Background:To better understand the kinds of ethical challenges that emerge when using coercion in mental healthcare, and the importance of these ethical challenges, this article presents a systematic review of scientific literature.Methods:A systematic search in the databases MEDLINE, PsychInfo, Cinahl, Sociologicals and Web of Knowledge was carried out. The search terms derived from the population, intervention, comparison/setting and outcome. A total of 22 studies were included.Ethical considerations:The review is conducted according to the Vancouver Protocol.Results:There are few studies that study ethical (...) challenges when using coercion in an explicit way. However, promoting the patient’s best interest is the most important justification for coercion. Patient autonomy is a fundamental challenge facing any use of coercion, and some kind of autonomy infringement is a key aspect of the concept of coercion. The concepts of coercion and autonomy and the relations between them are very complex. When coercion is used, a primary ethical challenge is to assess the balance between promoting good and inflicting harm. In the included studies, findings explicitly related to justice are few. Some studies focus on moral distress experienced by the healthcare professionals using coercion.Conclusion:There is a lack of literature explicitly addressing ethical challenges related to the use of coercion in mental healthcare. It is essential for healthcare personnel to develop a strong awareness of which ethical challenges they face in connection with the use of coercion, as well as challenges related to justice. How to address ethical challenges in ways that prevent illegitimate paternalism and strengthen beneficent treatment and care and trust in connection with the use of coercion is a ‘clinical must’. By developing a more refined and rich language describing ethical challenges, clinicians may be better equipped to prevent coercion and the accompanying moral distress. (shrink)

This paper aims to provide an overview of surveillance theories and concepts that can help to understand and debate surveillance in its many forms. As scholars from an increasingly wide range of disciplines are discussing surveillance, this literature review can offer much-needed common ground for the debate. We structure surveillance theory in three roughly chronological/thematic phases. The first two conceptualise surveillance through comprehensive theoretical frameworks which are elaborated in the third phase. The first phase, featuring Bentham and Foucault, offers architectural (...) theories of surveillance, where surveillance is often physical and spatial, involving centralised mechanisms of watching over subjects. Panoptic structures function as architectures of power, not only directly but also through disciplining of the watched subjects. The second phase offers infrastructural theories of surveillance, where surveillance is networked and relies primarily on digital rather than physical technologies. It involves distributed forms of watching over people, with increasing distance to the watched and often dealing with data doubles rather than physical persons. Deleuze, Haggerty and Ericson, and Zuboff develop different theoretical frameworks than panopticism to conceptualise the power play involved in networked surveillance. The third phase of scholarship refines, combines or extends the main conceptual frameworks developed earlier. Surveillance theory branches out to conceptualise surveillance through concepts such as dataveillance, access control, social sorting, peer-to-peer surveillance and resistance. With the datafication of society, surveillance combines the physical with the digital, government with corporate surveillance and top-down with self-surveillance. (shrink)

The French philosopher, Gilles Deleuze, is emerging as one of the most important and influential philosophers of the 20th century, having published widely on philosophy, literature, language, psychoanalysis, art, politics, and cinema. However, because of the ‘experimental’ nature of certain works, combined with the manner in which he draws upon a variety of sources from various disciplines, his work can seem difficult, obscure, and even ‘willfully obstructive’. In an attempt to resist such impressions, this paper will seek to provide an (...) accessible introduction to Deleuze's work, and to begin to discuss how it can be employed to provide a significant critique and reconceptualization of the theoretical foundations and therapeutic practices of psychiatry, psychotherapy, and mental health nursing. In order to do this, the paper will focus upon Deleuze's masterwork, and the cornerstone to his philosophy as a whole, Difference and Repetition; in particular, it will discuss how his innovative and challenging account of time can be employed to provide a conception of human life as a ‘continuity’, rather than as a series of distinct ‘moments’ or ‘events’. As well as discussing the manner in which his work can provide us with an understanding of how life is different and significant for each human being, this paper will also highlight the potential importance of Deleuze's work for logotherapy, for the recent ‘turn’ to ‘narrative’ as a psychotherapeutic approach and for contemporary mental health care's growing interest in ‘social constructionism’. As such, this paper also seeks to stimulate further discussion and research into the importance and the relevance of Deleuze's work for the theory and practice of psychiatry, psychotherapy, and mental health nursing. (shrink)

The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, the external forces—diffuse yet pervasive—impacting (...) upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities. (shrink)

From a position informed by the philosophical legacy of Gilles Deleuze and Felix Guattari, this paper examines the idea of ‘care’ in nursing theory and philosophy. Deleuze and Guattari make a distinction between, on the one hand, ‘concepts’, which are the proper domain of philosophy and, on the other, ‘functives’ which are the domain of science and all other empirical matters. At first blush, this distinction and use of the word concept appears rather odd, but Deleuze and Guattari hold it (...) to be important for reasons that go beyond the acknowledged and obvious differences between philosophy and science. In Deleuzian terms, a ‘functive’ is any proposition that makes a verifiable truth-claim about actual states of affairs, whereas a ‘concept’ is a philosophical tool that, although it is used in statements that make claims and that seek to affect our thinking on states of affairs, is not a representation of them in any verifiable (functive) sense. In this respect, philosophical concepts, and the statements in which they are used, are neither true nor false. I argue that the way in which the word ‘care’ is used in much nursing theory and philosophy conflates concept (neither true nor false) with functive (either true or false) with less than productive results. I seek to persuade that if we can gain more clarity between the use of care as a would-be functive and its use as a philosophical concept, this would strengthen the purpose of the use of the idea of care in nursing theory. This is to say that I take the view that the role of ‘care’ as a philosophical concept is to be used in statements that ‘think the event’ called nursing; that seek to be ‘worthy of the event’, but without being an actual part of the event. Finally, I show how the concept of care in nursing philosophy has been, and can continue to be, reworked to achieve the permanent task of surveying the ever-shifting planes of the event and how it is described. (shrink)