Not talking about illness at meeting places in Norwegian community mental health care: A discourse analysis of silence concerning illness-talk

Towards validating invalidated knowledge: a discourse analysis of firsthand accounts of hearing voices

BACKGROUND

As Foucault historically traced, dialogs about madness were silenced with the emergence of biomedical psychiatry. The silence entailed the epistemic violence of invalidating persons who hear voices as knowers, arguably leaving them without validating sensemaking languages for firsthand experiences. This article analyzes five Norwegian firsthand accounts of hearing voices, and how they differed from the predominating biomedical psychiatry discourse, in search of validating languages and knowledge that may facilitate making sense of voice-hearing for persons who hear voices.

METHODS

The text material consisted of four sets of blogs authored by four young women and a short interview with a man, all of whom had firsthand experiences of voice-hearing in a Norwegian context. Ian Parker's version of Foucauldian discourse analysis was used to analyze the material.

RESULTS

Six discourses were identified: biomedical psychiatry-discourse, discourse of reason, psychodynamic discourse, discourse of personal characteristics, spiritual discourse and discourse of personal relationships between hearer and voices. Within the discourses of biomedical psychiatry and reason, voice-hearing was rendered as hallucinations, unreason, and as a problem to be solved, preferably by professionals, thus silencing the person who hears voices. In contrast, within the discourses of psychodynamics, personal characteristics, spirituality, and personal relationships between hearer and voices, voice-hearing has diverse meanings, and they grant voice hearers greater freedom concerning voice-hearing. The psychodynamic discourse nonetheless aligns with the discourses of reason and biomedical psychiatry in allowing professionals the prerogative of determining the meaning of voice-hearing. The remaining three discourses appear to facilitate more space for voice-hearers to narrate and engage with their voice-hearing at their discretion, with little to no professional impingement.

CONCLUSIONS

Discursive complexity notwithstanding, I consider that particularly the discourses of personal characteristics, spirituality, and personal relationships facilitate languages that may enable a person to narrate their own experiences and actions at their own discretion, without needing an expert commentator on the side. To have such languages available is argued to entail clear strides towards more empowered positions in one's life.

'Through a kaleidoscope': A Foucauldian discourse analysis of Belgian policy regarding patients with a migration background and depression in general practices

A higher prevalence of depression is found among patients with a migration background within the Belgian population. Nevertheless, this group is underrepresented in ambulant and residential mental health care services. Since general practitioners (GPs) have a crucial gatekeeping role, this led some researchers to investigate the possibility of a provider bias influencing GPs' assessment and referral of depressed patients with a migration background. However, GPs' accounts may be influenced by wider professional discourses present at the policy level, which are inevitably linked to institutions regulating the conduct of GPs. Therefore, this study applied a Foucauldian discourse analysis (a) to identify broader professional discourses in Belgian policy documents regarding patients with a migration background and depression in general practices, (b) to examine how patients with a migration background are discursively positioned and (c) to investigate which different balances of power in the relationship between GPs and patients with a migration background are demonstrated in the identified discourses. We identified three recurring discourses: (a) the othering discourse, (b) the health literacy discourse, and (c) the person-centred discourse. Our analysis demonstrated that the former two discourses illustrate the perpetuation of a biomedical discourse. While the last discourse is aligned with a counter-discourse associated with the person-centred care model in health care. Consequently, our analysis demonstrated the construction of a contradictory discursive framework throughout the various policy documents on which GPs might rely when speaking about patients with a migration background suffering from depression.