Presenting Critical Realist Discourse Analysis as a Tool for Making Sense of Service Users’ Accounts of Their Mental Health Problems

Abstract

Making sense of service users' accounts of their mental health problems requires a method able to deal with complexity. Yet the different underlying epistemological and ontological positions of the methods researchers use, based for example on biomedicine or social constructionism, produce highly partial analyses. Addressing this problem, this article offers a method of Critical Realist Discourse Analysis (CRDA) that employs a synthesised discourse analysis, informed by critical realism, to examine the discursive, material, embodied and institutional factors that might inform how mental health service users make sense of their mental health problems and associated service use. The article describes the epistemological/ontological underpinnings of CRDA and its three phase methodology, before showcasing the method using, as examples, two data sets from care leavers and mothers. With our CRDA we demonstrate a method for analysing the complexity of interacting factors informing service users' understanding of their mental health problems.

Understanding Causation in Healthcare: An Introduction to Critical Realism

“…Critical realism is also appealing given its application to various research designs and methods for data collection and analysis. This approach has been applied across broad areas of health research including in several mental health focused studies ( Bergin et al, 2008 ; Lauzier-Jobin & Houle, 2021 ; Littlejohn, 2003 ; Martin, 2019 ; Sims-Schouten & Riley, 2018 ); rural health ( Reid, 2019 ); as a framework for understanding smoking and tobacco control in South Africa ( Oladele et al, 2013 ); for designing an integrated care initiative for vulnerable families in Australia ( Eastwood et al, 2019 ); and for explaining the relationship between human rights and social determinants of health ( Haigh et al, 2019 ).…”

‘A troublesome girl is pushed through’: Morality, biological determinism, resistance, resilience, and the Canadian child migration schemes, 1883–1939

“…Discussions of resilience, self-help, and character are typically framed with reference to risk, vulnerability, and protective factors (Smiles, 1871;Ungar, 2005;Werner and Smith, 1982). Yet in narratives and perceptions around 'troubled children', as can be seen from the analysis above, it was their behaviour that was being judged, and their capacity to develop resilience or resistance within this was not recognised (Moss et al, 2017;Moss, Wildman, and Lamont, 2020;Sims-Schouten and Riley, 2018;Sims-Schouten, Skinner, and Rivett, 2019).…”

“…Critical realism can thus form the basis for research with a focus on making sense of child protection practices, taking account of the fact that these practices and related perceptions are both socially constructed and influenced by external factors and forces that can be real and independent of any one person or social group (Sayer, 2000;Sims-Schouten, Skinner, and Rivett, 2019). Historical investigations can explain some of the mechanisms at play at the field level, influencing particular (uneven) outcomes and practices, such as the legacy of the punitive 'deserving/undeserving' paradigm inherited from the New Poor Law of 1834 (Mutch, 2014;Sims-Schouten, 2020;Sims-Schouten and Riley, 2018). The New Poor Law was implemented to reduce spending on the poor by centralising the notion of eligibility, the idea that some people (e.g.…”

“…In light of constructions around morality, biological determinism, and resilience/resistance, this article critically analyses correspondence and decisions regarding children/young people who were included in the child migration schemes and those who were deemed ‘undeserving’ and outside the scope of the schemes. Drawing on critical realist ontology, a metatheory that centralises the causal non-linear dynamics and generative mechanisms in the individual, the cultural sphere, and wider society, the study starts from the premise that the principle of ‘less or more eligibility’ lies at the heart of the British welfare system, both now and historically (Bhaskar, 1989, 2014; Sims-Schouten, Riley, and Willig, 2007). Critical realism provides insight into oppression, inequality, and uneven practices through the search for generative mechanisms and causal factors that, combined, may have created a phenomenon over time and thus influenced particular outcomes and practices (Mutch, 2014; Sims-Schouten, Skinner, and Rivett, 2019; Wilson, 2020).…”

Critical realism, critical discourse analysis, and the morphogenetic approach

“…In addition to the work carried out within CDA, a number of other authors have sought to develop critical realist approaches to discourse analysis. This section briefly engages with four of these: firstly, Elder-Vass's incorporation of Foucauldian discourse analysis into his emergentist social theory; secondly, 'critical realist discourse analysis' as developed and applied by Sims-Schouten and Riley (2019;Willig 2007a and2007b); thirdly, Banta's (2013) theorisation of discourse as a causal mechanism; fourthly, 'critical realist critical discourse analysis', as outlined by Flatschart (2016). It is notable that these four approaches do not reference one another, indicating the currently fractured nature of critical realist approaches to discourse analysis.…”