Discourse analysis and the experience of ECT

"The expert and the patient": a discourse analysis of the house of commons' debates regarding the 2007 Mental Health Act

BACKGROUND

The Mental Health Act 1983 was amended in 2007. This legislation appears to be predicated on the assumption that an entity of "mental disorder" exists and that people who are designated mentally disordered require medical treatment, administered by force if necessary.

AIMS

To explore the ways in which mental disorder is constructed and the possible practical effects of these constructions in the House of Commons' debates regarding the Mental Health Act 2007.

METHOD

Verbatim transcripts from the House of Commons debates on the Mental Health Act were studied through a discourse analysis.

RESULTS

Two primary discursive constructions were identified: "The Expert" and "The Patient."

CONCLUSION

Mental disorder and associated roles, such as "The Expert," were constructed through particular selective rhetoric, which taken together, made particular psychiatric practices and the need for legislation, such as compulsory detention, seem normal, and necessary.

Critical Psychiatry, Critical Psychology, and the Behaviorism of B. F. Skinner

Critical psychiatry suggests that the currently dominant medical model in psychiatry overstates internal disturbance and understates environmental stressors as important causal factors in psychological distress. Critical psychology suggests that when individuals experience problems in a culture, psychology emphasizes individual, rather than cultural, change. This article provides a brief overview of critical psychiatry and critical psychology and outlines how both movements share important epistemological similarities with the writings of B. F. Skinner, the founder of radical behaviorism.

Professional accounts of electroconvulsive therapy: A discourse analysis

Electroconvulsive therapy (ECT) is a socially contested psychiatric intervention. However, the accounts of professionals involved in its use have rarely been systematically investigated. This study aimed to examine the accounts of clinicians who have used ECT on a routine basis. Eight health professionals (psychiatrists, anaesthetists and psychiatric nurses from a major city in the United Kingdom) with experience of ECT administration were interviewed about the procedure. Discourse analysis was used to interpret the interview transcripts. Interviewees appeared to draw on a repertoire, which constructed ECT recipients as severely ill. This was used to support claims which had the effect of: defining who should receive ECT; warranting the use of urgent physical psychiatric treatments; reformulating distress in biological terms; and discounting the therapeutic value of alternative, non-physical interventions. The interviewees managed concerns about ECT in a variety of ways, for example by: rendering it as a medical procedure with concomitant risks and benefits; downplaying a lack of clarity over its evidence base; and undermining the legitimacy of criticisms. Implications of these findings are discussed.