Black knowledges matter: How the suppression of non‐white understandings of dementia harms us all and how we can combat it

Fletcher, James Rupert

doi:10.1111/1467-9566.13280

Cited by 11 publications

(7 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In drawing the synthesis together, we took a ‘decolonising attitude’ [ 4 ], i.e. listening to seldom heard voices, being inclusive of differences (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…However, professional health care training appears not to readily assuage these problems. One issue with Western health care (that privileges white claims to knowledge) is that racially minoritised people are readily positioned as ‘other’ [ 4 ]. This approach can decide what the problems are for (rather than in consultation with) racially minoritised people, sidelining the hidden disadvantages people face.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A meta-ethnography investigating relational influences on mental health and cancer-related health care interventions for racially minoritised people in the UK

et al. 2023

View full text Add to dashboard Cite

Objective Despite calls to increase the ‘cultural competence’ of health care providers, racially minoritised people continue to experience a range of problems when it comes to health care, including discrimination. While relevant qualitative meta-syntheses have suggested better ways forward for health care for racialised minorities, many have lacked conceptual depth, and none have specifically investigated the relational dimensions involved in care. We set out to investigate the social and cultural influences on health care interventions, focusing on psychological approaches and/or cancer care to inform the trial of a new psychological therapy for those living with or beyond cancer. Method A meta-ethnography approach was used to examine the relevant qualitative studies, following Noblit and Hare, and guided by patient involvement throughout. Papers were analysed between September 2018 and February 2023, with some interruptions caused by the Covid pandemic. The following databases were searched: Ovid MEDLINE, EBSCO CINAHL, Ovid Embase, EBSCO PsycINFO, Proquest Sociology Collection (including Applied Social Sciences Index & Abstracts (ASSIA), Sociological Abstracts and Sociology Database), EBSCO SocINDEX, Ovid AMED, and Web of Science. The systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) (ID: CRD42018107695), and reporting follows the eMERGe Reporting Guidance for meta-ethnographies (France et al. 2019). Results Twenty-nine journal papers were included in the final review. Themes (third-order constructs) developed in the paper include the centrality of the patient-practitioner relationship; how participants give meaning to their illness in connection to others; how families (rather than individuals) may make health decisions; how links with a higher power and spiritual/religious others can play a role in coping; and the ways in which a hierarchy of help-seeking develops, frequently with the first port of call being the resources of oneself. Participants in studies had a need to avoid being ‘othered’ in their care, valuing practitioners that connected with them, and who were able to recognise them as whole and complex (sometimes described in relational languages like ‘love’). Complex family-based health decision-making and/or the importance of relations with non-human interactants (e.g. God, spiritual beings) were frequently uncovered, not to mention the profoundly emergent nature of stigma, whereby families could be relatively safe havens for containing and dealing with health challenges. A conceptual framework of ‘animated via (frequently hidden) affective relationality’ emerged in the final synthesis, bringing all themes together, and drawing attention to the emergent nature of the salient issues facing minoritised patients in health care interactions. Conclusion Our analysis is important because it sheds light on the hitherto buried relational forces animating and producing the specific issues facing racially minoritised patients, which study participants thought were largely overlooked, but to which professionals can readily relate (given the universal nature of human relations). Thus, training around the affective relationality of consultations could be a fruitful avenue to explore to improve care of diverse patients.

show abstract

“…In drawing the synthesis together, we took a ‘decolonising attitude’ [ 4 ], i.e. listening to seldom heard voices, being inclusive of differences (e.g.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A meta-ethnography investigating relational influences on mental health and cancer-related health care interventions for racially minoritised people in the UK

et al. 2023

View full text Add to dashboard Cite

show abstract

“…This recognition has been forwarded elsewhere (e.g. Fletcher, 2020b, 2021; Forbat, 2003; MacKenzie, 2006; O’Connor et al, 2010), albeit infrequently. It is a concern to which we will return when considering what aspects of dementia are revealed by the newfound ethnicity problem, and what is concealed.…”

Section: Dementia’s New Ethnicity Problemmentioning

confidence: 93%

“…Echoing these wider scholarships on ethnicity and mental health, an emerging critical sociology of dementia aims to question the problematisation of ethnicity (e.g. Fletcher, 2020bFletcher, , 2021Roche et al, 2021). At its heart is the observation that the recent turn to ethnicity in dementia's neuropsychiatric development is contingent upon suspect claims, racialised assumptions, and positioning (minority) ethnicity as a new type of problem in relation to dementia.…”

Section: Dementia's New Ethnicity Problemmentioning

confidence: 99%

The neuropsychiatric biopolitics of dementia and its ethnicity problem

Fletcher

Zubair

Roche

2021

The Sociological Review

Self Cite

View full text Add to dashboard Cite

Sociological analyses of dementia have long drawn on critiques of medicalisation and the medical model. This approach fails to account for late 20th/early 21st century expansion of neuropsychiatric biopolitics, wherein a more subtle and pervasive (self-)governance of health, illness, and life itself is at stake. Since the 1970s, new neuropsychiatric imaginings of dementia have been promoted, as evident in government, third sector and research trajectories. From the 2000s, engagements with ethnicity have played an increasingly important role in these trajectories. Minority ethnic (ME) populations have emerged as a new type of dementia problem. Observations about diagnosis rates and timings, medication and nursing support (including care home admission) are normatively appraised to associate minority ethnicity with poor dementia outcomes. These outcomes are then attributed to purported cultural shortcomings of these populations. The emergence of (minority) ethnicity as a problem supports a neuropsychiatric biopolitics of dementia, wherein citizens must govern their conduct accordingly so as not to become like the imagined ‘ethnic’ antagonist. Ultimately, dementia’s newfound ethnicity problem may not serve the interests of people affected by dementia so much as researchers in the field, who should therefore reflect on their own contributions.

show abstract

“…Again, the authors argue such "beliefs" should be challenged by improving neuropsychiatric "knowledge" via educational interventions. This positioning of ethnicity in relation to dementia (see Fletcher, 2020cFletcher, , 2021bFletcher et al, 2021) reveals a delineation of different types of person in reference to their purported amenability to neuropsychiatric beliefs.…”

mentioning

confidence: 99%

Dissonant dementia: neuropsychiatry, awareness, and contradictions in cognitive decline

Fletcher

Maddock

2021

Humanit Soc Sci Commun

Self Cite

View full text Add to dashboard Cite

This paper presents an analysis of contemporary neuropsychiatric meaning-making regarding dementia, encompassing distinct beliefs, practices and objects, and the peculiarities of its fragmented public manifestations. First, some core neuropsychiatric beliefs are discussed, arguing that the designation of those beliefs as exceptional truths engenders an imperialist ethic whereby the beliefs must be spread into other populations. Second, the enactment of this spread through dementia awareness is considered, whereby people are presented as having wrong beliefs to justify the promotion of alternative correct knowledge. Third, some emerging contradictions within neuropsychiatric dementia are outlined, as moves toward early diagnosis and “living well” sit uneasily beside notions of dementia as a frightening epidemic. The paper concludes that this produces dissonant dementia wherein contradictory meanings are held together. Finally, it is suggested that this dissonance will likely continue, underpinned by specific interests.

show abstract

Black knowledges matter: How the suppression of non‐white understandings of dementia harms us all and how we can combat it

Cited by 11 publications

References 46 publications

A meta-ethnography investigating relational influences on mental health and cancer-related health care interventions for racially minoritised people in the UK

A meta-ethnography investigating relational influences on mental health and cancer-related health care interventions for racially minoritised people in the UK

The neuropsychiatric biopolitics of dementia and its ethnicity problem

Dissonant dementia: neuropsychiatry, awareness, and contradictions in cognitive decline

Contact Info

Product

Resources

About