Free Speech or Free to Hate?: Anti-LGBTQ+ Discourses in LGBTQ+-Affirming Spaces on Gab Social

This article presents a critical discourse analysis of groups on the free speech social media platform Gab that were intended to be LGBTQ+-friendly but became spaces of queerphobia. Results indicate that Gab users deployed discourses of difference to situate the platform as heteronormative and to denigrate the LGBTQ+ community. In particular, discourses utilized in the name of free speech were used to establish LGBTQ+ individuals as abominations, undergird hegemonic masculinity, and marginalize queer folk by reducing them to sex acts and sex organs. This study provides a better understanding of the (in)efficacy of "free speech" as a content moderation policy and unpacks how anti-LGBTQ+ hate speech spreads in digital spaces.

Mechanisms in sociology-a critical intervention

The notion of the mechanism is one of the most popular and widely used concepts in science and sociology is no exception. This paper problematizes the widespread and often uncritical use of the term "mechanism" in contemporary sociology. Drawing on the mechanistic worldview associated with leading figures of the scientific revolution, the paper emphasizes the impact of mechanistic thinking on the societal rationalization process identified by Max Weber and the Frankfurt School. The analysis suggests that mechanisms, when applied to sociological theories, may uncritically reproduce a cultural fetish of the rational society with potentially dehumanizing consequences. The author advocates for a critical reflection on the cultural and historical context of mechanisms, urging sociologists to view them not merely as analytical tools but as active contributors to the creation and shaping of social worlds erected on a belief in instrumental reason.

Digital loneliness-changes of social recognition through AI companions

Inherent to the experience of loneliness is a significant change of meaningful relatedness that (usually negatively) affects a person's relationship to self and others. This paper goes beyond a purely subjective-phenomenological description of individual suffering by emphasizing loneliness as a symptomatic expression of distortions of social recognition relations. Where there is loneliness, a recognition relation has changed. Most societies face an increase in loneliness among all groups of their population, and this sheds light on the reproduction conditions of social integration and inclusion. These functions are essential lifeworldly components of social cohesion and wellbeing. This study asks whether "social" AI promotes these societal success goals of social integration of lonely people. The increasing tendency to regard AI Companions (AICs) as reproducers of adequate recognition is critically discussed with this review. My skepticism requires further justification, especially as a large portion of sociopolitical prevention efforts aim to fight an increase of loneliness primarily with digital strategies. I will argue that AICs rather reproduce than sustainably reduce the pathodynamics of loneliness: loneliness gets simply "digitized."

Radicalisation studies: An emerging interdisciplinary field

This research note provides an overview of Radicalisation Studies as an emerging interdisciplinary field aimed at developing more holistic understandings of how and why individuals and groups turn to extreme ideologies and political violence. It traces the evolution of radicalisation research across core social science disciplines, including sociology, psychology, anthropology, and political science. While this burgeoning scholarship has expanded knowledge, persistent gaps remain due to studying radicalisation in disciplinary silos. To address this fragmentation, the research note proposes an integrated Radicalisation Studies approach grounded in critical social theory and reflexivity. This paradigm synthesises concepts and mechanisms from across disciplines to investigate the complex interplay between individual vulnerabilities, group dynamics, and broader socio-political contexts in generating radicalisation. The note outlines theoretical foundations, guiding research questions, and methodological strategies for this new field focused on mixed-methods, multi-level analysis. Radicalisation Studies holds promise for advancing theoretical integration, contextualised explanations, critical perspectives on radicalisation discourse, and evidence-based preventative policies. While challenges remain in institutionalising this emerging field, Radicalisation Studies has the potential to steer research towards greater interdisciplinarity and the nuanced understandings necessary to elucidate this complex phenomenon. The research note aims to spur debate on constructing Radicalisation Studies as a viable scholarly enterprise.

Images of depression in Charles Baudelaire: clinical understanding in the context of poetry and social history

There is increasing recognition of the importance of the humanities and arts in medical and psychiatric training. We explore the poetry of Charles Baudelaire (1821-1867) and its evocations of depression through themes of mood, time and self-consciousness and discuss their relation to images of 'spleen', the 'snuffling clock' and the 'sinister mirror'. Following the literary critical commentaries of Walter Benjamin (1892-1940) and Jean Starobinski (1920-2019) we identify some of their roots in the poet's experience of the rapid and alienating urbanisation of 19th-century Paris. Appreciation of the rich vocabulary of poetry and the images it generates adds depth to clinical practice by painting vivid pictures of subjective experience, including subjective experience of the 'social' as part of the biopsychosocial constellation.

On the bullshitisation of mental health nursing: A reluctant work rant

This discussion paper offers a critical provocation to my mental health nursing colleagues. Drawing upon David Graeber's account of bullshit work, work that is increasingly meaningless for workers, I pose the question: Is mental health nursing a bullshit job? Ever-increasing time spent on record keeping as opposed to direct care appears to represent a Graeberian bullshitisation of mental health nurses' work. In addition, core aspects of the role are not immune from bullshit. Professional rhetoric would have us believe that mental health nursing is a therapeutically beneficent occupation organised around ideals of care and compassion and providing fulfilling work for practitioners. Yet, there are some key characteristics of the experience of mental health nursing work that afford alternative judgements on its value and meaningfulness. Not least of these is the fact that many mental health nurses feel quite existentially unsettled in the practise of their work and many service users do not recognise the professional ideal, especially when compelled into increasingly coercive and restrictive services. In this context, Graeber's thesis is explored for its applicability to mental health nursing with a conclusion that many aspects of mental health nursing work are commensurate with bullshit but that mental health care can possibly be redeemed from bullshitisation by authentically democratising reforms. Engaging with posthumanist ideas, this exploration involves a flexing of aspects of Graeber's theory.

Disability Justice and the Americans with Disabilities Act: An Opportunity for Social Work

According to the Centers for Disease Control and Prevention, over 61 million Americans have a disability, which translates to about 26 percent of the national population. The most common types of disability are physical (13.7 percent), or those that impact mobility, and intellectual (10.8 percent), or those related to cognitive processing. The Bureau of Justice Statistics has reported that 32 percent of people in state prisons and 40 percent of people in county jails have at least one disability, rates that demonstrate alarming disproportionality. Yet the history of the disability rights movement, the impact of the Americans with Disabilities Act for people with disabilities who are involved with the criminal justice system, and the implications of disability justice and critical disability theory for the field of social work are not well understood. The purpose of this article is to review these under-recognized topics and offer recommendations for addressing this neglected area of social work education, research, policy, and practice.

Discursive constructions of family functions in forensic psychiatry: A critical ethnographic perspective

Significant barriers remain regarding the implementation of family-centred approaches in the domain of forensic psychiatry despite their effectiveness at increasing adherence to treatment, improving attendance to medical appointments, decreasing readmission rates and reducing episodes of relapse. We attribute these barriers to a fundamental gap in our understanding of the family function and its role within the forensic psychiatric system. Despite requesting to be included and considered as partners, some families feel excluded and sidelined, which causes distress, incomprehension and disengagement. We approached this tension at the discursive level through a critical ethnography of the Review Board and the work of Foucault on psychiatric power, which provided us with a unique opportunity to understand how the role of families are constructed and sustained in the Canadian forensic psychiatric system. To do so, we mobilized data stemming from ethnographic observations and documentary artifacts entitled 'reasons for disposition'. Data analysis allowed us to identify two discursive constructions of familial functions: (1) families as repositories of information and (2) families as supervisory agents. These results have implications for health care professionals and administrators in forensic psychiatry who are increasingly adhering to family-centred care models without questioning what such care or what such family engagement entails.

Standpoint theory and middle-range theorizing in International Sociology

This paper responds to Julian Go's Lecture "Thinking against Empire. Anti-colonial Thought and Social Theory." It proceeds in two parts: I first follow Go's invitation to read and reread Mabel Dove Danquah and Frantz Fanon and explore what their work contributes to our understanding of state-forms. I then examine the terms of Go's invitation more closely. I contrast Go's juxtaposition of imperial sociology on the one hand and anti-colonial sociology on the other hand, with the broader range of theoretical traditions and methods, which a practice-oriented sociology of sociology and an international history of sociology would highlight. I raise the question what "standpoint" adds to the authors Go discusses and the broader range of scholars who have engaged with post-colonial contexts in their research at this point in time. Calling for consideration of the anti-colonial standpoint is a particular choice, which has a distinctive heritage in Hegelian-Marxian projections of the social whole and is in tension with either deep exploration of particular thinkers or the middle-range theorizing that Go also seems to endorse. Defined at a level of abstraction that is "above" (or underneath) actual conversations in a range of fields and subfields, it can appear as a "test" for scholars who have long engaged with post-colonial contexts, which can have unintended consequences when coupled with the institutional power and asymmetric insularity of Anglo-American academia.

Bad or worse? Applying critical theory to explore the impacts of Payatas dumpsite closure on the former waste pickers

Numerous garbage dumpsites worldwide have been closed down to address the safety, health and environmental hazards facing waste pickers, such as potential landsides, diseases and pollution. As a result, the environment surrounding the (former) waste pickers may have been safer and cleaner. While the closure of garbage dumpsites may be an act of social justice to protect waste pickers, however, in some cases, the incomes and living standards of former waste pickers who continue to reside at these sites have been aggravated. Drawing on critical theory, and using observations and interviews, this case study examined the post-dumpsite-closure situation of Payatas in the Philippines. This study augments previous research on critical urban and regional studies through the presentation of a meta-critical theory by expanding, critiquing and reconceptualizing critical theory to address the problematic post-dumpsite situation created through the closure of the dumpsite.

A Scoping Review of Theoretical Lenses and Methodological Approaches in Indigenous Women's Health and Well-Being Research in North America over the Past Two Decades

Theoretical approaches influence research design, engagement, and outcomes. The relevance of critical theoretical and methodological approaches to Indigenous women's health and well-being research has increased in the last decade. It is difficult to assess the ways in which theoretical lenses can effectively interrupt and challenge systemic erasure, ongoing harms, and deficit-based (ill-health-centered) approaches to Indigenous women's health and well-being, a fact that is not broadly acknowledged. We conducted a scoping review to (a) map the type and frequency of critical theoretical lenses used by researchers focused on Indigenous women's health and well-being in North America over the past two decades and (b) identify which topics tend to use which theoretical lens. We have conducted a scoping review to examine peer-reviewed articles from eight electronic databases. In the articles selected over 2000-2021, we found an increase in the use of community-based participatory research, decolonial lenses, and feminist lenses. Over the last decade, there has been a decrease in quantitative social science approaches. While a range of critical theoretical and methodological approaches are increasingly being applied, the use of cultural resurgence and Indigenous feminism in health research is not widespread.

Intersection of social determinants of symptomatic breast cancer presentation in a rural setting: A critical ethnographic study

AIM

The aim of the study was to explore the determinants of time to presentation of women with breast cancer symptoms within a rural setting in Kenya.

DESIGN

A critical ethnographic study.

METHODS

Data were collected between July 2019 and April 2020 using semi-structured interviews and focus groups with 12 women and 23 disclosure recipients, respectively. Interviews and focus group discussions were audio recorded, transcribed verbatim, translated into English and thematically analysed. Further analysis using an intersectional lens added new insights into the data. Ethics approval was obtained in both Kenya and United Kingdom.

RESULTS

Participants narrated their experiences from the time they self-discovered breast cancer symptoms to the time they first came into contact with a healthcare professional. The core themes identified included local cancer knowledge, embodied experience, women's responses, social networks, cultural cancer schemas, gendered social structures and healthcare system experiences.

CONCLUSION

The findings revealed that symptomatic women predominantly faced multiple intersecting barriers to timely presentation. The key drivers of timeliness to presentation of women with breast cancer symptoms were identified. Several proximal and distal determinants, including economic, social, psychological and cultural determinants intersected to shape women's timeliness to symptomatic presentation.

IMPACT

This study identified intersectional structural determinants to timely symptomatic presentation of women with breast cancer symptoms. The findings have global health implications for social inequalities in female breast cancer and may inform the development of intersectional interventions to promote timely symptomatic presentation. Furthermore, this study identified an additional interval, precursory interval and revision of the Model of pathway to treatment may be needed should this interval be validated by future studies.

PATIENT OR PUBLIC CONTRIBUTION

To ensure the interview guides were culturally sensitive, they were co-designed with a female breast cancer survivor, nurses providing reproductive health care to women and a bilingual expert. Both women and disclosure recipients participated in scheduling for the interviews, including the mutually agreeable days and time. Participants were frequently contacted during data analysis and report writing to clarify meaning of certain words or pieces of data.

The Relationship between Religion, Substance Misuse, and Mental Health among Black Youth

Studies suggest that religion is a protective factor for substance misuse and mental health concerns among Black/African American youth despite reported declines in their religious involvement. However, few studies have investigated the associations among religion, substance misuse, and mental health among Black youth. Informed by Critical Race Theory, we evaluated the correlations between gender, depression, substance misuse, and unprotected sex on mental health. Using multiple linear regression, we assessed self-reported measures of drug use and sex, condom use, belief in God, and religiosity on mental health among a sample of Black youth (N = 638) living in a large midwestern city. Results indicated drug use, and sex while on drugs and alcohol, were significant and positively associated with mental health symptoms. Belief in God was negatively associated with having sex while on drugs and alcohol. The study's findings suggest that despite the many structural inequalities that Black youth face, religion continues to be protective for Black youth against a myriad of prevalent problem behaviors.

Becoming breastfeeding friendly in Great Britain-Does implementation science work?

The Becoming Breastfeeding Friendly (BBF) in Great Britain study was conducted during 2017-2019 comprising three country studies: BBF England, Wales and Scotland. It was part of an international project being coordinated during the same period by the Yale School of Public Health across five world regions to inform countries and guide policies to improve the environment for the promotion, protection and support of breastfeeding. This paper reports on the application of the BBF process that is based on an implementation science approach, across the countries that constitute Great Britain (England, Wales and Scotland). The process involves assessing 54 benchmarks across eight interlocking gears that drive a country's 'engine' towards a sustainable policy approach to supporting, promoting and protecting breastfeeding. It takes a consensus-oriented approach to the evaluation of benchmarks and the development of recommendations. This paper provides a critical overview of how the process was conducted, the findings and recommendations that emerged and how these were managed. We draw on critical theory as a theoretical framework for explaining the different outcomes for each country and some considerations for future action.

Perceptions of mobile and acute healthcare services among people experiencing homelessness

OBJECTIVES

This paper presents findings from our collaborative research on the perceptions and preferences of people experiencing homelessness regarding outreach nursing services.

METHOD

We conducted qualitative research using a critical ethnography approach.

SAMPLE

A total of 15 participants were interviewed individually (n = 12 people experiencing homelessness) and in focus groups (n = 3 care providers). We also conducted direct observation.

RESULTS

This paper focuses on one of the core categories that emerged from the data analysis "Perception of Health Care." This category emerged from the following three subcategories, which we will present in this paper: (1) Conflicting Relationships with Institutional Health Services; (2) Perception of Outreach Services; (3) Recommendations from Mobile Clinic Users.

CONCLUSION

There are a range of perceptions of health services among people experiencing homelessness. Some are satisfied with the care received in the public health system, while many have experienced dehumanizing practices. Overall, outreach services are a promising strategy to reach people who are not served by the traditional modes of care delivery. Based on our findings, we suggest several key practices to personalize and adapt healthcare services and foster inclusive environments to better serve people experiencing homelessness.

[A postcolonial couch, psychoanalysis and critical studies]

The expression "postcolonial couch" is first of all to be understood as an invitation to rethink psychoanalysis beyond the anthropological, epistemological and political categories that saw its birth (the Oedipus complex, sexual difference, etc.). But it must also be understood as a de-fense of psychoanalysis, and more specifically as a defense of the type of listening and care that its unique device, based on the hypothesis of the unconscious, makes possible.

Voicing student recovery: Embracing diversity in collegiate recovery programs

Objective: To discuss the engagement of patients and stakeholders (ie, faculty, staff, healthcare providers, and university administrators) in capacity building activities to prepare for future patient-centered research on collegiate recovery. Participants: 502 attended capacity building activities and provided input on priorities for future research in collegiate recovery and 77 participated in the deliberative democracy forum process. Methods: We used surveys and the deliberative democracy forum method, which includes framing sessions and forums for data collection. This method enables individuals with diverse backgrounds to share and learn about differing viewpoints to build consensus for decision making. Results: Forum participants prioritized barriers to recovery for future research and discussed the need to address diversity in collegiate recovery programs, including racial/ethnic diversity in the student recovery population and diversity in pathways to recovery, to decrease barriers to recovery. Conclusions: Institutional support for research on collegiate recovery is critical to move the field forward.

Two Attitudes towards Textuality in International Law: The Battle for Dualism

This article sketches out two distinct attitudes towards textuality in international law, namely international hermeneutics and international poetics. It argues that these two attitudes towards textuality espouse very different types of dualism of thought. This difference bears major implications on how the international lawyer approaches international legal texts. In exposing these two attitudes towards textuality and the distinct types of dualism they reveal, this article makes a plea for a greater embrace of international poetics by international lawyers, and thus for a complete remoulding of international lawyers' dualist patterns of thought.

"Your double-blind RCT needs feminism": an argument for engaging critical theory in quantitative rehabilitation research

PURPOSE

Rehabilitation science has, for years, endorsed a connection between quantitative research and the philosophical assumptions of positivism. These assumptions can limit the scope of rehabilitation research, particularly in relation to matters of equity, diversity, and inclusivity. As our field moves toward a greater focus on inclusivity in research design and patient-centred care, it is imperative that we reconsider the theoretical foundations of rehabilitation research and practice.

METHODS

We provide an analysis of positivism on equity, diversity, and inclusivity within quantitative rehabilitation research, using the Participant Intervention Comparison Outcome (PICO) model to provide structure for the resultant discussion and recommendations.

RESULTS

Our analysis reveals that there are significant limitations and ethical concerns to engaging in positivism as the primary paradigm for quantitative rehabilitation research. We argue that decoupling of positivism and quantitative research methods may be warranted.

CONCLUSIONS

Equitable and inclusive rehabilitation research requires the researcher to consider variables which are neglected in the positivist paradigm. We argue that critical theory can equip researchers with a lens to better address injustices within rehabilitation research. We provide a series of recommendations for researchers to engage critical theory at each stage of the PICO model of clinical trials.IMPLICATIONS FOR REHABILITATIONCommon assumptions in quantitative rehabilitation research (i.e., positivism) can limit the utility of research findings to rehabilitation patients.Equitable, diverse, and inclusive participant samples in research better reflect the diversity of real world rehabilitation patients, helping us better serve these populations.Critical theory can help researchers and clinicians identify and avoid interventions that may cause harm to rehabilitation patients.Research and practice that prioritize concepts of "normalcy" (i.e., "normal gait," "normal behaviours") may perpetuate negative concepts of disability and further marginalize the individuals that our interventions aim to serve.

Critical Research and Qualitative Methodologies: Theoretical Foundations and Contribution to Nursing Research

Background: Methodological approaches that draw on critical perspectives (critical ethnography, critical phenomenology, and critical grounded theory) share common concepts, including social justice, reflexivity, positionality, pragmatism and social transformation. These approaches differ from conventional phenomenology, ethnography and grounded theory despite sharing common methodological grounds.Purpose: In this article, we will outline the major contributions of critical theory, as a research paradigm, to the development and evolution of qualitative methodologies. In particular, we will discuss their application to nursing research. The historical and conceptual underpinnings of these critical methodologies will first be described to highlight their paradigmatic characteristics and implications for nursing.Implications for Practice: Although not yet widely employed in nursing research, critical qualitative methodologies are particularly well suited to the discipline as they shed light on issues of power, social control, and marginalization among the vulnerable populations with whom nurses practise on a daily basis. The use of critical approaches can expose the epistemic injustice and social and health inequality that continue to prevail in our society.

Antiracist Activism in Clinical Ethics: What's Stopping Us?

Although justice is a central principle in clinical ethics, work that centers social justice is often marginalized in clinical ethics. In addition to institutional barriers that may be preventing clinical ethicists from becoming the activists that Meyers argues we should be, we must also recognize the barriers embedded in the field of clinical ethics itself. As clinical ethicists, we have an opportunity to support anti-racism work in particular by altering our own organizational structures to be more inclusive and reflective of the Black, Indigenous, and other communities of color we serve, enhancing clinical ethics education and training by making critical theories foundational, and decolonizing our clinical ethics consultation tools and practices.

Critical ethnography in maternity care research: bridging creativity and rigour - a discussion paper

Ethnography is a useful research method for maternity care research, because it can identify elements of actual practice that may be missed using non-observational research. However, because of the relative creative freedom of writing ethnography, it can be difficult for novice researchers, because there is no particular set of steps to follow. Much of the work of an ethnography is actually just watching, thinking and writing. In this paper we discuss our three individual doctoral research projects- all variations of critical ethnography-in order to present some of the creative variety of ethnography in maternity care research and to promote discussion within this field about how to maintain robust ethnographic research while keeping hold of its creative aspects. Attempts to standardise ethnographic research have the potential to curtail a very flexible methodology and constrain the knowledge generating work of the researcher. We encourage fellow maternity researchers to contribute to literature on ethnographic methodology in order to expand and refine use of this methodology in maternity care settings.

Lessons on Older LGBTQ Individuals' Sexuality and Spirituality for Hospice and Palliative Care

Hospice and palliative care are in the beginning stages of providing inclusive care to older lesbian, gay, bisexual, transgender, queer (LGBTQ) patients. This inclusivity is exceedingly more pressing given the growing population of out and aging LGBTQ individuals. Hospice and palliative literature recognizes that spirituality and religion can be fraught topics for LGBTQ patients. A few resources are available to help providers give more inclusive care. Few in hospice and palliative care, however, explicitly outline the direct connection for LGBTQ elders between their sexuality and their spiritual lives. 16 LGBTQ individuals born before 1964 were interviewed in the Colorado Front Range. Keeping with the tradition of critical theory, participants were asked "is there a connection for you between your sexuality and your spirituality? if so, what?" The interviews were analyzed using a qualitative conceptual content analysis method. All 16 participants responded that there was a connection for them. The participants expanded on this connection using five themes in their answers: the sexual act itself is spiritual; their authentic LGBTQ journey as spiritual; love/attraction is spiritual; spirituality and sexuality are inseparable; and finally, noting the ineffability of the sexuality-spirituality connection.

Caring for a violent relative with severe mental illness: a qualitative study

Background

According to the literature reviewed, although families living with a mentally ill relative often face violence, this issue has been little studied in nursing.

Methods

We conducted a qualitative research study to explore the experience of families dealing with this complex reality. We adopted Jacques Donzelot's theory of the government of family as our theoretical framework and used grounded theory as our research methodology. In total, 14 participants who had been victims of violence perpetrated by relatives with severe mental illness were interviewed.

Findings

Qualitative analysis led to the identification of five themes: (a) medico-legal apparatus; (b) experience of violence; (c) the family's responsibility toward the violent relative; (d) exclusion and stigmatisation; and (e) suffering and resilience. The present paper focuses on the study's central theme: the family's responsibility toward the violent relative.

Mapping Moral Injury: Comparing Discourses of Moral Harm

Moral injury is a term whose popularity has grown in psychology and psychiatry, as well as philosophy, over the last several years. This presents challenges, because these fields use the term in different ways and draw their understanding from different sources, creating the potential for contradiction. This, however, is also an opportunity. Comparison between behavioral sciences and philosophy can help enrich understandings of harms considered not just psychological but moral. To this end, I provide an overview of the more influential writing of moral injury, mapping them into three broad discourses: clinical, juridical-critical, and structural. This overview then leads to a discussion of how comparative engagement among these discourses promises to expand on current theories of moral harm. I argue that such a comparison will demonstrate that more emphasis on structural violence will strengthen current understandings of moral injury, often understood in a more narrow sense to be a result of more direct, physical violence, allowing us to view moral injury as a result of institutional and social violence and injustices.

'This Is Not a Patient, This Is Property of the State': Nursing, ethics, and the immigrant detention apparatus

This paper opens with first-hand accounts of critical care medical interventions in which detainees, in the custody of U.S. Immigration and Customs Enforcement (ICE), are brought to the emergency department for treatment. This case dramatizes the extent to which the provision of ethical and acceptable nursing care is jeopardized by federal law enforcement paradigms. Drawing on the scholarship of Michel Foucault and Giorgio Agamben, this paper offers a theoretical account of the power dynamics that inform the health care of patients who find themselves caught in the custodial scaffolding of a vast immigration and detention apparatus. It offers an analysis of the display of sovereign and biopolitical power over the lives (and deaths) of detainees (Foucault), as well as the ways these individuals are reduced to "bare life" under the political pretext of an emergency or "state of exception" (Agamben). Our purpose here is both theoretical and practical: to better understand the often hidden agency or impersonal "will" exercised by the immigrant detention system, but also to equip clinicians in these and cognate facilities (e.g., prisons) with the critical tools by which they might better navigate incommensurable paradigms (i.e., care vs. custody) in order to deliver the best care while upholding their ethical duties as a care provider. This is all the more pressing because hospitals are not sanctuaries and given the incursion of federal law enforcement agents, nurses may find themselves conscripted as de facto agents of the state.

Climate Change Should Be on Every Nursing Research Agenda

Human-caused climate change is a global emergency, and its harms are predicted to increase exponentially in the coming years, particularly if unsustainable practices continue unmitigated. Adverse effects of climate change on communities affected by or at risk for cancer, such as frail older adults, are already measurable and deadly. If nurse scientists continue to ignore these realities, more people are likely to suffer and die as a result. The purpose of this critical reflection is to discuss the vital necessity of including climate change in the research agenda of the Oncology Nursing Society and all nursing science. Using an approach grounded in critical theory and design justice, the authors provide specific suggestions for the incorporation of scientific considerations and nursing measures related to climate change into oncology nursing science.

The potential contribution of critical theories in healthcare transition research and practice

BACKGROUND

Healthcare transition has been established as a significant topic of interest in pediatric rehabilitation. Healthcare transition research has primarily focused on barriers to self-management and achievement of a productive adulthood. Healthcare transition experts have recently called for further attention to social structural factors. Theoretical approaches are, therefore, needed to account for how such factors shape the lives of youth with disabilities, particularly those who experience marginalization and social exclusion.

PURPOSE

Taking up this call, the aim of this paper is to examine the potential contributions of two critical theories to healthcare transition research and practice.

METHODS

Review two theories - intersectionality and critical discourse analysis.

RESULTS

Intersectionality highlights how multiple intersecting social locations and social structures interact with youth's experiences, choices and health care needs. Critical discourse analysis focuses on how discourses and assumptions in healthcare transition research and practice contribute to marginalization and can be resisted and changed by youth, families, researchers, and clinicians.

CONCLUSIONS

The uptake of critical theories within health care transition research and practice can account for the complex interplay of social structures, power relations and youth's experiences. Such analysis can contribute to refining assessments and developing interventions that reflect how marginalization and exclusion impact youth's well-being.IMPLICATIONS FOR REHABILITATIONWhile critical theories have been applied in health and rehabilitation, there has been limited uptake of these theories in healthcare transition research and practice.Critical theories can promote awareness of how youth's experiences, choices and actions throughout the healthcare transition process are shaping and shaped by structural factors and assumptions about a productive adulthood.Applying critical theories in healthcare transition practice involves being responsive to the structural factors that may be shaping youth's experiences, choices and opportunities.Intersectional and critical discourse analyses can surface how to reduce social exclusion and marginalization for youth transitioning to adulthood through analyses of language, power, dominant discourse and practices amenable to change.

Innovating Governance for Planetary Health with Three Critically Informed Frames

In May 2019, the Intergovernmental Science-Policy Platform on Biodiversity and Ecosystem Services warned that "around one million animal and plant species are now threatened with extinction." In September 2019, Naomi Klein, an astute writer on environmental change, described the interconnected social and ecological breakdowns on the planet in a new book. Ecological crises noted by these and other scholars speak well to the rise of planetary health as a new scholarship. Loss of biodiversity has manifold negative impacts on health, for example, rise of zoonotic infections and changes in healthy microbiome. But reducing our ecological footprints is not enough. We ought to change mindsets, the narrow science, and technology governance regimes that value nature and other life forms instrumentally by their usefulness to us. I describe three new, broader and critically informed, frames on governance for planetary health. First, I explain why we ought to acknowledge animal sentience, for example, as recognized in Article 13 of the Lisbon Treaty in 2009. I describe how political determinants of health, power, and agency operate at multiple sociological and planetary loci, not only among human beings but also at human and nonhuman animal interfaces. Second, planetary health calls for a shift toward ecological and political determinants beyond a narrow anthropocentric view, while resisting the entrenched dogma of exponential growth with finite planetary natural resources. Third, for critically informed governance of emerging technologies in planetary health (e.g., glycomics, artificial intelligence, health care robots), I refer to a question highlighted recently (Frodeman, 2019): "When Plato (more exactly, Juvenal) asked who guards the guardians, he was questioning whether any group can be trusted to look past its own interests for the common good." Hence, it is time we broaden the question "Who will guard the guardians?" beyond the scientific community, to actors in science policy as well. Policy questions cannot be limited to "which social issues emerge from a new technology?" but ought to include, "who should be framing science and technology policy, and why?" Youth leaders of the global climate movement such as Greta Thunberg and others are now rightly asking these epistemological questions that might contribute toward a new social contract on health for all sentient beings on planet Earth. While ecological changes accelerate and a new space industry is emerging, governance for planetary health will continue to be at the epicenter of systems thinking, responsible innovation and science policy in the 21st century.

Social Psychological Theory as History: Outlining the Critical-Historical Approach to Theory

The mainstream epistemology of social psychology is markedly ahistorical, prioritizing the quantification of processes assumed to be lawful and generalizable. Social psychologists often consider theory to be either a practical tool for summarizing what is known about a problem area and making predictions or a torch that illuminates the counterintuitive causal force underlying a variety of disparate phenomena. I propose a third vision of critical-historical theory. From this perspective, theories should be committed to deep interdisciplinarity and historical validity claims-understanding individual and group experiences as part of historically contingent forces. Theories also should be critical, containing an awareness of the researcher as implicated in the social process and committed to actively improving society. To demonstrate its viability, I review classic works from the history of the discipline that exemplify critical-historical theory and offer concrete implications for theorists interested in employing this approach in their own work.

Exploring the neglected and hidden dimensions of large-scale healthcare change

Forms of large-scale change, such as the regiona l re-distribution of clinical services, are an enduring reform orthodoxy in health systems of high-income countries. The topic is of relevance and importance to medical sociology because of the way that large-scale change significantly disrupts and transforms therapeutic landscapes, relationships and practices. In this paper we review the literature on large-scale change. We find that the literature is dominated by competing forms of knowledge, such as health services research, and show how sociology can contribute new and critical perspectives and insights on what is for many people a troubling issue.

Queering Lactation: Contributions of Queer Theory to Lactation Support for LGBTQIA2S+ Individuals and Families

In this article I explore some contributions of queer theory to the provision of lactation support services. In doing so, I also undertake an intersectional analysis of queering lactation, recognizing that forms of oppression do not impact all individuals equally or in the same ways. While recognizing the history of tensions between queer and feminist politics and activism, I argue that queering lactation holds significant benefits for supporting lactation among LGBT families, as well as opening up possibilities for rethinking gender and possibilities for gender equality more generally.

A Critical and Intersectional Model of LGBTQ Microaggressions: Toward a More Comprehensive Understanding

This article summarizes a proposed critical and intersectional model of LGBTQ microaggressions that can be used by scholars and practitioners from multiple disciplines. Drawing on critical and intersectional paradigms and decades of research from multiple fields, we constructed a model that acknowledges the breadth, depth, scope, and complexity of LGBTQ microaggressions. This proposed model includes the following elements: hegemonic influences, intersectional complexities, perpetration, interpersonal and environmental contexts, and responses.

"You Know if You Quit, That's Failure, Right?": Barriers to Professional Lactation Certification

BACKGROUND

Researchers have confirmed that breastfeeding disparities persist and that International Board Certified Lactation Consultants (IBCLCs) play a key role in reducing them. However, there continues to be a limited availability of IBCLCs throughout the United States, with racial minorities facing persistent barriers during the certification process. Research aim: Using a critical race theory framework, the aim was to describe the barriers and supports that IBCLCs experience during the course of their certification.

METHODS

This study used a prospective, cross-sectional, qualitative design with semistructured interviews with IBCLCs ( N = 36) from across the United States. Interviews were audio-recorded and professionally transcribed. Results were analyzed using an in-depth thematic analysis from the perspective of critical race theory.

RESULTS

Women made up the majority ( n = 35; 97.22%) of the sample. People of color made up slightly less than half of the sample ( n = 16; 44.44%). Barriers were initially coded by the stages of the certification process. Existing healthcare providers experienced advantages in the certification process because of their connection to social networks and resources in their hospital or place of employment. Cost and racial discrimination were identified, using a structural racism lens, as primary barriers for certification. Race-related barriers were particularly pervasive and were detailed by each stage of the certification process.

CONCLUSION

Lactation organizations and care providers need to consider ways to mitigate these perceived differences in support and infrastructure. These changes could help to ensure equity in the profession and may reduce racial discrimination in lactation care.

Understanding access to healthcare among Indigenous peoples: A comparative analysis of biomedical and postcolonial perspectives

As nursing professionals, we believe access to healthcare is fundamental to health and that it is a determinant of health. Therefore, evidence suggesting access to healthcare is problematic for many Indigenous peoples is concerning. While biomedical perspectives underlie our current understanding of access, considering alternate perspectives could expand our awareness of and ability to address this issue. In this paper, we critique how access to healthcare is understood through a biomedical lens, how a postcolonial theoretical lens can extend that understanding, and the subsequent implications this alternative view raises for the nursing profession. Drawing on peer-reviewed published and gray literature concerning healthcare access and Indigenous peoples to inform this critique, we focus on the underlying theoretical lens shaping our current understanding of access. A postcolonial analysis provides a way of understanding healthcare as a social space and social relationship, presenting a unique perspective on access to healthcare. The novelty of this finding is of particular importance for the profession of nursing, as we are well situated to influence these social aspects, improving access to healthcare services broadly, and among Indigenous peoples specifically.

Introduction to positivism, interpretivism and critical theory

BACKGROUND

There are three commonly known philosophical research paradigms used to guide research methods and analysis: positivism, interpretivism and critical theory. Being able to justify the decision to adopt or reject a philosophy should be part of the basis of research. It is therefore important to understand these paradigms, their origins and principles, and to decide which is appropriate for a study and inform its design, methodology and analysis.

AIM

To help those new to research philosophy by explaining positivism, interpretivism and critical theory.

DISCUSSION

Positivism resulted from foundationalism and empiricism; positivists value objectivity and proving or disproving hypotheses. Interpretivism is in direct opposition to positivism; it originated from principles developed by Kant and values subjectivity. Critical theory originated in the Frankfurt School and considers the wider oppressive nature of politics or societal influences, and often includes feminist research.

CONCLUSION

This paper introduces the historical context of three well-referenced research philosophies and explains the common principles and values of each.

IMPLICATIONS FOR PRACTICE

The paper enables nurse researchers to make informed and rational decisions when embarking on research.

Civil War: A Board Game as Pedagogy and Critique

This paper describes the use of a board game, Civil War, as a learning experience in the context of a course on critical theory. Civil War was created by the Educational Games Company of Lebanon and is set during the 1975-1990 Lebanese civil war. The game functions both as a pedagogical instrument, in that players learn about the situation in Lebanon while playing the game, but also as a form of critique, in that its makers are clearly using it as a means of articulating their lived experiences and challenging the dominant narratives around the conflict. We suggest that the game is a rare example of one that is counter ideological in nature, as rather than perpetuating stereotyped views of Middle East conflicts that are constructed and imposed from outside, it instead directly presents the experience of those who are inside. A case study of using the game in the context of a class on postcolonialism is presented and responses by students are analysed. We argue that the active experience of playing a board game is an effective way of engaging students with a topic, and in this case in particular, an effective way of connecting them with the lived experiences of others.

Technical rationality and the decentring of patients and care delivery: A critique of 'unavoidable' in the context of patient harm

In recent decades, debate on the quality and safety of healthcare has been dominated by a measure and manage administrative rationality. More recently, this rationality has been overlaid by ideas from human factors, ergonomics and systems engineering. Little critical attention has been given in the nursing literature to how risk of harm is understood and actioned, or how patients can be subjectified and marginalised through these discourses. The problem of assuring safety for particular patient groups, and the dominance of technical forms of rationality, has seen the word 'unavoidable' used in connection with intractable forms of patient harm. Employing pressure injury policy as an exemplar, and critically reviewing notions of risk and unavoidable harm, we problematise the concept of unavoidable patient harm, highlighting how this dominant safety rationality risks perverse and taken-for-granted assumptions about patients, care processes and the nature of risk and harm. In this orthodoxy, those who specify or measure risk are positioned as having more insight into the nature of risk, compared to those who simply experience risk. Driven almost exclusively as a technical and administrative pursuit, the patient safety agenda risks decentring the focus from patients and patient care.

Deconstruction of destruction stories: narrative, inequality, and disasters

A commonly-held belief is that natural disasters do not discriminate. This paper, though, poses the following theoretical question: what does the elision of race, class, and gender in the news media say about disasters in the neoliberal era? It draws on the author's analysis of two prominent newspapers-The New York Times and USA Today-and their coverage of the recovery process after devastating tornadoes in two towns in the United States (Tuscaloosa, Alabama, and Joplin, Missouri) in 2011. The study asserts that the narrative of the news media is one with which people are familiar and that it fits into larger 'formula stories'. It utilises theoretical treatments of narrative to demonstrate how differences are erased and how they lead to complicity in hegemonic representations. Critical theory is used to elucidate why this occurs, and the paper sources Goldberg (2002) in suggesting that the news media employs 'fantasies of homogenisation' when representing post-disaster communities.

From the Anticipatory Corpse to the Participatory Body

Jeffrey Bishop's The Anticipatory Corpse demonstrates how death is present in and cloaked by contemporary practices of end-of-life care. A key to Bishop's argument is that for modern medicine the cadaver has become epistemologically normative and that a metaphysics shorn of formal and final causes now shapes contemporary healthcare practices. The essays of this symposium laud and interrogate Bishop's argument in three ways. First, they raise critical methodological challenges from the perspectives of human rights, Charles Taylor's concept of social imaginaries, and economics. Second, they demonstrate the analytical power of his argument by detailing how it might be extended to additional issues beyond simply end-of-life care and how it might be brought into conversation with sociology. Third, they engage the constructive turn Bishop takes at the end of the book. Bishop himself also updates readers on the reception of The Anticipatory Corpse, as well as the way his thinking has evolved over the past 5 years since its publication. He also engages the questions, challenges, and openings provided by our authors.

Articulating Connections between the Harm-Reduction Paradigm and the Marginalisation of People Who Use Illicit Drugs

In this paper, we argue for the importance of unsettling dominant narratives in the current terrain of harm-reduction policy, practice and research. To accomplish this, we trace the historical developments regarding the Human Immunodeficiency Virus (HIV), the Hepatitis C Virus (HCV) and harm-reduction policies and practice. We argue that multiple historical junctures rather than single causes of social exclusion engender the processes of marginalisation, propelled by social movements, institutional interests, state legislation, community practices, neo-liberalism and governmentality techniques. We analyse interests (activist, lay expert, institutional and state) in the harm-reduction field, and consider conceptualisations of risk, pleasure, stigma, social control and exclusionary moral identities. Based on our review of the literature, this paper provides recommendations for social workers and others delivering health and social care interested in the fields of substance use, HIV prevention and harm reduction.

Domestic Violence and Social Justice: A Structural Intersectional Framework for Teaching About Domestic Violence

My Domestic Violence and Social Justice law school course is organized around a structural intersectional framework to encourage students to recognize how structural inequalities inform the types of abuse perpetrated, individual and community responses to abuse, meanings that a victim ascribes to abuse, and factors that increase the risk of abuse. The course challenges the dominant neoliberal ideology focus on individual responsibility that eclipses shared responsibility. The course combines experiential exercises, a presentation by members of a community-based survivor organization, discussion of a hypothetical case with a legal practitioner, and court observation to help students apply theoretical insights to practical issues of individual representation and policy-making.

New risks: the intended and unintended effects of mental health reform

In crisis situations, the authority of the nurse is legitimised by legal powers and professional knowledge. Crisis stakeholders include those who directly use services and their families, and a wide range of health, social service and justice agencies. Alternative strategies such as therapeutic risk taking from the perspective of socially inclusive recovery policy coexist in a sometimes uneasy relationship with mental health legislation. A critical discourse analysis was undertaken to examine mental health policies and guidelines, and we interviewed service users, families, nurses and the police about experiences of accessing services. For those who attempt to access services early in crisis, as is suggested to lead to a better outcome, provision of services and rights appear to be reversed by an attempt to exclude them through practices that screen them out, rather than prioritising a choice in access.

Cosmopolitics: towards a new articulation of politics, science and critique

This paper explores how Ulrich Beck's world-risk-society theory (WRST) and Bruno Latour's Actor-Network Theory (ANT) can be combined to advance a theory of cosmopolitics. On the one hand, WRST helps to examine 'cosmopolitan politics', how actors try to inject cosmopolitanism into existing political practices and institutions anchored in the logic of nationalism. On the other hand, ANT sheds light on 'cosmological politics', how scientists participate in the construction of reality as a reference point for political struggles. By combining the WRST and ANT perspectives, it becomes possible to achieve a more comprehensive understanding of cosmopolitics that takes into account both political and ontological dimensions. The proposed synthesis of WRST and ANT also calls for a renewal of critical theory by making social scientists aware of their performative involvement in cosmopolitics. This renewal prompts social scientists to explore how they can pragmatically support certain ideals of cosmopolitics through continuous dialogues with their objects of study, actors who inhabit different nations and different cosmoses.

'The medical' and 'health' in a critical medical humanities

As befits an emerging field of enquiry, there is on-going discussion about the scope, role and future of the medical humanities. One relatively recent contribution to this debate proposes a differentiation of the field into two distinct terrains, 'medical humanities' and 'health humanities,' and calls for a supersession of the former by the latter. In this paper, we revisit the conceptual underpinnings for a distinction between 'the medical' and 'health' by looking at the history of an analogous debate between 'medical geography' and 'the geographies of health' that has, over the last few years, witnessed a re-blurring of the distinction. Highlighting the value of this debate within the social sciences for the future development of the medical humanities, we call for scholars to take seriously the challenges of critical and cultural theory, community-based arts and health, and the counter-cultural creative practices and strategies of activist movements in order to meet the new research challenges and fulfill the radical potential of a critical medical humanities.

Educational silos in nursing education: a critical review of practical nurse education in Canada

Changes to practical nurse education (with expanded scopes of practice) align with the increasing need for nurses and assistive personnel in global acute care contexts. A case in point is this critical exploration of Canadian practical nursing literature, undertaken to reveal predominating discourses and relationships to nursing disciplinary knowledge. The objectives of this poststructural critical review were to identify dominant discourses in practical nurse education literature and to analyze these discourses to uncover underlying beliefs, constructed truths, assumptions, ambiguities and sources of knowledge within the discursive landscape. Predominant themes in the discourses surrounding practical nurse education included conversations about the nurse shortage, expanded roles, collaboration, evidence-based practice, role confusion, cost/efficiency, the history of practical nurse education and employer interests. The complex relationships between practical nursing and the disciplinary landscape of nursing are revealed in the analysis of discourses related to the purpose(s) of practical nurse education, curricula/educational programming, relationships between RN and PN education and the role of nursing knowledge. Power dynamics related to employer needs and interests, as well as educational silos and the nature of women's work, are also revealed within the intersection of various discourses.