Can we remember differently? A case study of the new culture of memory in voluntary organisations

This article analyses the positive contribution that Slovenian voluntary, non–governmental organisations, users' organisations and community–based services in the field of mental health have made to the 'new culture of memory' of helpers and users. The conceptual differences between Slovenian psychiatric (institutional) treatment and voluntary community care are presented through the case study of Clare, a young woman who was diagnosed as a chronic schizophrenic. This example shows the importance of community care in voluntary organisations for the reduction of disability associated with mental disorders. The development of the new culture of memory in voluntary organisations and community–based services is not only the 'narrative turn' within social welfare, but also symbolises the 'implicit turn' in the relationship between the helper and the user. The real challenge of the new culture of memory in the process of help to disabled people (in respect of individuals working through traumatic memories) is that the helper can bear and support the user on a daily basis. During the process of their relationship, the deep implicit relational memories of both become activated and influence the change within the user as well as the helper.     

Developing a typology of the 'duty to work', as experienced by lay persons with musculoskeletal disorders

Musculoskeletal diagnoses account for the majority of cases of reduced work capacity. This article investigates lay persons' strategies in relation to work and musculoskeletal disorders. Twenty interviews were conducted and analysed using grounded theory. A typology of self-presentations was developed. The interviewees' self-presentations revealed a strong sense of a 'duty to work'. This sense of duty took four different forms, leading us to categorise persons expressing particular forms as workaholics, work manics, workhorses or relaxed workers. Relaxed workers seem to have the best prognosis for recovery as they had a confident self-agency and worked to fulfil their own needs rather than those of others. This was in contrast to work manics, with an uncertain self-agency and driven to work by others' needs. In conclusion, awareness of such linguistic forms as self-attributions and idiomatic phrases provides an opportunity to identify and talk about individual's self-agency and driving forces in the recovery process.     

Forced to work and liberated from work

The work-welfare nexus is essential in all social policy regimes. The question is in what situations individuals should be entitled to social welfare benefits and in which situations they should be obliged to work. Social welfare law and administrative practices define mechanisms that separate the deserving poor from people able to work. This article analyses the functions and character of these "separation mechanisms" in Sweden during three periods in history: a) in rural society in the late 19th century; b) in industrial society during the successful years of the Swedish model from World War II until the late 1970s; and c) the present, including the period of welfare retrenchment and reconsideration since the early 1980s. The conclusion is that Swedish social policy has always been strongly work-oriented, but the specific form and content of the work ethic has varied under the influence of different ideologies and handled in different social policy institutions. Under specific conditions the work line has been either generous or restrictive and it has been based on structural attempts to improve the opportunities to work as well as on attempts to strongly pressure the individual to work. The work line of today is seen as an interesting attempt to combine an effort to create good work through improved work conditions and an effort to reinforce elements of work enforcement in the social insurance system.     

Danish and Norwegian hospital social workers’ cross-institutional work amidst inter-sectoral restructuring of health and social welfare

Starting in the 2000s, Denmark and Norway have undergone extensive restructuring of their health-related social benefit programmes, including how they are governed. Several reforms have sought to enhance inter-sectoral collaboration. Aiming at ensuring patients’ faster return to work, policy-makers have instituted economic incentives to both individuals and the health and welfare organisations who handle them. Through an institutional logics approach, this paper explores how hospital social workers in these countries are experiencing these changes. The ‘social’ part of post-treatment care and rehabilitation receives more attention in the Norwegian institutional set-up than in the Danish, and whilst challenges are experienced in both countries, in group interviews Danish social workers in particular express concerns about the implications of the accelerated return-to-work focus. In both countries, they report increasing difficulties in ‘making their way through’ the state-municipal bureaucracy. However, by drawing on the formal health knowledge derived from medical settings and the symbolic capital it bestows on them, they often manage to negotiate the work-and-welfare services, thereby transforming the social context for the patients.     

Using a capabilities approach to understand poverty and social exclusion of psychiatric survivors

The purpose of this project is to better understand poverty and social exclusion of psychiatric survivors using a capabilities approach to social justice as part of a larger mixed-methods longitudinal study (N=380) in Ontario, Canada. Using thematic coding, four themes emerged: poverty, ‘You just try to survive’; stigma, ‘People treat you like trash’; belonging, ‘You feel like you don’t belong’; and shared concern and advocacy, ‘Everyone deserves housing’. This analysis provides a deeper understanding of poverty and other social determinants of experiences of psychiatric survivors, including the synergism of poverty and social exclusion.     

Decision‐Making in Paediatric Rehabilitation: Exploring Professionals' and Children's Views on Decision‐Making Involvement

The article explores the distinction that professionals make between difficult and less difficult decisions in paediatric rehabilitation interventions. This distinction is explored by looking at the involvement of two children in decisions regarding paediatric rehabilitation interventions. The article argues for a clinical practice where children's experiences are extensively used to improve practice and to accommodate the child's right to participate in medical decisions concerning their own body and life. The different ways the children and the professional describe their experiences provide an avenue for a discussion on how medical reasoning can curtail children's involvement in decisions.     

The duty to care and the need to split

This paper arises out of psychoanalytically oriented consultancy to teams of staff in the helping professions where there is a statutory 'duty to care'. It takes as its premise the seemingly paradoxical hypothesis that workers may need to split off part of their emotional experience in order to preserve their own mental health and provide reliable services to their clients. I argue that while a professional 'duty to care' requires us to be emotionally 'in touch', the demands of our clients together with the demands of the institutional response to the 'duty to care' cause us to split off parts of our awareness. I also argue that provided the splitting does not become extreme we are doing no more or less than the rest of society. In other words, there is a degree of 'normal splitting' which numbs our awareness of danger and destructiveness and seeks to protect us from too much anxiety and pain. Yet if professional workers are charged with the responsibility of assessing risk and acting accordingly for the protection of all concerned they need ways of being 'in touch' (re-integrating the splits) for some or enough of the time. Finally, I will describe ways of being 'in touch', illustrating the difficulty and the pain of re-integrating the splits and some of the insights that can arise out of this work with examples from my consultancy work.     

The unemployment of women with physical disabilities in Ghana: issues and recommendations

Unemployment among persons with disabilities is high. The situation is worse for women with disabilities as they experience multiple disadvantages on account of gender and disability. The condition for women with disabilities in Ghana could be more complicated, given the intersection of disability, gender, poverty, cultural beliefs and practices. As employment provides not only income for women with disabilities but opportunities for social participation and increases psychological well-being as well as self-esteem, it is imperative to remove barriers that hinder their employment. The current study examines issues associted with the unemployment of women with physical disabilities in Tamale, Ghana, and makes recommendations to policy-makers and practitioners in order to improve the condition of persons with disabilities in general, and particularly women with disabilities.     

Recovery From Mental Health Problems: Scratching The Surface Without Ethnography

This article examines a central plank of mental health policy (‘recovery’) in societies which have attempted to reverse the long-term warehousing of those with a diagnosis of mental disorder (de-institutionalisation). The emergence of the concept is traced in relation to the shift from an institutional to a more dispersed and community-based form of service organisation. Different usages of the term ‘recovery’, each with distinct implications for practice are considered on the part of three main interest groups (traditional bio-medical psychiatrists; social psychiatrists emphasising social skills training; and dissenting service users). These different usages suggest that ‘recovery’ is a polyvalent concept that creates an uneasy consensus point to define the management philosophies of local services enacting mental health policy. Also mental health work is about more than the group of patients mainly considered in relation to recovery (those with ‘severe and enduring mental health problems’). Practice-near research strategies are now required to investigate the varied practical scenarios these contradictions generate and ethnographic research is therefore indicated. Without multiple ethnographies, we will be left with competing rhetoric about recovery and its meaning or meanings may be rendered worthless.