06 SES 01, Inclusion and Exclusion in Mediated Culture and Society
The multi-perspective view of disability, according to WHO (2001), shows a paradigm shift from a purely medical to a bio-psycho-social understanding of disability. The concept of inclusion, which primarily relates to disability, not only regards to people with physical and/or mental disabilities. Furthermore it is to be understood sociologically as a worldwide societal development which strives for an ideal image of society, in which all people have equal rights to individual development and social participation regardless of their personal support needs (cf. Wansing 2012: 99). In this respect, structures and mechanisms of social exclusion should be reflected. The extent to which social conditions are produced, which enable an equal participation of all people in central areas and resources of society, such as employment, civil rights (personal, political, social) and reciprocal social relations, should be explored (cf. Kronauer 2013: 18).
These postulates are partially suspended in forensic psychiatry. According to the provisions of the country-specific legislation, psychologically ill, intellectually-impaired and addicted offenders are accommodated and treated worldwide in clinics designed according to extensive safety regulations. The main task of forensic psychiatry involves the exclusion of goods and opportunities for participation to protect society from convicted criminals through rigid security concepts. Simultaneously the different legislations determine a treatment contract that has close links to inclusion: patients should be treated through an interdisciplinary therapy concept in order to ensure their long-term impunity as well as to enable them to lead a life integrated into the community through therapeutic measures (e.g. for Germany: MRVG Section 1 (1) Sentence 1).
Since the possibilities of societal and social participation are largely determined by the media, according to the concept of inclusion, every individual should have access to media and media education, irrespective of their individual, socioeconomic status or personal circumstances (Schluchter 2010: 167). However, competent media handling is not only indispensable for participation in culture, society and the labour market, but also enables individuals to critically reflect their environment and themselves (cf. Schorb/Wagner 2013: 18). The use of (digital) media thus contributes significantly to the identity formation (cf. Wegener 2010: 58) and creates opportunities for self-reflection and self-awareness, as well as self-expression (cf. Holzwarth 2010: 446).
Regarding mental illness, digital media is usually discussed in the context of media-related disorders such as addiction, abusive behaviour or impulse-control disorders (cf., for example, Rehbein et al.: 2016). Therefore, the use of Internet-enabled and network-enabled devices in forensic psychiatry was previously largely prohibited for security reasons. Today it is still not as comprehensively as possible. However, the media-pedagogical potential in terms of diagnostics, neuropsychosocial training and connections to therapeutic approaches has so far not been considered (cf. Dieris-Hirche et al.: 2017), along with the opening of educational and participatory opportunities through the acquisition of media literacy.
In this respect, the question arises to what extent competence-enhancing handling of media can be enabled in the forensic psychiatry in order to best prepare the offenders for the living conditions outside of the institution. At the same time, it can be assumed that different forms of media pedagogical work could also be beneficial for therapeutic purposes and thus represent a useful supplement to the regular treatment in forensic psychiatry.
Therefore the central questions are which methods promote inclusion in the sense of social participation and where are exclusionary measures required. To answer these questions, evaluation results from the project "Medialiteracy for Patients" are presented. In the project, employees of a forensic psychiatry clinic were trained in supervised, competence-oriented media interaction, followed by media educational project work with their patients.
For project evaluation, three problem-centred (Witzel 1982) expert interviews (Meuser/Nagel 1991) were conducted with employees of the clinic who participated in the training measure. They initiated media educational projects in the areas of nursing, school and work therapy. The aim of the interviews was to systematically record the potentials, challenges and limitations of media educational work in forensic psychiatry, and to open up all relevant areas of the topic regarding the theoretical assumptions. Assessments of the interviewees concerning the planning and implementation of the media educational projects, the cooperation with the patients, difficulties in the implementation of the projects, as well as potentials related to the media work with the patients were covered in the interview guideline. Furthermore, an analysis of the media educational projects carried out by the participants of the training measure took place. The ten projects concerned themes of photography, video, communication and research, presentation techniques and light painting. The data is based on the products created by the patients as well as the documentation sheets prepared by the employees. The interviews and the documents were evaluated using qualitative content analysis (Mayring 2001). Specifically, the content-structuring analysis method was chosen for the interviews in order to filter out and summarise certain topics, contents and aspects from the material (ibid.: 103) and to develop a theory-led category system. For the document analysis, the explicit variant was used. With the help of the explicit content analysis, additional material was used to interpret texts and documents (ibid: 58/77). The results of the analysis were embedded in the research context and theoretically located with regard to possible forms and potentials, but also problems and limitations of the media educational work in forensic psychiatry.
The evaluation revealed the potential of media pedagogical work with the offenders. As a central effect of the media educational project work, the cooperation of the patients with each other could be determined. The shared experiences generated by the group's work and the follow-up communication in joint work on a media product (cf. Schell 2005: 15) offer patients a contribution to the acquisition of social and communicative competences – as a central goal of the therapy. In addition, it has been shown that the media educational work provides opportunities to the development of individual interests, abilities and perspectives, and to initiate reflective processes among the patients (cf. Demmler/Rösch 2012: 20). Patients also receive recognition from fellow patients and employees. A strengthened self-confidence such as this can support the patients, also after their release, to better cope with problems in everyday life, to act safer in everyday situations and to articulate their needs (cf. Niesyto 2010: 397). In this respect, media pedagogical work offers patients in forensic psychiatry the chance to reflexively engage with both their own personality and their living environment. Nevertheless, media-educational measures repeatedly run up against limitations. The implementation of the projects is significantly limited through the need to take into account the offense committed (e.g. sexual crimes) and the illness (e.g. psychosis) of the patients, as well as the close support through the staff required by safety regulations. Thus, projects that require Internet access are so far only feasible to a limited extend. In this sense, it is necessary to explore the scope for media educational work in forensic psychiatry. In order to meet the normative demand of inclusion media education in forensic psychiatry can be found in an increased field of tension between exclusion through measures of conservational education and competence acquisition.
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