Lisa Cosgrove

(2022)

Herrawi, F., Logan, J., Cheng, P., & Cosgrove, L. Journal of Theoretical and Philosophical Psychology, 52-60

Abstract:
This paper argues that the field of psychology—and the psy-disciplines generally—need to embrace an interdisciplinary approach if they are to be relevant and contribute to global social justice initiatives. It focuses on two such initiatives: The Global Mental Health movement and calls for increasing access to mental health services for immigrants. It suggests that a stronger focus on the upstream causes of ill-health, a deeper appreciation for the ways in which neoliberalism deflects attention away from these upstream determinants, and a greater engagement with the field of human rights and other disciplines will lead to more substantive gains in population mental health. Read more …

(2021)

Cosgrove, L., & Herrawi, F, The Humanistic Psychologist

Abstract:
As the coronavirus public health crisis continues to affect countries around the world, it has become increasingly evident that the burdens that are imposed by the pandemic are not shared equally. Those with fewer resources, immigrants, and members of marginalized and racialized groups are at a disproportionate risk of physical harm and emotional distress from coronavirus 2019. However, when responses to discrimination, social disadvantage, and racism are captured as depression, this may result in overmedicalization and overtreatment. Instead of focusing predominantly on increased access to mental health services, humanistic psychology has long recognized the need to address the structural and systemic obstacles that undermine well-being. Indeed, responses to wide-scale human suffering that focus exclusively on intraindividual interventions often keep the status quo intact and do not animate our political imagination. If mental health issues are embedded in inequality, which is a social and structural category, not a psychological category, then it is ignorance producing to suggest that one can solve mental health issues on an individual, psychological level. Finally, an important lesson can be learned from humanistic psychology’s emphasis on empathic dwelling when bearing witness to human suffering. Empathic dwelling is not a cognitive or intellectual exercise that simply facilitates mental health treatment. Rather, it is a purposeful stance or comportment from which we try “to feel one’s way into the other’s experience [ein-fu¨ hlen] . . . [what] Husserl described as ‘trading places’”. It is only in and through this type of comport ment, this deeply felt attunement, that we will be able to bring clinical and epistemic humility to fruition. Read more …

(May 2021)

Cosgrove, L., Morrill, Z. & Karter J. Economy and Society, Vol 50, 2021 – Issue 3, p359

Abstract:
The Food and Drug Administration (FDA) recently approved the first ever ‘digital’ drug, an antipsychotic (aripiprazole) embedded with a sensor (Abilify MyCite) that tracks data about drug ingestion as well as activity level and mood patterns. In this paper, we identify the financial and sociopolitical drivers that have facilitated the development and regulatory approval of a digital drug marketed for people with psychotic disorders. We explore the novel ways that such devices blur the distinctions between medication, machine and mind. The risks of digital aripiprazole obscuring and exacerbating the effects of social inequity are discussed. However, we also consider the possibility that this digital psychotropic drug may allow for new forms of personhood, performances of subjectivity, and resistance to emerge. This paper addresses both the conditions that enabled the development of digital aripiprazole as well as the possibilities and limitations it may bring to health providers and service-users. Read more …

(Dec 2020)

Cosgrove, L., Karter, J.M., McGinley, M., Morrill, Z. Harvard Health and Human Rights 2020 Dec, 22(2): 33-39

Abstract:
Digital technologies and tools hold much promise. Indeed, the COVID-19 pandemic has shown us how helpful telehealth platforms and mental health applications (apps) can be in a time of quarantine and social distancing. However, such technologies also pose risks to human rights at both the individual and population levels. For example, there are concerns not just about privacy but also about the agency and autonomy of the person using mental health apps. In this paper, we describe what digital phenotyping is, how it is used to predict mood, and why we ought to exercise caution before embracing it as a means of mental health surveillance. We also discuss the United States’ recent regulatory approval of the first-ever “digital” drug, an antipsychotic (aripiprazole) embedded with a sensor. Digital aripiprazole was developed in order to increase medication compliance, but we argue that it may undermine a rights-based approach in the mental health field by reinforcing coercive practices and power imbalances. The global dissemination and promotion of these apps raise human rights concerns. Read more …

(16 October 2020)

Cosgrove, L., Morrill, Z., Karter, J.M., Valdes, E., Cheng, C. Community Ment Health J 57, 3-9 (2021)

Abstract:
The movement for global mental health (MGMH) has raised awareness about the paucity of mental health services, particularly in low- and middle-income countries. In response, policies and programs have been developed by the World Health Organization and by the Lancet Commission on global mental health, among other organizations. These policy initiatives and programs, while recognizing the importance of being responsive to local needs and culture, are based on Western biomedical conceptualizations of emotional distress. In the paper, we discuss how a rights-based approach can promote the voice and participation of people with lived experience into the MGMH. We argue that a human rights framework can be enhanced by incorporating the conceptual approaches of critical inquiry and community mental health. We also discuss how rights-based approaches and service-user activism can productively reconfigure Western psychiatric conceptualizations of distress and provide both a moral and empirical justification for a paradigm shift within the MGMH. Read more …

(2020)

Cosgrove, L., Troeger, R., & Karter, J. M. The Humanistic Psychologist, 48(3), 221-231

Abstract:
Since the approval of fluoxetine in 1987, there have been contentious debates about whether antidepressants “work.” A recent meta-analysis on the efficacy and tolerability of antidepressants reinvigorated debates about their effectiveness—debates that have important implications for both research and practice in humanistic psychology. This article briefly discusses the findings and identifies the limitations of this meta-analysis, and we show that using psychopharmacology as a routine first response is not evidence based and incongruent with the basic principles of humanistic psychology. Additionally, we argue that the question “do antidepressants work?” is reductive and undermines our responsibility to individuals who are suffering from emotional distress. Responding to the Cipriani et al. (2018) study from a humanistic lens (a) deepens our appreciation for the lived experience of individuals diagnosed with depression and our responsibility to them, (b) complicates assumptions about the ontological status of “depression,” and (c) enhances collaborative, client-centered decision-making. Read more …

(June 2020)

Cosgrove, L. & Shaughnessy A, Harvard Health and Human Rights, Vol 22/1, June 2020, pp 61 -68

Abstract:
Although there is consensus that a rights-based approach to mental health is needed, there is disagreement about how best to conceptualize and execute it. The dominance of the medical model and industry’s influence on psychiatry has led to an over-emphasis on intra-individual solutions, namely increasing individuals’ access to biomedical treatments, with a resultant under-appreciation for the social and psychosocial determinants of health and the need for population-based health promotion. This paper argues that a robust rights-based approach to mental health is needed in order to overcome the effects of commercial interests on the mental health field. We show how commercialized science—the use of science primarily to meet industry needs—deflects attention away from the sociopolitical determinants of health, and we offer solutions for reform. Read more …

(2019)

Cosgrove, L., Cristea, I., Shaughnessy, A., Mintzes, B., Naudet, F. BMJ Evidence-Based Medicine 2019;24:231-238

Abstract:
Background In November 2017, the Food and Drug Administration (FDA) approved a version of a second-generation antipsychotic, aripiprazole, embedded with a sensor (Abilify MyCite).
Objective To systematically review the evidence supporting the FDA’s approval of digital aripiprazole and how that evidence was disseminated in the scientific literature and news reports. Read more …

(March 2019)

Cosgrove, L. & Jureidini J. (2019). Australian and New Zealand Journal of Psychiatry, 53(6):000486741983345

Abstract:
In a recent ‘Debate’ article, Dharmawardene and Menkes (2018) criticize the 2017 Report of the Special Rapporteur on the ‘right of everyone to the enjoyment of the highest attainable standard of physical and mental health’ (UN Human Rights Council, 2017). While praising the Report for drawing attention ‘to the pernicious problem of human rights abuses of the mentally ill’, they conclude that it is imbalanced and ideologically biased against biomedical approaches (p. 1). To facilitate discussion and debate about how best to integrate a rights-based discourse into mental health policy and practice, we list their three main criticisms below and offer the following responses. Read more …

(Jan 2019)

Cosgrove, L. Erlich, D. Shaughnessy, A. Journal of the American Board of Family Medicine, 2019 Jan-Feb; 32(1): 6-9

Abstract:
For over 2 decades, there have been debates, sometimes contentious, about the efficacy and safety of antidepressants. Growing awareness of the difficulty some patients have when discontinuing these medications has intensified these debates. Recently, Cipriani and colleagues published the largest meta-analysis to date that assessed the efficacy and tolerability of antidepressants. They concluded that all were more efficacious than placebo, and they also synthesized the trial results from head-to-head studies in an effort to guide pharmacologic treatment for major depressive disorder in adults. Although the researchers acknowledged many limitations in their analysis, including the fact that effect sizes were modest at best, the media overstated the results of the study. Both the meta-analysis and the news stories reinvigorated the debates about whether or not antidepressants “work.” Unfortunately, however, the key question-how can this meta-analysis help physicians in assisting their patients with a difficult decision about depression treatment options?-was lost in the controversy. In this commentary, we identify the questions and challenges that were not addressed in the current debate and offer specific suggestions for enhancing shared decision making for physicians working in primary care settings. Read more …