A retrospective study was conducted in a sample of 80 unemployed men selected from an unemployment benefit office in London. Psychiatric state was assessed using reliable, clinically-oriented, criteria for the diagnosis of affective disorders (depressive and anxiety states), and the date of onset of any disorder ascertained. Feelings of shame over unemployment were rated using explicit criteria, and information on life events, and difficulties, and a variety of other social factors ,collected using established procedures. Among men who were well at the time of job loss, one in seven subsequently developed a relatively severe ('case') affective disorder, and one in three a severe or a mild ('borderline case'?) disorder. Most of these were depressive states and had arisen in close proximity to the event of job loss. Factors found to increase the risk of onset of a disorder following job loss were (1) the lack of an intimate relationship with a wife or girlfriend (for the more severe disorders only) ; (2) economic difficulties antedating the present spell of unemployment (pre-existing money difficulties or a past history of insecure employment) and (3) the personality trait of shyness (each for the more severe and the milder disorders). Feelings of shame were reported by one in four men, and these were also associated with previous economic difficulties and with trait shyness. Shame was strongly associated with the onset of an affective disorder following job loss, and analysis indicated that the most likely explanation for this was that shame and affective disorder were both related to a common mediating factor, which it was suggested may have been chronically low or acutely damaged self-esteem.

Sibling relationships are significant in the lives of people who have a learning disability. They usually form a major part of their social network and there is an expectation at government, social and family level that siblings will provide some degree of support in the event of parental decline. A mixed methodological approach was taken, utilizing a survey in Stage one and Interpretative Phenomenological Analysis (IPA) at Stage two. In the latter, 15 face to face semi-structured interviews were conducted to support the research aim of listening to the voices of adult siblings of people who have a learning disability, regarding their personal wishes or preferences in relation to a future support role. Three overarching themes were identified from nine superordinate themes: impact of learning disability, services, and sibling needs and recommendations. Key messages raised were that learning disability has a significant impact upon sibling lives throughout the life course; although the areas and degree of impact varies widely between individuals, most participants voiced concern about the future, particularly when older parents would no longer be able to provide care. Service issues were raised, as was the difference in role and function between families and service providers. In order to better meet sibling needs and recommendations for lifelong support, information and advice, more productive partnerships need to be established, particularly in the area of futures planning. This research presents the clear perspective that tangible benefits may be available as a direct result of association with learning disability. It also provides a deeper insight into parental response to learning disability alongside further rational for a lack of futures plans and why siblings may not want to co-reside with a learning disabled person. These findings have relevance to service providers, siblings of learning disabled people, students in the field of health and social care and wider society.

Autism spectrum disorders (ASD) are defined in terms of qualitative atypicalities in social communication and interaction in the presence of restricted, repetitive patterns of behaviour, interests and activities (RRBs). Part of the main criteria for RRBs is hyper/hypo reactivity to sensory input, which appear to be particularly prevalent in the auditory domain and could result in atypical behaviours (APA, 2013). Despite the crucial role that sensory processing plays in learning, attention, cognitive and brain maturation, emotional regulation, and social communication development in humans (e.g., Ahn et al., 2004; Bundy et al., 2007), it remains unclear what precisely causes the sensory atypicalities observed in ASD or how they are associated with the development of key autistic symptomatology such as impairments in social communication (e.g., Jones et al., 2009; Leekam Prior & Uljarević, 2011). Thus, the main aim of the present thesis is to explore the nature of the auditory sensory issues and their relationship with core symptoms (i.e., RRBs and communicative ability) in ASD and the broader autism phenotype (BAP). In addition, the associations among speech perception and production, and communication were investigated. Four studies were conducted using adult samples with and without ASD. Chapter 2 reports findings indicating that the perception of intensity and frequency auditory parameters influence the severity of RRBs and that primary auditory discrimination abilities are characterised by high variability in ASD. Chapters 3 & 4 present evidence showing that the relationship between auditory intensity perception and sensation avoiding behaviours contribute to the communicative difficulties observed in adults with ASD or high levels of autistic traits. Chapter 5 provides a direct demonstration of deficits on primary syllable stress perception in ASD and its role on the speech production abnormalities and socio-communicative atypicalities in ASD. Taken together, the outcome of these investigations highlights the importance of considering the development of core autistic symptoms as an interactional multi-developmental process, which extends into the general population.

This thesis reports on a UK-based ethnography of prenatal screening for Down’s syndrome across two hospitals. By studying the mundane and routine practices of the clinic, I initially capture how Down’s syndrome screening is organised and how its sedimentation as a taken-for-granted aspect of pregnancy contributes to the procedure being ‘downgraded’. This downgrading accomplishes hierarchies of valued/valueless work and professional specialities and also, therefore, of certain professional identities. In what follows, I explore the conduct of care and how professionals detach from Down’s syndrome screening by assigning responsibility for decision-making to parents-to-be. Professionals’ devotion to the rhetoric of ‘informed choice’ and ‘non-directive care’ also naturalises screening as a ‘normal’ part of pregnancy, this routinisation being extended by parents-to-be (often with professionals) privileging the ‘social’ rather than ‘medical’ dimension of ultrasound scanning. I continue by analysing how Down’s syndrome itself is constituted both inside and outside screening encounters. During consultations, the condition is rarely discussed and is substituted with dominant discourses of ‘risk’, ‘problem’, and ‘abnormality’. The condition is subsequently constructed as a negative pregnancy outcome. This intersects with the production and reproduction of ideas around perfection in the social practices and cultural materials of the clinic and how, if a diagnosis is established, the unborn ‘baby’ is recast as a ‘foetus’. By making this move, the unborn baby is denied personhood and a termination of pregnancy is made possible. To conclude, I highlight how the routine practice of prenatal screening for Down’s syndrome has transformed antenatal medicine, invigorated parental expectations, shaped issues around reproductive politics, and cultivated certain body-society relations.

This thesis reports on a research project guided by the principles of grounded theory. It examines how learning disability nurses care for terminally ill people with profound learning disabilities in two National Health Service residential homes. The aim of the study is to explore the perceived knowledge and skills of this group of nurses. It concerns how they assess, recognise and discover patients’ illnesses and how they provide end of life care needs. A total of 36 learning disability nurses participated in in-depth interviews. Thematic analysis is achieved through analysis of interview transcripts and reflexive journaling (field notes). The analysis of data suggests that the main theme “longitudinal knowing” leads to the production of “knowing the patient well”. “Longitudinal knowing” is the principal process through which the “normal” and the “pathological” continuum is constructed. The observed changes help learning disability nurses to establish a clear demarcation between learning disability-related behaviour and disease-related behaviour. The strategy of “longitudinal knowing” the patient well helps learning disability nurses to understand what their patients are like before the illness, and after the onset of illness. In addition, this thesis reveals that learning disability nurses draw on different types of knowledge. This knowledge includes “intuition”, “commonsense” knowledge and “formal” knowledge. The analysis of data shows that the four types of knowledge derive from “longitudinal knowing”. They help learning disability nurses to understand and assess patient’s changing health conditions. These types of knowledge serve as tools to help learning disability nurses make appropriate nursing decisions about a patient’s health status. In this study, participants sometimes used a mixture of lay and technical language to describe their observed signs and symptoms. The analysis of data shows an area of “uncertainty of knowing”. It concerns an ambiguity about whether the specific signs and symptoms are attributed to the learning disability or to an illness. “Uncertainty of knowing” may be a potential barrier to the delivery of appropriate comfort care. The thesis also reveals an area of “certainty of not knowing”. This refers to moments when participants know for sure where the gaps in knowledge are. The analysis of data shows that participants seek to address this gap by searching for relevant internet resources. They also know that they need educational input in pathophysiology of advance diseases. This helps to reduce the tension created by “uncertainty of knowing” and comfort care. The thesis shows that for all participants, “longitudinal knowing” is fundamental for learning disability nurses in the delivery of appropriate and timely “comfort” end-of-life care.

Historically, in many areas of research examining birth and parenthood the role of the mother often took precedence over the role of the father. This may be because, within a traditional family system, the father took the role of the provider, while the mother was responsible for child care and household. Societal and cultural changes over the past few decades have highlighted the importance and competence of fathers in less traditional roles and scientific research is currently aiming to fill the gap of knowledge pertaining to fatherhood. One field of research that has traditionally been neglected in fathers is postpartum depression (PPD), even though prevalence rates for fathers were estimated to be almost as high as for mothers. Research into the risk factors for paternal PPD has only grown substantially within the past two decades. The first part of this thesis provides a systematic review of the available evidence for psychosocial risk factors in the development of paternal PPD as examined by longitudinal research designs. Results of the review indicated that there was a general lack of high quality research, but there was some evidence for higher risk of PPD if fathers experienced disconfirmed expectations of parenting demands, low parenting efficacy, low relationship satisfaction, concerns/anxiety about the birth, disagreement about pregnancy intendedness, low prenatal life satisfaction and stress, and high role strain. The results were discussed in the context of implications for antenatal interventions for fathers. The second part of this thesis was concerned with another neglected group of fathers – fathers who were addicted to opiate drugs. While there is a large research base for the risk to children exposed to parental substance use, fathers’ views on their parenting role and the cross-generational transmission of risk of child maltreatment and substance use has only partially been examined. Using Interpretative Phenomenological Analysis with a small sample of opiate-using fathers (N = 6), it was found that fathers experienced dichotomy in their father role. Their addiction caused them to be ‘disabled’ in the ir father role, characterised by selfishness, abandonment and an inability to meet their children’s needs. In contrast, the ‘Able Father’ came to light during stable periods of prescribed opiates or abstinence, and he was an involved, hands-on parent, sensitive to the child’s needs and motivated to repair the ill-effects of being ‘disabled’ by addiction. By ‘Connecting the Dots’ with their own upbringing, fathers were motivated to be better fathers than their own fathers, but they only had limited insight into the risk the ir ‘disabled’ parenting posed for their own children. The findings suggest that harnessing fathers’ motivation to be better fathers may be a useful asset in drug treatment and parenting interventions. Interventions aimed at increasing reflective functioning may contribute to positive outcomes for substance-using parents at the same time as reducing risk to their children, but more evidence is needed.

More than 1.6 million US military personnel have deployed during the past 10 years of war in Iraq and Afghanistan, also known as Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF), respectively. As a result of the protracted combat operations in two fronts, many military personnel have suffered traumatic experiences from seeing people die, coming close to death, or having killed people. Even for those who have not encountered direct combat, long deployments (commonly 12 months, but some experienced 15 months) and multiple deployments (often more than two), have caused many to suffer from combat stress. Hence, American military has focused much effort and spent lots of money on addressing the result of combat stress induced psychological injury known as Post Traumatic Stress Disorder, commonly referred to as PTSD, and the treatment thereof. However, research shows that only about 20% of combat veterans suffer from actual PTSD. In fact, most combat veterans probably suffer more from stressors of being in a combat deployment, with what is being referred to as 'combat stress injury', 'moral injury', or 'soul injury'. Furthermore, other research shows that growth (in various aspects of one's life) is possible; a greater percentage of people with various traumatic experiences report this potential to grow as a result of the traumata. Research shows that spirituality/religious faith helps people grow from traumatic experiences, and can lead to what is referred as Posttraumatic Growth (PTG). The central theological question of the thesis is: What is it about religious faith that helps people to eventually grow from trauma? The qualitative research conducted for this thesis indicates that the key element to PTG is actually community, more specifically, the community of faith, more than the individual's faith. The essential theological inquiry is how ecclesiology is embodied in the military chaplaincy context.

This thesis explores participatory research involving the author and a small group of adults with Asperger’s syndrome, as co-researchers. The research was based on the assumption that people with Asperger’s syndrome think differently from neuro-typical people (people who do not have Asperger’s syndrome or autism). It is not denied that people with Asperger’s syndrome have difficulties, but the thesis argues that these are caused by living in a world which is dominated by neuro-typical people who do not understand or allow for the differences that people with Asperger’s syndrome have. The research is based on the assumption that adults with Asperger’s syndrome are able to be co-researchers and that part of the task of the researcher and the co-researchers was to find a way of working together that was enabling to all involved in the research. The original aim of the research was to ascertain what kind of service provision adults with Asperger’s syndrome wanted and this formed the research question: ‘What support do adults with Asperger’s syndrome want?’ The findings of the research challenge traditional notions of support as the emphasis is taken away from support to consider forms of understanding. It has resulted in the proposal of a new way of understanding Asperger’s syndrome. It proposes models for understanding how people with Asperger’s syndrome and neuro-typical people relate to each other. These models challenge a currently prevailing deficit-based understanding of Asperger’s syndrome. The author and the co-researchers worked collaboratively to design research tools, collect and analyse data and disseminate findings. The data was collected from other adults with Asperger’s syndrome who took part in questionnaires and then different adults with Asperger’s syndrome who took part in a focus group and individual interviews. The work was informed by the literature on spatial understandings of how society is ordered. The thesis uses this spatial understanding as a way of analysing how people with Asperger’s syndrome are regarded in a society which is dominated by people who are neuro-typical. Insights from a spatial understanding are also used to consider the process of the research, including an application of the social model of disability to participatory research involving adults with Asperger’s syndrome. My original contribution to knowledge is that I have demonstrated that people with Asperger’s syndrome have the potential to work in group situations on a complex piece of research. I have shown that people with Asperger’s syndrome are able to make a significant contribution to the understanding of how people with Asperger’s syndrome and neuro-typical people relate to each other. I have also demonstrated how a non-disabled researcher and co-researchers with Asperger’s syndrome can work together and devise working methods which are enabling. In the words of the thesis, I have demonstrated how an ‘autistic research space’ can be created. This thesis discusses the role of the neuro-typical researcher in the creation of this research space. The research is regarded as having been co-produced and the meaning of this is explored. The thesis discusses the nature of participatory research using a spatial understanding. Emancipatory research is said to be based on the social model of disability, where non-disabled researchers are not involved. I have shown that participatory research can also be based on the insights from the social model of disability and achieve the outcomes required for emancipatory research. I have proposed a framework for planning and analysing participatory research. Perhaps the most significant contribution to knowledge is the new way of understanding Asperger’s syndrome proposed by the research which challenges the more traditionally accepted deficit based model.

This research investigated the psychoanalytic idea of containment in the context of NHS staff responses to a person diagnosed with personality disorder. The aim was to identify what, if any, containment was provided by staff for someone diagnosed with personality disorder by recording staff responses to an assessment and analysing the discourse. The research was undertaken with participants selected to represent a cross section of staff in the organisation and included senior and junior, clinical, administrative and managerial staff. The discourse analysis of the interviews examined defences against containment such as splitting, projective identification and idealisation and the positions people occupied in relation to the material and the researcher, as well as looking for examples of containment. Reflexivity was a key part of the methodology, forms a significant part of the thesis and is used to contribute to the discussion. Reflexivity, findings from the review of the literature and the analysis of the interviews form the basis of the discussion and conclusions. The research showed that containment, in its psychoanalytic sense, is often avoided and defended against. Key difficulties with developing the capacity for containment were found to be: conflict between the personal and professional in staff and anxiety in relation to the power of others in the organisation. Suggestions are made for how changes could be made within the organisation and how this could benefit both staff and people who use services. Changing the approach to containment could save costs as some repeat admissions could be avoided and staff satisfaction enhanced. The conclusions from the research make a contribution to clinical practice in NHS settings, to the psychoanalytic theory of containment and to the methodology of psychoanalytic discourse analysis. Recommendations for further research include more psychoanalytic discourse analysis to identify defences in text and research evaluating reflective staff groups.

There is a growing number of initiatives aiming to support people with intellectual disability (ID) to find romantic partners but minimal relevant research to inform these initiatives. The present study explored the ideal partner preferences of people with Down’s syndrome (DS); a genetic disorder resulting in ID. Adults with DS (5 male, 5 female) completed an interview incorporating the repertory grid from Personal Construct Psychology to explore their ideal partner preferences, explanations for these and how they relate to their perceptions of actual partners and self. Interview data was subjected to content analysis, thematic analysis and analysis using Idiogrid. Participants typically preferred partners who were good looking, warm, employed, nondisabled and similar to them with the exception of having no disability. Partner’s parental approval also appeared to be important. Explanations were grouped into five themes. Actual partners were typically dissimilar from ideal partners, including all but one having ID. Four participants’ more unique ways of thinking about people were also discussed. Five participants had a current partner. These relationships appeared to be maintained by valuing unconventional traits such as disability or managing expectations of a partner by making compromises or employing psychological defences. Initiatives aimed at facilitating relationships for people with DS may benefit from incorporating a service dedicated to helping them communicate their ideal partner preferences and process feelings linked with managing expectations. One area of future research could evaluate how best to facilitate these conversations.