A Discourse Analysis of Clinical Psychologists' Talk about Psychopathy in Forensic Settings

Background: Psychopathy is a controversial psychological construct with a contentious history. Ambiguity regarding its pathology persists, coincident with long-standing critique of the construct. Contemporary research indicates ontological confusion, limitations with assessment practices, and the presence of a negative bias towards individuals identified as psychopathic; the implications of this raise serious ethical concerns. Despite this, the psychopathy construct is used within forensic settings to understand the psychology of forensic service users; in particular, clinical psychologists hold status as a professional group able to understand, assess for, and confer the presence of, psychopathy. In addition to the aforementioned limitations, there is also a lack of research into the accounts of clinical psychologists working in forensic settings. Aims: To examine how clinical psychologists discursively construct psychopathy, including an investigation of the discourses and subjectivities produced and utilised in their talk, and the implications for action resultant from these. Method: Eight one-to-one semi-structured interviews were conducted with clinical psychologists currently working in forensic mental health contexts (low, medium and high secure). Foucauldian Discourse Analysis was used to analyse the data. Results: (1) Persons with psychopathy were constructed as problematised individuals. Constructions arose from four overarching discursive sites: dangerous, challenging, manipulative, and psychologically deficient. ‘At risk’ and ‘trauma’ discourses were utilised to explain the aetiology of psychopathy. ‘Intuition’ talk was employed by participants as a marker of the presence of psychopathy. (2) The psychopathy construct was identified as contested and problematic. To manage this, a variety of subject positions were taken up; three overarching subjectivities were identified: pragmatist, subversive, and expert/specialist. (3) Accounts pointed to a psychological imperative for psychopathy. Central to this was the promotion of three core psychology technologies: formulation, supervision, and reflective practice. These were constructed as solutions to the ‘problem’ of psychopathy in different ways. Clinical and research implications are discussed in light of the analysis

Poetry Written from the Words of People Given a Diagnosis of Dementia: A Narrative Analysis

Narrative - based research in dementia is limited. Theorists emphasise certain aspects as core features of ‘analysable’ narratives that are not reliably present in narratives of people diagnosed with dementia (e.g., temporality). This study, underpinned by social constructionist epistemology, demonstrates that attending to such narratives provides valuable understandings. Some narratives evidenced speakers’ lack of agency over their own experiences, appearing to coincide with constructions of low self - esteem, hopelessness, or being positioned by others into identities contradictory to speakers’ Self - constructs. Yet other na rratives demonstrated that, through acknowledgement and support of ‘personhood’, speakers retained a sense of control and purpose in their social world

A narrative analysis of poetry written from the words of people given a diagnosis of dementia

This study is underpinned by social constructionist epistemology, which points to the socially constructed character of our worlds, in that we co-create and are co-created by (including experience and identity) our social realities. Through narrative analysis of some poems from the words of people given a diagnosis of dementia, this study engaged in the process of meaning-making in relation to Self-construct and the wider social world. Some narratives evidenced speakers’ lack of agency over their experiences, not because of the ‘dementia’ but due to treatment and care contexts. Some narratives provided instances in which others positioned speakers into identity constructions contradictory to their life-long Self-constructs. Other narratives demonstrated that, through acknowledging and supporting ‘personhood’, speakers retained a sense of well-being and purpose in their social worlds. It is hoped that focusing on the words of individuals given dementia diagnoses, away from predominant bio-medical discourses, may facilitate professionals’ continuous reflection and person-centred practice

Community-based arts research for people with learning disabilities: challenging misconceptions about learning disabilities

This article presents some of the community-based artwork of a group of men with learning disabilities, who aimed to challenge some of the misconceptions associated with learning disabilities. People with learning disabilities regularly face many forms of direct and indirect stigma. The consequences of such negative perceptions may affect individuals’ social relationships and ensure that barriers are strengthened which prevent their full inclusion. The men in this project used a series of visual and creative methods to challenge some of these misconceptions by telling stories through art, demonstrating skill through photography, using poetry to talk about sexual identity and improvising drama and filmmaking to challenge stigma, and through sculpture expressed their voices. Thus, by doing so, they were able to challenge some of the stigma associated with learning disabilities, indicating that community-based arts research is a valuable way in which to promote the voices of people with learning disabilities

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Constructing ‘the Psychopath’: A Discourse Analysis of Psychologists’ Understandings of Psychopathy

Background: Psychopathy is a controversial psychological construct used within forensic settings to understand the psychology of forensic service users. Contemporary research into psychopathy indicates ontological confusion, limitations with assessment practices and the presence of a negative bias towards individuals identified as psychopathic. Aims: A moderate social constructionist epistemology underpins this study. Its purpose was to widen the clinical frame of psychopathy via sociological inquiry through an examination of how ‘the psychopath’ is constructed discursively by a particular group of specialists working directly with individuals with a psychopathy label. Methods: Subjects were eight clinical psychologists currently working throughout the UK in forensic mental health settings (low, medium and high-secure hospitals). Semi-structured interviews were conducted and the data were analysed qualitatively, using Discourse Analysis methods. Findings: Analysis demonstrated that persons with psychopathy are constructed as problematised individuals, located within four overarching, recurrent discursive sites: dangerous, challenging, manipulative, and psychologically deficient. Participants utilised ‘at risk’ and ‘trauma’ discourses to explain the aetiology of psychopathy and ‘intuition’ talk was employed as a marker of the presence of psychopathy. The findings of the study and their clinical implications are discussed

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

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