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The symbolic affordances of a video-mediated gaze in emergency psychiatry

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  • Trondsen, Marianne V.
  • Tjora, Aksel
  • Broom, Alex
  • Scambler, Graham

Abstract

While mental illness is a significant health challenge worldwide, the availability of specialists is limited, especially in rural areas and for psychiatric emergencies. Although tele-psychiatry, via real-time videoconferencing (VC), is used to provide consultative services in areas that lack psychiatrists, there are a paucity of studies on the use of VC for psychiatric emergencies. We examine how VC matters for patient involvement and professional practice in the first Norwegian emergency tele-psychiatric service. Through a decentralised on-call system, psychiatrists are accessible 24/7 by telephone and VC for patients and nurses in regional psychiatry centres. Based on 29 interviews with patients, psychiatrists and nurses, this article addresses how participation is fostered by VC, and how it may change the social dynamics of therapeutic emergency encounters. We identified four contributions of the ‘video-mediated gaze’ in the therapeutic encounter including those of the: (1) immediacy of assessment, (2) increased transparency, (3) sense of access to the ‘real’ expert, and (4) fostering of the patient's ‘voice’ in therapeutic decisions. These VC inflections of the therapeutic encounter are a mix of the pragmatic (1 and 2) and the symbolic (3 and 4), assembling in these contexts to foster patient-centeredness. With a sociological approach to video-conferenced emergency psychiatry, the identification of symbolic affordances adds necessary nuances to the application of new technologies into fragile therapeutic communication.

Suggested Citation

  • Trondsen, Marianne V. & Tjora, Aksel & Broom, Alex & Scambler, Graham, 2018. "The symbolic affordances of a video-mediated gaze in emergency psychiatry," Social Science & Medicine, Elsevier, vol. 197(C), pages 87-94.
    • Handle: RePEc:eee:socmed:v:197:y:2018:i:c:p:87-94
    DOI: 10.1016/j.socscimed.2017.11.056
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    References listed on IDEAS

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    1. Dedding, Christine & van Doorn, Roesja & Winkler, Lex & Reis, Ria, 2011. "How will e-health affect patient participation in the clinic? A review of e-health studies and the current evidence for changes in the relationship between medical professionals and patients," Social Science & Medicine, Elsevier, vol. 72(1), pages 49-53, January.
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    3. Tjora, Aksel Hagen & Scambler, Graham, 2009. "Square pegs in round holes: Information systems, hospitals and the significance of contextual awareness," Social Science & Medicine, Elsevier, vol. 68(3), pages 519-525, February.
    4. Lupton, Deborah & Jutel, Annemarie, 2015. "‘It's like having a physician in your pocket!’ A critical analysis of self-diagnosis smartphone apps," Social Science & Medicine, Elsevier, vol. 133(C), pages 128-135.
    5. Andreassen, Hege K., 2011. "What does an e-mail address add? - Doing health and technology at home," Social Science & Medicine, Elsevier, vol. 72(4), pages 521-528, February.
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