Anders Johan W. Andersen

Hell on earth: Textual reflections on the experience of mental illness

Background Some people who by themselves or by others are understood as having mental health problems have written autobiographies about their experiences. Aims The aim of this study is to explore how people write about their experiences of being mentally ill. Method Twelve Scandinavian autobiographies were studied using content analysis based on phenomenology and hermeneutics. Results Three themes were identified: feeling like a stranger in life and places, the transformation of life experiences into questions of disease and feeling ashamed. Conclusions Peoples experiences of being mentally ill might be understood as the result of medical constructions unsuitable for the persons themselves. We could instead say that mental problems are not diseases, but severe and painful phenomena in peoples lives.

Internet-based Mental Health Services in Norway and Sweden: Characteristics and Consequences

Internet-based mental health services increase rapidly. However, national surveys are incomplete and the consequences for such services are poorly discussed. This study describes characteristics of 60 Internet-based mental health services in Norway and Sweden and discusses their social consequences. More than half of the services were offered by voluntary organisations and targeted towards young people. Professionals answered service users’ questions in 60% of the services. Eight major themes were identified. These characteristics may indicate a shift in the delivery of mental health services in both countries, and imply changes in the understanding of mental health.

Generating dialogical practices in mental health: experiences from southern norway, 1998-2008.

In Norway and many other countries, political guidelines prescribe the development of mental health strategies with both a service user’s perspective and a treatment system established by the local authority. The development of new strategies frequently involves challenges regarding procedures and treatment as well as a view of knowledge and humanity. Dialogical practices might provide a solution for these challenges not only because of its procedures but also due to its attitudes toward service users. The aim is to explore the implementation of three dialogical practice programs in Southern Norway from 1998 to 2008 and to critically analyze and discuss the authors’ experiences during the implementation process. Three different programs of dialogical practices were initiated, established, and evaluated within the framework of participatory action research. Sustainable changes succeed individually and organizationally when all participants engage as partners during the implementation of new mental health practices. Generating dialogic practice requires shared understanding of the Open Dialogue Approach (ODA) and collaboration between professional networks and among the leaders. Developing a collaboration area that includes service users in all stages of the projects was one of the essential implementation factors. Other factors involved a common vision of ODA by the leaders and the actors, similar experiences, and a culture of collaboration. However, ODA challenged traditional medical therapy and encountered obstacles to collaboration. Perhaps the best way of surmounting those obstacles is to practice ODA itself during the implementation process.

Struggles for recognition: a content analysis of messages posted on the Internet

Background The Internet has enlarged the possibilities of human communication and opened new ways of exploring perceptions of mental health. This study is part of a research project aiming to explore, describe, and analyze different discourses of mental health in Norway and Sweden, using material from Internet-based services. Aim To examine messages posed by users of publicly available question-and-answer services and to describe their content. Methods A Web search was used to identify Norwegian and Swedish Websites offering mental health services by email or posted messages. A total of 601 messages from 20 services, 10 Norwegian and 10 Swedish, were analyzed by means of qualitative content analysis and further interpreted in light of the social theory of recognition by Honneth. Results Eight categories emerged from the analysis: family life, couples, others, violence, the ungovernable, self-image, negotiating normality, and life struggles. These categories were then grouped into three themes: (1) relationship to significant others, (2) relationship to self, and (3) relationship to the social community. The themes promoted an understanding of mental health as closely connected to political and social factors. Conclusions The results showed a variety of concerns from various parts of life and empowered the view that mental health should be understood broadly, at a conceptual level. Mental health emerged as a deeply relational concept that emphasized the equal distribution of chances in life. It strengthened the moral grammar of social inclusion and the acceptance of plurality in social life.

Unpacking the Black Box of Wilderness Therapy: A Realist Synthesis

Despite considerable progress within wilderness and adventure therapy research over the last decade, researchers are still unable to precisely answer why, how, and for whom this treatment modality works. There is also a need for more knowledge regarding the circumstances under which the treatment does not appear to be effective. In this realist synthesis, we attempt to unpack this “black box” of wilderness therapy more specifically, defined as a specialized approach to mental health treatment for adolescents. Through a focused review of the primary qualitative wilderness therapy studies, empirical findings are used to test and refine a key program theory. The synthesis results in a proposed wilderness therapy clinical model and offers informed implications for future theory development, research, and practice.

“Heaven and Hell on Earth” A critical discourse analysis of religious terms in Norwegian autobiographies describing personal experience of mental health problems

This article explores the use of religious terms in six Norwegian autobiographies written between 1925 and 2005 by people who themselves have been patients in the mental health services. Through a critical discourse analysis, we discuss the functions of religious discourse in the texts and its position in contrast to the medical discourse predominant in todays mental health services. It was found that religious (predominantly Christian) terms were used to varying degrees in all autobiographies as a means to capture the immensity and inherent ambivalence characteristic of mental health problems. Despite the “medical turn” in professional mental health discourse, there is no clear evidence of a decrease in the use of religious terms from the oldest to the most recent text. We propose that professional mental health workers to a larger extent take into account the religious dimension in therapy, and reflect on its larger historical and sociocultural context.

Reaching out to people struggling with their lives: a discourse analysis of answers from Internet-based services in Norway and Sweden.

The Internet has enlarged the scope of human communication, opening new avenues for connecting with people who are struggling with their lives. This article presents a discourse analysis of 101 responses to 98 questions that were posted on 14 different Internet-based mental health services in Norway and Sweden. We aimed to examine and describe the dominant understandings and favored recommendations in the services’ answers, and we reflected upon the social consequences of those answers. The services generally understood life struggles as an abnormal state of mind, life rhythms, or self-reinforcing loops. Internet-based mental health services primarily counsel service users to seek help, talk to health care professionals face-to-face, and discuss their life struggles openly and honestly. They also urge service users to take better care of themselves and socialize with other people. However, such answers might enhance the individualization of life problems, masking social origin and construction. Consequently, the services are challenged to include social explanations in their answers and strengthen their responsibility to amplify peoples’ messages at a societal level. Potentially, such answers could strengthen democratic structures and put pressure on social equity.

The dialogical bricoleur? : Expectations towards internet-based services in Norway and Sweden

Mental health is a multifaceted concept that has been described and understood differently throughout history. The emergence of internet-based services has signalled changes in both the delivery of services and the understanding of mental health that could alter expectations towards professionals. This study explores the implicit images of answerers online culled from messages by individuals who use internet-based mental health services (henceforth, submitters) and discusses the possible implications of the answerers. An internet search identified Norwegian and Swedish websites, and 444 messages from 13 of those services were included in our study and analysed via qualitative content analysis. Ten images of the answerers were constructed in this process and they were gathered into four main images named ‘the specialist’, ‘the counsellor’, ‘the therapist’ and ‘the master of discourse’. These four images form the structural element in our presentation of the empirical interpretations and serve as the main expectations towards the services. This article discusses these empirical interpretations in the context of both the scientific ‘bricoleur’ and the Open Dialogue Approach. Our results suggest that the ‘dialogical bricoleur’ is a unifying image in submitters’ expectations towards answerers online. Our study argues for strengthening sensitivity towards submitters and increasing the capacity to encompass human variation on the internet.

“Emotional Darkness without Solutions”: Subjective Experiences of Mental Health Crisis

Abstract: The purpose of this study is to explore and describe service users’ subjective experiences of mental health crisis. The main research question is: How do people with severe mental health problems experience and understand mental health crisis? Based on a hermeneutic-phenomenological methodology, in-depth interviews with seven participants have been carried out to encourage reflections on mental health crisis experiences. The findings reveal the crisis as being complex and multifaceted, which contains two dimensions in experiencing crisis—an existential dimension (personal) and a contextual (social) dimension. Three main themes identified through the analysis, “Feeling out of control,” “Emotional darkness,” and “Loneliness and seeking togetherness”. Mental health crisis is experienced as chaos, losing control, loss of energy, and feelings of hopelessness. During mental health crisis, one’s social life can be difficult and involve many paradoxes and daily challenges. However, the participants revealed an understanding of a need for help, as mental health crisis emerges as a continuity of struggles in complex situations. There is a need for more comprehensive and broader perspectives of mental health crisis as a phenomenon, especially from the person’s perspective. Conceptualizing mental health crisis experiences from the person-perspective offers an opportunity for understanding this as an integral part of people’s lives. The nature of mental health crisis explicitly captured and understood in light of the complexity of personal lives is critical in developing recovery-oriented mental health care.