University of Helsinki, Faculty of Humanities, P.O. Box 24, 00014, University of Helsinki, Finland.
Tampere University, Faculty of Social Sciences, 33014, Tampere University, Finland.
Soc Sci Med. 2021 Nov;289:114364. doi: 10.1016/j.socscimed.2021.114364. Epub 2021 Sep 2.
Being identified as "mentally ill" is a complicated social process that may be stigmatizing and socially problematic, as a mental illness diagnosis determines the criteria for what is considered normal. This has given rise to a number of anti-stigma campaigns designed to create awareness of the way stigmas affect people with mental health difficulties and to normalize those difficulties in society. One such campaign is the "diagnosis-free zone", which declares that those with mental health difficulties should not be categorized on the basis of their diagnosis; rather, they should be encountered as full individuals. In this paper, we investigate how mental health difficulties are discussed in Clubhouse communities, which adhere to the "diagnosis free zone" programme. The findings are based on conversation analysis of 29 video-recorded rehabilitation group meetings, in one Finnish Clubhouse, intended to advance clients' return to the labour market. The analysis demonstrated that members referred to their mental health difficulties to explain the misfortunes in their lives, especially interruptions and stoppages in their careers. By contrast, staff members disattended members' explanations and normalized their situations as typical of all humans and thus unrelated to their mental health difficulties as such. In this way, the discussion of mental health difficulties at the Clubhouse meetings was implicitly discouraged. We propose that the standards of normality expected of a person not suffering from a mental health difficulty may well be different from the expectations levelled at participants with a history of mental problems. Therefore, instead of considering cultural expectations of normality to be a unified domain, effective anti-stigma work might sometimes benefit from referring to mental-health diagnoses as a means of explicitly tailoring expectations of normality.
被认定为“精神疾病患者”是一个复杂的社会过程，可能会带来污名化和社会问题，因为精神疾病的诊断决定了什么被认为是正常的标准。这引发了许多反污名运动，旨在提高人们对污名如何影响心理健康困难者的认识，并使这些困难在社会中正常化。其中一个运动是“无诊断区”，它宣称有心理健康困难的人不应该根据他们的诊断来分类；相反，他们应该作为完整的个体被遇到。在本文中，我们调查了心理健康困难在坚持“无诊断区”计划的 Clubhouse 社区中是如何被讨论的。研究结果基于对芬兰一个 Clubhouse 的 29 个视频记录的康复小组会议的会话分析，旨在促进客户重返劳动力市场。分析表明，成员们提到他们的心理健康困难来解释他们生活中的不幸，特别是他们职业生涯的中断和停顿。相比之下，工作人员不关注成员们的解释，将他们的情况正常化为所有人都有的典型情况，因此与他们的心理健康困难无关。通过这种方式，Clubhouse 会议上对心理健康困难的讨论被暗中劝阻。我们提出，一个没有心理健康困难的人的正常标准可能与有精神问题历史的参与者的期望大不相同。因此，反污名工作不应将文化对正常的期望视为一个统一的领域，有时可能会受益于将心理健康诊断作为明确调整正常期望的手段。
