CHAPTER TWO: LITERATURE REVIEW
2.7 Sociological Perspectives, Theoretical Frameworks, and their Connection to this Research
There are relevant sociological theories that have not yet been applied to the
understanding of mental health systems. For example, scholars who detail feminist ethics of care highlight its relevance within health care settings, yet a review of the literature above particularly the research within clinical environments, outlines a complete absence of these theories. The analysis process of this research, utilised these sociological perspectives extensively. They provided a more in-depth understanding of the challenges within the mental health system and the
suggestions for how it may be improved. Therefore, these pieces of literature have been included in this literature review and are heavily drawn upon throughout the thesis.
2.7.1 Feminist Ethics of Care
The ethics of care is a theory that has close affinities with caring professions such as nursing (Edwards, 2009). Ethics of care can be loosely defined as a “compelling moral salience of attending to and meeting the needs of the particular others for whom we take responsibility” (Held, 2006, p.10). Ethics of care recognises that
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humans are dependent for many years of their life, including infancy, childhood, through illness, disability, and old age, requiring community and relationships during those times. Despite dominant rationalist approaches and moral theories that devalue the emotional, feminist ethics of care states that when evaluated and
properly implemented, sympathy, responsiveness, empathy, and caring
relationships, as exemplified by the one between mother and child, are elements that should be cultivated and encouraged (Held, 2006). Ethics of care, in its various forms, operates on the understanding that persons, in times of dependency or not, are innately relational rather than self-sufficient, as presented by other dominant moral, economic or political theories (Held, 2006), such as neoliberalism.
Feminist ethics of care challenge what can be referred to as traditionally “masculine”
understandings by taking the experiences of those within caring environments and activities associated with femininity such as mothering, celebrating the inherent emotional values within these practices, applying them to wider contexts, such as health care systems, businesses or political structures (Held, 2006; Johansson &
Wickstrom, 2022; Lawrence & Maitlis, 2012; Phillips & Willatt, 2019; Raghuram, 2019).
In contrast masculine understandings often refer to generalised moral principles or universal rules, that rely on abstraction, rationality, and reason (Johansson &
Edwards, 2021; Machold et al., 2008).
Gilligan’s empirical studies (1982, as cited by Held, 2006) were pivotal in the rise of feminist ethics of care, stating that the moral development and ability of a woman is not less than her male counterpart, even though she may not display high moral reasoning in accordance with traditionally masculine ethical understandings, her depiction of morality is simply different. While male participants in Gilligan’s (1982) study emphasised morality through the importance of individual autonomy, female participants constructed morality through caring relations (Held, 2006; Machold et al., 2008). Gilligan argued that these are different approaches to morality and she challenged the assumption that one understanding of morality should be valued
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over the other. Gilligan’s studies within feminist ethics of care provide a foundation of understanding, enabling us to understand how gendered power relations
influence the significance society places on feminine or masculine constructions of caring and morality. This is important to consider when we examine the dominance of traditionally masculine ethics or the subordination of feminist ethics within the mental health system in later chapters. The emotional values or characteristics that feminist ethics of care highlights such as nurture, love, empathy, concern, and drive for community, are all characteristics are associated with femininity (Held, 2006;
Johansson & Wickstrom, 2022; Machold et al., 2008; Nicholson & Kurucz, 2017;
Phillips & Willatt, 2019), and are therefore gendered.
Feminist accounts have varied in the “extent to which they view care as a disposition intrinsic to women” (Raghuram, 2019, p. 614), and within this research, caring
relations are understood in relation to feminist ethics of care, or masculine ethics of care and not attached to a specific sex or gender. Furthermore, Rughuram (2019), drawing on Gilligan (1993) and Hollway (2006), states that the experience of being cared for as a child, is a foundational experience most can relate to, irrespective of gender, and therefore feminist ethics of care can apply to all. These articles of research, specifically the detailed comparison between feminist ethics of care and traditionally masculine ethics of care which draw on self-sufficiency and rationality, are practically relevant when we discuss the difference between relational
approaches to mental health and the dominant model which draws on neoliberalism and individualism. This comparison is outlined in more detail in later chapters.
2.7.2 Biomedicine and the Medical Gaze
Foucault, through his written works, specifically ‘The Birth of the Clinic’ first
published in 1963, presents an understanding of the relationship between power and knowledge within medicine and the concept of the ‘medical gaze’ (O’Callaghan,
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2022). Foucault’s understanding of the medical gaze describes how medical professionals fit a patient’s story into the biomedical paradigm, and subsequently only focus on elements of the story relevant through the biomedical perspective (O’Callaghan, 2022). The concept of the medical gaze, and arguably the biomedical system itself, is caught up in a strange endless cycle of reciprocity. Classification terms, such as disease, various diagnoses and subsequently cure, only exist within the constructed, biomedical space. In theory as this space, or the system, obtains its aims of treatment, it proceeds to continually efface, gradually neutralising itself (Foucault & Sheridan, 2003). What we currently see through “the standardisation of biomedicine and its accompanying medical gaze”, is dehumanising, impairment focussed attitudes, primarily concentrating on identifying perceived problems
within a patient’s mind or body (Mac Carthaigh, 2020, p. 53). Critically analysing the medical gaze and its influence on how we understand disease or diagnosis, can enable us to consider an alternative lens through which to view physical or mental differences (Mac Carthaigh, 2020), understanding that the prevalence of these classifications’ rests only on the dominance of the biomedical space.
2.7.3 Critical Disability Studies and their Approach to Norms and Diagnosis
Our understandings of ‘normal’, ‘healthy’ or arguably even ‘neurotypical’ are based on socially constructed understandings of health, through a biomedical perspective.
The aim of this thesis is not to completely discredit biomedicine or the work it does.
However, a critical examination of knowledge, where it comes from and the assumptions it is based upon, helps us to understand the impact it has on
individuals. The perspectives of disability scholars, and their experience analysing how the biomedical model can perpetuate “discourses of personal tragedy” to explain differences in human function, subsequently utilising interventions to
‘extinguish’ perceived problems (Mac Carthaigh, 2020, p. 58), can broaden our understandings of the biomedical model and the impact it is having on young
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people with mental health challenges. Social understandings of what is deviant from the norm, or classified as a mental or physical deficit, rests on socially constructed understandings of what normal is. Research within critical disability studies states that deafness and blindness are only deficits in societies where individuals
communicate via print or speaking (Garland-Thompson, 1997). Those who use wheelchairs are only considered impaired, because we live in a world made of stairs rather than ramps (Garland-Thompson, 1997), and the same can be said for mental health challenges. Obsessive compulsive disorder, anxiety or attention
deficit/hyperactivity disorder are only considered a deficit because the medical model have defined them in this way and because some individuals within society do not experience them.
The normal and the abnormal are in relationship with each other, co-defining each meaning, and therefore children, or young people, who are categorised in each of these terms, are consistently compared and valued against each other (McLaughlin et al., 2016). While these norms that critical disability scholars are examining, may be considered socially constructed, their impacts are real, with ‘othered’ young people playing a crucial role in the continued validation of the “right kind of children”
(McLaughlin et al., 2016). This places young people on a hierarchical continuum where ‘disabled’ or ‘mentally unwell’ individuals are often subject to social judgement and exclusion. This concept of being compared to one another on a hierarchal continuum, and the impact this can have, is briefly described within this thesis, through understandings shared by Sparke (2016), who described an
individual’s mental health challenges or experiences as Capital. Capital which young people must enter into a system that then triages them, comparing their sensitive lived experiences to others. Research conducted by disability scholars state that there are no inherent physical flaws that categorise disability or ability, rather society legitimises and values some physical characteristics, imposing the role of inferiority on others (Garland-Thompson,1997; Mac Carthaigh, 2020; McLaughlin et al., 2016).
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This thesis draws upon this research and can utilise these understandings to critically engage with the concept of pathology.