Imagination is often considered the pinnacle of representational cognition. Looking at the concrete details of imagining in context, this paper aims to contribute to the emerging literature that is challenging this representational view by offering a relational and radically situated alternative. On the basis of observing architects in the process of making an architectural art installation, we show how to consider imagination not as de-contextualized achievement by an individual but as an opening up to larger-scale “affordances,” i.e. the unfolding possibilities (...) for action. We show how the architects coordinate the enactment of multiple affordances across different timescales, from small-scale affordances of picking up a mobile phone to the large-scale affordance of making the installation that takes months to unfold. These affordances get co-determined as they are jointly enacted. It is within this determining process that imagination too finds its place. On our view it is the indeterminacy of multiple affordances unfolding in action simultaneously that can be experienced as imaginative. The indeterminate character of this coordinative process allows activities to widen and open up, letting new possibilities for action enter into them. (shrink)

Despite technological innovations, clinical expertise remains the cornerstone of psychiatry. A clinical expert does not only have general textbook knowledge, but is sensitive to what is demanded for the individual patient in a particular situation. A method that can do justice to the subjective and situation-specific nature of clinical expertise is ethnography. Effective deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) involves an interpretive, evaluative process of optimizing stimulation parameters, which makes it an interesting case to study clinical expertise. The (...) aim of this study is to explore the role of clinical expertise through an ethnography of the particular case of DBS optimization in OCD. In line with the topic of the special issue this article is a part of, we will also use our findings to reflect on ethnography as a method to study complex phenomena like clinical expertise. This ethnography of DBS optimization is based on 18 months of participant observation and nine in-depth interviews with a team of expert clinicians who have been treating over 80 OCD patients since 2005. By repeatedly observing particular situations for an extended period of time, we found that there are recurrent patterns in the ways clinicians interact with patients. These patterns of clinical practice shape the possibilities clinicians have for making sense of DBS-induced changes in patients’ lived experience and behavior. Collective established patterns of clinical practice are dynamic and change under the influence of individual learning experiences in particular situations, opening up new possibilities and challenges. We conclude that patterns of clinical practice and particular situations are mutually constitutive. Ethnography is ideally suited to bring this relation into view thanks to its broad temporal scope and focus on the life-world. Based on our findings, we argue that clinical expertise not only implies skillful engagement with a concrete situation but also with the patterns of clinical practice that shape what is possible in this specific situation. Given this constraining and enabling role of practices, it is important to investigate them in order to find ways to improve diagnostic and therapeutic possibilities. (shrink)