Angie Hart

The digital divide, health information and everyday life

Survey data confirms that health information is very popular with internet users yet relatively little qualitative social science research has been conducted about how people incorporate information from the internet into their everyday information practices. This article reports on an empirical study of the role of the internet in people’s efforts to inform themselves about menopause and hormone replacement therapy (HRT) in the case of women, and erectile dysfunction and Viagra in the case of men. These experiences are used to interrogate the notion of the ‘digital divide’. We develop the concept of access to incorporate not only physical connection and information literacy, but also gendered and generational social relations. We also develop Barkardjieva’s concept of the ‘warm expert’ to draw attention to the different types of information that people need in order to make sense of generic medical information that is relevant to their own circumstances.

Staying in the ‘sweet spot’: A resilience-based analysis of the lived experience of low-risk drinking and abstention among British youth

Objective: The aim of this study was to understand how and why young people drink less or not at all when with their peers. Understanding the subjective experiences of moderate or non-drinkers may help identify protective processes facilitating resilience to cultural norm and influences that encourage excessive alcohol consumption among young people. Design: Semi-structured interviews were conducted with 25 moderate- or non-drinkers aged 17–25 years (13 young women) living in South East England. Interviews explored recent experiences of social situations and encounters that did or did not involve alcohol. Transcripts were analysed using Interpretative Phenomenological Analysis. Results: Analysis identified six conceptually coherent themes clustering within a superordinate theme of a healthy experience of moderate alcohol use or abstention: ‘the sweet spot’. These themes were: feeling good in the body, feeling like you can be who you are, feeling like you belong, making a free choice, enjoying the moment, and feeling safe and secure. Conclusions: This resilience-based analysis showed how non-drinking and moderate-drinking may be experienced as a positive and proactive choice. Understanding the subjective experiences of young people may aid development of specific, realistic interventions to promote moderate drinking and abstention among young people in drinking cultures.

Ethical Issues in Obtaining Informed Consent for Research from Those Recovering from Acute Mental Health Problems: A Commentary

This study appeared in full in the last issue of Research Ethics Review (2007; 3 (3): 91). It concerned the ethical review of a qualitative research study in which the participants are recovering from acute mental health problems. Debate focussed on the issue of how informed consent was to be obtained.

Core Principles and Therapeutic Objectives for Therapy with Adoptive and Permanent Foster Families

Angie Hart and Barry Luckock provide an organising framework for integrated practice decision-making in specialist therapy with adoptive and permanent foster families. The framework is located in current available insights from theory and evidence from empirical research, personal therapeutic practice and family life. The authors formulate an initial case example and use it to illustrate their approach throughout as it demonstrates the distinctiveness of adoptive and permanent foster family life. The paper then outlines a set of core principles and objectives in relation to which therapy for these families should be planned.

Factors facilitating effective use of electronic patient record systems for clinical audit and research in the UK maternity services

Purpose – This paper examines the factors that made services more or less effective in using electronic patient record systems to produce clinical information for clinical audit and research. Design/methodology/approach – Case studies of the use of electronic patient record systems in three maternity services in England, using qualitative research methods (semi-structured interviews, observations and shadowing). Findings – There were many contributing factors in each case site. The three main groups of determining factors were these: the resources devoted to, and acceptability to midwives of, the “IT midwife”; maternity managers prioritisation of information related matters; the relationship of maternity information systems with Trust-wide systems. Originality/value – Provides services with lists of factors they need to consider if they want to maximise the benefits realised for clinical audit and research from existing and new electronic patient record systems.

Building a New Community Psychology of Mental Health

This book provides a much-needed account of informal community-based approaches to working with mental distress. It starts from the premise that contemporary mainstream psychiatry and psychology struggle to capture how distress results from complex embodied arrays of social experiences that are embedded within specific historical, cultural, political and economic settings. The authors challenge mainstream understandings of mental health that position a naive public in need of mental health literacy. Instead it is clear that a considerable amount of invaluable mental distress work is undertaken in spaces in our communities that are not understood as mental health treatments. This book represents one of the first attempts to position these kinds of spaces at the center of how we understand and address problems of mental distress and suffering. The chapters draw on case studies from the UK and abroad to point toward an exciting new paradigm based on informal community and socially oriented approaches to mental health. Written in an unusually accessible and engaging style, this book will appeal to social science students, academics, practitioners and policy makers interested in community and social approaches to mental health.

Some Possible Directions for the Future

When we were children watching the various James Bond movies that repeatedly played on our televisions over the years, we were struck by a thought. The same thought each time. This was the case whether it was Max Zorin seeking to trigger an earthquake to flood silicon valley in order to take over the world microchip market (A View to a Kill, for those interested), Hugo Drax seeking to destroy all life on earth (Moonraker) or Stromberg pursuing his nuclear missile launch to destroy Moscow and New York City and hence triggering a global nuclear war (he would survive in an underwater sea empire of course). The same thought occurred—if they’d only been a little more modest in their aims, then there was a fair chance that their outcomes might have been a little more favourable. We can’t say in all honesty that James Bond was at the heart of our epistemological reflections when we sat down to write this book but what has become clear, now that we are at the end looking back, is that we never set out with the intention to ‘James Bond’ the world of mental health. Indeed our aims were far more modest and there are a number of reasons for this.

The Joy of Sex

Meet John. His story is an amalgamation of the insights we’ve got from a number of people one of us has interviewed over the years for various different projects related to sex. He’s just come back from a hippy tantra festival overseas. He thought it might help him with his porn addiction. He doesn’t call his problem a porn addiction, but like many men in the UK, if even conservative estimates are anything to go by, he’s addicted alright.

‘Helping Them Hold Up Their World’—Parents of Children with Complex Needs and the Beneficent Organisation

In a lovely article on many of the inherent contradictions of being a clinical psychologist, David Smail (1) said that ‘we cannot escape the clinic’. When it comes to helping people experiencing mental distress, it would be a callous society that stood back and offered them nothing on the presumption that, as Charles Waldegrave points out, therapy is little more than making poor people feel a bit better about themselves (2). Perhaps the problem however is not with therapy per se but with what therapy has become. The therapeutic relationship, when understood as an instance of ordinary humanity and as a source of solidarity can be eminently valuable. When it is treated as a technology of change with a progressive emphasis on what’s inside people’s heads, and that culminates in people becoming patients schooled to bear responsibility for circumstances beyond their control, then it loses its value (1). If we pare back the therapeutic process to understand Roger’s unconditional positive regard and empathy not as tools to achieve change but as an end in and of themselves, and where compassion rather than change becomes the overriding impulse, it allows us to see just how many other sites of social solidarity, compassion and humanity can be understood within this broader care framework. This is because empathy, support, positive regard and compassion can be delivered in most places, by most people.

I’m Singing in the Rain

Eddie, a 65 year old male diagnosed with ‘High Functioning Autism Spectrum Disorder’ sits alone on a park bench. Staring at the masses of people walking through, and playing, in Central Park, New York, he reflects on how all of his life Eddie has struggled to relate to people and the world outside. Here he sits, the noise of the yellow taxis, the subway, people shouting, laughing, crying; the noise, Eddie needs an escape and he needs it quickly. People not understanding Eddie has been a source of sadness for him his entire life, but when last week he was arrested under the ‘Homeland Security Act’ for monitoring and recording planes flying in and out of John F Kennedy Airport to establish the exact levels of CO2 clouding the New York air, something changed for Eddie. No longer could he go on unable to understand the people around him, knowing they will never fully understand him. Thinking back Eddie could see this moment coming for a long time, it was a time bomb waiting to go off. But now it was real, Eddie looked up one last time to see the chaos in front of him and put his hand in his pocket, he pulled out the Citalopram pills he had been stockpiling in his bedsit, along with some Citalopram oral solution to wash down the tablets. Ironically perhaps, a means to help Eddie through this suffering has been right under society’s nose all along.