I can see it and I can feel it, but I can't put my finger on it: A Foucauldian discourse analysis of experiences of relating on psychiatric inpatient units

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Abstract

Objectives

Research has shown interpersonal relationships influence experiences of inpatient psychiatric services. This study explored inpatient staff and service users' talk about relating, and consequences on available/limited social actions.

Design

A Foucauldian discourse analysis was used to analyse transcribed semi-structured interviews and focus groups with current inpatient staff members and members of a service-user involvement group.

Method

Two focus groups (service users n = 10; staff n = 6) and five interviews (service users n = 2; staff n = 3) were held, with participants responding to questions regarding the discursive object of ‘experiences of relating on inpatient wards’.

Results

A dominant ‘medical–technical–legal’ discourse was seen, alongside a counter discourse of ‘ordinary humane relating’. Through the tensions between these discourses emerged a discourse of ‘collaborative exploration’.

Conclusion

The medical–technical–legal discourse perpetuates notions of mental illness as impenetrable to relating. Staff fear of causing harm and positions of legal accountability generate mistrust which obstructs relating, whilst patients expect to be asked their opinions on their experiences and to be involved in deciding what treatment to accept, and experience frustration and alienation when this is not forthcoming. Ordinary humane relating was described as vital for service users in regaining a sense of self, although not considered enough in itself to promote recovery/wellness. ‘Treatment for my problems’ was constructed by service users as emerging through the collaborative exploration discourse, where therapeutic relationships can develop, enabling change and a return to safety.

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