Trusting on the Edge : Managing Uncertainty and Vulnerability in the Midst of Serious Mental Health Problems

Trust is fundamental to everyday interactions and the functioning of society. How trust develops, or fails to develop, within contexts of severe mental illness is a pertinent topic for social scientists and healthcare professionals, not simply because it is an under-researched area but because heightened uncertainty and amplified vulnerability amidst psychosis represent a crucible of the conditions where trust becomes relevant. Grounded in research within this crucible, this book explores a number of questions which are central to contemporary theoretical debates around the nature of trust. The authors link these abstract concerns to empirical analysis, involving interviews with service-users, practitioners and managers. This book will appeal to anyone interested in the concept of trust, including social science researchers and students, as well as practitioners, managers and policy makers working with vulnerable people. TRUSTING ON THE EDGE Contents Preface Introduction: Risk and trust in late-modern society Late-modernity and the illumination of uncertainties Strategies of managing vulnerability in the face of uncertainty: risk and trust Atmospheres of trust? Various forms of ‘hyphenated’ trust Overview of the book 1. Investigating trust: some theoretical and methodological underpinnings Risk, vulnerability and uncertainty Conceptualising trust Defining trust: a problem of knowing Relating trust in people to trust in systems Researching trust: epistemology and methodology Some central analytical foci 2. Constructing knowledge through social interactions: the role of interpersonal trust in negotiating negative institutional conceptions Three sources of negative institutional conceptions Different formats and concreteness of knowledge Trusting in mental health professionals: distinguishing the individual from the system Conclusion 3. Bridging uncertainty by constructing trust: the rationality of irrational approaches Rationality as an obstacle to social analysis Trust as necessary, appropriate and effective Dispositions and forming knowledge of others: habitus and trust Conclusion 4. Vulnerability and the ‘will to trust’ Dependence, choice and trust Luhmannian insights: choice, regret and attribution Choosing or not choosing? Recognising agency amidst structures The messiness of real world trust: trust and mistrust alongside one another Vulnerability and a ‘will to trust’ Conclusion 5. The difficulties of trust-work within a paradigm of risk Professionals in the midst of vulnerability Professionals, morality and the trust–control dialectic The interrelatedness of trust across different organisational dimensions Virtuous and vicious circles of trust Origins of virtuous and vicious circles A starting point for potential policy solutions Conclusion 6. Trusting on the edge:implications for policy Overview of key themes Policy implications: rediscovering trust Paths for future research Appendix Methods Design Sampling and participants Data collection Method of analysis References Index Trust is fundamental to everyday interactions and the functioning of society, but it is particularly relevant within healthcare contexts. An increased awareness of the limitations of medical knowledge and care systems, alongside the challenged authority of the professionals who work within these institutions, renders trust salient yet problematic. In spite of a growing body of research more generally, how trust develops, or fails to develop, within mental healthcare contexts remains poorly understood and under-researched. This book brings together key theories, existing research into trust in healthcare, as well as new empirical findings regarding trust within different dimensions of psychosis services, to answer a range of questions which are pertinent to mental healthcare settings and indeed trust research more broadly. The conditions of uncertainty and vulnerability, which make trust relevant, exist in amplified form in these service-contexts oriented towards people experiencing severe mental health problems. The study harnesses this ‘crucible’ of key factors to explore a number of themes which are central to contemporary theoretical debates around the nature of trust - the role of institutions, risk, rationality, habitus, choice and related concerns. The authors connect these abstract concerns to empirical analysis involving interviews with service-users, practitioners and managers. The findings and conclusions are related to contemporary policy-making issues as well empirical and theoretical research into risk, trust, vulnerable groups and other related topics This book explores issues central to contemporary theoretical debates around the nature of trust, linking abstract concerns to empirical analysis with interviews with service-users, practitioners and managers. An important analysis of trust in relation to mental health care, showing clearly how an instrumentalised focus on 'risk' is in crucial respects antithetical to a personal focus required to build trust