Rather than a ‘wastebasket’, I propose that we instead think about it as a ‘junk drawer’. A junk drawer is an ordering device whose function is the containment of things we want to keep but have nowhere else to put. Based on a critical document analysis of the research literature on MUS , the article explores how the MUS category is constituted and managed as a junk drawer in medical science.This article explores the making and management of anomaly in scientific work, taking ‘medically unexplained symptoms’ (MUS) as its case. MUS is a category used to characterize health conditions that are widely held to be ambiguous, in terms of their nature, causes and treatment. It has been suggested that MUS is a ‘wastebasket diagnosis’. However, although a powerful metaphor, it does neither the category nor the profession justice: Unlike waste in a wastebasket, unexplained symptoms are not discarded but  In this article I explore the making and management of anomaly in scientific work, taking ‘medically unexplained symptoms’ (MUS) as my case. MUS is a category used to characterize health conditions widely held to be ambiguous in terms of their nature, causes and treatment . SometimThe ambiguity of the clinic resonates with the ambiguity in medical science: As noted by members of the medical science community, research into MUS has been plagued by its lack of widely accepted modes of classification : 247. Thcontained, not ejected but managed. Just as patients with MUS are not chucked from the clinic, the category is not jettisoned from the jurisdiction of medical science. In fact, despite the lack of unitary classification, medically unexplained symptoms have become an increasingly hot topic of scientific inquiry. According to Web of Science, 951 research articles that topicalize MUS have been published in English between 1992 (earliest recorded) and 2018, with 5% (N = 47) published in the first 10 years compared to 73% (N = 692) in the last ten.1 Although the numbers are not necessarily entirely representative, they capture a real surge in scientific activity: Research is booming. Less is known, however, about how medical scientists, given the lack of consensus, actually go about classifying MUS, how the category is understood and used in scientific work. Learning how is the aim of the present article.In a review of the medical research literature, maintain order by containing disorder. Whereas a wastebasket is for getting rid of disorder, a junk drawer is for storage. As such, the latter facilitates future attempts at reordering: for puzzles to be solved or ‘junk’ to be reappraised at a later juncture.2To that end, I propose another metaphor. Rather than a wastebasket, I suggest that we think about MUS as a ‘junk drawer’. As I use it here, a junk drawer is a concept, referring to a particular kind of ordering device whose function is the containment of things we want to keep but have nowhere else to put. It frees us from having to leave disorderly things lying about, or from having to put them into neatly ordered drawers where they do not belong. Its job, then, is to help In performing its ‘containment function’, a junk drawer also reveals ‘imperfections’ in the system. It does this in two ways. First, in its very establishment and use: A ‘junk drawer category’ is constructed to manage imperfections in the current cultural order that result from a lack of fit with material reality. Thus, the presence of a ‘junk drawer’ is an indication of the mismatch between reality and the classification system with which reality is grasped and wherein the category is embedded. It thus simultaneously expresses our imperfect grasp of reality and our pragmatic capacity to adapt – the more visible the category, the stronger the reminder. Second, systemic imperfections are revealed in the mundane experience with which we are confronted when opening the junk drawer to review the contents. Doing so reminds us that there is an outright mess in the middle of our system. As such, over time a junk drawer can signal the need to tidy, reconfigure and reorder. Omitting to inspect it, on the other hand, can make us forget the mess, deluding us with a pleasant sense of order and control.In the following, I will provide a detailed examination of how medical scientists make and manage MUS as a ‘junk drawer category’. To that end, I have conducted a critical document analysis of the medical research literature (107 articles published between 2001 and 2016). My questions are: How is the MUS category constituted in research? And how do researchers manage it and its content?International Classification of Diseases and Health Related Problems (ICD) and the International Classification of Primary Care (ICPC), and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM). They provide a shared ‘terminological standard’, allowing for the commensurable codification of experience that renders ‘the world equivalent across cultures, time, and geography’  in the fourth edition of DSM, but was intentionally excluded from the fifth edition, published in 2013  to 7.4% (N = 88) of all publications between 2001 and 2016.Judging by the publication rates in the journals sampled, the MUS category is used mostly in the context of psychiatric and primary care research (most frequently in the former) (177/60), though MUS is invoked in My analysis centres on definitions and operationalizations. Definitions were commonly found in the opening sections of articles, operationalizations in the methods sections. As both definitions and operationalizations are salient forms of classification in science, analysing them offers important clues about the classification of MUS in scientific work.Articulations of definitions and operationalizations may deviate from what researchers actually think and do in practice. For the purposes of this study, it is more important what researchers want to communicate than what they think for themselves. Deviations from actual practice are, however, a possible problem. In the analysis, I therefore focus on what seem to be straightforward differences in classification practices . In the discussion, I raise the issue of how much crucial information is missing from the accounts.as varied classification practices stemmed from engaging with the data. Early versions of the analysis have been presented to audiences of social scientists and medical researchers on four occasions.I coded articulations of MUS thematically, first in a broad-brushed manner in Nvivo, then in a more finely grained manner in Word. During the analysis, I wrote memos subsequently incorporated in the analysis. I was interested in classification practices from the outset, but the interest in methodological variations Appendix, each with its own code consisting of two numbers (e.g. 1-3 or 5-7). Thus, ‘1-3’ refers to the third most cited article in journal one, whereas ‘5-7’ refers to the seventh most cited article in journal five. When referring to documents from the sample in the analysis, I use this coding system.All documents in the sample are listed in the Example A: ‘… any current principal somatic complaint reported by patients for which no definite medical diagnosis could be found by physical examination and appropriate investigation.’ B: ‘… patient-reported physical symptoms for which physicians cannot find corresponding physical pathology or for which the underlying physical pathology does not adequately account for the patient’s description of symptom severity or disability’ C: ‘… patients’ experience of physical symptoms [that are] discordant with the degree of tissue abnormality found on objective tests or with other observable signs of illness.’ D: ‘While most people experience at least some physical symptoms, a number of patients repeatedly attend with symptoms for which a conventional pathology cannot be identified.’ .E: ‘… persistent and distressing somatic symptoms for which adequate somatic examination does not reveal sufficient explanatory peripheral organ pathology.’ F: ‘… physical symptoms without any sufficient organic findings’ As an ordering device, a junk drawer is a means of controlling anomaly by containing it. The MUS category is thus a means to manage cases that are in some way considered anomalous. But what makes them anomalous? What defines a case of MUS? According to medical science, the most fundamental feature of MUS is the co-occurrence of present somatic symptoms and the absence of evidence/signs of somatic disease: Patients complain that something is physically wrong with them, but doctors find nothing to support that claim in or on their bodies. This is exemplified in the following list of brief and more or less explicit articulations, where MUS are defined as referring to:sufficient organic findings’ (F) or ‘pathology does not adequately account for’ the symptoms (B), to when ‘conventional pathology cannot be identified’ (D) or ‘physicians cannot find corresponding physical pathology’ (B) – or in the way in which some suggest a more limited membership (e.g. E: ‘persistent and distressing somatic symptoms’), whereas others are more inclusive . Yet each example exhibits the same co-occurrence of present somatic symptoms and absent somatic signs of disease. This co-occurrence is the core of how MUS is defined in the vast majority of cases in my sample, regardless of the source journal, disciplinary identity, method or aims. In fact, only one articulation explicitly deviated from this convention .There are differences between the examples, such as the degree to which symptoms are unexplained – ranging from when examination does not yield ‘2-10). It may seem equally obvious to outsiders. However, for analytical purposes, we should estrange ourselves and ask what it is about the co-occurrence of present symptoms and absent signs that motivates the invocation of a ‘junk drawer category’. Why is it problematic to have the one but not the other? The answer has to do with epistemic convention. The co-occurrence is expressive of a discrepancy, an indication that somatic signs are expected to accompany somatic symptoms. In particular, the uses of ‘discordant with’ (C) and ‘without’ (F) indicate that an expectation is being violated: there should be concordance between ‘physical symptoms’ and ‘the degree of tissue abnormality’; ‘sufficient organic findings’ should accompany organic symptoms. It makes sense to point out that you have the one (somatic symptom) but not the other (somatic sign) if you expected to have both. From the point of view of actors expecting both, MUS thus make manifest feelings of ambiguity, of uncertainty, doubt and risk. MUS thus become problematic.In medicine, the interest in this co-occurrence of present symptoms and missing signs seems self-evident. It is almost never discussed or thematized explicitly in the literature or in my sample . Yet even in these cases of non-definitional articulation, MUS were clearly revealed in the methods sections of articles as being premised on the co-occurrence of present symptoms and absent signs. For instance, in 9-4, the authors simply introduce MUS as symptoms that ‘occur frequently in all medical settings, and are associated with psychiatric disorder and reduced functioning’ . But although the category is not initially defined, the core criterion of co-occurrence is revealed in the account of the operationalization procedures (my emphasis below):physical symptoms; (b) they received investigations for these; and (c) the investigations and clinical examination revealed no abnormality, or abnormalities that were thought to be trivial or incidental .Criteria for a medically unexplained episode …: (a) the patient presented with In some cases, MUS are not defined explicitly but simply referred to as a familiar concept whose meaning is taken for granted , in biomedicine; or the symptom is dubious, since objective evidence are what identifies symptoms as real. It is thus against the background of these conventions that MUS are anomalous: their violation summons up the possibility that there is something medicine has not found or understood. The ‘discordance’ between what the patient says and what the doctor can find must thus be accounted for.MUS may thus be characterized as anomalies constituted by their lack of fit with scientific biomedicine, by their violation of expectations induced by the biomedical paradigm. When MUS are defined by the co-occurrence of present symptoms and absent signs, therefore, it is not simply that signs, like a great number of things, Another way of putting this is that the system of medical knowledge is causally implicated in the construction of MUS as a ‘junk drawer category’ – it causes the need for a category to manage anomalous symptoms. Cases of MUS thus become interestingly similar within the context of modern biomedicine, giving the category some sense of coherence. Typically, however, due to the framing of the core criterion, the deeper connection between biomedicine and the ambiguity of MUS is hidden from view.We can discern two main ways of framing the core criterion, which I call the doxic and the heterodoxic framing. They form a continuum rather than a neat dichotomy, with some articulations ambiguously poised in the middle.F above, my emphasis):patients in primary care suffer from physical symptoms without any sufficient organic findings. In some medical specialties, such as gynaecology, neurology, or gastroenterology, in 30–70% of cases no organic causes for the patients’ symptoms can be found. These patients with medically unexplained symptoms (MUS) constitute an economically relevant group in the health care system, since they receive many elaborate diagnostic examinations and medical interventions, in spite of the absence of an organic disease. International studies show that 10–20% of The doxic framing earns its name from its frequent occurrence in the sample and from the way it takes biomedicine for granted (doxa) as the basis for thinking about MUS. Its main characteristic is thus the silencing of how taking biomedicine for granted conceals its constitutive role in making MUS anomalous. The doxic framing thus centres on symptoms and patients, while keeping doctors and their knowledge more or less out of the picture. Consider the following example . The narrative presents MUS as having to do with symptoms and their patients, but not with the medical profession and its knowledge base that play a constitutive role in making these cases into medical problems in the first place. Doxa thus creates a problem, while the doxic framing deletes any trace of its involvement.The focus is clearly on symptoms and patients (and budgets). Of course, such a focus is not out of place in a medical context. But the (unintended) consequence that stems from this focus is important: By the very act of fixing its gaze on symptoms and patients, the text effectively turns its back on medical knowledge and medical professionals, rendering them almost invisible. Note, for instance, that we are told nothing of the doctors who are unable to come up with the right sort of evidence and the specific and limited techniques they have at their disposal in that regard, or that the demand for evidence of specific sorts results from the paradigm the doctors employ. Instead, the reader is confronted with A–F) all frame MUS in this doxic way . The taken for granted character of the articulations of MUS also extends to concepts such as ‘medically explained’, ‘disease’, ‘pathology’, ‘objective’ and so forth – the symptoms just are subjective, just as the missing forms of evidence just are objective.Accordingly, MUS seems like a quality inherent in the symptoms rather than an ascribed attribute resulting from the mismatch between those symptoms and the biomedical paradigm. The examples above (10-1) or in collaboration (e.g. 4-6), underscoring the doxa of the doxic framing, so to speak. The heterodoxic framing rightfully earns its name from its rebellion against doxa. Within this frame, MUS are not a quality of the symptoms and the patients, but of the consulting clinician and her or his medical knowledge. Consider, for instance, the following articulations (my emphases):G: ‘Many patients present to their general practitioner (GP) with symptoms that the doctor thinks are medically unexplained (MUSs)’ .H: ‘About 10–20% of patients present physical symptoms in primary care that their general practitioners (GPs) believe are not explained by physical disease’ .A minority of articles deviates from the doxic norm and instead employs what I have dubbed a heterodoxic framing. Most of these are by Peter Salmon, either alone (A–F), the difference is syntactically negligible but semantically substantial: MUS are now a phenomenon that refers to what doctors think (G) or believe (H) about symptoms. In other words, the heterodoxic frame topicalizes medical knowledge and expert judgement as part of the nature of MUS. This radically changes the meaning of MUS, moving their referent from the ontological to the epistemic realm. On rare occasions, the heterodoxic framing is even more explicit and critical. For instance, 2-10 present MUS as a convenient name for ‘symptoms that elude diagnosis … even though it is a failure to understand them rather than the symptoms themselves that define [sic] them as “unexplained”’ (2006: 269). The lack of correlate ‘tissue abnormality’ for ‘physical symptoms’ (C) is no longer a story of the symptoms themselves, but of the physicians’ lack of understanding and of current imperfections in their knowledge. The MUS category expresses ‘a failure to understand’ symptoms, rather than anything in particular about those symptoms.Compared to the examples of doxic framing above , as much as what is not (ignorance), that makes MUS ambiguous and problematic. Thus, the constitutive dynamic between symptom and epistemic order is made obscure by both framings.Apart from variations in framing, the sample is homogenous in its implicit agreement about the core criterion. But there are also important definitional variations, especially in the practices of establishing similarity between MUS and two other salient categories. The variations are interesting because they dramatically alter the scope and meaning of MUS, and thus about its constitution as a junk drawer in the epistemic order.attribute pain to the body that is actually in the mind .The first is ‘somatoform disorders’ (SD), referring to various forms of ‘somatization’, something a patient may be said to suffer from if (s)he is prone to ‘somatize’ (or ‘make somatic’), meaning that (s)he is likely to interpret and indeed experience mental illness as though it were bodily in kind. To somatize is to ind e.g. . As stat1-13 (2006: 169): ‘Somatization may be viewed as a phenomenon characterized by clinically significant yet medically unexplained symptoms (MUS), causing distress, disability, or maladaptive behaviour.’ An SD is thus a ‘clinically significant’ MUS, meaning that other MUS are more trivial or a ‘low threshold variant’ of SD . Others have articulated the connection schematically, presenting ‘somatizers’ as ‘people with both medically unexplained symptoms and anxiety and depression’ (7-5 2011: e295). The important thing to note is how MUS are articulated as a wide category that include SD but also less distressing or disabling symptoms. In other cases, MUS were articulated as synonymous with SD, such as in the following: ‘Somatoform  symptoms are common in the general population’ . Synonymous articulation also occurs when SD are defined exactly like MUS, as ‘the presence of somatic symptoms that cannot be sufficiently explained by organic etiology’ . Sometimes articulation simply glides from one concept to the other as though it made no difference. For instance, in 3-3 (2009: 2), articulations transition seamlessly from ‘the field of somatisation’ to ‘managing MUS’ and ‘MUS patients’. Such transitioning is sensible if one accepts that MUS and SD are synonymous, but senseless if one disagrees .MUS connect with SD in one of two ways. Some present SD as a special and more serious type of MUS. For instance, in The connection with SD is a frequent occurrence in the sample and in many cases the documents are as much about SD as they are about MUS. This is likely because most SD diagnoses have MUS as a core criterion. The explicit association with SD was stronger in articles in psychiatric than community medicine journals (~55% vs. ~15%): SD is a psychiatric category.5 As with SD, FSS were articulated either as a more serious version of MUS, or as synonymous with them. For instance, consider the following examples (my emphasis):I: ‘Many studies on unexplained physical symptoms have been performed among patients with diagnosed chronic functional syndromes such as fibromyalgia, irritable bowel syndrome, or chronic fatigue syndrome …. However, these syndromes represent the far end of the spectrum of unexplained symptoms.’ (1-12 2008: 265).J: ‘Medically unexplained syndromes, also known as functional somatic syndromes (FSS), are defined as ‘syndromes characterized more by symptoms, suffering and disability than by consistently demonstrable tissue abnormality’ . They are found in every medical speciality and include syndromes such as fibromyalgia, chronic fatigue syndrome (CFS), and irritable bowel syndrome (IBS).’ The second category with which MUS are frequently connected is ‘functional somatic syndromes’ (FSS). FSS refers to clusters of symptoms that are considered well-described and non-trivial complaints. FSS are typically exemplified by diagnoses such as chronic fatigue syndrome, fibromyalgia and irritable bowel syndrome, which, incidentally, are the most common exemplars of MUS in social science.I treats FSS as a special case of MUS (‘the far end of the spectrum’), J treats MUS and FSS as synonymous . Note also the overlapping examples : The authors describe the same conditions but disagree whether they are special or normal cases of MUS. I and J are not unique – as seen in, for instance, 1-3 (2001: 549) and 4-9 (2010: 2) respectively.Whereas synonymous with FSS (as in J) makes it a smaller, more ordered and severe category than if FSS made up only part of the MUS spectrum (as in I). The same is true of SD but the connection with SD is interesting for an additional reason: If the physical symptom can be reframed as a mental symptom that the patient has wrongly attributed to the body, the ambiguity of present somatic symptoms and absent somatic signs dissipates , my analysis reveals that, in the main, it does not. Here I present the most important ways in which operationalizing practices varied.A junk drawer is for containing disorder, for anomalous cases. What characterizes medical scientists’ management of the junk drawer? That is, how is the MUS category 10-7; 10-8),6 the key difference is in how they draw the line between MUS and medically explained symptoms (MES), e.g. 1-15) and in how they manage the ambiguous ‘grey area’ between the clearly unexplained and the clearly explained. For our purposes, it is intriguing how the studies variously include or exclude patients from consideration, and thus enables or prevents their illness experience from becoming part of what ‘MUS-knowledge’ is knowledge about. The grey area thus consists of the cases that are either recognized as anomalies or ignored. The grey area can, moreover, be of considerable size, as doctors widely disagree whether a symptom is (fully) explained . Thus, the difference between an inclusive or a restrictive operationalization of the core criterion decides which patients that are included in scientific research into MUS. It tells us of the function(s) of the junk drawer in science.Among those that articulate an interpretation of the core criterion . Likewise, in another study , both ‘definitely’ and ‘probably unexplained’ symptoms were treated as MUS. Thus, the grey area is incorporated into MUS. This is reminiscent of the definitions we saw above, where MUS include cases where ‘pathology does not adequately account for’ the symptom (B) or where there are not ‘sufficient organic findings’ (F). There may be pathology, and there may be organic findings, but not to a satisfactory degree. In some such cases , the grey area was operationalized as a subcategory of MUS called ‘minor acute illness’ (MAI), differentiated from ‘somatization’ (severe MUS). Although more finely grained, the procedure is just as inclusive (cases of MAI were included).Some researchers operationalize MUS inclusively as containing all symptoms not fully explained by ‘tissue abnormalities’ or other signs, including cases of doubt. If not MES, then MUS. For instance, in one study, symptoms were classified ‘as either “medically explained” or “(partly) medically unexplained”’ . Doubt is thus either resolved or kept clear of the MUS category. This latter strategy of removing doubt (i.e. disambiguation) is rigged in different ways. For instance, in 4-2, two researchers classified each case as MUS or MES, and in cases of disagreement they would discuss the matter until agreement was reached. The grey area is thus distributed between MUS and MES, thereby maintaining an orderly dichotomy. Compare this with 6-3, where the goal was instead to ensure the integrity of MUS and MES, keeping ambiguity away from both:6-3, 2011: 265-6)Symptoms that could be attributed to a known medical condition  were regarded as ‘medically explained.’ In cases where no pathologic findings could be detected, symptoms were regarded as ‘medically unexplained.’ If the findings were ambiguous, symptoms were regarded as ‘mixed.’  well-defined physical disease, (2) probably well-defined physical disease, (3) MUS, (4) mental disorder with connected physical symptoms or (5) no physical problem’ (2010: 2), and only categories (1) and (3) were included in the study.Cases of doubt are categorized as ‘mixed’ and thus kept out of the MUS category. A similar strategy was devised in have per se but in what doctors (and sometimes patients themselves) believe they have . For instance, in 1-7 (2005: 256), MUS was operationalized using ‘a procedure … to identify patients that, in the doctor’s opinion, have unexplained symptoms’. This manner of operationalization is typically found with the heterodoxic framing discussed above . But whereas the semantic difference between doxic and heterodoxic framings is dramatic, the operational differences are more superficial: whether recognized or not, the bottom line is always a doctor’s professional belief that, following physical examination, a case is unexplained by physical disease. There are certainly procedural differences to ensure the validity of the verdict but it is always ‘possible that some symptoms identified as “unexplained” might prove to have a pathological cause’ . Accordingly, the manner in which the grey area is dealt with in these cases varies along the same dimensions, as outlined above.Notably, a few studies are not interested in what the patients count, impact and persistence and the frequency of attendance at the clinic . The first three characterize the complexity and severity of the complaint: Count specifies a minimum number of symptoms, persistence specifies a minimum timespan the symptom must have existed, and impact specifies the power of the symptom, typically to distance MUS from ‘trivia’. So for instance, in some cases, research includes patients with single, recently onset and merely bothersome symptoms, whereas in other cases it is limited to patients with multiple and seriously debilitating symptoms lasting six months or more. Frequency of attendance is included either because repeatedly seeking help is considered a sign that the patient has MUS, a form of behaviour revealing that the patient is ‘excessively’ worried , or to ensure that the patient group in question consists of ‘high service users’ (3-5), thus delimiting MUS from an ‘economically irrelevant’ group of patients who do not suffer (enough), or who do suffer but for various reasons choose not to seek professional support . The latter is rarely articulated but is indicated by frequent reference to MUS as an expensive, resource-demanding group .In addition to the core criterion, studies have often enlisted additional criteria. The four most common types are symptom Based on the various uses of these additional criteria, we can distinguish between more or less inclusive classifications and specify the types of conditions and patients that are variously omitted or included in the junk drawer.4-7; 4-10; 7-9; 9-4) feature none of the criteria, meaning that ‘everything and anything’ passes for MUS, as long as there are no – or insufficient – findings. Thus, patients can have one symptom or many, the symptoms may have started recently or lingered for years, they may be trivial or seriously disabling functional impairments and the patients may be strangers or regulars at the clinic.First, we can note that some studies . Another study combined impact with persistence criteria, instructing ‘The GPs at each general practice [to select] patients with serious persistent medically unexplained symptoms’ . Other studies, such as the following study measuring the effects of acupuncture on MUS patients, used a more extensive and elaborate set of criteria (my emphases):‘Criteria for ‘persistent medically unexplained physical symptoms’a. The presentation of a physical symptomat least 3 monthsb. The symptom had existed for significant distress or impairmentc. It had caused clinically physical symptoms for which no clear or consistent organic pathology can be demonstrated’d. It could not be explained by physical disease, that is; ‘8 or more times in previous 12 months’ Other inclusion criteria (from electronic record search) Had consulted GPs  More often than not, however, one or more additional criteria are enlisted. For instance, in a study of predictors of psychiatric morbidity, impact was a criterion (though not a very specific one): ‘8-8, 2013: 300), the frequency of attendance was operationalized as relative  rather than absolute ( more than eight consultations per year), the persistence criterion was stricter (‘at least six months’ rather than ‘at least 3’) and the impact criterion was more lax . With regards to which patients and which health problems were included in research about MUS, the difference between 7-5 and 8-8 is substantial, just as the difference between these studies and those that enlisted no additional criteria (e.g. 7-9 above) is enormous.We can recognize the operationalized core criterion in item ‘d’ and we can see that frequency of attendance (‘8 or more times in previous 12 months’), persistence (‘at least three months’) and impact  are listed. Symptom count, however, was not relevant to inclusion. Some studies used the same set of criteria but operationalized them differently. For instance, in a study testing the effectiveness of mindfulness-based cognitive therapy, .8 Inclusion also required symptoms that were ‘significantly distressing’ (p. 393) but the persistence and frequency of attendance were not specified. Other studies (e.g. 6-2 and 6-6) made the same gender sensitive demand on symptom count, but with different criteria added. For instance, a study evaluating a psychotherapeutic intervention added criteria for persistence (‘persistent symptoms for at least three months’) and frequency of attendance  and used very specific if broadly inclusive means to determine impact .9 The reason for demanding a higher symptom count for women in these cases is to account for the fact that on average women report more symptoms than men do. The idea is, presumably, that this discrepancy has to do with gendered illness behaviour and illness experience more than with the actual conditions ‘themselves’. Researchers thus use gendered criteria to compensate for differences in male/female illness behaviour and illness experience.10To compare the examples reviewed so far, some studies make high and gender-specific demands on symptom count. For instance, a study testing the validity of a diagnostic instrument6-5 and 8-4). The difference is far from trivial: whereas, say, 8-4 includes women with four and five severe and persistent symptoms, 6-1 does not. Likewise, the difference between 6-1 and 8-7 is substantial: for instance, the latter discounts male patients with five severe and persistent symptoms if they have sought help only four times in the last year; the former does not. And the comparative difference between studies demanding multiple symptoms (e.g. 6-1 or 8-7) and those that do not (e.g. 4-7 or 8-1) is enormous. For instance, in one study, GPs classified 33% of the patient population in primary care as having MUS, but only about 3% as having multiple MUS .Other studies demanded multiple symptoms but typically set the bar at two or more without making gender specific demands . Yet the variations take on extra significance because the medical scientists are strangely silent about them. During a close reading of the research literature, this absence is striking: there are almost no intertextual references or discussions in the sample to how others have classified MUS and how one’s own approach differs. Thus, medical scientists seem 7-4 estimates the prevalence of MUS in primary care based on insights from two studies: One is a study of somatization disorders and ‘disorders of the mood’ . Moreover, I have given scant attention to what researchers hope to achieve by enlisting the MUS category in their work. Most of the articles sampled aim either at improving the quality of care for patients or the working conditions of doctors by testing various interventions or assessing or improving the classification of MUS or related complaints, often by testing novel categories and techniques for lumping together and splitting patient groups into categories. Among the latter, many express critical views of the MUS category and aim to avoid or replace it with other classifications.11 As pointed out by I have omitted some details concerning operationalization – notably the places  and players  involved, and the varied uses of classification instruments and (more rarely) selected codes from WHO’s main diagnostic manuals used to operationalize MUS  by the scientists themselves. Although the category thus is a common interest and a ‘meeting ground’ for the scientists, it is not (yet) a site of interaction and exchange.Though the claim that MUS are misfits in biomedical contexts is not new : 496, thMedical scientists are not discarding or ‘monster-barring’  MUS, notRegarding puzzle solving, historians of science and others suggest that when anomalous phenomena are not simply ignored or discarded, scientists will typically try somehow to make them fit in by making slight adjustments or creating new categories to the established order, or by proposing rule-exceptions that dampen or remove the anomalous character. These strategies are called ‘monster-adjustment’ .5-3) but not nearly as often as they are taken for granted. They come to the fore, for instance, in the conviction that psychiatric therapy is appropriate for but hampered by uncooperative patients  or in the fact that only two articles in the sample actually investigate new hypotheses that MUS have somatic causes . As indicated in the analysis, the connection with somatization is one way this assumption seeps through. Other ways are through concepts that carry similar psychogenic assumptions – such as ‘alexithymia’ (2-3), ‘illness perceptions’ (9-10), and ‘somatovisceral illusions’ (1-16), each indicating that the patients have misunderstood the nature of their symptoms. As such, psychogenic assumptions are part of the biomedical doxa and the commitment to make MUS ‘fit in’. They may be interpreted as a form of monster-adjustment, pushing for the resolution of the anomalous character of present symptoms without signs.There are strong indications of a move towards such strategies in the sample, in the form of assumptions that unexplained physical symptoms are really symptoms of mental distress e.g. . Such as6-5; 11-7). Undeterred, researchers have experimented with the reframing of psychiatric treatment as somatic treatment, trying to get patients into disguised psychiatric treatment . In one study, this strategy is unashamedly presented as ‘a Trojan horse’  – without considering the risk that patients will learn to fear the GPs when they come bearing ‘therapeutic gifts’.This interpretation of MUS as caused by a misunderstanding on the patient’s part has been criticized by some social scientists as a form of blame-shifting e.g. . Others Somatization in its varieties has yet to succeed as a monster-adjusting strategy. Moreover, due to recent changes whereby all SD diagnoses have been ejected from formal classifications , the strMembers of the research community have lamented the lack of formalized and widely shared standards for classifying MUS. In the absence of standards, creative but highly varied classification practices characterize research. But what difference would shared standards make?Formalizing a set of criteria, for instance relating to symptom count, impact and persistence, or the frequency of attendance, would probably enable researchers to study a more homogenous patient group than current practices allow for. However, standardized criteria do not necessarily make classification homogenous, as they must nevertheless be interpreted and applied in the course of situated practice . This leStandardizing the classification of MUS would therefore require a more thorough reflection over basic concepts such as disease, objective evidence and medical explanation. The potential advantage of doing so would be the ability to determine the value of MUS as a medical category – to test whether it is sensible and helpful to group patients based primarily on their lack of fit with the biomedical paradigm.


Multiple choice questions addressed a variety of basic and fundamental aspects of neuroimaging data analysis, such as signal analysis, linear algebra, and statistics. We analyzed performance with respect to the following factors: undergraduate degree , current researcher status , gender, and self-rated expertise levels. Overall accuracy was 72%. Not surprisingly, the Methods group performed best (87%), followed by Biology (73%) and Psychology (66%). Accuracy increased from undergraduate (59%) to PhD (74%) level, but not from PhD to post-doctoral (74%) level. The difference in performance for the Methods vs. non-methods (Psychology/Biology) groups was especially striking for questions related to signal analysis and linear algebra, two areas particularly relevant to neuroimaging research. Self-rated methods expertise was not strongly predictive of performance. The majority of respondents (93%) indicated they would like to receive at least some additional training on the topics covered in this survey. In conclusion, methods skills among junior researchers in cognitive neuroscience can be improved, researchers are aware of this, and there is strong demand for more skills-oriented training opportunities. We hope that this survey will provide an empirical basis for the development of bespoke skills-oriented training programs in cognitive neuroscience institutions. We will provide practical suggestions on how to achieve this.Cognitive neuroscience increasingly relies on complex data analysis methods. Researchers in this field come from highly diverse scientific backgrounds, such as psychology, engineering, and medicine. This poses challenges with respect to acquisition of appropriate scientific computing and data analysis skills, as well as communication among researchers with different knowledge and skills sets. Are researchers in cognitive neuroscience adequately equipped to address these challenges? Here, we present evidence from an online survey of methods skills. Respondents ( Researchers involved in this work come from diverse backgrounds in psychology, cognitive science, medicine, biology, physiology, engineering, computer science, physics, mathematics, etc. This poses challenges with respect to the acquisition of the appropriate scientific computing and data analysis skills, as well as for communication among researchers from very different scientific backgrounds2.Cognitive neuroscientists use physical measurements of neural activity and behavior to study information processing in mind and brain. The development of novel experimental methodology has been a strong driving force behind psychological research in general . In rece3,4), such as standard event-related fMRI or resting-state data, or conventional event-related potentials. Does this mean that empirical scientists no longer have to understand how their analysis pipelines work? There are several reasons why this is not the case. First, few experiments are ever purely “standard” or “conventional.” A new research question, or a small change in a conventional experimental paradigm, may require a significant change of the analysis pipeline or parameter choices. The application of a novel, non-established, high-level analysis method is often the highlight of a study, e.g., in the case of multivariate pattern information analysis or graph-theoretical methods. It may not be possible to apply these methods in the same way as in similar previous studies, because there aren’t any. Second, even for relatively standard analysis problems, there is often more than one solution, depending on how many people you ask. It is not uncommon to ask the nearest methods expert for advice, but it can be frustrating for a beginner to hear exactly the opposite advice from the next expert, especially if it is the reviewer of a paper or grant. One contributing factor to the recently reported “replication crisis” in cognitive science may be the large uncertainties in analysis procedures . Students of medicine and biology may have had basic training in physics and biostatistics, but not in scientific computing and signal processing. Students in psychology and social sciences usually have training in statistical methods, but not in signal processing and physical measurement methods. It is therefore likely that many of these researchers, whatever their backgrounds, start their careers in cognitive neuroscience with an incomplete methods skills set. Neuroimaging training programs vary considerably across institutions. It is therefore unclear to what degree junior researchers acquire appropriate methods skills for cognitive neuroscience at different stages of their academic development.Here, we evaluated the level of methods skills for researchers at different stages of their careers, mostly at post-graduate and post-doctoral level. We present results from an online survey of methods skills from 307 participants, mostly students and post-doctoral researchers working in the cognitive neurosciences. Questions in the survey covered basic aspects of data acquisition and analysis in the cognitive neurosciences, with a focus on neuroimaging research. We report results broken down by undergraduate degree , current researcher status , and gender. The purpose of this survey was to estimate the current skills level in the field, as a starting point for an evidence-based discussion of current skills-levels in cognitive neuroscience. We hope that this will usefully inform the development of future skills-oriented training opportunities, and we will provide practical suggestions on how to achieve this.5 , and was advertised via neuroimaging software mailing lists and posts on the MRC Cognition and Brain Sciences Unit’s Wiki pages. It was first advertised in January 2015, and most responses (about 90%) were collected in 2015. Participation was voluntary and no monetary or other material reward was offered. Participants were informed about the purpose and nature of the survey, e.g., that it should take around 10–15 min of their time. They were asked not to take part more than once, and to not use the internet or books to answer the questions. The study was approved by the Cambridge Psychology Research Ethics Committee.The survey was set up on the SurveyMonkey web-siteThe number of respondents in the final analysis was 307. They were selected from the group of all respondents as follows. 578 participants gave consent for their data to be used for analysis (by ticking a box). Among those, we only analyzed data from participants who provided responses to all methods-related questions . This resulted in 322 respondents. 214 respondents skipped all methods-related questions. Although it would have been interesting to analyze the demographics of these “skippers,” many of them also skipped most of the demographic questions. For example, only 66 of them disclosed their undergraduate degree .Given the wide range of undergraduate degrees of our respondents, and the relatively small group of respondents for some of them, we grouped them into three broader categories. “Psychology” contained those who responded that their undergraduate degrees were in “psychology,” “cognitive science” and “cognitive neuroscience.” “Methods” included those who responded “physics,” “math,” “computer science,” or “biomedical engineering.” “Biology” summarized those who responded “biology” or “medicine.” For 39 respondents who indicated “Other” , an appropriate group assignment was made by hand by the author. For another 17 respondents such an assignment could not be made , and they were removed from the analysis, reducing the number of respondents in the final analysis to 307.n = 145, 83 of which from Cambridge), followed by other European countries , the United States of America (n = 33) and Canada (5), Asia (12), Australia (4), and South America (3). 35 respondents did not provide clear information about their location.Forty eight percent of the remaining respondents were located in the United Kingdom at the time of the survey (n = 166) than male (139) respondents. Most respondents were PhD students (146), followed by post-doctoral researchers (90), undergraduate students (42), and research assistants (7). The mean age of all respondents was 29.6 (SD 6.9) years, and varied only slightly with respect to undergraduate degree. Most respondents expected to continue working in cognitive science (31%), clinical neuroscience (23%), or cognitive neuroscience (16%). The majority rated themselves as “no experts” or “sort of” experts, though this varied with undergraduate degree. The Biology group rated themselves mostly as “no experts” . The pattern was similar for the Psychology group, although with a smaller difference between “sort of expert” (39%) and “no expert” (46 and 13% “expert”). The Methods group consisted mostly of “sort of experts” (48%) and “no experts” (40%), compared to 9% “experts.”6 for original survey). This was followed by 18 methods-related questions (see n = 5), scientific computing (n = 3), linear algebra (n = 2), calculus (n = 3), statistics (n = 3), and physics (n = 2). In brief, statistics questions probed knowledge on correlation, power analysis and the multiple comparisons problem; signal processing probed the signal-to-noise ratio, Fourier analysis, frequency spectra, complex numbers, trigonometry; calculus probed derivatives, integrals and algebraic equations; linear algebra probed vector orthogonality and vector multiplication; scientific computing probed knowledge about Linux, “for loops,” and integer numbers; physics probed Ohm’s law and electric fields. Questions were presented in multiple-choice form, with four possible answers plus a “no idea” option. This option was included in order to test whether participants had at least an inkling about how to approach the problems, and also to highlight that it was ok not to.The survey started with questions about demographics, such as gender, age, undergraduate degree etc. (seeions see . Questioions see . QuestioThe choice of questions was constrained by:•the limited amount of time the voluntary participants were expected to invest in this survey (10–15 min),•the difficulty level of the questions, which should neither bore away experts nor scare away non-experts,•the relevance to cognitive neuroscience.The inclusion of particular questions, based on their relevance to cognitive neuroscience research was further determined through local discussions with researchers involved in methods training, as well as by consulting textbooks.7). Only data from respondents who responded to every methods question were included in the analysis. For demographic questions, the total number of respondents within each category are reported. For methods skills questions, analyses focus on correct responses unless indicated otherwise. We considered the number of error and no-idea responses too low to allow meaningful interpretation of their differences. Considering the number of respondents per group  effect would not have strong practical implications. Nevertheless, we ran ordered logistic regression analysis with the following simultaneous factors: undergraduate degree, current researcher status and gender. We used the function polr from the R (i386 3.1.3) package MASS, and assessed significance using the function pnorm. This analysis was run for overall performance as well as for sub-groups of methods questions as described below. We also present 95% confidence intervals for binomial probabilities for correct responses as error bars in our figures where appropriate (using the “exact” method of R’s binom function).p < 0.05). For the six sub-groups of questions, all results for the factor Undergraduate Degree were significant except for the questions about Statistics (p > 0.2), for the factor Gender except for Physics and Statistics (both p > 0.8), and for the factor Researcher Status except for Linear Algebra and Calculus (both p > 0.3). In the following, we interpret results only if they are based on non-overlapping confidence intervals. The practical relevance of these effects is discussed in the discussion section.As described in the Methods section, our conclusions are mostly based on the mean percentages of correct responses (rather than “error” and “no idea” responses), rather than statistical measures. Not surprisingly with the large number of participants, the results for all factors in our ordered logistic regression analysis of overall performance reached significance . For example, a lack of awareness that for matrices the commutative law does not necessarily hold , can potentially lead to incorrect results. In the domain of signal analysis, familiarity with the basic concepts of frequency spectra and Fourier analysis is a pre-requisite for time-frequency  and spectral connectivity  analyses . Overall performance of the Psychology group was about 20% lower than the Methods group, with Biology in-between. This difference was of similar magnitude for questions on signal processing, and was much larger  for questions on linear algebra. These two topics are fundamental to the analysis and interpretation of neuroimaging data. The particular questions addressed common problems in neuroimaging analysis, such as the orthogonality of vectors and the interpretation of a frequency spectrum. The multiplication of vectors and matrices is central to the general linear model (GLM), which is ubiquitous in fMRI and EEG/MEG data analysises e.g., . Calculues e.g., , 2011.Our results should be taken into account by methods developers and tutors. Methods should be described using concepts and terminology that the target audience understand. If a paper starts with the most general theoretical description of a method in order to then derive special cases that are relevant for practical purposes, many respondents of this survey will be lost straightaway. For example, starting with Bayesian model estimation in order to derive ordinary linear least-squares regression may not produce the desired learning outcome for researchers from a psychology or biology background. It may be better to try it the other way round: start with a problem the target audience are familiar with, and then address its limitations and how to look at the problem at increasingly general levels. Quantum physics can serve as an analogy: While it is undeniably more accurate and more general than Newtonian physics, the latter is still the obvious framework to explain macroscopic phenomena. It is not only “good enough” for lazy people, but also much more efficient to use, therefore less error-prone in practice, and easier to comprehend and teach. To our knowledge, most if not all textbooks on physics start with classical physics before they move on to quantum physics. This from-simple-to-complex approach also seems appropriate to teach data analysis in cognitive neuroscience, even if the right level of complexity for any given problem (and researcher) may not always be straightforward to determine. We provide some suggestions for general guidelines to set up a bespoke training program in Interestingly, we found an increase in performance from the undergraduate to the PhD and post-doctoral level, but no difference between the latter two. This suggests that researchers maintain the skills level they have acquired during their undergraduate and PhD degrees. This can impede progress in a fast developing interdisciplinary field where methodological innovations are a strong driving force, and where many researchers may end up in research areas that they did not even know at the beginning of their career.In order to choose the right type of training, or the right research topic to work on, it is important to know your own strengths and weaknesses if it comes to methods skills. We asked our respondents to rate themselves as “experts,” “sort of experts,” and “no experts.” Interestingly, only 9% in the Methods undergraduate group rated themselves as experts, less than for Psychology and Biology , and therefore our results may reflect other selection biases that should be studied in the future. Whatever these differences are, it is possible that small differences at early career stages, if not corrected, may amplify over time. For example, researchers who get frustrated with methodological challenges early-on may decide to change fields. This may also be relevant for the gender differences discussed above. It is therefore important to provide opportunities for researchers at different stages, especially at PhD and junior post-doctoral level, to develop and maintain their methods skills.Furthermore, it is important to communicate the relevance of these topics to students and post-doctoral researchers as well as supervisors. The necessary skills for a research project should be identified both by supervisors and students or post-doctoral researchers. Our survey was dominated by respondents from the United Kingdom (48%) and Europe (22%). Skills levels may vary depending on country and institution, and ideally should be evaluated locally before students enter a project.While a range of software-related workshops exist that focus on the “doing” part of data analysis, our results indicate that more needs to be done about the “understanding” part. In the future, the cognitive neuroscience community could agree on a core skills set for cognitive neuroscientists, taking into account different sub-disciplines such as neuroimaging, computational modeling and clinical neuroscience. Published examples for possible formats of such a training program already exist e.g., . These cGood teaching, whether on methods or other subjects, should be valued and appreciated [as lamented previously, e.g., The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.The studies involving human participants were reviewed and approved by Cambridge Psychology Research Ethics Committee, University of Cambridge, United Kingdom. The patients/participants provided their written informed consent to participate in this study.OH has conceptualized this study, collected and analyzed the data, and wrote the manuscript.The author declares that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Social media are responsible for aggravating mental health problems. This systematic study summarizes the effects of social network usage on mental health. Fifty papers were shortlisted from google scholar databases, and after the application of various inclusion and exclusion criteria, 16 papers were chosen and all papers were evaluated for quality. Eight papers were cross-sectional studies, three were longitudinal studies, two were qualitative studies, and others were systematic reviews. Findings were classified into two outcomes of mental health: anxiety and depression. Social media activity such as time spent to have a positive effect on the mental health domain. However, due to the cross-sectional design and methodological limitations of sampling, there are considerable differences. The structure of social media influences on mental health needs to be further analyzed through qualitative research and vertical cohort studies. Human beings are social creatures that require the companionship of others to make progress in life. Thus, being socially connected with other people can relieve stress, anxiety, and sadness, but lack of social connection can pose serious risks to mental health .Social mediaSocial media has recently become part of people's daily activities; many of them spend hours each day on Messenger, Instagram, Facebook, and other popular social media. Thus, many researchers and scholars study the impact of social media and applications on various aspects of people’s lives . MoreoveImpact on mental healthMental health is defined as a state of well-being in which people understand their abilities, solve everyday life problems, work well, and make a significant contribution to the lives of their communities . There iThe need for a systematic reviewSystematic studies can quantitatively and qualitatively identify, aggregate, and evaluate all accessible data to generate a warm and accurate response to the research questions involved . In addiThis paper attempt to systematically review all the relevant literature with the aim of filling the gap by examining social media impact on mental health, which is sedentary behavior, which, if in excess, raises the risk of health problems ,9,12. ThResearch strategyThe research was conducted to identify studies analyzing the role of social media on mental health. Google Scholar was used as our main database to find the relevant articles. Keywords that were used for the search were: 1) “social media”, (2) “mental health”, (3) “social media” AND “mental health”, (4) “social networking” AND “mental health”, and (5) “social networking” OR “social media” AND “mental health” (Table  “social Out of the results in Table Inclusion and exclusion criteriaPeer-reviewed, full-text research papers from the past five years were included in the review. All selected articles were in English language and any non-peer-reviewed and duplicate papers were excluded from finally selected articles.ResultOf the 16 selected research papers, there were a research focus on adults, gender, and preadolescents -19. In tDiscussionThis study has attempted to systematically analyze the existing literature on the effect of social media use on mental health. Although the results of the study were not completely consistent, this review found a general association between social media use and mental health issues. Although there is positive evidence for a link between social media and mental health, the opposite has been reported.For example, a previous study found no relationship between the amount of time spent on social media and depression or between social media-related activities, such as the number of online friends and the number of “selfies”, and depression . SimilarIn the 16 studies, anxiety and depression were the most commonly measured outcome. The prominent risk factors for anxiety and depression emerging from this study comprised time spent, activity, and addiction to social media. In today's world, anxiety is one of the basic mental health problems. People liked and commented on their uploaded photos and videos. In today's age, everyone is immune to the social media context. Some teens experience anxiety from social media related to fear of loss, which causes teens to try to respond and check all their friends' messages and messages on a regular basis.On the contrary, depression is one of the unintended significances of unnecessary use of social media. In detail, depression is limited not only to Facebooks but also to other social networking sites, which causes psychological problems. A new study found that individuals who are involved in social media, games, texts, mobile phones, etc. are more likely to experience depression.The previous study found a 70% increase in self-reported depressive symptoms among the group using social media. The other social media influence that causes depression is sexual fun . The intAnother study assessed gender differences in associations between social media use and mental health. Females were found to be more addicted to social media as compared with males . PassiveLimitation and suggestionThe limitations and suggestions were identified by the evidence involved in the study and review process. Previously, 7 of the 16 studies were cross-sectional and slightly failed to determine the causal relationship between the variables of interest. Given the evidence from cross-sectional studies, it is not possible to conclude that the use of social networks causes mental health problems. Only three longitudinal studies examined the causal relationship between social media and mental health, which is hard to examine if the mental health problem appeared more pronounced in those who use social media more compared with those who use it less or do not use at all ,20,24. NSocial media is a new study that is rapidly growing and gaining popularity. Thus, there are many unexplored and unexpected constructive answers associated with it. Lately, studies have found that using social media platforms can have a detrimental effect on the psychological health of its users. However, the extent to which the use of social media impacts the public is yet to be determined. This systematic review has found that social media envy can affect the level of anxiety and depression in individuals. In addition, other potential causes of anxiety and depression have been identified, which require further exploration.The importance of such findings is to facilitate further research on social media and mental health. In addition, the information obtained from this study can be helpful not only to medical professionals but also to social science research. The findings of this study suggest that potential causal factors from social media can be considered when cooperating with patients who have been diagnosed with anxiety or depression. Also, if the results from this study were used to explore more relationships with another construct, this could potentially enhance the findings to reduce anxiety and depression rates and prevent suicide rates from occurring.


There is a growing recognition that nonsuicidal self-injury commonly incorporates communicative and interactional dimensions. But regardless of whether we approach self-injury within the terms of deliberate interpersonal communication, it is undeniably something that conveys a significant impact into the social and communicative field between people. As such, it is something that can be approached and analysed as communicative in this more general sense. In this paper, we draw on 13 in-depth qualitative interviews with the parents of people who self-injure, conducted for a larger pilot study, to explore some of these more general communicative processes, spaces and impacts associated with self-injury. By providing a phenomenologically informed examination of parents’ experiences, we argue that self-injury is in fact a richly communicative phenomenon, albeit one that cannot be adequately mapped using the traditional sender-receiver communication paradigm. To provide a more nuanced mapping, we look beyond this paradigm to include more subtle, ambiguous, pre-reflexive and bodily forms of communication. Indeed, self-injury offers a particularly powerful case study with which to think through a more complex model of communication, one that connects the interpersonal, intersubjective and intercorporeal levels, and that, as such, is more appropriate to the sociologies of everyday life and embodiment. Where social context is considered, it is usually cast as a set of secondary biographical correlates to the primary inner facts of the matter; with the figure of the individual taken as both the sole cause and exclusive site of the self-injury  in terms of interpersonal communication, it is undeniably something that significantly impacts on the social and communicative field that exists between people  were conducted with both people who self-injure (n = 9), people who are in relationships with people who self-injure (n = 12), and people who have had both experiences (n = 6). The overall aim was to better understand and describe the interaction between self-injury and the key relationships forming its immediate social context. We interviewed nine mothers and three fathers, ranging from 43 to 75 in age. Ten of these parents had not themselves self-injured, while two of them had their own history of self-injury. The analysis presented here represents one key strand of the findings from the overall study.interpersonal, the intersubjective1 and the intercorporeal. These three conceptual lenses are used to disclose and analyse the communicative dimension present within our participants’ accounts, as well as to understand how reflexively aware they were of such communicative processes and their effects. Though, as already mentioned, we have put the question of whether self-injury can ever be thought of as an unambiguously deliberate interpersonal communication to one side for the purposes of this article, it is necessary nonetheless to look at what is going on at the level of interpersonal communication where self-injury can be correlated with changing patterns of normative and linguistic interaction. Intersubjective communication describes the range of reflexive and expressive practices that facilitate interpersonal communication, but which are characterised by an ambiguity in communicative intent. And intercorporeal communication describes multiple pre-reflexive processes that allow one body to resonate with another, creating the communicative context of a visceral ‘we’ that enables more explicit and reflexive forms of communication to occur . This is the realm of what would let Mia know that she had found them. So, while these items were hidden from sight, Mia knew her mother was going into her room and nonetheless continued to leave items there to be found. This suggests a communicative process at work, where Mia’s bedroom works as an alternative bulletin board in which things left, and things discovered enabled an alternative mode of indirect communication. Indeed, Mia even told her Childhood and Adolescent Mental Health Services (CAMHS) worker to tell her mother where, in Mia’s bedroom, she could find some old suicide notes that she had written, something she could not talk to her mother about directly.Crucially, while Rachel would not remove the razor blades she she started shutting herself away in her bedroom. Um, I’d clear the bedroom, I’d find the tissues um, with blood, and that used to bother me, used to make me feel sick. And then I found um, there was like letters and things where she kind of left them out, I think, for me to see … I was always looking for signs.Paula described a similar situation with her daughter, Mary: did in fact become a kind of communicative zone, how intentional this communication was is ambiguous, and in turn, ambiguity is characteristic of intersubjective communication within the context of self-injury. For example, the moment that self-injury is disclosed to another is often marked by ambiguity. Rachel discovered Mia’s self-injury when Mia put on a ‘strappy little top’ and went sunbathing in the garden, revealing her arms and her scars: I remember saying to her, my mum was outside, and I obviously didn’t want to draw attention, so I just said to her: ‘oh, can I, can we just go and have a chat inside in a minute?’ She knew I’d clocked it, she’d know, but she’d obviously, she’d put a strappy top on, so she must have known I was going to see that day … Um, so you know, whether that, that element was, you know, she was ready to, to share that information with me I guess.While Mia’s and Mary’s bedrooms Rachel clearly interprets Mia’s actions as deliberately communicative, but this is an interpretation and the ambiguity is obvious. Likewise, as Ingrid recalls.the fact that [Carl] self-harmed only came to light … [b]ecause they were re-vamping the common room er, painting it, he happened to wear some short-sleeved t-shirts which then showed some scarring, at which point the housemaster rang us and said, you know ‘were you aware?’ And we certainly weren’t.[Steggals]: Yeah. So, there must have been a period where he was doing this very privately and nobody knew.Ingrid: Yeah, he always has done to be honest. This is the first year since maybe six months ago where he doesn’t mind wandering around anywhere, except in front of his grandmother, with short sleeves on because the scarring on his left arm was quite substantial and some of it’s quite, quite deep and, um, but until then he always hid it and, you know, looking back at that time when we got the phone call, he’d have the occasional sort of sweatband that he’d wear. Um, seemed a bit weird but, you know, kids do all sorts of things. But when we look back, where he wore the sweatband you can now see that there’s scarring underneath, so he hid it and he wouldn’t wander around in a short-sleeved t-shirt and we’d say ‘good grief, it’s 25 degrees out there, what are you doing? You know, normally you’d wear shorts and a t-shirt, how come you’re wearing a shirt?’ And then you can add it all up afterwards. At the time: no idea.as forms of communicative action, short-circuiting the weight and implications of more normative, obviously deliberate communication.While Carl’s wearing a t-shirt that day could have been a mistake, it does not fit the overall pattern of attentively hiding his scars, and so seems suspiciously like an intersubjective, albeit ambiguous, communication. Indeed, such ambiguity is quite characteristic in people’s reflections on the communicative status of self-injury. And this remains the case even when it is the person who self-injured who is reflecting on their own past actions. Perhaps ambiguity is not just a problem that clouds issues of intent and interpretation then, but an element of how such patterns of behaviour work shown rather than secret, or public rather than private. Rather, she re-drew the boundary of the secret and the private so that they stopped being wholly individual (to Mia) and now included herself as well.While we can recognise the ambiguity of both Mia’s actions when she wore the ‘strappy top’, and Rachel’s interpretation of them, Rachel nevertheless does seem to feel that Mia’s actions were in some sense deliberate and that she had decided to share the secret of her self-injury. However, Rachel was not ready to share the secret with her own mother, Mia’s grandmother, and described controlling her own reaction to the discovery of self-injury so as to not ‘draw [her mother’s] attention’. In fact, Rachel successfully kept Mia’s self-injury a secret, not just from Mia’s grandmother, but also from Mia’s father and Mia’s sister. Rachel didn’t see Mia’s disclosure of self-injury as inauthentic, as now being inside the secret, and who outside. Rachel became involved in some of the same practices and performances of secrecy that Mia has previously been pursuing alone, albeit filtered and articulated through the social identity and concerns of the parent. And this includes the anxiety of discovery and sense of shame that comes with a secret stigma. Similarly, Barbara for example,told Steggals about how her daughter, Monica, was ready to drop the secret and consider her scars as part of her public identity, but for Barbara the scars were a source of embarrassment and the judgmental gaze of outsiders: Almost like she [daughter] had gone through it and she had dealt with it, and this is what she’s left with, and she’s not going to hide it and be ashamed of herself any more.And that’s how she felt, and I felt differently; I was thinking ‘just cover them up’ … Because I don’t want to have to deal with people’s looks of her being judged and then me being judged. Because people do, they think ‘oh, they obviously haven’t been very good parents then, if they’ve done that. They haven’t kept them safe’ or ‘what sort of home life have they got if the children are doing that to themselves?’ And people do judge, and they make wrong judgements and assumptions.So, while we may think of secrecy in self-injury as something being kept hermetically sealed within the boundaries of the individual, our data suggest that a secret shared remains a secret nonetheless; carrying the same power to mark off social space as before. What changes is the division of who is marked off as There are a number of things going on. I have to respect Karen’s [daughter’s] right to privacy. But I so want to talk to somebody. I want to share and maybe get absolution from my listener who will tell me that I’m not a bad mother after all. And then again - maybe I’d rather do without the absolution and just keep the secret so that nobody else is tipped off to what a failure I’ve been. So, I want to keep the secret and I want to share it too.Such anxiety involves complexity, as Donna (a woman in her early 60s with a teenage daughter) notes in her account of the ‘the burden of secrecy’: [W]hen one sees children, one ’sees’ parents. When one sees children who have problems, one looks for parents, especially mothers. When one seeks solutions to children’s problems … one immediately turns to parents who are then scrutinized by a variety of establishments , p. 530This anxiety about being blamed is of course an entirely rational one, since parents, especially mothers, are generally held to be responsible for bad things in a child’s life . In addition,parental influence is unlikely to be the only factor in a young person’s desire to self-injure. Furthermore, alongside secrecy and shame, parents typically experienced anxiety and the sense of a familiar world becoming strange and threatening.Once she discovered Mia’s selfinjury, Rachel explained that: communicated or passed on, a vector for negative affect. These feelings, concerns, dilemmas and sensitivities are, while filtered and mediated by the parental role, nonetheless the same feelings and sensitivities that are traditionally associated with someone who is self-injuring. This kind of communication then runs well below the traditional sender–receiver model and suggests a kind of intercorporeality or inter-bodily resonance, an ‘entanglement between self and other’ . In many ways the diagram nicely illustrates the concept of the homo clausus: both individuals are closed and sealed into their own inner worlds; information about thoughts, moods and feelings are inaccessibly locked up inside the private inner space of each person, unless and until that person chooses to communicate this information to another. But obviously the diagram also speaks to the linear sender–receiver communication paradigm that we mentioned in the introduction. Indeed, the wires in this diagram recall that Shannon and Weaver’s highly influential version of this paradigm grew out of their wartime experience in the Bell Telephone Laboratories  . Perhaps ironically then, given how central the epistemology of the Körper .communicative bodies . If the discourses of the homo clausus and the sender–receiver communication paradigm are still present in the phenomenon of self-injury then, they are nonetheless transformed by the process of the communicative body ‘acting out’ in its estranged mode. They become, as Steggals argued, less a set regulative norms than the source material for a kind of transgressively hyperbolic bricolage. It is not that the truth of self-injuryis contained within these discourses then, nor can self-injury be understood when such discourses are taken for ontology. Rather, these discourses have become the productive and enabling media for the communicative body to ‘act out’ and speak up, to disclose and draw itself out beneath the talking head that has fallen silent.As the evidence of intercorporeal, intersubjective and inter-kinesthetic communication empirically sketched and theoretically described above demonstrates, our bodies are fundamentally e bodies . Describe bodies , p. 3. Spurely private and secret phenomena, we must remember that the vernacular use of ‘private’ and ‘secret’ has never implied a hermetically sealed individualism.The phrase ‘private life’ tends to refer to people’s close and intimate relationships, while secrets are often shared amongst confidants without them being considered either inauthentic, or secrets no longer. The capacity and the desire to mask things or keep them secret is itself an accomplishment of social communicative capabilities because ‘secrecy constitutes a relational experience between people’ (homo clausus (If self-injury has commonly suggested to us a  people’ , p. 11.  clausus , p. 110.either individual or social, secret or communicated, private or shared. What we have found is that the personal is not something wholly contained within the boundaries of the body, but something that extends outward through other bodies, relationships and spaces. At the same time, the social is not something wholly exterior but rather something that saturates us, informing our most private thoughts, feelings and orientations. The personal and the social necessarily implicate one another. As such, while self-injury may be experienced as intensely personal, it is nonetheless best conceptualised as a richly communicative phenomenon: even if that communication is not an overt and fully deliberate interpersonal communication of the kind envisaged by the sender–receiver paradigm. A successful sociology of self-injury then, must include alongside any analysis of interpersonal communication, an appreciation of the intercorporeal, intersubjective, inter-kinesthetic. And this means that any account of the body in self-injury must understand this body as foundational to subjectivity, meaningfully extended through its environment, fundamentally relational, and deeply communicative. Indeed, self-injury offers a particularly powerful case study with which to think through a more complex model of communication and the role of the communicative body; something that ought to be of significant interest to the full range of sociologies of everyday life and embodiment.The disturbances and excitations of the communicative field of the family home that we have described here, demonstrate that self-injury cannot be thought of as something that is