So far we have seen some of the discursive strategies of resisting entering into talk of diagnoses in psychiatric terms, along with narratives of struggling to understand the meaning of diagnostic classifications such as schizophrenia. The following section focuses on the problems involved in accounting for mental health difficulties once their labelling as diagnoses is recognised by users. Namely, what is the impact of
recognising that you have received a diagnosis? Firstly, by focusing broadly around strategies of accepting diagnosis, which relates to the issue of producing a
classification system that users feel more comfortable with. This indelibly involves the problem of acceptance, which is clearly illuminated in the following extract:
Ian: mm (2) what about your diagnosis then? Have you always agreed with it? Ben: °well I always knew° there was something wrong cos you don’t hear
voices for (.) no apparent reason (I: mm) (3) and I kept, when wh..wh..when they didn’t diagnose me at first (.) I kept saying you know (.) I know there’s something wrong (I: mm) (1) and then when it was, the diagnosis was given (.) to me it was like (1) finally some closure (.) you know what I mean I..I..I have got something wrong (I: mm) (1) but then I (.) on the other hand it was like schizophrenia (.) I’ve got to live with that for the rest of my life (I: mm) (1) so it was kind of mixed emotions (I: mm) (3) so
Ian: so you (1) you think it’s something then (.) that’s it then you’ll (.) you’ll
have for the rest of your life…..(lines 342-352)
In this extract with Ben we can see the way the dilemma of acceptance works. Ben’s diagnosis of schizophrenia came after a period in which he claims he knew something was wrong. He had identified his experiences as problematic, which positioned them as something requiring an explanation. He states his concern at the time that he was not provided with a diagnosis immediately. Thus, he was very relieved when a diagnosis was given, and his experiences were categorised as schizophrenic. Receiving an explanatory diagnosis can be a distressing event, as it means that fears regarding ill health are confirmed as an actual illness. However, the reception of diagnosis can be a positive event, as it allows for prior distressing experience to be accounted for, which in turn facilitates a course of treatment and (hopefully) positive outcome. In Ben’s account though, this posed a new problem; that of accepting a category that re-coded his past experiences in a potentially stigmatising way. Ben states that “it was
schizophrenia, I’ve got to live with that for the rest of my life”. On the one hand he was relieved to have an explanation for the behaviour, but on the other, the explanation came at a cost, namely a stigmatising category. This is a prime example of the problem faced by users when it comes to diagnosis. That is, how to accept entering an
explanatory category, that in turn re-codes one’s life in a stigmatising way. A strategy aimed at overcoming this dilemma can be seen in the next section of Ben’s extract:
Ben: yeah, that’s the way I look upon it \\ cos it’s not getting any better \\ Ian: \\ but is that \\
Ben: it’s not getting any easier
Ian: mm (1) have you been told that have you or?
Ben: I haven’t been told that no I just, my mum’s got it, my my real mum,
biological mum (I: mm) she’s got it (.) she’s got schizophrenia, and my uncle has (I: mm) (.) and my biological dad had a personality disorder (I: mm) so (1) there was an increased chance that (I: mm) (.) I’d get it but (.) only by a little (.) so
Ian: mm (3) so do you think there’s sort of a (.) gene.. genetic element to it
Ben: yeah (I: mm) (1) yeah definitely (1) sometimes when I’m off on one and I
(.) can’t come back (1) er (.) come back to (.) society (2) I’ll always say, Frances, that’s my real mum, shouldn’t have had kids (I: mm) (1) cos I’m not going to have kids (.) cos I wouldn’t like to pass it on (I: mm) so (1) and e..e...er that’s just a decision I’ve made (.) (I: so you..) I wouldn’t like, I wouldn’t like to wish this on anyone you know what I mean (I: mm)…..(lines 404-420)
Ben’s ‘answer’ to this is to produce a category based upon both psychiatric knowledge and personal experience. He states that he knows his diagnosis is long-term as his mother suffered from schizophrenia. This turn is a key one. By introducing a family history of schizophrenic prevalence he can categorise a system based upon the notion of genetics. The problem presented to him by knowledge that his diagnosis is long-term is subtly worked so as to introduce the notion of genetics, and the biological
determinism it brings. If the category is placed upon him due to his genes, then there is not a great deal he can do about it, and, more importantly, there was not much he could have done to avoid it in the first place. Thus, responsibility for his mental health
difficulties can be framed in genetic terms, rather than as part of personal control.
By stating that “he always knew” something was wrong “in the first place”, Ben works to provide himself as having a position of expertise over the following claims. This is a form of category entitlement, as it presents Ben as the expert regarding his own mental health difficulties. It follows that he welcomes his diagnosis, something that as he points out, is difficult due to the stigmatised nature of the ‘schizophrenia’
classification. The initial category entitlement allows for the development of an understanding of the reasons for his own diagnosis that is acceptable for his identity. Namely, the genetic explanation, which whilst not ideal, at least can be located as part of Ben’s identity that he has no initial control over, in the same way as the colour of his hair or gender for example.
Towards the end of the extract Ben's position regarding control moves from being externally represented to something he claims back for himself. Initially, control over onset of mental health difficulties resided in genetic factors, something Ben had no
command over himself. Ben regains authority over his life through positioning himself as choosing not to have children. This enables control over genetics to be taken. His argument being that he may have had no control over onset of his mental health problems, but he can take responsibility over whether he passes any genetic potential on to anyone else.