A Discourse Analysis of Self-management for Bipolar Disorder

In line with a movement across all areas of health concerned with chronic illness, self-management practices have become an important part of what it means to provide contemporary mental health care to people with the psychiatric diagnosis of bipolar disorder. In mental health settings it is a taken-for-granted practice. The aim of this thesis is to use Foucauldian Discourse Analysis to explore how the discursive practices of self-management for bipolar disorder produce particular forms of subjectivity for those understood to have the condition and the implications of this for processes of self-formation. In order to consider how discourse is used to both govern others and govern the self, two sources of text are used for analysis. The first source is the Psychoeducation Manual for Bipolar Disorder (Colom & Vieta, 2006) which details how mental health professionals can teach people with bipolar disorder about their condition in order that they might better manage themselves. The questions guiding the analysis of this text as how discourse constructs bipolar as an object, what subject positions it makes available and what relationship people are expected to have with the object named as bipolar disorder. The second source of text are the transcripts of semi-structured interviews completed with 25 people with bipolar disorder as part of their entry to a clinical trial of psychotherapy and medication management as a means to reduce rates of acute psychiatric assessment and hospitalization. Analysis of these texts is concerned with how discourse is used to govern the self and is developed in a two stage process. The analysis is guided firstly by questions that ask how bipolar disorder is constructed, how is self-management constructed as an object, how is life with bipolar disorder constructed and what discourses are drawn on the process. The second stage of analysis of these texts focuses on the subject positions being made available in self-management discourse. This analysis finds that as an object, bipolar disorder is constructed as both an illness of the brain and an object the produces an unreliable mind such that it is an object that is separate from a person’s sense of self while also being an object that interferes with the mind’s capacity to know itself. This results in persistent tensions to be negotiated within self-management practices such that self-management discourse produces subject positions characterised by dividing practices and contradiction. The discourses of medicine and psychology can be seen to act to tightly regulate how bipolar disorder can be understood which results in all aspects of a person’s self being shaped by the condition they are understood have. These discourses have become the only way a person can legitimately construct a sense of themselves and through the workings of pastoral styles of power relationships psychological discourse can be seen to be used ultimately in the service of medical discourse. With self-management discourse seen as operating on the basis of division and contradiction, this thesis proposes that the nature of the problem in the self-management of bipolar disorder is not the disorder or the person it is understood to inhabit but rather the norms of the self on which contemporary Western society bases its understanding of what it means to be a normal subject. The thesis concludes firstly with two alternate constructions of selfhood; the self as formed through connection and the self as formed through the management of the abject and then with a proposal for an alternate approach to psychoeducation as a particular strategy of self-management discourse for bipolar disorder. The significance of this thesis lies in its use of a Foucauldian methodology to question the assumptions of beneficence understood to drive the promulgation of self-management practices in health care. Its resulting re-evaluation of the nature of the self in the discursive practices of self-management for bipolar disorder and its proposal for an alternate approach to psychoeducation is put forward as a contribution to the project of a contemporary critical psychiatry

Health professional perspectives on translation of cultural safety concepts into practice: A scoping study

People from unique and diverse populations, (i.e., social groupings excluded by the dominant majority by, for example, ethnicity, gender, age, sexual orientation, disability or even rurality), experience dissimilar health outcomes. Members of such populations who have long-term health conditions experience further health disparities through inefficient management and treatment. This remains a significant hindrance to achieving equity in health outcomes. Being responsive and acting upon the cultural needs of unique and diverse populations within health services is pivotal in addressing health disparities. Despite provision of professional training to health professionals, cultural competency remains an elusive goal. This scoping study summarized available literature about what helped health professionals translate cultural safety concepts into practice. We searched electronic databases using MeSH terms and keywords for English language articles and reference lists of potentially included studies. Quality appraisal was undertaken using Joanna Briggs Institute critical appraisal tools. Data were charted, with a descriptive numerical summary and thematic analysis of study findings undertaken. Twelve qualitative studies with n = 206 participants were included. Learning through and from direct experience, and the individual qualities of professionals (i.e., individual capacity for relational skills and intentionality of engagement with one's own values and biases) facilitated translation of cultural safety concepts into practice. Also important was the need for cultural training interventions to address both issues of content and process within course design. Doing this would take into consideration the benefits that can come from learning as a part of a collective. In each of these themes was evidence of how health professionals needed the ability to manage emotional discomfort as part of the process of learning. A dearth of information exists exploring professionals' perspectives on translating cultural safety concepts into practice. There may be merit in designing educational interventions that look beyond the classroom. We also suggest that nurturing people's relational skills likely holds benefits to growing culturally safe practice as does increasing health professional's capacity to sit with the discomfort that occurs when paying attention to one's own and others values and biases

Traumatic imagery following glucocorticoid administration in earthquake-related post-traumatic stress disorder: A preliminary functional magnetic resonance imaging study

OBJECTIVE: Post-traumatic stress disorder involves excessive retrieval of traumatic memories. Glucocorticoids impair declarative memory retrieval. This preliminary study examined the effect of acute hydrocortisone administration on brain activation in individuals with earthquake-related post-traumatic stress disorder compared with earthquake-exposed healthy individuals, during retrieval of traumatic memories. METHOD: Participants exposed to earthquakes with ( n = 11) and without post-traumatic stress disorder ( n = 11) underwent two functional magnetic resonance imaging scans, 1-week apart, in a double-blind, placebo-controlled, counter-balanced design. On one occasion, they received oral hydrocortisone (20 mg), and on the other, placebo, 1 hour before scanning. Symptom provocation involved script-driven imagery (traumatic and neutral scripts) and measures of self-reported anxiety. RESULTS: Arterial spin labelling showed that both post-traumatic stress disorder and trauma-exposed controls had significantly reduced cerebral blood flow in response to retrieval of traumatic versus neutral memories in the right hippocampus, parahippocampal gyrus, calcarine sulcus, middle and superior temporal gyrus, posterior cingulate, Heschl's gyrus, inferior parietal lobule, angular gyrus, middle occipital gyrus, supramarginal gyrus, lingual gyrus and cuneus, and the left prefrontal cortex. Hydrocortisone resulted in non-significant trends of increasing subjective distress and reduced regional cerebral blood flow in the left inferior frontal gyrus, left anterior cingulate gyrus, middle temporal gyrus, cerebellum, postcentral gyrus and right frontal pole, during the trauma script. CONCLUSION: Findings do not fit with some aspects of the accepted neurocircuitry model of post-traumatic stress disorder, i.e., failure of the medial prefrontal cortex to quieten hyperresponsive amygdala activity, and the potential therapeutic benefits of hydrocortisone. They do, however, provide further evidence that exposure to earthquake trauma, regardless of whether post-traumatic stress disorder eventuates, impacts brain activity and highlights the importance of inclusion of trauma-exposed comparisons in studies of post-traumatic stress disorder

A Discourse Analysis of Self-management for Bipolar Disorder

In line with a movement across all areas of health concerned with chronic illness, self-management practices have become an important part of what it means to provide contemporary mental health care to people with the psychiatric diagnosis of bipolar disorder. In mental health settings it is a taken-for-granted practice. The aim of this thesis is to use Foucauldian Discourse Analysis to explore how the discursive practices of self-management for bipolar disorder produce particular forms of subjectivity for those understood to have the condition and the implications of this for processes of self-formation. In order to consider how discourse is used to both govern others and govern the self, two sources of text are used for analysis. The first source is the Psychoeducation Manual for Bipolar Disorder (Colom & Vieta, 2006) which details how mental health professionals can teach people with bipolar disorder about their condition in order that they might better manage themselves. The questions guiding the analysis of this text as how discourse constructs bipolar as an object, what subject positions it makes available and what relationship people are expected to have with the object named as bipolar disorder. The second source of text are the transcripts of semi-structured interviews completed with 25 people with bipolar disorder as part of their entry to a clinical trial of psychotherapy and medication management as a means to reduce rates of acute psychiatric assessment and hospitalization. Analysis of these texts is concerned with how discourse is used to govern the self and is developed in a two stage process. The analysis is guided firstly by questions that ask how bipolar disorder is constructed, how is self-management constructed as an object, how is life with bipolar disorder constructed and what discourses are drawn on the process. The second stage of analysis of these texts focuses on the subject positions being made available in self-management discourse. This analysis finds that as an object, bipolar disorder is constructed as both an illness of the brain and an object the produces an unreliable mind such that it is an object that is separate from a person’s sense of self while also being an object that interferes with the mind’s capacity to know itself. This results in persistent tensions to be negotiated within self-management practices such that self-management discourse produces subject positions characterised by dividing practices and contradiction. The discourses of medicine and psychology can be seen to act to tightly regulate how bipolar disorder can be understood which results in all aspects of a person’s self being shaped by the condition they are understood have. These discourses have become the only way a person can legitimately construct a sense of themselves and through the workings of pastoral styles of power relationships psychological discourse can be seen to be used ultimately in the service of medical discourse. With self-management discourse seen as operating on the basis of division and contradiction, this thesis proposes that the nature of the problem in the self-management of bipolar disorder is not the disorder or the person it is understood to inhabit but rather the norms of the self on which contemporary Western society bases its understanding of what it means to be a normal subject. The thesis concludes firstly with two alternate constructions of selfhood; the self as formed through connection and the self as formed through the management of the abject and then with a proposal for an alternate approach to psychoeducation as a particular strategy of self-management discourse for bipolar disorder. The significance of this thesis lies in its use of a Foucauldian methodology to question the assumptions of beneficence understood to drive the promulgation of self-management practices in health care. Its resulting re-evaluation of the nature of the self in the discursive practices of self-management for bipolar disorder and its proposal for an alternate approach to psychoeducation is put forward as a contribution to the project of a contemporary critical psychiatry

Australian and New Zealand Nurses: Social and Emotional Attributes and Work Engagement

The COVID-19 pandemic presented significant job engagement challenges for the nursing workforce with increased pressures and workplace changes. Nursing staff shortages have increased nurse anxiety, burnout, fear, low morale and intentions to leave the profession. Nursing care is inherently stressful and at times complex, with stress often due to work inconsistencies, a lack of role clarity, workloads and time pressures. This study explores nurses job engagement, by looking specifically at nurses social-emotional attributes – Occupational Commitment, Self-efficacy Beliefs, Collective Efficacy Beliefs, Resilience, Adaptability and Emotional Labour. This protocol describes a mixed methods convergent parallel study, incorporating a survey questionnaire. The survey comprised of quantitative and qualitative questions, with data collected simultaneously, analysed separately, and integrated in the final analysis step. The survey design used validated social-emotional items, sorting and ranking questions and short answer responses. Analysis will involve individual and comparative analysis of the two participants groups, they are: Australian nurses ( n = 86) and New Zealand Nurses ( n = 275). Data collection was conducted during two different time periods – Australian pilot (2020-21) and in New Zealand (2022–2023). Recruitment involved the use of professional and personal nursing networks, newsletters and social media communications. Ethics approval was obtained through participating universities in both countries. Results will be disseminated through peer-reviewed publications, conferences, blogs, newsletters and reports to nursing networks. The study will provide valuable insights into nurses’ social-emotional attributes and the role they play in job engagement