Title:
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Women and violence : exploring its construction as a health care issue
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Adopting a case study approach (Reinharz, 1992; Stake, 1998) this study which was undertaken
in collaboration with two Primary Care Trusts (PCTs) explores the health service response to
domestic violence. Developed is a feminist Foucauldian discursive approach, enabling an
exploration of the impact of the relationship between power, knowledge and language on the
provision of services. This approach combines three stands of theory; feminist theory (Flax,
2000; Willot, 1998; Gavey, 1989, 2002; Weedon, 1987), Foucauldian discourse analysis (Willig,
1999; 2001; Parker, 1992) and positioning theory (Davies and Harre, 1990, 2001; Willig, 2000).
The study offers a critical consideration of the impact of the discourses through which domestic
violence and health are constructed within the health care arena, at a dominant and subjugated
level. Considered is the negotiation of these discourses and the practices and subject positions
they make available. Thus the approach taken enables a theoretically grounded understanding of
the interplay between the experiences of different actors in the health and domestic violence
arena.
Drawing on feminist research principles the research encompassed two phases of exploration and
data collection employing semi-structured (Smith, 1995) and generative 'depth' interviews
(Flick, 1998; Wengraf, 20001). The first phase explored the ways in which domestic violence
was constructed by policy makers, implementers, advocates and health professionals within the
health arena and the implications arising from these constructions.- The second phase aimed to
explore further this discursive landscape considering the ways in which women who access
services, in relation to their experience of domestic violence, constructed and experienced such
responses. A 'unified' approach to analysing discourse (Wetherell, 1998), drawing upon the
guidelines developed by Willig (1999), was employed. This approach draws on aspects of both
discursive psychology and Foucauldian discourse analysis, which Wetherell, suggests provides
'the most productive basis for discourse work in social psychology (Wetherell, 1998:389).
Unlike previous research which has explored domestic violence from what might be termed a
'realist' framework, this research draws upon social constructionist and postmodern thinking.
This approach has made possible an alternate way of considering domestic violence. Drawing
upon the metaphor of Pandora's Box the research illustrates the impact of the medical discourse
upon the District's services, those who respond and women who access services. Brought to the
surface are some of the subjugated knowledges of women and health professionals, argued to be
constrained by this discourse. These draw attention to the limitations of current discursive
practices and make visible possibilities for desirable alternatives (Willig, 1999). A number of
key issues arise from the research. Highlighted through the subjugated knowledge of health
professionals is their vulnerability and isolation when responding to domestic violence in ways
which appear to meet the needs of women service users. Such responding it is suggested
requires relational change (Finch and Mason, 2000) and thus positions health professionals
outside of the protective mechanisms associated with the medical discourse (Keller, 1985).
Highlighted through women's subjugated knowledges is the impact of being able to construct
and experience a stronger subjectivity. Such subjectivity is framed by women as crucial in
resisting and overcoming domestic violence. A key component of this constructive process
appears to be the discursive resources and practices made available to women through the
Intercept domestic violence project.
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