Treatment of Dual Diagnosis in Denmark: Models for Cooperation and Positions of Power

Treatment for dual diagnosis in Denmark is divided between a medically based psychiatric treatment system and a socially oriented substance use treatment system; consequently, in order to deliver the most effective treatment to people with dual diagnosis, the two need to cooperate. A number of projects have been initiated to try out different models for cooperation, yet, on a larger, societal scale, we have not solved the puzzle of how it can be made to work in practice. My focus in this article is to suggest some reasons why it is so difficult to introduce cooperation between psychiatry and addiction treatment despite the many projects directed explicitly towards this. I suggest that at least part of the answer lies in the unequal power relations between psychiatry and substance use treatment

„DET ER IKKE EN FORLYSTELSESPARK, VI DRIVER HER“ Behandling vs. nydelse og andre modsætninger i det danske program

I 2008 vedtog det danske folketing, at behandling med lægeordineret heroin skulle være en behandlingsmulighed i dansk misbrugsbehandling. Med indførelsen af lægeordineret heroin indførte man ikke kun et stof, der for nogle stofbrugere er meget attraktivt. Man indførte også et meget komplekst behandlingstilbud med en række indbyggede modsætninger. Baseret på et omfattende feltarbejde på de fem danske heroinklinikker analyserer denne artikel tre centrale modsætninger i behandlingstilbuddet. Den første modsætning er, at heroin både er problemet – det afhængighedsskabende stof – og samtidig løsningen – behandlingen. Den anden modsætning er, at brugernes rationale for at tage stoffet – nemlig nydelsen – er meget anderledes end personalets rationale bag at give stoffet – afhjælpelse af lidelse. Den tredje modsætning er, at behandlingen søger at normalisere brugerne og samtidig omfatter praksisser – injektion af afhængighedsskabende stoffer, kokseri og overdosis – der almindeligvis betragtes som radikalt afvigende. Afslutningsvis bruges diskussionerne af disse modsætninger til at identificere en række implicitte antagelser blandt personalet på heroinklinikkerne om, hvad behandling er: Behandling er tæt knyttet til medicin og medicinske logikker, behandling kræver en aktiv indsats fra brugernes side, og endelig må behandling helst ikke må være for nydelsesfuldt for brugerne. Søgeord: misbrugsbehandling, heroin, nydelse, rus, medikalisering, normalisering &nbsp

Transkulturel psykiatri - psykiatriens forståelse af det kulturelt anderledes

I artiklen argumenteres der for, at psykiatriens opfattelse af kultur og af relationen mellem kultur og sygdom er forankret i en tænkemåde, der strækker sig over 100 år tilbage i tiden til en tid med kolonialismen, hvor synet på den kulturelt anderledes var domineret af racetænkning og evolutionisme. Dette har betydet, at forsøg på at introducere en mere kompleks og dynamisk kulturforståelse i psykiatrien er mislykkedes, på trods af, at forskellige større forskningsprojekter har påpeget behovet af en mere tidssvarende og videnskabelig valid kulturopfattelse. I artiklen illustreres dels nogle af de tænkemåder, som psykiatrien trækker på samt nogle af de forskningsprojekter, der har illustreret behovet for en nytænkning af kultur og relationen mellem kultur og psykisk sygdom i psykiatrien

ET ANTROPOLOGISK BLIK PÅ PSYKIATRISK SYGDOMSOPFATTELSE: Sociale og kulturelle aspekter af en sygdomsmodel for skizofreni

This article is about the cultural perception of schizophrenia among psychiatric staff in Denmark. The author argues that it is possible to identify a shared and coherent perception of the disease among the staff and illustrates this by introducing and discussing the theoretical concept of disease models. It is further is argued that the field of psychiatry is a pertinent environment for identifying a disease model among staff. After surveying a number of other studies, the disease model of schizophrenia is presented. It is a model where medicine and behaviour play dominant roles and where concepts of stability and chronicity are the major characteristics of the disease. Furthermore, the author presents a discussion on how the psychiatric staff seems to comprise the dominant social group in the psychiatric wards and therefore plays the major role in determining treatment &nbsp

DER ER TO I ET MØDE: Perspektiver på kulturmødet fra psykiatrien

The psychiatric treatment system in Denmark is one of the institutions where the meeting with the ethnic Other has gained increased attention in the last couple of years. Even though this is being spoken of as a meeting, focus is normally only on the ethnic patients, their culture, and the problems staff experience when working with this group of patients. Doing anthropological research in the Danish psychiatric system, makes it obvious, however, that the psychiatric system itself plays an important part in the meeting. Psychiatry has its own way of understanding what culture is, and its own way of framing how culture can be talked about. Using a modern, relational concept of culture I will show how the psychiatric departments can be perceived as producing their own culture and that this culture plays an important part in how patients with another ethnic background than Danish are perceived. Patients who are perceived as ethnic are often patients that psychiatry finds it difficult to treat, either because the technology of treatment is not suited to this group of patients, or due to the way psychiatry perceives the relation between psychiatric disorder and culture

Psykisk Sundhedsarbejde og Politik

Psykisk Sundhedsarbejde og Politi

SYMPTOMER OG SOCIALITET: Interview med Dorte Effersøe Gannik

Dorte Effersøe Gannik’s book Social Theory of Disease: A Situational Perspective is the revised version of her doctoral thesis in medical sociology. In the book, Gannik uses empirical research on backaches to construct a general sociological theory of disease. In this interview with Jansbøl and Johansen, Gannik primarily talks about the theoretical aspects of her work. Gannik’s theory of disease helps us reach a more precise understanding of connections between the two complex entities “disease” and “the social”. Gannik claims that disease is far more socially embedded than the health sector thus far has acknowledged, and she points out that factors outside of the health sector determine whether or not a person interprets some kind of physical discomfort as a symptom of disease severe enough to seek medical attention for. Even after a person has been transformed into a patient, many of his or her symptom-related actions are still more often determined by conditions in the home, at work, or among friends than it is by strictly medical matters. Gannik claims that the health sector hitherto has had an inadequate understanding of disease, because its spokespersons have defined it as a fundamentally biological entity which is largely unaffected by social conditions. In contrast, Gannik argues that disease can only be properly understood if one seriously takes into consideration the social lives of patients, inside the health sector, as well as outside it. &nbsp

Reform eller stabilitet?

Artiklens formål er at identificere, analysere og diskutere udviklingen af velfærdsrationa- lerne i de nationale politikker, der i perioden 2009-2019 er offentliggjort som politiske bud på at styre og forandre det psykiatriske område i Danmark. I lyset af Bacchis tilgang til analyse af politiske velfærdsrationaler undersøges de tre elementer, som tilsammen kon- stituerer rationalerne i politikkerne i perioden: 1) De generiske måder hvorpå målgrup- pen beskrives i perioden, 2) de politiske redskaber der foreslås til at forandre og håndtere målgruppen i perioden og 3) de begrundelser der bruges i politikkerne til at legitimere indsatserne gennem perioden. Målgruppen repræsenteres som risikable, syge, sårbare, om- kostningsfulde og i særlige tilfælde farlige og komplekse. Repræsentationen danner grund- lag for en betoning af civilsamfundets ansvar, frivillighed recovery og forebyggelse, mens fremstillingen af de farlige og komplekse lægger op til øget brug af tvang. Velfærdsrationa- lerne i perioden afspejler, at majoriteten af målgruppen frivilligt forventes at påtage sig rollen som risikabel, sårbar og psykisk syg og deltage i de beskrevne tiltag for ikke at belaste velfærdsstaten. Trods en politisk ambition om en omfattende reform af det psykiatriske område, der imødekommer udfordringer som stigmatisering, umyndiggørelse og ulighed i sundhed, reflekterer politikkerne i stigende grad, at staten er villig til at fratage hele eller dele af ikke-frivilligt-deltagende og farlige personers selvbestemmelse igennem perioden. Derved repræsenterer politikkernes velfærdsrationaler ikke et bud på en radikal ændring af psykiatriens struktur, organisering og funktion. I stedet har de sidste ti års velfærdspolitik- ker stabiliseret paradigmet i det eksisterende system, snarere end at radikalt reformere det

Self, substance, and society: Ethnographic explorations of addiction

The article explores the role of addictive substances, and how they constitute the experience of pleasure and categories of addictions (Garriott & Raikhel 2015). In two separate studies, one of the users in heroin-assisted treatment of addiction in Denmark and the other of consumers’ food perceptions, we became interested in the roles played by the addictive substance and the concept of addiction – as a cultural category with social, moral, and political significance (Keane 2002) – among our informants. More specifically, we focused on how pleasure is constrained, made, or enacted in societal responses and treatment practices by comparing the case of heroin and sugar. The juxtaposition of the two types of addiction serves to illustrate the relationship between a specific substance, cultural categories, and responses.Analysis focuses on the interplay between the addict, the substance, social networks, and institutions. We argue that both the addict as a subject and the effect of the addictive substance are produced by a network of actors, experiences, moral values, societal institutions, and public discourses. The two cases show the importance of attending to substance effect in this context, and to variations in a single cultural setting – ultimately demonstrating that substance use and the experience of pleasure are not simply matters of choice but rather results of embodied conditioning, whereby social forces constrain the experience of pleasure. In both cases, recovery becomes a means of finding what is perceived to be one’s inner core in a society marked by industrial interference and artificiality, manifested in – among many other objects – certain chemical substances. In some situations, however, by regaining some degree of autonomy and by getting in touch with one’s “inner core” the substance becomes a possible actant for the enjoyment of pleasureThe article explores the role of addictive substances, and how they constitute the experience of pleasure and categories of addictions (Garriott & Raikhel 2015). In two separate studies, one of the users in heroin-assisted treatment of addiction in Denmark and the other of consumers’ food perceptions, we became interested in the roles played by the addictive substance and the concept of addiction – as a cultural category with social, moral, and political significance (Keane 2002) – among our informants. More specifically, we focused on how pleasure is constrained, made, or enacted in societal responses and treatment practices by comparing the case of heroin and sugar. The juxtaposition of the two types of addiction serves to illustrate the relationship between a specific substance, cultural categories, and responses.Analysis focuses on the interplay between the addict, the substance, social networks, and institutions. We argue that both the addict as a subject and the effect of the addictive substance are produced by a network of actors, experiences, moral values, societal institutions, and public discourses. The two cases show the importance of attending to substance effect in this context, and to variations in a single cultural setting – ultimately demonstrating that substance use and the experience of pleasure are not simply matters of choice but rather results of embodied conditioning, whereby social forces constrain the experience of pleasure. In both cases, recovery becomes a means of finding what is perceived to be one’s inner core in a society marked by industrial interference and artificiality, manifested in – among many other objects – certain chemical substances. In some situations, however, by regaining some degree of autonomy and by getting in touch with one’s “inner core” the substance becomes a possible actant for the enjoyment of pleasur

SPÆNDINGSFELTET MELLEM DYNAMIK OG STABILITET

Udvikling og behandling af mennesker med sindslidelser i det danske velfærdssamfund Mennesker med alvorlige sindslidelser hører til blandt nogle af de mest udsattemennesker i vores velfærdssamfund, og der findes i dag omfattende indsatser rettetmod denne gruppe. Forandringer i velfærdssamfundet har derfor direkte betydningfor disse mennesker – det gælder også skiftet fra en stat, der fokuserer på at skabestabilitet, til en stat, der har fokus på at fremme konkurrence og dynamik. Baseretpå empirisk materiale fra to forskellige psykiatriske institutioner argumenterer vifor, at skiftet fra velfærdsstat til konkurrencestat har betydet en ændring i spændingsfeltetstabilitet-dynamik for disse mennesker. Vi argumenterer i artiklen146for, at et centralt forhold ved de udviklings- og dokumentationsredskaber, somman arbejder med i psykiatrien og socialpsykiatrien i dag, er, at de observerer ogbeskriver patienternes/beboernes liv og væren stadig mere detaljeret for på dennemåde at kunne dokumentere den ønskede forandring. Det har de konsekvenser, atmedarbejdernes arbejde bliver meget styret, og at rum til refleksion formindskes.Samtidig risikerer sindslidendes ønsker om stabilitet at blive tilsidesat til fordel foren præference for en særlig slags dynamisk udvikling, som er vanskeligt for demat efterleve. Derfor foreslår vi afslutningsvis, at begrebsparret dynamik-stabilitetinddrages som analytisk opmærksomhedspunkt i fremtidige undersøgelser afvelfærdssamfundet.Søgeord: psykiatri, socialt arbejde