Risk, Suffering and Competing Narratives in the Psychiatric Assessment of an Iraqi Refugee

Abstract

This paper highlights the problem of "place" for an Iraqi refugee who, for years, had been tortured and imprisoned in his home country. Specifically, the paper presents a case study of a clinical encounter with this refugee, who had come to the attention of an Australian Crisis Assessment and Treatment Team. Drawing from narrative theory, the paper describes the chaotic nature of the encounter to show how the diverse motives, claims and actions of those present expose the struggle involved in the emplotment of an emerging narrative. The case study is constructed and analysed to illustrate the interpretive machinery of "clinical reasoning" and, in particular, the tension and play between "paradigmatic thinking" and "narrative thinking." More generally, this analysis follows the work of social scientists who seek to expand methodologies for writing about human suffering.

Perception of risk for older people living with a mental illness: Balancing uncertainty

“…As suggested in the literature, there is a tendency for risk to focus on the avoidance of harm, rather than on what might be best for consumers as individuals, taking account of all aspects of their well‐being (Barker & Buchanan‐Barker ; Manuel & Crowe ; Sykes et al ; Wand ; Wand et al ). This was particularly notable from the manager participants, and might well reflect the importance they attribute to the medico‐legal aspects of risk (Barker & Buchanan‐Barker ; Manuel & Crowe ; Savy & Sawyer ; Wand et al ). Given their vulnerability within the current service‐delivery framework, this is understandable.…”

“…For example, while all participants identified potential harms or dangers associated with mental illness and the associated care and treatment, they did not all use the same terminology to describe them. Although the language of risk now dominates the discourse of service provision (Manuel & Crowe ; Savy & Sawyer ; Wand et al ), the language used by consumers of services and their families and carers is not defined by risk. The term ‘safety’ is much more commonly used (Clancy et al ; Fagerstrom et al ), describing a desire for security and confidence for themselves or their loved ones, rather than specific measures to avoid the potential for harm.…”

“…At the individual level, these different perspectives are likely to impact the care consumers receive with the avoidance of risk taking priority (Clancy et al ; Savy & Sawyer ; Szmukler & Rose ; Wand et al ). Indeed, the focus on risk would appear antithetical to the recovery principles underlying contemporary mental health services (Sykes et al ).…”

“…Risk assessment and management practices are now so prevalent in mental health discourse that they are seen to have taken precedence over many other clinical practices (Savy & Sawyer ; Szmukler ; Wand et al ). Indeed, concerns over reputational risk to institutions are now thought by some to surpass the interests of consumers (Brown & Calnan ) and have assumed noticeable salience.…”

The Language of Risk: Common Understanding or Diverse Perspectives?

“…Consequently, the perceived need to assess and manage risk has emerged as a major preoccupation (Wand, 2013). The literature suggests risk assessment and management practices have taken precedence over the provision of clinical care to meet individual needs (Alaszewski, 2006;Savy & Sawyer, 2008). Additionally, risk management practices have been introduced into older persons' mental health care from mainstream adult mental health environments with limited supporting research or regard for the unique requirements of older people in mental health care (Clarke, 2006).…”