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Violence, research, and non-identity in the psychiatric clinic

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Abstract

Violence in psychiatric clinics has been a consistent problem since the birth of modern psychiatry. In this paper, I examine current efforts to understand and reduce both violence and coercive responses to violence in psychiatry, arguing that these efforts are destined to fall short. By and large, scholarship on psychiatric violence reduction has focused on identifying discrete factors that are statistically associated with violence, such as patient demographics and clinical qualities, in an effort to quantify risk and predict violent acts before they happen. Using the work of Horkheimer and Adorno, I characterize the theoretical orientation of such efforts as identity thinking. I then argue that these approaches lead to epistemic imperceptiveness and a subtle form of conceptual restraint on patients. I suggest a reorientation in psychiatric research, away from identity thinking and toward a more productive and just approach to the problem of violence in psychiatric clinics.

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Notes

  1. Violence is, of course, a broad term used in the literature to describe a variety of phenomena from physical assault to verbal abuse. Where possible, I try to describe what researchers mean by terms such as violence and aggression. However, I encourage the reader to interpret violence expansively.

  2. Here I refer to the use of physical restraints, forced medication (usually sedatives), and seclusion as coercive measures. This is reflective of the predominance of literature that uses coercive to describe such interventions and in keeping with the definition of coercion as an act of compelling or dominating by force. It is worth noting that not all patients view restraints negatively (see [2]).

  3. More specific data are not available, as hospitals are not required to report such incidences.

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  1. Albert Gnaegi Center for Health Care Ethics, Saint Louis University, Saint Louis, MO, USA

    Michelle Bach

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Correspondence to Michelle Bach.

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Bach, M. Violence, research, and non-identity in the psychiatric clinic. Theor Med Bioeth 39, 283–299 (2018). https://doi.org/10.1007/s11017-018-9451-2

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