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A Narrative Analysis of Personal Stories About Mental Illness Online University of Calgary PRISM: University of Calgary's Digital Repository Graduate Studies The Vault: Electronic Theses and Dissertations 2015-05-08 Managing the Medicalization of Madness: A Narrative Analysis of Personal Stories about Mental Illness Online Solomon, Monique de Boer Solomon, M. B. (2015). Managing the Medicalization of Madness: A Narrative Analysis of Personal Stories about Mental Illness Online (Unpublished doctoral thesis). University of Calgary, Calgary, AB. doi:10.11575/PRISM/26823 http://hdl.handle.net/11023/2251 doctoral thesis University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission. Downloaded from PRISM: https://prism.ucalgary.ca UNIVERSITY OF CALGARY Managing the Medicalization of Madness: A Narrative Analysis of Personal Stories about Mental Illness Online by Monique de Boer Solomon A THESIS SUBMITTED TO THE FACULTY OF GRADUATE STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY GRADUATE PROGRAM IN COMMUNICATIONS STUDIES CALGARY, ALBERTA May 2015 © Monique de Boer Solomon 2015 Abstract Emancipatory in spirit this thesis asserts personal narratives are an essential and active contributor to the development of meanings in discourse about mental illness and they have an influential role managing medicalization. The medicalization of madness is increasingly contested as people describe and explain how medical approaches and definitions of mental illness at best fail to adequately account for personal experiences of distress, and at worst are the cause of increased physical and psychological trauma. This thesis examines personal narratives posted publicly on medical, social care, and activist websites by organizations and individuals offering support and information about mental illness, community care options, psychiatric survivorship, activism and advocacy. Initial reviews indicated personal stories are included on websites by organizations and individuals with differing views, either for or against medical approaches, suggesting narratives are valued as a way to support or challenge various perspectives on medical approaches to mental illness. In this thesis the objective is not to determine which view is correct or truthful, rather it is to examine how people manage discourse about mental illness as it relates to their personal experiences, whether they identify as health care consumers, patients, ex-patients, or psychiatric survivors. Drawing on Habermas’s (1987) Theory of Communicative Action and Fairclough’s (1992) Social Theory of Discourse this thesis conceptualizes personal narratives as discursive practices and active sites where meaning is negotiated as people work to express lifeworld experiences in ways that fit with, yet challenge system discourses about mental illness. Using Gubrium and Holstein’s (2009) methodology of Narrative Ethnography the analysis identifies and examines personal stories about what it’s like being a patient, how social relationships matter, and why recovery is personal. The analysis shows people manage medicalization of their experiences in their stories by making meaningful ii connections between personal experiences and discourse about mental illness via a narrative practice (introduced here) called narrative bridging. To accomplish this people use narrative strategies of resisting, re-informing, and reinforcing discourse about mental illness, and it is through these strategies and the consequences of narrative bridging that medicalization is managed in personal narratives. iii Acknowledgements A special thank you to the people whose stories appear in this thesis, and to everyone whose stories I collected and read online. I hope in some way this helps your words travel and be reflected upon in new ways. Your stories make a difference. It is with great respect and appreciation that I acknowledge and thank my Supervisor, Dr. Barbara Schneider for her infinite patience and gracious encouragement. Thank you Barbara, I am ever grateful for your wisdom and guidance. My sincere appreciation to my Supervisory Committee, Dr. Edna Einsiedel and Dr. Fiona Nelson, for mentorship at key moments throughout the journey. Thank you Dr. Tania Smith and Dr. David Este for your support during my candidacy exams. Thank you Dr. Andrew Estefan and Dr. Brenda LeFrançois for sharing valuable insight for revisions and during my doctoral defense. Thanks to friends inside and outside of the academy for your encouragement. Special thanks to Dr. Amanda Williams and Ken Paulson for offering me a quiet place to rise up after a fall (complete with broken ankle) to complete a crucial step in this journey. Thank you to my family. To my parents Herman and Jeanine de Boer for being there to help, talk and listen when I had something (or not much) to say. To my beautiful children, Nicolas and Keira, who always inspire me. Thank you for your hugs and for telling me every day “You can do it mommy!” Thank you Temo my ever true companion as I wrote the words. Thank you to my best friend and husband Terry, with you I find strength and reason to believe in myself. I truly couldn’t have done this without you, tlwitw, Mq. I am blessed and challenged to have many valuable moments of my life come together at the same time. Thank you Lord Jesus for granting me your Peace, for strength to persevere, and for the wonderful people in my life. iv Dedication To Barbara for keeping the belief alight and To my family for helping me believe v Table of Contents Abstract............................................................................................................................... ii Acknowledgements............................................................................................................ iv Dedication............................................................................................................................v Table of Contents............................................................................................................... vi List of Tables .......................................................................................................................x Epigraph............................................................................................................................. xi CHAPTER 1 INTRODUCTION .........................................................................................1 Introduction......................................................................................................................1 Regarding Language: Madness or Mental Illness? ....................................................2 The Issue: The Medicalization of Madness .....................................................................5 Background: The Historical Dominance of Medical Discourse to Explain Madness ...10 Background: The Development of the Consumer/Survivor/Ex-Patient Movement......13 The Significance of Personal Narratives for a Study of Medicalization .......................15 Being present to personal stories..............................................................................16 The authorial significance of stories.........................................................................18 Theoretical Framework..................................................................................................22 Theory of Communicative Action............................................................................23 Social Theory of Discourse ......................................................................................27 Connecting Personal Experience with Dominant Discourse....................................29 Methodological Approach .............................................................................................32 Outline of Thesis Chapters ............................................................................................34 CHAPTER 2 LITERATURE REVIEW ............................................................................39 Personal Narratives about Madness...............................................................................39 Outline of the literature review: Narrative as a bridge .............................................40 Social Science Literature and Personal Narratives about Madness...............................42 Narrative Identity, Recovery, and Sense-Making ....................................................44 Narrative Context and Construction.........................................................................52 Narrative Types and Themes....................................................................................57 Narrative and Consumer-Survivor-Ex-Patients........................................................62 Medical Literature and Personal Narratives about Mental Illness.................................66 Improving psychiatry and psychology with patient narratives.................................66 Supplementing medical education............................................................................71 Literary Studies and Personal Narratives about Madness .............................................76 Connecting historical, societal, cultural, and medical views of madness ................76 Challenging traditional
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