The (Un)managed Self: Paradoxical Forms of Agency in Self-Management of Bipolar Disorder

Self-management of mental illness is a therapeutic paradigm that draws on a distinctly biomedical conceptualization of the isolability of personhood from pathology. This discourse posits a stable and rational patient/consumer who can observe, anticipate, and preside over his disease through a set of learned practices. But in the case of bipolar disorder, where the rationality of the patient is called into question, the managing self is elusive, and the disease that is managed coincides with the self. While humanist critiques of the biomedical model as applied to mental illness have argued that its logic fatalistically denies patients intentionality and effectiveness (Luhrmann, Of Two Minds: The Growing Disorder in American Psychiatry, 2000), biomedical proponents claim that psychiatry’s way of envisioning the body as under the control of the intentional mind actually returns agency to the patient/consumer. Rose (The Psychiatric Gaze, 1999) remarks that biomedical models have the potential to “[open] that which was considered natural to a form of choice” (p. 37), and that techniques of medical self-control help constitute the free embodied liberal subject who is obliged to calculate and choose. Through an examination of clinical literature as well as the practices and narratives of members of a bipolar support group, this paper explores ethnographically the possibilities for subjectivity and agency that are conditioned or foreclosed by the self-management paradigm, which seems to simultaneously confer and deny rational selfhood to bipolar patients. To express their expertise as rational self-managers, patients/consumers must, paradoxically, articulate constant suspicion toward their present thoughts and emotions, and distrust of an imagined future self. I argue that through their self-management practices, bipolar support group members model provisional and distributed forms of agency based on an elusive, discontinuous, and only partially knowable or controllable self—revealing, perhaps, the limits of the contemporary reification and medicalization of both selfhood and disease.     

Brain Networks Responsible for Sense of Agency: An EEG Study

BackgroundSelf-agency (SA) is a person’s feeling that his action was generated by himself. The neural substrates of SA have been investigated in many neuroimaging studies, but the functional connectivity of identified regions has rarely been investigated. The goal of this study is to investigate the neural network related to SA.MethodsSA of hand movements was modulated with virtual reality. We examined the cortical network relating to SA modulation with electroencephalography (EEG) power spectrum and phase coherence of alpha, beta, and gamma frequency bands in 16 right-handed, healthy volunteers.ResultsIn the alpha band, significant relative power changes and phase coherence of alpha band were associated with SA modulation. The relative power decrease over the central, bilateral parietal, and right temporal regions (C4, Pz, P3, P4, T6) became larger as participants more effectively controlled the virtual hand movements. The phase coherence of the alpha band within frontal areas (F7-FP2, F7-Fz) was directly related to changes in SA. The functional connectivity was lower as the participants felt that they could control their virtual hand. In the other frequency bands, significant phase coherences were observed in the frontal (or central) to parietal, temporal, and occipital regions during SA modulation (Fz-O1, F3-O1, Cz-O1, C3-T4L in beta band; FP1-T6, FP1-O2, F7-T4L, F8-Cz in gamma band).ConclusionsOur study suggests that alpha band activity may be the main neural oscillation of SA, which suggests that the neural network within the anterior frontal area may be important in the generation of SA.     

Visual Feedback Dominates the Sense of Agency for Brain-Machine Actions

Recent advances in neuroscience and engineering have led to the development of technologies that permit the control of external devices through real-time decoding of brain activity (brain-machine interfaces; BMI). Though the feeling of controlling bodily movements (sense of agency; SOA) has been well studied and a number of well-defined sensorimotor and cognitive mechanisms have been put forth, very little is known about the SOA for BMI-actions. Using an on-line BMI, and verifying that our subjects achieved a reasonable level of control, we sought to describe the SOA for BMI-mediated actions. Our results demonstrate that discrepancies between decoded neural activity and its resultant real-time sensory feedback are associated with a decrease in the SOA, similar to SOA mechanisms proposed for bodily actions. However, if the feedback discrepancy serves to correct a poorly controlled BMI-action, then the SOA can be high and can increase with increasing discrepancy, demonstrating the dominance of visual feedback on the SOA. Taken together, our results suggest that bodily and BMI-actions rely on common mechanisms of sensorimotor integration for agency judgments, but that visual feedback dominates the SOA in the absence of overt bodily movements or proprioceptive feedback, however erroneous the visual feedback may be.     

The Sense of Agency during Continuous Action: Performance Is More Important than Action-Feedback Association

The sense of agency refers to the feeling that one is controlling events through one’s own behavior. This study examined how task performance and the delay of events influence one’s sense of agency during continuous action accompanied by a goal. The participants were instructed to direct a moving dot into a square as quickly as possible by pressing the left and right keys on a keyboard to control the direction in which the dot traveled. The interval between the key press and response of the dot (i.e., direction change) was manipulated to vary task difficulty. Moreover, in the assisted condition, the computer ignored participants’ erroneous commands, resulting in improved task performance but a weaker association between the participants’ commands and actual movements of the dot relative to the condition in which all of the participants’ commands were executed (i.e., self-control condition). The results showed that participants’ sense of agency increased with better performance in the assisted condition relative to the self-control condition, even though a large proportion of their commands were not executed. We concluded that, when the action-feedback association was uncertain, cognitive inference was more dominant relative to the process of comparing predicted and perceived information in the judgment of agency.     

The Sense Organs and Ventral Ganglion of Sagitta (Chaetognatha)

This paper describes some features of the chaetognath nervous system from ultrastructural observations and observations on material stained with specific techniques for nervous tissue, and from records of the activity of the locomotor muscles and ventral ganglion. Sensory cells grouped on the ventral surface of the head bear ciliary processes (some with multiple tubules), and are probably in connexion with the central nervous system by their own axons, unlike the sensory cells of the hair fan vibration receptors of head and body. The ventral ganglion is motor to the locomotor muscles of the body, and controls the rhythmic locomotor activity of the animal. Electrical events associated with contraction of these muscles are compound non-overshooting spike-like potentials. The ventral ganglion contains several large nerve fibres constant in position and connexions in different individuals. Some of these arise from cells in the ganglia of the head, and pass to the ventral ganglion, others from cells within the ventral ganglion, and probably supply the ciliary hair fan receptors of the body, whilst the motor axons issuing from the ventral ganglion are smaller in diameter. The ganglion is arranged on a ladder-like plan, and axons of the lateral cell bodies cross the central neuropil transversely before they contribute to the longitudinal tracts or pass out in the radial nerves. Synapses in the neuropil contain 30–40 nm electron lucent vesicles; the transmitter is unknown, but is unlikely to be either acetylcholine or l -glutamate. Occasional larger electron dense vesicles up to 70 nm in diameter are also found within nerve fibres of the neuropil. It is concluded that the arrangement of the peripheral nervous system is unlike that of several groups which have been suggested as related to chaetognaths.     

The (Paleo)Geography of Evolution: Making Sense of Changing Biology and Changing Continents

During the voyage of the H.M.S. Beagle, Charles Darwin quickly realized that geographic isolation led to significant changes in the adaptation of local flora and fauna (Darwin 1859). Genetic isolation is one of the well-known mechanisms by which adaptation (allopatric speciation) can occur (Palumbi, Annu Rev Ecol Syst 25:547?C72, 1994; Ricklefs, J Avian Biol 33:207?C11, 2002; Burns et al., Evolution 56:1240?C52, 2002; Hendry et al., Science 290:516?C8, 2009). Evolutionary changes can also occur when landmasses converge or are ??bridged.?? An important and relatively recent (Pliocene Epoch) example known as the ??Great American Biotic Interchange?? allowed for the migration of previously isolated species into new ecological niches between North and South America (Webb 1985, Ann Mo Bot Gard 93:245?C57, 2006; Kirby and MacFadden, Palaeogeogr Palaeoclimatol Palaeoecol 228:193?C202, 2005). Geographic isolation (vicariance) or geographic merging (geodispersal) can occur for a variety of reasons (sea level rise, splitting of continents, mountain building). In addition, the growth of a large supercontinent (or breakup) may change the climatic zonation on the globe and form a different type of barrier for species migration. This short review paper focuses on changing paleogeography throughout the Phanerozoic and the close ties between paleogeography and the evolutionary history of life on Earth.     

Sense organs on the antennal flagellum of mayflies (Ephemeroptera)

A few very small sensory pegs with the characteristics of chemoreceptors are present in both males and females on the antennal flagellum of the mayflies, Stenacron interpunctatum (Say)

1 Stenacron interpunctatum (Say) is Stenonema interpunctatum (Say) of earlier literature.

and Cloeon sp. They are situated near the proximal end of the flagellum on its ventro-lateral surface and have escaped the attention of earlier investigators.     

内共生菌Cardinium对烟粉虱MED隐种耐药性的影响

【目的】次生内共生菌感染可影响烟粉虱Bemisia tabaci对杀虫剂的敏感性。本研究旨在揭示内共生菌Cardinium感染对烟粉虱B. tabaci MED隐种耐药性的影响。【方法】室内测定海南陵水与山东寿光烟粉虱MED隐种种群内遗传背景一致的Cardinium感染与未感染品系对不同浓度新烟碱类杀虫剂噻虫嗪和吡虫啉的耐药性。【结果】各浓度噻虫嗪和吡虫啉处理后,烟粉虱陵水种群感染Cardinium品系死亡率比未感染品系显著降低;100, 150, 175和200 mg/L噻虫嗪以及175和200 mg/L吡虫啉处理后,烟粉虱寿光种群感染Cardinium品系死亡率比未感染品系显著上升。相对于未感染品系,烟粉虱陵水种群感染Cardinium品系对噻虫嗪、吡虫啉的抗性倍数(RR)分别是1.355和1.847,烟粉虱寿光种群感染Cardinium品系的RR分别是0.790和0.847。【结论】内共生菌Cardinium感染能影响烟粉虱MED隐种对噻虫嗪和吡虫啉的耐药性,且这种影响在不同种群间存在差异。研究结果对于揭示烟粉虱MED隐种的种群适应性及扩张机制具有重要参考价值。     

Modernity,Cultural Anesthesia,and Sensory Agency: Technologies of the Listening Self in a US Collegiate Jazz Music Program

In this article, I rely on Michel Foucault's notion of ‘technologies of the self’ to theorize the micro-practices by which individuals actively negotiate the reconfiguration of their sensory skills as a result of modernization processes. In doing so, I draw on ethnographic fieldwork I conducted in a collegiate jazz music program in the USA. By exploring a number of interactional games in which jazz students attempt to negotiate the challenge of cultivating aural skills in a pedagogical context that embraces visually mediated modes of knowledge production and transmission as a result of the professionalization and rationalization of jazz training, I inquire into the conditions of possibility for sensory agency under modernity.     

The Effectiveness of Electronic Differential Diagnoses (DDX) Generators: A Systematic Review and Meta-Analysis

Background

Diagnostic errors are costly and they can contribute to adverse patient outcomes, including avoidable deaths. Differential diagnosis (DDX) generators are electronic tools that may facilitate the diagnostic process.

Methods and Findings

We conducted a systematic review and meta-analysis to investigate the efficacy and utility of DDX generators. We undertook a comprehensive search of the literature including 16 databases from inception to May 2015 and specialist patient safety databases. We also searched the reference lists of included studies. Article screening, selection and data extraction were independently conducted by 2 reviewers. 36 articles met the eligibility criteria and the pooled accurate diagnosis retrieval rate of DDX tools was high with high heterogeneity (pooled rate = 0.70, 95% CI = 0.63 to 0.77; I² = 97%, p<0.0001). DDX generators did not demonstrate improved diagnostic retrieval compared to clinicians but small improvements were seen in the before and after studies where clinicians had the opportunity to revisit their diagnoses following DDX generator consultation. Clinical utility data generally indicated high levels of user satisfaction and significant reductions in time taken to use for newer web-based tools. Lengthy differential lists and their low relevance were areas of concern and have the potential to increase diagnostic uncertainty. Data on the number of investigations ordered and on cost-effectiveness remain inconclusive.

Conclusions

DDX generators have the potential to improve diagnostic practice among clinicians. However, the high levels of heterogeneity, the variable quality of the reported data and the minimal benefits observed for complex cases suggest caution. Further research needs to be undertaken in routine clinical settings with greater consideration of enablers and barriers which are likely to impact on DDX use before their use in routine clinical practice can be recommended.     

Ambiguating Agency: The Case of Malinowski's Ghost

Agency is useful to people not so much for controlling a site of authorship or authority as for ambiguating social relationships and authority. Both indigenous and anthropological practices of ambiguation are critical sites of discourse that allow the gaps and ruptures between epistemologies the possibility of positive value.     

The Fundamental Theorem of Natural Selection in Ewens'' Sense (Case of Fertility Selection)

We show that the Fundamental Theorem of Natural Selection in Ewens' sense is valid in the case of fertility selection: the additive genetic variance in fertility divided by the mean fertility is exactly equal to the partial change in the mean fertility from the current generation to the next. This partial change is the increase in the mean additive value caused by frequency changes from one generation to the next but keeping unchanged the additive values. The only hypothesis on mating is that it does not affect the allelic frequencies in the sense that these are the same before and after mating in the parental generation, which occurs for a wide range of mating patterns going from random mating to several regular systems of inbreeding and cases of assortative mating. The fertility of couples is determined by the genes at an arbitrary number of loci, and the additive (average) allelic effects are defined by a linear system of equations, which is used to extend Ewens' optimality principle to the case of fertility selection.     

Influences on the density and dispersion of bumble bee nests (Hymenoptera: Apidae)

To determine some of the influences on nesting densities of bumble bees I examined the dispersion and occupancy of 35 nests in an old field on Amherst Island, Ontario, Canada and 39 nests found by Cumber (1953) in England. Densities up to 1 nest per 200 m² were observed. Overall, Cumber's nests were randomly dispersed, but nests on the ground surface were aggregated. Nests of surface-nesting species were consequently more aggregated than expected at random, whereas surface-nesting and underground-nesting species seldom nested near one another. This distribution of nests probably reflects the nesting habits of the rodents that originally constructed the nests, rather than interactions between bees. On Amherst Island, abnormally wet spring weather apparently hampered normal colony development, particularly of underground-nesting bees based on a low frequency of underground nests, scarcity of workers of two underground-nesting species compared with the relative abundance of spring queens, and delayed appearance of workers of all species relative to the previous year. The nests of two common species were randomly dispersed, but those of a third species were regularly distributed, suggesting that intraspecific interactions may limit nesting density for this species.     

The Camera and the Anthropologist: Reflections on Photographic Agency

How does our choice of camera impact the way we see our field sites and carry out our work within them? What kinds of seeing does a particular camera enable or foreclose? This essay draws on recent theoretical interventions in new materialism and object-oriented ontology, as well as the author’s last decade of experience producing images in the field, to argue that visual anthropology is a collaborative, co-agentive act between anthropologist and camera. Our cameras matter, we conclude, and it is time for us to begin thinking through how they matter and the kinds of material differences they make.