This paper explores the role of friendship in the lives of people with psychiatric disabilities through the use of narrative. We suggest that the use of phenomenologically based investigation in experimental or other traditional research designs provides a more in-depth and complex view of the lives of people with serious mental illness. We offer the example of the Partnership Project, which provides people with psychiatric disabilities a consumer or non-consumer "partner" with whom to enjoy community activities and spend a weekly (...) stipend. Through the lens of narrative, we examine the ways that friendship differs between people matched with either a consumer or non-consumer partner and delve into the importance of connection and friendship in the lives of people with psychiatric disabilities. (shrink)

This dissertation in Theory of Practical Knowledge contends that depression is a disorder of the self. Using the existential-phenomenology of Maurice Merleau-Ponty, I argue that if we want to disclose the basic structure of depressed experience, then we must likewise disclose how selfexperience is inseparable from depressed experience. However, even though depression is a contemporary psychiatric category of illness, it is nevertheless a historically and heterogenous concept. To make sense of depression in the context of contemporary psychiatric practice, I show (...) that depression has historically been characterized by two broad models of causation; that is, a phenomenon that is causally explained by either a biological dysfunction or a psychological conflict. But this stark characterization is not limited just to history; by conducting qualitative interviews with psychiatric professionals, I illustrate how this causal dichotomy remains prevalent in contemporary psychiatric practice. On one hand, the clinicians report dissatisfaction with the depression diagnostic criteria (i.e. it is impersonal or vague), while on the other hand, the clinicians also recognize that a depression diagnosis is useful insofar as a diagnosis facilitates access to various resources associated with psychiatric care. Consequently, clinicians have developed a coping strategy that is witnessed in their empathetic desire to distance patients from their depression diagnosis, which led to statements such as, “you are not the problem, the problem is depression.” One consequence of this approach is that depression is artificially cleaved from the person who experiences depression, which subsequently means that depression is viewed to be something independent of oneself. Because I argue that depression and the self are mutually implicated, it is crucial to disseminate some of the most influential contemporary models of selfhood. I show that the brainbound, situated, psychological, and narrative model of self, all have respective strengths and weaknesses. But I also go beyond these models and characterize selfhood as a developmental phenomenon that is expressed as an embodied-style. This style reflects the way in which we establish perceptual contact with the otherness, without which there could be no self-experience. (shrink)

The purpose of this paper was to provide an example from phenomenological research of moving from rich descriptive interview data to coherent revelatory descriptions employing empathic bridges within the narrative structure of storytelling. We used transcribed data from two interviews concerning recovery from severe mental illness: one with an American woman in her early thirties, and the other with a Swedish man in his mid-thirties. Five investigators analyzed the transcribed data into individual first-person narrative descriptions according to existing empirical phenomenological (...) methods including an independent reading, identification of themes relevant to processes of recovery from severe mental illness, temporal ordering of themes meaningfully reflecting the sequence of the recounted events, and consensus development. Our findings support the use of empathic bridges as a methodological tool with the narrative structure of firstperson storytelling, as well as the viability and importance of employing this tool to better understand processes of recovery for persons with severe mental illness. (shrink)

Philosophical discussion of the general methodology of qualitative research, such as that used in some health research, has been inductivist or relativist to date, ignoring critical rationalism as a philosophical approach with which to discuss the general methodology of qualitative research. This paper presents a discussion of the general methodology of qualitative research from a critical rationalist perspective (inspired by Popper), using as an example mental health research. The widespread endorsement of induction in qualitative research is positivist and is suspect, (...) if not false, particularly in relation to the context of justification (or rather theory testing) as compared to the context of discovery (or rather theory generation). Relativism is riddled with philosophical weaknesses and hence it is suspect if not false too. Theory testing is compatible with qualitative research, contrary to much writing about and in qualitative research, as theory testing involves learning from trial and error, which is part of qualitative research, and which may be the form of learning most conducive to generalization. Generalization involves comparison, which is a fundamental methodological requirement of any type of research (qualitative or other); hence the traditional grounding of quantitative and experimental research in generalization. Comparison—rather than generalization—is necessary for, and hence compatible with, qualitative research; hence, the common opposition to generalization in qualitative research is misdirected, disregarding whether this opposition’s claims are true or false. In conclusion, qualitative research, similar to quantitative and experimental research, assumes comparison as a general methodological requirement, which is necessary for health research. (shrink)

Research in psychopathology is booming in an unprecedented way, at least, in terms of increasing number of publications. Yet, a few questions arise: Does quantity also give us quality? Are the collected data generally of sound quality? How are data typically collected in psychopathology? Are the applied methods of data collection appropriate for this particular field of study? This article explores three different methods of data collection in psychopathology, namely self-rating scales, structured interviews, and semi-structured, phenomenological interviews. To identify the (...) most adequate methodological approach, we first establish the nature of the object of psychopathology and then we critically assess each method’s appropriateness to this field of study. We emphasize fundamental issues that make self-rating scales and structured interviews unfit for the task of adequately examining psychopathology. By contrast, we propose that a semi-structured, phenomenological interview presents a more appropriate method. Finally, we describe two types of semi-structured, phenomenological interviews that can be applied to assess and explore psychopathology, respectively. (shrink)

Research in psychopathology is booming in an unprecedented way, at least, in terms of increasing number of publications. Yet, a few questions arise: Does quantity also give us quality? Are the collected data generally of sound quality? How are data typically collected in psychopathology? Are the applied methods of data collection appropriate for this particular field of study? This article explores three different methods of data collection in psychopathology, namely self-rating scales, structured interviews, and semi-structured, phenomenological interviews. To identify the (...) most adequate methodological approach, we first establish the nature of the object of psychopathology and then we critically assess each method’s appropriateness to this field of study. We emphasize fundamental issues that make self-rating scales and structured interviews unfit for the task of adequately examining psychopathology. By contrast, we propose that a semi-structured, phenomenological interview presents a more appropriate method. Finally, we describe two types of semi-structured, phenomenological interviews that can be applied to assess and explore psychopathology, respectively. (shrink)

ObjectiveTo provide insights on emergent ethical tensions experienced by mental health practitioners during system re-organisation, which is sufficiently grounded in empirical data at the local level to inform policy on recovery at institutional and provincial levels.MethodEthnographic methods using narrative and critical phenomenological resources over 24 months.FindingsEveryday ethical tensions emerged at the confluence of different experiences of time, for example, how a context of increasing pressure to decrease patients’ length of stay at the hospital challenged efforts to listen to and advocate (...) for what mattered to patients and maintain the integrity of interventions. In this context, practitioners drew on clinical language and that of personal recovery to strategically ‘push back’, ‘play with’ or ‘take back’ time.DiscussionExamining everyday practices through ethnographic methods can illuminate the everyday ethical tensions that arise when mental health professionals and psychiatrists grapple with, often competing, goods. Critical phenomenological resources can help expand the structural considerations in empirical ethics, excavate underground practices and raise questions about the conceptual categories undergirding normative ethics. Experiencing-with practitioners in clinical contexts as they encounter and creatively resolve ethical tensions also propose a normative ethics of possibility, to help bridge the gap between empirical and normative ethics.ConclusionFocus on the relationship between policy, temporal practices and ethics suggests a reconfiguration of time and re-imagination of ethics in institutional settings in ways that can ultimately benefit patients and professionals alike. (shrink)

From good intentions to real life: introducing crisis resolution teams in Norway In Norway, as in most western countries, the adult services for people experiencing mental health problems have gone through major changes over the last decades. A report submitted to the Norwegian Parliament in 1997 summarized several areas of improvement in the provision of mental health‐care to its population, and led to the introduction of a national mental health programme in 1998 for its implementation to be completed by 2008. (...) The most significant recent development in Norway is ‘Crisis Resolution/Home Treatment’ (CRHT) teams that provide an alternative to acute hospital care services. The major aim of this study is to explore an emerging form of community mental health‐care, and present a framework for establishment and examination of CRHT teams applying the user perspectives. An illustration of user experiences in an already established CRHT team provides a background for understanding implications of this form of service in relation to service users’ needs in acute crises. (shrink)

Moral constructions of suicide are deliberately avoided in contemporary suicidology, yet morality persists, little or imperfectly acknowledged, in its practices and in the policies, discourses, and instruments that it underpins. This study used narrative methodologies to examine the normative force of suicidology and its implications for persons who had engaged in an act of nonfatal suicidal behavior. I interviewed a convenience sample of twelve persons from two inner–urban community mental health centers who were receiving crisis and case management services after (...) a recent act of nonfatal suicidal behavior. Interviews focused on events leading up to and after participants’ suicidal behavior; the responses their suicidal behavior generated in others, including family, friends, and the health professionals caring for them; and cultural views of suicide more broadly. Analysis of these interviews revealed that, although participants’ narratives were broadly consistent with a number of recognizable, canonical story formats common to our cultural repertoire of stories of suicide, they also revealed important tensions, divisions, conflicts, and challenges to contemporary suicidological discourse and practice. Despite evidence to suggest that biomedical understandings of suicide provided some therapeutic benefit to participants, they did not address important social and moral dimensions of human life or explore their connection to suicidal behavior—aspects of the suicidal event that were critical to its causation and to its retelling and “resolution.” The results of this study provide important insights into the moral features of suicidal behavior, the moral and ethical implications of suicide research, and the limitations of moral and ethical discourse in suicidology. (shrink)

The recovery model, as applied in mental health, is significant because it intends to foster a critical retrieval by the subject of herself as a self-determining agent of change. This paper will show that the recovery model represents an approach to caring for the self that is congruent with critical themes inherent in some forms of contemporary philosophy, particularly that of Michel Foucault and Jurgen Habermas. The paper will also consider the contribution that Habermas’ discourse ethics could make towards the (...) non-coercive, dialogical resolution of differences between clients and professionals. (shrink)

Love is a universal experience that most people desire. A serious, long-term, and stigmatized illness makes entering and maintaining close relationships difficult, however. Ten persons, who have been diagnosed with schizophrenia, and lived with their illness for between years and decades of their lifetimes, shared their stories. They reported how the illness has influenced their emotional experiences regarding love and their intimate relationship experiences. We present here a qualitative Interpretative Phenomenological analysis (IPA) of their narratives. This analysis has been done (...) with an explicit intention to give voice to the patient’s perspective. The results highlight how illness adjustment and hospitalizations have an alienating effect on relationships through stigmatization and self-stigmatization; how illness creates psychological obstacles to love, such as diminished trust toward oneself and others; and how long-term patients experience practical difficulties in creating and sustaining relationships, such as poverty. Moreover, we show how patients experience changes in sexuality and the risks involved in it, and discuss possible coping strategies from their perspectives. (shrink)