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Trusting on the edge

Trusting on the edge: Managing uncertainty and vulnerability in the midst of serious mental health problems

Patrick Brown
Michael Calnan
Copyright Date: 2012
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  • Book Info
    Trusting on the edge
    Book Description:

    Trust is fundamental to everyday interactions and the functioning of society. How trust develops, or fails to develop, within contexts of severe mental illness is a pertinent topic for social scientists and healthcare professionals, not simply because it is an under-researched area but because heightened uncertainty and amplified vulnerability amidst psychosis represent a crucible of the conditions where trust becomes relevant. Grounded in research within this crucible, this book explores a number of questions which are central to contemporary theoretical debates around the nature of trust. The authors link these abstract concerns to empirical analysis, involving interviews with service-users, practitioners and managers. This book will appeal to anyone interested in the concept of trust, including social science researchers and students, as well as practitioners, managers and policy makers working with vulnerable people.

    eISBN: 978-1-84742-890-5
    Subjects: Health Sciences, Sociology

Table of Contents

  1. Front Matter
    (pp. i-ii)
  2. Table of Contents
    (pp. iii-iii)
  3. Preface
    (pp. iv-vi)
  4. INTRODUCTION: Risk and trust in late-modern society
    (pp. 1-16)

    The study of trust presented in this book is predominantly theoretical in nature, though our analyses of the concept are nevertheless grounded in, and illustrated through, qualitative data collected in our research within community-based services that deliver healthcare for people experiencing serious mental health problems – especially those with diagnoses of psychosis – in Southern England. The empirical research that informs the theoretical frameworks we develop not only serves to enable more robust, empirically relevant conceptualisations, but also allows us to consider the relevance of trust where it is most vital and yet potentially most problematic – amidst especially heightened levels of vulnerability...

  5. ONE Investigating trust: some theoretical and methodological underpinnings
    (pp. 17-32)

    In the Introduction, we outlined a number of features of late-modern societies – uncertainty, complexity and abstractness in particular – which may serve to heighten experiences of anxiety and vulnerability (Wilkinson, 2001) and, moreover, exacerbate challenges to individual considerations of action and decision-making (Beck, 1992). We noted the existence of various processes, connected to the individualisation of society, by which the futures of individual actors are seemingly more contingent on their own decisions than was previously the case (eg pension-planning; see Jones et al, 2010), but where the range of information and expert support is also perceived as more contested, constructed and...

  6. TWO Constructing knowledge through social interactions: the role of interpersonal trust in negotiating negative institutional conceptions
    (pp. 33-52)

    This chapter will develop a theoretical framework for understanding how trust in the context of psychosis services is possible – in spite of the emphasis upon more negative characteristics of mental heath institutions within a range of narratives in public sphere discussions and, moreover, within the experiences of many service users. As touched upon in Chapter One, there are a range of potentially significant obstacles to trust in the context of psychosis services and it has been argued that trust, though necessary, would appearprima facieunlikely (Brown et al, 2009:453). First of all, we survey a range of sources of...

  7. THREE Bridging uncertainty by constructing trust: the rationality of irrational approaches
    (pp. 53-70)

    Chapter Two analysed various ways in which service users developed trust in spite of general public perceptions, not to mention significant personal experiences, which might have warded against such positive expectations.¹ Many of the social contexts and professional relations described by participants suggested positive grounds for trust, yet histories of negative outcomes combined with the multiple uncertainties described towards the end of Chapter One (regarding the possibility and durability of recovery, the effectiveness of interventions, and the professionals’ embedding within a risk-prioritised service) point towards an apparentunknowablenessassociated with mental healthcare or, indeed, healthcare in general (Titmuss, 2004). As...

  8. FOUR Vulnerability and the ‘will to trust’
    (pp. 71-86)

    A number of questions have appeared, more or less explicitly, within the preceding chapters pertaining to a tension between processes of trust formation and the extent of choice involved within these. One example of this was in Chapter Three where we followed Barbalet in noting a ‘forced option’ (Barbalet, 2009: 372) aspect to trust, as was made evident in comments by participants such as ‘You have to [trust] in some ways’. In Chapter One, we suggested that some degree of choice was intrinsic to trust (following Luhmann, 1988) and that this, therefore, presents us with an apparent contradiction. A number...

  9. FIVE The difficulties of trust-work within a paradigm of risk
    (pp. 87-104)

    Thus far, much attention has been paid to the contexts of vulnerability and uncertainty that make trust relevant and salient for service users. We have briefly noted in earlier chapters that mental health professionals deal with manifold uncertainties, though the ways in which these uncertainties are intertwined with high levels of vulnerability have not been discussed in any significant depth up to this point. This chapter begins by noting how professionals respond to vulnerability and how these responses are shaped by institutional and policy contexts. We assess the format of risk approaches that aims at control and explore the ‘trust-control...

  10. SIX Trusting on the edge: implications for policy
    (pp. 105-116)

    This final chapter has two main aims. First, to summarise the major themes that emerged from the theoretical and empirical analysis and discuss their implications for furthering the understanding of the nature and salience of trust relations in the context of mental healthcare and beyond. This will involve a summary of the key conclusions that emerge from the different elements of the analysis. The second aim is to consider the policy implications that flow from the empirical findings and the theoretical framework. While policy notions are applied throughout this book and form the very context within which theorisations are developed,...

  11. Appendix
    (pp. 117-120)
  12. References
    (pp. 121-132)
  13. Index
    (pp. 133-138)
  14. Back Matter
    (pp. 139-139)