Identity and multiple admissions to psychiatric hospital: a biographic narrative study of the experiences of patients.

Abstract

A small percentage of mentally ill patients, sometimes referred to as 'revolving door' patients, are frequently readmitted to psychiatric hospitals. This study explores how these patients construct meaning and reality and how this enacted reality provides a context for shaping their identities. The study draws on mental health policy, political ideologies and the history of deinstitutionalisation in order to illuminate this problematic phenomenon. The study is framed within the social sciences, but more specifically within the fields of mental health and social work practice. The methodology is qualitative, placing emphasis on a hermeneutic phenomenological approach. The foundation of the study is underpinned by a social construction and social psychology framework. A unique minimalist interview technique based on the Biographic Narrative Interpretive Method is used for data collection and analysis. Data from seven interviews with participants are presented followed by the researcher's reflections on the interviews and post-interview process. The life stories of four of the seven participants are analysed by using reflective teams. The lived life, or chronological chain of events as narrated, is analysed sequentially and separately. The told story, or thematic ordering of the narration, is then analysed using thematic field analysis; this involved reconstructing the participants' system of knowledge, their interpretations of their lives and their classification of experiences into thematic fields. An integrated procedure of abductive and inductive analysis of the stories elicited from participants offered immense potential for constructing meaning. Perspectives on 'revolving door' patients have often regarded them as having a one-dimensional life. This study revealed that these existential lives are complex and diverse and exist within a cultural matrix of social and psychological constructs. Interpretations of these patients' experiences illuminate the complexities arising from multiple admissions to psychiatric hospitals and highlight the problematic aspects which impact their socially constructed identities. These case studies of 'revolving door' patients' personally narrated lives extend the social psychological study of self/identity and contribute to the field of mental health research.