'Doing diagnosis differently': An exploration of vitality and technology in mental health

Lead Research Organisation: Goldsmiths University of London
Department Name: Sociology

Abstract

How do new methods of detecting neurodegenerative disease map the 'person-in-time'? How do people
come to participate in techno-scientific projects that seek to track cognitive decline earlier and more
intensively than ever before (Leibing 2014; Boenink, Van Lente, and Moors 2016; Swallow 2019)? What
ethical and epistemic challenges do these new measurement and diagnostic practices bring? In
this fellowship, I will draw on empirical, methodological, and conceptual insights from my PhD and postdoc
to develop a research programme to tackle these pressing questions.

In my PhD, I argued that working against mainstream classifications of need created possibilities but
came at a cost. To produce eligibility and access to clinical care for underserved groups, voluntary care
providers articulated mental health needs in alternative, non-diagnostic ways. This required laborious
negotiations across funders, internal values and interests, and wider matters of concern. It also produced
new tensions between 'knowledge of' mental ill health and the indeterminate 'lived experience' of
service users. In my post-doc, I am beginning to see how similar tensions might manifest in the context
of neurodegenerative disease. Where prevention and treatment trials demand the early detection of
Alzheimer's disease, there is a need to investigate the effects of using innovative technologies to detect
signs of the disease before it is diagnosed clinically (Milne et al. 2018) and the implications for inclusion
in trials (Epstein 2008). How do recruitment and measurement practices shape, become shaped by, or
conflict with the lives and subjectivities of research participants? Whose interests do they serve? This
fellowship will enable me to 'follow' such empirical inquiries to a new field site and develop them into a
bigger programme of work, aligned to the UK Industrial Strategy on our ageing society and AI & data.

As well as this empirical link between my PhD and emerging research, there are theoretical and
methodological threads running between them. In both, I adopt a 'vitalist' framework - currently
receiving much attention within medical anthropology/sociology - that theorises the dynamic relations
between mental (ill) health, environment, biology, and society (Canguilhem 1952/2001; Wahlberg 2018;
Lupton 2019). To put this theory to work empirically, I have developed a methodological approach
employing visual and other 'live' methods (inspired by Goldsmiths scholars (Wakeford & Lury 2012)).
Under the mentorship of Monica Greco, an expert in vitalist thinking, I will publish and build on my PhD to
generate 'live' ways to engage with spaces and temporalities within the mental health systems of a
'hyper-cognitive' society (Post 2000). This will establish a methodological and theoretical toolbox to
explore themes of diagnosis, technology, and vitality in the field of Alzheimer's disease. A major output
will be grant proposals that attend to the relations between lived time and the biology of disease
trajectories when it comes to detecting neurodegenerative disease.

The outputs combine academic publications from my PhD and post-doc work, user and public
engagement, and scoping for grant development. Scoping work will be in the MRC Dementias Platform
UK's "Deep and Frequent Phenotyping" (DFP) project: a perfect example of a research programme
focussed on assessment and detection (but not clinical diagnosis) of a psychiatric condition. With the
support of the DFP principle investigator, and my third mentor (an ethical advisor to the study) I will
immediately be ready to engage scientists, researchers, participants and wider communities that have
stakes in this research. Impact and engagement activities will be closely linked to the scoping work and
academic outputs. I will run both public and user engagement workshops to set priorities and creatively
explore the way new technologies measure cognitive decline.

Publications

10 25 50
 
Title "To a future self, with love from a very present present," for the Dementia Letter Project 
Description This was a piece of creative writing contributing to an ongoing project to collect letters from people to their future selves with dementia, in order to change the way people think about their futures and the future of an ageing society. The aim was to make the letters accessible to a wide readership - ranging from academics interested in dementia, time, futures, hope, possibilities and potentialities, speculation, selfhood, storytelling and a whole variety of topics we will discover through writing and reading the collection, to people whose lives are touched by dementia in one way or another, family and professional carers included, and all others who are simply interested in reading them. My letter was published on the project website and the editors hope to compile and publish an edited volume including it. 
Type Of Art Creative Writing 
Year Produced 2021 
Impact Emotional impact for community of caregivers I am part of, as well as intellectual and political impact for thinking about our own ageing and an ageing society. 
URL https://www.anneliekedriessen.com/natassiabrenman
 
Description A key set of findings emerged from my scoping research into the effects of the Covid-19 pandemic on dementia research and the role of technology in shaping the future landscape of diagnosis and prevention of dementias. During the Covid-19 pandemic, existing practical, ethical and social issues in dementia research re-emerged with more complexity, compounded by additional challenges for researchers. My scoping research study sought to address this, provide space for discussion, and identify urgent issues and questions for the future of clinical research in dementia. Three focus group discussions were carried out online, comprising researchers from different clinical research sites working on similar aspects of dementia research (on-site, off-site, and investigator roles). Findings emerged under four main themes:
1) Impact of Covid on clinical research: The de-prioritisation of dementia and precarious position of universities puts non-Covid related research under existential threat. A key question was how to effectively and ethically support and secure a process of re- prioritisation?
2) Impact on patients and participants - inclusion and access to dementia research: Reducing the diversity of studies meant reducing diversity amongst participants. There have been direct (age-related) and indirect barriers to participation due to Covid. Indirect exclusions relate to other health burdens plus limited access to clinical research, care, and technologies. The pandemic is predicted to make dementia research less diverse.
3) Practical and ethical challenges to conducting dementia research: The complex relationship between age, Covid risk, and dementia risk presented difficult practical and ethical problems to researchers. Risk-averse decisions to protect vulnerable participants and patients from Covid can exacerbate or "re-exclude" already underrepresented groups in clinical research.
4) The role of remote testing and digital biomarkers, during and post-pandemic: There has been an increased need for remote technologies during lockdowns. However, there were split opinions between on-site and off-site groups about which model of phenotyping or assessment best enables prevention: digital phenotyping ('empowering' for the individual) or deep phenotyping (emphasising brain disease as treatable and preventable)?
Overall, participants were keen to harness new forms of data and technology to address two key issues that have been made more visible and amplified by the Covid-19 crisis: the importance of early prevention and access to care and research. However, the future of how technologies will and should be used in their broader social and scientific context remained uncertain and open for debate.

Together with two colleagues from Wellcome Connecting Science, I developed, presented and published theoretical findings relating to these more applied findings. In a paper on "Digital phenotyping and the (data) shadow of Alzheimer's disease", we examine the practice and promises of digital phenotyping in dementia and brain health. We build on work on the 'data self' to focus on a medical domain in which the value and nature of knowledge and relations with data have been played out with particular persistence, that of Alzheimer's disease research. Drawing on research with researchers and developers, we consider the intersection of hopes and concerns related to both digital tools and Alzheimer's disease using the metaphor of the 'data shadow'. We suggest that as a tool for engaging with the nature of the data self, the shadow is usefully able to capture both the dynamic and distorted nature of data representations, and the unease and concern associated with encounters between individuals or groups and data about them.

Relatedly, I brought together scholars working on digital psychiatry in the context of the pandemic and beyond to produce a set of findings, which should be seen as a research agenda for future work, rather than a conclusion to research in this field. We suggest that the emergent knowledge practices of digital phenotyping are part of a burgeoning digital psychiatry that crafts an alternate future no longer reliant on shared linguistic constructs, symptom recall, interpersonal rapport, or the clinic as a separate sphere and infrastructure. Put differently, digital phenotyping, and the broader set of practices and imaginaries that we call 'digital psy' untether the common arrangements of place, temporality, language, labour, service users, experts and carers characteristic of the Western psychiatric model. This, we suggest, deserves close ethnographic attention, and we call for different and more imaginative modes of engagement and critique when it comes to digital methods of tracking and tracing mental ill health.
Exploitation Route The Dementias Platform UK are keen to further explore the potential of remote methods to enable further access to dementia research, developing these more social and ethical research questions my research posed, alongside their main focus on clinical trials and biomedical research. Most notably, they are doing this through through the newly emerging Brain Health Clinic network, led by my partners at Oxford. My co-author and collaborator continues to develop research and public engagement in his role as co-director of the Kavli Centre for Ethics, Science, and the Public in Cambridge, such as the Hopes and Fears Lab and ongoing work at Wellcome Connecting Science.

My workshop on speculative futures and chronic illness sparked a great deal of enthusiasm amongst scholars across the social sciences and several participants are developing their work to build a collection of published papers in the journal Medical Anthropology. The proposal has been peer reviewed and accepted for publication in the journal and the academics involved are currently developing their work for this purpose.

Since being invited as a speaker at the Writing the Good City at the Centre for Urban Wellbeing, plans have been made to develop the Mental Health Humanities Network which will generate projects and funding based on interdisciplinary expertise on mental health, cities and wellbeing,
Sectors Digital/Communication/Information Technologies (including Software),Education,Healthcare,Pharmaceuticals and Medical Biotechnology

 
Description The Dementias Platform UK have already used my scoping research to argue for the re-prioritisation of dementia research in the clinical trials and health technology landscape. Industry partners were very interested in using these findings as a way to forge links with academia and align their priorities in order to create the best outcomes for people living with dementias and associated pre-conditions such as Mild Cognitive Impairment. The impact work we developed as part of the collaborative project on digital psychiatry focussed on creatively exploring and raising awareness about digital exclusion, particularly since the pandemic. We created an opportunity for people with lived experience of digital exclusion to explore and communicate their experiences through a theatre workshop and developed a platform for this to create impact in the wider public via a podcast. Some of the outcomes of this funding related to my PhD, for example, my contribution to an edited volume on the power of ethnography to expose 'banal inequalities' in contemporary society. This has been compiled as an accessible book for a range of audiences interested in writing, social research and activist scholarship. The methodologies demonstrated in my chapter and the book as a whole can be taken forward by students, scholars, activists and others interested in using ethnographic writing as a tool for social change.
First Year Of Impact 2021
Sector Digital/Communication/Information Technologies (including Software),Healthcare,Pharmaceuticals and Medical Biotechnology
Impact Types Cultural,Societal

 
Description DPUK commissioned report on the effects of covid on dementia research
Geographic Reach National 
Policy Influence Type Contribution to new or improved professional practice
Impact The research contributed to a broader set of policy engagements by my research partner's at the University of Oxford and DPUK including the development of Brain Health Clinics to be scaled up across the country to "translate state-of-the-art research gains into the clinic, whilst simultaneously facilitating research with real-world clinical data and access to patients for clinical trials" (WIN policy engagement ).
URL https://www.dementiaresearcher.nihr.ac.uk/wp-content/uploads/2021/06/RECORD-dementia-research-report...
 
Title RECORD: Researching the Effects of COVID-19 on Research in Dementia 
Description RECORD is a qualitative focus group study, developed in collaboration with the Oxford team of the MRC Dementias Platform UK Deep and Frequent Phenotyping (DFP) Study, which is a multi-centred UK-wide cohort study. Three focus groups were carried out online, comprising researchers from different sites working on similar aspects of dementia research: 1. On-site clinical researchers 2. Off-site researchers using digital and remote methods 3. Investigators leading clinical research at key sites Recruitment was carried out via the DFP and its clinical and research networks using a snowball sampling technique. 10 participants were recruited from across sites and roles (4 participants in the first group and 3 participants in groups 2 and 3). They included clinical researchers from Oxford, Exeter, London, Edinburgh, Manchester, and Newcastle, as well as an industry partner and an academic involved in the broader dementia research network in the UK. Each discussion took between 1.5 and 2 hours, depending on the size of the group, and the online sessions were video and audio recorded. Discussions were transcribed and analysed using thematic analysis using NVivo software. Ethical approval for the study was granted by the University of Cambridge. 
Type Of Material Database/Collection of data 
Year Produced 2021 
Provided To Others? No  
Impact This data set revealed important social and ethical elements of the impact of covid on dementia research and provided evidence needed to advocate for the re-prioritisation of dementia research in the clinical trials and health technology landscape. 
URL https://www.dementiaresearcher.nihr.ac.uk/wp-content/uploads/2021/06/RECORD-dementia-research-report...
 
Description Co-leading blog series and engagement project: Tracking Digital Psy: Mental Health and Technology in an Age of Disruption 
Organisation Massachusetts Institute of Technology
Country United States 
Sector Academic/University 
PI Contribution Co-editor of blog series - Tracking Digital Psy: Mental Health and Technology in an Age of Disruption http://somatosphere.net/series/tracking-digital-psy/ Co-author of editors' call and introduction essay published online - The subjects of digital psychiatry http://somatosphere.net/2020/subjects-of-digital-psychiatry.html/ Contributor to podcast, led by Dörte Bemme: Digital exclusions: mental health and digital life
Collaborator Contribution Dörte Bemme, Lecturer at the Centre for Society & Mental Health and the Department for Global Health and Social Medicine at King's College London: established the collaboration, led the communications with online blog editors at Somatosphere, led the public engagement podcast to close the series, Co-editor of blog series, Co-author of editors' call and introduction essay published online. Beth Semel, Postdoctoral Associate in Anthropology at the Massachusetts Institute of Technology: Co-editor of blog series, Co-author of editors' call and introduction essay published online, Contributor to podcast, co-author of Form, Content, Data, Bodies: Jonathan Zong and Beth Semel on Biometric Sans (with Jonathon Wang) Somatosphere, A collaborative website covering the intersections of medical anthropology, science and technology studies, cultural psychiatry, psychology and bioethics.
Impact Blog series, including editors' call and introduction essay published online. Podcast for KCL's Our Sick Society (see engagement section)
Start Year 2020
 
Description Cross-institutional collaboration contributing to conference panel and published paper in special issue on digital phenotyping 
Organisation Wellcome Genome Campus
Country United Kingdom 
Sector Private 
PI Contribution Led conference paper and presentation, co-authored paper
Collaborator Contribution Richard Milne was first author on our paper Alessia Costa was second author on the paper
Impact Original research paper: https://journals.sagepub.com/doi/full/10.1177/20539517211070748
Start Year 2020
 
Description International collaboration: 2-day international workshop, public lectures, and special issue development 
Organisation Leiden University
Country Netherlands 
Sector Academic/University 
PI Contribution I co-led organised a social science symposium on 'Interrogating Speculative Futures', hosted by Goldsmiths Centre for Invention and Social Process with my collaborator, Dr Natashe Lemos-Dekker, from the University of Leiden in the Netherlands. We are now guest editing a special issue in the journal Medical Anthropology on this theme. questions surrounding the politics of speculation in the field of chronic health and illness. We hosted two days of presentations and discussion across a range of disciplines within the social sciences and included included two artistic contributions to inspire and engage the participants. The workshop addressed questions surrounding the politics of speculation in the field of chronic health and illness. We organised 2 public lectures by two leading experts in the field, which were widely attended via an online streaming platform. We published a report on the workshop, on the widely read academic blog, Somatosphere to publicise the outcomes. We have had a special issue accepted to a highly regarded international journal and I currently guest editing this special issue, and co-authoring the introduction. This is due to be published in 2024.
Collaborator Contribution All activities were co-produced, although my collaborator presented her own work at the symposium.
Impact A Conference Report on the workshop, on the widely read academic blog, Somatosphere. 2 public lectures by two leading experts in the field, which were widely attended via an online streaming platform. Peer reviewed special issue proposal - accepted to a highly regarded international journal, due to be published in 2024
Start Year 2020
 
Description MRC Dementias Platform UK, Deep and Frequent Phenotyping Study Team, University of Oxford 
Organisation MRC Dementias Platform UK
Country United Kingdom 
Sector Academic/University 
PI Contribution Qualitative research study and report: RECORD: Researching the Effects of Covid on Research in Dementia.
Collaborator Contribution Support in study design and access to sites/participants, dissemination of output including formatting and press releases, ongoing collaborations and access to field sites for a future project.
Impact MRC Dementias Platform UK commissioned priority-setting study and report for the current state and future of dementia research - RECORD: Researching the Effects of Covid on Research in Dementia. Study revealed pressing concerns and debates about how technology should be used in dementia diagnosis and prevention and is being disseminated widely by DPUK communications team.
Start Year 2020
 
Description MRC Dementias Platform UK, Deep and Frequent Phenotyping Study Team, University of Oxford 
Organisation University of Oxford
Department Department of Psychiatry
Country United Kingdom 
Sector Academic/University 
PI Contribution Qualitative research study and report: RECORD: Researching the Effects of Covid on Research in Dementia.
Collaborator Contribution Support in study design and access to sites/participants, dissemination of output including formatting and press releases, ongoing collaborations and access to field sites for a future project.
Impact MRC Dementias Platform UK commissioned priority-setting study and report for the current state and future of dementia research - RECORD: Researching the Effects of Covid on Research in Dementia. Study revealed pressing concerns and debates about how technology should be used in dementia diagnosis and prevention and is being disseminated widely by DPUK communications team.
Start Year 2020
 
Description Vitalities Collective 
Organisation King's College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Joint lead of the cross-institutional Vitalities Collective: Holding regular writing workshops, peer review, reading groups, and conference participation (see below) Author of conference paper: "Bringing pre-dementia to life: 'silent' disease and the spaces of clinical research" Panel convener and discussant for Chronic Living Conference 2020, Copenhagen and online: Three-part Panel - "Vital spaces: chronic living and the (un)making of place" Panel description: This panel considers how the lens of chronicity and vitality might enable us to re-conceptualise place. Rather than seeing either place or the body as separate, given and pre-defined, we focus on how chronic illnesses make place in different ways, creating or allowing for particular interactions, connections, and looping effects.
Collaborator Contribution Dr Rebecca Lynch - founder of the collective Dr Rebecca Lynch - co-convener of conference panel "Vital spaces: chronic living and the (un)making of place"
Impact Three-part conference panel, Chronic Living, Copenhagen and online 2020 - "Vital spaces: chronic living and the (un)making of place" Conference paper: "Bringing pre-dementia to life: 'silent' disease and the spaces of clinical research"
Start Year 2020
 
Description Digital Methodologies Workshop - Centre for Society and Mental Health 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Patients, carers and/or patient groups
Results and Impact I was invited to present at the Digital Methodologies Workshop at King's College London on "PASSIVE SENSING IN 'DIGITAL PSYCHIATRY': The case of digital technologies for dementia prevention", which brought together academics and people with lived experience of mental health problems to explore and encourage participation in digital methods for understanding mental (ill) health. We later developed plans for further activities that engage with and make visible 'missing voices' in digital mental health such as the Impact Fund project on digital exclusions.
Year(s) Of Engagement Activity 2020
 
Description International workshop and lectures on Speculative Futures and Chronic Health 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Postgraduate students
Results and Impact We organised an international online event entitled "Interrogating Speculative Futures: A workshop on the politics of imagining a future with(out) chronic illness'". Whilst the workshop was closed to participating academics and artists, we organised two publicly accessible lectures by two leading academics in the field, which over 100 people registers for. We streamed them via Vimeo and moderated a Q&A session which sparked conversation and debate. The Centre for Invention and Social Process received excellent feedback on the event and lectures.
Year(s) Of Engagement Activity 2020
URL https://sites.gold.ac.uk/sociology/interrogating-speculative-futures/
 
Description Participation in the Dementia Letter project 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Patients, carers and/or patient groups
Results and Impact A creative project to collect letters from people to their future selves with dementia, in order to change the way people think about their futures and the future of an ageing society. The aim was to make the letters accessible to a wide readership - ranging from academics interested in dementia, time, futures, hope, possibilities and potentialities, speculation, selfhood, storytelling and a whole variety of topics we will discover through writing and reading the collection, to people whose lives are touched by dementia in one way or another, family and professional carers included, and all others who are simply interested in reading them. My letter was published on the project website and the editors hope to compile and publish an edited volume including it.
Year(s) Of Engagement Activity 2021
URL https://www.anneliekedriessen.com/natassiabrenman
 
Description Podcast for KCL's Our Sick Society 
Form Of Engagement Activity A broadcast e.g. TV/radio/film/podcast (other than news/press)
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact Together with colleagues from KCL and MIT and in collaboration with theatre company Clean Break, I was part of creating a podcast for KCL's Our Sick Society. This sought to include voices that are often missing from academic discussions on this topic and was a novel medium for communicating to a wider audience about issues relating to exclusion arising from my research and blog series on 'Tracking Digital Psy: Mental health and technology in an age of disruption'.
The podcast was made widely available via spotify, apple podcasts and soundcloud and has been listened to 667 on soundcloud alone.
Year(s) Of Engagement Activity 2021
URL https://soundcloud.com/oursicksociety/episode-9-digital-exclusion
 
Description Press release for study findings from 'RECORD: Researching the Effects of COVID-19 on Research in Dementia' disseminated through the Dementia Platform UK public website 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Professional Practitioners
Results and Impact The Dementia Platform UK developed a press release to highlight my research and report on the effects of Covid on dementia research, including but not restricted to the work of my study partners at the University of Oxford. Dissemination of the report helped make the case for continued investment in research and innovation in the field of dementia as it highlighted the finding that urgency of COVID research overshadowed the important work needed to tackle chronic conditions such as dementia. It also suggested ways to foreground dementia research in the post-pandemic landscape, and highlighted the role of new remote monitoring technologies in this landscape.
Year(s) Of Engagement Activity 2021
URL https://www.dementiasplatform.uk/news-and-media/latest-news/report-reveals-the-effects-of-covid-19-o...
 
Description Public talks and panel discussion on the future of ageing 
Form Of Engagement Activity A formal working group, expert panel or dialogue
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Professional Practitioners
Results and Impact I was invited to organise and moderate an online international event entitled "'Ageing the future': A conversation on public health and growing older in an intergenerational world" for the Interhub Online Conversation Series, MIT Presencing Institute. As a result several people contacted me to join the intergenerational futures network, which I coordinate to bring together public heath practitioners, academics and other professionals engaged in ageing and future building.
Year(s) Of Engagement Activity 2020