The Patient’s View: Issues of Theory and Practice

Abstract

Almost all the knowledge now produced about psychiatry includes what is called ''the patient's or client's perspective.'' This paper analyzes how this notion has been framed in the discourses on mental health over the last two decades, particularly in mental health research and in anthropology. The very concept of the ''patient's perspective'' is a social and historical construct. Despite its remarkable prevalence, the notion remains vague. Mental health research pictures it as a stable attribute of the individual. Anthropologists integrate the contextual nature of the patient view; but they still largely envision the psychiatric patient as a rational actor producing narratives based on common sense. However, in psychiatric practice, the client's perspective is not something the patient individually produces; it is rather shaped by and in a context. To explore this process, my research investigated interactions between staff and patients in a French community mental health center, and showed that the client's perspective is the result of a collective process. Further analysis demonstrates that eliciting or producing the patient's view is sometimes considered a therapeutic goal in itself, since being granted the status of a rational and narrative actor gives access to the most valued model of care, one that is based on partnership. Being an outcome that is negotiated between patients and care providers, the ''patient's view'' then becomes a new resource in mental health settings.Statement on ethics: The research conducted for this paper followed the ethical guidelines of the University Paris 5. After being presented with the objectives of the study and informed of their right to withdraw from the study as well as of the rules of confidentiality, the staff members and the residents separately gave their oral and written consent.L. Velpry

Quest for client autonomy in improving long‐term mental health care

“…Therefore, while learning client preferences, professionals had to ascertain if a client's view was genuine or rather, a symptom of mental illness (see Velpry 2008 for a similar analysis). The paradox was that only after a choice was made and its outcome revealed could anyone judge whether a choice was really a choice.…”

“…First, it is often related to making one's own decisions, and one of the ‘problems’ of people with mental illness is exactly that they (are perceived to) have difficulty making decisions (Dekkers 2001). Second, because some symptoms of mental illness do not tally with rational thinking and decision making, some choices that they make might not be deemed justified or beneficial, and effort might then be put in creating ‘choices’ that correspond to caregivers' ideas (Velpry 2008). Third, involuntary treatment is sometimes deemed necessary in mental health‐care settings (Harnett & Greaney 2008; Sjöstrand & Helgesson 2008).…”

Środowisko. Wykluczenie i reintegracja społeczna w praktyce psychiatrii środowiskowej

“…Wynikające z koncepcji moich badań skupienie na doświadczeniu terapeutek nie usuwa problemu braku głosu pacjentów: w antropologii psychiatrii, której centralnym zagadnieniem jest dyskursywne i społeczne wykluczenie perspektywy osób z chorobami psychicznymi, wybór rozmówców i pytań badawczych ma charakter tyleż metodologicznego, co etyczny. Perspektywa pacjenta w badaniu etnograficznym oznacza oddanie głosu, ale też zagrożenie błędnym rozumieniem, uprzedmiotowieniem i nadużyciem (Velpry 2008). Chodzi nie tylko o tezę, że wiedza uzyskana w warunkach nierówności spełnia funkcje dyscyplinujące (Graeber 2012: 122), lecz o badanie jako formę przemocy.…”

Writing process research: implications for manuscript support for academic authors

“…Furthermore, Murray's refl ections on 'being protocoled' as a subject (p. 169) were given in an appendix, foreshadowing, or rather in step with, a growing concern for rendering the patients' views in medicine, particularly mental illness (for background, see Velpry 2008). Among other insights Murray shared was the fact that even this highly self-aware writer was surprised by some fi ndings, driving home the importance of a protocolized research base for a literature initially derived from introspection.…”