Mental Health Recovery Narratives: A Thematic Analysis

Llewellyn-Beardsley, J., Rennick-Egglestone, S., Pollock, K., Ali, Y., Watson, E., Franklin, D., … & Edgley, A. (2022). ‘Maybe I shouldn’t talk’: The role of power in the telling of mental health recovery stories. Qualitative Health Research, 32(12), 1828-1842.

Rationale

Mental health “recovery narratives” are increasingly used in healthcare settings for purposes like staff training, challenging stigma, and peer support (Salter & Newkirk, 2019; Slade et al., 2021).

However, their use has been critiqued as potentially co-opting lived experience to serve organizational agendas rather than empowering narrators (Costa et al., 2012; Fisher & Lees, 2016).

Despite these critiques, the perspectives of people with lived experience on what it is like to tell their stories have not been explored at scale.

This study aimed to address this gap by examining how stories of lived experience are told in various settings from the perspectives of people from specific marginalized groups.

Method

This qualitative study used purposeful sampling to recruit 84 people with lived experience of mental distress from specific marginalized groups in England.

Semi-structured interviews lasting 40-120 minutes were conducted, including an open-ended narrative elicitation question and a topic guide.

For this analysis, data from 71 participants responding to a question about how their stories might vary in different settings was examined.

A reflexive, inductive approach to thematic analysis was used within a critical constructivist methodology.

Sample

The 71 participants included 39 women, 29 men, and 3 who chose not to specify gender.

Ages ranged from under 25 to over 65. 25 participants identified as being from Black, Asian or other minority ethnic communities, 15 identified as LGBTQ+, 39 had self-identified experiences of psychosis, and 28 had paid or voluntary peer trainer or support roles.

Results

The overarching finding was that power dynamics affected how lived experience stories were told. Four key themes were identified:

1. Challenging the status quo:

Peer participants reported using their stories to challenge stigma and conventional assumptions.

Peers reported opportunities to disrupt traditional power relationships within health services through reciprocal exchange of personal experiences.

For example, one participant described sharing her adverse childhood experiences to change perceptions:

“It’s easy for people to think [of those who] have grown up around heroin addiction and squats as lesser […] But when you’re making those judgements, you’re making those judgements about me.”

2. Risky consequences:

Both peer and non-peer participants reported a strong sense of risk associated with sharing their stories.

Getting the story ‘right’ was crucial because the consequences of getting it wrong were seen as potentially serious.

Participants described perceiving strong risks in telling their stories, including exacerbating shame, causing distress, being stigmatized, or losing benefits/jobs.

Participants described making fine judgments about what to share, when, and with whom. This involved a process of ‘sussing out’ recipients and gauging their reactions in real-time.

Participants also feared judgment for describing their recovery, which could be seen as boastful.

One participant explained:

“I suppose, when I’m talking to a clinician I would be very wary, I think, because if I say half the stuff that has happened in my head, they might go, ‘right, lock you up’!”

3. Producing “acceptable” stories:

Participants reported pressure to tell normative, acceptable stories rather than authentic ones.

Certain experiences, particularly those related to psychosis, were reported as being less acceptable than other forms of mental distress.

The pressure to produce acceptable stories often resulted in participants feeling unable to share their full, authentic experiences, particularly regarding trauma or systemic issues.

One described:

“You’re allowed to say, ‘I’ve been having a difficult time’. But, telling somebody that you’ve been sectioned? It does not go down well.”

4. Untellable stories:

Some participants reported being unable to speak about certain traumatic parts of their stories, either temporarily or long-term.

These often included accounts of psychosis-like experiences, sexual abuse, suicide attempts, and rape.

These experiences were described as things that “really scar us deeply and are really painful.”

Untellable aspects of stories were sometimes demonstrated in interviews through fading sentences or dissolving speech when approaching traumatic subjects.

One participant’s speech broke down when trying to discuss childhood sexual abuse:

“Yeah. Those are deep dark, dark, dark, dark, don’t, don’t … that you don’t do.”

Insight

This study provides valuable insights into the complexities and power dynamics involved in telling mental health recovery stories.

It highlights how marginalized individuals must carefully navigate different contexts when sharing their experiences, often at the cost of authenticity.

The findings support critiques of how recovery narratives are used in mental health services, showing how organizational agendas can constrain which stories are deemed acceptable.

The study also reveals the ongoing impact of stigma and trauma in shaping what can and cannot be told about mental distress experiences.

Clinical Implications

The results have significant implications for how mental health services and researchers approach the use of recovery narratives.

They suggest a need for more trauma-informed, power-conscious practices that create safer spaces for authentic storytelling.

The findings highlight the importance of addressing systemic inequalities and stigma that constrain narratives, particularly for people with intersecting marginalized identities.

Mental health practitioners, policymakers, and researchers may need to critically examine how they elicit and use lived experience stories to avoid inadvertently reinforcing harmful power dynamics.

Strengths

The study had many methodological strengths including:

• A large, diverse sample of participants from marginalized groups
• Use of researchers with lived experience of mental distress and other marginalized identities
• A reflexive, critical approach to analysis
• Rich qualitative data providing in-depth insights into participants’ experiences

Limitations

• The study was limited by occurring in the context of a health sciences study specifically asking for “recovery” stories, which may have shaped participants’ responses.
• Analysis was restricted to data from one interview question, potentially missing relevant context. T
• he sample was limited to participants in England, so findings may not be generalizable to other cultural contexts.
• The focus on marginalized groups, while a strength, also means experiences of more privileged individuals were not captured.

References

Primary reference

Llewellyn-Beardsley, J., Rennick-Egglestone, S., Pollock, K., Ali, Y., Watson, E., Franklin, D., … & Edgley, A. (2022). ‘Maybe I shouldn’t talk’: The role of power in the telling of mental health recovery stories. Qualitative Health Research, 32(12), 1828-1842.

Other references

Costa, L., Voronka, J., Landry, D., Reid, J., Mcfarlane, B., Reville, D., & Church, K. (2012). “Recovering our stories”: A small act of resistance. Studies in Social Justice, 6(1), 85-101.

Fisher, P., & Lees, J. (2016). Narrative approaches in mental health: Preserving the emancipatory tradition. Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine, 20(6), 599-615.

Salter, L., & Newkirk, J. (2019). Collective storytelling for health: A three-part story. Storytelling, Self, Society, 15(1), 108-129.

Slade, M., Rennick-Egglestone, S., Llewellyn-Beardsley, J., Yeo, C., Roe, J., Bailey, S., Smith, R. A., Booth, S., Harrison, J., Bhogal, A., Mor´an, P. P., Hui, A., Quadri, D., Robinson, C., Smuk, M., Farkas, M., Davidson, L., van der Krieke, L., Slade, E., & Ng, F. (2021). Recorded mental health recovery narratives as a resource for people affected by mental health problems: Development of the Narrative Experiences Online (NEON) intervention. JMIR Formative Research, 5(5), Article e24417.

Keep Learning

Suggested Socratic questions for a college class to discuss this paper:

1. How might power dynamics in different settings influence the way people tell their mental health stories? What are some examples from your own experiences?
2. What ethical considerations arise when asking people to share traumatic or stigmatizing experiences? How can researchers and practitioners balance the potential benefits and risks?
3. How do societal narratives about mental health shape individual stories? What role do factors like race, gender, and sexuality play in this process?
4. What are the implications of this research for mental health services? How might practices need to change to create safer spaces for authentic storytelling?
5. How does the concept of “acceptable” stories relate to broader issues of stigma and discrimination in society? What would need to change for a wider range of mental health experiences to become “tellable”?
6. What are the potential benefits and drawbacks of using recovery narratives in mental health education and anti-stigma campaigns? How might this research inform those practices?
7. How might the findings of this study apply to other areas where personal narratives are used, such as in social movements or public health campaigns?
8. What further research questions does this study raise? How would you design a follow-up study to address some of the limitations or expand on these findings?