The end of ambivalence. A narrative perspective on ambivalence in the suicidal process.

INTRODUCTION: Suicidal ambivalence is a recognized phenomenon in suicidology, yet not much is known about it in the context of progression from suicidal ideation to action. The current study addresses this gap. We explore narrative dynamics of suicidal ambivalence in stories about transition from suicidal ideation to action. METHODS: We employ an experiential qualitative approach to gain in-depth understanding of narrated experience of suicidal ambivalence. We conducted semi-structured interviews with 22 patients hospitalized after a suicide attempt. For a detailed analysis, we selected 11 interviews in which the interviewees' accounts spontaneously referred to their ambivalence about attempting suicide. We used a text-oriented version of Critical Discourse Studies (CDS) to analyze the semantics and syntax, as well as the functions of what was said within the local context, and the social actions thus accomplished. RESULTS: Our study shows primarily that ambivalence is not resolved. Rather, it is set aside and removed from the narrative and replaced by an action-focused narrative with no references to mental activities. CONCLUSION: We propose that ambivalence recedes and gives way to action and that qualitative research provides a useful evidence base for conceptualizing and understanding the role of ambivalence in transition from suicidal ideation to action.

Crossover of the dimensions of work-family and family-work conflict in couples: Protocol for a qualitative study.

Conflict between work and non-work is a bidirectional and a multidimensional construct that has garnered much attention from researchers and practitioners alike. Previously, studies with a dyadic design demonstrated that interrole conflict can cross over between partners in romantic relationships. The aim of the present study is to explore-from an individual and dyadic perspective-how partners perceive dimensions of interrole conflict (that is: time, strain, behaviour, and possibly others) and whether crossover between partners is dimension-dependent. This protocol outlines a qualitative interview study. Participants (N = 40) will be dual-earner couples that meet two inclusion criteria: both partners need to be professionally active, and the couples need to have lived together for at least a year. Interviews will be conducted separately with each partner. To analyse the data at the individual level we will use reflexive thematic analysis. To analyse the data at the dyadic level we will apply an adapted version of the framework method. We anticipate that findings of this study will have the potential to advance theoretical models depicting crossover processes and, more generally, the interface between work and family lives. Moreover, insights into how couples experience dimension-based interrole conflict will be important for the development of targeted interventions.

Discourses of work life in narrative identities of people with advanced dementia.

OBJECTIVES: There is no consensus as to whether people with advanced dementia can create a narrative identity. It is most often thought to be disturbed due to autobiographical memory disorders. In this paper, we examined how people with advanced dementia constructed their narrative identities in relation to their professional experience. METHODS: This qualitative study used data obtained from 8 semi-structured interviews. The interviewees were people with advanced dementia aged between 66 and 89 years. We analyzed the dataset based on the textual-oriented discourse analysis. RESULTS: The study participants created narrative identities. Their narrative identities were constructed within residual professional discourses learned during their lifespan. These discourses blended their narrative identities into coherent stories about who they are now, offered languages to describe current experiences, and emphasized important values for their self-image. The participants built narrative identities by referring to the past and imagining a better present with the omission of the future. The past was valued positively and was a source of positive nostalgia. Projections of a better present served to reveal their needs and assess ways to meet them. CONCLUSIONS: We argue that people with advanced dementia can create complex and coherent narrative identities. They are constructed around discourses and not only using autobiographical memories. Encouraging them to create narrative identities in the dialogue can be a simple therapeutic method by which they can maintain a sense of self-cohesion and belonging to the world.

Epistemic justice is the basis of shared decision making.

BACKGROUND: There is little evidence that share decision-making (SDM) is being successfully implemented, with a significant gap between theory and clinical practice. In this article we look at SDM explicitly acknowledging its social and cultural situatedness and examine it as a set of practices (e.g. actions, such as communicating, referring, or prescribing, and decisions relating to them). We study clinicians' communicative performance as anchored in the context of professional and institutional practice and within the expected behavioural norms of actors situated in clinical encounters. DISCUSSION: We propose to see conditions for shared decision-making in terms of epistemic justice, an explicit acknowledgment and acceptance of the legitimacy of healthcare users and their accounts and knowledges. We propose that shared decision-making is primarily a communicative encounter which requires both participants to have equal communicative rights. It is a process that is started by the clinician's decision and requires the suspension of their inherent interactional advantage. CONCLUSION: The epistemic-justice perspective we adopt leads to at least three implications for clinical practices. First, clinical training must go beyond the development of communication skills and focus more on an understanding of healthcare as a set of social practices. Second, we suggest medicine develop a stronger relationship with humanities and the social sciences. Third, we advocate that shared decision-making has issues of justice, equity, and agency at its core.

Assessment Team Recommendations on the Continuation of Involuntary Commitment in Poland.

This study explores explicit justifications for recommendations regarding patients' continuing detention in forensic psychiatric wards. We are interested in what arguments are used in recommendations for the continuing detention of involuntarily committed patients made by assessment teams for legal proceedings. Our frequency analysis shows that assessment teams refer predominantly to arguments related to the mental state of the detainee. When recommending a change of security level, the assessment teams frequently refer to behavioural factors. However, very rarely does such argumentation appear in recommendations for continuation of detention at the same security level. Additionally, our qualitative analysis shows a very high level of certainty with which pronouncements about patients' behaviour are made, typically in the absence of any social/institutional context. Our study shows that assessment teams tend to opt for safe decisions that are unlikely to be challenged by legal proceedings and that allow them full control over the patient.

Experience of the Absence of the Journey to Sessions in Clients' Narratives About Online Psychotherapy.

BACKGROUND: Remotely provided psychotherapy due to the COVID-19 pandemic became common. One of the most significant changes related to providing online psychotherapy services is that clients no longer travel to their sessions. AIMS: In the article we are interested in the narrated experience of the absence of journey to psychotherapy sessions. We study clients' stories of past journeys and how their absence, resulting from the change of the mode of therapy provision, is coped with and replaced by other activities in their narratives. METHODS: The study takes a constructionist approach to discourse and focuses on the lexico-grammatical form of the notes. The data come from 12 semi-structured interviews with people who declared attending remote psychotherapy sessions after the national lockdown had been introduced. RESULTS: In the collected data, the physical journey is constructed not only as travel time, solitude which can be used for reflection, but, importantly, as an active process which ends with a resolution. In contrast, in narratives of the time before an online session, constructions of unfettered agents are replaced with those of people whose actions are hedged and qualified. CONCLUSION: We argue that in the informants' narratives the journey to psychotherapy is meaningful and is part of the therapeutic process. We propose that it is a time of passing between two states-one before therapy and one in session. The journey therefore is experienced as a process of change, and not only a process of traveling.

Construction of suicidal ideation in medical records.

In this article, the authors are interested in exploring discursive transformation of patients' stories of suicidal ideation into medical discourses. In other words, they focus on how the narrated experience of suicidal thoughts made during the psychiatric assessment interview is recorded in the patients' medical record. The authors' data come from recordings of psychiatric interviews, as well as the doctors' notes in the medical records made after the interviews, collected in psychiatric hospitals in Poland. Assuming a constructionist view of discourse, they demonstrate that lived experience of suicide ideation resulting in stories of a complex and homogeneous group of "thoughts" is reduced to brief statements of fact of presence/existence. Exploration of the relationship between the interviews and the notes suggest a stark imposition of the medical gaze upon them. The authors end with arguments that discursive practices relegating lived experience from the focus of clinical practice deprives it of information which is meaningful and clinically significant.

Time and the psychiatric interview: the negotiation of temporal criteria of the depressive disorder.

In this article, I am concerned with doctors' negotiations of the temporal dimension of the diagnostic criteria of depressive disorders during the first psychiatric interview. The data come from 16 initial psychiatric interviews recorded by doctors in three psychiatric hospitals in Poland. Taking a constructionist view of discourse and psychiatric practices, I shall argue that the discursive practice related to temporal information about patients' illnesses serves in gaining information, which is useful in the medical model of psychiatric diagnosis. The doctors positioned the patients' experiences on the timeline when the illness history was taken and temporal information authenticated the information. Conversely, the patients' current conditions were constructed in a limitless present, which allowed the psychiatrists to remove the relativity.

Experience of suicidal thoughts: a discourse analytic study.

In this paper we explore the relationship between current psychiatric thinking on suicide and service users' accounts of suicidal ideation and suicide attempts. The data comes from recordings of psychiatric interviews collected in three psychiatric hospitals in Poland. Assuming a constructionist view of discourse we argue that the literature on suicide ignores and simplifies the experience of those who think about suicide and attempt to commit it, and constructs their experiences as a homogeneous group of 'thoughts' with only limited content. We also offer a preliminary insight into the complexity of 'suicide thoughts', as narrated by those reporting them. We demonstrate that they are marginalized and made relatively irrelevant in the accounts of attempted suicide. Additionally, we demonstrate that while women construct suicide attempts (whether actually attempted in the end or not) as at least potentially beyond their control, men's narratives show them in control of the attempt, as if choosing an available option. We conclude by exploring possibilities of further qualitative discourse analytic research which builds on the findings we present here.

Positions in doctors' questions during psychiatric interviews.

In this article I apply the concept of positioning to the analysis of 15 initial psychiatric interviews. I argue that through their questions the psychiatrists-in-training impose positions requiring the patients to gaze at themselves and their actual problems from particular perspectives. I point to three such positions: (a) the position of the observing assessor, from which it is expected that the patients will make a detached assessment of themselves or their problems, (b) the position of the informing witness, which requires the patients only to verify the information about themselves, and (c) the marginal one, the position of the experiencing narrator, from which talk about experiences and problems is expected. I explore the roots and consequences of the positions, with particular attention toward objectivization of the patients' experiences in the dominant witness and assessor positions. I conclude with a discussion about the medical model in psychiatry.

Identity ambivalence and embodiment in women's accounts of the gynaecological examination.

In this article we are interested in the negotiation of identities in women's narratives of their gynaecological examination and more particularly, the shifts of identity positions that permeate their stories. Taking a constructionist view of discourse and identity, we make two arguments in the article. First, we demonstrate that women talking about their gynaecological examinations constructed their selves ambiguously. The identity spaces that they discursively opened in the narratives were not inhabited. Second, we show that the embodiment of their identities--the inclusion of the body into the construction of self--fluctuates depending on the stage of the narrative of the examination.

Gender and the gynecological examination: women's identities in doctors' narratives.

The authors explore the constructions of gender in male doctors' narratives of gynecological examinations. Focusing on the ways in which gender identities are constructed in the stories of the medical encounter, they argue, first, that gender is more flexible during the visit with a gynecologist than has been suggested. Gendered identities are assumed and put aside as the interaction progresses, with its final stage--the pelvic examination--being constructed with gender removed. Second, they argue that undressing is invested with a special status during the examination. It is a gendered rite of passage between the two different ungendered subject positions of the doctor and the patient. They conclude that contrary to the assumptions in the literature on gynecological interactions, it is the genderization of undressing that is most conducive to securing the least face-threatening gynecological examination for the woman.