The conditions of possibilities for recovery: A critical discourse analysis in a Danish psychiatric context

Abstract

Aims and objectives: This paper explores the conditions for the possibilities of recovery in a Danish mental healthcare practice, expressed from the perspective of nurses. The results and discussion of the study help to make visible and explore the muddle of conceptualisations of recovery in mental healthcare practice.

Background: Few studies examine the possibilities of recovery for inpatients and outpatients in mental health centres from a nursing perspective.

Design: A qualitative design using a critical social constructionist frame of understanding, in which the real world is considered as a series of social constructions.

Method: A Fairclough-inspired critical discourse analysis was chosen as the analytical strategy. The analysis is comprised of ten interviews in mental health care and notes, written by nurses, in medical records of ten patients with a mental illness admitted to a mental healthcare centre in 2016-2017. The Consolidated Criteria for Reporting Qualitative Research checklist was used as a guideline to secure accurate and complete reporting of the study (See Appendix S1).

Results: From the findings of the textual analysis and the analysis of the discourse practice, it seems clear that the social relations and structures relating to recovery in Danish psychiatry are steered and controlled by discourses that reflect, in general terms, the essence of the core of neoliberal ideology.

Conclusion: Recovery is generally articulated from an overall discourse of neoliberalism with its embedded discourses of paternalism, biomedicine, self-care and holism. All these discourses coexist in nursing practice, but the paternalistic discourse becomes the framework for the conditions for the possibility of how recovery is expressed in practice.

Relevance to clinical practice: Nurses need to be supported to seek clarity in the understanding and operationalisation of a recovery-oriented approach, if the agenda is to be truly adopted and strengthened.

Keywords: clinical decision-making; clinical-research approaches; discourse analysis; mental health nursing; patient participation; recovery; user involvement.