Unraveling Reactionary Care: The Experience of Mother-Caregivers of Adults with Severe Mental Disorders in Catalonia.

In most Mediterranean countries, people diagnosed with severe mental disorders (SMDs) are typically cared for by the mother, causing a significant burden on people in this family role. Based on a broader mental health participatory action and qualitative research carried out in Catalonia (Spain) of 12 in-depth interviews and 3 focus groups, this article analyses the mother-caregivers' experience in the domestic space. The results show that patients and caregivers are engaged in a relationship of "nested dependencies", which create social isolation. This produces the conditions of "reactionary care", practices that limit the autonomy of those affected and that reproduce forms of disciplinary psychiatric institutions. We conclude that both institutional violence derived from economic rationality and that which stems from the gender mandate feed off each other into the domestic sphere. This research argues for placing care at the center of clinical practice and shows the need to consider the structural forces shaping it.

Being just their hands? Personal assistance for disabled people as bodywork.

Drawing on the notion of bodywork, we analyse the bodily aspects of personal assistance to expand the dialogue between medical sociology and disability studies. We aim to, firstly, overcome the lack of attention to the bodywork of personal assistant (PAs) in disability studies; secondly, explore the micropolitics of personal assistance and the role of independent living mandates in configuring this bodywork of PAs; and, thirdly, propose a more relational and material approach to the impairment/disability debate. This exploration is based on qualitative semi-structured interviews with 23 PAs conducted in Spain between 2018 and 2020. Our research reveals that PAs' bodywork implies performing their body as body-absence, such as when they enact body-tool and body-prosthesis figurations, but also as body-presence, for instance, as acting bodies and affected/affecting bodies in specific situations. Through their analysis, we foreground how PAs' bodywork conveys normative ways of enacting the body and how these body figurations are not only challenged and negotiated but define the actual practice of personal assistance. To conclude, we stress on the theoretical contributions of our study towards both disability studies and medical sociology.

Embodying disabled liminality: A matter of mal/adjustment to dis/ableism.

This article combines the line of work that links disability and liminality with feminist dis/ability studies to analyse how the 'disabled body-subject' is produced and subjectified during hospitalisation and post-hospitalisation. This analysis is based on six bodily itineraries conducted with three men and three women with a spinal cord injury (five with tetraplegia and one with paraplegia) acquired during their adolescence. First, we interpret hospitalisation as a phase of 'acute liminality' in which the disabled body-subject starts being produced as suspicious, expropriated and de/gendered. Secondly, we illustrate how discharge and the 'return' to the community entail the formation of several bodily assemblages that embody mal/adjustment. This leaves the subject in a state of 'sustained liminality' plagued with paradoxes and ambivalence. We argue that both liminalities lead disabled subjects to do an emotional work consisting of adjusting to situations of affective disablism while also opening up spaces of resistance regarding heterosexist and ableist mandates. We conclude by pointing out the potentialities of a two-way dialogue between medical sociology and dis/ability studies.

The collaborative management of antipsychotic medication and its obstacles: A qualitative study.

Antipsychotic medication is the primary treatment for psychotic conditions such as schizophrenia and schizoaffective disorders; nevertheless, its administration is not free from conflicts. Despite taking their medication regularly, 25-50% of patients report no benefits or perceive this type of treatment as an imposition. Following in the footsteps of a previous initiative in Quebec (Canada), the Gestion Autonome de la Médication en Santé Mentale (GAM), this article ethnographically analyses the main obstacles to the collaborative management of antipsychotics in Catalonia (Spain) as a previous step for the implementation of this initiative in the Catalan mental healthcare network. We conducted in-depth interviews with patients (38), family caregivers (18) and mental health professionals (19), as well as ten focus groups, in two public mental health services, and patients' and caregivers' associations. Data were collected between February and December 2018. We detected three main obstacles to collaboration among participants. First, different understanding of the patient's distress, either as deriving from the symptoms of the disorder (professionals) or the adverse effects of the medication (patients). Second, differences in the definition of (un)awareness of the disorder. Whereas professionals associated disorder awareness with treatment compliance, caregivers understood it as synonymous with self-care, and among patients "awareness of suffering" emerged as a comprehensive category of a set of discomforts (i.e., symptoms, adverse effects of medication, previous admissions, stigma). Third, discordant expectations regarding clinical communication that can be condensed in the differences in meaning between the Spanish words "trato" and "tratamiento", where the first denotes having a pleasant manner and agreement, and the second handling and management. We conclude that these three obstacles pave the way for coercive practices and promote patients' de-subjectivation, named here as the "total patient" effect. This study is the first GAM initiative in Europe.