Item Details

Causal accounts as a consequential device in categorizing mental health and substance abuse problems

Issue: Vol 10 No. 3 (2013)

Journal: Communication & Medicine

Subject Areas: Healthcare Communication Linguistics

DOI: 10.1558/cam.v10i3.237

Abstract:

Professionals in human service work are at the centre of complicated client cases. The ways client cases are constructed and the problems explained form the basis for professionals’ assessments, decisions, actions and interventions. In this article the ways professionals make sense of dual-diagnosis client cases are examined. Applying the concept of causal accounting, it is argued that ‘theories of cause’ are embedded in professional discourse and profoundly shape professionals’ understandings of social and health problems, as well as of their own roles and responsibilities and of what interventions and outcomes are possible. The data consist of 48 tape-recorded weekly team meetings among professionals in a supported housing unit targeted for clients with both mental health and substance abuse problems. It was found that professionals reason about the relationship between these two problems in four different ways: (1) substance abuse causes or makes mental health problems worse; (2) substance abuse eases mental health problems; (3) mental health problems cause or make substance abuse worse; or (4) good mental health reduces substance abuse. Causal account research makes visible the ways professionals do institutional work by categorizing clients, accounting for responsibilities as well as assessing their work and clients’ achievements according to moral expectations of a ‘good’ professional and a worthy client.

Author: Suvi Maaria Raitakari, Kirsi Günther, Kirsi Juhila, Sirpa Saario

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References :

Academy of Finland (2010) Ethical guidelines. Retrieved August 17, 2011 from http://aka.fi/en-GB/A/Funding-and-guidance/Use-of-funding/Ethical-guidelines/
Antaki, C. (1988) Explanations, communication and social cognition. In C. Antaki (ed.) Analysing Everyday Explanation: A Casebook of Methods, 1–14. London: Sage.
Antaki, C. (1994) Explaining and Arguing: The Social Organization of Accounts. London: Sage.
Antaki, C. and Widdicombe, S. (1998) Identity as an achievement and as a tool. In C. Antaki and S. Widdicombe (eds) Identities in Talk, 1–14. London: Sage.
Bergmann, J. R. (1998) Introduction: Morality in discourse. Research on Language and Social Interaction 31 (3–4): 279–294.
Bull, R. and Shaw, I. (1992) Constructing causal accounts in social work. Sociology 26 (4): 635–649. http://dx.doi.org/10.1177/0038038592026004006
Buttny, R. (1993) Social Accountability in Communication. London: Sage.
Buttny, R. and Morris, G. (2001) Accounting. In W. Robinson and H. Giles (eds) The New Handbook of Language and Social Psychology, 285–302. Chichester: John Wiley and Sons.
Dillon, P. J. (2011) Moral accounts and membership categorization in primary care medical interviews. Communication and Medicine 8 (3): 211–221. http://dx.doi.org/10.1558/cam.v8i3.211
Draper, S. W. (1998) What’s going on in everyday explanation? In C. Antaki (ed.) Analysing Everyday Explanation: A Casebook of Methods, 15–31. London: Sage.
Edwards, D. and Potter, J. (1993) Language and causation: A discursive action model of description and attribution. Psychological Review 100 (1): 23–41. http://dx.doi.org/10.1037/0033-295X.100.1.23
Edwards, D. and Potter, J. (1995) Attribution. In R. Harre and P. Stearns (eds) Discursive Psychology in Practice, 87–119. London: Sage.
Edwards, D. and Potter, J. (2005) Discursive psychology, mental states and descriptions. In H. Molder and J. Potter (eds) Conversation and Cognition. Cambridge: Cambridge University Press. http://dx.doi.org/10.1017/CBO9780511489990.012
Eglin, P. and Hester, S. (2003) The Montreal Massacre: A Story on Membership Categorization Analysis. Waterloo, ON: Wilfrid Laurier University Press.
Furnham, A. and Malik, R. (1994) Cross-cultural beliefs about depression. The International Journal of Social Psychiatry 40 (2): 106–123. http://dx.doi.org/10.1177/002076409404000203
Garfinkel, H. (1967) Studies in Ethnomethodology. Cambridge, MA: Prentice Hall.
Gill, V. T. (1998) Doing attributions in medical interaction: Patients’ explanations for illness and doctors’ responses. Social Psychology Quarterly 61 (4): 342–360. http://dx.doi.org/10.2307/2787034
Gill, V. T. and Maynard D. W. (2006) Explaining illness: Patients’ proposals and physicians’ responses. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, 115–150. Cambridge: Cambridge University Press.
Griffiths, L. (2001) Categorising to exclude: The discursive construction of cases in community mental health teams. Sociology of Health & Illness 23 (5): 678–700. http://dx.doi.org/10.1111/1467-9566.00271
Hall, C., Juhila, K., Matarese, M. and Van Nijnatten, C. (eds) (2014). Analysing Social Work Communication: Discourse in Practice. Abingdon: Routledge.
Hall, C., Juhila, K., Parton, N. and Pösö, T. (eds) (2003) Constructing Clienthood in Social Work and Human Services: Interaction, Identities and Practices. London: Jessica Kingsley Publishers.
Hall, C., Slembrouck, S. and Sarangi, S. (2006) Language Practices in Social Work Categorisation and Accountability in Child Welfare. London: Routledge.
Heritage, J. and Maynard, D. W. (2006) Introduction: Analysing interaction between doctors and patients in primary care encounters. In J. Heritage and D. W. Maynard (eds) Communication in Medical Care: Interaction between Primary Care Physicians and Patients, 1–21. Cambridge: Cambridge University Press.
Juhila, K. (2003) Creating a ‘bad’ client: Disalignment of institutional identities in social work. In C. Hall, K. Juhila, N. Parton and T. Pösö (eds) Constructing Clienthood in Social Work and Human Services. Interaction, Identities and Practices, 83–95. London: Jessica Kingsley.
Juhila, K. and Abrams, L. (2011) Special issue editorial: Constructing identities in social work settings. Qualitative Social Work 10 (3), 277–292. http://dx.doi.org/10.1177/1473325011409480
Juhila, K., Günther, K. and Raitakari, S. (2014) Negotiating mental health rehabilitation plans: Joint future talk and clashing time talk in professional client interaction. Time & Society (OnlineFirst). http://dx.doi.org/10.1177/0961463X14523925
Juhila, K., Hall, C. and Raitakari, S. (2010) Accounting for the clients’ troublesome behaviour in a supported housing unit: Blames, excuses and responsibility in professionals’ talk. Journal of Social Work 10 (1): 59–79. http://dx.doi.org/10.1177/1468017309350657
Juhila, K. and Raitakari, S. (2010) Ethics in professional interaction: Justifying the limits of helping in a supported housing unit. Ethics and Social Welfare 4 (1): 56–70. http://dx.doi.org/10.1080/17496531003608154
Juhila, K., Saario, S., Günther, K. and Raitakari, S. (2014) Reported client–practitioner conversations as assessment in mental health practitioners' talk. Text & Talk 34 (1): 69–88. http://dx.doi.org/10.1515/text-2013-0038
Kavanagh, D. J., Greenaway, L., Jenner, L., Saunders, J. B., White, A., Sorban, J. and Hamilton, G. (2000) Contrasting views and experiences of health professionals on the management of comorbid substance misuse and mental disorders. Australian and New Zealand Journal of Psychiatry 34 (2): 279–289. http://dx.doi.org/10.1080/j.1440-1614.2000.00711.x
Keddell, E. (2011) Reasoning processes in child protection decision making: Negotiating moral minefields and risky relationships. British Journal of Social Work 41 (11): 1251–1270. http://dx.doi.org/10.1093/bjsw/bcr012
Kendall, J., Hatton, D., Beckett, A. and Leo, M. (2003) Children’s accounts of attention-deficit/hyperactivity disorder. Advances in Nursing Studies 26 (2): 114–130. http://dx.doi.org/10.1097/00012272-200304000-00004
Kleinman, A., Eisenberg, L. and Good, B. (1978) Culture, illness and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine 88 (2): 251–258. http://dx.doi.org/10.7326/0003-4819-88-2-251
Kolind, T., Vanderplasschen, W. and De Maeyer, J. (2009) Dilemmas when working with substance abusers with multiple and complex problems: The case manager’s perspective. International Journal of Social Welfare 18 (3): 270–280. http://dx.doi.org/10.1111/j.1468-2397.2008.00608.x
Lawton, J., Ahmad, N., Peel, E. and Hallowell, N. (2007) Contextualising accounts of illness: Notions of responsibility and blame in white and South Asian respondents’ accounts of diabetes causation. Sociology of Health & Illness 29 (6): 891–906. http://dx.doi.org/10.1111/j.1467-9566.2007.01036.x
Mäkitalo, Å. (2003) Accounting practices as situated knowing: Dilemmas and dynamics in institutional categorization. Discourse Studies 5 (4): 495–516. http://dx.doi.org/10.1177/14614456030054003
Matthias, M. S., Mitchelle, P., Salyers, A., Rollins, L. and Frankel, R. M. (2012) Decision making in recovery-oriented mental health care. Psychiatric Rehabilitation Journal 35 (4): 305–314. http://dx.doi.org/10.2975/35.4.2012.305.314
Messmer, H. and Hitzler, S. (2011) Declientification: Undoing client identities in care planning conferences on the termination of residential care. British Journal of Social Work 41 (4): 778–798. http://dx.doi.org/10.1093/bjsw/bcr054
Michailakis, D. and Schirmer, W. (2010) Agents of their health? How the Swedish welfare state introduces expectations of individual responsibility. Sociology of Health & Illness 32 (6): 930–947. http://dx.doi.org/10.1111/j.1467-9566.2010.01262.x
Peräkylä, A. (2006) Communicating and responding to diagnosis. In J. Heritage. and D. W. Maynard (eds) Communication in Medical Care: Interaction Between Primary Care Physicians and Patients, 214–247. Cambridge: Cambridge University Press.
Peräkylä, A. and Vehviläinen, S. (2003) Conversation analysis and the professional stocks of interactional knowledge. Discourse & Society 14 (6): 727–750. http://dx.doi.org/10.1177/09579265030146003
Perelman, C. (1977/1996) Retoriikan valtakunta. [L’empire Rhetorique et Argumentation]. Tampere: Vastapaino.
Pithouse, A. and Atkinson, P. (1988) Telling the case: Occupational narrative in a social work office. In N. Coupland (ed.) Styles of Discourse, 183–200. London: Croom Helm.
Potter, J. and Edwards, D. (2001) Discursive social psychology. In W. Robinson and H. Giles (eds) The New Handbook of Language and Social Psychology, 103–118. Chichester: John Wiley and Sons.
Potter, J., Edwards, D. and Wetherell, M. (1993) A model of discourse in action. American Behavioral Scientist 36 (3): 383–401. http://dx.doi.org/10.1177/0002764293036003008
Potter, J. and Wetherell, M. (1987) Discourse and Social Psychology. London: Sage.
Psathas, G. (1999) Studying the organization in action: Membership categorization and interaction analysis. Human Studies 22 (2–4): 139–162. http://dx.doi.org/10.1023/A:1005422932589
Raitakari, S., Saario, S., Juhila, K. and Günther, K. (forthcoming) Client participation in mental health: Shifting positions in decision making. Nordic Social Work Research.
Roy, S. (2008) ‘Taking charge of your health’: Discourses of responsibility in English-Canadian women's magazines. Sociology of Health & Illness 30 (3): 463–477. http://dx.doi.org/10.1111/j.1467-9566.2007.01066.x
Saario, S. (2014) Audit Techniques in Mental Health: Practitioners’ Responses to Electronic Health Records and Service Purchasing Agreements. Acta Universitatis Tamperensis 1907. Tampere: Tampere University Press.
Sacks, H. (1992) Lectures on Conversation, Volume 1. Ed. G. Jefferson. Oxford: Blackwell.
Saunders, B. (2011) ‘Sometimes you’ve just got to have fun, haven’t you?’: The discursive construction of social drinking practices in young adults’ accounts of chronic illness. Communication & Medicine 8 (1): 77–87. http://dx.doi.org/10.1558/cam.v8i1.77
Schubert, S. J., Hansen, S., Dyer, K. R. and Rapley, M. (2009) ‘ADHD patient’ or ‘illicit drug user?’: Managing medico-moral membership categories in drug dependence services. Discourse & Society 20 (4): 499–516. http://dx.doi.org/10.1177/0957926509104025
Scott, M. B. and Lyman, S. M. (1968) Accounts. American Sociological Review 33 (1): 46–62. http://dx.doi.org/10.2307/2092239
Share, M. and Strain, M. (2008) Making schools and young people responsible: A critical analysis of Ireland’s obesity strategy. Health and Social Care in the Community 16 (3): 234–243. http://dx.doi.org/10.1111/j.1365-2524.2008.00763.x
Shaw, I. and Shaw, A. (1997) Game plans, buzzes, and sheer luck: Doing well in social work. Social Work Research 21 (2): 69–79. http://dx.doi.org/10.1093/swr/21.2.69
Smith, D. E. (1987) ‘K is mentally ill’: The anatomy of a factual account. Sociology 12 (1): 23–53. http://dx.doi.org/10.1177/003803857801200103
Stokoe, E. (2003) Mothers, single mothers and sluts: Gender, morality and membership categorization in neighbor disputes. Feminism & Psychology 13 (3): 317–344. http://dx.doi.org/10.1177/0959353503013003006
Taylor, C. and White, S. (2000) Practising Reflexivity in Health and Welfare: Making Knowledge. Buckingham: Open University Press.
Taylor, C. and White, S. (2006) Knowledge and reasoning in social work: Educating for humane judgement. British Journal of Social Work 36 (6): 937–954. http://dx.doi.org/10.1093/bjsw/bch365
Waal, H. (1998) Understanding the incomprehensible limited rationality as an approach to ‘double-diagnosis’ patients. Nordic Journal of Psychiatry 52 (1): 23–29. http://dx.doi.org/10.1080/080394898422535
Webb, H. (2009) ‘I’ve put weight on cos I’ve bin inactive, cos I’ve ’ad me knee done’: Moral work in the obesity clinic. Sociology of Health & Illness 31 (6): 854–871. http://dx.doi.org/10.1111/j.1467-9566.2009.01188.x
White, S. (2002) Accomplishing ‘the case’ in paediatrics and child health. Sociology of Health & Illness 24 (4): 409–435. http://dx.doi.org/10.1111/1467-9566.00302
White, S. (2003) The social worker and a moral judge: Blame, responsibility and case formulation. In C. Hall, K. Juhila, N. Parton and T. Pösö (eds) Constructing Clienthood in Social Work and Human Services: Interaction, Identities and Practices, 177–192. London: Jessica Kingsley Publishers.