Hough, Rebecca and Hodge, Suzanne and Daiches, Anna (2015) Psychiatric diagnosis : learning from people who have been labeled and the practitioners who work with them. PhD thesis, Lancaster University.
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Abstract
This thesis comprises a literature review, a research paper and a critical review of the research process. In the literature review, a metasynthesis method was used to identify and synthesise 12 studies that explored experiences of psychiatric diagnosis. Four themes emerged; ‘the diagnostic experience: problems with validity and utility’; ‘reaction to diagnosis: devastation and hope’; ‘personal experience: impact on self’; and ‘interpersonal experience: relationships and identity’. Findings are discussed in terms of the impact of diagnosis on self and identity and suggest that there are both positive and negative aspects to diagnosis. Working with diagnosis and psychological formulation in mental health practice is considered, focusing on ameliorating the negative and preserving the positive aspects of diagnosis. The study presented in the research paper used a grounded theory methodology, where ten participants who were practitioners in adult mental health services in the National Health Service in England were interviewed, to develop a theory that explained how diagnosis was used in practice. The core category ‘needing a certain foundation for practice’ was constructed from the data, with two further categories; ‘holding and coping with inconsistent and differing views’ and ‘impact on practice: depersonalisation and not challenging diagnosis’. Findings suggest that diagnosis has survived because for some it provides a secure base for practice and for others the power dynamics inherent in working in a system predicated on diagnosis and the perceived lack of utility of diagnosis, make challenging it unappealing. Critical consideration of all frameworks used to understand distress is encouraged and findings are discussed in relation to attachment and cognitive theories. The critical review discusses further findings about the role of psychology and power. Then, reflections are offered about epistemology, using grounded theory methodology and conducting research when practising clinically.