Att vårdas eller fostras. Det rättspsykiatriska vårdandet och traditionens grepp

To be sentenced to care in the forensic psychiatric services can be seen as one of the most comprehensive encroachments society can make on a person's life and being, as it entails a limitation of the individual's freedom but with no time limit. The aim of this dissertation is to describe caring in forensic psychiatry based on how it is experienced by those who perform the caring and by those are cared for in a maximum secure unit. A reflective lifeworld approach, based on phenomenological philosophy, has been applied. The data has been collected in interviews that have been analyzed by use of a meaning analysis searching for the essence of the phenomenon. The results of the research are presented in two empirical studies and a general structure based on the empirical findings. The dissertation also contains an excursus, a philosophical intermediate chapter containing further analysis of the results of the studies. The results show how the forensic psychiatric care is experienced as being non-caring by the patients with only small "pockets" of good care. Caring consists of corrective techniques that are unreflected and contradictory, where the conditions are determined by the caregivers and the ward culture. The correcting takes place through the modification of the patients' behaviour with the aim of the patients having to adapt themselves to the terms of the care provision. This care results in the patients trying, by use of different strategies, to adapt them-selves to the demands of the caregivers in order to gain privileges. At the same time the patients long to get away from the care system and are lacking real, meaningful and close relationships. To be the subject of care entails struggling against an approaching overwhelming sense of resignation and to care entails experiencing both power and powerlessness in performing the care. A destructive power struggle is being waged within forensic psychiatric care that suppresses the caring potential and true caring is thus elusive. The characteristics of forensic psychiatric care, based on the results of the research, are clarified in the dissertation's excursus. These include the corrective and disciplinary nature of forensic psychiatric care, its power and how this is materialized in care situations as well as the influence of tradition on current forensic psychiatric care in the light of the work of the French philosopher Michel Foucault. The dissertation shows that if the caring potential is to be able to be developed and form a caring nucleus for forensic psychiatric care then education levels need to be further developed. A caring culture and caring environment is needed where true caring can gain a foothold. In order for this to become a possibility the current caring culture and environment must be clarified, questioned and examined. The prevalent fundamental ideas in forensic psychiatric care have to be "jeopardized" and challenged by new scientifically based ideas on what constitutes true caring in this context