Fathers, Fatherhood and Mental Illness

A Discourse Analysis of Rejection

Dariusz Galasinski

• Publisher: Palgrave Macmillan
• Year: 2013
• Print ISBN: 9780230393011
• eBook ISBN: 9780230393028
• Topic: Languages & Linguistics
• Subtopic: Linguistics
• Index: Languages & Linguistics

Fathers, Fatherhood and Mental Illness provides thefirst book-length study of fathers' experiences of mental illness, arguing that a discourse analytic focus upon the experience of mental illness is relevant both to social scientists and mental health scholars and practitioners.

1

Introduction

This is a book about fathers. When I said to friends or colleagues that I am writing a book about fathers, they immediately assumed that I was writing about masculinity and fatherhood at its peak, about strength or providing. The dominant model of fatherhood kicked in immediately, the moment I uttered the word ‘father’. And indeed, we, fathers, are under constant pressure to be role models, providers and the ever-positive ‘father figures’ – a set of discourses which castigates us for not caring, not spending the time, not being there, but which demands we be like Jean-Luc Picard, who both had the time to save the galaxy and still be able occasionally to speak to Wesley Crusher, providing him with golden advice and intellectual nurturing.

This book is about fathers who live with a mental illness. The idea was born of a contradiction. On the one hand, fatherhood is precisely about the expectations mentioned above. He is expected to be strong, providing, nurturing, a role model and this on top of the ‘normal’ expectations of what it means to be a man: active, enterprising, tough and powerful. But on the other hand, mental illness undermines all this. Social perceptions of mental illness are precisely the opposite of what it is to be a role model, while the illnesses often prevent men from being ‘manly’. And so, this book is an exploration of what it means to be a mentally ill father. I am interested in experiences of fathers who have to ‘square the circle’ and be fathers in what is a most adverse social context: mental illness. In other words, there is an inherent contradiction between the dominant expectations of fatherhood and the dominant discourses and imagery of mental illness. The overarching argument I shall develop is that mental illness is inextricably and negatively intertwined with the experience of fatherhood. For fathers with mental illness, there seems to be no fatherhood outside it – it is an illness which undermines fatherhood.

There are three main avenues I shall take in exploring the experience of fatherhood in relation to mental illness. First, I want to explore the narratives of fatherhood itself. I am interested in how the fathers I spoke to constructed themselves as fathers. Second, I am interested in how they talked about their illness, and in particular how they talked about their illness with their children. Third, I am interested in how my informants constructed their children and their relationships with them.

Aims of this book

As in my previous book, Men’s Discourses of Depression, I am very aware that writing about fathers with mental illness is political. I would therefore like to make my political aims explicit. My first aim is to restate the importance of research into masculinity and, in particular, fatherhood, especially as it concerns vulnerable fathers. As I will show below, while we already know a lot about men and men’s health, we know very little about men who are fathers, and we know even less about their experiences, most particularly experiences of mental illness. The existing research on fathers focuses on them as providers, carers, facilitators – there is practically no research on vulnerable fatherhood and its experience. I would like to restate the importance of such research, including that which concerns white, middle-class, middle-aged and heterosexual men. Men like me. Our experiences, including those of fatherhood and mental illness, are not only interesting, but also socially important.

I have just described what Johnson (1997) described as the all-purpose universal oppressor. Yes, many such men are indeed oppressors. But it is important to remember, and this is my second political aim, that there are also considerable numbers of such men who are oppressed and vulnerable themselves (see also New, 2001; Taylor, 2006). This book is about such men: oppressed, vulnerable men who are at their most powerless, struggling against all odds to provide their children with love and nurturing. Yet, they are also mentally ill, which in itself puts them at the margins of society and also, to their despair, in the eyes of their own children. This is a book about men’s vulnerability and weakness, which I want to put on the agenda so as to stimulate research into men and masculinity. I want to reinforce the message that inequality, strife, vulnerability, marginality or powerlessness apply also to men.

My third aim is to give a voice to the fathers I spoke to, or at least some voice. I want to write a book from the point of view of vulnerable fathers. I would like to show fatherhood in mental illness as narrated by those who must negotiate this contradiction.

Finally, there is also a personal aim to this book. This is by far the most difficult book I have written. The stories I heard during the interviews were heart-wrenching. I had never heard so many stories which were so very sad. While I had previously engaged in research into human misery, what I heard this time went well beyond what I had expected. Time and again, I heard stories of rejection and self-rejection, failure, concealment – and yet a surmounting of this by an unconditional love of their children and a yearning for some reciprocity which in most cases never came (at least this is how the speaking fathers represented it). As I appreciate very much my informants’ willingness to share their experiences with me, I would like to do them justice, especially since the stories I heard were often told to me with the hope that the book would help other fathers to know that their experiences are shared and that it would be read by those who are loved and whose love is needed very much.

In the following sections I shall briefly clarify my ‘starting points’, the assumptions I shall be making with reference to four major research issues in regard to mental illness and in particular mental illness in discourse analytic studies. I shall then position my considerations in relation to debates on fatherhood, before discussing the literature on fatherhood and mental illness. I shall finish by laying down my approach to discourse analysis, and suggest how it might be useful in the exploration of mental illness.

Mental illness

Before I continue, I would like to make a reservation here. I do not wish to make a statement as to the nature of mental illness; that would be well outside the scope of my argument. Rather, the discussion below serves two main functions. First, it is to show the contested nature of mental illness, discussions that are very far from over, as was recently evidenced again in the discussions on the preparations of the new edition of the American Psychiatric Association’s diagnostic manual, the DSM-V, and especially the outcry related to the proposed inclusion of the ‘pre-psychotic disorder’ – where mental illness consists, it seems, in not being quite ill enough (see New Scientist’s editorial, 12 December 2009). Second, the flip side of this is that mental illness, regardless of one’s approach to it, is social and thereby political. It is invoked by a decision and must be seen as a way in which society views certain experiences.

There are two major definitions of mental illness. One is offered by the World Health Organization (1992) in its ICD-10 Classification of Mental and Behavioural Disorders (10th edition) and the other by the American Psychiatric Association (APA) (2000) in its Diagnostic and Statistical Manual of Mental Disorders (4th edition, revised). According to the WHO (1992: 11):

The term ‘disorder’ is used throughout the classification, so as to avoid even greater problems inherent in the use of terms such as ‘disease’ and ‘illness’. ‘Disorder’ is not an exact term, but it is used here to imply the existence of a clinically recognizable set of symptoms or behaviour associated in most cases with distress and with interference with personal functions. Social deviance or conflict alone, without personal dysfunction, should not be included in mental disorder as defined here.

According to the APA (2000: xxxi):

[mental disorder is] a clinically significant behavioural or psychological syndrome or pattern that occurs in an individual and that is associated with present distress (e.g. a painful symptom) or disability (i.e. impairment in one or more important areas of functioning) or with a significantly increased risk of suffering, death, disability, or an important loss of freedom.

The APA adds that the disorder must not be expected and culturally sanctioned; must be a manifestation of a dysfunction; and cannot be reduced to social deviance.

Now, while these definitions of mental disorder are well anchored in the dominant discourses of psychiatry, they are still severely contested. One of the most recent critiques was made by Busfield (2011; but see also, however, critiques by Kutchins and Kirk 1999 who deconstructed the APA’s definition). Busfield notes that the definition firmly puts mental illness within the medical understanding of illness. She points out further that distress is often a normal (and I would add expected (after Kutchins and Kirk 1999)) reaction to certain events, noting also that cultural expectation of certain experiences is fuzzy and undetermined. Busfield finishes by saying that dysfunction in the definition is not operationalised and in the process becomes reduced to distress and disability. The only positive comment she offers concerns the distinction between wrongdoing and mental illness, reinforcing the assertion that deviance in itself cannot be taken to be indicative of a mental disorder.

Busfield’s or Kutchins and Kirk’s critiques are by no means unique (see a review of the issues in Bolton, 2008). Both within psychiatry and in the social sciences of medicine/psychiatry there is a significant opposition both to the psychopathological nosology, as well as to the notions of mental disorder as currently conceptualised within the dominant discourses of psychopathology. It is quite uncontroversial to say that psychiatric categories are not natural kinds (e.g. Zachar, 2000; Cooper, 2004; Kirmayer, 2005). In other words, they do not refer to diseases that naturally occur in the world, but they are practical categories which help describe and deal with distress. In this sense the two main psychiatric diagnostic manuals are merely public policies (Sadler, 2005). Moreover, given the perennial problems with what constitutes normality, the decision whether a condition is a mental disorder is partly a value judgement (Fulford, 1989; Barilan and Weintraub, 2001; Cooper, 2004), underpinned by the personal values and expectations of the individual clinician (Corin, 1996; Galasiński and Opaliński, 2012).

Jenkins and Kleinman (1991) stress that all psychopathological considerations, including those of the threshold and duration of what counts as a disorder, are ultimately grounded in culturally specific and locally defined judgements about what constitutes abnormal behaviour. Pilgrim and Bentall (1999) second this, pointing out that dominant discourses of psychopathology assume mental illness to be transhistorical and transcultural, while the clinician operates in an atypical social setting, having a superior epistemological status, as he or she is equipped with the ‘warranting voice’ (Gergen, 1989) of the dominant discourse. And yet, this clinician must refer to the lay account of distress in order to make his or her judgement, an account which is inherently indeterminate (Jenkins and Kleinman, 1991). However, a recent and unique study by Galasiński and Ziółkowska (2013) underscores these problems even further, demonstrating that doctors’ notes recording his or her interview with a patient are ridden by misrepresentations and cannot be seen as in any way documenting the patient’s distress.

The diagnostic criteria which are to capture mental distress in all people in all situations can be challenged further. Much criticism has been made of the progressive loss of lay conceptualisations of distress in favour of biological models (e.g. Kleinman, 1988; 1995; Fabrega, 1996; Miller, 2005), of a lack of inclusion of the patient’s perspective (e.g. Mezzich, 1999; Schmolke, 1999; Ziółkowska, 2009), normally coupled with postulates for inclusion of the social sciences in nosological considerations (e.g. Lewis, 2000; Fabrega, 2005).

Such debates form an important context in which mental illness should be seen. Whether ‘biological’ (understood in terms of diagnostic criteria) or not, mental illness is also social. And even though the men I interviewed were all psychiatrically diagnosed within two spectrums of mental disorder (I shall describe the sample in some detail below), this in fact does not guarantee consistency or even similarity of their experience (see e.g. Kirk and Kutchins, 1988; Kirk and Hsieh, 2004). Yet, I am interested in those experiences that made them seek psychiatric help and which psychiatry and society calls a mental disorder. They all shared the need to seek help and had to deal with the problems and stigmas associated with a psychiatric diagnosis, psychiatric treatment and psychiatric hospitalisation. As Lally (1989: 259) puts it aptly when discussing the impact of psychiatric services on the self-image of users, psychiatric treatment is a situation in which ‘a part-time psychotic person can become full-time crazy’.

Stigma and social exclusion

Now, the most important aspect of the socialness of mental illness that I would like to raise throughout the book is its stigmatisation. The literature on stigmatising aspects of mental illness is vast. Recent major texts (Corrigan, 2005; Thornicroft, 2006; Hinshaw, 2007; Boardman et al., 2010) review hundreds of studies exploring stigma in a variety of ways and aspects. It is not only impossible to review all of them, but even to mention most of the themes and topics related to it. In what follows I shall therefore only sketch out a rough framework of what is involved in the wide area of the stigma of mental illness. I shall then consider stigma in three broad areas: stigmatisation of the mentally ill, stigma by association, and self-stigma.

What is understood by stigma? In a foreword to Thornicroft’s book, Chamberlin (2006) proposes the most basic definition of ‘stigma’. She says that it is a mixture of prejudice, negative attitudes, discrimination and codification of such attitudes. Hinshaw (2007) summarises his deliberations by saying that stigma is indicative of a ‘deep mark of shame and degradation’ carried by a member of a social group by virtue of belonging to the group. Corrigan and Kleinlein (2005), as well as Pilgrim and Rogers (2010), add another aspect to the conceptualisation of stigma. They also speak of a stereotyping which underlies the prejudice and discrimination. Link and Phelan (2001) see stigma in terms of five interrelated components: labelling, stereotyping, separation, status loss and discrimination, underpinning these with a dimension of power differential. The stigmatised person is one who possesses less power.

Pilgrim and Rogers (2010) also point out that, in order for stereotyping to become stigmatising, it requires two other factors. First, the stereotyping must be emotional – it must involve anxiety, hostility or pity. Second, they contend, stereotyping is moral (see also Charmaz, 1999). And so it may hover between paternalism, moral outrage or revulsion. In such a way the stigmatised person is set apart from the ‘normal group’, those who do the stigmatising. It is worth noting, incidentally, that a diagnosis of mental illness is stigmatising regardless of whether ‘abnormal’ behaviour is present or not (Byrne, 1997).

Hinshaw (2007) proposes that stigmatisation occurs in at least four spheres of social life. First, he points to stigmatising language (and narratives), showing a plethora of uses that relate to mental illness, as well as both personal accounts and the narratives of significant others, which are stigmatising and discriminating. Second, he discusses public media as a vehicle of stigma, indicating the portrayal of a predominantly negative image of mental illness (especially in terms of violence). Third, attitudes and practices of mental health professionals are identified as stigmatising as well. Indeed the British Care Quality Commission continues to point out that there is considerable room for improvement in such aspects of the mental health service which involve patients in decisions concerning their care or in assessing and recording their consent to treatment. The fourth area of stigmatisation concerns policies and laws, in particular housing, employment, insurance coverage for treatment and legal rights.

To sum up, it is probably fair to say that stigma, as a process of negative ‘Othering’, is conveyed in just about all contexts in which a mentally ill person can find her or himself. Below, I shall point to only a few aspects of the consequences of stigmatisation.

People with mental illness

Wilson and her co-authors (2010) recount a story of a person involved with the mental health services. After ten years of treatment he was asked to identify his ‘significant others’. Quite astonishingly, he could only identify his psychiatrist and care coordinator. The rest, his family, friends, colleagues, had disappeared. This very poignant case of a person who, through mental illness, had lost his social life, describes well the stigma and social exclusion related to people suffering from mental illness and receiving psychiatric treatment. Indeed, in an often quoted Swedish study, almost a fifth of relatives of people with mental illness thought that their ill relative would be better off dead (Ostman and Kjellin, 2002).

The literature on the stigma indicates that people with mental illness have smaller social networks, with the illness being responsible for the collapse of the ne...

Table of contents

• Cover
• Title
• 1  Introduction
• 2  I Did Too Little: Stories of Failed Fatherhood
• 3  A Father’s Love: Towards a Normal Family
• 4  The Father in Hiding
• 5  The Father Communicating on Illness
• 6  The Silent Father1
• 7  Children and the Illness
• 8  The Rejected Father
• 9  Fathers, Fatherhood and Mental Illness
• References
• Index