Trauma, Women’s Mental Health, and Social Justice: Pitfalls and Possibilities
Abstract
This book argues that while notions of trauma in mental health hold promise for the advancement of women’s rights, the mainstreaming of trauma treatments and therapies has had mixed implications, sometimes replacing genuine social change efforts with new forms of female oppression by psychiatry. It contends that trauma interventions often represent a "business as usual" approach within psychiatry, with women being expected to comply with rigid treatment protocols, accepting the advice given by trauma "experts" that they are mentally unstable and that they must learn to manage the effects of violence in the absence of any real changes to their circumstances or resources. A critique of trauma treatment in its current form, Trauma, Women’s Mental Health, and Social Justice recommends practical steps towards a socio-political perspective on trauma which passionately re-engages with feminist values and activist principles.
... Social researchers have noted that while the concept of trauma facilitates social analyses of mental illness (Tseris, 2019), its definition and aetiology are contested (Leys, 2000). Clinical and psychological perspectives on trauma also have the potential to individualise the sociopolitical issues that contribute to AOD-related problems and reinscribe people who use drugs as psychologically deficient and/or mentally unwell (valentine & Fraser, 2008). ...
... Similarly, while trauma experiences are thought to be more common among trans and gender diverse people (Gibson et al., 2022;Shipherd et al., 2019), little is known about how trauma shapes experiences of AOD-related problems, and their implications for support needs. While the greater focus on women and sexual violence has identified the long-term harms of violence against women and children (Burstow, 2005;Tseris, 2019), this focus may obscure how gender and sexuality operate more broadly in linking trauma and AOD consumption. The gendered mediation of trauma warrants careful scholarly attention, as does the role trauma plays in 'making up' gendered and sexual subjects (Hacking, 1986), and both its potential and limits as a tool of resistance to gendered forms of violence and abuse. ...
... Importantly, the adoption of trauma-informed treatment in AOD services has significant effects for how we understand and treat AODrelated problems. As noted earlier, the medicalisation of trauma has been a central focus in critical trauma studies, including how the medical-diagnostic model may obscure sociopolitical issues of gender inequality and discourage a social justice approach to these issues (Tseris, 2019). These effects have been explored in greater detail in mental health research but are pertinent to considerations of how trauma-informed approaches may transform understandings of AOD consumption by linking it to potentially pathologising mental health diagnoses, rather than in concert with social issues such as inequality, prohibition, incarceration, and drug-related stigma (Fraser, et al., 2014). ...
Trauma is increasingly understood to shape a range of alcohol and other drug (AOD)-related problems, including addiction, relapse, mental illness and overdose. However, the merits of understanding AOD-related problems as the effect of trauma are uncertain with the nature and implications of such linkages requiring closer scrutiny. Where trauma is linked to AOD-related problems, this relationship is typically treated as self-evident, obscuring the uncertainties in knowledge surrounding the notion of trauma itself. Informed by insights from critical drugs and trauma scholarship that challenge deterministic notions of AOD 'problems' and trauma, this essay identifies key issues for social research in this area that warrant further consideration. We argue that there is a pressing need to acknowledge variation and diversity in the relationship between trauma and AOD-related problems, and the gendered and sexual dynamics shaping the expansion of the trauma paradigm. We then outline how critical Indigenist interdisciplinary work can inform culturally specific knowledge on trauma and AOD-related problems, and also suggest targeted research on the delivery and experience of trauma-informed approaches in the AOD context. To this end, we present several recommendations for a social research agenda underpinned by critical, qualitative research into how people experience and manage trauma and AOD-related problems in their everyday lives.
... A recent review of the strategic role of social work in mental health in Northern Ireland, recognised "social work can bring a counterbalance to more individualised, more clinical and more treatment focused perspectives on mental health" [8] (p. 16). This captures the essence of social work values and ethics and is core to social work practice. ...
... However, the learning resources that support the teaching of paradigmatic influences on mental health social work are limited. Detailed exploration of these influences is rare in the mental health social work textbooks to which we refer [10,12,[15][16][17][18][19][20][21]. Thus, in considering a social work contribution to transformations in mental health thinking and practice we began by exploring a selection of existing paradigms and their influence on mental health social work [22]. ...
... Mental health social work texts have pragmatically needed to focus upon medical terminology, mental state examination, needs assessment and intervention, legislation and provisions for compulsory treatment, and working within multi-disciplinary team structures [9,18]. A groundswell of renewed thinking about differential ideas about "evidence", whose evidence informs good practice, service user choice and the potential of rights-based approaches, have reopened the possibilities for social work to contribute to transformative approaches that are respectful, inclusive, individuated, collaborative, holistic and anti-oppressive; that is a values-based lens towards practice [16,19,54,80]. Conversely, the recognition of the intent of practice is sometimes allusive, and potentially "invisible social work" [81]. ...
When graduates of Australian social work courses embark on a career in mental health, the systems they enter are complex, fragmented and evolving. Emerging practitioners will commonly be confronted by the loneliness, social exclusion, poverty and prejudice experienced by people living with mental distress; however, social work practice may not be focused on these factors. Instead, in accordance with the dominant biomedical perspective, symptom and risk management may predominate. Frustration with the limitations evident in this approach has seen the United Nations call for the transformation of mental health service delivery. Recognising paradigmatic influences on mental health social work may lead to a more considered enactment of person centred, recovery and rights-based approaches. This paper compares and contrasts influences of neo-liberalism, critical theory, human rights and post-structuralism on mental health social work practice. In preparing social work practitioners to recognise the influence of, and work more creatively with, intersecting paradigms, social work educators strive to foster a transformative approach to mental health practice that straddles discourses.
... The contemporary captivation with neurobiological accounts of trauma has been understood as part of a broader era of "neuroenchantment" (Ali, Lifshitz, & Raz, 2014), in which the brain and its neurological processes are now considered to be wholly constitutive of the self. In this era, "brain claims" reign supreme, often with very little critical analysis of their explanatory relevance to complex social issues (Tseris, 2019). This neurobiological discourse has been taken up recently in notions of the "neurobiology of trauma", whereby traumatic events are said to cause floods of neurotransmitters, which impede bodily function, memory, and mobility. ...
... Specifically, feminist researchers and advocates have adopted these discourses as counterpoints of resistance against patriarchal victim-blaming discourses, which deny or minimize the profound impacts of trauma (Tseris, 2019). Against a backdrop of patriarchal violencewhich works to normalize, minimize, or deny the impacts of violencea focus on the body and the brain can be strategically advantageous for those seeking to validate or legitimize the suffering of others, namely because physical suffering is more difficult to dismiss than psychological or emotional suffering (Marecek, 1999). ...
... 4). Moreover, the capacity of neuroimaging to support broad neurobiological claims remains limited (Ali, Lifshitz, & Raz, 2014), and research is in its very early stages, meaning that claims about the neurobiological bases of trauma should be treated with caution (Tseris, 2019). ...
Public discussions about trauma are circulating exponentially in the wake of global movements against structural violence, and efforts to mainstream "trauma-informed" approaches in mental health, human services, and organizational contexts. Within these discussions, the term "institutional trauma" is increasingly being deployed to make sense of structural violence and its impacts. However, such discussions typically reproduce highly individualistic understandings of trauma. Recent feminist advances in trauma theory articulate trauma as a distinctly socio-political form of distress (Tseris, 2015; 2018; 2019), and critical feminist psychological work argues that gender and other institutions play a substantial role in defining and mediating experiences of trauma (Segalo, 2015). However, the role of institutions in the (re)production of trauma remains under-theorized in the psychological literature. This paper applies feminist, critical mental health, and decolonial perspectives to identify the limitations of mainstream psychological perspectives on trauma and proposes a critical psychological theory of "institutional trauma". I apply this critical analytic to argue that dominant biomedical and neoliberal frameworks fail to adequately account for the socio-political dimensions of trauma. I then consider institutional theory as a useful feminist psychological analytic through which to expand trauma theory and subvert pathologizing accounts of trauma as disordered and maladaptive.
... There is a frustration that the principles newly claimed by trauma-informed practice (safety, trust, empowerment, choice, collaboration) are not unique to psychology but have, in fact, underpinned many professional approaches for decades (including youth work). And there is also a strong sense of ennui about this being the latest government policy fad, which has created a booming unregulated market of trauma-informed 'experts' selling their services (Bath, 2017;Smith & Monteux, 2023;Tseris, 2019). ...
Background
Home Fae Home was an action research project, working with young people in Dundee, Scotland, to redesign the interior environment of a community‐based youth work facility, through the lens of trauma‐informed practice. Multi‐disciplinary in nature, the project integrated the fields of psychology, architecture and spatial design with youth and community work.
Methods
Over 150 young people were engaged over 4 years in the co‐design process through a range of creative workshops. As part of these workshops, a multi‐methods approach to data collection was used, with semi‐structured interviews and focus groups, as well as more creative and informal engagements.
Results
Spatially, the project has provided six new/additional diverse and adaptable youth work spaces, each thoughtfully designed by young people, to help them feel safe, process complex emotions, support recovery, avoid re‐traumatization and reduce stress levels. Through the process, important new knowledge was also generated by the young people, highlighting the importance of expression and culture for adolescents and their need to have choice and ownership of their space.
Conclusions
The project clearly demonstrated that young people should be trusted as experts of their own experience of trauma and recovery and evidenced the crucial need for professionals who work with young people to deliberately redress power imbalances in order to facilitate this.
... Given these developments, TIC purports to embrace a more comprehensive, multidisciplinary understanding of trauma reflecting a biopsychosocial perspective (Goodman, 2017), integrating research from fields of neurobiology, attachment, trauma, and resilience (Bath, Seita and Brendtro, 2018). The literature describes TIC as a strengths-based framework that considers the person's broader ecological context (Bateman and Henderson, 2013; The National Child Traumatic Stress Network, 2016) concerned with issues of social justice, power relationships and human rights (Tseris, 2019b). ...
he TARA (Trauma, Attachment, Resilience into Action) Project represents a successful high�level partnership between the Dublin South Central Integrated Service Area (DSC) of TUSLA,
Child and Family Agency (hereafter TUSLA) and University College Cork (UCC). The
overarching aim of this partnership is to integrate trauma-informed practices across the
service area of DSC to support practice in responding to the complex needs of children and
families they encounter. The Project is being approached in two phases. This report
presents Phase 1 which delivered and evaluated the Continuing Professional Development Certificate in Trauma-informed Care: Theory and Practice, a professional graduate-level education in trauma-informed practice, to DSC professional staff across diverse levels of roles and responsibilities. The findings of this study will inform the second Phase of the Project.
... In the context of work that seeks to address inequality and social justice, such as domestic violence and its intersection with other health concerns, practitioners must also navigate documentation as a medium that wields considerable influence over service user experiences, trajectories, and outcomes (Phillips et al., 2021;Warshaw & Tinnon, 2018). Issues of violence and abuse have historically been shrouded in silence and inadequately addressed from the perspectives of both service provision and lived experience (Trevillion et al., 2016;Tseris, 2019). Accountability and visibility of those that cause harm continues to be sorely lacking. ...
Purpose
Domestic violence-informed documentation practices across health and human services were explored as an aspect of a wider action research project in New South Wales, Australia. In health and human service responses to families living at the intersection of domestic violence, substance misuse and mental ill-health, practitioners navigate the complexities of collaborative and integrated work to address violence and abuse. Documentation is an aspect of practice where ethical, quality and safety issues arise, impacting individuals, organizations, and service sectors.
Methods
Senior practitioners from specialist domestic violence, substance use, mental health and child protection services participated in a series of Communities of Practice to explore integrated and collaborative practice using the Safe & Together™ Model approach to working with families impacted by domestic violence and abuse. Documentary practices were explored as an important aspect of the wider research project, and ethnographic notes from Community of Practice and reflective focus groups were thematically analyzed.
Results
Four key themes regarding domestic violence-informed documentation practices were highlighted in the analysis: recognizing the power of documentation; maintaining an all-of-family focus; focussing on patterns and context; and the importance of language that emphasizes behavioral specificity. Taken together, these themes speak to the powerful role played by domestic violence-informed documentation for clients accessing services, as well as to the opportunity for practice-changing work through documentation that diverse practitioners can take up when working with families and with each other.
Conclusion
This paper contributes to a growing body of practice-led knowledge building and provides an in-depth examination of domestic violence-informed documentation practices from the perspectives of practitioners working at the intersections of domestic violence, substance use, mental health and child protection issues across health and human services. It highlights the complex and empowering opportunities that attention to language and documentation holds and emphasizes the need for further research exploration and capacity building for domestic violence-informed practice.
... This plays out in two ways: the defi nitions of some mental disorders correspond closely to the life conditions of particular groups (we relate this to trauma, and to surveillance); and in other cases, the criteria for diagnoses resonate with the emotional specialization of particular groups. Tseris (2019) shows that the emergence of trauma as a core concept for psy-professionals around the world raised hopes of empowering women, by acknowledging types of violence that particularly aff ect them. The creation of this way of making sense of and categorizing mental illness thus relates to the existence of violent oppression, which tends to target particular groups (women, racialized ethnic groups, LGBT+ people). ...
... This plays out in two ways: the defi nitions of some mental disorders correspond closely to the life conditions of particular groups (we relate this to trauma, and to surveillance); and in other cases, the criteria for diagnoses resonate with the emotional specialization of particular groups. Tseris (2019) shows that the emergence of trauma as a core concept for psy-professionals around the world raised hopes of empowering women, by acknowledging types of violence that particularly aff ect them. The creation of this way of making sense of and categorizing mental illness thus relates to the existence of violent oppression, which tends to target particular groups (women, racialized ethnic groups, LGBT+ people). ...
... This logic is dominant within Australian mental health policy and practice more broadly (Byrne, Happell, and Reid-Searl 2016b;Dawson et al. 2020), suggesting the inclusion of peer work within this policy response does little to disrupt the dominant construction of the 'problem' and it's underpinning assumptions. The mental health system is represented as essential to 'fix' the 'mentally ill' individual, further reinforcing the notion of individual dysfunction (Tseris 2019). ...
The inclusion of peer work within mental health policy offers potential for lived experience expertise to shape the construction of, and subsequent responses to, mental health ‘problems’. However, increasingly, scholars and activists are highlighting limits to such inclusionary practices. We explore these tensions through a critical analysis of problem representations including peer workers within Australian mental health policy. Drawing on Mad studies and user/survivor scholarship, we suggest that despite popular conceptions of inclusion as having universally positive effects, the inclusion of peer workers within policy has both liberating and troubling effects. Such effects include positioning peer workers as complicit in managing ‘problems’ that reinforce psy-regimes of governance and limiting the political subjectivities available to promote alternative representations. By highlighting such complexity, we endeavour to create opportunities for re-imagining peer work and inclusion in ways that bring such practices closer to achieving self-determination and social justice.
... This plays out in two ways: the defi nitions of some mental disorders correspond closely to the life conditions of particular groups (we relate this to trauma, and to surveillance); and in other cases, the criteria for diagnoses resonate with the emotional specialization of particular groups. Tseris (2019) shows that the emergence of trauma as a core concept for psy-professionals around the world raised hopes of empowering women, by acknowledging types of violence that particularly aff ect them. The creation of this way of making sense of and categorizing mental illness thus relates to the existence of violent oppression, which tends to target particular groups (women, racialized ethnic groups, LGBT+ people). ...
Marge Piercy's novel Woman on the Edge of Time (1976) begins with Connie's psychiatric hospitalization for ‘violent behaviour’. A working class, Latino woman in 1970s US, Connie was ‘violent’ indeed. She violently protected her niece against a pimp – hitting him with a bottle in an attempt to prevent her niece undergoing a forced abortion. Living in a threatening neighbourhood, she might have used violence in other situations, or become used to it. But decontextualized ‘violence’ appears inadmissible, pathological, morally reprehensible. In this story, mental health professionals decontextualize Connie's actions, making them illegitimate, the sign of an individual flaw, and this had terrible outcomes. Tragically, Connie finds herself locked up and dispossessed from the custody of her child. But in the hospital, a ray of hope shines in the form of Luciente's visits. Luciente introduces Connie into a bright future, a fulfilling, utopian social organization that Connie can eventually explore by herself, meeting its members, discovering how their community overcame the plagues of capitalism, individualism and sexism. Whether these visits are imaginary or real is another question.
In the society Connie discovers, words implement change. A significant one is ‘per’. Per, the first three letters of ‘person’, is used instead of ‘he’ or ‘she’, both as an outcome and catalyst of the shifting gender relations that drove this future world out of masculine domination: people are referred to as persons, not as sexes. As such, some parts of this story critique how institutions categorize behaviours in a way that minimizes their social context, especially for those who, like Connie, do not have the means to resist. Further, Woman on the Edge of Time raises reflections on the power carried by categorizations. What does it mean to be ‘violent’? What does it mean to be called ‘he’, ‘she’ – ‘per’? Categories are hinges between realities and their perception. As such, because people live through how they name things, labelling mechanisms have both conservative and transformative potential: they draw a space of possibilities.
... This plays out in two ways: the defi nitions of some mental disorders correspond closely to the life conditions of particular groups (we relate this to trauma, and to surveillance); and in other cases, the criteria for diagnoses resonate with the emotional specialization of particular groups. Tseris (2019) shows that the emergence of trauma as a core concept for psy-professionals around the world raised hopes of empowering women, by acknowledging types of violence that particularly aff ect them. The creation of this way of making sense of and categorizing mental illness thus relates to the existence of violent oppression, which tends to target particular groups (women, racialized ethnic groups, LGBT+ people). ...
Every four years, the US National Intelligence Council (NIC), known for its ties to the Central Intelligence Agency, releases a report outlining the main changes to be expected in the world in the next two decades. Following this tradition, after the election of Joe Biden, a new report was published in March 2021: Global Trends 2040. It includes a short mention of mental health.
Mental health and substance abuse disorders increased 13 percent during the past decade, principally because of increases in population and life expectancy but also because of the disproportionate prevalence of mental illness among adolescents. Currently, between 10 and 20 percent of children and adolescents globally suffer from mental health disorders, and suicide is the third leading cause of death among people between 15 and 19 years old. Health experts project that the economic cost of mental illness worldwide could exceed $16 trillion during the next 20 years, with much of the economic burden resulting from lost income and productivity as a result of chronic disability and premature death. Preliminary research suggests that because of the pandemic, people in every region will experience increased rates of mental distress caused by economic losses and social isolation stress disorder. (NIC, 2021, p 23)
Three causes are evoked for the rising prevalence of mental disorders: population growth, probably because it induces an increase of the absolute number of people living with mental illness, adolescent suffering and COVID-19. Most, if not all policy documents we could find approach mental health as a growing, costly problem for which few responses exist except recruiting more specialized professionals, making mental health services more ‘effective’ and ‘accessible’, and, tacitly, responsibilizing populations to manage their own distress – with increased focus on building ‘resilience’ and promoting ‘recovery’ (Harper and Speed, 2014). ‘Evidence-based’ policies then evaluate the ‘efficiency’ of these programmes and keep the most cost-effective ones, ignoring that beyond the help and relief these services certainly offer for many people suffering from mental disorders and their relatives, at a societal level, diagnosed mental disorders keep rising everywhere, no matter how cost-effective such services are.
... Many of the childhood adversities linked to later development of psychotic experiences were mentioned in the accounts of the participants in these studies, including negative family relations, abuse and victimization, as well as experiences of undermining and rejection (Harper et al., 2021;Tseris, 2019). The common element binding all the participants' accounts, however, was upbringing in a conservative religious family, pointing to the role of family culture, in conjunction with broader cultural environments, in the development and form of psychotic experiences. ...
This paper describes a pattern regarding the relationship between feminine sexuality, religiousness and psychotic distress that was discerned in two independent multiple case studies in Greece. One study utilized grounded theory to develop a model of therapeutic change through recording the development of voice hearers’ understanding and coping with their voices during a therapeutic intervention. The other study applied biographical and thematic analysis to interviews with persons with psychosis and their families, in order to explore family narratives regarding life with a family member with psychosis. A common pattern was detected for all the female participants, whereby following a religious upbringing in childhood and pursuing independence from the family together with social and sexual exploration in early adulthood, the onset of psychosis marked a return to the family home and a religious frame of reference. The psychotic experiences seemed to resemble engrained experiences of shaming regarding sexual and gender norms. Moreover, they had the effect of re-signifying female identity and sexuality, bringing them into line with conservative religious principles. This pattern suggests that psychotic experiences may not only express culturally prescribed female gender norms but also may serve to regulate women’s sexuality in conservative religious cultural environments.
... Tiers 3-5 comprise the core functions of the state mental health and addiction services system to provide services to those individuals and families experiencing the presence of severe mental health disorders and/or harmful substance use/gambling which results in moderate to severe functional impacts. Symptom-led reactive care has been characteristic of biomedical approaches to mental health (Morrow & Malcoe, 2017;Tseris, 2019). Individuals challenged by substance abuse and/or addiction issues who do not meet tier 3 criteria may be excluded from accessing services despite having a traumatic history that deeply compromises their current quality of life and relationships with themselves, partners, families and community. ...
Background
This research was conducted in response to concerns reported by social work practitioners to a Canadian College of Social Work which indicated that their practice was constrained by ideological and system limitations in publicly funded mental health and addiction systems.
Method
The dislocation theory of addiction which posits globalization and neoliberalism is linked to addiction rates worldwide, serves as an analytical frame to examine findings from fifty interviews, three focus groups and an online survey with one hundred and fifteen respondents.
Results
Themes specific to social work practice in addiction services referred to neoliberalism, stigma, biomedicalization, trauma and addiction, elimination of women services, shrinking services and privatization.
Conclusion
Social workers expressed a dissonance between their training rooted in relational approaches and biopsychosocial models of practice and system expectations. Our findings indicate concern about the erosion of core social work values within addiction services, the reduction of state funded programming and need for further research.
This chapter explores the vested interests involved when psy-professionals are given the central decision-making power and resources to define distress, crisis, and suffering—experiences that are most commonly referred to in contemporary times as amounting to a mental health ‘crisis’. It includes reflections on the complexities and tensions involved in sustaining a critical perspective on ‘mental health’, within a tertiary education context. In addition to well-documented financial interests driving pharmaceutical research, there are also more subtle professional interests that shape the pursuit of biomedical and therapeutic approaches to conceptualising human experience. Such perspectives reinforce a neoliberal status quo, whereby ‘problems’ are perpetually located within individuals. Serious engagement with the sanist oppressions embedded in the mental health professional project is therefore necessary across the academy. This will enable broader and more transformative understandings of distress to become visible, which incorporate experiential expertise and social justice perspectives on psychiatric power. From here, it should become possible to look beyond the limitations of professional expertise and mainstream service provision in developing understandings of madness and difference.
Editorial in 2 parts: 'Social work, the politics of cruelty and political resistance' by Kendra Cox, Donna Baines, Eileen Joy andLiz Beddoe; and 'On rangatiratanga' by Kendra Cox.
This chapter provides an overview of dominant mental health paradigms in contemporary Western contexts, with a focus on critically analysing two foundational assumptions of psychiatry: ‘benevolence’ and ‘expertise’. Mainstream mental health campaigns implore people to seek help when distressed, leading to widely accepted claims that mental health services are the only appropriate form of support in times of distress, suffering, or crisis. Strongly held beliefs that coercion is in the best interests of psychiatrised people reinforce the status of mental health services and marginalise the perspectives and knowledges of people with experiences of psychiatric harm, and yet the evidence-base for biomedical psychiatry is highly contested. It is argued that robust critiques of the claims of psychiatry are urgently required, given the harms caused by psychiatric practices, including the routine use of involuntary interventions by acute mental health services. We also argue that a gendered and socio-political analysis of psychiatrised women’s experiences is needed. Given the scale of change that is required, it is essential to move beyond tokenistic reform gestures. This chapter introduces a participatory action research study, exploring women’s experiences of and resistances to involuntary mental health treatment. Key definitions and an overview of the book as a whole are also included.
This article focuses on the workplace experiences of peer workers with a diagnosis of borderline personality disorder (BPD) in mental healthcare settings in Australia. Our article is located at the intersection of political, social, cultural, and legislative forces that have fostered the development of peer work as a paid profession. We draw on the concept of stigma to analyse findings from qualitative interviews with peer workers conducted in [state], Australia. By examining peer work in the broader context of lifeworlds of BPD, we address the interplay of work and professional identity, and the experience of a profoundly stigmatised diagnosis at this intersection.Our findings demonstrate the physical and emotional effects of stigma and how it produces boundaries and inequalities between peer workers and other health practitioners. These boundaries are reinforced by invisible markers that delineate what is expected, 'normal' and deemed professional in the workplace. Moreover, these same medico-socio-political relations help shape peer workers' identities and experiences. The development of peer workforces in mental healthcare service delivery is a prominent area of reform in Australia and internationally. Our research highlights the urgency of efforts to transform current socio-cultural-political relations that inhibit peer workers in their roles and impact workplace experiences.
Social workers are positioned to respond to clients with a history of trauma by practicing bio-psycho-social, trauma, and violence-informed care but frequently encounter systemic barriers to providing holistic care. The research presented in this article was initiated by a College of Social Work in Canada in response to concerns raised by social work providers that their practice was constrained by ideological, structural, and system limitations within publicly funded mental health and addiction services. Ideologically trauma-based social work care is defined by five principles of safety, trust, collaboration, choice, and empowerment and recognizes that what has happened to individuals, including early adversity, can influence their bio-psycho-social functioning across the lifespan. Structurally, trauma-based care recognizes the corrosive impact of poverty, systemic discrimination, and exclusion.
Findings
Our research included a literature review, an online survey (n = 115 completed surveys), individual interviews (n = 50), and three focus groups (n = 15). The findings consistently highlighted a dissonance between dominant bio-medical approaches and reliance on the Diagnostic Statistical Manual of Disorders and social justice–based practice. Primary themes included a recognition by social workers of the pervasive presence of trauma and its effects, including mental health and addiction challenges; intergenerational impacts of trauma; the limitations of the medical model; and the need to reposition social work practice.
Applications
Repositioning the role of social work within mental health and addiction settings to center social justice responses to trauma presents transformative opportunities to better meet the needs of service users and increase workplace satisfaction.
Universal assessment practices aimed at assessing the mental states of women during pregnancy and early parenthood have led to the perinatal period being viewed as synonymous with psychological vulnerability. In addition, women themselves are encouraged to engage in taxing self-monitoring processes aimed at recognising potential ‘signs’ of mental distress, with friends and family also urged to participate. Although both professional and ‘lay’ assessments of maternal mental health are usually imbued with notions of ‘care’ and ‘best interests’, medical and/or therapeutic interventions for mothers who have been identified as distressed frequently locate distress as a biological process and as evidence of individual ‘dysfunction’, thus failing to recognise or address the social drivers of distress, including isolation, gendered violence, and poverty. Further, the highly gendered nexus between maternal mental health and child development theorisations has led to a discourse of ‘compulsory happiness’ for pregnant women and new mothers, whereby they are obliged to manage and monitor their emotional states, regardless of their interpersonal and socio-political circumstances.
In this article, my approach to grief tending for the adult survivor of childhood trauma is to integrate a practice of poetic inquiry into one’s evolving relationship with oneself. As has been well documented by trauma theory, arts-based practices, here working strictly with poetry, are capable of embracing the often non-linear and multi-layered realities of our emotional woundings that are carried with us throughout our lives. By forging pathways through the wilderness of grief with poetic modes of inquiry and exploration, I suggest that we are able to shift healing work toward creative and empowering survivor-centred practices.
The objective of this paper is to critically examine assumptions underpinning research into music therapy and psychological trauma with adult populations. A critical interpretive synthesis was conducted, iteratively and inductively analysing a recently published body of research literature. The results of this process indicate that clinical discourse and psychiatric constructions of trauma recovery are privileged in this body of literature and a lack of participant voice has been identified. Additionally, the researchers extended the analysis of trauma discourses, through constructing two music-based constructs based on themes emerging in the included literature, as well as broader literature review, to understand how these discourses have been assumed within contemporary music therapy research. We called these constructs ‘Timing’ and ‘Silence’, and through a process of deductive and interpretive analysis, uncovered a range of sub-themes. These related to assumptions around containing and structuring functions of rhythm, the use of music as an anchor in the present moment, the ubiquity of linear trauma origin stories, silence as meaningful communication, and systems which compound trauma.
Given the recent surge of research about sexual violence, it is timely to revisit the role of ethics in this field. This article examines two key frameworks which govern ethics in sexual violence research: institutional risk management and trauma discourse. While recognising the importance of these frameworks, we argue that they share a narrow conceptualisation of the potential harms of sexual violence research. Drawing on the legacy of decades of feminist research on sexual violence, we call for a deeper engagement with ethical and epistemological questions of knowledge, positionality and power. We argue that researchers need to consider the broader social and political contexts that shape survivors’ lives and experiences of disclosure in undertaking ethical research. Sexual violence researchers must also consider the potential harms of their research on marginalised communities – from questioning who is included in research, to the implications of the responses to violence advocated for. Utilising insights from feminist, critical and intersectional traditions – and reflections on our own experiences as sexual violence researchers – we argue for ethical considerations to extend beyond risk management and medicalised trauma frameworks.
This article describes an ongoing process of transformation in sexual abuse counselling centres in Norway that involves a new classification of groups of victims. These centres have traditionally operated at the grassroots level and outside the statutory system of services for victims and with an open-door policy for all victims. Drawing on field visits and interviews with staff, we explore how the centres are now working to secure their place within the expanding organisational field of services engaged in victim support and anti-violence work – and the dilemmas this produces related to some victims. Theoretically, our analysis departs from a Bourdieusian approach to organisational fields as well as Abbott’s concept of professional regression. We find that the centres have adopted ways of thinking and working that stem from the discipline of psychology and the powerful trauma-discourse that has permeated the organisational field they are part of. This ‘psychological turn’ manifests in different ways in the centres, including an increasing problematisation and marginalisation of the centres’ original user group – women who are severely affected by childhood sexual abuse – who no longer are seen as benefitting from the services offered. Hence, it involves a regression from what used to be the centres’ purpose and niche, to care for the most vulnerable and marginalised victims.
The Routledge International Handbook of Critical Mental Health offers the most comprehensive collection of theoretical and applied writings to date with which students, scholars, researchers and practitioners within the social and health sciences can systematically problematise the practices, priorities and knowledge base of the Western system of mental health. With the continuing contested nature of psychiatric discourse and the work of psy-professionals, this book is a timely return to theorising the business of mental health as a social, economic, political and cultural project: one which necessarily involves the consideration of wider societal and structural dynamics including labelling and deviance, ideological and social control, professional power, consumption, capital, neoliberalism and self-governance.
'Psychiatric Hegemony' offers a comprehensive Marxist critique of the business of mental health, demonstrating how the prerogatives of neoliberal capitalism for productive, self-governing citizens have allowed the discourse on mental illness to expand beyond the psychiatric institution into many previously untouched areas of public and private life including the home, school and the workplace. Through historical and contemporary analysis of psy-professional knowledge-claims and practices, sociologist Bruce Cohen shows how the extension of psychiatric authority can only be fully comprehended through the systematic theorising of power relations within capitalist society. From schizophrenia and hysteria to Attention-Deficit Hyperactivity Disorder and Borderline Personality Disorder, from spinning chairs and lobotomies to shock treatment and antidepressants, from the incarceration of working class women in the nineteenth century to the torture of prisoners of the ‘war on terror’ in the twenty-first, 'Psychiatric Hegemony' is an uncompromising account of mental health ideology in neoliberal society.
With the recent proliferation of categories of mental illness and an increasing acceptance within western society of such categories as evidence of real disease, this chapter is a timely reminder of the social constructionist challenge to the existence of mental illness, and thus the validity of psychiatric practice as a whole. With reference to some of the key research on categories of mental illness, it is argued that while the social constructionist understanding of the discourse of mental illness as a myth and psychiatry as an institution of social control remains valid, the explanatory power of the approach is limited. Social constructionism can explain increasing professional power as part of state surveillance and control of populations, yet it cannot account for tensions and disagreements within psychiatry nor processes, which appear counter-productive for psychiatry such as the occasional de-medicalisation of some mental illness categories over time. To understand fully Western psychiatry, the chapter argues that we need to conceptualise the profession as an ideological state apparatus, which conforms and functions to the needs of capital and the ruling classes. This is illustrated through a survey of some of the Marxist writings on medicine and a demonstration of how this can work within the field of psychiatry; in doing so, time is given to exploring the discipline's role in the reproduction of gender inequalities and the normalisation of patriarchal relations. It is concluded that further critical work around the idea of psychiatric hegemony could be most productive in light of the forthcoming publication of the DSM V.
Introducing the rationale for the Routledge International Handbook of Critical Mental Health, Cohen surveys the history of critical approaches from the 1960s and 1970s, and theorises as to why there has been a retreat from critical thinking in the social and health sciences—and consequently a move back to conservative “social causation” approaches—since that period. With the evidence base on mental illness remaining highly contested, he argues that now more than ever critical perspectives are necessary to effectively problematise the practices, priorities, and knowledge base of the mental health system.
Sanism is a devastating form of oppression, often leading to negative stereotyping or arguments that individuals with 'mental health' histories are not fit to study social work. However, the term sanism is rarely used, understood, or interrogated in the social work academy, even in anti-oppressive spaces. Indeed, social work has been so loyal to the medical model that sanist aggressions, such as pathologizing, labelling, exclusion, and dismissal have become a 'normal' part of professional practice and education. We query the moral integrity of a profession that at its foundational core could play a role in such a discriminatory tactic as sanism. We wonder what the effect of this has been on social work and its education. We ask, who has been excluded, what has been silenced or denied because of the privileging of medical conceptualizations of madness, and how can we work toward anti-sanist social work today? In this paper we provide an overview of sanism. We offer a more critical review of the literature on 'mental health' and social work. We report on our anti-sanist participatory pilot research, and aligned with current Canadian rights work, we call for action with respect to how social workers theorize, research, and respond to madness now.
This paper presents a user/survivor researcher perspective to the debate among psychiatrists on the suggested introduction of Community Treatment Orders in Ireland. Critical questions are raised about evidence and the construction of psychiatric knowledge. Important questions include: How is this evidence created? What and whose knowledge have not been considered? Some critical issues around coercion, ‘insight’, and attributions of ‘lack of capacity’ are briefly considered. Further legal considerations are then introduced based on the United Nations Convention on the Rights of Persons with Disability. The paper concludes with a human rights-based appeal to reject the introduction of coercive community treatment in Ireland.
Sexual assault is a frequent interpersonal trauma, which often leads to posttraumatic stress disorder (PTSD). Among other postassault characteristics, self-blame attributions were suggested to play an important role in sexually assaulted individuals' coping, and were consistently associated with PTSD in this population. The present study aimed to elucidate the neural underpinnings that may associate self-blame and PTSD in women who experienced sexual assault at adulthood, using structural and resting-state functional MRI. Thirty-eight sexually assaulted women and 24 non-exposed matched controls were studied (mean age: 25 years). Among the sexually assaulted participants, assault-related self-blame was negatively correlated with gray matter volume (GMV) bilaterally in the lingual gyrus and adjacent intracalcarine cortex. GMV in this cluster was also predicted by intrusion symptoms and negative social reactions. Resting-state functional connectivity (rs-FC) of this cluster with the left anterior temporal fusiform cortex significantly differed between PTSD and non-PTSD sexually assaulted participants, and was inversely correlated with intrusion symptoms and with peritraumatic dissociation. Finally, lingual cluster's GMV and rs-FC with the anterior fusiform mediated the association between self-blame and intrusion symptoms across sexually assaulted participants. These findings link assault-related self-blame, disrupted postassault recovery and the neural circuitry involved in the processing of traumatic memories.
Background:
Early-life maltreatment has severe consequences for the affected individual, and it has an impact on the next generation. To improve understanding of the intergenerational effects of abuse, we investigated the consequences of early-life maltreatment on maternal sensitivity and associated brain mechanisms during mother-child interactions.
Methods:
In total, 47 mothers (22 with a history of physical and/or sexual childhood abuse and 25 without, all without current mental disorders) took part in a standardized real-life interaction with their 7- to 11-year-old child (not abused) and a subsequent functional imaging script-driven imagery task.
Results:
Mothers with early-life maltreatment were less sensitive in real-life mother-child interactions, but while imagining conflictual interactions with their child, they showed increased activation in regions of the salience and emotion-processing network, such as the amygdala, insula and hippocampus. This activation pattern was in contrast to that of mothers without early-life maltreatment, who showed higher activations in those regions in response to pleasant mother-child interactions. Mothers with early-life maltreatment also showed reduced functional connectivity between regions of the salience and the mentalizing networks.
Limitations:
Region-of-interest analyses, which were performed in addition to whole-brain analyses, were exploratory in nature, because they were not further controlled for multiple comparisons.
Conclusions:
Results suggest that for mothers with early-life maltreatment, conflictual interactions with their child may be more salient and behaviourally relevant than pleasant interactions, and that their salience network is poorly modulated by the brain regions involved in mentalizing processes. This activation pattern offers new insights into the mechanisms behind the intergenerational effects of maltreatment and into options for reducing these effects.
In the context of the Dutch welfare state, precarisation entails particular pedagogies: citizens are taught how to feel about being insecure through the techniques of (1) accepting; (2) controlling; and (3) imagining. Welfare activation thus focuses on teaching citizens to accept their precarious position, to embrace it and to prepare for its continuation while remaining optimistic about its discontinuation. Perhaps cruelly, then, the state teaches citizens to develop optimism towards certain imagined futures while at the same time acknowledging the unattainability of these futures. Importantly, case managers in Dutch welfare offices are often precarious themselves too, making the affective labour they perform both difficult and essential for themselves. Contemporary activation and workfare programmes are therefore best understood as characterised by insecurity and precarisation on both the receiving and the providing end of state–citizen encounters.
Mindfulness-based treatments for posttraumatic stress disorder (PTSD) have emerged as promising adjunctive or alternative intervention approaches. A scoping review of the literature on PTSD treatment studies, including approaches such as mindfulness-based stress reduction, mindfulness-based cognitive therapy and metta mindfulness, reveals low attrition with medium to large effect sizes. We review the convergence between neurobiological models of PTSD and neuroimaging findings in the mindfulness literature, where mindfulness interventions may target emotional under- and overmodulation, both of which are critical features of PTSD symptomatology. Recent emerging work indicates that mindfulness-based treatments may also be effective in restoring connectivity between large-scale brain networks among individuals with PTSD, including connectivity between the default mode network and the central executive and salience networks. Future directions, including further identification of the neurobiological mechanisms of mindfulness interventions in patients with PTSD and direct comparison of these interventions to first-line treatments for PTSD are discussed.
Qualitative researchers with a critical sociocultural orientation tend to approach their research as an ethical and political endeavor as well as an intellectual project. Working from the claim that knowledge and power go together, many deliberately mobilize their research to spotlight inequalities and to support social transformation as well as to produce “data.” Within psychology, much qualitative scholarship of this kind is interview or focus group-based and designed to yield a flow of information from participants to researcher. When our work pinpoints patterns of inequality that appear to participants to be freely chosen, deserved, or inevitable (or that escape their notice altogether), however, how else might we proceed? In this article, we introduce a dynamic sociocultural research methodology we developed to investigate but also, potentially, to diversify participants’ savoir regarding, feminism, sexism, and gendered inequalities. We begin by explaining the theoretical basis of the approach, detailing how it combines elements of Freirean praxis together with critical feminist and Foucauldian scholarship. From here, we describe how we translated the methodological framework into a two-part research project investigating gender, sexism, and feminism with young people, whereby problem-posing group workshops created a dynamic analytical and political context for the individual interviews that followed. We conclude with some reflections on the analytic and ethico-political potential of dynamic sociocultural research and some key considerations for researchers.
Drawing on in-depth interviews and group discussions, Mothering Babies in Domestic Violence sheds new light on the impact of domestic violence on mother/baby relationships by placing women’s experiences of that violence at its heart. It challenges the dominant attachment theory paradigm, offering an alternative understanding of how primary relationships between women and infants are formed in these situations. Mothering Babies in Domestic Violence reflects current policy and practice focus on early intervention and prevention, but its unique analysis of real-life experiences provides new multi-disciplinary approaches to helping women, children, and anyone raised in a setting of domestic violence.
While intimate partner violence (IPV) against women and violence against children (VAC) have emerged as distinct fields of research and programming, a growing number of studies demonstrate the extent to which these forms of violence overlap in the same households. However, existing knowledge of how and why such co-occurrence takes place is limited, particularly in the Global South. The current study aims to advance empirical and conceptual understanding of intersecting IPV and VAC within families in order to inform potential programming. We explore shared perceptions and experiences of IPV and VAC using qualitative data collected in December 2016 from adults and children in Kampala, Uganda (n = 106). We find that the patriarchal family structure creates an environment that normalizes many forms of violence, simultaneously infantilizing women and reinforcing their subordination (alongside children). Based on participant experiences, we identify four potential patterns that suggest how IPV and VAC not only co-occur, but more profoundly intersect within the family, triggering cycles of emotional and physical abuse: bystander trauma, negative role modeling, protection and further victimization, and displaced aggression. The discussion is situated within a feminist analysis, including careful consideration of maternal violence and an emphasis on the ways in which gender and power dynamics can coalesce and contribute to intra-family violence.
Guiding students step-by-step through the research process while simultaneously introducing a range of debates, challenges and tools that feminist scholars use, the second edition of this popular textbook provides a vital resource to those students and researchers approaching their studies from a feminist perspective. Interdisciplinary in its approach, the book covers everything from research design, analysis and presentation, to formulating research questions, data collection and publishing research. Offering the most comprehensive and practical guide to the subject available, the text is now also fully updated to take account of recent developments in the field, including participatory action research, new technologies and methods for working with big data and social media.
Doing Feminist Research is required reading for undergraduate and postgraduate courses taking a feminist approach to social science methodology, research design and methods. It is the ideal guide for all students and scholars carrying out feminist research, whether in the fields of international relations, political science, interdisciplinary international and global studies, development studies or gender and women's studies.
New to this Edition:
- New discussions of contemporary research methods, including participatory action research, survey research and technology, and methods for big data and social media.
- Updated to reflect recent developments in feminist and gender theory, with references to the latest research examples and new boxes considering recent shifts in the social and political sciences.
- Brand new boxed examples throughout covering topics including collaborations, femicide, negotiating changing research environments and the pros and cons of feminist participatory action research.
- The text is now written in the first (authors) and second (readers) person making the text clearer, more consistent and inclusive from the reader point of view.
We now have a new kind of psycho-politics; a brutal and destructive alliance between neoliberalism and an expanding psychiatric empire. This article will explore how mental health service users/survivors and other mental health campaigners can connect with the critical analysis and action embodied in the work and values of Peter Sedgwick at a time of crisis and reaction. They have seen ideas like ‘user involvement’ and ‘recovery’ co-opted and undermined, and both their experiences and aspirations individualised and devalued. Emerging interest in mad studies, it is suggested, offers a way forward that challenges both the marketisation and medicalisation of people’s distress. This discussion will explore the continuities and discontinuities with Peter Sedgwick’s pioneering work and highlight, as he did, the importance of making explicit the political and ideological relations of survivors’ struggles within and against the psychiatric system.
In the contemporary era we have seen a proliferation of storytelling activities, from the phenomenon of TED talks and Humans of New York to a plethora of story-coaching agencies and consultants. Curated Stories seeks to understand the rise of this storytelling culture alongside a broader shift to neoliberal free market economies. The book shows how in the turn to free market orders, stories have been reconfigured to promote liberal and neoliberal self-making and are restructured as easily digestible soundbites mobilized toward utilitarian ends. The reader is taken to several sites around the world where we can hear stories and observe varied contemporary modes of storytelling: the online Afghan Women’s Writing Project, the domestic workers movement and the undocumented student Dreamer movement in the United States, and the Misión Cultura storytelling project in Venezuela. Curated stories are often heartbreaking accounts of poverty and mistreatment that may move us deeply. But what do they move us to? What are the stakes, and for whom, in the crafting and mobilization of storytelling? A careful analysis of the conditions under which the stories are told, the tropes through which they are narrated, and the ways in which they are responded to shows how stories may actually work to disguise the deeper contexts of global inequality in which these marginal lives are situated. The book is also concerned with how we might reclaim storytelling as a craft that allows for the fullness and complexity of experience to be expressed in pursuit of transformative social change.
Elizabeth Reid (AO, FASSA, FAIIA) was the first adviser on women's affairs to any head of government in the world, appointed by Prime Minister Gough Whitlam in 1973. Drawing on her own life and writing, and those of other members of the Women's Liberation Movement and the Women's Electoral Lobby, Reid recreates the fire that burned in 1970s feminists. Weaving together connections between sexuality, justice, morality, and the cultural structures of sexism, Reid evokes women's experiences of personal disempowerment that fuelled their activism and political determination. In 1973 when the Prime Minister's office advertised for a Women's Adviser, feminists debated whether or not revolution could be made from within government. Reid recalls her work as Women's Adviser, and her leadership of the Australian delegation to the 1975 International Women's Year events in Mexico City. As the nation's most prominent feminist, Reid travelled around Australia and spoke to all kinds of women. She received more letters than any member of Cabinet other than the Prime Minister. In this significant retrospective, Reid summarises the achievements of the Whitlam Government in various areas, the constraints it faced, and more broadly the successes of the 1970s feminist movement and what we can learn from it now.
How do survivors of child abuse, bullying, chronic oppression and discrimination, and other developmental traumas adapt to such unimaginable situations? It is taken for granted that experiences such as hearing voices, altered states of consciousness, dissociative states, lack of trust, and intense emotions are inherently problematic. But what does the evidence actually show? And how much do we still need to learn?
Despite numerous studies that report the preponderance of domestic violence is perpetrated by men against women, other empirical studies suggest that rates of domestic violence by women and men are equivalent. This article explores these claims of gender symmetry in intimate partners' use of violence by reviewing the empirical foundations of the research and critiquing existing sources of data on domestic violence. The author suggests methods to reconcile the disparate data and encourages researchers and practitioners to acknowledge women's use of violence while understanding why it tends to be very different from violence by men toward their female partners.
A social work perspective of the nature of seclusion and restraint in Australia’s public mental health systems is presented. The article suggests a theme of seclusion and restraint as a regulatory mechanism despite evidence of harm and even death. The case that the use of seclusion and restraint constitutes a social justice issue as it can be understood as an abuse of human rights and form of torture is established. An incident of a person dying in an Australian mental health facility after being secluded is presented to substantiate this claim. An over focus on individual expressions of violence or risk can be at the expense of understanding the systemic and cultural nature of violence in mental health systems. It is important to understand the nature of, and perhaps to question the presumed necessity of, seclusion and restraint practices to ensure that social workers are not breaching their professional obligations to people who are mental health clients.
The recent article byWhite and Wastell (2016)poses important questions for the social work profession as we move to integrate scientific knowledge about epigenetics into our knowledge base, arguing that it is too soon to adopt this knowledge and posing ethical questions. In this reply, I take an approach that is more optimistic than that of White and Wastell, emphasising the reversibility of gene expression changes and the importance of social policy and interventions for addressing much of the damage caused by poverty, racism and violence. © The Author 2017. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.
Anti-oppressive practice (AOP) has been popularly adopted in the undergraduate and graduate levels as a dominant framework for theorising about oppression, the self and working towards change. It is conceptualised as the socially just framework to practise from when engaging racialised and marginalised populations. Using a post-structural Foucauldian analysis, I intend to examine the discursive effects of AOP as occupying a position of mastery. Specifically, the active process of - anti-ing' is a way of governing the self which becomes a form of currency when it is taken up as a dominant discourse. Looking at three tenets of AOP theory relating to identity, authenticity and resistance, I suggest that AOP can operate to re-inscribe a normalcy that relies on the construction of a moral subjectivity, effectively obscuring the types of work that are required to modify and regulate oneself when performing - anti-ing'.
Childhood emotional abuse (CEA) is the most common and psychologically harmful form of child abuse. While there has been attention to how gender discourses and power relations frame other forms of interpersonal violence and abuse, there has been no research into the gendered dimensions of CEA. This article reports on the findings from a qualitative interview study with men who have these backgrounds. The study was framed by a poststructural feminist understanding of gender, discourse, and power and R. W. Connell’s concept of hegemonic masculinity and social practices of gender. Narrative-discursive analysis revealed a powerful discourse about “becoming a better man” in spite of abuse through practices of hegemonic masculinity, particularly the control of emotion and prevailing over abusers. The article considers the positive and negative implications for abused men’s subjectivities as well as those for women and wider gender power relations. The article also considers gender-aware approaches for social workers and other professionals working with individuals who have these backgrounds.
This article examines the experience of motherhood among 14 women with mental health problems. The aim is to discuss the subjective meaning of being a mother with mental health problems through the perspective of structural factors such as discourses on motherhood and mental illness. The article shows how these mothers are caught in a bind between the discourses of mentally ill mothers as “deviant” and the current ideology of “intensive mothering.” The empirical material reveals two main, interwoven patterns of identity work: the struggle for normality, and how to handle a self-identity as a “dangerous” mother. The mothers understood the stress and difficulties they experienced as personal problems, resulting in self-blaming, feelings of loneliness, and a resistance towards expressing a need for help with parenting issues. The findings suggest that understanding these mothers’ ambivalence towards intervention as a kind of complex identity work—rather than as reluctance to receive help, or denial of their own problems—might be a way for professional helpers to build a confident relationship with mentally ill mothers.
Discourses of recovery and resilience have risen to positions of dominance in the mental health field. Models of recovery and resilience enjoy purchase, in both policy and practice, across a range of settings from self-described psychiatric survivors through to mental health charities through to statutory mental health service providers. Despite this ubiquity, there is confusion about what recovery means. In this article we problematize notions of recovery and resilience, and consider what, if anything, should be recovered from these concepts. We focus on three key issues, i) individualization, ii) the persistence of a deficit model, and iii) collective approaches to recovery. Through documentary analysis we consider these issues across third sector organizations, and public and mental health policy. Firstly, definitional debates about recovery reflect wider ideological debates about the nature of mental health. The vagueness of these concepts and implicit assumptions inherent in dominant recovery and resilience discourses render them problematic because they individualize what are social problems. Secondly, these discourses, despite being seen as inherently liberatory are conceptually dependent on a notion of deficit in that talk of “positives” and “strengths” requires the existence of “negatives” and “weaknesses” for these concepts to make sense. We argue that this does little to substantially transform dominant understandings of psychological distress. Thirdly, these issues combine to impact upon the progressive potential of recovery. It comes to be seen as an individualistic experiential narrative accompaniment to medical understandings where the structural causes of distress are obscured. This in turn impacts upon the potential for recovery to be used to explore more collective, political aspects of emotional distress. Drawing on the work of Fraser, we use this critique to characterize “recovery” as a “struggle for recognition,” founded on a model of identity politics which displaces and marginalizes the need for social, political and economic redistribution to address many of the underlying causes of emotional distress. We conclude by stating that it is only when the collective, structural experiences of inequality and injustice are explicitly linked to processes of emotional distress that recovery will be possible.
This article explores how girls' and young women's sexual behaviours have been and currently are constructed and responded to within social work. Contemporary views of childhood consider young people as sexually innocent and lacking (sexual) agency. Moreover, the experience of sexual abuse is believed to be traumatic and to result in long-term adverse life experiences. Such narratives can influence how social workers perceive and respond to abuse and indeed whether sexual activities involving young people are understood as abusive. Drawing on different but related Economic and Social Research Council (ESRC)-funded projects, the article introduces narratives of girls who were resident at the school where allegations against Jimmy Savile originate from. It then considers research looking at adult women's engagement with the childhood sexual abuse (CSA) recovery literature and draws links from this to the ways in which cases of sexual exploitation in UK towns such as Rotherham are responded to. Both examples challenge dominant understandings of CSA, raising questions of girls' agency, but also of how sexual experience might act to remove a responsibility to protect girls from abuse. We argue that there is merit in separating out wrongfulness from harm in how social workers respond to such issues. © 2016 The Author. Published by Oxford University Press on behalf of The British Association of Social Workers. All rights reserved.
This article seeks to contribute to current person-centred research exploring post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG), by offering a person-centred political critique of some individualizing/pathologizing ways in which these two discourses seem to be developing. Notions of lower resilience (Regel & Joseph, ), faulty brains (Bell, ), lower intelligence (Bomyea, Risbrough, & Lang, ), faulty femininity (Lilly, Pole, Best, Metzler, & Marmar, ) and personal deficits (Joseph, Murphy, & Regel, ) are identified. Some troubling parallels with the borderline personality disorder (BPD) discourse are drawn. Yet, while the meanings/implications of a BPD diagnosis increasingly attract stringent criticism, current PTSD and PTG research is not being sufficiently challenged from a political perspective. The article argues that person-centred approaches (PCAs) need to be more recognized as treatments for PTSD - this work is already underway (see Murphy, Archard, Regel, & Joseph, for instance) - and that, concurrently and then increasingly, practitioners of PCAs must intervene in the PTSD discourse, also challenging themselves to conceptualize what is now termed PTSD as actually just one incongruence amongst many, rather than a psychopathology encountered by some (deficient) people.
This article commences with a discussion about the need for social workers to challenge a biomedical conceptualisation of emotional distress (often called ‘mental illness’). It then critiques the increasing focus on the ‘mental health’ impacts of women’s experiences of gender-based violence. Although it is vital to acknowledge the immense distress caused by abuse and oppression, it is argued that a sole focus on women’s emotional worlds ultimately invites complacency relating to broader political questions about male privilege and gendered power relations. In contrast, a contextualised analysis of women’s distress allows social workers to participate in more expansive considerations of how aspects of the social world function to condone and perpetuate gender inequality. This broader view opens up practice opportunities that extend beyond treating ‘dysfunction’ and ‘symptoms’. Social workers who adopt a critical mental health lens are able to reconceptualise their work with women who have been labelled with psychiatric diagnoses in a range of creative ways. These include both micro activist practices, which occur at the level of meaning-making, as well as more explicit engagements in alternative community practices.
Women have been disproportionately affected by funding cuts to services following the 2008 global financial crisis. Using a feminist intersectional analysis of austerity measures applied to family violence (FV) services in Victoria, Australia, including 11 service provider interviews, we find that: the Australian government drew on global narratives of austerity in constructing a ‘budget crisis’, with subsequent cuts to funds addressing FV; budget cuts negatively impacted services’ abilities to address the needs of culturally and linguistically diverse (CALD) women; there is a lack of qualified interpreters and multilingual services, and; there are missed opportunities to engage and support young CALD people in FV services. Policy recommendations to support FV services and their abilities to help CALD women and young people are provided.
Posttraumatic and Acute Stress Disorder, Fifth Edition is a concise, up-to-date presentation of the latest scientific information and clinical challenges regarding posttraumatic stress disorder (PTSD) as well as acute reactions to stressful events. Written for non-PTSD specialists including practitioners in general psychiatry, primary care practitioners and graduate students, Post Traumatic & Acute Stress Disorder, Fifth Edition explicitly addresses diagnostic, including differential diagnostic, and assessment issues. This newest edition now includes current examples of PTSD in military personnel deployed to Iraq and Afghanistan.
In this article, I critically evaluate a characteristic tendency that is found across the various traditions of poststructuralism, both narrowly and more broadly defined. This is an increasing propensity to be preoccupied with ontological questions and seemingly at the expense of either a refinement of political concepts or a concrete analysis of forms of power and domination. I consider the reasons for this development and stress how this characteristic feature of poststructuralism appears to follow from the very fact of ontological pluralism. What we see in contemporary continental thought is a proliferation of different traditions, and each side seeks to defend their position in ontological terms. Following this, I advance the idea of a relative autonomy between ontology and politics, where the former does not determine the latter in any direct or straightforward fashion. I argue that we need to stress this relative autonomy to open a little space between ontology and politics, space where we can return poststructuralism to a more concrete engagement with ‘the political’.
Childhood emotional abuse (CEA) is the least researched but most common and psychologically harmful form of child abuse. While there is a robust body of feminist research into the gendered discourses framing child sexual abuse, domestic violence, and rape and sexual assault, there has been little feminist examination of CEA. This article reports on the findings from two interview studies with women who have backgrounds of CEA exploring how this form of abuse is constituted through gendered discourses, practices, and power relations. The studies were framed by McNay’s theoretical concept of situated intersubjectivity, which attends to both the discursive and material bases of gender oppression. Discourse analysis was used to examine the gender discourses and practices in women’s narratives of CEA. Based on the analysis of the interviews, CEA is theorized as a gender practice that is often concerned with imposing a traditional femininity on daughters, but it is also shown to encapsulate contradictions about contemporary femininities where rights to autonomy and independence sit in some tension with traditional expectations. The article adds to feminist theorization by considering how the gender discourses and practices constituting CEA and other forms of violence against women intertwine with structural gender power relations and considers the implications of these insights for social work practice.
This paper presents findings from an exploratory study with Master of Social Work (MSW) graduates in Canada to explore the extent to which their classroom and practicum learning addressed social justice and anti-oppressive practice. Thirty-five MSW graduates took part in a semi-structured online survey regarding the quality of social justice knowledge and practice skills in their field instruction and coursework. The survey also examined how graduates employ social justice in their current social work practice. The majority of the study sample reported favorable educational outcomes and embraced social justice goals in their current practice. Discourse analysis of written comments, however, identified a disconnect between social justice theory, field education, and the overall climate of the social work program. Despite an explicit endorsement of social justice values by the program and the profession, graduates reported limited opportunities to learn anti-oppressive practice or apply social justice theories in their field education. We argue that the ‘hidden curriculum’ in social work education reflects market pressures that privilege task-oriented goals while ‘mainstreaming’ social justice rhetoric. Skills to confront oppression with transformative change are viewed as abstract goals and thus less useful than clinical practice.