Advertisement

Human Arenas

, Volume 1, Issue 3, pp 249–261 | Cite as

Psychiatric Diagnosis in a Woman’s Personal Narrative: Possibilities of Semiotic Analysis

  • Brena Cristiane Bahia de Carvalho
  • Marilena Ristum
Arena of the Body

Abstract

Motherhood is a potentially disruptive experience in the life cycle. When the psychiatric diagnosis is added to this experience, it can become even more complex. Understanding the diagnostic categories as semiotic mediators, the present article seeks to analyze, through a narrative, the ways in which a woman diagnosed with a mental disorder gives meaning to her psychic suffering and the ways she integrates it into her conception of herself. It is proposed that in the case studied, in the face of a situation permeated by ambivalence, the diagnosis appears as a strong generalized sign which, while encompassing a series of personal experiences, inhibits the possibility of new subjective constructions. It is concluded that, as a sign, the psychiatric diagnosis should be analyzed in its various microgenetic semiotic dimensions, in order to better clarify its implications for the experience of the diagnosed person.

Keywords

Mental health Psychiatric diagnosis Semiotic mediator 

Maternity and Psychiatric Diagnosis as Potentially Disruptive Experiences in the Life Cycle

The transition to motherhood is one of the most profound and significant challenges in the family’s life course (Carter and McGoldrick 1995). In this period, characterized as unique and intense, important changes are experienced (Cabell et al. 2015). These changes influence the intra- and interpersonal dynamics of women, and may in some cases result in conflicts and, consequently, dramatic transformations of their identity. However, it is important to emphasize that, in addition to the organic activity of generating a child, motherhood assumes contours that are also socio-culturally determined.

Authors like Zittoun (2015), Abbey (2011), and Bastos, Santos, Araujo e Meneses (2015) proposed that motherhood could be understood as a complex and dynamic psychological and sociocultural construction whose meanings change over time and between generations. It is an experience, therefore, greatly affected by the social control exerted by political and religious groups, educational institutions, and corporations, which usually establish prescriptions about how women’s lives should be, in order to regulate their thoughts, feelings, and actions. According to Abbey (2011), the very establishment of standardized maternity labels serves this attempt at control, since they make it possible to construct valuable boundaries around maternity and, consequently, a homogeneous symbolic category that masks the intersubjective variability of the experience of being a mother.

According to Zittoun (2015), these boundaries of motherhood can be questioned when one explores non-normative cases, which are often silenced in the name of normative narratives that promote the stereotype of the pregnant and happy woman. The author states that non-normative experiences of motherhood can be lived with great difficulty, related both to the specific care directed to the baby, and to situations of social vulnerability. Speaking specifically about the cases of Brazilian women living in situations of vulnerability, Zittoun (2015) states that one must admit that their lives may seem very limited, or that they may be faced with few options. Such limits, according to the author, can be of a material nature, for example, women living in violent environments where their children may be killed or their partners may be physically aggressive; a social nature, such as the restriction of access to work and education; and a symbolic nature, like feeling that they cannot reveal such desires as to not be mothers or to not breastfeed. However, the author acknowledges that, even in the face of these disruptive contexts, some women can develop personal strategies of resistance, opening new and possible developmental routes.

Maternity lived by women with severe mental disorders may present very disruptive contours. Studies show that they seem to live this experience with a lot of ambivalence, associated with positive feelings as well as difficulties and tensions. Among the positive experiences, the following points are highlighted: (1) children are often seen as important parts of the mothers’ self and a source of great stimulus for adherence to and maintenance of psychosocial treatment (Blegen et al. 2014; (2) mothers demonstrate a great commitment to the effort to be “good mothers” and to be present in caregiving relationships with their children (Blegen et al. 2012); (3) the possibility of having family support is characterized as an important resource for coping with these situations (Perera et al. 2015).

Among the difficulties and tensions, the research points out (1) that women diagnosed are used to feeling guilt, shame, and low self-confidence related to motherhood (Perera et al. 2015); (2) that they face practical difficulties in dealing with the symptoms and the care of their own and their children’s health (Blegen et al. 2014); (3) that they recognize the social stigma attached to “madness” (Dolman, Jones and Howard 2013; Carteado 2008); (4) their frequent involvement with child protection agencies and their constant fear of the threat of losing custody of their children (McCauley-Elsom and Kulkami 2007); and (5) the difficulty that some families face in providing adequate support, which usually generates relational conflicts (Carvalho et al. 2007). However, while such studies provide an important understanding of the personal experience of these women, the conception of mental disorder presented by the authors, as well as an analysis of the ways in which these women signify their own psychic suffering and integrate it into their narratives about themselves, are not clear.

Brinkmann (2016) points out that there seems to be no consensus in literature about what could be conceived as a mental disorder. According to the author, while some adopt more essentialist perspectives, conceiving diseases as entities with their own existence, others defend a more sociological perspective, according to which diseases can only be understood from a social and normative context. However, for the author, it is necessary to develop a perspective that considers the representations offered by people who are themselves diagnosed with mental disorders. Thus, the author makes use of the assumptions of cultural psychology and proposes a “situated disease theory” capable of illuminating, through the qualitative approach, the personal life of the subjects and the ways in which the diagnoses relate to their experiences and the social contexts in which they are inserted.

Illness, in this context, appears as a real, concrete dispositional phenomenon, whose dimensions are relational, performative, and radically situated. Brinkmann (2016), then, emphasizes the importance of understanding the mediators involved in presenting a particular mental disorder, and the ways in which these mediators might be changed in ways that favor people. Considering the relevance of the aforementioned notions, this study proposes to clarify, from the narrative of a mother diagnosed with a mental disorder, the semiotic configurations that the diagnosis, as a sign, assumes in her experience, analyzing, then, the modes in which it is integrated into her personal synthesis of herself.1

The Narrative as a Resource for the Construction of the Personal Synthesis of Oneself

Human beings are embedded in a semiotic universe that mediates the relationship between their personal experiences and culture. Thus, they internalize and create signs capable of organizing and giving meaning to phenomena, self-regulating their mental functioning (Valsiner 2012; Zittoun et al. 2013). According to Zittoun et al. (2013), even the experience can be conceived as a holistic field created by socially recognized signs as part of a given language, and which give us the feeling of being in touch with the world beyond the here and now.

Bruner (2001), discussing the processes of constructing the senses of self, states that the self is constructed autobiographically as people become capable of transforming the primary qualities of experience into secondary qualities of higher knowledge. In this process, narratives appear as a resource capable of organizing the lived experience, putting sequential events into a meaningful context. According to the author, the narrative process arises when the subject needs to account for an exceptional event, an occurrence that in some way violates what is considered canonical by implicit popular psychology, thus guaranteeing a process of individualization.

Such a process, at a microgenetic level of analysis, can be understood from the developmental model of the emergence of meanings proposed by Valsiner and Abbey (2005). According to the authors, humans use signs as resources to deal, at present, with the uncertainty of the future. In this case, once established, the sign is understood as something that, for an interpreting mind, is in the place of an object, and can assume the iconic representational (image representations that maintain similarity to the object), indexical (when the sign emerges from the impact of the represented object), and symbolic (sign conventionally and arbitrarily established by the verbal community to designate an object) natures (Valsiner 2012; Silva 2017).

Valsiner and Abbey (2005) further suggest that, once established throughout experience, the sign not only designates its own field (A) and limits, but also refers to its opposite field of signification (Non-A), in which changes that it may suffer in the future would be included. Thus, they assume that it is the ambivalence contained between fields A and Non-A which guarantees to human beings, in the developmental path, the flexibility to deal with the uncertainty of the future and the possibility of overcoming it through the creation of new meanings. The authors also point out that different levels of ambivalence may lead to different conditions for the emergence of signs. In a condition where a situation does not set itself up as an unsettling or exceptional event, ambivalence and the construction of new meanings would be avoided. However, being more and more accentuated, the ambivalence could lead to a bifurcation in the trajectory, or to the extinction of the semiotic emergency due to the high level of uncertainty or the search for new meanings. In the latter case, the new meanings can be understood as elements that will compose the new narratives capable of giving meaning to the events felt as exceptional.

The moment of bifurcation, thus, appears as an important place for social interventions, since it can assist the individual in the construction of new senses, providing signs, cultural suggestions that diminish or help the individual to tolerate the level of uncertainty. Thus, Bruner (2001) emphasizes that narratives can follow certain cultural limits, certain linguistic rules present in each context, thus relating to the interpretations that other people provide for the narrated history. In this sense, narratives are highly negotiable and sensitive to the reference group. In other words, it is possible to assume that people create signs under the guidance of other human beings who are, in turn, collectively guided by other social institutions (Pontes 2013, p.33).

Therefore, assuming motherhood and psychic suffering as conditions that can lead to the interruption of the continuous process of identity construction, to the discontinuity of the sense of self (Pontes 2013, p. 34), it is important to analyze canonical cultural narratives about the psychic suffering that are available in the collective culture (Valsiner 2012). These narratives seem to be described in Brinkmann’s work (2016) as languages about suffering, as will be explained below.

Canonical Cultural Narratives of Suffering and Psychiatric Diagnosis as a Semiotic Mediator

Considering that human beings are always trying to interpret their own experience through language, Brinkmann (2014) grounds his work in some pragmatic and hermeneutic framing. He agrees that linguistic resources function as tools that enable us to act and deal with the world, mediating the relationships between personal and collective cultures.

In this way, he has proposed what he has called “languages of suffering”—meaning the vocabulary we use to give sense and to regulate our experience of stress. For the author, these languages “work in our lives through social practices, with various associated rituals and symbols and are inscribed into the human body and its habitus” (2014, p.634). In his work, Brinkmann examined five different languages—the diagnostic, the religious, the existential, the moral, and the political.

According to him (Brinkmann 2014), the diagnostic language understands suffering in terms of symptoms described in diagnostic manuals. Following this language, people are supposed to believe that there is a clear boundary between the normal and the sick and that it is possible to conceive discrete illnesses, which can be explained mainly in their biological aspects. In this perspective, it is also possible to comprehend human beings as instances of general laws, and find some causal relations between the disorder and the behaviors, devaluating other social and psychological aspects. By diagnostic culture, in its turn, the author means a tendency to increase the use of psychiatric diagnoses when people have to deal with different forms of distress.

Recognizing the criticisms that traditional psychiatry has received from the social sciences, Brinkmann (2014) affirmed that critics often fail to comprehend the personal and “significant experience of being diagnosed, or the various roles that the psychiatric diagnoses play in the lives of the diagnosed today”(2014 p. 122). Therefore, trying to go deeper, the author proposed that it is possible to conceive the psychiatric diagnosis as a semiotic mediator people use to comprehend themselves. He also added that, as a semiotic mediator, it could have three different functions in the lives of the diagnosed person—an explanatory function, a self-affirming function and a disclaiming function. By the explanatory function, Brinkmann (2014) means that people may use the descriptions of some diagnosis to explain—in a circular way—the causes of these symptoms. The self-affirming function happens when people begin to read numerous phenomena as symptoms, and the last one, the disclaiming function, refers to the possibility of using the diagnosis to medicalize aspects of the moral life and to excuse and disclaim responsibility.

Although the description of these functions may be an important heuristic tool to describe the multiplicity of implications of the subject’s use of a psychiatric diagnosis, once it is conceived as a sign, it would be interesting to situate this understanding within the microgenetic semiotic studies. In this way, it would be possible to characterize the psychiatric diagnosis based on its representational nature, structural complexity, representational power, mediating function, and level of generalization (Silva 2017).

In relation to the representational nature, as already mentioned, signs can be configured as icons, indexes, and symbols. In relation to their structural complexity, they could be organized as point-type or field-type signs. The point-type signs are those that derive from schematic processes and are characterized as simple logical-formal categories (Silva, 2017, p. 13), but useful, for example, for the sharing of experiences between humans. Field-type signs, on the other hand, can be characterized as more complex representations of reality.

The dimension of semiotic representational power refers to the degree to which the signs embody the represented reality. In this dimension, signs can be understood as fragile, when they do not stand in confrontation with reality, meaning, when they satisfactorily represent reality, although they maintain a certain level of flexibility for change, and strong, when they monologize the possible representations of reality and the advance of the dialogical process (Silva 2017, p.10).

In relation to semiotic functions, the signs can be characterized as catalysts and regulators. According to Cabell (2010), catalysts are signs that provide the necessary conditions for the operation or future employment of semiotic regulators, while the latter act directly in the ongoing psychological process, inhibiting or promoting its continuation and development. Thus, catalysts serve as a background, as a condition for other mediation processes (semiotic regulation), without, however, acting directly on the psychological process.

Semiotic regulators, on the other hand, can be classified as intra-mental devices (such as affective signs) or extra-mental devices (symbolic resources), which act directly and simultaneously on psychological processes, personal cultures, and the collective cultural field. As promoter semiotic regulators, they are characterized as field-type abstract signs, whose action is based on the orientation of the possible construction of meaning in the future (Valsiner 2012, p.53). Acting as inhibitory semiotic regulators, signs block or inhibit the emergence of alternative senses, making it difficult to orient oneself toward the future (Mattos 2013, p.52).

Finally, in relation to the level of generalization, signs can be classified by what Valsiner (2014) denominated the hierarchical model of semiotic regulation. The author proposed that it is possible to identify, in the experience of affective regulation, differentiated levels of experience. The first corresponds to the primary physiological activation, the second to the immediate pre-semiotic feeling, the third to the categorial designation of feelings, the fourth to the generalization of aspects of experience, and the fifth to the hypergeneralized field. At the level of hypergeneralized signs, according to the author, no word is necessary.

Methodological Aspects

In order to construct the data analyzed here, narrative interviews were conducted by the first authors with Mary, a fifty-three-year-old woman, mother of seven children, who was diagnosed eight years ago with “bipolar affective disorder” and “enduring personality change after psychiatric Illness.” Initially, we contacted the mental health professionals of the Psychosocial Care Center in which Mary is registered in Salvador, Bahia, Brazil, and asked them to locate possible clients who fit the proposal of our study. Once Mary was indicated, we contacted her by phone and scheduled a personal encounter to discuss our research proposal. In the first meeting, we explained the research proposal and objectives. As she agreed to participate, we conducted an initial interview, attempting to map her family situation and her introduction to the Psychosocial Care Center. After the initial interview, we scheduled three more meetings in which we applied the body-map storytelling technique, proposed by Gastaldo, Magalhães, Carrasco, and Davy (2012). According to the authors, body maps can be defined as images of the body, in real size, created through artistic techniques such as drawing and painting, which have the potential to represent some aspects about people’s lives, their bodies, and the world in which they live. During these meetings, the researcher invites the participant to produce a body map, which will function as a kind of personal totem, containing symbols with different meanings that can only be understood in relation to the creator of the history. The outcomes of applying this technique are: the elaboration of a testimonial, the full-size body map, and the legend (i.e., how the person signifies each element of the body map) (Gastaldo, Magalhães, Carrasco, and Davy 2012). These outcomes are later used for case analysis. Figure 1 illustrates the activities programmed, by the researches, for the three sessions on body-map storytelling:
Fig. 1

Body-map storytelling sessions

However, for the analysis represented in this study, only the narratives indicated by the participant through the body-mapping process were selected. More specifically, the narrative episodes selected (Silva 2017) were those in which the participant referred to signs of illness, “madness,” normality, and medication, since these signs were considered events relevant to our attempt to understand the ways in which psychic suffering and psychiatric diagnosis are meant.

Mary’s Case

Mary was born in 1963 in a little city in the state of Bahia, and at age 18 moved to Salvador. She is the mother of seven children, unplanned fruits of five different relationships, as can be seen in Table 1.
Table 1

Family frame narrated by Maria

 

Partner

Child

 

1

Does not refer the name—dead at one-year-old

 

2

Rita (31 years) and Júnior (28 years)

Mary

3

Lívia (20 years) and Daniela (22 years)

 

4

Mariana (16 years)

 

5

Luzia (12 years)

Currently, Mary lives with her youngest daughter, Luzia. Six years ago, she lived with her partner, André, with whom she had no children. Rita, Daniela, and Lívia are in stable relationships and reside with their husbands and children. Júnior lives alone and Mariana with her paternal family. Except for Rita, who resides in another state, each one has a very close relationship with Mary, and Daniela is the main person responsible for accompanying her to medical appointments at the psychosocial care center. Although Mary has worked as a house cleaner at times, she does not work presently. She maintains herself with only the resources of her partner and from the governmental financial benefit that she receives on behalf of her youngest daughter.

Throughout the meetings, Mary narrated episodes of her personal trajectory, such as her move to Salvador, her relationships, pregnancies, and maternal experiences. These episodes are marked by situations of extreme social and economic vulnerability—such as moments when she was the victim of domestic violence by her partners, moments in which she did not have her own residence or job, and when she faced the absence of assistance by the fathers in the provision for children—as well as by a series of personal coping strategies—such as personal decisions she made to end abusive relationships—that seem to have allowed her to build some continuity in her personal experience. However, as has been said previously, the focus in this study will be on her experience of being diagnosed with a mental disorder.

Speaking about her entry into mental health services, Mary reports that it occurred at a very difficult time, marked by a turbulent separation at the end of her relationship with her fourth husband, Mariana’s father, who assumed the paternity of Luzia. She says that, in that moment, she felt very sad and with a series of bodily sensations that, while disturbing, were not translatable to the general field of language.

I felt a lot of sadness, my heart broke. I felt it was frozen, I felt like I was going to faint, a lot of things at the same time. I felt pain in my body, a lot of things, a lot of sensations. (Mary)

She said that she had already visited basic health services a few times when the medical doctor referred her to the specialized psychiatric unit. According to her, he recommended the specialized professional after he asked if she had had any recent “separation.”

I do not know if he got it from my way of speech, or because of my sadness. I do not know what I have taken to arrive at this thought, but it should be it... Then he said, “Are you experiencing some separation?” And I said, “Yes, I am.” Then he said, “Probably it is why you are feeling this way. Search for a psychiatrist.” And I said, “OK.” (Mary)

Although Mary does not present a precise understanding of the reasons that led her physician to propose the psychiatric consultation, her pre-semiotic experience, through this suggestion, came to be signified under the label of a psychiatric problem and conceived as emotional, psychomotor, and cognitive alterations. Among the emotional changes, Mary highlights a feeling of deep sadness and anhedonia. Among the psychomotor alterations, there are complaints such as feeling “the cold body,” shortness of breath, feeling faint, belly pain, and insomnia. Finally, among cognitive changes, she reports that when she is in crisis, her thoughts “do not go the same” and that she has “horrible dreams.”

Diagnoses of mental disorders, as symbols, were arbitrarily established by the medical community to represent, through a syndrome-related classification, a collection of behaviors built on the assumption that there is a common etiological basis and then a prognosis and a specific indication for treatment. They are therefore aimed to identify abnormal functional units of behavior. Despite their blurred boundaries and obscure principles of organization (even for health professionals), and the fact that they have already been recognized as flawed regarding the specificity of the established classificatory criteria and the indication of specific prognostics and treatments (Hayes and Follette 1992), such signs seem to be taken by the population embedded in a diagnostic culture (Brinkmann 2016) as a generalized point-of-view of psychic suffering which, by proposing to totalize human experience, acquires enormous regulatory power.

Valsiner (2000) states that human life is a constant novel and that it is not possible to find a repetition of the same experience. The author claims the transformation of dynamic processes of development into the static use of descriptors of language, to which he attributes a causal sense, to be an obstacle to science. Thinking about the heterogeneous classes as if they were homogeneous, “has made it difficult to appreciate the central feature of biological and social realities, namely their variability of forms which belong to the same general class” (Valsiner 2000, p.11). The researcher also denounces that one of the reasons that phenomena with high variability has been conceived as belonging to the categories of homogeneous classification relates to the interest of institutions in exercising social control. The most appropriate position, according to the author, would then be to consider human development as an open system whose dynamic stability is built over time, and from the exchange relations that the individual exercises with his or her biological, psychological, and social development.

In the case of Mary, it is inferred that, in the face of a lived ambivalent situation, the social suggestion given by the clinician and later deciphered as a bipolar affective disorder, she assumed as a rigid sign capable of explaining, although circularly (Brinkmann 2016), a large part of her unsettling experience, attenuating her anguish. Such a configuration seems to allow other elements to be included under the aegis of diagnosis, as causal factors, such as the separation, as indicated by the physician, or sometimes as such symptoms as the series of unplanned pregnancies retroactively included in the category. This process seems to be related to what Brinkmann (2016) calls the self-assertion function of the psychiatric diagnosis, represented in the narrative of the participant by the following discourse:

I think most of my kids were not planned. I think I’d already had this disease in my twenties. I was already in trouble. Then, I started to do a lot of wrong thing. She was grateful, she had her children, she was going... (Mary)

However, given its scope and rigidity, this sign seems to act in Mary’s trajectory as an inhibiting regulatory sign, constraining the creative possibilities of new constructions and personal syntheses, which the psychiatric community seems to have labeled through the acronym, “Enduring Personality Change After Psychiatric Illness (EPCAI).” According to the International Classification of Diseases (ICD-10), this classification refers to a “personality change persisting for at least two years, attributable to the traumatic experience of a severe psychiatric illness. According to the manual, it is characterized by “symptoms” like:

Dependency on others (passively assumes, or demands, that others take responsibility for his/her own life; unwilling to decide on important issues related to own actions or future (…) Social withdrawal or isolation secondary to a conviction (not delusional) or feeling of being “changed” or stigmatized as a result of the illness. (…) Passivity, reduced interests and diminished involvement in previously entertained leisure activities (which may reinforce the social isolation (…) A change in the person’s perception of self leading to a frequent or constant claim of being ill. This feature may be associated with hypochondriacal behaviour and an increased utilization of psychiatric or other medical services. (5) A demanding attitude toward other persons in which the subject expects special favours or consider himself/herself deserving special attention or treatment.2

This inhibition, in turn, seems to be strongly associated with Mary’s continued use of neuroleptics (risperidone) and mood stabilizers (valproic acid). In her narrative, the use of these medications carries a lot of ambivalence. This is because, while they are adopted to reduce the negative effects of their symptoms, being associated in the collective culture with the hypergeneralized sign of madness, they legitimate the existence of the disorder itself, and add to the experience of suffering their own side effects (drowsiness, weight gain, loss of memory).

I think it's bad, I wanted to stop these drugs, I do not like it... (silence) I think it’s horrible!(...) There are some people who have prejudice... Because it takes medicine, calls that medicine crazy, these things... (Mary).

In addressing the subject of madness, Foucault (1972) points out the impacts that cartesian epistemology has brought to the conception of it. The author reports that, starting from Descartes, madness has been placed alongside the dream and all forms of error (Foucault 1972, p.52). The possibility of doubt, attributed to the subjects of reason as a criterion for the exercise of rationality itself, would therefore be excluded from the experience of madness, and the mad man precluded from the possibilities of detaining his rights to the truth (Foucault 1972).

Although it is possible to perceive some flexibility on the part of the team of psychiatrists regarding its prescription medication—Mary has already used other medications and narrated episodes in which she complained and had the prescription adjusted—the continued use of the drug therapy seems to be placed as an imposition on her trajectory, as can be seen in the following section:

I talked to the doctor here, what he said ... he said something like this, “You shouldn’t leave the medicines, should you? Do you think you have nothing?” I said, “No, I think I have something.” He said, “So happy for you that you still have the medicine to take.” (Mary)

In this sense, Mary reported she is afraid to stress the relationship with the team of professionals with the proposition that she could exercise some autonomy and introduce some flexibility to her medical treatment. Thus, sometimes she ends up privately formulating personal strategies whose criteria are not based on the pharmacological aspects of the medicines. In the episode described below, for example, Mary states that she had to suspend the medication in order to attend her daughter, Daniela, after the birth of her grandson:

I slept one night there, without taking medicine! But I was not sleeping all night(…) From 10 o’clock to 5 in the morning, sitting, but for me it was a happiness! I was going to take medicine, but Livia said, “Do not take it, because if you take it...” Daniela is waking up every 10 minutes, 15 minutes, to change diapers, to nurse, to drink water... Then someone had to get up right, to get... Then, I stayed there... (Mary)

Throughout the narrative, one could also perceive that the border between the disease sign and the hypergeneralized field of madness appeared to be maintained, especially by her familiar microculture. As Mary related, her children and her partner, André, recognize her as a person who presents a “disease,” but who is a normal person, capable of arbitrating over her own life, having secured its legitimacy as mother and as wife.

There at home I am not, they don’t see me in this way. There, my children do not think of me like that... They see me as a normal person, they do not see me as crazy. (Mary)

In addition, in her discourse, her relatives appear as people capable of offering other therapeutic strategies, besides drugs, more affective at stabilizing her in situations where she presents some psychic decompensation:

I’ve already had a crisis, already with Junior, already ... He kept telling me to take water... I was naked... He said, “Calm down, Mother,” and I wanted to leave. He said, “Calm down, go and take a shower, go, go get some water.” He picked up a bottle of cold water for me to drink... I was drinking water, then I had a stomachache. I had it all at the same time... Then he took me to the bathroom (…) He suffered a lot on that day that I had this crisis. He said, “Tomorrow you will, I will take you into the center of psychosocial attention. Stay there.” Then, I took it and took the water. He said, “Then, I will give you medicine. Take the cold water that will pass, be quiet there.” Then, I put on my clothes, then he told me to lie down. I picked him up and went to bed. Then, he went, he went and it passed, I took medicine and passed him. (Mary)

Thus, one can say that motherhood appears to be an important element in her personal synthesis, providing her with some ontological security, this vital yearning for an experience of the world and existence itself, as endowed with order, justification, and meaning (Peters 2014, p.21). This assumption agrees with the results of the studies produced by Carteado (2008); Blegen et al. (2014); Perera et al. (2015); and Carvalho et al. (2007). These authors stated that, for women with a psychiatric diagnosis, maternity appears as a normalizing achievement of adult life, making it possible for these subjects to be de-alienated in relation to the restrictions imposed by the stigma of madness. Although she affirms the difficulties of being the mother of so many children in a situation of such social and economic vulnerability, Mary recognizes the children as “privileges of God,” and as “sources of happiness.” In this way, the psychiatric diagnosis, the continuous treatment, and motherhood appear as elements that integrate her personal synthesis, as can be seen in the following section:

Researcher: If you were to introduce yourself... and say, your personal characteristics... what would you say?

Mary: I am Mary, I do treatment at CAPS. I have my children and I will tell you how many children I have, how long I have been treating here. I am much better here, thank God. Only that.

Figure 2 illustrates a graphical attempt to represent the elements highlighted in this analysis.
Fig. 2

Personal synthesis

At the primary physiological activation level of experience, the strangeness of Mary’s sensations, decoded as symptoms through the psychopathological bias, came to be understood as an element that confirms the psychiatric diagnosis, which appears culturally imbricated with the hypergeneralized field of madness. At the same time, her experience of motherhood and the legitimacy of her social place by her family demarcate a border between mental disorder and madness, placing Maria within the field of normality in which she has preserved her autonomy and the possibility of self-management of her treatment, including the possibility of not using the medicines. The use of psychiatric medications, in this way, seems to occupy an ambiguous place in her trajectory. If, on the one hand, this use confirms the diagnosis and promotes a series of unwanted side effects, on the other hand, it aids her process of emotional regulation and the attenuation of her ambivalence.

Final Considerations

The analysis carried out in this article proposed that psychiatric diagnosis, as a sign, can be configured in different ways regarding its nature, power, representational structure, and its semiotic function. Such configurations will depend on the modes in which the subject signifies them throughout their interaction with significant social others. It emphasized that, given the prevalence of what Brinkmann (2016) called the diagnostic culture, the psychiatric label presents great potential to be configured as a strong and inhibitory regulatory sign, implying in future and very restricted possibilities of signification. The imposition of continued medical treatment, as well as the paltry supply of other languages to deal with suffering, seem to support the monologization of experience. In the case presented, we sought to analyze the ways in which the participant integrates diagnosis and maternity, as potentially disruptive events in her notion of herself. It was proposed that family microculture appears as an important resource in promoting a personal synthesis that, if on the one hand recognizes illness, on the other establishes reasonably clear boundaries between what is conceived as mental disorder and the hypergeneralized field of madness, guaranteeing certain personal integrity and legitimacy of her social function as a mother.

Finally, it was proposed that the configuration of the psychiatric diagnosis, as a semiotic mediator, on a microgenetic level, can help in understanding the processes involved—alongside the contingent relationships that holistically characterize the experience of the people—the psychiatric diagnosis functions described by Brinkman (2016): explanatory, self-affirming, and disclaiming.

Footnotes

  1. 1.

    This proposal is part of a larger research project in which we try to analyze the meanings of motherhood and “filhity” in dyads, including mothers who present psychiatric diagnoses and their small children, as well as the networks of social protection available to them.

  2. 2.

References

  1. Abbey, E. (2011). Beyond "women", "mothers" and "me": Imagination, poetics, and why surpassing social normas means surpassing the self. In. A.C.S. Bastos, K. Uriko, & J. Valsiner (Eds.), Cultural dynamics of women's lives. (pp. 95-1106) Charlotte, N.C: Information Age.Google Scholar
  2. Bastos, A.C., Santos, A. K., Araujo, J., Meneses, S. (2015). I-Mother the Caregiver? How a Strong Sign Persists Through Semiotic Self-Scaffolding Along Life Transitions. In: Cabell K., Marsico G., Cornejo C., Valsiner J. (Org.). Making Meaning, Making Motherhood. 1ed.Charlotte, NC, Estados Unidos: Information Age Publishing. v. 1, pp. 279–308.Google Scholar
  3. Blegen, N. E., Hummelvoll, J. K., & Severinsson, E. (2012). Experiences of motherhood when suffering from mental illness: a hermeneutic study. International Journal of Mental Health, (5), 419–427.Google Scholar
  4. Blegen, N. E., Eriksson, K., & Bondas, T. (2014). Through the depths and heights of darkness: Mothers as patients in psychiatric care. Scandinavian Journal of Caring Sciences, 28(4), 856–860.CrossRefGoogle Scholar
  5. Brinkmann, S. (2014). Languages of suffering. Theory & Psychology, 24(5), 630–648.CrossRefGoogle Scholar
  6. Brinkmann, S. (2016). Diagnostic cultures: A cultural approach to the Pathologization of modern life. London: Routledge.Google Scholar
  7. Bruner, J. (2001). Self-making and world making. In: J. Brockmeier & D. Carbaugh (Eds.). Narrative and identity: studies in autobiography, self and culture. Amsterdam/Philadelphia: John Benjamins Publishing Company.Google Scholar
  8. Cabell, K. (2010). Mediators, regulators, and catalyzers: a context-inclusive model of trajectory development. Psychology & Society, 3(1), 26–41.Google Scholar
  9. Cabell, K. R., Cornejo, C., Marsico, G., & Valsiner, J. (Eds.). (2015). Making meaning, making motherhood. Annals of Cultural Psychology, Vol. 1. Charlotte: Information Age.Google Scholar
  10. Carteado, M. (2008). Ela não pode ser mãe: quando maternidade e loucura se cruzam. In: Silva, M.V.O; IN-tensa /EX-tensa: A Clínica Psicossocial das Psicoses. 1ª. ed. Salvador: LEV - Laboratório de Estudos Vinculares / UFBA.Google Scholar
  11. Carter, B., & McGoldrick, M. (1995). As mudanças no ciclo de vida familiar: uma estrutura para a terapia familiar. Porto Alegre: Artes Médicas.Google Scholar
  12. Carvalho, A. M. P., Souza, J., Farinha, M. G., & Corradi-Webster. (2007). Mães com transtornos mentais: um estudo exploratório. Revista Eletrônica Saúde Mental Àlcool Drogas, 3(1), 1–17.CrossRefGoogle Scholar
  13. Dolman, C., Jones, J., & Howard, L. (2013). Pre-conception to parenting: a systematic review and meta-synthesis of qualitative literature on motherhood for women with severe mental illness. Archives of Women's Mental Health, 16(13), 173–196.CrossRefPubMedGoogle Scholar
  14. Foucault, M. (1972). A história da loucura na idade clássica. São Paulo. In Perspectiva.Google Scholar
  15. Gastaldo, D., Magalhães, L., Carrasco, C., and Davy, C. (2012). Body-Map Storytelling as Research: Methodological considerations for telling the stories of undocumented workers through body mapping. Retrieved from http://www.migrationhealth.ca/undocumented-workers-ontario/body-mapping. Accessed 15 June 2015.
  16. Hayes, S. C., & Follette, W. C. (1992). Can functional analysis provide a substitute for syndromal classification? Behavioral Assessment, 14, 345–365.Google Scholar
  17. Mattos, E. de (2013). Self development in the transition to adulthood: A longitudinal study with youth from Bahia. Tese de Doutorado, Instituto de Psicologia, Universidade Federal da Bahia, Salvador.Google Scholar
  18. Mccauley-Elson, K., & Kulkami, J. (2007). Managing psychosis in pregnancy. The Australian and New Zealand Journal of Psychiatry, 31(3), 289–292.CrossRefGoogle Scholar
  19. Perera, D., Short, L., & Fernbacker, S. (2015). There is a lot to it: being a mother and living with a mental illness. Advances in Mental Health, 12(3), 167–181.CrossRefGoogle Scholar
  20. Peters, G. (2014). From sociological existentialism to insane epistemology: social order as a psychic problem. 364f. Tese (Doutorado em Sociologia) – Instituto de Estudos Sociais e Políticos, Universidade do Estado do Rio de JaneiroGoogle Scholar
  21. Pontes, V. V. (2013) Construindo continuidade frente a sucessivas rupturas: estratégias semióticas de reparação dinâmica do self. Tese de Doutorado, Instituto de Psicologia, Universidade Federal da Bahia, Salvador, Bahia.Google Scholar
  22. Silva, M. S. (2017). Affective-semiotic processes in the integration of a child loss for violent death to the mother’s sense of personal identity. Tese de Doutorado, Instituto de Psicologia, Universidade Federal da Bahia, Salvador, Bahia.Google Scholar
  23. Valsiner, J., & Abbey, E. (2005). Emergence of meanings through ambivalence. Forum, Qualitative Social Research / Forum, Qualitative Sozialforschung, 6(1), 1–16.Google Scholar
  24. Valsiner, J. (2000). Cultural and human development. USA, Sage Publications Ltd.Google Scholar
  25. Valsiner, J. (2012). Fundamentos de uma psicologia cultura: mundos da mente, mundos da vida. São Paulo: Artmed.Google Scholar
  26. Valsiner, J. (2014). Why cultural psychology? Making the human condition meaningful. In: Jaan Valsiner (Ed.), An invitation to cultural psychology. USA, Sage Publications Ltda.Google Scholar
  27. Zittoun, T. (2015). Imagining one’s life: imagination, transitions and developmental trajectories. In S. M. G. Gondim & I. D. Bichara (Orgs.) A Psicologia e os Desafios do Mundo Contemporâneo: livro de conferências. Salvador: EDUFBA.Google Scholar
  28. Zittoun, T., Valsiner, J., Vedeler, D., Salgado, J., Gonçalves, M., & Ferring, D. (2013). Human development in the life course: melodies of living. Cambridge University Press.Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Brena Cristiane Bahia de Carvalho
    • 1
  • Marilena Ristum
    • 1
  1. 1.Federal University of BahiaSalvadorBrazil

Personalised recommendations