Everyday ethics of participation: a case study of a CBPR in Nunavik.

INTRODUCTION: Multiple reports highlight the need for community-based family-oriented prevention services for Aboriginal peoples in order to address important health and social inequalities. Participatory, empowerment-based approaches are generally favoured for these means. Faced with important social issues, in a context of colonisation and complex power dynamics, we question how community members experience participation, as well as the everyday dynamics that take place when attempting to create community-level change. CONTEXT: The initial steps of this community-based participatory research (CBPR) took place over a two-year period in a community of Nunavik, a large northern region of the province of Quebec. The objective of the CBPR was to develop a community-driven project aimed at supporting families to be able to keep children within their homes or communities, rather than having to be placed under child welfare services. METHOD: We participated in, and documented, various group meetings, community workshops, informal reflexive discussions, and formal interviews with community partners to explore their everyday experiences of participation in community-based change. RESULTS: We describe some of the initial actions taken in this project. We describe how certain social and power dynamics infiltrated into the process of participation leading to various tensions, personal and interpersonal experiences and needs. DISCUSSION: We discuss how these experiences led to everyday ethical dilemmas regarding participation. We conclude that although participatory approaches towards community change may be effective, they are also ethically challenging and at times disempowering for those who participate. We describe some of the approaches used to work with these ethical challenges.

Suicide, schizophrenia, and schizoid-type psychosis: role of life events and childhood factors.

The first objective was to identify the provoking events of suicide in patients with schizophrenia or schizoid-type disorder, and to assess the humiliation component of these events. The second objective was to verify if quality of care during childhood is a vulnerability factor for suicide in patients with schizophrenia or schizoid-type psychosis. Thirty-three cases of suicide with a diagnosis of schizophrenia or schizoid-type psychosis were compared with 34 living patients with a similar diagnosis. The psychological autopsy method was used. The assessments were made with the Structured Clinical Interview for the Diagnostic and Statistical Manual for Axis I mental disorders, the Life Events and Difficulties Schedule, and the Child Experiences and Child Abuse Interview. The suicide group (SG) experienced more often a recent severe event, usually of a humiliation nature, than the control group (CG). It also experienced more severe events associated with aggressive behavior or with psychiatric impairment. Contrary to expectations, the CG had worse scores than the SG for quality of care during childhood. In conclusion, suicide in schizophrenia is related both to environmental stress and to psychiatric impairment.