Browsing by Author "Holmes, Dave"
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Item Abjection and the weaponization of bodily excretions in forensic psychiatry settings: a poststructural reflection(2021) Johansson, Jim A.; Holmes, DaveNurses working in forensic psychiatric settings face unique challenges in practice, where they take on a dual role of custody and caring. Patient resistance is wide-spread within these restrictive settings and can take many forms. Perhaps the most disturbing form of resistance entails a patient's weaponization of their bodily fluids, with nurses as their target. The tendency in assigning motive for this act is to relegate to the psychopathology of the patient. This paper will adopt a post-structuralist perspective to reexamine this phenomenon as an act of resistance through the lens of Kristeva's concept of abjection. Patients confined in these set-tings have little sense of control, and in resistance may resort to the only thing available: their bodily fluids. By weaponizing the abject, patients actively violate and permeate the physical and psychological boundaries of nurses—the very boundaries considered crucial to safe and professional forensic psychiatric nursing practice. By recognizing this phenomenon as an act of resistance to confinement and loss of control, nurses may reorient their approach to care in forensic psychiatric settings.Item Canada’s aging federal prison population: health disparity, risk, and compassionate release for older persons convicted of sexual offences(2023) Johansson, Jim A.; Holmes, Dave; Paradis-Gagné, EtienneThe Canadian federal prison population is increasingly aging within institutions that were never intended or designed to meet the complex medical and mental health needs of older incarcerated persons. Increasing numbers of incarcerated persons are “aging in place,” and many are dying within federal correctional institutions. Persons convicted of sexual offenses comprise a large—and growing—proportion of this aging population. The Correctional Investigator Canada has recently called for an expansion of access to compassionate release for the aging federal prison population, yet little progress has been made. In this article, we explore the significant challenges faced by the aging population in federal institutions, including insufficient access to appropriate care, challenges in application for compassionate release, and how questions of risk may affect the potential for community transfer. Questions of risk overshadow decisions on early release of incarcerated persons, especially those convicted of sexual offenses. Nurses play a central role in the provision of care to aging incarcerated persons and in advocacy for better access to services when a patient's needs cannot be met within the institution. This article presents a call to action for forensic nurses in Canada (and beyond) to advocate for both improved services within federal correctional institutions and for expedited access to compassionate release of aging incarcerated persons, especially those nearing end of life. The significant disparity in access to health care for aging incarcerated persons compared with their nonincarcerated counterparts represents a significant concern.Item The clean and proper self: the relevance of Kristeva’s concept of abjection for nursing(2022) Johansson, Jim A.; Holmes, DaveNurses regularly encounter feelings of disgust in practice, from bodily fluids and wounds to the criminal histories of patients. Though these experiences are widespread in nursing practice, there exists a culture in which they are regularly and intentionally ignored by nurses, and have received little attention in the literature. French-Bulgarian philosopher Julie Kristeva described these feelings of disgust within her psychoanalytic concepts of abjection and the clean and proper self. When nurses experience abjection, they work to protect and maintain the boundaries of the clean and proper self. This paper will employ a conceptual analysis to explore the implications of abjection and the maintenance of the clean and proper in nursing practice, with a specific focus on forensic nursing. A literature review of scientific articles and monographs addressing issues of disgust and abjection was conducted. The work of Kristeva provides the theoretical framework for this analysis. The analysis illustrates that nurses erect boundaries between themselves and patients, with significant consequences for patient care. An enactment of rituals to avoid the uncomfortable feelings of abjection and an effort to maintain the clean and proper self is widespread in nursing practice. Acknowledging the presence of abjection in nursing practice, recommendations are given on how to both embrace and overcome this experience.Item Poststructuralism and the construction of subjectivities in forensic mental health: opportunities for resistance(2023) Johansson, Jim A.; Holmes, DaveNurses working in correctional and forensic mental health settings face unique challenges in the provision of care to patients within custodial settings. The subjectivities of both patients and nurses are subject to the power relations, discourses and abjection encountered within these practice milieus. Using a poststructuralist approach using the work of Foucault, Kristeva, and Deleuze and Guattari, this paper explores how both patient and nurse subjectivities are produced within the carceral logic of this apparatus of capture. Recognizing that subjectivities are fluid and dynamic, and capable of change, Deleuze and Guattari's concept of deterritorialization will illustrate opportunities for resistance, where nurses can begin to practice outside the dominant carcerallogic (and restrictions) of the system.Item “Recovery” in mental health services, now and then: a poststructuralist examination of the despotic State machine's effects(2023) Johansson, Jim A.; Holmes, DaveRecovery is a model of care in (forensic) mental health settings across Western nations that aims to move past the paternalistic and punitive models of institutional care of the 20th century and toward more patient‐centered approaches. But as we argue in this paper, the recovery‐oriented services that evolved out of the early stages of this liberating movement signaled a shift in nursing practices that cannot be viewed only as improvements. In effect, as “recovery” nursing practices became more established, more codified, and more institutional(ized), a stasis developed. Recovery had been reterritorialized. The purpose of this paper is to examine some of the threads of recovery, from its early days of antipsychiatry activism to its codification into mental health—including forensic mental health—institutions through the lens of poststructuralist philosophers Gilles Deleuze and Felix Guattari. We believe that Deleuze and Guattari's scholarship provides the necessary, albeit uncomfortable, framework for this critical examination. From a conceptualization of recovery as an assemblage, we critically examine how we can go about creating something new, caught in a tension between stasis and change.Item The use of recovery model in forensic psychiatric settings: a Foucauldian critique(2022) Johansson, Jim A.; Holmes, DaveRecovery, a model of care aimed at patient-led nursing practice emphasizing autonomy, hope and self-determination, has in recent years been adapted for the secure forensic psychiatric setting. Often referred to as ‘secure recovery’, this model suggests the aims of recovery are achievable even in highly restrictive settings. This paper will adopt a Foucauldian perspective to offer a critical analysis of recovery in forensic settings. In providing recovery-oriented care, nurses utilize pastoral power in guiding patients to institutionally preferred outcomes. Akin to Christian religious conversion, nurses engage in a neo-religious conversion of patients to a neoliberal subjectivity of homo-economicus. This path of recovery is grounded in an ethos of personal responsibility and self-government, inseparable from the greater context of neoliberal governmentality. Despite attempts at transforming forensic nursing practice into more egalitarian directions, recovery remains a coercive practice, and fails to meet the overall goals of this paradigm in secure settings.