The biomedical approach to refugee mental health, with its focus on the refugee as actual or pote... more The biomedical approach to refugee mental health, with its focus on the refugee as actual or potential victim of pathology, is increasingly being contested. In an era when refugees are either spoken about or spoken for, the medical discourse is seen as being complicit in configuring the refugee as ‘other’. In response, literature has emerged that focuses on the ‘social suffering’ of refugees, paying heed to the displaced person as a textured human being whose emotional pain is made sense of in the context of collective and individual relationships and biographies. Through this study, we contribute to the field by exploring the narratives of 20 Bosnian refugees living in Western Australia. We focus on their descriptions of distress, emerging from experiences of exile. The narratives depict suffering not as a discrete pathological entity, but rather as an experience of radical discordance. We suggest that these narratives provide an alternative voice, which challenges the configurations of refugee, time and place existing in nationalist and medical discourses. Furthermore, we argue that through narrative, the refugees in this study have been able to actively contest prevailing discourses by repositioning themselves as agents and the supposedly benevolent ‘receiving society’ as the source of suffering.
This article explores expositions of subjectivity in accounts of postnatal depression (PND). It e... more This article explores expositions of subjectivity in accounts of postnatal depression (PND). It examines the public narratives of 19 Australian women contributing to a health information website (healthtalkaustralia.org), collected across two Australian qualitative research studies conducted between 2011 and 2014. For the first part of the paper we analysed narrative data using a combination of phenomenological and psychoanalytic techniques. We found that postnatal distress was described in embodied, relational terms and that women depicted their distress as a pre-verbal intrusion into ‘known’ selves. We interpreted this intrusion as a doubly relational phenomenon - informed at once by a woman’s encounter with her infant and her ‘body memory’ of earlier relational experiences. For the second part we examined how and why women classified this relational distress as PND. We drew on illness narrative literature and recent work on narrative identity to explore why women would want to ‘narrate PND’ – an apparently antithetical act in an environment where there is a duty to be a good (healthy) mother. We highlight the dual purpose of the public PND narration – as a means of re-establishing a socially sanctioned known self and as a relational act prompted by the heightened relationality of early maternity. Our focus on the salutary aspects of narrating PND, and its links to relational maternal subjectivities, offers a novel contribution to the current literature and a timely analysis of a largely uninterrogated sociocultural phenomenon.
Supported decision-making has become popular among policymakers and mental health advocates as a ... more Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed 'entangled' relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus less agency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.
In this paper we consider the intersections of early maternal distress and clinical care praxis, ... more In this paper we consider the intersections of early maternal distress and clinical care praxis, drawing on interviews with Australian women. We critically consider the notion of 'care barriers'; a popular rhetorical practice and emergent logic in clinical contexts for explaining why 'not enough' women seek out clinical care. As an alternative to the logic of 'barriers' we propose a series of problematics regarding 'care entanglements' and 'haunted care', offering novel ways of conceptualizing the often conflicted character of formalized care relations. We argue that clinical encounters are 'haunted' by women's biographies, circulating discourses, and the relational clinical moment, which accounts for why women reject formalized care. We contend that many women have already 'slipped through' to the clinic, whether this be in their adoption of medical language to describe their distress, or in their enactments in designated clinical spaces. Finally, we reflect on researching/encountering/co-creating the maternal, care and distress.
The biomedical approach to refugee mental health, with its focus on the refugee as actual or pote... more The biomedical approach to refugee mental health, with its focus on the refugee as actual or potential victim of pathology, is increasingly being contested. In an era when refugees are either spoken about or spoken for, the medical discourse is seen as being complicit in configuring the refugee as ‘other’. In response, literature has emerged that focuses on the ‘social suffering’ of refugees, paying heed to the displaced person as a textured human being whose emotional pain is made sense of in the context of collective and individual relationships and biographies. Through this study, we contribute to the field by exploring the narratives of 20 Bosnian refugees living in Western Australia. We focus on their descriptions of distress, emerging from experiences of exile. The narratives depict suffering not as a discrete pathological entity, but rather as an experience of radical discordance. We suggest that these narratives provide an alternative voice, which challenges the configurations of refugee, time and place existing in nationalist and medical discourses. Furthermore, we argue that through narrative, the refugees in this study have been able to actively contest prevailing discourses by repositioning themselves as agents and the supposedly benevolent ‘receiving society’ as the source of suffering.
This article explores expositions of subjectivity in accounts of postnatal depression (PND). It e... more This article explores expositions of subjectivity in accounts of postnatal depression (PND). It examines the public narratives of 19 Australian women contributing to a health information website (healthtalkaustralia.org), collected across two Australian qualitative research studies conducted between 2011 and 2014. For the first part of the paper we analysed narrative data using a combination of phenomenological and psychoanalytic techniques. We found that postnatal distress was described in embodied, relational terms and that women depicted their distress as a pre-verbal intrusion into ‘known’ selves. We interpreted this intrusion as a doubly relational phenomenon - informed at once by a woman’s encounter with her infant and her ‘body memory’ of earlier relational experiences. For the second part we examined how and why women classified this relational distress as PND. We drew on illness narrative literature and recent work on narrative identity to explore why women would want to ‘narrate PND’ – an apparently antithetical act in an environment where there is a duty to be a good (healthy) mother. We highlight the dual purpose of the public PND narration – as a means of re-establishing a socially sanctioned known self and as a relational act prompted by the heightened relationality of early maternity. Our focus on the salutary aspects of narrating PND, and its links to relational maternal subjectivities, offers a novel contribution to the current literature and a timely analysis of a largely uninterrogated sociocultural phenomenon.
Supported decision-making has become popular among policymakers and mental health advocates as a ... more Supported decision-making has become popular among policymakers and mental health advocates as a means of reducing coercion in mental healthcare. Nevertheless, users of psychiatric services often seem equivocal about the value of supported decision-making initiatives. In this paper we explore why such initiatives might be rejected or ignored by the would-be beneficiaries, and we reflect on broader implications for care and coercion. We take a critical medical humanities approach, particularly through the lens of entanglement. We analyse the narratives of 29 people diagnosed with mental illness, and 29 self-identified carers speaking of their experiences of an Australian mental healthcare system and of their views of supported decision-making. As a scaffolding for our critique we consider two supported decision-making instruments in the 2014 Victorian Mental Health Act: the advance statement and the nominated person. These instruments presuppose that patients and carers endorse a particular set of relationships between the agentic self and illness, as well as between patient, carer and the healthcare system. Our participant narratives instead conveyed 'entangled' relations, which we explore in three sections. In the first we show how ideas about fault and illness often coexisted, which corresponded with shifting views on the need for more versus less agency for patients. In the second section, we illustrate how family carers struggled to embody the supported decision-making ideal of the independent yet altruistic nominated person, and in the final section we suggest that both care and coercion were narrated as existing across informal/formal care divisions. We conclude by reflecting on how these dynamic relations complicate supported decision-making projects, and prompt a rethink of how care and coercion unfold in contemporary mental healthcare.
In this paper we consider the intersections of early maternal distress and clinical care praxis, ... more In this paper we consider the intersections of early maternal distress and clinical care praxis, drawing on interviews with Australian women. We critically consider the notion of 'care barriers'; a popular rhetorical practice and emergent logic in clinical contexts for explaining why 'not enough' women seek out clinical care. As an alternative to the logic of 'barriers' we propose a series of problematics regarding 'care entanglements' and 'haunted care', offering novel ways of conceptualizing the often conflicted character of formalized care relations. We argue that clinical encounters are 'haunted' by women's biographies, circulating discourses, and the relational clinical moment, which accounts for why women reject formalized care. We contend that many women have already 'slipped through' to the clinic, whether this be in their adoption of medical language to describe their distress, or in their enactments in designated clinical spaces. Finally, we reflect on researching/encountering/co-creating the maternal, care and distress.
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