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15 - Travelling Memories: Repairing the Past and Imagining the Future in Medium-Secure Forensic Psychiatric Care
- Edited by Dimitris Papadopoulos, University of Nottingham, Maria Puig de la Bellacasa, University of Warwick, Maddalena Tacchetti, University of Nottingham
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- Book:
- Ecological Reparation
- Published by:
- Bristol University Press
- Published online:
- 28 March 2024
- Print publication:
- 01 December 2023, pp 225-241
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Summary
Introduction
Memory is the connective tissue that makes lives meaningful. A connection to the past enables sense making in the present and renders possible futures as thinkable. In the case of traumatic or difficult pasts, this connection becomes intensely important. At personal, collective and national levels, past harms and injustices need to be made visible and subject to commemorative exploration in order for victims to ‘go on’ in the present. In this context, repair is usually considered to be a memorial work of putting the past in order to meet ongoing moral and epistemic demands (Margalit, 2002; Blustein, 2008; Campbell, 2014). Through this work it becomes possible to envisage a reconstruction or ‘healing’ of personal and social ecologies of thought and feeling.
This understanding of memorial work as repair is complicated by issues around mental health. For example, while some approaches to trauma (for example Johnstone and Boyle, 2018) emphasize the need to understand personal histories – ‘what happened to you’ – as a way of addressing current feelings and experiences – ‘what’s wrong with you’ – there is also a counter-discourse around the inherently unrepresentable nature of traumatic pasts (Caruth, 1996). Pain and suffering incurred through extraordinary and horrific violations of social and personal relations may be simply incomprehensible and hence difficult to both recollect and to narrate. Mental health issues may also call into question the reliability of memory. Victims – and in some cases perpetrators – may have their recollected experiences problematized or discounted (see Haaken and Reavey, 2010). They may also be accused of focusing unduly and unhelpfully upon the past rather than facing up to problems in the present. Here, repair can take the form of an injunction to disconnect from a difficult past in order to ‘move on’ with living.
In this chapter, we want to explore the tensions in memorial repair work around mental health. We will be concerned with the question of when and how the past comes to matter for persons managing severe and enduring mental health issues. Crucially, we look at the practices which are enacted to manage these tensions, and how they are collectively performed within an institutional setting. Our argument is informed by work we have conducted in a medium-secure forensic pathway in a large inpatient psychiatric unit.
Exploring determinants of self-management in adults with severe mental illness: a qualitative evidence synthesis
- Claire Carswell, Jennifer Brown, Abisola Balogun, Jo Taylor, Peter Coventry, Charlotte Kitchen, Ian Kellar, Emily Peckham, Sue Bellass, Sarah Alderson, Jennie Lister, Richard Holt, Catherine Hewitt, Rowena Jacobs, David Shiers, Jan Boehnke, Ramzi Ajjan, Najma Siddiqi, On behalf of the DIAMONDS Research team
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S13
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- Article
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Aims
To systematically review and synthesise qualitative evidence about determinants of self-management in adults with SMI. The goal is to use findings from this review to inform the design of effective self-management strategies for people with SMI and LTCs.
BackgroundPeople living with serious mental illness (SMI) have a reduced life expectancy by around 15–20 years, mainly due to the high prevalence of long-term physical conditions such as diabetes and heart disease. People with SMI face many challenges when trying to manage their physical health. Little is known about the determinants of self-management – managing the emotional and practical issues – of long-term conditions (LTCs) for people with SMI.
MethodSix databases, including CINAHL and MEDLINE, were searched to identify qualitative studies that explored people's perceptions about determinants of self-management in adults with SMI (with or without comorbid LTCs). Self-management was defined according to the American Association of Diabetes Educator's self-care behaviours (AADE7). Determinants were defined according to the Capabilities, Opportunity, Motivations and Behaviours (COM-B) framework. Eligible studies were purposively sampled for synthesis according to the richness of the data (assessed using Ames et al (2017)'s data richness scale), and thematically synthesised.
ResultTwenty-six articles were included in the synthesis. Seven studies focused on self-management of LTCs, with the remaining articles exploring self-management of SMI. Six analytic themes and 28 sub-themes were identified from the synthesis. The themes included: the additional burden of SMI; living with comorbidities; beliefs and attitudes about self-management; support from others for self-management; social and environmental factors; routine, structure and planning. Capabilities for self-management were linked to people's perceptions about the support they received for their SMI and LTC from healthcare professionals, family and friends. Opportunities for self-management were more commonly expressed in the context of social and environmental factors. Motivation for self-management was influenced by beliefs and attitudes, whilst being closely related to the burden of SMI.
ConclusionThe themes identified from the synthesis suggest that capabilities, opportunities and motivations for self-management can be negatively influenced by the experience of SMI, whilst social and professional support, improved access to resources, and increased involvement in care, could promote self-management. Support programmes for people with SMI and LTCs need to account for these experiences and adapt to meet the unique needs of this population.