New book: (Re)thinking Violence in Health Care Settings

This comprehensive volume explores various forms of violence in health care settings. Using a broad range of critical approaches in the field of anthropology, cultural studies, gender studies, political philosophy and sociology, it examines violence following three definite yet interrelated streams: institutional and managerial violence against health care workers or patients; horizontal violence amongst health care providers and finally, patients’ violence towards health care providers. Drawing together the latest research from Australia, Canada, the UK, and the US, (Re)Thinking Violence in Health Care Settings engages with the work of critical theorists such as Bourdieu, Butler, Foucault, Latour, and Žižek, amongst others, to address the issue of violence and theorise its workings in creative and controversial ways.  As such, it will be of interest to sociologists and anthropologists with research expertise in health, medicine, violence and organisations, as well as to health care professionals.

  • Contents:   Foreword, Dave Holmes; Introduction: (re)thinking violence in health care settings, Dave Holmes, Trudy Rudge, Amélie Perron and Isabelle St-Pierre; Part I Institutional and Managerial Violence: A critical reflection on the use of behaviour modification programs in forensic psychiatry settings, Dave Holmes and Stuart J. Murray; The violence of tolerance in a multicultural workplace: examples from nursing, Trudy Rudge, Virginia Mapedzahama, Sandra West and Amélie Perron; Changing discourses of blame in nursing and healthcare, Hannah Cooke; Hospital policies regarding violence in the workplace: a discourse analysis, Penny Powers; Exploring violence in a forensic hospital: a theoretical experimentation, Amélie Perron and Trudy Rudge; Nurses’ failure to report elder abuse in long-term care: an exploratory study, Gloria Hamel-Lauzon and Sylvie Lauzon. Part II Horizontal Violence: Foucault and the nexus between violence and power: the context of intra/inter professional aggression, Isabelle St-Pierre; Examining nurse-to-nurse horizontal violence and nurse-to-student vertical violence through the lens of phenomenology, Sandra P. Thomas; The rise of violence in HIV/AIDS prevention campaigns: a critical discourse analysis, Marilou Gagnon and Jean Daniel Jacob; Bullying in the workplace: a qualitative study of newly licensed registered nurses, Shellie Simons and Barbara Mawn; Sexual health nursing assessments: examining the violence of intimate exposures, Patrick O’Byrne and Cory Woodyatt; Bullying on the back-channels: everyday interpersonal communicative relations in telephone talk as a space for covert forms of professional manipulation, Jackie Cook and Colette Snowden. Part III Patients’ Violence: Assessment of risk and special observations in mental health practice: a comparison of forensic and non-forensic settings, Elizabeth Mason-Whitehead and Tom Mason; Policing pornography in high-secure care: the discursive construction of gendered inequality, David Mercer; Warning – this job contains strong language and adult themes: do nurses require thick skins and broad shoulders to deal with encounters involving swearing?, Teresa Stone and Margaret McMillan; Prison nursing: managing the threats to caring, Elizabeth Walsh; The mentally ill and civil commitment: assessing dangerousness in law and psychiatry, Cary Federman; Working in a violent environment: the pitfall of integrating security imperatives into forensic psychiatry nursing, Jean Daniel Jacob; Index.

About the Editor:  Dave Holmes is Professor and University Research Chair in Forensic Nursing, School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada and co-editor of both Critical Interventions in the Ethics of Healthcare and Abjectly Boundless: Boundaries, Bodies and Health Work. Trudy Rudge is Professor at Sydney Nursing School, University of Sydney, Australia, and co-editor of Abjectly Boundless: Boundaries, Bodies and Health Work. Amélie Perron is Assistant Professor, School of Nursing, Faculty of Health Sciences, University of Ottawa, Canada.

Edgework 2: going beyond the white, middle-class male perspective

In my previous post ‘Edgework: the fun of risk-taking’, I discussed the emotional dimension of voluntary risk-taking. Edgework research has predominantly focused on male risk-takers, the vast majority of whom are white and middle-class. These men are able to afford to engage in ‘adventure holidays’ or such ‘extreme sports’ as skydiving, BASE jumping or white-water kayaking. Other research suggests that such individuals engage in voluntary risk-taking for different reasons than do people who are less socially and economically privileged. Gender also influences why people take risks and how they feel about risk-taking.

In her study of young Scottish women imprisoned for engaging in violent behaviour and other criminal activities such as stealing and illicit drug use, Bachelor (2007) argues that these women were initially drawn to engage in this behaviour because of the shared adrenaline ‘rush’ or ‘buzz’ they felt, a desire to escape boredom and to feel as if they could foster friendships and belong to a group. Some of these young women displayed an attraction towards traditionally masculine behaviour such as violence and the feeling of power and toughness engaging in afforded them. However the women increasingly came to undertake such activities as a means of blocking out powerful emotions such as grief and rage caused by life experiences of abuse, family dysfunction and institutional care, or by eliciting more pleasurable emotions. They remarked that they often felt ‘emotionally numb’ and ‘detached’ and that risk-taking was a way of making them feel more alive.

For these young women, violent behaviour, self-harm and drug use were ways of feeling different, either by helping to avoid conscious thoughts which were distressing, evoking feelings of power and control when feeling helpless or venting feelings of anger and hurt by hurting others. These young women were not taking risks to escape the alienating world of work and to achieve a sense of authenticity and hyperreality, as do privileged white men. They were attempting to achieve a sense of control over a world in which they felt increasingly disempowered and looking for a way of feeling close to others (their peer-group) in a context in which their families had not provided intimacy and caring and a sense of belonging.

While men may experience feelings of exhilaration and omnipotence in their edgework experiences, this research showed that when reflecting on their behaviour young women were more likely to feel ambivalent about it. They viewed such risk-taking activities as irrational and expressed feelings of guilt and shame about the violent and criminal activities in which they engaged. They may have felt in control at the time of the behaviour, but when they looked back at what they had done viewed it as being ‘out-of-control’ and as ‘going too far’. In interpreting their behaviour in this way, the young women are drawing on discourses of normative femininity, which position such behaviours as abnormal and inappropriate for women.

As this research suggests, edgework has many different nuances. It is not simply about evoking and controlling intense emotion. It is not simply about engaging in risk-taking as part of legally sanctioned and expensive leisure pursuits. Edgework also incorporates criminal behaviour, perhaps one of the few avenues for members of the underclass to seek out risky pursuits. It may not represent an escape from the banality of the safety and routines of a privileged life, but may also be a way of escaping the misery of a life including experiences of abuse, poverty and family dysfunction.

Reference

Bachelor, S. (2007) ‘Getting mad wi’ it’: risk seeking by young women. In Hannah-Moffat, K. and O’Malley, P. (eds), Gendered Risks. Milton Park: Routledge-Cavendish, pp. 205—28.

Edgework: taking risks for the fun of it

Español: persona que salto

Español: persona que salto (Photo credit: Wikipedia)

There is a very large literature on the sociology of risk-taking these days. Much of this writing focuses on risk as a negative concept, something dangerous or hazardous which must be avoided. One important aspect of risk-taking however, is the pleasures and emotional intensities some people may experience when voluntarily taking risks.

The work of Stephen Lyng using the concept of ‘edgework’ explores the reasons why people take risks as part of leisure activities. The concept of edgework incorporates the notion that voluntary risk-taking activities are about exploring the edges that exist along cultural boundaries. These boundaries may include those between sanity and insanity, consciousness and unconsciousness and life and death.

Edgework involves skilful practices combined with emotional intensity. But the emotional dimension of voluntary risk-taking is more complex than simply involving the desire to incite intense emotions. Emotions such as fear, excitement and anxiety are central to edgework, but so are their control. Mental toughness, the ability to master and control the fear that one is experiencing and keep calm so as to avoid physical harm or death, is an integral aspect of edgework. When risk-takers are able to exert mastery over emotions that are viewed as negative, they experience heightened feelings of control.

Smith (2005) gives the example of white-water kayaking, in which it is important to maintain control over fear so that the kayak will stay afloat and will be able navigate the hazards of the water it is traversing. Smith claims that it is the individual’s awareness of maintaining this control despite the almost overwhelming embodied sensations of fear and excitement, which produces the sense of elation that risk-takers seek.

Lyng and Matthews (2007) similarly note that what is deemed important for voluntary risk-takers is not to override fear but to acknowledge its presence and convert it into something that is sensually appealing. This involves an acceptance of fear combined with confidence that one can act skilfully to avoid accident or death. This combination of intense emotional arousal and focused attention leads to edgeworkers experience alterations in perception of time and space, feelings of hyerreality which leads to a sense of the experience as deeply authentic, as feeling truly alive. Edgeworkers commonly describe a sense of blurring of the boundaries between themselves and the technologies under their control (kayaks, climbing ropes, parachutes, racing cars, motor cycles and so on), so that they have a sense of ‘being one with their machines’.

Edgework can represent both a challenge to limits, everyday routines and social expectations, but paradoxically, may also be an expression of dominant institutional demands and imperatives. To be entrepreneurial in the business world, for example, people are expected to voluntarily take risks to increase productivity and profits. Thus there may be said to be a degree of synergy between the skills, competencies and symbolic resources engendered via participation in edgework practices and the demands of late modernity. Edgework is simultaneously part of efforts to transcend institutional imperatives in some contexts (dangerous leisure activities, for example) and in others a vital dimension of conforming to these imperatives. As Lyng (2005) notes, while these two sides of edgework may seem to be contradictory, they may also be viewed as complementary. The skills and expertise derived from leisure-based risk-taking practices may be employed to win success in the workplace.

References

Lyng, S. (2005) Edgework and the risk-taking experience. In Lyng, S. (ed), Edgework: The Sociology of Risk-Taking. New York: Routledge, pp. 17—49.

Lyng, S. and Matthews, R. (2007) Risk, edgework, and masculinities. In Hannah-Moffat, K. and O’Malley, P. (eds), Gendered Risks. Milton Park: Routledge-Cavendish, pp. 75—98.

Smith, C. (2005) Financial edgework: trading in market currents. In Lyng, S. (ed), Edgework: The Sociology of Risk-Taking. New York: Routledge, pp. 187—200.