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This thesis explores whether participatory action research (PAR) can be a vehicle for knowledge democracy in mental health by telling the compelling tale of a team of mental health service users formed to conduct a PAR project in adult NHS mental health services. PAR is a methodology that seeks change through action and the collaborative efforts of participants, often people from marginalised groups. The team, self-named PAR Excellence, actively participated in every step of the research process, from the initial identification of the research topic (shared decision making in mental health), literature review, research design, data collection and analysis, to dissemination. The original contribution to knowledge is in two parts: findings on shared decision making and the use of recorded service user experiences in mental health, and findings on the PAR process itself. Through these intertwining efforts, an original analysis of knowledge democracy in the context of adult NHS mental health services in the UK has been reached. Having chosen shared decision making in mental health, PAR Excellence developed a multi-media library of service user experiences to be used as a shared decision making resource. They explored with NHS mental health staff whether this approach supported shared decision making through qualitative focus groups and interviews. It was concluded that whilst the use of recorded service user experiences as a shared decision making resource was generally welcomed in principle by staff, in practice there was limited utilisation of the resource. However, it was highly valued as an opportunity for staff reflective practice, and when used judiciously, showed the potential for having a profound effect for service users. It was also found that shared decision making is a complex concept that has many different meanings amongst staff, and they work in a system where true shared decision making cannot consistently occur. However, it was discovered that staff found the involvement of service users in the research process gave the project authenticity and credibility over research generated purely by traditional researchers, and were therefore more likely to engage with it. The shared decision making resource also provoked a particularly positive response in staff members who have used mental health services themselves. Throughout the project, qualitative focus groups were also held with PAR Excellence to explore the participatory process and its outcomes overall. These findings established that the motivations of the team (who were highly critical of mental health services) were rooted in a profound understanding of the power mental health services had over them, dissatisfaction with services, and a deep sense of injustice. This led the team to express a concept of subversive "meddling" in mental health services to address these issues. They found that whilst personal transformation through PAR was achievable, the potential for more general, external transformation was limited due to the enmeshment of the political and economic climate in which mental health services operate.

Collecting recipes was an established tradition that continued in elite English households throughout the eighteenth century. This thesis is on medical recipes and advice, and it addresses the evolution of recipe collecting from the seventeenth century and throughout the eighteenth century. It investigates elite domestic medicine within a cultural history of medicine framework and uses social and material history approaches to reveal why elites continued to collect medical recipes, given the commercialisation of medicine. This thesis contends that the meaning of domestic medicine must be understood within a wider context of elite healthcare in order to appreciate how the recipe collecting tradition evolved alongside cultural shifts, and shifts within the medical economy. My re-appraisal of the meaning of domestic medicine gives elite healthcare a clearer role within the narrative of the social history of medicine. Elite healthcare was about choice. Wealthy individuals had economic agency in consumerism, and recipe compilers interacted with new sources of information and products; recipe books are evidence of this consumer engagement. In addition to being household objects, recipe books had cultural significance as heirlooms, and as objects of literacy, authority, and creativity. A crucial reason for the continuation of the recipe collecting tradition was due to its continued engagement with cultural attitudes towards social obligation, knowledge exchange, taste, and sociability as an intellectual pursuit. Positioning the household as an important space of creativity, experiment, and innovation, this thesis reinforces domestic medicine as an important part of the interconnected histories of science and medicine. This thesis moreover contributes to the social history of eighteenth-century England by demonstrating the central role domestic medicine had in elite healthcare, and reveals the elite reception of the commercialisation of medicine from a consumer perspective through an investigation of personal records of intellectual pastimes and patient experiences.

This thesis investigates the allure of narrative genres, such as horror, that have historically been viewed as philosophically (and often morally) problematic owing to their negative content and the painful emotional responses they elicit. It departs from the majority of classical and contemporary solutions to the alleged paradox posed by such genres, in that it does not attempt to render their pleasures explicable by appealing to their fictive status, thematic or ideological meanings or the more comprehensibly-pleasurable meta-responses they inspire. Rather, this account suggests that we choose to consume stories – fictional and factual – that depict violent or distressing situations and evoke discomforting emotions, for the same reason we choose to engage with less obviously conflict-filled narratives. Fictions compel our attention insofar as they resemble potentially salient information, appealing to a set of deeply ingrained and unconscious cognitive biases that prompt us to attend to certain kinds of stimuli. We are capable of finding narrative genres such as horror, tragedy and the ‘misery memoir’ compelling – without, it is important to note, finding their content in any way pleasant – because we are predisposed to find some types of mental effort rewarding. While horror is often criticised – and defended – on the grounds that its pleasures must lie in slaking anti-social appetites, this thesis criticises the model of fiction’s appeal on which such assumptions are based. Instead it suggests that narrative pleasure characteristically resides in intellectual and emotional absorption or stimulation rather than any straightforward fulfilment of our real life desires. In support of this contention, this account incorporates analyses of a number of related topics, examining subjects such as the alleged rationality of the emotions, whether our attraction to non-factual narratives represents an adaptive trait and how fiction-making, criticism and consuming function as cultural practices.

Palatal dysfunction is the most common form of dynamic upper respiratory tract (URT) obstruction affecting racehorses and therefore is of great importance to the horseracing industry. There is an urgent need to develop a robust evidence base in this area of equine sports medicine. The aim of this thesis was to establish the evidence base for the diagnosis, aetiopathogenesis and treatment of dynamic palatal dysfunction and to undertake targeted studies to address key areas. There was poor experimental evidence to fully explain the aetiopathogenesis, which impacted on the efficacy of treatments available. A systematic review of intervention studies showed that decision making for choice of intervention is currently based on inadequate published data, personal experience or anecdote rather than on evidence based data. Many studies were based upon horses without a definitive diagnosis of this condition and there was poor understanding of appropriate outcome metrics for intervention studies. A novel technique of o verground endoscopy was shown to produce diagnostic images of the URT in exercising horses. A comparison of overground endoscopy and treadmill endoscopy showed that dorsal displacement of the soft palate (DDSP) was diagnosed significantly less often during overground endoscopy. A study of overground exercise tests showed that DDSP was more likely to be diagnosed when longer test distances were performed. Certain endoscopic characteristics of the soft palate/epiglottis were shown to be associated with progression of palatal instability to DDSP. The effect of palatal dysfunction on measures ofventilationlgas exchange were evaluated. One form of palatal instability was shown to be detrimental to gas exchange, although this was not as great as the detrimental effect ofDDSP. The value of using race performance as an outcome measure was assessed. Several factors were identified which show that outcome measures such as earnings may not be ideal for assessing intervention efficacy.