Research in Psychology

Dr Sally Walters has made a series of introductory videos on research in Psychology and generously made them available for remixing using a Creative Commons Attribution License. I have mixed the videos together to create a 47 minute video (with the CC Attribution License). Many of the principles outlined here are relevant to research in Psychiatry (quantitative and qualitative research is covered) and so this video provides a useful introduction for Psychiatrists who are thinking about starting research projects (or revising for exams).

An index of the TAWOP site can be found here and here. The page contains links to all of the articles in the blog in chronological order. Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Towards a Definition of Psychiatry 2.0

Psychiatry 2.0 is a term that I am using to describe the  application of web technology to Psychiatry. While this might seem a rather abstract exercise, the hope is that this definition can contribute to improving patient care. This first stage in establishing a definition however is a long way from achieving this aim in any systematic way.  Additionally the process of arriving at such a definition runs in parallel with experiences in the real world where applications of the principles that will form part of such a future definition are already happening. This move towards a definition therefore is partly a formalisation of events that are already happening (e.g open access journals). However another part of the definition consists of structuring principles in such a way that they can form a basis for organising the available technologies in novel ways.

So what is Psychiatry 2.0 all about? To begin with, Psychiatry 2.0 is about the application of the web culture to Psychiatry. I have used the term web culture here which encompasses the interaction of people and web technology. Thus the web culture is the culture resulting from the ability of people to connect with each other, with technologies and with datasets using part of the internet referred to as the World Wide Web. The internet is a global connected network of computers which communicate using the internet protocol. The World Wide Web is part of the internet which is organised according to the principles of hypertext linking. In essence this means that you can click on a hypertext word or link with the mouse and navigate to a related page. In one sense this means the difference between typing in an IP address on the keyboard and using the mouse to get to where you want to go. Although hypertext links were a useful innovation (the formal proposal was written by Tim Berners Lee and Robert Cailliau), the initial proposal involved some technical software and hardware specifications that ensured that the concept worked. The World Wide Web is much more than a network of computers connected through hyperlinks and is accessed through web browsers and web servers.

So what is the Web Culture? This is more tricky to answer and evolves with time. As a starting point I have borrowed from the definition of Web 2.0 to begin to answer this question. Web 2.0 was a term coined at the O’Reilly Conference and described some of the ways in which people have adapted to the possibilities generated by the World Wide Web. The original Web 2.0 definition used many examples to illustrate the principles including commercial companies that had successfully utilised World Wide Web technologies. I have taken a closer look at the Web 2.0 definition in previous posts in relation to science (see Appendix 1).

Having thus far established that Web 2.0 principles can be used to generate a definition of Psychiatry 2.0, the next step is to deconstruct Psychiatry itself. In order to apply Web 2.0 principles to Psychiatry there has to be a clear understanding of what Psychiatry is. Broadly speaking Psychiatry is that branch of Medicine which is concerned with the assessment and management of people with mental illnesses. Although this seems fairly straightforward, for the purposes of the definition of Psychiatry 2.0 this has to be further deconstructed.

I would suggest therefore that Psychiatry can be divided into the theoretical and the clinical. ‘Theoretical Psychiatry’ is the broad term that I will use here to describe the theoretical underpinning of Psychiatric practice. This can be further subdivided into the body of knowledge that can directly or indirectly be applied through Clinical Psychiatry and the means to arrive at that knowledge. This knowledge itself is less than straightforward to understand. The most well known clinical Psychiatric applications – Psychotherapy and Psychopharmacology have been influenced by a diverse range of disciplines. Psychotherapy has been influenced heavily by the Humanities as well as the Sciences whilst Psychopharmacology has been significantly influenced by those Sciences including Psychology, Biochemistry, Pharmacology, Neuroanatomy, Chemistry and Physics to name just a few.  Psychopathology – the study of the pathology of the inner experiences of the mind has been influenced by Philosophy, Literature and several branches of the Sciences again just to name a few. Psychiatry encompasses a broader range of considerations than discussed here but already it will be evident that the disciplines contributing to the theoretical underpinnings of Psychiatry are diverse. Practically speaking there are intuitive limits to the areas of these disciplines which are more usually considered to be immediately relevant to Psychiatry. These limits are a function of culture.

Having considered the body of knowledge that is relevant directly or indirectly to Clinical Psychiatry we can now turn to how that body of knowledge is arrived at. For each area of knowledge there are corresponding disciplines each with their own communities. I have examined one aspect of scientific communities in my review of Thomas Kuhn’s ‘The Structure of Scientific Revolutions’ as well as an ongoing interpretation of scientific revolutions (See Appendix 2). Here the application of Web 2.0 is more appropriately considered by the communities themselves although at the interface there is significant room for exploration*.

Turning to Clinical Psychiatry this is an area where there would appear to be more immediate clinical benefits for the application of Web 2.0 principles. I will deconstruct Clinical Psychiatry into the following broad categories

1. Psychiatric Technology. The application of the body of Psychiatric knowledge. Bear in mind that this knowledge base is both direct and indirect and potentially vast. Also the definition of technology here is broader than some definitions of technology which are restricted to the application of scientific knowledge .

2. Management of clinical resources. Here the term refers broadly to the management of clinical resources ranging from economic considerations through to workflow processes within the clinical setting.

3. Relationship with the patient and the public. Since it is the patient and public that are served by Psychiatry, the relationship of Psychiatrists and Psychiatry to the patient and public is a significant consideration.

4. Relation to colleagues and synergistic organisations. Psychiatrists work with a range of allied healthcare professionals, other professionals and synergistic organisations in order to deliver clinical care. This again is an area for consideration.

5. Knowledge transfer into the domain of Clinical Psychiatry. This covers a range of processes which ensure that knowledge transfer occurs at both the level of the individual and the community. This includes the conversion from knowledge to technology.

6. Evaluation and improvement of the application of Psychiatric Technology. In order to maximise the benefits from the application of Psychiatric Technology, the application needs to be governed by mechanisms which ensure an improvement in clinical outcomes and clinical processes.

The coverage of all of these areas provides a clear overview of this initial definition of Psychiatry 2.0. I would add just one further point which is the issue of licensing. Whilst debate can be stifled by issues around trademarking, I would consider Psychiatry 2.0 to be a public domain concept rather than a trademarked concept. The aim here is to facilitate discussion and collaboration, to ensure debate is not stifled. The potential for the Psychiatry 2.0 debate is too significant for it to be diverted by future trademark assertions and so at this early stage I make a claim through this detailed definition for Psychiatry 2.0 for the term to remain in the public domain. Although this may appear to be a curious point to make, Trademark cases have been made for other such terms including Web 2.0.

*In this area, it is entirely possible that languages can be developed to facilitate the traversing of these boundaries.

Appendix 1 – Science 4.0 Articles on the TAWOP Site

What is Science 4.0 and Why is it Necessary?

Doing Science 4.0. Deconstructing Web 2.0. Lightweight Programming Models

Doing Science 4.0. Deconstructing Web 2.0. The Importance of Data

Doing Science 4.0. Harnessing Collective Intelligence by Curating the Blogosphere

Doing Science 4.0. Deconstructing Web 2.0. Harnessing Collective Intelligence

Doing Science 4.0. Deconstructing the Web 2.0. The Web as Platform.

Doing Science 4.0. Deconstructing Web 2.0. The End of the Software Cycle

Doing Science 4.0. Deconstructing Web 2.0. Software Above the Level of a Single Device

Doing Science 4.0 Deconstructing Web 2.0 – Rich User Experiences

Doing Science 4.0. Part 1. What is Science 4.0?

Doing Science 4.0. Web 2.0

Open MRS 

 

Appendix 2 – Discussion of Thomas Kuhn on the TAWOP Site

A Review of the Structure of Scientific Revolutions

An Interpretation of Scientific Revolutions – Part 1

An Interpretation of Scientific Revolutions – Part 2

An Interpretation of Scientific Revolutions – Part 3

An Interpretation of Scientific Revolutions – Part 4

An Interpretation of Scientific Revolutions – Part 5

An Interpretation of Scientific Revolutions – Part 6

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

An Interpretation of Scientific Revolutions – Part 7 – A Discussion of the Anomaly and Beyond

Thomas Kuhn’s ‘The Structure of Scientific Revolutions’ was a landmark publication which helped reassess and refine the understanding of the core principles of scientific endeavour. The essence of Kuhn’s work was that scientific activity occurs in two broad categories – normal science and revolutionary science.  At the time of revolutionary science, the core principles of the established scientific paradigm within a community are challenged by a competing paradigm. The resulting Hegelian Dialectical involves a replacement of the old paradigm by the new. The process of normal science occurs within a paradigm and describes the most common form of scientific activity where lines of inquiry reflect a tacit acceptance of the framework of assumptions of the guiding paradigm. In Chapter 6 (see Appendix) Kuhn writes about the anomaly in relation to emerging scientific discoveries. The essence of this chapter as I have interpreted it is that the revolutionary and normal scientific activities are inextricably linked. Kuhn suggests that anomalies arise during the course of normal science. A finding occurs which cannot be explained within the framework of the guiding paradigm. Further activity better characterises this anomaly and further lines of inquiry arise. Explanations for this anomaly give rise to a new paradigm – the revolutionary paradigm.

How can such an understanding be applied to a science which is eclectic, pragmatic and empirical in approach? One interpretation is that such a science cannot readily have the normal scientific activities unless these occur within the scientific community operating within the central paradigm. If this same science is eclectic in approach then it is disenfranchised from the above relationship between normal and revolutionary science as the normal science occurs within other scientific communities. The necessary anomalies result from the normal scientific activities of those communities and the anomalies are more readily recognised within those same communities. Additionally those same scientific communities may also be better equipped to investigate these anomalies and generate the foundations of the subsequent paradigms. However this period of revolutionary science is one of de novo generation. The iconic cultural events have yet to occur and eclectic scientific communities are well placed to participate in this movement although not to carry this through unless becoming part of this community. There are solutions which have been discussed in a previous post.

Interestingly individual branches of science may with time diversify to such an extent that rather than being homogenous they may instead come to form a heterogenous group of scientific communities. In this case any common identity necessitates the adoption of an eclectic understanding in contrast with superspecialisation if an identity is to be maintained. Indeed this tension between identity and specialisation may itself generate a misplaced expenditure of resources. This issue of superspecialisation however is distinct from that of Kuhn’s argument about anomalies but interacts as it must at the level of the culture of a scientific community. In his book, Kuhn gives the example of disciplines which are sufficiently refined with time as to become separate branches of science and indeed to generate their own sub-branches. This however was not central to Kuhn’s arguments. The textbook which Kuhn refers to elsewhere must also become an examplar of the eclectic approach to a branch of science being as it is aimed at the student. A distillation of the science for the initiate is necessarily bereft of the cultural nuances which make a scientific community as Kuhn’s work implies that one aspect of science is almost organic – ‘living’ within the scientific community with which it is synonymous. Indeed the distillation is only an approximation of the scientific language which is spoken by the community.

However one last point is that the anomaly is a key concept here as Kuhn is characterising the scientific community and not other communities.

Appendix

Review of Chapter 6 (see link for rest of review)

The sixth chapter in Kuhn’s book ‘The Structure of Scientific Revolutions’ is titled ‘Anomaly and the Emergence of Scientific Discoveries’. Kuhn gives the example of Thomas Priestley and his ‘discovery’ of Oxygen. The discovery of Oxygen is undoubtedly an important one. Kuhn playfully moves around the history of the discovery of Oxygen showing the futility of pinning it down to the discovery at a certain point in time by means of a simple act. Instead he argues that there must be another means of conceptualising this. The identification and characterisation of Oxygen occurred not in isolation but in the context of contemporary theory. It was through the change in theory that the significance of Oxygen came to be appreciated. In effect it was a network of scientists that collectively brought about the discovery of Oxygen combining both the experimental and conceptual elements necessary for this accomplishment. Kuhn gives other examples. Continuing with his division of science into normal science and revolutionary science, he argues that normal science restricts the focus of the scientist towards confirmation. However this very process highlights anomalies and it is these anomalies that form the basis for revolutionary science. Revolutionary and normal science can be considered to be activities at different levels of a theoretical hierarchy. The implication is that even when activities are geared towards one level of that hierarchy they lead necessarily to changes at other layers of the hierarchy (and perhaps in an unpredictable way). Kuhn gives the example of an experiment involving the presentation of playing cards to subjects. One of the playing cards would be distinct but unless they were looking for this, the subjects didn’t register it consciously. When they were challenged on this after the presentation a small minority of the subjects would become confused about what they had seen and Kuhn hints at what is to come later in the book. By looking at the material in this way, Kuhn offers us insights into the underlying mechanisms of science as well as offering the potential to look at alternative approaches.

Related Resources on the TAWOP Site

A Review of the Structure of Scientific Revolutions

An Interpretation of Scientific Revolutions – Part 1

An Interpretation of Scientific Revolutions – Part 2

An Interpretation of Scientific Revolutions – Part 3

An Interpretation of Scientific Revolutions – Part 4

Index: There are indices for the TAWOP site here and here Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link. Podcast: You can listen to this post on Odiogo by clicking on this link (there may be a small delay between publishing of the blog article and the availability of the podcast). It is available for a limited period. TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link. Responses: If you have any comments, you can leave them below or alternatively e-mail justinmarley17@yahoo.co.uk. Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.