Ontological insecurity of inattentiveness: Conceptualizing how risk management practices impact on patient recovery when admitted to an acute psychiatric hospital

Risk management which assesses and mitigates risks such as suicide and violence is under scrutiny, particularly within psychiatric inpatient settings. Restrictive practices, which result from risk assessment, such as observations, physical restraint and ward seclusion can impact negatively on patient recovery, hindering abilities to develop a meaningful life that emphasizes purpose, hope and autonomy, despite experiencing mental distress. Yet, less is known about the impact from the patient's perspective when first admitted to hospital, a period which among other reasons may come with increasing risk management practices owing to the clinical uncertainties about patient risks. In this grounded theory study, we explore the impact on recovery, interviewing 15 adult participants with patient experiences of being in an acute hospital. The main theme of the study, termed a core category with a grounded theory, was identified as "ontological insecurity of inattentiveness". This highlighted a staff inattentiveness with involving patients with risk management and explaining the purposes of the practice, which raised insecurities about what was happening to the patients when admitted to hospital. Four subcategories support the core category; discounting the patients' experiences to gain a meaningful grasp of risk management, ambiguity about risk management rules, particularly the reasons around their use, forebodingness to the hospital environment and, management from afar, with patients feeling scrutinized from observations without a voice to offer different views. It is hoped these findings will add to the field of patient involvement in psychiatric inpatient settings, proposing attempts to raise understanding and inclusivity of risk management, starting when first admitted to hospital.

Covid-19: crisis, emotional governance and populist fantasy narratives

This short article discusses how different fantasy narratives have come together during the Covid-19 crisis in various far-right movements, parties and audiences across the world and how much of these fantasies rely on racialised and gendered notions of a fantastical world-order in which particular forms of emotional governance provide a relief and sense of security to certain societal groups. This involves a close engagement with crisis and crisis narratives in relation to ontological insecurity and anxiety; how such crisis narratives have materialised in fantasies related to borders and corona nationalism, and the emotional governance of these particular fantasies in the hands of populist leaders and their increasingly receptive audiences.

Correlation Between Ontological Insecurity and Daily Epidemic Prevention Behavior Among Inpatients During the COVID-19 Pandemic

This study evaluates inpatients' ontological insecurity and daily epidemic prevention behavior during the pandemic and explores the factors influencing daily epidemic prevention behaviors. The outbreak of coronavirus disease (COVID-19) in December 2019 caused a global public health crisis that has affected the very structure of society and the order of daily life. Ontological security is the ability to predict the impact of changes in social environments on personal security, such as during the pandemic. A cross-sectional study was used to collect data from 1185 inpatients of a hospital in Zhejiang, China, from July 11 to August 9, 2021. Our questionnaire recorded information on demographics, ontological insecurity, and daily epidemic prevention behaviors. The Mann-Whitney U test, Kruskal-Wallis H test, Spearman's correlation analysis, and logistic regression analysis were used to determine the influencing factors of daily epidemic prevention behavior on ontological security. Results showed a negative correlation between inpatients' ontological insecurity and daily epidemic prevention behavior (r = -.253, P < .001). The logistic regression analysis showed that the independent factors affecting daily epidemic prevention behavior include ontological insecurity (OR: 0.952; 95% CI: 0.937-0.968) (P < .001), sex (OR: 1.292; 95% CI: 1.004-1.663), age (OR: 0.880; 95%: 0.790-0.980), education (OR: 1.307; 95% CI: 1.098-1.556), and occupation [famers vs civil servants, staff or professional (OR: 0.596; 95% CI: 0.374-0.949),other versus civil servants, staff, or professional (OR: 0.693; 95% CI: 0.503-0.953)] (P < .05). Inpatients were shown to have good ontological security during the COVID-19 epidemic, younger patients, female patients, patients with stronger ontological security, patients with a higher educational level, and those who work in a fixed unit or organization showed higher levels of daily epidemic prevention behavior. Hospital managers should strengthen the intervention management of epidemic prevention behavior based on patient characteristics.

Of precarity and conspiracy: Introducing a socio-functional model of conspiracy beliefs

Conspiracy Beliefs (CB) are a key vector of violent extremism, radicalism and unconventional political events. So far, social-psychological research has extensively documented how cognitive, emotional and intergroup factors can promote CB. Evidence also suggests that adherence to CB moves along social class lines: low-income and low-education are among the most robust predictors of CB. Yet, the potential role of precarity-the subjective experience of permanent insecurity stemming from objective material strain-in shaping CB remains largely unexplored. In this paper, we propose for the first time a socio-functional model of CB. We test the hypothesis that precarity could foster increased CB because it undermines trust in government and the broader political 'elites'. Data from the World Value Survey (n = 21,650; Study 1, electoral CB) and from representative samples from polls conducted in France (n = 1760, Study 2a, conspiracy mentality) and Italy (n = 2196, Study 2b, COVID-19 CB), corroborate a mediation model whereby precarity is directly and indirectly associated with lower trust in authorities and higher CB. In addition, these links are robust to adjustment on income, self-reported SES and education. Considering precarity allows for a truly social-psychological understanding of CB as the by-product of structural issues (e.g. growing inequalities). Results from our socio-functional model suggest that implementing solutions at the socio-economic level could prove efficient in fighting CB.

Pandemic, Politics, and Public Opinion About Crime

Prior scholarship links ontological insecurities, racial tensions, and health issues to public opinion about crime. This project examined these forces in the context of the 2020 pandemic, racial justice demonstrations, and politics using data from the Nebraska 2020 survey (N = 2775). Pandemic-related insecurities and racial animus were associated with avoiding places in the community, worry about crime, and the belief that police in one's community are underfunded. Trusting politicians but distrusting health leaders, and viewing COVID as an economic threat but not a health threat were associated with the belief police are underfunded. Results suggest that the politicization of the pandemic may influence support for criminal justice policies that promise a return to “law and order.”

"Existential Catastrophe Anxiety": Phenomenology of Fearful Emotions in a Subset of Service Users With Severe Mental Health Conditions

A subset of people with severe mental health conditions feels they are on the verge of losing control, even in the absence of external threats or triggers. Some go to extreme ends to avoid affective arousal and associated expectations of a possible, impending catastrophe. We have learned about such phenomenological, emotional challenges in a group of individuals with severe, composite mental health problems and psychosocial disabilities. These individuals have had long treatment histories in the mental health care system. They have been encountered at a specialized inpatient ward offering exposure-based therapy that aims at restoring self-regulation and recovery. We describe the phenomenology of anxiety and fear presented by these service users, a fear we have coined existential catastrophe anxiety (ECa). We also suggest a set of underlying, interacting, psychological mechanisms that may give rise to ECa, before comparing ECa with three other constructs previously described in the literature—annihilation anxiety, ontological insecurity, and affect phobia. These comparisons show several similarities, but also unique qualities with ECa and its suggested underlying mechanisms. The conceptualization of ECa may aid clinicians in addressing extreme experiential turmoil and engage service users in empowering therapeutic projects.

Ontological insecurity II: Relationship to attachment, childhood trauma, and subclinical psychotic-like experiences

OBJECTIVES

To examine ontological insecurity as a predictor of positive psychotic-like experiences (PLEs) relative to concepts of childhood trauma, parental bonding, and adult attachment style.

METHODS

A nonclinical sample (N = 298) completed the Ontological Insecurity Scale (OIS-34), a new measure of ontological insecurity, along with measures of the above concepts.

RESULTS

The OIS-34 accounted for a significantly greater proportion of unique variance in positive PLEs than any other theoretical variable. Anxious and avoidant adult attachment were also strongly associated with positive PLEs, but these relationships were mediated by the OIS-34, ceasing to be significant once this latter variable entered the hierarchical regression equation.

CONCLUSIONS

The results are consistent with R. D. Laing's theory that ontological insecurity plays a significant role in psychosis. Moreover, the results suggest that this concept may mediate the established relationship between anxious/avoidant adult attachment and positive PLEs. Implications for psychological approaches to clinical psychosis are discussed.

Ontological insecurity I: Psychometric development of a new measure and relationship to subclinical psychotic-like experiences

OBJECTIVES

The present study sought to develop a new psychometrically sound measure of ontological insecurity, the OIS-34 and, determine its relationship with subclinical psychotic-like experiences (PLEs).

METHODS

A nonclinical sample (N = 600) completed an initial 60-item version of the new scale along with measures of PLEs, psychosis proneness, and mental health history.

RESULTS

Exploratory factor analysis indicated a single factor, ontological insecurity, with 34 items loading positively and above a criterion of 0.4. Internal consistency and test-retest reliability were excellent. The OIS-34 correlated positively and significantly with psychosis proneness and subclinical positive and negative symptom PLEs. The OIS-34 also differentiated significantly between participants with and without a history of mental health problems, including psychosis.

CONCLUSIONS

The OIS-34 appears to represent a psychometrically sound measure of ontological insecurity. The results suggest that the concept is associated with PLEs. Directions for further research are discussed.