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The professional regulation of madness in nursing and social work
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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.
Debates around the benefits of flexible work arrangements for employee well-being are limited by a lack of empirical analyses on whether flexible working enables employees with work or family stressors to cope with their levels of stress. This study examines whether the availability and use of different flexible work arrangements are associated with lower allostatic load (an index of chronic stress-related biomarkers) in a large representative study of UK adults. Male and female employees who made use of reduced hours working arrangements had lower levels of allostatic load. Among women caring for two or more children aged under 15, there was a difference of almost one unit of the allostatic load index (an additional biomarker risk) between women who used reduced hours flexible work and those without such arrangements. Reduced hours flexible work arrangements could enable women who combine work and family roles to reduce their levels of chronic stress.
This article traces my endeavors to enlist research participants in my doctoral research. I interviewed both people who like me hold a ‘psychosis’ history, as well as their direct caregivers, who were most often family members. My research is embedded in an emancipatory episteme, and focuses on understanding the barriers to recovery in the psy-medico-legal landscape prevalent in India. During my participant recruitment process, I encountered ‘silence’ of diverse sorts and with this article I attempt to deconstruct that silence. At the individual level, I was met with silence by individuals and their caregivers who were reluctant to be interviewed due to various forms of stigma, paternalism, and their hesitancy to question psychiatric authority. At the organizational level, NGOs were largely unsupportive of my work because my research queries psychiatry and its motives, and this undermines the powers of dominant psychiatric discourses. Central to my argument is that as a ‘peer researcher,’ my position destabilizes common held truths about ex-patients. Thus, being an ‘insider’ researcher actually hindered my access to some potential participants because I was understood as an ‘exception’ who should not be engaged with. I end by exploring the asymmetrical power relations between researchers and those we research, and the potential that emancipatory approaches bring to mental health social change.
Aim
To synthesise and critically interpret literature of relevance to intervening in intergenerational transmission of relational trauma within parent‐infant relationships.
Background
Intergenerational trauma is a discrete process and form of psychological trauma transmitted within families and communities. Intergenerational trauma can be transmitted through attachment relationships where the parent has experienced relational trauma and have significant impacts upon individuals across the lifespan, including predisposition to further trauma.
Design
Critical Interpretive Synthesis (CIS) was used. CIS is an inductive qualitative process that generates new theory grounded within reviewed literature
Methods
The review commenced by systematically searching for literature on interventions for intergenerational trauma. As the core theoretical construct emerged, elements that may contribute to preventing intergenerational trauma were identified iteratively and influenced further searching. In the final synthesis, 77 articles were included from the fields of intergenerational trauma, trauma interventions and attachment interventions. The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses checklist.
Results
The key construct is that prevention of intergenerational trauma transmission is the key intervention. The two contributing constructs were identified as ‘resolving parental trauma’ and ‘actively supporting parent‐infant attachment’.
Conclusions
Prevention is the most effective intervention approach for intergenerational transmission of trauma. Prevention requires trauma‐specific interventions with adults and attachment‐focused interventions within families. Preventative strategies need to target individual, relationship, familial, community and societal levels, as addressing and preventing trauma requires a multipronged, multisystemic approach.
Relevance to clinical practice
Systematic trauma‐informed attachment‐focused interventions in health and social service settings are recommended. There are opportunities to provide multi‐focal individual and relational interventions within existing services that work with parents to help prevent the likelihood and impact of transmission of intergenerational relational trauma within families. Nurses are well‐placed to provide preventative interventions in mental health, early childhood and primary health settings.
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Advocacy for people using health and social care services is widely promoted but its theoretical foundation is under-developed and its impact poorly conceptualised. This paper explores the liberatory potential of independent advocacy, using Fricker's concept of ‘epistemic injustice’ as a framework. People experiencing mental distress are particularly vulnerable to epistemic injustices as a consequence of deeply embedded social stigma resulting in a priori assumptions of irrationality and unreliability such that their knowledge is often discounted or downgraded. The mental health service user/survivor movement is at the forefront of validating personal experience and narrative to secure a different ontological and epistemological basis for mental distress. A foundational strand of this is advocacy to enable people to give voice to their experience. The case of independent mental health advocacy (IMHA) services under mental health legislation in England, provides an opportunity to critically examine whether advocacy can promote epistemic justice as a result of the legally sanctioned encounter between clinical assessment and subjective experience, pivoting on judgements about risk. This paper draws on empirical data from a national evaluation of IMHA services, which included 90 individual interviews with people subject to detention and three focus groups with mental health service users. Fricker's concept of epistemic injustice is used as a lens to investigate how this type of advocacy might mitigate forms of epistemic injustice, and thereby promote greater social justice in mental health. The concept of epistemic injustice provides a valuable theoretical basis for understanding the worth of advocacy in addressing testimonial injustice as well as its relative weakness in overcoming hermeneutical injustice. The challenge of independent advocacy to the dominant discourse within mental health is considered and questions raised about the place of advocacy in modern democratic mental health systems.
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.
An exploration of the relationship between madness, distress and disability, bringing together leading scholars and activists from Europe, North America, Australia and India.
This book examines for the first time the exclusionary nature of prevailing political ideologies. Bringing together theory, practice and the relationship between participation, political ideology and social welfare, it offers a detailed critique of how the crucial move to more participatory approaches may be achieved.
Amidst renewed interest in the psychiatric writings of Frantz Fanon, this article reads his work against the background of contemporary mental health advocacy and scholarship. Epitomized in the emergent field of Mad Studies, whose origins lie in anti-psychiatry and psychiatric user/survivor movements, this body of scholarship espouses a discourse of madness as identity and culture. While Fanon continues to be disassociated from or (occasionally) associated with anti-psychiatry, this article elaborates elements in his work that animate such ambiguity. It proposes that Fanon and Mad studies be put in a relation of mutual critique.
This article addresses whether autonomy is being adequately protected within therapeutic jurisprudence models. It first outlines the history and theory of therapeutic jurisprudence - noting that protection for autonomy has been theorised as a key component of therapeutic jurisprudence. It then examines therapeutic jurisprudence in light of critical disability theory and identifies that traditional therapeutic models, which often prioritises the decision-making of professionals, can undermine the autonomy of the individual. The article then describes the protection for autonomy provided by the right to legal capacity in Article 12 of the Convention on the Rights of Persons with Disabilities. An analysis is undertaken of practical examples of where therapeutic jurisprudence falls short of the demands of Article 12. Finally, the article presents solutions for how therapeutic jurisprudence models could better protect autonomy via respect for the right to legal capacity in Article 12.
The focus of this study is the WHO's mhGAP‐Intervention Guide (mhGAP‐IG) 2.0 (2016), an evidence‐based tool and guideline to help detect, diagnose and manage the most common mental disorders, designed for use by non‐specialists globally but particularly in low‐ and middle‐income countries. This research is a starting point in tracing the multiple ‘doings’ of mhGAP‐IG – connecting questions of how it is ‘done’ and what does it ‘do’ – to the living histories and wider global mental health assemblages that make the tool possible and shape its global circulation. We examine the conditions of possibility that produce and legitimate mhGAP‐IG, and the ways these are ‘black boxed’ through casting mhGAP‐IG in technical rather than epistemological terms. The study illuminates how its explicit design for global expansion positions mhGAP‐IG as open to questioning from those who are technical ‘insiders’ and setting the epistemological parameters of its own critique. It analyses mhGAP‐IG as an ‘inscription device’ that inscribes and materialises algorithmic imaginaries of mental health that impact on design and local implementation. This study is one attempt at initiating dialogue with the WHO from perspectives and methodological approaches not usually included in the conversation.
Medical discourse currently dominates as the defining framework for madness in educational praxis. Consequently, ideas rooted in a mental health/illness binary abound in higher learning, as both curriculum content and through institutional procedures that reinforce structures of normalcy. While madness, then, is included in university spaces, this inclusion proceeds in ways that continue to pathologize madness and disenfranchise mad people. This paper offers Mad Studies as an alternative entry point for engaging with madness in higher education, arguing that centring madness in pedagogical praxis has the potential to interrupt hegemonic ways of knowing, being, and learning. We illustrate how this disruption is facilitated by examining particular aspects of pedagogical praxis mobilized in Mad Studies, including building curriculum alongside mad community, centring madness in course design and student assessment, and the practice of mad positivity. Ultimately, this approach provides a metacurriculum of unlearning, challenging students to consider how their engagement with madness in the classroom, and beyond, has the potential to disrupt sanist systems of oppression and the normalcy they reconstitute.
In October 2018, the UK government, positioning itself as a global leader in mental health, hosted a Global Ministerial Mental Health Summit. The event was scheduled to coincide with the publication of the Lancet Commission on Global Mental Health and Sustainable Development. Despite claiming a public health and social determinants approach, the report focused on the importance of ‘closing the treatment gap’ through the use of Western diagnostic tools and interventions. In response, coalitions of mental health activists and service-users organized open letters detailing their concerns with the summit and report. Among these concerns were the ways in which recent UK government policies, particularly welfare reform, violated the rights of persons with disabilities; the lack of stakeholder representation and involvement in the report; and the continuation of the colonial legacy in which the ‘North drives the South.’ Expanding on the concerns raised by this coalition of activists and service-users, we argue that a focus on societal (structural) determinants and political economy could open new possibilities for global mental health beyond narrow individualized interventions. Additionally, we suggest that a politically informed societal determinants of health framework is needed in order to move the Global Mental Health Movement in a more emancipatory direction.
This chapter is devoted to an understanding of how the confluence of violence within the different punishing regimes of Western biomedical psychiatrically dominated structures are sustained through policy and law to imprison difference, while simultaneously (re) creating ideas of whiteness, the pristine, the innocent, and the deserving. Specifically, through an examination of the Faster Removal of Foreign Criminals Act, the Not Criminally Responsible Reform Act, and the Antiterrorism Act in Canada and their corresponding amendments to existing legislation, this chapter interrogates the deployment of racial and eugenic ideas for their replication of dehumanizing colonial discursive and rhetorical violence in everyday use, the institutionalization of violence within contemporary law, and the currently violent direct human consequences of these historically violent practices that ensure imprisonment of particular minds and bodies
This book interrogates normative conceptions of Indigenous self-determination and the structures of Indigenous self-government institutions, arguing that Indigenous self-determination is not achievable without restructuring all relations of domination beyond that with the state; nor can it be secured in the absence of gender justice. It demonstrates that the current rights discourse and focus on Indigenous–state relations is limited in scope and fails to convey the full meaning of self-determination for Indigenous peoples. Besides settler colonialism and neoliberal capitalism, relations of domination include racism, sexism, homophobia, misogyny, and gender violence, including violence against women, queer, trans and gender-nonconforming persons, and structural violence. Drawing on extensive participant interviews in Canada, Greenland, and Scandinavia, this book theorizes Indigenous self-determination as a foundational value, informed by the norm of integrity. This norm has two interrelated dimensions: bodily integrity and integrity of the land, both of which are a sine qua non for Indigenous gender justice. Conceptualizing self-determination as a foundational value seeks to restructure all relations of domination, including the hierarchical relation between self-determination and gender created and maintained by international law, Indigenous political discourse, and Indigenous institutions. The book argues that the persistent separation of issues between self-determination/self-government and gender/social is a major obstacle in implementing, realizing, and exercising Indigenous self-determination. Restructuring relations of domination further entails examining the gender regimes present in existing Indigenous self-government institutions, interrogating the relationship between Indigenous self-determination and gender violence, and considering future visions of Indigenous self-determination, including rematriation of Indigenous governance and an independent statehood.
Mental health law provides for the involuntary detention and psychiatric treatment of persons with severe mental impairment. While it has always been controversial, since the entry into force of the Convention on the Rights of Persons with Disabilities (CRPD), certain scholars, disability and human rights advocates and international human rights bodies have called for the abolition of mental health law on the grounds that it is discriminatory and is an unnecessary interference with individual liberty and bodily integrity. A number of alternative approaches that use the provision of decision-making support to decrease coercion and increase the recognition of the subjective 'will' and 'preferences' of persons with mental impairment have also emerged. However, throughout the debate on the future of mental health law, the right to life has received little attention. This article explores the contours of the right to life contained in Article 10 of the CRPD in the context of the debate surrounding the future of mental health law with a focus on the challenges of suicide and avoidable accidental death.
This article is about teaching the first university credit course devoted to Mad People's History. The focus is on situating the course within the academy and community, curriculum development and pedagogical controversies.
This article argues that Canadian law plays a central role in creating and ameliorating conditions of disaster vulnerability. Using the circumstances surrounding the 2016 Fort McMurray wildfire for context, the article identifies and assesses the shared, structural features of Canada’s emergency management laws and their application to “natural” disasters. This article argues that these laws lag behind foundational social science research on disasters. It argues that Canadian emergency management laws fail to incorporate a multi-faceted vulnerability perspective, which leaves communities unnecessarily susceptible to disaster harm. This article offers some preliminary suggestions on how Canadian disaster law can begin to integrate a vulnerability perspective to rectify existing gaps and flaws at all stages of the disaster cycle.
This article calls for literary studies and the humanities to critically engage with the emerging subfield of Mad Studies. Developing alongside anti-psychiatry activism and Disability Studies, Mad Studies critiques how mentally and emotionally disabled individuals evidence the breadth of state violence and discrimination. After tracing a genealogy of Mad Studies, the article offers a model of a Mad literary studies approach by analyzing Shadrack from Toni Morrison's Sula (1973) as a complex figure which resists flattened readings of Black madness. The novel's scholarly history, while rich in Disability Studies readings, makes evident persistent societal neglect of distressed characters—especially distressed characters of color—as peripheral or symbolic. This article pulls from critical race theory, Disability Studies, and trauma studies to form an intersectional inquiry into the material and lived conditions of mad individuals of color. In so doing, the article demonstrates the significant possibilities of this developing interdisciplinary methodology.
This paper mobilizes transdisciplinary inquiry to explore and deconstruct the often-used comparison of racialized/colonized people, intellectually disabled people and mad people as being like children. To be childlike is a metaphor that is used to denigrate, to classify as irrational and incompetent, to dismiss as not being knowledge holders, to justify governance and action on others’ behalf, to deem as being animistic, as undeveloped, underdeveloped or wrongly developed, and, hence, to subjugate. We explore the political work done by the metaphorical appeal to childhood, and particularly the centrality of the metaphor of childhood to legitimizing colonialism and white supremacy. The article attends to the ways in which this metaphor contributes to the shaping of the material and discursive realities of racialized and colonized others, as well as those who have been psychiatrized and deemed “intellectually disabled”. Further, we explore specific metaphors of child-colony, and child-mad-“crip”. We then detail the developmental logic underlying the historical and continued use of the metaphorics of childhood, and explore how this makes possible an infantilization of colonized peoples and the global South more widely. The material and discursive impact of this metaphor on children’s lives, and particularly children who are racialized, colonized, and/or deemed mad or “crip”, is then considered. We argue that complex adult-child relations, sane-mad relations and Western-majority world relations within global psychiatry, are situated firmly within pejorative notions of what it means to be childlike, and reproduce multi-systemic forms of oppression that, ostensibly in their “best interests”, govern children and all those deemed childlike.
This book explores the dramatic evolution of a feminist movement that mobilised to challenge a women’s prison system in crisis. Through in-depth historical research conducted in the Australian state of Victoria that spans the 1980s and 1990s, the authors uncover how incarcerated women have worked productively with feminist activists and community coalitions to expose, critique and resist the conditions and harms of their confinement. Resisting Carceral Violence tells the story of how activists, through a combination of creative direct actions, reformist lobbying and legal challenges, forged an anti-carceral feminist movement that traversed the prison walls. This powerful history provides vital lessons for service providers, social justice advocates and campaigners, academics and students concerned with the violence of incarceration. It calls for a willingness to look beyond the prison and instead embrace creative solutions to broader structural inequalities and social harm.
Peter Beresford comments on the Global Summit on Mental Health, hosted by the UK government, which gave rise to the open letters of concern regarding the event
In The End of the Cognitive Empire Boaventura de Sousa Santos further develops his concept of the "epistemologies of the South," in which he outlines a theoretical, methodological, and pedagogical framework for challenging the dominance of Eurocentric thought. As a collection of knowledges born of and anchored in the experiences of marginalized peoples who actively resist capitalism, colonialism, and patriarchy, epistemologies of the South represent those forms of knowledge that are generally discredited, erased, and ignored by dominant cultures of the global North. Noting the declining efficacy of established social and political solutions to combat inequality and discrimination, Santos suggests that global justice can only come about through an epistemological shift that guarantees cognitive justice. Such a shift would create new, alternative strategies for political mobilization and activism and give oppressed social groups the means through which to represent the world as their own and in their own terms.
This chapter focuses on Chinese mental health service users in the UK and aims to illustrate how structural inequalities shape their recovery journeys. It starts with a discussion of the Recovery Approach with which the research critically engaged. It then introduces the diversity within the Chinese community in the UK. It selects two stories from the research to shed light on how, for UK Chinese people, inequalities such as class, gender, and ethnicity intersect at national and transnational levels, and impact on the way recovery journeys unfold. Such inequalities contribute to their distress and ill-health in the first place and could hinder their recovery. The implications for community development work with Chinese communities are then discussed.