Background: In spite of a national strategy for reducing coercion in the mental health services,
The ethics of care and a dialogical approach are suggested as ethical frameworks for preventing fear, danger and aggression in psychiatric wards. Both frameworks can be understood as patient-driven, including the relational and contextual perspectives. It means a shift from professionally driven processes to patient-driven dialogue.
Patients and staff have different perceptions of involuntary commitment. Based on the patients' points of view, mental health care ought to be characterized by inclusion and recognition, treating patients as equal citizens comparable to guests in a hotel.
Abstract:This article is based upon ethnographic fieldwork in a Norwegian psychiatric unit practicing a psycho-educational treatment of young adults diagnosed with schizophrenia. An aim of the programis that patients learn to detect and monitor their 'symptoms' in order to obtain 'insight into their own illness', thus transforming themselves into self-governed and self-responsible subjects who are able to cope with life outside institutions. The program is constituted within a medical framework with strong emphasis on medicine-compliance. I explore the dynamics of power relations inherent in the program, referring to Foucault's descriptions of discipline and normalisation through pedagogy and examinations. His concepts of governmentality and self-technologies have proved useful as a frame for a critical evaluation of such programs.However, subjectivities cannot be read off directly from educational technology, and my data from everyday, mundane settings in the institution reveal paradoxes and contradictions which are accounted for in this study.
The dominating paradigm in Western psychiatry is grounded in biomedical thinking, and biological explanations appear to increasingly take the lead. There has been a shift from a psychological approach to the treatment of such experiences to a biomedical framework, with medication and medicine compliance at its core. Patients diagnosed with schizophrenia often tell about extraordinary experiences, such as encounters with UFOs and angels. Drawing upon data collected during 8 months of fieldwork in a Norwegian psychiatric rehabilitation clinic, we explore the translation, transformation and transition of such experiences into psychiatric terminology based upon biomedical knowledge and understanding. We approach these issues with extended reference to a particular patient’s experiences, which appeared to represent a fairly typical scenario at this Norwegian and other treatment units. We take a close view into how a patient in a psychiatric rehabilitation unit explains and interprets his extraordinary experiences, how he perceives the manner in which his experiences are confronted by professionals within the psychiatric field of knowledge, and how these phenomena are explained and handled by professionals. The article closes with some indications of potential consequences of employing a different approach to extraordinary experiences.
This article aims at giving insight into Norwegian mental health service by exploring the ideologies of two diametrical philosophers, the American Robert Nozick (1938–2002) and the German Axel Honneth (1949‐). Nozick proposes as an ideal a minimal state in which citizens have a “negative right” to the absence of interference and to follow their own interests without restriction from the state. On the other side, Axel Honneth claims that there is no freedom without state interference. In his view, governmental involvement is understood as a prerequisite for personal freedom. We may call this state an opposite of the minimal state; a maximal state. To get a better understanding of these opposite philosophies, we use texts written from conversations with people suffering from mental health problems, nurses and other caregivers in four Norwegian municipalities. Nozick's notion of the minimal state and Honneth's political philosophy of freedom and recognition were used as analytical tools. Among patients and helpers, there were different opinions about good care and how much caregivers should intervene. Some emphasized autonomy, independency, minimal involvement in human contact by nurses and other caregivers, similar a minimal state. Others perceived good care as bonding between helpers and service‐users. They underlined equal and personal relationships, as well as helping with practicalities, similar a maximal state. In the discussion, we focus on how people with chronic illnesses are supposed to transform themselves into self‐cared individuals, able to manage their own condition successfully with minimal help from public welfare and at a lower cost. Finally, we express concerns about who will care for disempowered patients without family and other resources in a minimal state.
I denne artikkelen som baserer seg et på et åtte måneders feltarbeid i en psykiatrisk rehabiliteringsavdeling, retter jeg et kritisk søkelys på anvendelse av sykepleiediagnoser i psykisk helsearbeid. Jeg tar utgangspunkt i det amerikanske sykepleiediagnostiske klassifikasjonssystemet NANDA-NOC-NIC og vurderer relevansen av slike systemer på bakgrunn av erfaringer fra mitt feltarbeid. Jeg fant at såkalte tegn på psykisk lidelse ikke var statiske størrelser, men endret seg gjennom relasjoner, kontekst, tid og laering. Mine observasjoner tyder på at sykepleiediagnoser ikke egner seg i psykisk helsearbeid, fordi de ikke forholder seg til at mennesker forandrer seg. Klassifikasjonene slås fast som uforanderlige fakta, de problematiseres ikke og innbyr ikke til dialog eller utforsking av ulike perspektiver. De fanger ikke opp det komplekse og dynamiske mangfoldet av menneskelige følelser, tanker og atferd som jeg erfarte i mitt forskningsarbeid. InnledningUtvikling av sykepleiediagnoser i psykisk helsearbeid skjøt for alvor fart i Norge på begynnelsen av 2000-tallet. Dette må sees på bakgrunn av en generell internasjonal utvikling innenfor
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