UNISA Institute for Social and Health Sciences, P.O. Box 1087, Lenasia, 1820, South Africa.
Department of Psychology, University of the Witwatersrand, Johannesburg, South Africa.
Cult Med Psychiatry. 2023 Dec;47(4):857-877. doi: 10.1007/s11013-022-09809-x. Epub 2022 Nov 8.
In 2014, the United Nations Convention on the Rights of Disabilities adopted recommendations advising the replacement of involuntary care with supported care. This has polarised many about how best to provide for People living with Mental Conditions (PLPCs). Notwithstanding the contentions of this debate, we find on a personal discursive level that involuntary care is concealed as a self-evident and unquestionable response to the treatment of PLPCs. This can mean that policy-makers and professionals reproduce approaches to PLPCs uncritically. Considering these complexities, we used Critical Discourse Analysis (CDA) to examine what current norms surround involuntary care in the South African psy-complex, and how these are reproduced. We interviewed nine members of the South African psy-complex, including review board members, psychologists, and psychiatrists, and found several discourses maintaining current psychiatric norms. These include biomedical and techno-disciplinary discourses of treatment, clinico-legal disciplinary and danger discourses, and paternalistic discourses of institutional care. Each of these uniquely highlights the ways in which involuntary care is maintained and normalised, revealing that careful consideration is required to prevent potential human rights violations on behalf of professionals and policy-makers, regardless of whether in involuntary or support paradigms.
2014 年,《联合国残疾人权利公约》通过了建议,建议用支持性护理取代非自愿护理。这在如何最好地为精神障碍患者(PLPC)提供服务方面引起了许多争议。尽管存在这种争论,但我们在个人话语层面发现,非自愿护理被掩盖为对 PLPC 治疗的不言而喻和不容置疑的回应。这可能意味着政策制定者和专业人员不加批判地复制对 PLPC 的处理方法。考虑到这些复杂性,我们使用批评性话语分析(CDA)来研究南非心理复合体中非自愿护理的当前规范以及这些规范是如何复制的。我们采访了南非心理复合体的九名成员,包括审查委员会成员、心理学家和精神病学家,发现了一些维持当前精神病学规范的话语。这些包括治疗的生物医学和技术学科话语、临床法律纪律和危险话语,以及机构护理的家长式话语。这些话语各自独特地突出了维持和规范非自愿护理的方式,揭示了无论在非自愿或支持模式下,专业人员和政策制定者都需要谨慎考虑,以防止潜在的侵犯人权行为。