Self-Disclosure and Non-Communication: Stigma Management in Third-Sector Transitional Employment.

People who are recovering from a mental illness often have difficulties finding and maintaining employment. One of the main reasons for these difficulties is the negative label, or stigma, attached to mental illnesses. People who possess stigmatizing characteristics may use compensatory stigma management strategies to reduce discrimination. Due to mental illnesses' invisible characteristics, information control is an important stigma management strategy. People can often choose whether they disclose or non-communicate their illness. Nevertheless, it might be difficult to decide when and to whom to disclose or non-communicate the stigma. Since stigma management is a dilemmatic process, workers in mental health services play an important role in informing their clients of when it is best to disclose or non-communicate their illness. In this article, we adopt the perspective of discursive social psychology to investigate how workers of one mental health service programme evaluate and construct self-disclosure and non-communication as stigma management strategies. We demonstrate how these workers recommend non-communication and formulate strict stipulations for self-disclosure. At the same time, they differentiate non-communication from lying or providing false information. The study contributes to an improved understanding of stigma management in contemporary mental health services.

Discussing mental health difficulties in a "diagnosis free zone".

Being identified as "mentally ill" is a complicated social process that may be stigmatizing and socially problematic, as a mental illness diagnosis determines the criteria for what is considered normal. This has given rise to a number of anti-stigma campaigns designed to create awareness of the way stigmas affect people with mental health difficulties and to normalize those difficulties in society. One such campaign is the "diagnosis-free zone", which declares that those with mental health difficulties should not be categorized on the basis of their diagnosis; rather, they should be encountered as full individuals. In this paper, we investigate how mental health difficulties are discussed in Clubhouse communities, which adhere to the "diagnosis free zone" programme. The findings are based on conversation analysis of 29 video-recorded rehabilitation group meetings, in one Finnish Clubhouse, intended to advance clients' return to the labour market. The analysis demonstrated that members referred to their mental health difficulties to explain the misfortunes in their lives, especially interruptions and stoppages in their careers. By contrast, staff members disattended members' explanations and normalized their situations as typical of all humans and thus unrelated to their mental health difficulties as such. In this way, the discussion of mental health difficulties at the Clubhouse meetings was implicitly discouraged. We propose that the standards of normality expected of a person not suffering from a mental health difficulty may well be different from the expectations levelled at participants with a history of mental problems. Therefore, instead of considering cultural expectations of normality to be a unified domain, effective anti-stigma work might sometimes benefit from referring to mental-health diagnoses as a means of explicitly tailoring expectations of normality.

Offering patients opportunities to reveal their subjective experiences in psychiatric assessment interviews.

OBJECTIVE: With the intention of understanding the dynamics of psychiatric interviews, we investigated the usual (DSM/ICD-based) psychiatric assessment process and an alternative assessment process based on a case formulation method. We compared the two different approaches in terms of the clinicians' practices for offering patients opportunities to reveal their subjective experiences. METHODS: Using qualitative and quantitative applications of conversation analysis, we compared patient-clinician interaction in five usual psychiatric assessments (AAU) with five assessment interviews based on dialogical sequence analysis (DSA). RESULTS: The frequency of conversational sequences where the patient described his/her problematic experiences was higher in the DSA interviews than in the AAU interviews. In DSA, the clinicians typically facilitated the patient's subjective experience talk by experience-focused questions and formulations, whereas in AAU, such talk typically occurred in environments where the clinicians' questions and formulations focused on non-experiential, medical matters. CONCLUSION: Interaction in DSA was organized to provide for the patient's experience-focused talk, whereas in AAU, the patient needed to go against the conversational grain to produce such talk. PRACTICE IMPLICATIONS: By facilitating patients' opportunities to uncover subjective experiences, it is possible to promote their individualized care planning in psychiatry.

Institutionalised otherness: Patients references to psychiatric diagnostic categories.

Diagnosis is integral part of the way medicine organises illness: it is important for identifying treatment options, predicting outcomes and providing an explanatory framework for clinicians. Previous research has shown that during a medical visit not only the clinician but also patients provide explanations for the causes of their symptoms and health problems. Patients' lifeworld explanations are often differentiated from the diagnostic explanations provided by clinicians. However, while previous conversation analytic research has elaborated the ways in which diagnostic and lifeworld explanations are interactionally structured in somatic medicine, there is little research on how these explanations are organised in psychiatry. Psychiatric diagnosis is particularly interesting because in mental disorders illness itself is not determined by any objective measurement. Understanding of the patient's problem is constructed in interaction between the patient and clinician. The focus of this research will be patients' references to diagnosis in psychiatry and the functions of these references. The findings are based on conversation analysis of 29 audio-recorded diagnostic interviews in a psychiatric outpatient clinic. Our results demonstrate that patients can utilise diagnostic categories in several ways: disavowing a category to distance their symptoms from it, accounting for their life experiences being rooted in psychiatric illnesses and explaining their illnesses as being caused by certain life experiences. We argue that these explanations are important in patients' face-work - in constructing and maintaining a coherent and meaningful view of the patient's self.