Myalgic encephalomyelitis (ME), also referred to as chronic fatigue syndrome (CFS), is a symptomatically defined and debilitating condition that presents as a range of physiological and psychological effects. Post-exertional fatigue and ongoing low energy levels are cardinal features. Whilst ME-like conditions have been recognised for at least two hundred years, they have been characterised over recent decades by a fiercely contested debate as to whether aetiology is primarily psychological or physiological. ME sufferers experience profound changes to their self-perception, ability to maintain daily routines and activities and how they are perceived in terms of their capacity to carry out social roles, including illness-status. The contested aetiology results in-part from a climate of dualistic thought and the biomedical model upon which ME is treated and theorised. Whilst the effects of ME on self experience have been investigated from various qualitative and quantitative perspectives, the primary purpose of this thesis is to develop a psychosocial framework from which to explore previously neglected dimensions of the effect of ME on self experience. Developing a psychosocial understanding of ME is in keeping with a turn towards post-Cartesian and non-dualistic thinking. The second interconnected purpose of this thesis is to address the role played by the material environment and objects and to conceptualise their importance and relation to self and how it is affected by ME. This is currently absent in the literature on ME. Developing a psychosocial framework suitable for this purpose rested on a synthesis of Actor Network Theory (ANT) and a psychoanalytically influenced use of metaphor and metonymy. At the heart of this synthesis are the notions of relational ontology (Latour, 1997; DeLanda, 2002) and assemblage (Deleuze and Guattari, 1987; DeLanda, 2002; Hodder, 2012). A relational ontology focuses on the relations between disparate objects such as material artefacts, humans, other organisms and concepts and avoids prioritising any one ‘thing’ as more important than another. The notion of assemblage has emerged alongside ideas concerning complexity, chaos and indeterminacy and informs a vocabulary addressing the problem of causality, determination and the stability of social and psychological phenomena (Venn, 2006). As part of a psychoanalytically informed psychosocial framework these concepts enable an exploration of ME by bringing together disparate aspects such as everyday objects, experiences, symptoms and environments in a non-causal, non-dualistic and processual manner. The psychoanalytic element also enables an exploration of the unconscious and irrational aspects of experience, which is most pertinent with regards to the effects of ME. Thus, the premise of this research was to establish a psychosocial methodology and theoretical basis from which to explore the effects of ME on self experience. Moreover, this methodology was designed to engage with the complex, coincident and entangled nature of the symptoms, discourses, objects, material artefacts, environments and non-human organisms that ME appears to be comprised of. Methods were developed which enabled the researcher to be with and explore the day-to-day life and routines of eight ME sufferers in their everyday environments over a six month period. This involved working with the ME sufferers taking part primarily in their own homes and spaces around their home which they frequented, such as shopping malls and even a cemetery; in itself novel in terms of qualitative research into ME. Of these eight sufferers, three were male [age range 49 – 65; earliest formal diagnosis of ME occurring in 2005] and five females [age range 25 – 63; earliest diagnosis 2002]. Two sufferers were in paid employment, one was retired and five were unable to work due to their ME. Due to the extensive nature of the data, only 3 case studies, two male and three female, were selected for in-depth analysis. Cases selected were those that most clearly illustrated central analytic themes. Data comprised talk, audio-visual material and the affective responses of the researcher. Analytic methods were devised which initially adopted a thematic approach before metaphoric and metonymic equivalences were drawn between what ME sufferers discussed and aspects of the routines, objects and environments they were engaged with. This informed descriptions of how these things became networked, in an ANT sense, and how self experience was implicated. A key finding which emerged is the notion of debilitating spaces. This term captures the manner in which, for certain sufferers, the experience and hence the maintenance of ME was intrinsically enmeshed with their immediate physical environment. Further findings discussed include the way in which seemingly everyday objects such as food blenders can be co-opted by sufferers as a means of enhancing their self-experience in light of ME. Overall, the findings of this PhD are discussed in terms of the success and applicability of that premise and its contribution to the field of psychosocial approaches. The key assertion is that the methodology enhances an understanding of ME and its effects, highlighting the variable yet particular nature of ME and its effect on self experience and in incorporating the hitherto unconsidered range of objects outlined above.

This dissertation explores the role of relationships with front-line officers on the subjective wellbeing of the recipients of the conditional cash transfer programme in Mexico, Oportunidades-Prospera. To do so, it builds bridges between the literatures on wellbeing, development and public policy. In recent decades, wellbeing has acquired greater significance in public policy with the interest of changing the conceptualization of progress from one driven by economic growth to one which takes quality of life as its ultimate aim. Much attention has been placed on measuring wellbeing for national policy deliberation. This dissertation, instead, is interested in understanding how taking a wellbeing approach may contribute to street-level development: to the design, practice and implementation of social policies and programmes. The value of wellbeing is that it draws attention to dimensions of experience that policy has tended to under-estimate or ignore. In this respect, one of the most consistent findings of wellbeing scholarship is the centrality of social relationships in shaping action and driving how people evaluate their lives. While the main emphasis has been on close relationships, this dissertation asks how the relationships created during the implementation of social programmes may influence wellbeing – and hence the overall impact of policies themselves. This research focuses on relationships at the health clinics which clients of Oportunidades-Prospera are required to attend as a condition for receiving a cash transfer. It follows a mixed-methods approach that reveals that relationships with health officers have a significant role on recipients’ sense of what they can do and be in different domains. It also finds that the quality of these relationships has two dimensions, positive and negative, and that these have differential effects on wellbeing. The study concludes that paying attention to the wellbeing implications of officer-recipient relationships deepens understanding of the overall effect of social programmes on their clients, highlighting unintended effects that are usually unaccounted for. In addition, the significance of relationships in implementation indicates a vital dimension of the policy process that requires direct attention if social policy and programmes are to achieve their full potential to improve people’s wellbeing.

Les « symptômes comportementaux et psychologiques de la démence » (SCPD) posent, au quotidien du prendre-soin et de l’accompagnement des personnes présentant un syndrome démentiel, des difficultés plus importantes que les autres types de troubles, cognitifs notamment. La littérature et les études consacrées à ces SCPD n’avaient jusqu’à présent pas fait l’objet d’une revue critique permettant de faire le point sur leur définition et leur interprétation de ces troubles, et sur les pistes de prévention et d’apaisement proposées.Le présent travail, se plaçant sous l’égide d’une conception phénoménologique des syndromes démentiels telle que développée par le psychogérontologue anglais Tom Kitwood, suivra plusieurs étapes essentielles pour mieux comprendre les différentes dimensions à l’origine de ces troubles : les modifications des facultés cognitives, les altérations de l’humeur, les facteurs environnementaux et psycho-sociaux (stigmatisation et exclusion notamment).Ces premières étapes conduiront dans un second temps à présenter quelques unes des pistes élaborées par plusieurs auteurs, parmi lesquels Louis Ploton, Tom Kitwood et ses collègues du Bradford Dementia Group, destinées à prévenir ces troubles par l’élaboration d’un prendre-soin adapté et d’un environnement prothétique.Nous reviendrons ensuite au cœur des conceptions et définitions des SCPD. Pour les aborder avec un autre regard et mieux percevoir ce qu’ils expriment, ce qu’ils nous disent, ce qu’ils appellent comme philosophies et approches du prendre-soin. / The “behavioral and psychological symptoms of dementia” (BPSD) present, in the daily care of people with dementia, greater difficulties than other types of disorders, including cognitive. Literature and studies on these BPSD had so far not been critically reviewed to take stock of their definition and interpretation of these disorders and the prevention guidelines and appeasement which are proposed.This work, placing itself under the aegis of a phenomenological concept of dementia as developed by the English social-psychologist Tom Kitwood, will follow several key steps to better understand the different dimensions which are the origin of these disorders: changes in schools cognitive, mood alterations, environmental and psycho-social factors (stigmatization and exclusion in particular).These initial steps will lead a second time to present some of the tracks developed by several authors, including Louis Ploton, Tom Kitwood and his colleagues of the Bradford Dementia Group, to prevent these problems by developing a suitable care and a prosthetic environment.Then back to the heart of conceptions and definitions of BPSD. In order to approach them with a different look and better express what they perceive, what they tell us, what they call as philosophies and approaches of taking care.