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About this book

At a time when service users' perspectives are increasingly recognized in healthcare, this seminal book highlights the importance of clients' perceptions of all aspects of mental illness. It examines the implications of these understandings, especially in relation to clients' relationships with services.

Table of Contents

1. Allowing madness vox

Abstract
Divine retribution, possession by evil spirits, the effects of a degenerate lifestyle, societally sanctioned role playing, societally unsanctioned rule breaking, a chemical imbalance, the result of difficult life experiences, an alternative lifestyle, an organic failure in the brain. At different points throughout history, in different cultures, and to some extent still today in Western society, mental ill health has been defined and regarded as all of the these: discussion and controversy abound when it comes to understanding ‘madness’ or mental health problems. Indeed, we need only look to the plethora of paintings, literature, poetry and drama depicting madness to find support for Foucault’s (1961) assertion that ‘On all sides, madness fascinates man’ (p. 23).
Juliet L. H. Foster

2. Perspectives from psychology, psychiatry and other disciplines

Abstract
As highlighted in the previous chapter, a large number of studies in the social sciences have considered the understandings of mental ill health held by various groups. This chapter will review some of these studies, the conclusions we can draw from them and, perhaps more importantly, consider where the gaps lie.
Juliet L. H. Foster

3. Perspectives from clients and the mental health service user movement

Abstract
Although, as the previous two chapters demonstrate, society’s habit of not listening to the views and ideas of those diagnosed and labelled as mentally ill is both culturally deeply engrained and historically enduring, this does not mean that they have been silent. We may have to look harder, and to turn, at least until recently, outside academic work, but individuals with mental health problems tell of their experiences and beliefs in many places. This chapter will review some of this work, taking a historical perspective and firstly discussing autobiography and similar writings, before moving on to discuss more recent work undertaken within the mental health service user movement and to consider this very important development.
Juliet L. H. Foster

4. Defining mental health problems by and through experience

Abstract
In this chapter, I will begin to consider the way in which clients of the mental health services define and understand mental health and illness in more depth, drawing not only on the studies discussed in Chapters 2 and 3, but also on my own research into client understandings.
Juliet L. H. Foster

5. The journey through mental illness

Abstract
The previous chapter showed how clients of the mental health services rely on the notion of a journey through mental ill health to understand their experiences, and how, in doing so, they engage in strategies, or projects, with regard to their mental health.
Juliet L. H. Foster

6. Labelled, spoiled, negotiated and rejected: issues of identity

Abstract
In light of the stigma associated with mental health problems, an enduring question in the social sciences has been how being diagnosed with a mental health problem affects an individual’s identity and sense of self. Goffman’s (1961; 1968) consideration of the moral career of the mental patient, and subsequent attempts to deal with a stigmatised identity, and Scheff’s (1966) adaptation of labelling theory have been particularly influential in attempting to answer this question. In this chapter, I intend to reexamine these important theories, in light of data from my own research, and other recent studies, considering how a client of the mental health services maintains and constructs his or her identity in the face of the negative representations found amongst the public. How far can the developing alternative representations of mental ill health discussed in the previous chapters protect a client from the stigma associated with mental illness in other representations, and how much identity work is needed to sustain a positive identity under such circumstances?
Juliet L. H. Foster

7. Representing mental ill health

Abstract
This chapter will begin to draw some conclusions about client understandings of mental ill health, in particular from the results of my own study, but also from other work in this area. It will introduce the idea that, overall, clients can represent mental health problems along two dimensions — controllability and location. Clients might take different positions within these dimensions at different times as their journeys through mental health problems progress. The positions that can be taken within this structure will be discussed, and the implications of these with regards to outcome briefly considered.
Juliet L. H. Foster

8. Conclusions and implications

Summary
Throughout this book I have argued that, contrary to some claims and assumptions, clients and former clients of the mental health services have well-developed understandings of mental health and ill health and that they develop these communally with other clients as they move through different mental health services and as their own experiences change and develop. These understandings centre around the notion of mental ill health as a journey, and clients embark upon projects in order to progress through this journey in different ways. The activity needed by the client to engage in this journey, the aims of it and the strategies employed may differ, but clients at the same services engage in similar projects, and certain aspects of a journey are seen as key by most clients. Within these journeys, mental ill health might be represented as something internal or external, and as something controllable or controlling: these representations are likely to change as the client progresses through his or her journey.
The implications of these arguments are manifold: in this final chapter, I would like to focus on two, the theoretical and the practical. Theoretically, considering client understanding of mental ill health allows us to pay closer attention to the interaction between different forms of knowledge. I will discuss this opportunity first in greater depth, drawing in particular on work from the field of the sociology of scientific knowledge (SSK), in addition to social representations theory, to consider the possibilities afforded by such interaction. This leads to the next implication, the practical: here, I will consider some of the ways in which the mental health services might incorporate client understanding and adapt or change accordingly.
Juliet L. H. Foster
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