The starting point for analysis was highlighting how service users related talk of diagnosis to their mental health difficulties. This would require recruitment into a language of diagnosis, and it was of interest how service users manage the relationship between their own mental health experiences and the formal diagnosis. Consider the following extract:
Ian: but do you feel (1) have you ever been given a diagnosis or anything like
that then? (.) or would you have wanted one or?
Jim: such as what?
Ian: er well (1) depressive o::r a..anything like that?
Jim: well they told me I got scarring of the lungs [I: uh mm] (.) well I (.) had a
lot of bacteria in me (.) body when I was a kid like you know [I: mm] and that’s what done that and er (2) they said “have you smoked” (1) and I said “no” (.) never smoked in my life and I wouldn’t thank you for one [I: mm] (1) and I (.) I said “I used to drink” (.) but I (.) I’ve cut down (.) hell of a lot now cos I used to be (.) twenty odd pints a night [I: mm] (.) no thinking about it like you know (1) I cut…..(lines 443 - 453)
In this extract Jim works to highlight one of the problems that can face service users when discussing issues of diagnosis. This is the issue surrounding knowledge of what is and is not relevant in regard to how a particular category was given to someone. Jim highlights that knowledge of what drives the application of a category is not always clear and straightforward. An understanding of diagnosis according to a psychiatric definition was not apparent. When faced with the opportunity to name his past experiences according to a psychiatric diagnosis he does not undertake to do this. By asking about his diagnosis, he is invited to enter a category that he may find
problematic. What he does is to work to re-code his past experiences in an alternative way, with reference to his general health, rather than mental health. This indicates that he struggles to know what is relevant or not; in terms of the reasoning behind the question. His initial “such as what?” response suggests the uncertainty regarding the
reasoning behind the question. The response directly provides the opportunity to enter into the area of psychiatric diagnosis, namely the “well depressive, or anything like that”. This opportunity though is not taken up, as Jim produces an alternative narrative relating to a consultation focused on the condition of his lungs.
His account is corroborated (Potter, 1996) through inclusion of external witnesses to his poor health. He states that "they told me", in reference to a team of medical practitioners, that he has scarring of the lungs. This works to make a stronger claim than to refer to just one individual. Jim goes on to provide greater detail of
accountability for the scarring of his lungs, which he claims is, at least in part, due to him having a lot of bacteria in his body as a child. In addition he constructs an account which demonstrates that he is possibly in part responsible for his ill health, as he used to drink a lot. This claim is countered by his adamant denial that he has ever smoked, and although his admission of drinking lessens the external accountability, the statement that he does not drink heavily anymore allows for him to claim a current position of personal responsibility over his health. This is an example of one of the problems facing service users, namely that of understanding what is relevant, along with framing their experiences in such a way that coheres neatly with a language of diagnosis. Another example of this lack of understanding of psychiatric diagnosis as a concept can be seen in the following extract:
Ian: how do you feel (.) do you think (.) how (.) what have your experiences
been like then with the (.) the psychiatrist, have they been ok (.) have you always agreed with what they’ve had to say and things?
Harry: er (.) I fully agreed (.) agreed with them [I: mm] I mean (1) they’re
helping you [I: mm] they’re not (1) you know (.) they’re not going (.) t:o be horrible to you [I: mm] o:r (.) anything like that they’re helping you [I: mm] (.) e:r (.) at the end of the day (.) um (.) you can’t be (.) exactly (.) harsh to them [I: mm] (.) they're the ones (.) helping you [I: mm] u::m (2) but (.) that’s [I: mm] (.) that’s my reason really
Ian: did they like (.) did they give you a diagnosis or anything then?
Harry: e:r yeah [I: mm] (.) got that everything [I: mm] check me out (.) I had
(1) my injections and some [I: mm] (1) everything [I: mm] (.) it was great
Harry: u:m (1) it was (.) ten out of ten [I: mm] (.) I mean [I: mm] (.) they said
that you’re (.) you know (.) reasonably fit [I: mm] (.) stocky [I: mm] (.) e:r very very fit [I: mm] (1) at the end of the day (.) it’s just the zinc [I: mm] that (.) it’s (.) tearing me apart (.) basically…..(lines 201-217)
Harry's understanding of diagnosis is similarly linked to the concept of physical health, as seen in Jim's extract. Harry frames the administration of diagnosis as part of his incorporation into service use, through his initial assessment, in which he was 'checked out', given some injections; an overall experience which he is positive about. The use of stating that he was given injections works to further laminate the account with scientific credibility, as it refers to a well established scientific practice, based upon firm scientific evidence that a chemical (of which he does not specify) is effective as part of a medical practice. Inclusion of the injection claim allows Harry to buy into this kind of knowledge. Diagnosis is understood and presented as part of the assessment of Harry's general health. Harry does not specify who the psychiatric team consisted of, preferring to use the general term 'they'. This is utilised to corroborate his account, as the claim that his fitness is good, and overall assessment was positive, is framed in terms of what the psychiatric team said. The use of third party corroboration is a useful tool for contributing to the credibility of claims (Edwards & Potter, 1992).
The last sentence is interesting as it appears to contradict his earlier claims to good health. He states that “the zinc” is the only problem left, as if for fear of painting too rosy a picture of his current physical well being. This seems reasonable, but is followed by a very strong statement that, despite being “only” the zinc left as problematic, it is actually “tearing him apart”. Edwards and Potter (1992) point out that variability in accounts is a central function of descriptions, in terms of people’s stake and interest. In this interaction Harry is positioned as someone of whom a response to my invitation to discuss diagnosis is required. This he duly obliges, with a general health account. The strong ending operates to lay claim to his current position, as someone who has been approached due to poor mental health. His narrative of general health negates any recognition of this, and as such, the ending serves to do this recognition work. His avoidance of entering into psychiatric talk leaves his current state as service user unexplained. His solution to this is to include the rather ambiguous “tearing me apart”,
which constructs severity, but in a non-specific way, but goes some way to producing him as someone ‘in need’, even if that need is not thoroughly detailed.
What we see in these accounts is the invitation to enter into a category of psychiatric definition taken on and worked into an alternative diagnostic framework. A system of general health is produced, that positions the account away from psychiatric diagnoses. Indeed, in developing this system, no mention of psychiatric diagnoses is required. The general health framework provides an excellent tool through which any integration with psychiatric categories can be avoided. In this sense, a form of category avoidance is worked up, which requires no form of denial or counter explanation to defend against potential stigmatisation of psychiatric diagnoses, as to talk only in general health terms is a tangential move that negates any requirement to manage an identity in relation to psychiatric diagnosis. By avoiding entering a psychiatric category, none of the potential negative implications of becoming a member need to be overcome.