Date of Award

2014

Document Type

Thesis

Publisher

Edith Cowan University

Degree Name

Doctor of Philosophy

School

School of Psychology and Social Science

Faculty

Faculty of Health, Engineering and Science

First Supervisor

Dr Ken Robinson

Abstract

Severe mental illness has a profound effect on the affected individuals yet it does not necessarily prevent them from leading a meaningful and fulfilling life, and therefore recovering. Recovery has received a great interest in clinical and consumer research yet little is known about how those individuals who do not primarily identify with recovery respond to the concept and come to accept it as something that is personally meaningful. Using a qualitative approach following the principles of Gadamer’s (1975) hermeneutics, the present study explored people’s subjective experience of mental illness with the aim of identifying factors related to their views of mental illness, their adaptation, coping and recovery, and the subjective meanings they gave to the phenomenon.

In Phase I, 25 adults diagnosed with mental illness participated in unstructured, confidential interviews at the end of which they completed the Recovery Assessment Scale-Revised (RAS-R) (Corrigan et al., 1999). The study identified six main themes related to person-centred and social/relational factors that played a role in the persons’ life with mental illness: (a) mental illness as a journey, (b) personal conceptualisations of mental illness, (c) illness management and coping, (d) losses and gains, (e) professional help, and (f) the role of others.

Phase II was completed by 18 participants from the original sample who were provided with feedback on their respective RAS-R (Corrigan et al., 1999) results and who in turn provided their feedback on the scale and their experience of completing it; this was followed by a discussion of recovery. The participant narratives suggested that recovery was conceptualised in two broad ways: as a return to baseline following crisis and as living as best as one can given personal circumstances. The findings further indicated that recovery as a concept had the potential to remain abstract and lack in meaning unless the person’s biases and perceptions were explored in an opened, non-directive conversation.

Both the initial interview and the follow-up session were audiotaped, transcribed and consequently subjected to thematic content analysis. Following the analysis, the participants were invited for a third interview during which they were asked to provide feedback on the analysis and add further information. This represented Phase III, which was completed by 10 participants from the original sample; this phase also served as a reflection on the experience of research participation. Findings indicated that research participation was generally seen as a positive experience that could have potentially therapeutic benefits. The process involved active engagement for both the participants and the researcher, which may have helped foster closeness but that also raised a number of ethical dilemmas, primarily in terms of dual roles and researcher self-disclosure.

Overall, the studies highlighted the complex interplay of both clinical and non-clinical factors that the individuals took into account as they were making sense of their experience. The studies have a number of clinical implications, specifically addressing the role of hospitals in treatment, the relationship between mental illness and trauma, participatory assessment of recovery, and the role of clinical psychology in the treatment of severe mental illness. Furthermore, the studies point out the potential benefits of supplementing clinical work, whether in research or in treatment, with the methods and processes of Gadamerian hermeneutics.

The core principles of the Gadamerian approach (the fusion of the horizons of meaning, the hermeneutic circle and the dialogue) promote viewing of a phenomenon as a contextually embedded experience that is interpreted through the person’s pre-existing views and his/her present range of vision. The approach conceptualises interactions between two parties as opened conversations that aim at shared understanding, rather than objective truth. Such conversations are characterised by a back-and-forth movement between the whole and its parts, which eventually leads to improved understanding. Therefore greater appreciation of contextual information and meaning-making processes; treating both sources of expertise (consumer and professional) as equally important; viewing psychopathology as only one part of mental illness and mental illness as one part of the person’s life; and finally approaching clinical and research interactions as relational endeavours that test the underlying assumptions of both parties could help influence the way mental health professionals work with individuals with severe mental illness.

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