Brokenhearted lifetimes: Ethnography, subjectivity, and psychosocial rehabilitation

Journal/Book: Int J Ment Health. 1995; 24: 80 Business Park Dr, PH#914-273-1800, Armonk, NY 10504. M E Sharpe Inc. 82-92.

Abstract: One evening in the summer of 1990, I accompanied to choir practice at her church a woman who was participating in my current study. She is in her forties, the mother of three and grandmother of one, is African-American, and is diagnosed with schizophrenia. The only Caucasian present, I sat in a back pew with her granddaughter on my knees and her teen-age daughter at my side. When the choir began to sing, my acquaintance's face and posture were transformed-from troubled and self-conscious to joyful, free, and flowing. Her face and body reflected relief, peace, and happiness as she swayed with the music; she was a different person from the psychotic, fearful, confused woman I had first interviewed in a hospital two years previously. After practice, she chatted easily with friends of many years (none of the people I saw with her that night appeared on the social network I had painstakingly elicited from her on two separate occasions), introduced me to a sister I had not heard about in four research interviews, and seemed socially nested-a mother, grandmother, and sister who was part of her community. This woman had not had the benefit of psychosocial rehabilitation services: she had had primarily the benefit of herself and the passage of time as a means of ''getting better,'' plus Prolixin and a monthly visit to a busy psychiatrist at a mental health center. The psychiatrist told her that she might get sick if she tried to work again (but never suggested she apply for disability benefits); so, although she had worked for years before her first hospitalization, she now spent most of her time sitting on the front porch of her father's ramshackle house, watching the neighborhood and the world pass by. I had had no way of really knowing what she was missing when she had mentioned that she missed going to church and singing in the choir. Now it was evident that she was retrieving lost social roles and contacts, reconstructing her self and her life in all the ways rehabilitation professionals hope for. It was clear that the research instruments I had used and the interviews I had conducted fell far short of capturing the nature and significance of what I had witnessed at the church; it was also apparent that I could not know each study participant in the same depth, nor address pressing theoretical and clinical outcome questions with a collection of ''thick'' ethnographic descriptions. This story illustrates the complexity and richness of the lives of the people who are the focus of psychosocial rehabilitation efforts. It should humble researchers, posing substantial challenges to the methods we use and the conventions of knowledge production, particularly of outcome research, that cannot accommodate scenes such as I had observed.

Note: Article SE Estroff, Univ N Carolina, Dept Social Med, CB 7240, Wing D, Chapel Hill, NC 27599 USA

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