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This article reports on the findings from a small-scale co-produced qualitative study on experiences of distress caused by the war in Bosnia and Herzegovina (BiH). Inspired by the emerging interdisciplinary field of Mad Studies, the study is novel and unique in two ways. First, it prioritises social understanding and interpretation of madness and distress. Second, an emphasis is placed on experiential knowledge. Beyond interviews with 20 people who experienced distress due to political conflict, this included contextualisation of the study in the knowledge generated through survivor research and within the field of Mad Studies. Study findings highlight the social causes and consequences of distress caused by conflict, such as war-related violence, gender-based violence, experiences of poverty and corruption. Participants stressed the importance of safety and support within their own home, mutual and supportive relationships with their families, friends, other people who experienced distress, the broader community and opportunities to do everyday activities they enjoy. In terms of professional support, the findings suggest that poverty alleviation and protection of people's right to self-determination through access to human rights advocacy and representation may be as relevant as non-coercive community-based services. This indicates that support for distress caused by political conflict need not be different from any other support for people who experience distress. Emphasis should be placed on survivor-run initiatives and non-coercive, community-based support which addresses social causes of distress and enables people to exercise self-determination.

Work participation is known to benefit people's overall health and wellbeing, but accessing vocational support during periods of sickness absence to facilitate return-to-work can be challenging for many people. In this study, we explored how vocational advice was delivered by trained vocational support workers (VSWs) to people who had been signed-off from work by their General Practitioner (GP), as part of a feasibility study testing a vocational advice intervention. We investigated the discursive and interactional strategies employed by VSWs and people absent from work, to pursue their joint and respective goals. Theme-oriented discourse analysis was carried out on eight VSW consultations. These consultations were shown to be complex interactions, during which VSWs utilised a range of strategies to provide therapeutic support in discussions about work. These included; signalling empathy with the person's perspective; positively evaluating their personal qualities and prior actions; reflecting individuals' views back to them to show they had been heard and understood; fostering a collaborative approach to action-planning; and attempting to reassure individuals about their return-to-work concerns. Some individuals were reluctant to engage in return-to-work planning, resulting in back-and-forth interactional negotiations between theirs and the VSW's individual goals and agendas. This led to VSWs putting in considerable interactional 'work' to subtly shift the discussion towards return-to-work planning. The discursive strategies we have identified have implications for training health professionals to facilitate work-orientated conversations with their patients, and will also inform training provided to VSWs ahead of a randomised controlled trial.

Psychiatric practice has always entailed a coercive dimension, visible not only in its formal expressions (e.g. compulsory treatment) but in many informal and implicit forms. In fact, contemporary psychiatric practices are characterized by an interplay of coercion and dialog to be interpreted not as binary categories but as extremes of a spectrum. Within this perspective, it becomes crucial to draw boundaries attributing meaning to professional identities and practices in psychiatric work. This is particularly relevant in acute wards: to explore this issue, we selected two cases according to a most-different-cases design, one ward with a mechanical-restraint approach compared to one with no-mechanical-restraint. We argue that gender, mobilized to performatively draw distinctions and hierarchies in order to define and justify different approaches to psychiatric crises along the continuum between coercion and dialog, is a key dimension in the boundary-making process. The analysis identifies two main dimensions of drawing gendered boundaries: inter-gender boundaries (overlapping the binary distinction between masculinity and femininity with a more coercive or relational-dialogic approach to crisis) and intra-gender boundaries (distinguishing and ranking of different masculinities and femininities), associating a less coercive orientation with a devirilized masculinity.

This article analyses the digital screen as a health technology. In particular, the article asks how screens as a part of therapy settings or counselling practices materialise - or fail to materialise - care. The empirical data comprise interviews with therapy and counselling professionals, whose experiences with technology during the COVID-19 pandemic were my original interest. Adopting a sociomaterial approach to technology use, it scrutinises not only how screens are used, but also how screens themselves act and operate. This approach foregrounds the screen as 'multiple', complicating a dichotomous understanding between in-person therapy and remote therapy. The article argues that the screen operates in a variety of ways that might either facilitate or degrade care and is an essential part of more-than-human care in digitalised societies. Acknowledging the agential capacities of all matter, the article also conceptualises screens as 'vibrant matter'.

The Mental Health Act (1996) is legislation that directs voluntary and involuntary psychiatric treatment for people experiencing mental health issues in British Columbia (BC), Canada. This critical discursive analysis explores how BC's Mental Health Act (1996) and the Guide to the Mental Health Act (2005) structure involuntary psychiatric treatment and illustrates how the discourses within these texts constitute people experiencing mental health issues as passive recipients of care. Understandings of people experiencing mental health issues as pathological, incapable, vulnerable and dangerous justify their need for protection and the protection of others. Protection is identified as a central legitimising discourse in the use of involuntary psychiatric treatment. Further, these texts define the roles and responsibilities of police, physicians and nurses in authorising and implementing involuntary psychiatric treatment. This analysis describes how this legislation erodes consent and entrenches social marginalisation. Alternatively, discourses of equity have potential to transform health care practices and structures that reproduce discourses of deficit, vulnerability and dangerousness, shifting towards promotion of the rights and safety of people experiencing mental health issues and crises.

What does it mean to claim that somebody's personality is disordered? The aim in this paper is to examine how the process of diagnosing personality disorders (PD) unfolds on a practical level. We take an in-depth look at PD interviews, paying close attention to the occasional discrepancies in the clinicians' and the patients' approaches to generalising the behaviour of patients to describe their personality. Clinicians are guided by the medical model and structured interviews in their approach. We regard the interview situation as interplay between the institution, the clinician and the patient - and the final diagnosis as an interactional construction between them. Our data consists of video-recorded interviews in Finland with 10 adult patients and three psychiatric nurses. The collection was compiled from 22 excerpts in which the participants orient differently to the generalisability of personality traits. Our observations show that, in these interviews, patients frequently make sense of their behaviour differently from what is expected - not as a reflection of their personality traits, but as an outcome of many situational factors. Our understanding leads us to emphasise the importance of making visible the practices that shape the diagnostic process in psychiatry.

This paper contributes to challenging common behavioural or cognitive explanations for health and wellbeing outcomes, focussing on social practices through which people, with the help of other subjects, try to improve their health conditions. To renew the debate about health promotion, my work is placed at the intersection between the sociology of health and illness and science and technology studies, adopting the concepts of care infrastructures and health practices that are introduced in the next section. With this goal, my paper draws on a qualitative study concerning a Workplace Health Promotion programme aimed at reducing the risks of Type-2 diabetes and cardiovascular diseases among sedentary workers. The findings illustrate how a care infrastructure in the field of health promotion is designed, put to work, repaired and 'put aside' in relation to two health practices ('doing physical activity' and 'following the Mediterranean diet'). Drawing on the presented case, I show how the change in daily habits in the fields of nutrition and physical activity is a collective effort involving different spheres of life, connecting human and non-human elements and bringing out affective intensities among them.

Policy promotes the active participation of those with lived experience of mental health difficulties in UK NHS mental health services, from the level of collaborative care-planning to service delivery, leadership and development. However, research indicates different forms of resistance to the implementation of such service user involvement. This article reports the findings of a qualitative, interview-based study which used Foucauldian discourse analysis and psychoanalytic theory to understand how resistances are produced through the interplay of clinical mental health professionals' subjectivity and their organisational context. Service user involvement was found to highlight conflicts within clinicians' roles. Central to this conflict was an ambivalent relationship to the power associated with these roles. Power could protect professionals from work related stresses, but could also be used to dominate, silence and coerce service users in ways that conflicted with the core function of providing care. Whilst important, raising awareness of such conflict will arouse discomfort and resistance where psychological defences are challenged. A parallel is drawn with psychotherapeutic change, in which resistance must be understood and worked with as part of meaningful change.

To improve the safety of healthcare systems, it is necessary to understand harm-related events that occur in these systems. In mental health services, particular attention is paid to harm arising from the actions of patients against themselves or others. The primary intention of examining these adverse events is to inform changes to care provision so as to reduce the likelihood of the recurrence of such events. The predominant approach to investigating adverse incidents has relied on the cause-and-effect conceptualisation of past events. Whilst the merits of approaches which are reliant on cause-and-effect narratives have been questioned, alternatives models to explain adverse incidents in health settings have not been theoretically or empirically tested. This novel article (i) examines the notion of causation (and the related notion of omission) in the context of explaining adverse events in mental health settings, and (ii) draws on a long-established discipline devoted to the study of how the past is interpreted (namely historiography) to theoretically investigate the innovative application of two historiographical approaches (i.e. counterfactual analysis and historical materialism) to understanding adverse events in mental health settings.

The prevalence of Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses and medication use has increased over time around the world, but significant regional differences remain. This paper aims to determine and explain disparities in ADHD prevalence and medication use among school-aged children in two distinct school systems, in Flanders (Belgium) and Québec (Canada). We present detailed descriptive and comparative analyses of data from 35 schools, 114 teachers, and 1046 parents (children) that were collected as part of a comparative international project. The data concern teacher and parent suspicions, teachers' ratings of ADHD-related behaviors in children, teachers' views of medication use, and teachers' beliefs about ADHD. The results show that, compared with Flanders, Québec had significantly more children diagnosed with ADHD and more frequent suspicions of ADHD in children by teachers and parents. We refer to the conceptual, institutional, and interactional levels of medicalization to interpret our findings and conclude that social and cultural readings of children's behaviors differ greatly between regions. Medicalization of children's behaviors is more common in Québec than in Flanders.