Care and Coercion: An Existential and Psychosocial Narrative Study of Mental Health Care Professionals

This book presents an existential and psychosocial interpretation of the experiences of mental health care practitioners whose work involves use of coercion. Through in-depth case studies carried out in Norway, and theoretical discussions, it examines how the use of coercion is not merely directed by laws and regulations, but also by the situated subjectivities of the practitioners, and the wider contexts informing them. It demonstrates how the inner and outer worlds, the psychic and the social, and the existential and the cultural, all impact the professionals' experience and capacity to care. Employing a phenomenological and contextual approach, the book explores the practitioners' paradoxical experiences of mandating and physically undertaking coercive measures toward vulnerable patients, while at the same time being members of a democratic society in which autonomy is a defining feature. It demonstrates the impact on professionals who are both authorized to use coercion and critiqued by the authorities for doing so. The author discusses what informs the moral deliberations taking place within and between professional subjects in charged situations involving use of coercion, and how the experience of using coercion informs the self-understanding of the professional and thus potentially future decision-making processes pertaining to the use of coercive measures. In doing so the book provides a look behind closed doors of "total institutions" that addresses, and partly undresses, psychiatric power. This book offers a rich, contextual examination of mental health care practice that will be of interest to students, practitioners, and researchers of psychiatry, as well as those of adjacent fields such as psychology, social work, nursing, and criminology. Kjetil Moen is Associate Professor at the Faculty of Health Sciences at the University of Stavanger, Norway. He also works as Chaplain at the University Hospital of Stavanger and is the author of Death at Work: Existential and Psychosocial Perspectives on End-of-Life Care, (2018). Prologue Acknowledgments Contents 1: Introduction 1.1 The Study 1.1.1 A Practice Under Increasing Scrutiny 1.1.2 An Existential and Psychosocial Perspective 1.1.3 Oral and Written Testimonies 1.2 The Participants: And Their Different Ways of Telling 1.2.1 Alice (Specialist in Psychology) 1.2.2 John (Specialist in Psychology) 1.2.3 Esther (Psychiatric Nurse) 1.2.4 Frank (Nurse-Assistant) 1.2.5 Casper (Assistant) 1.2.6 Kate (Psychiatric Nurse) 1.2.7 Isaac (Social Educator) 1.2.8 Hilmar (Nurse) 1.2.9 Leah (Psychiatrist) 1.2.10 Grace (Psychiatrist) 1.2.11 Benjamin (Psychiatrist) 1.2.12 Daamir (Psychiatrist) 1.3 Limitations 1.4 The Book References Part I: Star Cases Introduction 2: Esther 2.1 Lived Life 2.2 Told Story 2.3 A History of How the Case Evolved 2.3.1 Encountering Shame: And Pride 2.3.2 “Psychiatry I Will Do Wherever I Am Going to Work Because I Need It” 2.3.3 “What Do I Have in the Backpack?” 2.3.4 “I Don’t Know if I Dare to Say It” 2.3.5 In “the Eye of the Storm” 2.3.6 A Haunting Suicide 2.3.7 On Loyalty and Integrity 2.3.8 “I Should Probably Never Have Said It” 2.3.9 The Mystery of Personal Chemistry 2.3.10 White Lies 2.3.11 Door-Knob Confessions and Omissions 2.4 Concluding Remarks 3: Daamir 3.1 Lived Life 3.2 Told Story 3.3 A History of How the Case Evolved 3.3.1 “Yes, but” 3.3.2 Opening a Pandora’s Box of the “Awful” and “Fascinating” 3.3.3 The 15-Year-Old Manic Psychotic 3.3.4 The Leather-Jacket Story 3.3.5 The Difficulty of Beginnings and the Struggle for Harmonious Endings 3.3.6 The First Encounter with Adult Psychiatry 3.3.7 The Ultimate Non-harmonious Ending 3.3.8 Policy and Disharmony 3.3.9 Slamming the Door 3.3.10 A Peek Behind the Door 3.4 Concluding Remarks Reference 4: Hilmar 4.1 Lived Life 4.2 Told Story 4.3 A History of How the Case Evolved 4.3.1 Broad Strokes and Bright Colors 4.3.2 “Ending Up at the Psychiatric Hospital”: Part I 4.3.3 At Home 4.3.4 Practitioner of Coercion: Part I 4.3.5 An Unprecedented Early Ending 4.3.6 The Descent 4.3.7 A Return to His Father’s House 4.3.8 “Ending Up at the Psychiatric Hospital”: Part II 4.3.9 The Ascent 4.3.10 Practitioner of Coercion: First Uncomfortable Experiences 4.3.11 A Decrease in Uncomfortableness 4.3.12 Authority or Servility? 4.3.13 The Mystery of Personal Chemistry 4.3.14 Diplomacy and Loyalty 4.4 Concluding Remarks 5: Leah 5.1 Lived Life 5.2 Told Story 5.3 A History of How the Case Evolved 5.3.1 Three Decades and Three Continents in Five Minutes 5.3.2 Professional Trajectory with a Finer Brush 5.3.3 Wanting to Give Up 5.3.4 Therapeutic “blah-blah-blah” 5.3.5 “I Had to Swallow My Pride” 5.3.6 “12 Hours Later He Had Shot Himself” 5.3.7 “I Never Liked Using Coercion” 5.3.8 “When They See the Needle They Do Agree” 5.3.9 “Not Happy with the Philosophy” 5.4 Concluding Remarks Part II: A Careful Reading Across All Cases Introduction 6: The Mindful and Thoughtless Practitioner 6.1 Mindfulness of Others 6.2 Variance in Self-Referencing 6.3 Old-School and New-School Reflections (Frank’s Story) 6.4 Reflections and Projections on a Moment’s Loss of Moral Ground (Casper’s Story) 6.5 Unpredictability, Safety, and Loyalty 6.6 Thoughtlessness of Self 6.6.1 Self-Misunderstandings (“Maybe I’m Fooling Myself”) 6.6.2 The “Open Book” (Alice’s Story) 6.7 Self-Reflections in Writing 6.7.1 Casper and Hilmar in Writing 6.7.2 Daamir in Writing 6.7.3 Kate and John in Writing References 7: The Wounding and Wounded Healer 7.1 Seeing Oneself as an Abuser 7.1.1 “It Felt Like Abuse” 7.2 Being Perceived as an Abuser 7.2.1 “Coercion Is Equal to Abuse” 7.2.2 “They Don’t See What I See” 7.3 The Wounded Healer 7.3.1 At Personal Risk 7.3.2 A Personal Resonance (Grace’s Story) 7.3.3 Past Informing Present References 8: The Needed and Unwanted Doorkeeper 8.1 A Sense of Powerlessness 8.2 Doors of Protection and Oppression 8.3 Door-Keeping Without Consent 8.4 Unlocking “Doors” Retrospectively 8.5 Door-Keeping at the Boundary (Death) 8.6 The Elephant in the Room 8.7 A Sense of Inadequacy (Grace’s Story) 8.8 A Case Against “Retrospective Medicine” (Benjamin’s Story) References Part III: An Existential and Psychosocial Reading Introduction 9: Will-to-Power 9.1 Introduction 9.2 The Struggle for Recognition 9.3 To Look-One-More-Time: Or Not 9.4 Opposite Moral Careers 9.5 Inequality, Autonomy, and Reciprocity 9.6 The Dancers: And Those Who Could Not Hear the Music 9.7 A Community of Fate: Not Doubt? 9.8 Concluding Remarks References 10: Will-to-Knowledge 10.1 Introduction 10.2 Masters of Madness 10.3 Instrumental Mistakes 10.4 The Not-Knowing Therapists 10.5 The Blind Benefactors 10.6 Knowing What Is Good 10.7 The Reality and Relativity of Moral Truths 10.8 The Irrational, Emotional, and Embodied Practitioners 10.9 Moods and Existential Feelings 10.10 Concluding Remarks References 11: Will-to-Truth 11.1 Introduction 11.2 Hermeneutics of Self 11.2.1 Examining Oneself 11.2.2 Knowing Oneself 11.2.3 Disclosing Oneself 11.3 Hermeneutics of Ethics 11.3.1 Truth and Reparation 11.3.2 Devotion to Truth 11.3.3 A Limited Capacity for Truth 11.3.4 Selective Memory 11.3.5 Denial of Death 11.3.6 Deep and Common Memory 11.3.7 Failures in Mutuality 11.4 Concluding Remarks References 12: Epilogue (Will-to-Hope) 12.1 Enemies of Hope 12.1.1 Pessimism 12.1.2 Optimism 12.2 Sources of Hope 12.2.1 Hope as the Breath and Wings of Life 12.2.2 Hope as a Practical Postulate 12.2.3 Hope in Compassionate Realism References Index