Uncertainty work and temporality in psychiatry: how clinicians and patients experience and manage risk in practice?

Hautamäki, Lotta

doi:10.1080/13698575.2018.1442918

Cited by 19 publications

(28 citation statements)

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“…Within the clinical practices of psychiatry, everyday uncertainties are salient for “psychiatrists and patients [who] need to work their way through these in diagnosis and treatment decisions” (Hautamäki : 45; see also Rafalovich ). Similar issues are at stake in the realm of psychology, where practitioners must decide what patients to work with and to what ends.…”

Section: Introductionmentioning

confidence: 99%

Uncertainty work as ontological negotiation: adjudicating access to therapy in clinical psychology

Pickersgill

2019

Sociology Health & Illness

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Across the UK, wide‐ranging efforts have been made to enhance citizen access to psychological therapy. Clinical psychologists are key providers of and gatekeepers for therapy. This article is concerned with how clinical psychologists foster access (or not) to psychological care. More specifically, it interrogates how psychologists manage, and make decisions around, patient referrals. Following a referral, psychologists must resolve an uncertain situation: should they accept a referral and continue with an assessment? Thereafter, they must decide whether a patient is suitable for their service – and for therapy more generally. Certainty is synthesised against a backdrop of sometimes powerful pressures to meet service targets. Taking cues from medical sociology and science and technology studies (STS), this article interrogates some of the uncertainties around access to psychological therapy, and how decisions made by clinical psychologists involve negotiations of patient, service and professional ontologies. To do so, it draws on interviews with 40 psychologists across England and Scotland. The paper spotlights a professional group that is often absent from or only dimly lit within sociological observation and analysis: clinical psychology. Through attending to the discourses of psychologists, I extend conversations about uncertainty through a distinctive case study.

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Section: Introductionmentioning

confidence: 99%

Uncertainty work as ontological negotiation: adjudicating access to therapy in clinical psychology

Pickersgill

2019

Sociology Health & Illness

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“…The reason for this is the absence of testable biomarkers that can reveal mental disorders (Joyce 2011;Leo 2004;Singh and Rose 2009). To compensate for this, standardised diagnostic classifications and diagnostic questionnaires are used as an attempt to tame this inherent uncertainty and weak reliability (Burstow 2015;Ekeland 2011;Hautamäki 2018;Leo 2004).…”

Section: Introductionmentioning

confidence: 99%

Overcoming Diagnostic Uncertainty: Clinicians, Patients and Institutional Work in Practice

Olesen

2019

Scandinavian Journal of Disability Research

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This article uses aspects from Institutional Ethnography to explore how both clinicians and young adults with mental health problems use different adaptation strategies to overcome the diagnostic uncertainty in psychiatry. The article illustrates the connection between the local production of diagnoses in Norwegian psychiatric outpatient clinics and the individual experience of being identified with multiple psychiatric diagnoses. The article explores how two clinicians from two psychiatric outpatient clinics produce diagnoses locally. It is shown how institutional texts coordinate the diagnostic work as 'ruling relations'. On the other side of the desk, the arbitrary element affects the young adults with mental health problems, who perform a large amount of identity work when dealing with the numerous diagnoses they are given. The young adults find the ease with which they are diagnosed, the number of diagnoses, and the way the diagnoses are used to be disturbing and confusing.

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“…Whereas the common assumption is that risk knowledge is first formulated, and then applied in everyday risk management practice, a number of articles in this special issue stress the way that risk is continually constructed and reconstructed within interactions and organisational contexts (see especially Farre et al, 2017;Hautomäki, 2018). Far from employing straightforward time-frames in handling risk, Hautomäki (2018) shows how risk tools, such as standardised questionnaires, 'materialise symptoms' and shape a new understanding and experience of the condition for professionals and patients, (re)creating pasts and presents through the intervention. Rather than drawing upon risk knowledge to intervene in a distinct reality therefore, risk work intervenes through reconstructing the condition and experiences of it (see also Mol, 2002;van Loon, 2014), amid ongoing feedback between knowledge, intervention and social relations (as implied in Figure 1).…”

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confidence: 99%

“…This destabilised relationship between risk and condition throws into doubt the possibility of knowing and neatly intervening in risk (Heyman, 2010); hence Hautomäki's (2018) use of the term 'uncertainty work'. The tensions around risk which emerge when exploring risk work (see Brown & Gale, 2018) suggest, therefore, a reading of risk far closer to that of a material-semiotic or techno-semiotic approach (e.g.…”

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confidence: 99%

“…The tensions around risk which emerge when exploring risk work (see Brown & Gale, 2018) suggest, therefore, a reading of risk far closer to that of a material-semiotic or techno-semiotic approach (e.g. van Loon, 2014), one where risk must be reconstructed by professionals in conjunction with each other, with clients, with tools and technologies and various other actors (see Farre et al, 2017;Hautomäki, 2018). Yet the way in which risk interventions reshape their socio-material contexts -'matter, energy and information' (van Loon, 2014, p. 444)renders important limits to the control and power of professionals.…”

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confidence: 99%

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Developing a sociology of risk work in client-facing contexts: an editorial

Brown

Gale

2018

Health, Risk & Society

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Through this editorial we introduce the fourth 'theory special issue' of Health, Risk and Society. The aim of the series, published more or less annually since 2014, is to provide a platform for theoretical development around core and emerging topics within social scientific studies of risk and uncertainty. By including original research articles alongside other formats, such as guest editorials or review articles, the previous special issues have sought to stimulate theorising, and reflection on theorising, through different ways of connecting theory to the empirical. We have sought to do something similar in this current special issue. By way of introduction to the special issue, we will first set out our conceptualisation of risk work and what this means for the foci of the articles included. We then proceed to set out some key intersections between the sociology of risk and uncertainty and the sociology of professions and professional work. These are pertinent for furthering understandings of risk work but also in understanding how studies of risk work can contribute to these wider fields, as is apparent from the studies within the issue. We will then briefly introduce these different studies, relating them to each other in terms of some common emerging themes, before concluding with some future theoretical and methodological directions, concerns and challenges. Risk work in client-facing contextsdelineating the focus of this issue The contributors to the previous theory special issue (volume 18: 7-8) addressed the topic of 'dealing with uncertainty and risk in everyday practice'. The starting point of that collection was Zinn's (2008) consideration of different ways of handling uncertainty (e.g.risk, trust, hope, intuition) and various ways in which these approaches are combined or 'bricolaged' (Horlick-Jones, Walls, & Kitzinger, 2007) in everyday practices. There is therefore a strong connection between that issue and this current collection in that in our writing to date on 'risk work', which we have used to frame the special issue, we have been influenced by Zinn's work alongside Horlick-Jones's (2005) use of 'risk work' to emphasise the pragmatic, situated manner by which risk and uncertainty are negotiated or handled in everyday working contextsthat is how this work 'gets done' (see Brown & Gale, 2018; Gale, Thomas, Thwaites, Greenfield, & Brown, 2016). But whereas Horlick-Jones (2005) and another recent book on risk work (Power, 2016) consider these practices chiefly in terms of organisational power structures and agendas within these, our emphasis is far more on the workers themselvestheir lived, embodied experiences and occupational identities, and how these relate to everyday practiceswhile still locating these within wider organisational and (para)professional power dynamics (Brown & Gale, 2018). One further distinction (cf. Power, 2016) is that we are interested in clientfacing, 1 front-line (Harrits & Møller, 2014) or street-level (Gale, Dowswell, Greenfield, & Marshall, 2017, Lipsky, 1980) work ...

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Uncertainty work and temporality in psychiatry: how clinicians and patients experience and manage risk in practice?

Cited by 19 publications

References 47 publications

Uncertainty work as ontological negotiation: adjudicating access to therapy in clinical psychology

Uncertainty work as ontological negotiation: adjudicating access to therapy in clinical psychology

Overcoming Diagnostic Uncertainty: Clinicians, Patients and Institutional Work in Practice

Developing a sociology of risk work in client-facing contexts: an editorial

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