Academic journal article Health Sociology Review

The Dodo Bird Verdict and the Elephant in the Room: A Service User-Led Investigation of Crisis Resolution and Home Treatment

Academic journal article Health Sociology Review

The Dodo Bird Verdict and the Elephant in the Room: A Service User-Led Investigation of Crisis Resolution and Home Treatment

Article excerpt

Introduction

One of the threads uniting the study of mental health diffi culties and those who administer to them with social science is that both are continually challenged by similar epistemological, conceptual and methodological issues. Karl Jaspers is credited with fi rst applying the terms erklären (translated as 'to explain') and verstehen (translated as 'to understand') to different ways of making sense of mental disorder or diffi culties almost 100 years ago (Jaspers 1913 [1963]). This distinction has been familiar amongst social scientists for as long, if not longer. Wilhelm Dilthey (1833-1911) is credited with introducing the terms into philosophy and human sciences. The conceptual and methodological implications of distinctions between explanatory and interpretive approaches to social knowledge are explicit in the works of Emile Durkheim, George Simmel, Max Weber and Talcott Parsons. They include distinctions between positivist and antipositivist epistemologies, approximately parallel distinctions between quantitative and qualitative research methodologies, and the different implications of nomothetic, dimensional and idiographic approaches to classifi cation.

In terms of Jasper's application to mental health issues, erklären is the development of knowledge that might inform a more mechanistic, medical approach, such as when and how to apply a formal diagnosis, prescribe a medicine or offer a psychological 'treatment'. This form of knowing is generally derived from an external, 'expert' perspective using an experimental and positivist approach generated by quantitative methods. By contrast, verstehen places emphasis on capturing patients' unique lived experiences of their psychological/emotional distress and assisting them through a dialogue that acknowledges it. This form of knowing is generally derived from accounts of experiences or being administered to during an episode of psychological diffi culty using an interpretive approach generated by qualitative methods. Broadly, following decline in the popularity and infl uence of psychoanalysis and rising interest in psychopharmacology during the 1960s and 1970s, mainstream mental health practice and policy making have followed an ideology based upon the former: mental health diffi culties are viewed as 'illnesses to be treated' rather than the result of individuals' sufferings as they negotiate life's challenges.

This ideological position faces a growing number of criticisms. They include several coherent accounts which suggest that claims for effi cacy amongst psycho-pharmaceuticals may be at least as much a marketing ploy as they are dispassionately obtained scientifi c fi ndings (Kirsch et al. 2008); the voices of dissatisfi ed service users empowered by more consumerist approaches to healthcare (May 2010; Hearing Voices Network 2011); and more individualised approaches fuelled by needs to respect the diverse expectations and experiences of a racially and culturally heterogeneous population.

One area of practice where challenges to the dominant 'illness' ideology are prominently visible is in the activities of home treatment or crisis resolution teams. In recent years crisis resolution home treatment (CRHT) teams have become an integral part of mental health services in many parts of the world. Broadly, they were introduced to provide an alternative to the commonly stigmatising and intimidating experience of being admitted to an acute mental health inpatient facility when in crisis. Circumstances which might benefi t from CRHT team support and which previously may have resulted in admission include intensifi ed derogatory auditory hallucinations (hearing voices) causing distress and desperate behaviour; depression and despair leading to acts of self-harm or suicide, where emotional support, practical help and perhaps attention to medication can be helpful; and intense anxiety impeding the ability to get out and about and tend to essential needs and responsibilities such as shopping or childcare. …

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