In this chapter I will illuminate some of the methodological issues associated with this thesis. This will enable an underpinning practical account to be narrated, which serves to mark the problems faced when undertaking research of this kind. Given the primary emphasis placed upon direct empirical efforts towards first hand experience of service users, I will start by discussing the viability and utility of such an approach.
3.1.1 What is Service User Research?
As seen in the review of literature in Chapter Two, service user research refers to placing the experiences of using mental health services at the forefront of research. By directly focusing on those experiences it is argued knowledge can be gained from the ‘experts’ of what it means to live with mental health difficulties in the community care paradigm. This is not to suggest they have more superior knowledge about clinical features of mental health diagnoses than mental health clinicians, but that if one seeks to unpick some of the mediated and layered operation of service user experience, directly addressing their accounts is the most appropriate means of access. In this sense, an approach is required that can analyse and unfold some of the complex nature of service user experience. As seen in the previous chapter, many different strategies have been used for placing service user experience at the forefront of empirical efforts. Each strategy though, faces a similar set of factors to address.
3.1.2 The Challenges Faced
By means of a way to discuss some of the challenges facing service user research I would like to work comments around a data extract. Some of the data of the overall corpus collected for this project involved the reporting of ‘abnormal’ beliefs (or ‘delusions’ according to a psychiatric vocabulary) as part of accounts of people’s experiences, including those in relation to diagnosis. Despite the psychiatric status of delusions as beliefs not grounded in reality, their inclusion in this project is no different to that of the non-delusional narratives. That is, they are analysed for their functionality
as part of the discursive work of accounting for one’s experiences, and in this case, in relation to diagnosis. Consider the following extract:
Chris: how powerful this man is I speak to across the phone (.) this planet is
one dimensional, one (.) planet one time (I: mm) imagine suffering (actual death) (.) as million and millions and millions of planets (.) in space, the universe (.) in SIX EARTH DAYS (.) that’s how powerful this man is I speak to across the phone in heaven, Uncle Imbed (.) and what he’s going to do to these people for what happened to me and this particular person I mentioned earlier (I: mm) and we were both hurt by lots of evil people (.) and the doctors want to get on the right side of (her) (.) cos my actual father (.) is staying in a little room at my mum’s for the last ten years (I: mm) and (INAUDIBLE) in that book called The Wild Geese by Daniel Carney (.) chapters three four five and six (.) it’s talking about a little boy who gets his own way ..hh a rich powerful Dallas family ..hh and the Devil’s son (.) the own person in the universe more powerful than this man, the only person he’s afraid of (.) and very soon he’s going to get dealt with (.) how powerful this man is I speak to across the phone (.) million and millions of planets in space, the universe (.) in six earth DAYS…..(lines 261-276)
In the first instance this extract appears to be one whose contents do not correspond to actual life events happening in Chris’s life. He talks about talking on the phone to an all powerful being, who is able to seek revenge on Chris’s behalf for the failings he reported earlier in the interview regarding the psychiatric care he received during a spell in hospital. Let us consider some of the difficulties in analysis that this kind of extract typifies.
Perhaps one of the most common claims made about problems with addressing service users’ experiences is that they are, by the nature of the fact they are suffering from mental health difficulties, not a valid source of data (Coleman, 1999). This view has some historical precedence, based upon the premise that mental health difficulties involve some form of abnormal mental functioning, and as such, experiences and accounts cannot be taken as an accurate or veridical description of lives. For instance, if we are listening to a service user talking about their daily lives, how do we know
they are not merely hallucinating?4 This is a claim that one could expect to be heard when faced with an extract like Chris’s. It is not a big step from this to recognise the potential effects of such ideas in terms of bracketing off the accounts of people
experiencing mental health difficulties as an unrecognisable source of data, which have played a significant part in the absence of a service user ‘voice’ in mental health
research until relatively recently.
At some level this kind of argument makes sense. If we take some mental disorders, e.g. hallucinations, as featuring experiences that involve losing touch with reality of everyday occurrences, than does it not necessitate that such experiences be accepted as ‘not real?’ If they are not grounded in actual life experience, then what use are they to the researcher? This idea is based on the notion of such experiences being problematic, and as such, needing treatment to attempt to limit or eradicate them. Such a notion forms a line of argument that is an underpinning force in the armoury of drug
medication, in terms of being conceptualised as needing to be controlled, and it is the use of medication treatments that have developed to facilitate this. This kind of position negates any importance placed upon, and attending to, the content of voices.
There is a counter position to this though, which places primary importance on the content of people’s mental health experiences, which forms an approach that centres around psychotic experience, predominantly in the area of auditory hallucinations. Rather than take voice hearing as indicative of illness, with concern only that voices exist, other approaches have taken an alternate tack. These kinds of approaches have argued that knowledge can be gained through analysing the content of people’s psychosis, as we saw in Romme & Escher’s (1994) work covered in the previous chapter. They analysed voices heard by voice hearers, and formulated a therapeutic process based upon building knowledge as to the meaning of voices heard, and how their content relates back to potentially mentally damaging past experience that
catalysed the development of people’s mental health difficulties originally. In this way, the content of people’s psychotic experiences can be linked to actual life experiences, i.e. possible abuse. This forms one approach in which attending to service users’ experiences provides a valuable contribution to knowledge.
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