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The “Mental disease " as a discursive configuration

Gianpiero Turchi, Amina Pizzala, Elena Fogliata, Dalila Barbanera

This paper - derives from a research developed in a Mental Health Center (in Italy called CSM), that is a structure, or an institute in which are hospitalized all those persons who are considered and diagnosed as mentally hill.

Slides 1

The epistemological reference of the research is the narrativistic paradigm and its theoretical reference is the dialogical identity in which the identity is considered as constructed by discursive practices that nominee it and so generate it as real.

Clarifying this definition, it will be better to consider a graphical representation that shows how the dialogical identity is generated by virtue of the discursive processes that contribute (from different polarity or different "voices") to build a discursive reality (in this case the reality of a mental disease).

The design (Tricuspid valve) represents the discursive space of the identity in which the identity is the result of the intersection of several discursive poles: or rather the intersections of the first and third person ( sentences like….I am.. he is..) and all the possible discourses used to describe a "mental patient".

Observing the tricuspid will be easier to understand what it has been sad: there are three discursive poles, the first is that of the self-attributions or what a person says about itself as ‘mental patient’ , for example ‘ I feel myself depressed', ‘I have to do it because I’m hill..’ etc…. Another one vertex is that of other-attributions, or people who talks about ‘mental patients’, for example saying ‘that boy is a mental patient‘, ‘he is crazy’, or ‘ she has some problems”, finally the last vertex on the top is the collective Matrix, in other words all the possible discourses about ‘mental disease’ that is possible to produce in a particular historical-cultural time and that people can use.

It’s easy to understand how the identity, so constructed, couldn’t never be fix, but will be continuously in change, because of the possible voices that can contribute to its generation, but it is also clear that if all voices – also the patient – will talk and construct a reality about the patient referring to the illness, its identity will became fix, limited and without possibility to be different : it will be typified.

Slides 2

By the discursive construction of the identity the aim of the research here presented is to describe the processes for building the dialogical identity "user of a Mental Health Centre ", this through the analysis of how an institution that has the aims to recovery mental illness' contributes – as voice of the society - to the discursive construction and maintenance of the mental illness it is trying to cure. 

Starting from this aim, the research used questionnaires composed by opened questions to collect the discursive practices produced.

In particular the sample was composed by service operators, (or the experts of the field), 'common people' (or persons that never have been users of a health service,)and Users of CSM.

More, have been interviewed those at their first access to the CSM, at the moment of their first interview entering in the structure. These sample was chosen to reveal the strength of the access and the stay in this kind of institutes and the change of the discursive reality during that stay.

So, the sample have been constituted as follows:

1.Users: 40 users of a mental institute (CSM)

2.New entry: 40 people at its first interview, entering in the CSM

3.Operator: 40 health operators of CSM

4.Common sense: 40 persons not ‘expert’, interviewed in the street

To pursue the aim of the research, as methodology was used MADIT, the methodology of textual processing data analysis, promoted by prof Turchi. In the specific was used the software SPAD.T., that is an analysis of textual data collected by different groups of answerers: the answers given are inserted in a software and elaborated through a methodology that permits to highlight how persons construct the reality through the use of the language, the single words, the structure of the sentences, the punctuation, the pauses. To know deeper the features of this methodology you can read the papers of the symposium titled Epistemological foundation and methodological exactness regarding research in the discursive science or the book 'MADIT', Gian Piero Turchi et al, 2007.

Slides 3

the questionnaire was constituted by questions prepared ad hoc in reference to defined criteria :

-- the questions addressed to Users aimed to obtain by the user a description of oneself in retrospective, current and future perspective , this to gather how the person describes oneself in different phases of its hospitalised career.

-- about users have been also constructed some questions to obtain how users anticipated the operators could describe them

-- the questions addressed to Operators aimed to obtain by the operators an anticipation about how an user describes oneself, this to know indirectly how the operators themselves describe 'the user of CSM'

-- addressed to Common sense have been constructed questions to obtain the description of the user before entering, to gather the discursive modality of the common sense about the user ‘new entry’

-- and finally addressed to the new entry users, have been drafted some questions to obtain by this sample the description of an user of the centre during, before and after its stay at the CSM.

Slides 4

Let’s now talk about the results of the administration.

HOW IT IS POSSIBLE TO SEE IN the slide , now we will consider two questions: the first, addressed to the users of the CSM: “how do you think that today the operators describe you, thinking to your most important relationships?”, and that addressed to the operators: “how do you think that an user describes oneself in reference to its relationships?”

In the table we can see how the two groups use both the same three repertoires: or action, disease and role characteristics, that is they construct the reality basing it on tree focuses, that of the action, that of the disease and that of the characteristics of role. Analysing this results, we can consider that both the operators and the users describe the Users as those who - within their relationships – behave always in reference to their disease and act their role of ‘hill’.

Slides 5

Considering another couple of questions, the first addressed to the Operators and the common sense “How do you describe the user of the CSM, before entering in?” and the second addressed to the users ”How do you describe yourself before entering in CSM?”, we can make this three considerations:


the repertoire of the disease and that of the characteristics of role are used again to describe the reality of the user

second: these repertories are used by all interviewed roles: so by common sense , operators and users

third: the experts construct the reality in the same way of those not expert in the health field, in this sense experts make reference to what people think and not to scientific theories.

about these three points we can say that,

first: the user is always described considering its hospitalization and its illness, so not only referring to the relationships of the users – how explained before - but also to the life before entering in the CSM, that is referring to a period in which the person was considered in health. This shows how the hospitalization influences and pervades the life of a person.

second: as explained about the theory of the dialogical identity, here we have all the roles involved in the construction of the reality of a patient that use and refer to illness, fixing in this way the identity of the patient and typifying it. In other words, if all the roles of the context of the hospitalized person, use to describe it discourses about the illness, it will be blocked in a reality only characterized by discursive elements about the illness, remaining in a stereotyped definition of oneself.

third: those who has to intervene in a scientific way, using their experience and competences move, work and operate using the same references of the common sense, not expert in this field.

Slides 6

Observing now the last couple of questions administered, we have: “how do you describe yourself at the end of the hospitalization in CSM”? addressed to Users and new entry, and “how do you describe an user at the end of its hospitalization in CSM”? addressed to operators and common sense, so we can say that:

Also here users, operators and common sense used the same repertories, that of the disease and that of the characteristics of role. Interesting, instead, is what answered the new entry group, that focus their attention on the declared and official function of the CSM that is the recovery and did not consider disease aspects, but. In this sense they use the repertoire of the resolution.

Slides 7

Four points we may reveal:

here we have considered the feature of the users, after the stay in the CSM, and, as at the beginning of the hospitalization, there is a link between the person and the illness, so also before the supposed recovery, users, common sense and ALSO OPERATORS think to the patient referring to the illness.

The experts use a references of the common sense, without refer to scientific basics

New entry once became users lost the resolution point of view, assuming that of the disease

At the beginning and imagining the end of the therapeutic train there aren’t changes in the description and representation of the patient.

Slides 8

Concluding it is possible to make some general considerations, in fact the reference to the reality ‘illness’ of a person pervades its life once it enters in the health circuit, notwithstanding a pat to recovery. This implies that all roles of the contest of a patient uses terms and references about the illness talking about it and maintain its identity of mentally ill without leaving space for other possible realities.

More, experts, or operators work on the same level of the common people, without using their knowledge and scientific references, offering a service unfounded and , in this way, not different by the street.

Finally, new entry users describe oneselves talking about the possibility of a recovery and their normalization, but once become users lost this vision, being absorbed by an illness reality.

In this sense we reveal how a service that formally has to recover a person, contributes to generate and maintain the disease.

Slides 9

By these conclusions, the proposal we can do in operative terms is on different levels:

a. About the hospitalisation: to offer services and intervention pinched from the common sense way of thinking

b. About the operators: to organize specific training to guarantee its methodological and operational rigour and scientificity.

c. About all the voices that concur to construct and maintain the identity of mental ill, so both about the structure, the operator and the common sens:, to offer interventions on the discourses generated by all, promoting the generation of discourses that permits to the ill person to consider different possibilities by the mental disease.


in the section “DIALOGICAL MODEL”

- Epistemological foundation and methodological exactness regarding research in the discursive science, symposium and slides files

in the section 'HEALTH' all papers and symposia exemplifies the process of generation of the dialogical identity



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