What is the Problem of Dual Diagnosis Represented to be in Sharing the Vision?

Abstract

This thesis critically analyses the role of Ireland’s national mental health policy, Sharing the Vision (Government of Ireland, 2020), in shaping a public healthcare issue known as dual diagnosis. In the thesis, I undertake a scoping review of the literature to explore how dual diagnosis is defined and problematised. Afterwards, I deploy a poststructuralist approach that rests on a form of governmentality theory to examine how Sharing the Vision produces dual diagnosis in particular ways, primarily through the use of problems. Drawing on the analytical framework known as the ‘What’s the Problem Represented to be? (WPR) approach (Bacchi, 2009), I examine the ways in which Sharing the Vision represents the problem of dual diagnosis; the medical, rationalist and neo-liberal discourses that belie these representations; and the silences that are an effect of these representations; closing off other ways of imagining dual diagnosis. Though the object of this thesis is government policy, the concern is for the conceptualisation of dual diagnosis, and the implications particular representations have on the lives of people that are affected. The thesis contributes to a gap both in the critical analysis of the concept of dual diagnosis (Iudici et al., 2020) and the absence of such an analysis in the Irish context. The research aims to support and inform dialogue on dual diagnosis in Ireland, pointing to the way in which this issue is contested and challenged