The experience of mental health

The first contribution is the development ot conceptual and methodological tools that enable a greater understanding of the meanings involved in the experience of “mental disorders” and their social production. What are known as “mental disorders,” “mental illnesses,” or “mental health issues” are not self-evident distinctions separating the healthy from the sick and the normal from the pathological. They are prisms through which societies that believe in the legitimacy of medical, psychiatric, and psychological knowledge construct, reflect upon, and justify differences between people. By empathically exploring lived experiences through the study of words and behaviors, the symbolic interactionist perspective generates critical distance toward this production of differences.

Methodologically speaking, this implies that symbolic interactionists would generally study schizophrenia, office work, and amateur cooking in the same way, by talking to people about their everyday lives, taking what they say seriously, observing reflexively how they behave, and exploring how they make sense of their situation. This refusal to pre-conceive mental disorders as something fundamentally distinct from other behaviors and emotions, or as something discrediting, is one of the core attributes of the symbolic interactionist view of mental health. Especially if we treat mental disorders as “deviances” can we use generic concepts to comparatively study various transgressions, as did Becker (1963) and Joel Best and David Luckenbill (1980); we can also ask what the commonalities are between those deemed “alcoholics,” “thieves,” “anorectics,”or “sex offenders” and those “suffering from depression.” For one thing, they are all considered by at least some people, possibly those with authority backed by a legitimate organization (e.g., doctors, psychiatrists, police officers), to behave in an abnormal or unhealthy way. Their behavior is subject to interventions to change, cure, punish, care for, or contain. Generally, because it de-naturalizes the basis of these interventions, the symbolic interactionist focus on deviance tacitly gives weight to the point of view held by the most dominated and disadvantaged groups (Becker, 1967).

Some interpretive tools have been developed to study mental disorders from this perspective. Among those who proposed methodological adjustments (Doubt, 1994; Karp, 1994; Woodward, 2003), Branca Telles Ribeiro (1994) used Goffman’s frame analysis to make sense of “psychotic crises,” those moments during which patients seem to act and talk incoherently, such as during hallucinations. Frames are the references that help people understand their own situation. Usually, some social conventions signal that frames are shifting; for example, people indicate when they start or leave a conversation or when they take on different roles. Ribeiro showed that it was possible to understand psychotic crises as interactions characterized by several frames with transitions that are either unannounced or announced in unconventional ways. “People in crises” can, for instance, address their absent family members, past or present, while talking to their psychiatrist, shifting frames within sentences without providing their interlocutor or any indication of whom they are talking to or when they are talking. Frame analysis serves to decipher seemingly delusional dialogue. Another argument, as made by Morris Rosenberg (1984), is that the foundation of mental health issues, such as psychosis, may not be characteristic of those deemed psychotic but rather an inability of their interlocutors to understand them — or, in a more moderate sense, that one must consider people s words in light of the variable credibility given to them in certain settings, therefore broadening the space of interpretive possibilities (Brossard, 2019a). Recent works have significantly progressed the analytical descriptions of emotions, bodily sensations, and thought processes associated with mental health—related issues (e.g., Olson, 2014; McKinzie, 2017; Esala and Del Rosso, 2020); some improvements are also being elaborated to explore how social inequalities and divides shape everyday experiences (see Chandler, 2019 on critical phenomenology).

Through this sympathetic position, symbolic interactionists reflect on the basis of social relations and agency, even in cases of the most serious disorders. There exists no psychiatric problem with “symptoms” that would immediately emanate from biochemical, cognitive, or psychological phenomena; even the outcomes of serotonin levels only take place and make sense through interactions, meaning they are negotiated to some extent. Thus, research showing how individuals deal with, anticipate, or avoid mental health issues in various social contexts is of particular value here. This is exemplified by Jay Marlowe (2013) and his participant, who takes things “slowly” to avoid “cracking up,” and by Julia E. H. Brown and Simone Dennis (2017), who examine the daily experience of schizophrenia as negotiated through conceptions of the mind—body divide and medicine. Research into self-harm provides good examples of this mental health—related agency; while this practice is mostly solitary, it involves a deeply communicative process engaging forms of emotion management and self-control (Chandler, 2016; Brassard, 2018; Steggals et al., 2020). Another way to study agency entails asking how mental health conditions change peoples sense of self, or their identity, especially in chronic cases (Charmaz, 1983). For example, Tracy X. Karner and Donna Bobbitt-Zeher (2005) examined how patients suffering from dementia “lose their self” on account of the disease as well as the changes in their relationships with caregivers.

In sum, the very premise of symbolic interactionism takes on a singular resonance in the field of mental health. The “simple” aim to nonjudgmentally understand people questions the social construction of the differences that constitute the field of mental health, redefines how experiences can be interpreted as social processes, and, through the study of agency and relations, critiques the mainstream psychiatric approaches to mental disorders.

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