Making sense of mental illness: the importance of inclusive dialogue (original) (raw)
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Mental Health, Discourse and Stigma
BMC Psychology
In this editorial to the special collection “Mental Health, Discourse and Stigma” we outline the concepts of mental, health, discourse and stigma as they are examined through sociolinguistic lenses. We examine the sociolinguistic approach to mental health and stigma and discuss the different theoretical frameworks and methodological approaches that have been applied in such contexts. Sociolinguistics views mental health and stigma as discursively constructed and constituted, i.e. they are both manifest, negotiated, reinforced or contested in the language that people use. We highlight existing gaps in sociolinguistic research and outline how it could enrich research in psychology and psychiatry and contribute to professional practice. Specifically, sociolinguistics provides well-established methodological tools to research the ‘voices’ of people with a history of mental ill health, their family, carers and mental health professionals in both online and off-line contexts. This is vita...
This paper examines the theoretical and practical basis for engaging in dialogue with very disadvantaged people. Using a selective literature review, conceptual analysis, and clinical examples, we explore the reasonable limits of dialogue with disadvantaged populations in order to better understand dialogue, as well as to explore ways to effectively involve disadvantaged people in dialogue. Although people with serious mental illness represent only one very disadvantaged population, we suggest that examining dialogue with this population can serve as a test case for dialogue with disadvantaged people more generally. A recovery-oriented approach can support dialogue processes with people who have mental illness, as their recovery may require, or at least benefit from, dialogue. The inclusion of two clinical scenarios serves to highlight differences in clinical and personal recovery outcomes when dialogue is and is not present in mental health care. Furthermore, although it is not required from a standard principles-based bioethical approach, involving people with mental health issues in dialogue can complement a standard bioethics approach, through dialogical bioethics. A dialogical approach goes beyond the standard principles of bioethics by means of a process that allows relevant bioethical principles to be prioritised, based in part on the person’s informed choice. Overall, our findings suggest that involving very disadvantaged people in dialogue – in this case, people with serious mental illness – is not only possible, it is plausible and can be constructive in relation to a variety of dialogical aims that range from informing to supporting to decision-making processes.
Discussing mental health difficulties in a “diagnosis free zone”
Social Science & Medicine, 2021
Being identified as "mentally ill" is a complicated social process that may be stigmatizing and socially problematic, as a mental illness diagnosis determines the criteria for what is considered normal. This has given rise to a number of anti-stigma campaigns designed to create awareness of the way stigmas affect people with mental health difficulties and to normalize those difficulties in society. One such campaign is the "diagnosis-free zone", which declares that those with mental health difficulties should not be categorized on the basis of their diagnosis; rather, they should be encountered as full individuals. In this paper, we investigate how mental health difficulties are discussed in Clubhouse communities, which adhere to the "diagnosis free zone" programme. The findings are based on conversation analysis of 29 video-recorded rehabilitation group meetings, in one Finnish Clubhouse, intended to advance clients' return to the labour market. The analysis demonstrated that members referred to their mental health difficulties to explain the misfortunes in their lives, especially interruptions and stoppages in their careers. By contrast, staff members disattended members' explanations and normalized their situations as typical of all humans and thus unrelated to their mental health difficulties as such. In this way, the discussion of mental health difficulties at the Clubhouse meetings was implicitly discouraged. We propose that the standards of normality expected of a person not suffering from a mental health difficulty may well be different from the expectations levelled at participants with a history of mental problems. Therefore, instead of considering cultural expectations of normality to be a unified domain, effective anti-stigma work might sometimes benefit from referring to mental-health diagnoses as a means of explicitly tailoring expectations of normality.
Involving Disadvantaged People in Dialogue: Arguments and Examples from Mental Health Care
Journal of Dialogue Studies
This paper examines the theoretical and practical basis for engaging in dialogue with very disadvantaged people. Using a selective literature review, conceptual analysis, and clinical examples, we explore the reasonable limits of dialogue with disadvantaged populations in order to better understand dialogue, as well as to explore ways to effectively involve disadvantaged people in dialogue. Although people with serious mental illness represent only one very disadvantaged population, we suggest that examining dialogue with this population can serve as a test case for dialogue with disadvantaged people more generally. A recovery-oriented approach can support dialogue processes with people who have mental illness, as their recovery may require, or at least benefit from, dialogue. The inclusion of two clinical scenarios serves to highlight differences in clinical and personal recovery outcomes when dialogue is and is not present in mental health care. Furthermore, although it is not req...