Journal of Mental Health, 2012; Early Online: 1–11 © 2012 Informa UK, Ltd. ISSN: 0963-8237 print / ISSN 1360-0567 online DOI: 10.3109/09638237.2012.734648
Discourse analytic research on mental distress: A critical overview
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
EUGENIE GEORGACA Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
Abstract Background. Discourse analytic approaches to mental distress have been developed in the last two decades as part of the broader social constructionist movement in psychology. Aims. The paper reviews existing discourse analytic studies on issues pertaining to mental distress, aiming to identify strengths and gaps in the existing literature as well as to assess their contribution to conceptualizing and managing distress. Method. Discourse analytic and social constructionist studies of different aspects of mental distress, conducted within the field of psychology, were identified and reviewed. Results. The studies reviewed have been organized in four themes: (a) exploring users’ accounts and experiences, (b) examining professional accounts and practices, (c) focusing on mental healthrelated public texts and (d) deconstructing clinical categories. Conclusions. The main function of discourse analytic studies on mental distress has been to highlight the historically contingent and socially constructed character of professional forms of knowledge and practice. More specifically, this research trend has highlighted the discursive resources drawn upon to conceptualize mental distress, the discursive practices through which specific versions of distress are constructed and the discursive effects of these constructions for institutions, subjectivity and social practices.
Keywords: discourse analysis, mental distress, social constructionism
Social constructionism, an epistemological approach that conceives of social and psychological phenomena as constituted through interpersonal and wider social processes, and discourse analysis, a method of examining the function of discourses, that is to say of socially determined systematic ways of speaking, in specific texts, started influencing psychology in the 1970s and 1980s and have rapidly expanded in some fields of psychology. However, the influence of social constructionist ideas in the clinical realm has been rather delayed and limited in range. The first overview of the field, Dave Harper’s paper called “Discourse analysis and mental health” published in 1995 in this journal, quoted hardly a handful of actual discourse analytic studies and was more of a programmatic statement regarding the possible contribution of discourse analysis to the field of mental health than a review of existing work. In this presentation, I will revisit Harper’s original endeavor and examine the work that has been done using discourse analysis, as it has developed within psychology,
Correspondence: Eugenie Georgaca, Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki 541 24, Greece. Tel: +30 2310 997472. Fax: +30 2310 997384. E-mail:
[email protected]
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
2
E. Georgaca
to address issues pertaining to mental distress.The first part of the paper outlines the issues that discourse analytic studies on mental distress address, organized by topic, aiming to provide a descriptive overview of the field. The second, more analytic part evaluates the contribution of this research field to understanding and dealing with mental health problems, in terms of three key concepts in social constructionist work, discursive resources, discursive practices and discursive effects. The articles included in this paper were collected through a series of comprehensive searches, conducted over the past few years, of studies self-identified as discourse analytic on issues pertaining to mental health. Discourse analysis spans several disciplines and there is considerable variability between them in the way discourse is conceptualized and analyzed. They all, however, share a social constructionist view of language as context-bound, functional and constructive (Wetherell et al., 2001). In psychology, there are broadly speaking two strands of discourse analysis. One strand, post-structuralist or Foucauldian discourse analysis, focuses on discursive resources, that is to say the socially available discourses that people draw upon when they present their experiences and views, which in turn shape these very experiences and form their subjectivity. The other strand, discursive psychology, focuses on discursive practices, that is to say the strategies people use to justify their versions and construct a view of themselves as credible (Willig, 2001). The studies reviewed here belong to both these strands. It is a central social constructionist position that arguing for the social construction of knowledge and practice in the field of mental health does not deny or undermine human suffering. On the contrary, it is claimed that the deconstruction of dominant discourses might enable the emergence of more useful and empowering ways of understanding and dealing with the troubling and distressing experiences which are conventionally classified as mental disorders. For this reason, the term “mental distress” will be used in this paper, as a term that acknowledges the troubling character of the experiences under consideration without subscribing to any specific model of conceptualizing them.
Issues examined by discourse analytic studies on mental distress Exploring users’ accounts and experiences There is a group of discourse analytic studies which analyze interviews with users of mental health services, with the aim of highlighting users’ accounts and experiences regarding their mental health problem. These studies focus on the ways in which people draw upon socially available discourses in their accounts and how the use of these discourses in turn shapes participants’ experiences, understandings of their condition and self-management practices. Moreover, they highlight how, through the use of these discourses, participants construct specific subjectivities (Burns & Gavey, 2004; LaFrance & Stoppard, 2006). For example, in one of the early studies, Lewis (1995) looked at the different discourses people draw upon to make sense of their “depression” and the effects that the use of each discourse has for their understanding both of their condition and of themselves. Although a variety of discourses have been identified, most papers witness the prominence of the medical discourse, the view of mental distress as illness caused by biological brain dysfunction, in shaping participants’ experiences, views and subjectivity. In some cases participants take on the medical discourse themselves (LaFrance, 2007; Swann & Ussher, 1995). Swann and Ussher (1995), for example, show that the use of medical discourse, according to which the “premenstrual syndrome” is purely biologically generated, allows the participants to locate the problem within their body and thus to exonerate and undermine the
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
Discourse analytic research on mental distress 3 possible role their life conditions or problems could play in their experiences. Quite often, however, individuals have already been positioned within the medical discourse as patients, through previous encounters with the mental health system, with the implications of lack of agency, insight and meaning that this positioning carries, and are actively engaged in re-negotiating that positioning in the context of the study (Benson et al., 2003). Maybe the most extreme consequence of being positioned as a patient in the medical discourse can be found in the case of delusions, whereby what is at stake is the very reality of the person, which within the medical discourse is undermined as delusional. The ways in which individuals with a diagnosis of delusions negotiate this impossible position have been explored by Georgaca (2000, 2004) and Harper (1995). There are other studies which focus on discursive practices and examine the ways in which users construct specific versions of themselves (Drew et al., 1999) and formulate their views on issues such as cognitive behavioral therapy (Messari & Hallam, 2003) and the users’ movement (Armes, 2009). It is noticeable, however, that the discourse analytic work on users of services has focused much more on the effects of discourse in shaping users’ accounts, experiences and subjectivity than on the ways in which users actively form and negotiate their versions. Examining professional accounts and practices In contrast to the studies of users’ experiences and accounts, which tend to focus on the way available discourses on mental distress shape users’ subjectivity and experience, the discourse analytic studies of professionals’ accounts are mainly located in the strand of discursive practices, that is, to say they examine the discursive strategies professionals use to justify their actions, aiming to deconstruct the objective and self-evident scientific character of professional practices in the field of mental health. One group of studies is based on interviews with mental health professionals on specific topics of mental health practice, such as conceptualizing disorders (Thomas-McLean & Stopppard, 2004), diagnosis (Harper, 1994a, 1995), medication (Harper 1999; Liebert & Gavey, 2009) and the use of electroconvulsive therapy (Stevens & Harper, 2007). The central social constructionist premise here is that professional practices are not based on disinterested and objective implementation of scientific procedures, but that they are constructions linked to context and influenced by various institutional, social and practical considerations. The studies highlight the complexity of mental health practices and the flexibility in their implementation, description and justification. Especially in the case of controversial issues, such as the use of electroconvulsive therapy (Stevens & Harper, 2007), medication failure (Harper, 1999) and serious adverse effects of medication (Liebert & Gavey, 2009), professionals are shown to actively manage responsibility and blame and to employ several discursive strategies in order to justify the continuation of such practices despite their problematic character. These strategies invariably involve the portrayal of the recipients of these practices as severely ill, stressing the severity and chronicity of client problems and assuming the existence of a biologically based condition which is the source of client complaints as well as of the persistence of symptoms despite treatment. The professional participants are correspondingly positioned as expert medical practitioners who adopt a disinterested position of applying medical procedures while weighing risks against benefits. Once again, then, we find that the medical discourse provides the means through which professional practices in mental health acquire legitimacy and an almost self-evident character. Although patient–professional interaction has been widely researched in conversation analysis, ethnomethodology, ethnography etc (McCabe et al., 2002; Terkelsen, 2009), the
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
4
E. Georgaca
actual interaction between mental health professionals and users in clinical settings has scarcely been examined by discourse analytic studies. Discourse analysis could be employed to explore the negotiation processes taking place between client and professional, the ways in which clients’ versions of their experiences are gradually shaped by professional discourses, and could also identify possible strategies for client resistance to the dominance of professional discourses, when these are unhelpful or too restrictive. Similarly, there is a paucity of discourse analytic work on actual professional practices in institutional settings, such as clinical case conferences, tribunals, case reports etc. (with the exceptions of Griffiths, 2001 and Stowell-Smith & McKeown, 1999). Work on professional interactions and practices conducted within similarly minded fields (e.g. Barrett, 1996; Soyland, 1994) has explored how professionals in their actual practice construct cases out of people who present with mental health problems and the effects this construction has in terms of the care and treatment options offered to them. These studies show how the formulation of clinical cases is context-bound and depends on various considerations, such as the definition of client problems, assessment of severity and risk, availability of staff and access to services, as professionals are conducting their business of making practical decisions regarding the duty to care and the allocation of resources. These professional meetings are also a site of demonstration of professional expertise, whereby participants’ conduct is actively regulated by the standards of their profession, and also become a domain of power struggle between professions, as participants negotiate competing versions of client problems. Through these dynamic processes specific formulations of clients’ problems are achieved, which in turn influence the decisions taken regarding the course of treatment offered to them. The field of professional practices can be a particularly promising research area for discourse analysis, which has the advantage of linking the micro-analytic emphasis on interactional dynamics, shared by other methods, with the examination of macro-social systems of meanings and practices. Focusing on mental health-related public texts Another prominent trend in discourse analytic research on mental health issues has been the analysis of public texts. This field of research investigates the discourses drawn upon and the discursive strategies used in public texts to construct specific versions of mental health problems, as well the consequences of these constructions for public views, for users of services and for mental health policy. Particular emphasis has been given to media portrayals of mental health issues, since the media has long been held responsible for biased depictions of mental illness, which perpetuate negative public perceptions of people with mental health problems. There are a few studies to date, which have explored the portrayal of mental illness, mainly in print media, in New Zealand (Allen & Nairn, 1997; Coverdale et al., 2002; Hazelton, 1997; Nairn, 1999; Nairn & Coverdale, 2005; Nairn et al., 2001), Canada (Olstead, 2002) and Serbia (Bilic´ & Georgaca, 2007). A consistent finding has been that the media make use of medical discourse to portray mental health problems, that is to say they present mental illness as a biological condition with the corresponding repercussions of chronicity, disability and passivity. The portrayal of mental illness in the media is also permeated by a discourse of dangerousness, whereby violent acts by people with mental health problems are customarily highlighted and linked with notions of meaninglessness, purposelessness and unpredictability. The use of the discourse of dangerousness by the media draws upon and in turn contributes to the inflation of the risk posed by people with mental health problems, despite evidence that the percentage of crimes committed by individuals with a diagnosis of a mental disorder
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
Discourse analytic research on mental distress 5 is not significantly higher than that of the general population (Pilgrim & Rogers, 2003). Obviously, this perpetuates negative public views on mental illness and the stigmatization people with mental health problems experience in various domains of their lives. Discourse analytic studies of mental health legislation and governmental policy documents (Harper, 2004; Moon, 2000) show that, similarly to the media, the mobilization of medical discourse, but mainly of the discourse of dangerousness, in policy texts functions in a way that legitimizes the use of restrictive measures on grounds of the need for treatment but mainly of protecting public safety. Discourse analysis has also been applied to government and users’ groups publications (Hui & Stickley, 2007), health promotion popular texts (Burns & Gavey, 2004) and scientific publications (Johnstone & Frith, 2005). These studies take on different kinds of texts and highlight several interesting topics of investigation, and should, thus, be seen as examples of the directions future discourse analytic research of public texts can take. Deconstructing clinical categories A major trend within the social constructionist movement in psychology has been the deconstruction of psychological categories through highlighting their historically contingent and socially constructed character as well as their function of serving dominant professional interests and maintaining scientific credentials. This, in the field of mental health, has been translated to an attempt to deconstruct major clinical categories, and here the social constructionist deconstructive work is at its best. This significantly overlaps with similar studies conducted in the fields of anthropology, sociology, philosophy and history (Barrett, 1996; Castel et al., 1982; Hacking, 1995), but only work within the field of psychology will be considered here. A certain trend in this endeavor has been dedicated to studying the history of psychiatric categories. These studies explore the historically changing character of specific clinical categories and the forces and dominant discourses which have shaped them at each historical phase. The explicit aim of these studies is to denaturalize clinical categories and destabilize their objective and taken-for-granted character, in other words to demonstrate that these categories do not refer to independently existing ahistorical entities that are eventually identified by scientific research but that they are produced by historically and socially contingent scientific and professional systems of knowledge and practice. Clinical entities that have been subjected to such analysis include anxiety (Hallam, 1994), personality disorder (Swartz & Ismail, 2001), paranoia (Harper, 1994b), anorexia (Hepworth, 1999) and hallucinations (Blackman, 2001). Other attempts at deconstructing clinical categories develop a critical reading of them, through highlighting and overturning their underlying assumptions. This kind of deconstructive work has been carried out on the clinical categories of psychopathy (Stowell-Smith & McKeown, 1999), bipolar disorder (Liebert, 2010), delusions (Georgaca, 2000, 2004; Harper, 1992, 1996) and psychotic speech (Parker et al., 1995). Finally, some theorists have taken a step further and have formulated alternative ways of conceptualizing the experiences that are conventionally classified as symptoms of clinical categories. These studies provide accounts of human experiences which have come to be categorized within the dominant paradigm as multiple personality disorder (Gillett, 1997), depression (LaFrance, 2009; Stoppard, 2000), paranoia (Cromby & Harper, 2009), hallucinations (Blackman, 2001) or psychotic speech (Parker et al., 1995) by taking into account the role of dominant narratives, the sociocultural context as well as professional knowledges and practices in shaping them. Stoppard (2000), for example, argues that “depression” is a subjective, embodied and
6
E. Georgaca
discursively produced experience, intimately linked to culturally dominant notions of femininity, and that the socially available understandings of how to enact “depression” provide the template upon which women’s experience of “depression” is shaped. This field of social constructionist research which critically examines the production and maintenance of dominant clinical categories and attempts to denaturalize and destabilize them through a series of deconstructive strategies has been one of the major contributions of discursive approaches to critical mental health work.
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
The contribution of discourse analytic and social constructionist studies to conceptualizing and managing distress The main function of discourse analytic studies in the field of mental health has been to highlight the historically contingent and socially constructed character of professional knowledges and practices. With regard to knowledge, discourse analytic studies have shown how psychopathological categories are not labels pointing to really existing entities, but constructs produced within specific sociohistorical conditions through examining their historical development or deconstructing their underlying assumptions. With regard to practices, they have shown how professional practices, such as case formulations, diagnosis and treatment, are not disinterested and objective applications of scientific knowledge but that they are complex processes dependent on a variety of contextual factors. Moreover, discourse analytic studies have been particularly apt for examining the functions of these knowledges and practices in terms of supporting and maintaining dominant modes of understanding and dealing with distress, as well as the consequences of them for positioning both the professionals and the recipients of these knowledges and practices, individuals in distress. To put it briefly, discourse analytic work in the field of mental health has effected two kinds of shifts in terms of conceptualizing distress and its management. First, it has shifted the emphasis from psychological to interpersonal and sociocultural processes, locating the experience, understanding and management of distress not within individual minds and bodies but in interactional processes and culturally available discourses. Second, it has shifted the way we understand the knowledge and practice of the psy disciplines from considering them as a discovery-driven objective development of scientific knowledge and its implementation to viewing them as social practices, multi-determined by several contextual factors and serving a variety of functions. In what follows, I will examine in more detail the contribution of discourse analytic and social constructionist studies to conceptualizing and managing distress, using as organizing principles three notions which are central to discourse analytic work, those of discursive resources, discursive practices and discursive effects. A starting premise of social constructionism is that human experience, understanding and practice are formed through and permeated by socially available modes of conceptualizing the world, what has been called discourses. Discourses, socially sanctioned organized bodies of knowledge and practice, operate as discursive resources individuals draw upon to understand themselves and act in the social world. Discursive research in the area of mental health has focused on how discourses shape our understanding of distress. These discourses have been shown to permeate public texts, such as media, policy, cultural and professional documents, and to perpetuate thus certain versions of distress. Discourses permeate professional knowledge, i.e. psychopathological categories, and practice, i.e. case formulations, professional reports etc. Mental health professionals draw upon them to construct clinical cases, formulate their role and position the recipients of their services. Finally, individuals in distress draw upon them to make sense of their experience, manage themselves and
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
Discourse analytic research on mental distress 7 form views regarding mental health services. A consistent finding of discourse analytic studies is the ubiquitousness of medical discourse, which conceptualizes distress as illness, locates its route in the human body, treats the person in distress as a passive sufferer and positions the individuals located within it in terms of expert and patient. The medical understanding of distress has been dominant for a few decades. It has been argued, however, that it is very restrictive in terms of the understanding and managing of distress it makes available and is very disempowering for people located in the position of the patient (Bracken & Thomas, 2005; Parker et al., 1995). A main concern of discourse analytic studies has, therefore, been to examine the consequences of this discourse and deconstruct it. Apart from the medical discourse, a number of other discourses have been found to be in operation not only in personal but also in professional accounts of mental health issues. The discourse of dangerousness seems to be consistently drawn upon in media and policy texts, when they refer to mental distress. Discourses of gender (LaFrance, 2009; Stoppard, 2000; Swann & Ussher, 1995), race (Stowell-Smith & McKeown, 1999) and health (Burns & Gavey, 2004) seem to permeate personal accounts of mental distress, professional practices and cultural texts, respectively. In all these cases, discourse analytic studies pinpoint the discourses that are drawn upon in a text, examine the specific versions of distress constructed through the use of these discourses and discuss the implications of the use of these discursive resources. In this way, they highlight in practice the way socially available systems of meaning shape the experience and understanding of distress, enabling, thus, a critical examination of their functions and effects. This leads to the second central notion of discourse analysis, that of discursive practices. Discourses do not simply find themselves in texts, they are actively drawn upon to perform certain discursive actions. The emphasis in this respect has been on the ways in which certain versions of mental health problems or practices are constructed by participants and the functions these constructions have. This has proven an extremely fruitful field for exploration. Researchers have examined, for example, how the combined use of medical discourse and the discourse of dangerousness in the media constructs a version of people with mental health problems as sufferers of a medical condition, incomprehensible and unpredictable, and therefore prone to acts of violence. In policy texts, this portrayal is complemented with an explicit concern for public safety and the need for providing care for mental health patients. Mental health professionals, both in their accounts of their practices and in their actual communication between them and with patients, construct different versions of themselves as professionals, the recipients of their practices as patients and the object of their expertise, i.e. mental illness, in flexible and context-bound ways, and this can serve functions, such as claiming professional expertise, justifying their practice, attributing responsibility, managing resources etc. Finally, people in distress draw upon socially available discourses to make sense of their experience, present themselves in socially acceptable ways, manage their everyday practices, negotiate their role within the mental health system, exonerate their life conditions and choices etc. The emphasis here is on what people do with their accounts, what accounts accomplish through the way they are organized. This demonstrates the socially constructed and interpersonally oriented, and thus functional and flexible, character of professional practices and individual identities. The investigation of professional practices and individual identities as processes which serve specific functions deconstructs their objective character and allows a critical consideration of their effects, potentially opening the way for more empowering practices. Discursive functions are not easily distinguishable from discursive effects, but for the purposes of this paper I will use the term discursive effects to refer to the ways in which constructions of mental health issues are linked to institutions, form subjectivities, shape the socially
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
8
E. Georgaca
available ways of understanding distress and affect the lives of individuals in distress. Here discourse analytic work reveals the extensive impact of the dominant constructions of mental distress in each one of the above domains. The dominant versions of mental distress serve to maintain the power of the institutions socially sanctioned to deal with it. They sustain the clinical categories used to understand distress, they secure the position of professionals as experts, they shape professional identities and roles, and they justify the continuing use of professional practices of diagnosis and treatment. The portrayal of mental distress in public texts shapes and reinforces public views of distress as a biological condition and its construction in policy texts legitimizes the continuing use of restrictive measures for managing people with mental health problems. These constructions of mental distress seep into and perpetuate the socially available ways of understanding distress, which is turn shapes the way individuals experience and make sense of their distress. The dominant versions of mental distress, circulating through popular and professional discourses, also have a profound effect on the lives of individuals with mental health problems, both in terms of the repercussions of them being positioned as patients within the mental health system and in terms of the stigma that inevitably accompanies the socially dominant versions of distress as mental illness. Here too the investigation of the restrictive and disabling effects of dominant discourses on mental distress can open the way to more empowering ways of understanding and dealing with mental health problems. Discourse analytic work in mental health thus offers an innovative conceptualization of mental health issues. It enables the investigation of the complexity of mental health issues and their intimate relation to their interactional, social and historical context (Harper & Warner, 1993). Not only does it bridge the individual-social divide, but it also shows how the two are inseparable and intricately intertwined (Harper, 1995). It demonstrates the mutual relation between lay and professional knowledge, between professional knowledges and practices, as well as between discourses of mental distress and individual experience (Parker et al., 1995). Discourse analysis also has limitations, as its emphasis on language and meaning has had the effect of neglecting, undermining or rendering difficult the consideration of the visual, materiality and embodied experience (Nightingale & Cromby, 1999), issues which are pertinent to the field of mental health. Discourse analytic and social constructionist work has been at the forefront of radical work in the field of mental health, with researchers being politically engaged and committed to social critique and to bringing about social change. The deconstructive thrust of discourse analysis has been directed to denaturalizing mainstream categories, exposing the socially constructed character of mental health concepts and practices and highlighting their constraining effects for users of mental health services. The impact of this work, therefore, has been mainly in terms of deconstruction, in an attempt to open up spaces for alternative knowledges and practices. It has rightly been pointed out (Willig, 1999) that discourse analysts are reluctant to move beyond deconstruction to make recommendations for improved social and psychological practice. According to Willig, apart from providing social critique, discourse analysis can contribute to social change through the identification and promotion of subversive discourses, practices and spaces for resistance as well as through assisting the formulation of proposals for improved practice. Both of these directions are yet to be taken in the discourse analytic approach to mental health. Through deconstructing harmful professional accounts and practices and opening up alternative spaces and positions discourse analysis does not directly lead to possible interventions, but can inform them (Harper, 1999), and this would be more effective if discourse analytic researchers make the effort of formulating the implications of their findings for different groups involved (Harper, 2006). If discourse analysis is to move
Discourse analytic research on mental distress 9 beyond deconstruction toward a more direct impact in the field of mental health, it would need to take some important steps, which would include placing emphasis on the links between research, implementation and interventions, forging alliances between discourse researchers, mental health service users and critical professionals, and making tactical use of research findings through utilizing multiple forms of dissemination and consultation (Georgaca & Avdi, 2012). Declaration of Interest: None.
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
References Allen, R., & Nairn, R.G. (1997). Media depictions of mental illness: An analysis of the use of dangerousness. Australian and New Zealand Journal of Psychiatry, 31, 375–381. Armes, D.G. (2009). Mission informed discursive tactics of British mental health service-user/survivor movement (BSUSM) resistance to formalization pressures accompanying contractual relationships with purchasing authorities. Journal of Mental Health, 18(4), 344–352. Barrett, R.J. (1996). The psychiatric team and the social definition of schizophrenia: An anthropological study of person and Illness. Cambridge: Cambridge University Press. Benson, A., Secker, J., Balfe, E., Lipsedge, M., Robinson, S., & Walker, J. (2003). Discourses of blame: Accounting for aggression and violence on an acute mental health inpatient ward. Social Science & Medicine, 57, 917–926. Bilic´, B., & Georgaca, E. (2007). Representations of “mental illness” in Serbian newspapers: A critical discourse analysis. Qualitative Research in Psychology, 4, 167–186. Blackman, L. (2001). Hearing Voices: Embodiment and Experience. London: Free Association Books. Bracken, P., & Thomas, P. (2005). Post-psychiatry: Mental health in a postmodern world. Oxford: Oxford University Press. Burns, M., & Gavey, N. (2004). “Healthy weight” at what cost? “Bulimia” and a discourse of weight control. Journal of Health Psychology, 9(4), 549–565. Castel, R., Castel, F., & Lovell, A. (1982). The psychiatric society. New York, NY: Columbia University Press. Coverdale, J., Nairn, R., & Claasen, D. (2002). Depictions of mental illness in print media: A prospective national sample. Australian and New Zealand Journal of Psychiatry, 36, 697–700. Cromby, J., & Harper, D. (2009). Paranoia: A social account. Theory & Psychology, 19(3), 335–361. Drew, M.L., Dobson, K.S., & Stam, H. (1999). The negative self-concept in clinical depression: A discourse analysis. Canadian Psychology, 40(2), 192–204. Georgaca, E. (2000). Reality and discourse: A critical analysis of the category of “delusions”. British Journal of Medical Psychology, 73, 227–242. Georgaca, E. (2004). Factualisation and plausibility in “delusional” discourse. Philosophy, Psychiatry and Psychology, 11(1), 13–23. Georgaca, E., & Avdi, E. (2012). Discourse analysis. In A. Thompson & D.J. Harper (Eds.), Qualitative research methods in mental health and psychotherapy: A guide for students and practitioners (pp. 147–162). Chichester: Wiley. Gillett, G. (1997). A discursive account of multiple personality disorder. Philosophy, Psychiatry and Psychology, 4(3), 213–222. Griffiths, L. (2001). Categorising to exclude: The discursive construction of cases in community mental health teams. Sociology of Health and Illness, 23, 678–700. Hacking, I. (1995). Rewriting the soul: Multiple personality and the sciences of memory. Princeton, NJ: Princeton University Press. Hallam, R.S. (1994). Some constructionist observations on “anxiety” and its history. In T.R. Sarbin & J.I. Kitsuse (Eds.), Constructing the social (pp. 139–156). London: Sage. Harper, D.J. (1992). Defining delusions and the serving of professional interests: The case of “paranoia”. British Journal of Medical Psychology, 65, 357–369. Harper, D.J. (1994a). The professional construction of “paranoia” and the discursive use of diagnostic criteria. British Journal of Medical Psychology, 67, 131–143. Harper, D.J. (1994b). Histories of suspicion in a time of conspiracy: A reflection on Aubrey Lewis’ history of paranoia. History of the Human Sciences, 7, 89–109. Harper, D.J. (1995). Discourse analysis and “mental health”. Journal of Mental Health, 4, 347–357. Harper, D.J. (1996). Deconstructing “paranoia”: Towards a discursive understanding of apparently unwarranted suspicion. Theory and Psychology, 6(3), 423–448.
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
10
E. Georgaca
Harper, D.J. (1999). Tablet talk and depot discourse: Discourse analysis and psychiatric medication. In C. Willig (Ed.), Applied discourse analysis: Social and psychological interventions (pp. 125–144). Buckingham: Open University Press. Harper, D.J. (2004). Storying policy: Constructions of risk in proposals to reform UK mental health legislation. In B. Hurwitz, T. Greenhalgh, & V. Skultans (Eds.), Narrative research in health and illness (pp. 397–413). London: Blackwell. Harper, D.J. (2006). Discourse analysis. In M. Slade & S. Priebe (Eds.), Choosing methods in mental health research (pp. 47–67). London: Routledge. Harper, D.J., & Warner, S.J. (1993). Discourse, social constructionism and clinical psychology. Changes, 11, 72–79. Hazelton, M. (1997). Reporting mental health: A discourse analysis of mental health related news in two Australian newspapers. Australian and New Zealand Journal of Mental Health Nursing, 6(2), 73–89. Hepworth, J. (1999). The social construction of anorexia. London: Sage. Hui, A., & Stickley, T. (2007). Mental health policy and mental health service user perspectives on involvement: A discourse analysis. Journal of Advanced Nursing, 59(4), 416–426. Johnstone, L., & Frith, H. (2005). Discourse analysis and the experience of ECT. Psychology and Psychotherapy: Theory, Research and Practice, 78, 189–203. LaFrance, M.N. (2007). A bitter pill: A discursive analysis of women’s medicalized accounts of depression. Journal of Health Psychology, 12(1), 127–140. LaFrance, M.N. (2009). Women and depression: Recovery and resistance. Hove: Routledge/Psychology Press. LaFrance, M.N., & Stoppard, J. (2006). Constructing a non-depressed self: Women’s accounts of recovery from depression. Feminism & Psychology, 16(3), 307–325. Lewis, S.E. (1995). A search for meaning: Making sense of depression. Journal of Mental Health, 4, 369–382. Liebert, R. (2010). Synaptic peacekeeping: Of bipolar and securitization. Womens’ Studies Quarterly, 38(3&4), 325–342. Liebert, R., & Gavey, N. (2009). “There are always two sides to these things”: Managing the dilemma of serious adverse effects from SSRIs. Social Science & Medicine, 68, 1882–1891. McCabe, R., Heath, C., Burns, C., & Priebe, S. (2002). Engagement of patients with psychosis in the consultation: Conversation analytic study. British Medical Journal, 325, 1148–1151. Messari, S., & Hallam, R. (2003). CBT for psychosis: A qualitative analysis of clients’ experiences. British Journal of Clinical Psychology, 42, 171–188. Moon, G. (2000). Risk and protection: The discourse of confinement in contemporary mental health policy. Health & Place, 6, 239–250. Nairn, R. (1999). Does the use of psychiatrists as sources of information improve media depictions of mental illness? A pilot study. Australian and New Zealand Journal of Psychiatry, 33, 583–589. Nairn, R., & Coverdale, J. (2005). People never see us living well: An appraisal of the personal stories about mental illness in a prospective print media sample. Australian and New Zealand Journal of Psychiatry, 39, 281–287. Nairn, R., Coverdale, J., & Claasen, D. (2001). From source material to news story in New Zealand print media: A prospective study of the stigmatizing processes in depicting mental illness. Australian and New Zealand Journal of Psychiatry, 35, 654–659. Nightingale, D.J., & Cromby, J. (Eds.) (1999). Social constructionist psychology: A critical analysis of theory and practice. Buckingham: Open University Press. Olstead, R. (2002). Contesting the text: Canadian media depictions of the conflation of mental illness and criminality. Sociology of Health and Illness, 24, 621–643. Parker, I., Georgaca, E., Harper, D., McLaughlin, T., & Stowell-Smith, M. (1995). Deconstructing Psychopathology. London: Sage. Pilgrim, D., & Rogers, A. (2003). Mental disorder and violence: An empirical picture in context. Journal of Mental Health, 12(1), 7–18. Soyland, A.J. (1994). Functions of the psychiatric case-summary. Text, 14(1), 113–140. Stevens, P., & Harper, D.J. (2007). Professional accounts of electroconvulsive therapy: A discourse analysis. Social Science & Medicine, 64, 1475–1486. Stoppard, J.M. (2000). Understanding depression: Feminist social constructionist approaches. London: Routledge. Stowell-Smith, M., & McKeown, M. (1999). Race, psychopathy and the self: A discourse analytic study. British Journal of Medical Psychology, 72, 459–470. Swann, C.J., & Ussher, J.M. (1995). A discourse analytic approach to women’s experience of premenstrual syndrome. Journal of Mental Health, 4, 359–367. Swartz, S., & Ismail, F. (2001). A motley crowd: The emergence of personality disorder as a diagnostic category in early 20th century South African psychiatry. History of Psychiatry, 7, 157–176.
Discourse analytic research on mental distress
11
J Ment Health Downloaded from informahealthcare.com by 87.202.161.160 on 01/16/13 For personal use only.
Thomas-McLean, R., & Stoppard, J. (2004). Physicians’ constructions of depression: Inside/outside the boundaries of medicalization. Health, 8, 275–293. Terkelsen, T.B. (2009). Transforming subjectivities in psychiatric care. Subjectivity, 27, 195–216. Wetherell, M., Taylor, S., & Yates, S.J. (Eds.) (2001). Discourse theory and practice: A reader. London: Sage. Willig, C. (1999). Introduction: Making a difference. In C. Willig (Ed.), Applied discourse analysis: Social and psychological interventions (pp. 1–21). Buckingham: Open University Press. Willig, C. (2001). Introducing qualitative research in psychology: Adventures in theory and method. Maidenhead: Open University Press.
