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Interactional aspects of violent behaviour on acute psychiatric wards

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Violence on psychiatric wards involving staff and patients is a significant problem in many countries. Whilst patient psychopathology is often a factor, the violent interaction between ward staff and patients is often comparable to other violent interactions in the outside world. Thus, approaches from the social sciences can help to analyse the interactional patterns on psychiatric wards in order to benefit from their similarity to “ordinary” violent interactions. The concepts of aversive stimulation and double contingency are applied here to conclude that many acts of violence on wards occur following frustration or other rule imposition by staff. Both staff and patients can be seen as coping with perceived threat presented by the other in the interaction in a context of uncertainty about the behaviour of the other. The combination of misunderstanding, reciprocal anger and need for safety underpins an escalating tension in the interaction. These notions help us to understand these interactions better and could be incorporated in training for mental health staff.

Keywords: Aggression; aversive stimulation; double contingency; interaction; mental health care

Document Type: Research Article


Affiliations: 1: School of Health Sciences, University of Liverpool, Liverpool, L69 3GB, UK 2: Westphalian Hospital Muenster, Germany, and Institute of Sociology, University of Muenster, Germany

Publication date: December 1, 2005

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