Who and What Does Involvement Involve? A Multi-Sited Field Study of Involvement of Relatives in Danish Psychiatry

Abstract

This article gives an account of aspects of a multi-sited field study of involvement of relatives in Danish psychiatry. By following metaphors of involvement across three sites of the psychiatric system-a family site, a clinical site and a policy site-the first author (J.O.) investigated how, and on what grounds, involvement of relatives is perceived in Danish psychiatry. Paradoxically, the current understanding of involvement of relatives fails to take into consideration the perspectives of the relatives per se and families that were being studied. By analyzing involvement from a discourse theoretical perspective laid out by Ernesto Laclau and Chantal Mouffe, the aim of this study is to show how the dominant discourse about involvement at the political and clinical sites is constituted by understandings of mentally ill individuals and by political objectives of involvement. The analysis elucidates how a psycho-ideological discourse positions the mentally ill person as weak, incapable, and ineffective. By contrast, the supporting relative is positioned as a strong, capable, and effective co-therapist. Furthermore, the analysis considers how this dominant discourse of involvement is constituted by a broader discourse of neoliberalism and market orientation, which justifies involvement as a subtle institutionalization of social control. The article highlights that the role of the relative as a co-therapist may be contested by the families' discourse, which emphasizes issues concerning the responsibility toward the mental health of the ill individual as well as toward the psychological milieu of the family.

Recovery orientation in mental health inpatient settings: Inpatient experiences?

“…Some have argued that the mental health services’ adoption of personal recovery has merely formed a hybrid model of the concept that continues to favour more traditional notions of mental health treatment as focused primarily on medical symptom relief (Oute et al . ,b). Our results seem to justify this concern, given the important call for equal and respectful dialogue with health professionals, and the predominance of the medical paradigm, whether accepted by inpatients or not.…”

‘Men just drink more than women. Women have friends to talk to’—Gendered understandings of depression among healthcare professionals and their implications

“…This gendered analysis of depression is part of a larger anthropological field study conducted in a provincial area of Denmark between 2011 and 2013. By means of a constructivist fieldwork methodology called multisited ethnography (Marcus, ; Però, Shore, & Wright, ), the field researcher followed the social transformation of notions of involvement across a family site, a clinical site and a political site (Hansen, ; Oute, Petersen, & Huniche, ). At an early stage of the fieldwork in the clinical site, a dominant view of masculinity started to emerge.…”

“…Third, the binary gender stereotypes reflected in the narratives from the clinical site call for a more sophisticated analysis of relations and interactions between the plurality of other and perhaps more subordinate or even marginalized gendered subjectivities (Connell, 2012). As previously argued, such dynamics could have been articulated among, for example, younger nurses, male nurses, female doctors, male patients with depression and masculinized relatives in other settings even though such processes did not emerge clearly during the fieldwork in the clinical site (Hansen, 2016;Oute et al, 2015).…”

How patient participation is constructed in mental health care: a grounded theory study

“…In the literature, it is not clear what is meant by ‘patient participation’, and several discourses on patient participation exist simultaneously . Terms including ‘patient participation’, ‘mental health consumer’, ‘partnership’, ‘collaboration’, ‘user involvement’, ‘recovery’, ‘compliance’, ‘mental health services’, ‘person‐centred care’ and ‘shared decision‐making’ are used, in combination with terms such as ‘patients’, ‘citizens’, ‘clients’ and ‘service users’ .…”

“…In the literature, it is not clear what is meant by 'patient participation', and several discourses on patient participation exist simultaneously (6,12). Terms including 'patient participation', 'mental health consumer', Danish Health Policy uses a rhetoric in which the service user is to be activated and take responsibility for his or her health and treatment (11,26,27), but how does patient participation develop in social interaction processes where the health professionals are taking care of the service users' lives?…”