Attachment theory makes sense of two phenomena observed in some people with learning disabilities: it provides a reason for their limited exploration of the world, and it explains discontinuities in the pattern and intensity of their expressions of anger. Applying this framework to three enmeshed relationships occurring between an adult with learning disabilities and a member of care staff achieved at least partial resolution of their problems. Attachment theory's critics have set a number of challenges for its proponents, including emphasizing an interactional rather than a unidirectional approach to relationships; prioritizing social context; and understanding the attachment dynamic dimensionally rather than as a set of categories. The latter issue is pertinent for residential services: facilitating secure attachment relationships for distressed clients may be difficult for professionals, but partial assuagement of their attachment needs is a realistic clinical goal.
Mourning exists at the nexus between individual experience, professional discourses, research, and culture, making it a complex issue for health services that has shown vibrant change in recent years. By contrast, bereavement discourse in intellectual disability is suffused by dogmatic assertions about correct intervention: we describe four vignettes to illustrate bereavement issues in intellectual disability. Suggestions concerning issues and management are made, but the article focuses primarily on the conceptual issues that underpin clinical intervention. The analysis shows how challenges to the meaning of the disabled life, and to the understandings carers and staff draw on, tend to be resisted. We hypothesize this is most likely to surround issues that evoke cultural uncertainty, such as bereavement. The thesis is that the field of intellectual disability tends to be isolationist because meaning is difficult to create and easily dissolved, especially when addressing culturally contested topics. Dialogue with other disciplines is necessary to stop the field from atrophying, but needs to be carried out in ways that enable carers and clinicians to continue providing the support that people with intellectual disability require.
This paper argues that we are at a point of change in ID services, that new ideas and different frames of reference are required to take services forward in the 21st century. We describe how contemporary thinking in architecture, philosophy and organisational theory can assist in generating service principles for specialist services that allow us to better address the continuing isolation that is the experience of many people with ID, and the moral judgements that can limit service possibilities. We do not seek to offer a rigid blueprint for any particular service but one that allows for agency from its participants and relationships between them.
Neoliberalism is a transatlantic free market ideology based on individual liberty and limited government, developed by Hayek and von Mises. In its third wave (1980–2008), commitment to deregulation, privatization, and individual freedom moved beyond the economy into politics and culture. The citizen was recast as a consumer, and public servants became required to satisfy consumer choice. This addressed 1970s social turmoil and improved economies, but the increased wealth went to elites while resources declined for the poor. Hayek had argued for social welfare safety nets initially, but these were rejected by peers in the Mont Pelerin Society. Business-funded transatlantic think tanks promulgated the neoliberal tenets that markets are wiser than any government and state interference makes things worse. Yet, despite these rhetorical claims, neoliberalism has actually been imposed, driven, and underwritten by governments that claim their policy is nonintervention. Neoliberalism soon influenced the political economies of most countries in the developed world, but the degree of separation engendered between rich and poor is a political choice: most extreme in the United States, with the United Kingdom a close second. Establishing neoliberal values like autonomy and choice as taken for granted occurred by “hollowing out” organizations and communities in ways that block dissent and drastically narrow the scope for debate. Psychology is both an academic and applied discipline, with applied psychologists significantly outnumbering academics throughout the 20th century. Expansion was particularly marked during third-wave neoliberalism (1980–2008) in the United Kingdom, when the British Psychological Society grew more than fivefold to over 40,000 members. Two special editions of journals in 2018 and 2019 raised concerns about the relationship between psychology and neoliberalism. In sum, they argued that applied psychology’s self-presentation as a discipline that can solve the problems experienced by individuals glosses over the social origin of most human difficulties, and that modern psychology’s alienated and individualist epistemology makes it a potent neoliberal institution rather than a discipline that can generate alternatives.
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