Whose madness is it anyway: perspectives from the voice of unreason
Overview: Currently service users views are included as part of the diagnostic construction. The impact of mental health language is difficult to explore as terminology is shifting through the decades. The term madness has survived. Therefore constructions of this term and its societal and subjective consequences can be investigated. Objectives: The objective of the study was to investigate what constructions are held in regards the term ‘madness’, as well as the perceived ‘function’ of those constructions from the perspective of mental health service users. Design: A qualitative methodological approach was used to deconstruct the term ‘madness’ using Discourse Analysis. The term was chosen as it represents a long-standing construct that has not changed over time unlike current mental health terminology. Service users were asked to share their constructions of the term as current literature on the topic is lacking from the mental health service user perspective. Method: Following NHS Ethics approval, participants were selected from Service User Involvement Forums in West London using opportunistic sampling. Individual (n=3) and Group (n=4) semi-structured interviews were used. Discourse Analysis methodology formed the analytic procedure. Results: The term ‘madness’ can be placed within a continuum of similar terminology such as insane or crazy but the use of the term has varied functions: 1) Flippant, non-offensive, non-labelling term; 2) Labelling and harmful, with or without intention to do so; 3) An accurate description of ‘an experience’; and 4) Labelling but positive, indicating creativity/uniqueness. Conclusions: The term ‘madness’ is not clinical, though clinical terms may be translated as ‘madness’. The term can be harmful when misused (e.g. through the media). The term is most helpfully re-claimed and re-constructed by service users, in order to encourage acceptance. A change in clinical philosophy, re-thinking the use of clinical language as well as re-considering normalising, and suggesting opportunities to encourage transparent working are promoted.
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