Alverson Hoyt S, Drake Robert E, Carpenter-Song Elizabeth A, Chu Edward, Ritsema Mieka, Smith Beverly
Department of Anthropology, Dartmouth College, Hanover, NH 03755, USA.
Psychiatr Serv. 2007 Dec;58(12):1541-6. doi: 10.1176/ps.2007.58.12.1541.
In the delivery of mental health services over the past decade, the field has attempted to shift from paternalism to client-centered care, in which treatment and recovery are based on client-practitioner collaboration. Such a shift requires that providers elicit and work with clients' discursive accounts of their illness experiences and understand these accounts in the context of clients' ethnocultural backgrounds. The purpose of this ethnography was to elucidate ethnocultural aspects of illness accounts and interactions with the mental health system.
Over 18 months, 25 ethnically diverse, unemployed, inner-city residents with severe and long-term mental disorders participated in an ethnographic (participant observation) study of illness accounts and their relationship to sociocultural background. Field ethnographers shared in activities with participants at many of their regular haunts, engaging in observation, conversation, and informal interviewing in many real-world contexts and settings.
The study revealed significant differences between the ways that European Americans, African Americans, and Puerto Rican Americans discursively constructed their illness experiences and their interactions with the mental health system. The clients' narratives of their illness experiences provided valuable information, which clinicians could use to open up topics for discussion, insert themselves into an engaging relationship with clients, and link clinical advice or guidance with the clients' own conceptions of how mental illness fits into their larger lived world.
To develop a working therapeutic partnership with clients, mental health service providers must become aware through context-sensitive, context-informed dialog of the differences in how individual clients "en-story," communicate, and experience their illnesses.
在过去十年的心理健康服务提供过程中，该领域一直试图从家长式作风转向以客户为中心的护理模式，即治疗和康复基于客户与从业者的合作。这种转变要求提供者引出并利用客户对其疾病经历的话语描述，并在客户的民族文化背景下理解这些描述。本民族志的目的是阐明疾病描述的民族文化方面以及与心理健康系统的互动。
在18个月的时间里，25名来自不同种族、失业的市中心居民，患有严重的长期精神疾病，参与了一项关于疾病描述及其与社会文化背景关系的民族志（参与观察）研究。实地民族志研究者在参与者经常出没的许多地方与他们一起活动，在许多现实世界的背景和环境中进行观察、交谈和非正式访谈。
研究揭示了欧裔美国人、非裔美国人和波多黎各裔美国人在话语构建其疾病经历以及与心理健康系统的互动方式上存在显著差异。客户对其疾病经历的叙述提供了有价值的信息，临床医生可以利用这些信息开启讨论话题，与客户建立起引人入胜的关系，并将临床建议或指导与客户自己关于精神疾病如何融入其更广阔生活世界的观念联系起来。
为了与客户建立有效的治疗伙伴关系，心理健康服务提供者必须通过情境敏感、情境知情的对话，意识到个体客户在“讲述经历”、沟通以及体验疾病方式上的差异。
