Sociological perspectives of coercion in psychiatry

Abstract

In this chapter, consideration is given to ways in which psychiatric inpatients’ experiences of coercion and the use of coercive measures by staff might be influenced in ways best understood from a social sciences perspective. It opens with some reflections on what a sociological perspective might be and how that might differ from other, perhaps more medical perspectives. Reference is made to the unhelpful stereotyping that has developed around the expression "antipsychiatry". Against this background two classic studies of psychiatric inpatients’ experiences (Goffman. Asylums, essays on the social situation of mental patients and other inmates. New York: Anchor Books, 1968; Rosenhan. Science 179:250-258, 1973) are revisited with a view to revealing how "inpatient hood" is widely experienced as coercive, even when particularly coercive measures are not used. This is echoed by empirical data from the EUNOMIA project (Fiorillo et al. Acta Psychiatrica Scandinavica 125:460-467, 2012; Kalisova et al. Social Psychiatry and Psychiatric Epidemiology 49:1619-1629, 2014) which can be considered as pointing to important influences of social context and micro-social processes upon the experience of coercion by inpatients and the use of coercive measures by staff. Bowers’ explorations of student nurses’ experiences (Bowers et al. Nurse Education Today 24:435-442, 2004; International Journal of Nursing Studies 44:357-364, 2007; International Journal of Nursing Studies 44:349-346, 2007) can be interpreted in a similar way. Consideration is also given to the interface between law and medical practice, where the use of coercive measures is legitimised. The Law and Medicine can be considered differing logical frameworks, and when they intersect compromise is inevitable. The legitimation of coercion on the grounds of "ill health" can be understood as a pragmatic solution to an inconvenient truth; that conceptualisations of the human being as one governed by individualised reason are not in themselves a sufficient description of "the nature of Man".