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Friesinger JG, Topor A, Lindvig GR, Larsen IB. Micropolitics of Mental Health Recovery: An Assemblage Analysis of People's Experiences of Becoming Well. Community Ment Health J 2024:10.1007/s10597-024-01311-5. [PMID: 38922508 DOI: 10.1007/s10597-024-01311-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Accepted: 06/08/2024] [Indexed: 06/27/2024]
Abstract
Mental health recovery takes place in a social and material world. However, socio-material contexts have often been absent from recovery studies. The present study was conducted in Norway, a Scandinavian welfare country. We interviewed people at meeting places who had experiences as service users, focusing on their experiences of becoming well, and analyzed their recovery stories using an assemblage framework. Our analysis identified four constitutive dimensions that promote mental health recovery: an atmosphere of togetherness, doings as more than the act, personal development, and integration in society. We discuss how these dimensions might be seen as social, relational, and material forces that create important micropolitics that challenge the individualistic professionalization of the recovery concept.
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Affiliation(s)
| | - Alain Topor
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | | | - Inger Beate Larsen
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
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Quah ELY, Chua KZY, Lin CKR, Vijayan AV, Abdul Hamid NAB, Owyong JLJ, Satku N, Woong N, Lim C, Phua GLG, Ong EK, Fong W, Krishna LKR. The role of patients' stories in medicine: a systematic scoping review. BMC Palliat Care 2023; 22:199. [PMID: 38087237 PMCID: PMC10714554 DOI: 10.1186/s12904-023-01319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Patients' stories provide Palliative Care physicians with a glimpse into the former's lives and their psycho-emotional, sociocultural, and contextual considerations. Yet, few physicians are trained to interpret and apply patients' stories in their practice. Inherent variability in how stories are transmitted and interpreted raises questions over their potential effects on care. Amidst a dearth of accounts in Palliative Care, we map current use of patient stories to guide the training, assessment, and oversight of this 'care influencing' practice in medicine. METHODS This systematic scoping review was guided by the Systematic Evidence-Based Approach (SEBA) to ensure a reproducible and structured approach. The themes and categories identified through the Split Approach's concurrent and independent thematic and directed content analyses provided a comprehensive sketch of the included articles. The Jigsaw Perspective combined the themes and categories identified. The last stage of SEBA compared these results with two recent reviews of storytelling to ensure consistency of the domains created that guided the discussion. RESULTS Ten thousand two hundred seven articles were reviewed, 963 full text articles were evaluated, and 199 articles were included. The four domains identified were study characteristics, benefits, approaches, and positive effects and concerns. CONCLUSION Stories support patient-centered, personalized, and holistic clinical care. However, variability in the stories, their interpretations and use in care decisions underscore the need for further study on the structuring, teaching, assessing, and delivery of this 'care influencing' practice.
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Affiliation(s)
- Elaine Li Ying Quah
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Keith Zi Yuan Chua
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Casper Keegan Ronggui Lin
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
- Division of Outpatient Pharmacy, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Andrew Vimal Vijayan
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Nur Amira Binte Abdul Hamid
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Jasmine Lerk Juan Owyong
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
| | - Neeta Satku
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore
| | - Natalie Woong
- Department of Internal Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Crystal Lim
- Medical Social Services, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore
| | - Gillian Li Gek Phua
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Lien Centre for Palliative Care, Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
| | - Eng Koon Ong
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Assisi Hospice, 832 Thomson Road, Singapore, 574627, Singapore
| | - Warren Fong
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore
- Department of Rheumatology and Immunology, Singapore General Hospital, 16 College Road, Block 6 Level 9, Singapore, 169854, Singapore
| | - Lalit Kumar Radha Krishna
- Yong Loo Lin School of Medicine, National University Singapore, Level 11 NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore.
- Division of Supportive and Palliative Care, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Centre for Biomedical Ethics, National University of Singapore, Blk MD11, 10 Medical Drive, #02-03, Singapore, 117597, Singapore.
- Division of Cancer Education, National Cancer Centre Singapore, 30 Hospital Boulevard, Singapore, 168583, Singapore.
- Duke-NUS Medical School, National University of Singapore, 8 College Road, Singapore, 169857, Singapore.
- Palliative Care Institute Liverpool, Academic Palliative & End of Life Care Centre, University of Liverpool, 200 London Rd, Liverpool, L3 9TA, UK.
- PalC, The Palliative Care Centre for Excellence in Research and Education, PalC C/O Dover Park Hospice, 10 Jalan Tan Tock Seng, Singapore, 308436, Singapore.
- Health Data Science, University of Liverpool, Whelan Building The Quadrangle, Brownlow Hill, Liverpool, L69 3GB, UK.
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van Sambeek N, Franssen G, van Geelen S, Scheepers F. Making meaning of trauma in psychosis. Front Psychiatry 2023; 14:1272683. [PMID: 38025479 PMCID: PMC10656619 DOI: 10.3389/fpsyt.2023.1272683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 10/20/2023] [Indexed: 12/01/2023] Open
Abstract
Background Finding new meaning and identity in the aftermath of trauma has been identified as a key process of mental health recovery. However, research indicates that this meaning-making process is compromised in people with psychosis. Considering the high prevalence, yet under-treatment of trauma in people with psychosis, it is urgent to gain insight into how their meaning-making process can be supported. Aim To gain insight into how people with psychosis make meaning of trauma and identify barriers and facilitators in their meaning-making process. Methods Qualitative inquiry of N = 21 interviews transcripts from the Dutch Psychiatry Storybank. We included interviews of people who (a) lived through multiple psychotic episodes, and (b) spontaneously addressed traumatic experiences in a low-structured interview. Storyline analysis was performed to gain insight into the meaning-making of trauma within their self-stories. Psychosocial conceptualizations of narrative identity were used to inform the analysis. A data-validation session with four experts-by-experience was organized to check and improve the quality of our analysis. Results We identified four different story types: (1) Psychiatry as the wrong setting to find meaning; (2) The ongoing struggle to get trauma-therapy; (3) Exposure to trauma as a threat to a stable life, and (4) Disclosure as the key to resolving alienation. Each story type comprises a different plot, meaning of trauma withing the self-story, (lack of) integration and barriers and facilitators in the meaning-making process. Overall, barriers in the meaning-making process were mostly situated within mental healthcare and stigma-related. People felt particularly hindered by pessimistic ideas on their capacity to develop self-insight and cope with distress, resulting in limited treatment options. Their process of adaptive meaning-making often started with supportive, non-judgmental relationships with individuals or communities that offered them the safety to disclose trauma and motivated them to engage in a process of self-inquiry and growth. Conclusion The outcomes illuminate the social context of the meaning-making challenges that people with psychosis face and illustrate the devastating influence of stigma. Our outcomes offer guidance to remove barriers to adaptive meaning-making in people with psychosis, and can help clinicians to attune to differences in the meaning-making of trauma.
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Affiliation(s)
- Nienke van Sambeek
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
| | - Gaston Franssen
- Faculty of Humanities, University of Amsterdam, Amsterdam, Netherlands
| | | | - Floortje Scheepers
- Department of Psychiatry, University Medical Center Utrecht, Utrecht, Netherlands
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Lobban F, Marshall P, Barbrook J, Collins G, Foster S, Glossop Z, Inkster C, Jebb P, Johnston R, Khan H, Lodge C, Machin K, Michalak E, Powell S, Rycroft-Malone J, Slade M, Whittaker L, Jones SH. Designing a library of lived experience for mental health (LoLEM): protocol for integrating a realist synthesis and experience based codesign approach. BMJ Open 2023; 13:e068548. [PMID: 36889824 PMCID: PMC10008385 DOI: 10.1136/bmjopen-2022-068548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023] Open
Abstract
INTRODUCTION People with lived expertise in managing mental health challenges can be an important source of knowledge and support for other people facing similar challenges, and for carers to learn how best to help. However, opportunities for sharing lived expertise are limited. Living libraries support people with lived expertise to be 'living books', sharing their experiences in dialogue with 'readers' who can ask questions. Living libraries have been piloted worldwide in health-related contexts but without a clear model of how they work or rigorous evaluation of their impacts. We aim to develop a programme theory about how a living library could be used to improve mental health outcomes, using this theory to codesign an implementation guide that can be evaluated across different contexts. METHODS AND ANALYSIS We will use a novel integration of realist synthesis and experience-based codesign (EBCD) to produce a programme theory about how living libraries work and a theory and experience informed guide to establishing a library of lived experience for mental health (LoLEM). Two workstreams will run concurrently: (1) a realist synthesis of literature on living libraries, combined with stakeholder interviews, will produce several programme theories; theories will be developed collaboratively with an expert advisory group of stakeholders who have hosted or taken part in a living library and will form our initial analysis framework; a systematic search will identify literature about living libraries; data will be coded into our analysis framework, and we will use retroductive reasoning to explain living libraries' impacts across multiple contexts. Individual stakeholder interviews will help refine and test theories; (2) data from workstream 1 will inform 10 EBCD workshops with people with experience of managing mental health difficulties and health professionals to produce a LoLEM implementation guide; data from this process will also inform the theory in workstream 1. ETHICS AND DISSEMINATION Ethical approval was granted by Coventry and Warwick National Health Service Research Ethics Committee on 29 December 2021 (reference number 305975). The programme theory and implementation guide will be published as open access and shared widely through a knowledge exchange event, a study website, mental health provider and peer support networks, peer reviewed journals and a funders report. PROSPERO REGISTRATION DETAILS CRD42022312789.
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Affiliation(s)
- Fiona Lobban
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Paul Marshall
- Division of Health Research, Lancaster University, Lancaster, UK
| | - John Barbrook
- Lancaster University Library, Lancaster University, Lancaster, UK
| | | | - Sheena Foster
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Zoe Glossop
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Paul Jebb
- Patient Experience, Engagement & Safeguarding, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Rose Johnston
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Hameed Khan
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | | | - Erin Michalak
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Sarah Powell
- Lancaster Medical School, Lancaster University, Lancaster, UK
| | | | - Mike Slade
- Institue of Mental Health, University of Nottingham School of Health Sciences, Nottingham, UK
- Faculty of Medicine and Health Sciences, Nord University, Namsos, Norway
| | - Lesley Whittaker
- Patient Experience, Engagement & Safeguarding, Lancashire and South Cumbria NHS Foundation Trust, Preston, UK
| | - Steven H Jones
- Division of Health Research, Lancaster University, Lancaster, UK
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