Benson Anne, Secker Jenny, Balfe Emma, Lipsedge Maurice, Robinson Sarah, Walker Julian
Florence Nightingale School of Nursing and Midwifery, King's College, London, UK.
Soc Sci Med. 2003 Sep;57(5):917-26. doi: 10.1016/s0277-9536(02)00460-4.
The English National Service Framework for Mental Health stipulates that the highest quality of health care should be provided for mental health service users in the most efficient and effective manner. Incidents of aggression and violence militate against achieving that goal, yet such incidents are frequently reported in inpatient settings. Traditionally, research in this area has focused on the extent of the phenomenon, the individual characteristics of those involved and precursors to the incident. For the most part the literature reflects a dualistic, perpetrator/victim conceptualisation of incidents. This study aimed to address the lack of research undertaken from a more systemic perspective by examining how all those involved understood and attributed meaning to violent or aggressive situations and how these attributions justified individual perceptions, reactions and actions. Working from the position that all behaviour, including violent behaviour, has meaning to those involved and can be understood, 16 semi-structured interviews were carried out in one mental health unit. Because only one client was both willing and able to give a full account of an incident, we focus here on two incidents in which that client was involved. Discourse analytic techniques were used to examine her account of the two incidents and those of the staff members involved. Participants discussed key themes from the interviews in terms of several dilemmas: whether the violent or aggressive behaviour was 'mad' or 'bad'; predictable or unpredictable; and had resulted from 'personality' or ' mental illness'. The client and staff discourses were strikingly similar and in each case the central concern was with the attribution of blame. The findings have implications for the professional discourse of mental health care, including the discourse of the current policy agenda, a discourse itself constructed with the primary function of exoneration from and attribution of blame.
英国国家精神健康服务框架规定，应以最高效、最有效的方式为精神健康服务使用者提供最高质量的医疗保健。攻击和暴力事件不利于实现这一目标，但此类事件在住院环境中却屡见不鲜。传统上，该领域的研究主要集中在这一现象的程度、相关人员的个体特征以及事件的先兆。在很大程度上，文献反映了对事件的二元化、肇事者/受害者概念化。本研究旨在通过考察所有相关人员如何理解暴力或攻击性行为并赋予其意义，以及这些归因如何证明个人的认知、反应和行为的合理性，从更系统的角度弥补研究的不足。基于所有行为，包括暴力行为，对相关人员都有意义且可以被理解这一观点，在一个精神健康单元进行了16次半结构化访谈。由于只有一名服务对象愿意并能够完整讲述一起事件，我们在此重点关注该服务对象参与的两起事件。运用话语分析技术来考察她对这两起事件的描述以及相关工作人员的描述。参与者围绕几个困境讨论了访谈中的关键主题：暴力或攻击性行为是“疯狂的 ”还是“恶劣的”；是可预测的还是不可预测的；以及是由“个性”还是“精神疾病”导致的。服务对象和工作人员的话语惊人地相似，在每一个案例中，核心关注点都是责任的归属。这些发现对精神卫生保健的专业话语有启示意义，包括当前政策议程的话语，这种话语本身的主要功能是免除责任和归咎责任。
