Shared dilemmas, choice and autonomy in the management of psychosis: a phenomenological analysis
| Pages | 256-266 |
| Published date | 14 December 2015 |
| Date | 14 December 2015 |
| DOI | https://doi.org/10.1108/MHRJ-07-2014-0025 |
| Author | Simon Wharne |
| Subject Matter | Health & social care,Mental health |
Shared dilemmas, choice and autonomy
in the management of psychosis:
a phenomenological analysis
Simon Wharne
Dr Simon Wharne is based at
The Open University, Milton
Keynes, UK.
Abstract
Purpose –When detaining and enforcing treatment, psychiatric services often assumed that the person is
separate from their dysfunctional biology and removed from their social context. Coproduction is hindered
by polarised views where one party holds power and others are not able to promote their views.
But if biomedical models are abandoned, ethical grounding for mental health law would be lost. The purpose
of this paper is to explore the experience of detaining and being detained, clarifying understandings of trust,
illness, personhood and control.
Design/methodology/approach –A hermeneutic phenomenological approach was employed.
Findings –A Social Worker and man who suffers from psychosis report that their choices are limited by
mental health law. They both experience themselves as passive. The man rejects society and withdraws
to avoid stress; while the Social Worker just follows legal guidelines. Interaction in mental healthcare is
experienced as lacking trust, involving threat, but sometimes negotiation is possible. Control over illness is
associated with having a choice of treatments. Psychosis is not experienced as a separate illness process
and control is exercised over the person rather than that illness.
Research limitations/implications –This was a small qualitative study designed to prompt discussion and
inform further research and policy review.
Practical implications –To enable coproduction, detention or enforced treatment should be grounded
more firmly in morality or criminal justice.
Social implications –People who suffer psychosis could be understood and their views more often
accepted.
Originality/value –An innovative research approach is used to bring new understanding.
Keywords Coproduction, Decision making, Hermeneutic phenomenology, Psychosis, Mental healthcare,
Recovery philosophy
Paper type Research paper
Introduction
Coproduction in mental healthcare requires that people reach agreement over what is accepted
as appropriate care and treatment. If professional groups and people who have lived experience
of mental illness are to work together, they need a shared understanding of the tasks they seek to
achieve. This is not a new problem as professional groups have always worked with contrasting
theoretical frameworks. For example, competing models of psychosis are promoted (Read et al.,
2009). Practitioners who are trained in medical or psychological approaches could be seen as
competing agents. These groups can promote their understandings through their professional
institutions and research traditions, but people who use services have only recently established
networks through which research and theoretical understanding can be developed.
Received 11 July 2014
Revised 19 December 2014
Accepted 26 June 2015
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VOL. 20 NO. 4 2015, pp. 256-266, © Emerald Group Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-07-2014-0025
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