Alastair Morgan

A critical narrative analysis of shared decision-making in acute inpatient mental health care

ABSTRACT Shared decision-making (SDM) is a high priority in healthcare policy and is complementary to the recovery philosophy in mental health care. This agenda has been operationalised within the Values-Based Practice (VBP) framework, which offers a theoretical and practical model to promote democratic interprofessional approaches to decision-making. However, these are limited by a lack of recognition of the implications of power implicit within the mental health system. This study considers issues of power within the context of decision-making and examines to what extent decisions about patients’ care on acute in-patient wards are perceived to be shared. Focus groups were conducted with 46 mental health professionals, service users, and carers. The data were analysed using the framework of critical narrative analysis (CNA). The findings of the study suggested each group constructed different identity positions, which placed them as inside or outside of the decision-making process. This reflected their view of themselves as best placed to influence a decision on behalf of the service user. In conclusion, the discourse of VBP and SDM needs to take account of how differentials of power and the positioning of speakers affect the context in which decisions take place.

Schizophrenia, reification and deadened life

Recent debates concerning the abolition of the schizophrenia label in psychiatry have focused upon problems with the scientific status of the concept. In this article, I argue that rather than attacking schizophrenia for its lack of scientific validity, we should focus on the conceptual history of this label. I reconstruct a specific tradition when exploring the conceptual history of schizophrenia. This is the concern with the question of the sense of life itself, conducted through the confrontation with schizophrenia as a form of life that does not live, or as Robert Jay Lifton termed it ‘lifeless life’ (1979: 222—39). I conclude by arguing that the contemporary attempt to deconstruct or abolish the schizophrenia concept involves a fundamental shift in concern. The attempt both to normalize psychotic experiences, and to conceive them purely in terms of cognitive processes that can be mapped onto brain function, results in a fundamental move away from the attempt to understand the experience of madness.

The ‘living entity’ Reification and forgetting

In his attempt at a renewal of the concept of reification, Axel Honneth has referred to reification as a kind of forgetting. He uses an epigraph from Adorno and Horkheimer’s work to introduce this theme. This article considers the different accounts that are given by Honneth, on the one hand, and Adorno and Horkheimer, on the other, as to the way that reification is a forgetting of core experiential capacities of intersubjective human relations. It argues that Honneth’s account relies too much on a foundational and undifferentiated notion of ‘empathetic engagement’, and that in order to articulate the damage done by reification, we need to contend with the more radical notion of forgetting that is outlined in Adorno and Horkheimer’s work.

Mere Life, Damaged Life and Ephemeral Life. Adorno and the concept of life.

Abstract This paper analyses three concepts of life in Adornos philosophy and considers the relationship between these concepts and the idea of a speculative materialism. The paper is concerned with Adornos late concept of metaphysical experience and articulates a response to two key problems for the interpretation of this concept. First, given Adornos emphasis on a purely negative philosophy, how does transcendence arise? Second, how can we give an experiential content to this idea of transcendence? A response to these two questions is configured through an analysis of three concepts of life; mere life, damaged life and ephemeral life.