Abstract
The present thesis examines the challenges that health visitors face in their work to ensure that children of mothers diagnosed with borderline personality disorder are given adequate growth and development conditions. It also looks into what knowledge health visitors have about this disorder and how they contribute to safeguarding children through relevant health initiatives.
Based upon a number of studies it is shown that there is reason for close attention to children of mothers with borderline personality disorder as this disorder in a mother may imply overbearing behaviour towards the child, reduced ability to regulate the child, hostility towards the child, poor expression of emotions vis-à-vis the child, and poorly regulated communication between mother and child.
It is argued that the study is relevant in the context of social work and in relation to the impact of a given borderline condition on the relation between mother and child. The Child Health Care system is described in a brief historical outline leading to an explanation of the health visitor profession as well as the framework guiding them in their work.
The thesis also describes the borderline personality disorder, the diagnostic systems used, the aetiology of diagnosis and gives a short presentation of the diagnostic debate that has prevailed over time.
The study is qualitative and uses interviews with health visitors as empirical data. The Canadian-American sociologist and social psychologist Erving Goffman provides the theoretical foundation for the analysis of the health visitors’ stories, and draws on Goffman’s deviation sociological theory as well as his everyday-life sociological theory of the importance of roles in interactions.
The first part of the analysis shows that health visitors largely focus on the link between mother and child and thus weigh the observation of mother-child interaction without necessarily focusing on the potential impact on the child of a borderline diagnosis. Applying Goffman's everyday-life sociological theory, the analysis shows that, when backstage, health visitors reflect on their own practice, conscious that when acting frontstage, their social interactions in the interaction with mothers / families are important. On the deviation sociological theory the analysis shows that health visitors contribute to enhancing the competence of mothers and thus are fundamentally sympathetic towards possibly diagnosed mothers.
The second part of the analysis shows that health visitors experience that interdisciplinary and intersectoral collaboration is subject to difficulties in the form of lengthy procedures and the lack of communication. They experience their own profession as primarily preventive and guiding with a unique knowledge of the early relationship between mother and child. In a multidisciplinary and intersectoral context they have the experience that this unique knowledge is not to a sufficient extent taken into account in the cooperation concerning families.
The study concludes that health visitors have varying degrees of knowledge about borderline personality disorder and that their knowledge depends on prior experience and / or personal interest in psychiatry. It is concluded that health visitors use their professional knowledge to maintain a professional façade. They have a feeling that via external partners they could be better equipped to handle the meeting with diagnosed mothers. It is also concluded that health visitors make use of the options that are embedded in their own professional guidelines but that they also have an impression of having limited options. When it comes to ensuring children of mothers with a borderline diagnosis adequate growth and development conditions, health visitors see limitations of their own options as well as limitations that are outside their field of competence.