W. M. L. Finlay

Methodological issues in interviewing and using self-report questionnaires with people with mental retardation.

: In this article the authors review methodological issues that arise when interviews and self-report questionnaires are used with people with mental retardation and offer suggestions for overcoming some of the difficulties described. Examples are drawn from studies that use qualitative methodology, quantitative studies assessing different question types, and studies reporting on the development of instruments measuring psychiatric symptoms, self-concept, and quality of life. Specific problems that arise with respect to item content (e.g., quantitative judgments, generalizations), question phrasing (e.g., modifiers), response format (e.g., acquiescence, multiple-choice questions), and psychometric properties (factor structure and validity) are discussed. It is argued that because many self-report questionnaires include questions that have been found to be problematic in this population, more attention needs to be paid to establishing the validity of such measures and to clearly defining the population for which the instrument is designed.

Is low self-esteem an inevitable consequence of stigma? An example from women with chronic mental health problems

It is often assumed that membership in a stigmatized group has negative consequences for the self-concept. However, this relationship is neither straightforward nor inevitable, and there is evidence suggesting that negative consequences may not necessarily occur (Psychol. Rev. 96(4) (1989) 608). This paper argues that the relationship has not been sufficiently theorized, and that a more detailed analysis is called for in order to understand the relationship between stigma and the self. The paper presents a critical examination of modified labeling theory (Am. Sociol. Rev. 52 (1987) 96), with examples from a study examining perceptions of stigma and their relationship to self-evaluation in women with chronic mental health problems. Open-ended interviews and qualitative analyses were used in preference to global measures of self-esteem. It was found that although the women were aware of societys unfavorable representations of mental illness, and the effects this had on their lives, they did not accept these representations as valid and therefore rejected them as applicable to the self. The participants did not deny their mental health problems, but their acceptance of labels was critical and pragmatic. Labels were rejected when they were perceived as carrying an unrealistic and negative stereotype, or when the women felt that their symptoms did not fit with the diagnostic criteria. The research illustrates the importance of considering peoples subjective understandings of stigmatized conditions and societal reactions in order to understand the relation between stigma and the self.

Promoting choice and control in residential services for people with learning disabilities

This paper discusses the gap between policy goals and practice in residential services for people with learning disabilities. Drawing on a nine month ethnographic study of three residential services, it outlines a range of obstacles to the promotion of choice and control that were routinely observed in the culture and working practices of the services. Issues discussed include conflicting service values and agendas, inspection regimes, an attention to the bigger decisions in a persons life when empowerment could more quickly and effectively be promoted at the level of everyday practice, problems of communication and interpretation and the pervasiveness of teaching. We offer a range of suggestions as to how these obstacles might be tackled.

Rejecting the label: A social constructionist analysis

Research has shown that people often do not claim labels associated with mental retardation or learning difficulties. We discussed the interpretation that this rejection is an example of a denial process, the purpose of which is to protect self-esteem. Alternative explanations for this lack of identification were offered, based on an understanding of the socially constructed nature of diagnostic labels and on the distinction between diagnostic labels and social categories. Some of the problems in using the label as a descriptive or explanatory resource are illustrated using quotes from a study in which people who have been labeled discussed the label.

Offering Choices to People with Intellectual Disabilities: An Interactional Study.

BACKGROUND At the level of policy recommendation, it is agreed that people with intellectual impairments ought to be given opportunities to make choices in their lives; indeed, in the UK, the Mental Capacity Act of 2005 enshrines such a right in law. However, at the level of practice, there is a dearth of evidence as to how choices are actually offered in everyday situations, which must hinder recommendations to change. METHOD This qualitative interactional study, based on video recordings in British residential homes, combines ethnography with the fine-grained methods of Conversation Analysis. RESULTS We identify six conversational practices that staff use to offer choices to residents with intellectual disabilities. CONCLUSIONS We describe the unwanted consequences of some of these practices, and how the institutional imperative to solicit clear and decisive choice may sometimes succeed only in producing the opposite.

Patients’ perceptions of the impact of involuntary inpatient care on self, relationships and recovery

Background: Qualitative investigations show that people can have positive and negative experiences of involuntary inpatient care. Legal changes have extended the use of compulsory treatment. Aims: To explore patients’ perceptions of the impact of involuntary inpatient care on self, relationships and recovery. Method: Twelve participants were interviewed using a semi-structured interview schedule, exploring their experiences of involuntary inpatient care. Interviews were transcribed and analysed using a Thematic Analysis. Results: Participants reported varying experiences of involuntary inpatient care, with respect to perceived effects on self, relationships and recovery. Participants’ perceptions of self were related to their experience of relationships with professionals. Perceived loss of competence and negative experiences of medication were seen as barriers to recovery. Conclusions: The development of caring and supportive relationships between ward staff/ mental health professionals and patients should be emphasized during involuntary inpatient care. Alternative forms of treatment should be routinely provided.

Saying no to the staff: an analysis of refusals in a home for people with severe communication difficulties

People with severe communication difficulties may attempt to exercise control over their lives by verbally or non-verbally refusing an activity proposed by supporters. We detail examples in which such refusals are treated by care home staff as a temporary reluctance, warranting further attempts to persuade the individual to co-operate. We identify the following conversational (and bodily) practices by which staff achieve their institutional ends: appreciating a residents behaviour as something other than refusal; formulating the invitation again in a no-blame format; minimising the task required; escalating the invitation to a request and an order; moving the person bodily; and positively glossing the proceedings. Dealing with refusals illustrates the dilemma faced by institutional personnel in health and care settings in accepting choices which might disrupt the efficient management of the service.

His brain is totally different: An analysisof care-staff explanations of aggressive challenging behaviour and the impactof gendered discourses

Using a discourse analysis on the texts of 10 interviews with care staff, this research explored the discourses used by care staff in constructing the aggressive challenging behaviours of men and women with learning disabilities. The research also explored discourses used differentially to understand the aggressive challenging behaviour of one gender. The analysis demonstrated the use of two main discourses, an individual pathology discourse which constructed the behaviour as originating in factors stable and internal to the client, and a context discourse which constructed the behaviour as a response to the clients circumstances. Participants used these accounts flexibly within their talk, and also used a mixed discourse which constructed the behaviour as due to both individual pathology and context. Despite the staff presenting their understandings as not being affected by the clients gender, the presence of two gendered individualizing discourses within the interviews was also demonstrated. Womens behaviour, unlike mens, was constructed with the use of discourses about their menstrual cycle or character flaws. The consequences of the use of these different discourses are discussed, as are the subject positions which they afford for both staff and clients. It is argued that clients are disempowered by the individual pathology discourse; that consideration of the broad contexts within which care-staff actions are situated may allow them to manage blame whilst reflecting on their practice, and that the impact of gender stereotypes on the understandings staff have of a clients behaviour should be a legitimate area for consideration in clinical practice.

Conversational Shaping: Staff Members' Solicitation of Talk From People With an Intellectual Impairment

In initiating and maintaining talk with people with intellectual impairments, members of care staff use a range of recurrent conversational devices. The authors list six of the more common of these devices, explain how they work interactionally, and speculate on how they serve institutional interests. As in other dealings between staff members and the people with intellectual impairments they support, there is a pervasive dilemma between, on one hand, encouraging participation and, on the other, getting institutional jobs done. The authors show how the practices of encouraging talk that they describe move between the two horns of that dilemma.

Pathologizing dissent: Identity politics, Zionism and the self-hating Jew

This article discusses problems with Kurt Lewins notion of self-hatred among Jews (Lewin, 1941/1948), and illustrates the ways in which the concept is used in identity politics. It argues that the way the notion of self-hatred is often used makes it problematic as a psychological concept because it requires that we accept particular definitions of group identities and particular political positions as central to those identities. Often, however, such issues are disputed by group members. Examination of the literature illustrates that it is rarely a straightforward decision whether those behaviours or attitudes identified as manifestations of self-hatred are best explained in this way. The function of the self-hatred concept in current debate over Israeli policy is described as an example of how arguments over identity are part of political conflict. In the case of current Middle Eastern politics, the concept of self-hatred is used by rightwing Zionists to label those who criticize policies of the current Israeli government as disloyal and pathological.