Historically, nature has been considered central to healing and recovery in institutional mental ... more Historically, nature has been considered central to healing and recovery in institutional mental health settings, with inpatient spaces designed to mirror the restorative forces nature may afford. Within contemporary healthcare architecture, the discourse surrounding nature's role has once again become prominent, especially in the concept of 'healing architecture'. While the literature on 'healing architecture' primarily considers how to connect recovery to nature through interventions in the built environment, less interest has been directed towards how nature is configured in design processes and what implications that has for the everyday experiences of patients and staff. In this paper we consider the design and implementation of one particular psychiatric hospital in Denmark to show that the 'nature' brought into this healthcare space can be experienced as anything but 'natural' and may reduce rather than enhance a felt sense of 'vitality' amongst patients. Based on our analysis, we end the paper by suggesting four principles for future healthcare design.
In this paper, we consider the changes to memorial practice for mental health service users, duri... more In this paper, we consider the changes to memorial practice for mental health service users, during the asylum period of the mid-19 th up to the end of the 20 th century and into the 21 st century. The closing of the large asylum in the UK has been largely welcomed by professionals and service-users alike, and yet, their closure has led to a decrease in continuous and consistent care for those with enduring mental health challenges. Furthermore, temporary and time-limited mental health services, largely dedicated to crisis management and risk reduction have failed to adequately account for, and help enable, memory practices outside the therapy room. Privatised memories are thus favoured over any collective memorial activity. Collective memories of difficult and traumatic life experiences, social and cultural barriers and forms of discrimination, which may be significant factors in the generation of mental health difficulties, are not given sufficient space among communities of service users. We argue that the communification of service user memories, especially in institutions containing large numbers of long stay patients, would benefit both staff and patients. The benefit would be in the development of awareness of how service users make sense of their past in relation to their present stay in hospital, how they might connect with others in similar positions and how they may connect with the world and others, upon future release. This seems to us central to a project of recovery and yet is rarely practiced in any mental health institution, despite being central to other forms of care provision, such as elderly and children's care services. We offer some suggestions on how collective and communification models of memory in mental health might assist in this project of recovery and create greater visibility between past, present and future imaginings; a project we believe will help, not hinder.
The sociocultural model of autobiographical memory focuses on the narrative or storied nature of ... more The sociocultural model of autobiographical memory focuses on the narrative or storied nature of autobiographical memories and the role of adult–child interactions in scaffolding these stories. Work in discursive psychology extends this interactional focus and demonstrates the action orientation of jointly constructed narratives. However, in this work, there is hitherto little differentiation made among types of autobiographical narratives. Memories of “difficult” or “painful” events, such as sexual violence, neglect, physical injury, and “traumatic” experiences, present particular challenges in terms of narrative organization, interaction, and agency. Speakers must demonstrate responsibility in how they recruit one another into such narratives. Where there is a power asymmetry, this can involve a collaborative “managed accessibility” for memories of particularly distressing details. This chapter provides a conceptual scheme for approaching “vital memories” of these sorts and discus...
In this paper, we consider changes to memorial practices for mental health service users during t... more In this paper, we consider changes to memorial practices for mental health service users during the asylum period of the mid-nineteenth up to the end of the twentieth century and into the twenty-first century. The closing of large asylums in the UK has been largely welcomed by professionals and service-users alike, but their closure has led to a decrease in continuous and consistent care for those with enduring mental health challenges. Temporary and time-limited mental health services, largely dedicated to crisis management and risk reduction have failed to enable memory practices outside the therapy room. This is an unusual case of privatised memories being favoured over collective memorial activity. We argue that the collectivisation of service user memories, especially in institutions containing large numbers of long-stay patients, would benefit both staff and patients. The benefit would be in the development of awareness of how service users make sense of their past in relation...
Medium secure forensic psychiatric units are unique environments within the broader “post asylum”... more Medium secure forensic psychiatric units are unique environments within the broader “post asylum” landscape of mental health services. Length of stay is much greater and restrictions on behavior, including sexual behavior, are legally and institutionally legitimated, due to concerns regarding risk. As a result, sexuality is rarely explored with service users and no official policies on sexual conduct and sexual safety have yet been developed, despite sexuality being linked to positive recovery outcomes. The aim of this study was to explore with service users how they experience and more specifically “feel” their sexuality during their time in secure care and in the community. A further aim was to understand how sexuality connected with their thoughts and feelings on recovery and relationships, and their perceived impact on mental health. We report on the findings from 29 service users participating in a qualitative-visual study, using drawing as a visual technique to provide an opportunity for expression of feeling. In this paper, the analytical focus is on how institutional practices can induce a “liminal hot-spot”, wherein an impasse between past crisis and future recovery is reached, taking theoretical direction from Stenner’s work on liminality and Fuch’s work on vitality. Specifically, we examine how service users experience liminality and the practices that emerge from such a state of living that can serve to objectify and suspend feelings of vitality. Finally, we discuss the implications of these findings for a recovery model and the development of policies on sexuality, sexual safety and relationality, within secure forensic settings.
Contemporary reformulations of the nature of “the psychological” call out for different approache... more Contemporary reformulations of the nature of “the psychological” call out for different approaches to autobiographical memory. If epistemic and methodological differences are set aside, debate can be focused on four key themes—function, accessibility, accuracy, and life story. What persons do with memory needs to be indexed to the interactional contexts where the past is invoked, where the accessibility of autobiographical memories is a collaborative accomplishment. While the accuracy of memory is nearly always at issue, the criterion and procedures through which it is established vary across practices, as do capacities to produce biographical coherency. An “expanded” or “modern” view of memory should seek to analyze brains, voices, objects, and settings together.
Environment and Planning D: Society and Space, 2021
Sitting between the psychiatric and criminal justice systems, and yet fully located in neither, f... more Sitting between the psychiatric and criminal justice systems, and yet fully located in neither, forensic psychiatric units are complex spaces. Both a therapeutic landscape and a carceral space, forensic services must try to balance the demands of therapy and security, or recovery and risk, within the confines of a strictly controlled institutional space. This article draws on qualitative material collected in a large forensic psychiatric unit in the UK, comprising 20 staff interviews and 20 photo production interviews with patients. We use John Law’s ‘modes of ordering’ to explore how the materials, relations and spaces are mobilised in everyday processes of living and working on the unit. We identify two ‘modes of ordering’: ‘keeping safe’, which we argue tends towards empty, stultified and static spaces; and ‘keep progressing’ which instead requires filling, enriching and ingraining spaces. We discuss ways in which tensions between these modes of ordering are resolved in the unit,...
The dynamics of memory are broadly distributed across relationships, institutions, material affor... more The dynamics of memory are broadly distributed across relationships, institutions, material affordances and, of course, discursive practices. The Chancellor's memory is an attempt to show how the subject matter parsed by cognitive psychology can be lifted wholesale into a discursive approach. Discursive Psychology has its roots in the Sociology of Scientific Knowledge, a discipline that was acutely aware of the vacuous nature of claims to systematicity, rigor, and most notoriously replication. Dave Middleton's early work shared a concern with the linguistic steering of children's activities, having been part of the group that refined the experimental demonstration of scaffolding in parent child interactions. These studies were critical to a move in developmental psychology of placing cognitive development in a sociocultural context. Edwards and Goodwin argue that lexical development in children is poorly grasped when it is treated in terms of gradual conceptual understan...
The relationship between place and remembering has been a longstanding matter of phenomenological... more The relationship between place and remembering has been a longstanding matter of phenomenological concern. The role of the ‘lived body’ in mediating acts of remembering in context is clearly crucial. In this paper we contribute to an ‘expanded view of memory’ by describing how remembering difficult or problematic events ― ‘vital memories’ ― draws upon inter-subjective and inter-objective relations. We discuss two conceptual tools that provide an analytic framework ― the concept of ‘life space’ drawn from Kurt Lewin (1936) and the idea of the ‘setting specificity’ of remembering. From this perspective we can see that the ‘lived body’ does not constitute a singular unity but rather a ‘plurality’ of potential bodies that have ‘operative solidarity’ (cf. Simondon, 2009) with the material relations in which they are constituted. Drawing on the work of Eduardo Viveiros de Castro, we argue that ‘body memories’ need to be analysed from within the embodied material-relational perspective whe...
How are relations of care and security between hospital staff and patients organized through soun... more How are relations of care and security between hospital staff and patients organized through sound? This article argues that a shifting distinction between meaningful sound and noise is fundamental to the lived experience of immersion in an organizational acoustic environment. Based around a qualitative study of listening practices and ‘ear-work’ at a medium-secure forensic psychiatric hospital, using interview and photo-production methods, the article positions the organizing of the sensory as central to formal organization. Analysis of empirical material demonstrates how the refinement of key listening practices is critical to the ways in which staff and patients orient to the hospital setting. It also details how the design process for the unit has undermined the capacity to manage and control through sound, or ‘panauralism’, rendering it as a reversible and contested struggle to make sense of the acoustic environment, and describes the attempts by patients to create alternative ...
Historically, nature has been considered central to healing and recovery in institutional mental ... more Historically, nature has been considered central to healing and recovery in institutional mental health settings, with inpatient spaces designed to mirror the restorative forces nature may afford. Within contemporary healthcare architecture, the discourse surrounding nature's role has once again become prominent, especially in the concept of 'healing architecture'. While the literature on 'healing architecture' primarily considers how to connect recovery to nature through interventions in the built environment, less interest has been directed towards how nature is configured in design processes and what implications that has for the everyday experiences of patients and staff. In this paper we consider the design and implementation of one particular psychiatric hospital in Denmark to show that the 'nature' brought into this healthcare space can be experienced as anything but 'natural' and may reduce rather than enhance a felt sense of 'vitality' amongst patients. Based on our analysis, we end the paper by suggesting four principles for future healthcare design.
In this paper, we consider the changes to memorial practice for mental health service users, duri... more In this paper, we consider the changes to memorial practice for mental health service users, during the asylum period of the mid-19 th up to the end of the 20 th century and into the 21 st century. The closing of the large asylum in the UK has been largely welcomed by professionals and service-users alike, and yet, their closure has led to a decrease in continuous and consistent care for those with enduring mental health challenges. Furthermore, temporary and time-limited mental health services, largely dedicated to crisis management and risk reduction have failed to adequately account for, and help enable, memory practices outside the therapy room. Privatised memories are thus favoured over any collective memorial activity. Collective memories of difficult and traumatic life experiences, social and cultural barriers and forms of discrimination, which may be significant factors in the generation of mental health difficulties, are not given sufficient space among communities of service users. We argue that the communification of service user memories, especially in institutions containing large numbers of long stay patients, would benefit both staff and patients. The benefit would be in the development of awareness of how service users make sense of their past in relation to their present stay in hospital, how they might connect with others in similar positions and how they may connect with the world and others, upon future release. This seems to us central to a project of recovery and yet is rarely practiced in any mental health institution, despite being central to other forms of care provision, such as elderly and children's care services. We offer some suggestions on how collective and communification models of memory in mental health might assist in this project of recovery and create greater visibility between past, present and future imaginings; a project we believe will help, not hinder.
The sociocultural model of autobiographical memory focuses on the narrative or storied nature of ... more The sociocultural model of autobiographical memory focuses on the narrative or storied nature of autobiographical memories and the role of adult–child interactions in scaffolding these stories. Work in discursive psychology extends this interactional focus and demonstrates the action orientation of jointly constructed narratives. However, in this work, there is hitherto little differentiation made among types of autobiographical narratives. Memories of “difficult” or “painful” events, such as sexual violence, neglect, physical injury, and “traumatic” experiences, present particular challenges in terms of narrative organization, interaction, and agency. Speakers must demonstrate responsibility in how they recruit one another into such narratives. Where there is a power asymmetry, this can involve a collaborative “managed accessibility” for memories of particularly distressing details. This chapter provides a conceptual scheme for approaching “vital memories” of these sorts and discus...
In this paper, we consider changes to memorial practices for mental health service users during t... more In this paper, we consider changes to memorial practices for mental health service users during the asylum period of the mid-nineteenth up to the end of the twentieth century and into the twenty-first century. The closing of large asylums in the UK has been largely welcomed by professionals and service-users alike, but their closure has led to a decrease in continuous and consistent care for those with enduring mental health challenges. Temporary and time-limited mental health services, largely dedicated to crisis management and risk reduction have failed to enable memory practices outside the therapy room. This is an unusual case of privatised memories being favoured over collective memorial activity. We argue that the collectivisation of service user memories, especially in institutions containing large numbers of long-stay patients, would benefit both staff and patients. The benefit would be in the development of awareness of how service users make sense of their past in relation...
Medium secure forensic psychiatric units are unique environments within the broader “post asylum”... more Medium secure forensic psychiatric units are unique environments within the broader “post asylum” landscape of mental health services. Length of stay is much greater and restrictions on behavior, including sexual behavior, are legally and institutionally legitimated, due to concerns regarding risk. As a result, sexuality is rarely explored with service users and no official policies on sexual conduct and sexual safety have yet been developed, despite sexuality being linked to positive recovery outcomes. The aim of this study was to explore with service users how they experience and more specifically “feel” their sexuality during their time in secure care and in the community. A further aim was to understand how sexuality connected with their thoughts and feelings on recovery and relationships, and their perceived impact on mental health. We report on the findings from 29 service users participating in a qualitative-visual study, using drawing as a visual technique to provide an opportunity for expression of feeling. In this paper, the analytical focus is on how institutional practices can induce a “liminal hot-spot”, wherein an impasse between past crisis and future recovery is reached, taking theoretical direction from Stenner’s work on liminality and Fuch’s work on vitality. Specifically, we examine how service users experience liminality and the practices that emerge from such a state of living that can serve to objectify and suspend feelings of vitality. Finally, we discuss the implications of these findings for a recovery model and the development of policies on sexuality, sexual safety and relationality, within secure forensic settings.
Contemporary reformulations of the nature of “the psychological” call out for different approache... more Contemporary reformulations of the nature of “the psychological” call out for different approaches to autobiographical memory. If epistemic and methodological differences are set aside, debate can be focused on four key themes—function, accessibility, accuracy, and life story. What persons do with memory needs to be indexed to the interactional contexts where the past is invoked, where the accessibility of autobiographical memories is a collaborative accomplishment. While the accuracy of memory is nearly always at issue, the criterion and procedures through which it is established vary across practices, as do capacities to produce biographical coherency. An “expanded” or “modern” view of memory should seek to analyze brains, voices, objects, and settings together.
Environment and Planning D: Society and Space, 2021
Sitting between the psychiatric and criminal justice systems, and yet fully located in neither, f... more Sitting between the psychiatric and criminal justice systems, and yet fully located in neither, forensic psychiatric units are complex spaces. Both a therapeutic landscape and a carceral space, forensic services must try to balance the demands of therapy and security, or recovery and risk, within the confines of a strictly controlled institutional space. This article draws on qualitative material collected in a large forensic psychiatric unit in the UK, comprising 20 staff interviews and 20 photo production interviews with patients. We use John Law’s ‘modes of ordering’ to explore how the materials, relations and spaces are mobilised in everyday processes of living and working on the unit. We identify two ‘modes of ordering’: ‘keeping safe’, which we argue tends towards empty, stultified and static spaces; and ‘keep progressing’ which instead requires filling, enriching and ingraining spaces. We discuss ways in which tensions between these modes of ordering are resolved in the unit,...
The dynamics of memory are broadly distributed across relationships, institutions, material affor... more The dynamics of memory are broadly distributed across relationships, institutions, material affordances and, of course, discursive practices. The Chancellor's memory is an attempt to show how the subject matter parsed by cognitive psychology can be lifted wholesale into a discursive approach. Discursive Psychology has its roots in the Sociology of Scientific Knowledge, a discipline that was acutely aware of the vacuous nature of claims to systematicity, rigor, and most notoriously replication. Dave Middleton's early work shared a concern with the linguistic steering of children's activities, having been part of the group that refined the experimental demonstration of scaffolding in parent child interactions. These studies were critical to a move in developmental psychology of placing cognitive development in a sociocultural context. Edwards and Goodwin argue that lexical development in children is poorly grasped when it is treated in terms of gradual conceptual understan...
The relationship between place and remembering has been a longstanding matter of phenomenological... more The relationship between place and remembering has been a longstanding matter of phenomenological concern. The role of the ‘lived body’ in mediating acts of remembering in context is clearly crucial. In this paper we contribute to an ‘expanded view of memory’ by describing how remembering difficult or problematic events ― ‘vital memories’ ― draws upon inter-subjective and inter-objective relations. We discuss two conceptual tools that provide an analytic framework ― the concept of ‘life space’ drawn from Kurt Lewin (1936) and the idea of the ‘setting specificity’ of remembering. From this perspective we can see that the ‘lived body’ does not constitute a singular unity but rather a ‘plurality’ of potential bodies that have ‘operative solidarity’ (cf. Simondon, 2009) with the material relations in which they are constituted. Drawing on the work of Eduardo Viveiros de Castro, we argue that ‘body memories’ need to be analysed from within the embodied material-relational perspective whe...
How are relations of care and security between hospital staff and patients organized through soun... more How are relations of care and security between hospital staff and patients organized through sound? This article argues that a shifting distinction between meaningful sound and noise is fundamental to the lived experience of immersion in an organizational acoustic environment. Based around a qualitative study of listening practices and ‘ear-work’ at a medium-secure forensic psychiatric hospital, using interview and photo-production methods, the article positions the organizing of the sensory as central to formal organization. Analysis of empirical material demonstrates how the refinement of key listening practices is critical to the ways in which staff and patients orient to the hospital setting. It also details how the design process for the unit has undermined the capacity to manage and control through sound, or ‘panauralism’, rendering it as a reversible and contested struggle to make sense of the acoustic environment, and describes the attempts by patients to create alternative ...
The dichotomy between ‘truth’ and ‘falsity’ in relation to memory is difficult to clearly sustain... more The dichotomy between ‘truth’ and ‘falsity’ in relation to memory is difficult to clearly sustain. The veridicality of memory is typically established by drawing on the local, normative procedures that operate in a given setting (e.g. legal, clinical, social). Since all procedures are strictly relative, all memories are technically either ‘relatively falsified’ or ‘relatively as-yet-unfalsified’. False memory studies claim to be able explain the production of false memories, but do not offer criterion to effectively differentiate populations of so-called ‘true’ and ‘false’ victims. The narrative of the discovery of the ‘false memories’ themselves is inconsistent and demonstrates a significant level of imagination inflation and suggestibility to dominant narratives in post-war psychology. In attending to the setting specificity of memory, researchers may wish to consider how their work impacts on the experience–ecologies to which they contribute.
Individuals with mental health problems are considered to be part of a group labeled 'vulnera... more Individuals with mental health problems are considered to be part of a group labeled 'vulnerable' in forensic psychology literature and the legal system more generally. In producing witness statements, there are numerous guidelines in the UK, designed to facilitate the production of reliable and valid accounts by those deemed to be vulnerable witnesses. And yet, it is not entirely clear how mental health impacts on reliability and validity within the judicial system, partly due to the diversity of those who present with mental health difficulties. In this paper, we set out to explore how legal professionals operating in the UK understand the impact of mental distress on the practical production of witness testimonies. Twenty legal professionals, including police officers, judges, magistrates and detectives were involved in a semi-structured interview to examine their knowledge and experience of working with mental health problems, and how they approached and worked with this...
International journal of law and psychiatry, Jan 17, 2015
Very little is known about the sexual activities of psychiatric patients during their stay in hos... more Very little is known about the sexual activities of psychiatric patients during their stay in hospital and beyond. In this article, we have explored how mental health professionals working within a forensic psychiatric unit construct the issue of patient sexuality in order to ascertain the range of sexual possibilities open to patients. Drawing on interviews with twenty four participants - psychiatrists and clinical psychologists (clinical staff), we examined how participants made sense of patient sexuality and their clinical judgments in relation to them. Using a thematic analysis, we were able to identify a number of relevant themes emerging, including a) what the limits of acceptable sexual behaviour were judged to be, b) discrimination against transgender and same sex relationships, c) vulnerability among female patients and therapeutic efficacy, and d) an abject fear of patient pregnancy. Furthermore, a general concern throughout was the putative professional conflict between t...
Previous research on young people's satisfaction of inpatient services has often relied on the re... more Previous research on young people's satisfaction of inpatient services has often relied on the responses of carers and relevant practitioners. It is difficult to ascertain to what extent such reporting accurately represents the satisfaction levels of young people, with emerging research suggesting wide discrepancies. As part of a wider study evaluating the effectiveness of a Supported Discharge Service (SDS) operating within SLaM, this paper examines how young people's experience inpatient services, on a social and emotional level. Twenty young people, (ten SDS and ten TAU) participated in a semi-structured visual-interview study to examine their experiences of admission, ward-life and treatment. A thematic analysis was conducted on the data and specific themes relevant to satisfaction and engagement with inpatient services was examined in-depth. These include a) Behavioural surveillance as care surrogate and b) Managing the delicate emotional ecology of the ward: openness, triggering, sterility and relational engagements. Finally, we explore some of the implications of these inpatient experiences for supported discharge services.
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