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Diagnostic identity and the legitimisation of mental health problems: An ethnographic study with a focus on bipolar disorder

Lane, Rhiannon 2018. Diagnostic identity and the legitimisation of mental health problems: An ethnographic study with a focus on bipolar disorder. PhD Thesis, Cardiff University.
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Psychiatric diagnosis has become a pervasive aspect of modern culture, exerting an increasing influence on forms of personhood, identity practices, and modes of self-governing. Debates surrounding the classification of psychiatric disorders are also prevalent, with particular disputes surrounding the relative merits of ‘biomedical’ vs ‘psychosocial’ understandings of mental health difficulties. There is arguably a need for further empirical exploration into the social and cultural implications of psychiatric classification and categorising practices within mental health service interactions. Drawing on ethnographic research conducted within several UK mental health settings, this thesis considers the role of diagnosis in constituting patient identities and in shaping professional categorisation practices, with a particular focus on bipolar disorder. Observations were conducted within sites where diagnostic identities are particularly salient: Psychiatric diagnostic and screening assessments, and a psychoeducation programme for bipolar disorder. Focusing on the formal and informal categorisation practices of service users and professionals, this study highlights the way in which psychiatric classifications can be negotiated, ascribed, and withheld in order to legitimate and contest particular kinds of suffering; in particular, it explores the way in which diagnostic categories – in particular bipolar disorder - can be used to interpret and medicalise morally problematic forms of experience and behaviour. Whilst diagnosis itself can function to medicalise aspects of moral life, its ability to perform this function is also shown to depend upon its conceptualisation as a biomedical disease entity. Findings suggest that bipolar disorder gives rise to particularly somatic concepts of personhood; its conceptualisation as an essentialised and reified illness category, with its cause located within the brain, enables a legitimisation of psychiatric ‘symptoms’ for both patients and professionals. In seeking access to more specialised mental health services with limited resources, potential patients can face trivialisation and deligitimisation of their problems by professionals, which at times manifests in the withholding of diagnosis. This is particularly the case within a mental health policy context which has increasingly moved towards the prioritisation of those with ‘severe mental illness’. As such, the study shows how the legitimising function of diagnoses such as bipolar disorder, can lead to a tendency for it to be both sought after by patients, but contested by professionals and amongst patients. In light of the apparent advantages conferred by this diagnosis, the moral and personal consequences of diagnostic membership, exclusion, and uncertainty are considered; in particular, the potential for this essentialised category to create divides between those considered to ‘have’ the disorder and those who are not, is contemplated.

Item Type: Thesis (PhD)
Date Type: Submission
Status: Unpublished
Schools: Social Sciences (Includes Criminology and Education)
Subjects: H Social Sciences > H Social Sciences (General)
Funders: Economic and Social Reserach Council
Date of First Compliant Deposit: 7 December 2018
Last Modified: 15 Oct 2020 01:40

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