This article offers a comprehensive critical review of the most popular theoretical accounts on the recent processes of deinstitutionalization and reform of mental health services and their possible underlying factors, focusing in the sharp contrast between the straightforward ideas and models maintained by mainstream psychiatry and the different interpretations delivered by authors coming from the social sciences or applying conceptual tools stemming from diverse social theories. Since all these appraisals tend to illuminate only some aspects of the process while obscuring (...) others, or do not fit at all with some important points of the actual changes, it is concluded that the quest for an adequate explanation is far from having been completed. Finally, some methodological and conceptual strategies for a renewed theoretical understanding of these significant transformations are also briefly discussed, including a comprehensive empirical evaluation of the facts, the consideration of the shifting social values and needs involved in mental health care provision and the historical analysis of deinstitutionalization policies within the framework of the broader social and cultural trends of the decades following World War II. (shrink)

This paper examines the ethical dimensions of the closure process of an English large long-stay institution for people with learning difficulties during the last quarter of the twentieth century. It does this primarily through an analysis of oral historical interview data stemming from those managers who implemented rundown. The paper illustrates the ways in which their testimonies indicate the presence of a morally infused dominant rhetoric, which was based upon the therapeutic benefits of closure, informed by the ideas of normalisation (...) and social role valorisation. However, the paper argues that this principled managerial perspective had unfortunate ethical consequences, in that it under-acknowledged, marginalised and discredited staff viewpoints which raised pertinent issues relating to the downsizing of this particular hospital. (shrink)

Although it is widely acknowledged that Foucault’s accounts of the concept of heterotopia remain briefly sketched and somewhat confusing, the notion has provoked many interpretations and applications across a range of disciplines. In particular, it has been coupled with different stages or processes of modernity and persistently linked to forms of resistance. This article re-examines Foucault’s concept through a close textual analysis. It contrasts heterotopia with Lefebvre’s conceptualization of heterotopy and wider formulations of utopia. Drawing on Foucault’s study of the (...) spaces of literature of Borges, and particularly Blanchot, the article argues that heterotopia refers to varied spatial and temporal disruptions that imaginatively interrogate and undermine certain formulations of utopia. It concludes by outlining how heterotopia contests the space in which we live. (shrink)

The “patient perspective” serves as an analytical tool to present patients as knowing subjects in research, rather than as objects known by medicine. This paper analyses problems encountered with the concept of the patient perspective as applied to long-term mental health care. One problem is that “having a perspective” requires a perception of oneself as an individual and the ability to represent one’s individual situation in language; this excludes from research patients who do not express themselves verbally. Another problem is (...) that the idea of “talk” as a representation of the world ignores the fact that talk is also performative in the world: it requires, at least, the ability to deal with an interview situation. To think up alternative ways of including patients as subjects in research, I develop an approach that takes this performativity as a starting point. Analysing practical situations and activities, I argue that patients enact appreciations, making known what they like or dislike by verbal or non-verbal means in a given material environment, in situations that are co-produced by others. Thus, subjectivity is linked to situations and interactions, rather than just to individual characteristics; to “patient positions,” rather than “patient perspectives.”. (shrink)

A feminist ethics that bases morality on dependence or vulnerability challenges the moral priority of uniform over disparate treatment. Persons with disabilities resist equality's homogenization of moral personhood. But displacing equality in favor of caring or trust reprises the repression of those already marginalized. The ethics of difference proves an ineffective remedy for the negative consequences attendant on how historically marginalized groups are different. An historicized conception of equality resolves the dilemma.

This paper examines the prevalence of the ideal of “independence” in intellectual disability care in the Netherlands. It responds to a number of scholars who have interrogated this ideal through the lens of Michel Foucault’s vocabulary of governmentality. Such analyses hold that the goal of “becoming independent” subjects people with intellectual disabilities to various constraints and limitations that ensure their continued oppression. As a result, these authors contend, the commitment to the ideal of “independence” – the “ethic of autonomy” – (...) actually threatens to become an obstacle to flourishing in the group home. This paper offers an alternative analysis. It does so by drawing on a case study taken from an ethnographic study on group home life in the Netherlands. Briefly put, the disagreement stems from differing conceptualizations of moral life. Put in the vocabulary of moral anthropologist Cheryl Mattingly, the authors propose to approach the group home more from a “first-person” perspective rather than chiefly from a “third-person” perspective. They then draw on Mattingly to cast the group home as a “moral laboratory” in which the ethic of autonomy is not just reproduced but also enacted, and in which the terms of (in)dependence constantly get renegotiated in practice. What emerges is not only a new perspective on the workings of the “ethic of autonomy” in the group home, but also an argument about the possible limitations of the vocabulary of governmentality for analysing care practices. (shrink)

This paper describes the approach of empirical ethics, a form of ethics that integrates non-positivist ethnographic empirical research and philosophy. Empirical ethics as it is discussed here builds on the ‘empirical turn’ in epistemology. It radicalizes the relational approach that care ethics introduced to think about care between people by drawing in relations between people and technologies as things people relate to. Empirical ethics studies care practices by analysing their intra-normativity, or the ways of living together the actors within these (...) practices strive for or bring about as good practices. Different from care ethics, what care is and if it is good is not defined beforehand. A care practice may be contested by comparing it to alternative practices with different notions of good care. By contrasting practices as different ways of living together that are normatively oriented, suggestions for the best possible care may be argued for. Whether these suggestions will actually be put to practice is, however, again a relational question; new actors need to re-localize suggestions, to make them work in new practices and fit them in with local intra-normativities with their particular routines, material infrastructures, know-how and strivings. (shrink)

Charles Taylor argues that recognition begins with the politics of "self-image," as groups represented in the past by others in ways harmful to their own identity replace negative historical self-images with positive ones of their own making. Given the centrality of "self image" to his politics of recognition, it is striking that Taylor, himself, represents disabled people in language that is both limiting and depreciating. The author argues such negative self-images are not unique to Taylor but endemic to modern political (...) thought from John Locke to John Rawls, as the disabled are constituted in direct opposition to the rational person and/or citizen. Using contemporary social theories of disability, as articulated by disabled scholars and advocates, the author concludes that such negative self-images must be purged from political theory and replaced with an alternative theory of personhood/citizenship rooted in the image of interdependency. (shrink)