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The McGill Illness Narrative Interview (MINI): An Interview Schedule to Elicit Meanings and Modes of Reasoning Related to Illness Experience

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Abstract

This article summarizes the rationale, development and application of the McGill Illness Narrative Interview (MINI), a theoretically driven, semistructured, qualitative interview protocol designed to elicit illness narratives in health research. The MINI is sequentially structured with three main sections that obtain: (1) A basic temporal narrative of symptom and illness experience, organized in terms of the contiguity of events; (2) salient prototypes related to current health problems, based on previous experience of the interviewee, family members or friends, and mass media or other popular representations; and (3) any explanatory models, including labels, causal attributions, expectations for treatment, course and outcome. Supplementary sections of the MINI explore help seeking and pathways to care, treatment experience, adherence and impact of the illness on identity, self-perception and relationships with others. Narratives produced by the MINI can be used with a wide variety of interpretive strategies drawn from medical anthropology, sociology and discursive psychology.
The McGill Illness Narrative Interview (MINI): An
Interview Schedule to Elicit Meanings and Modes of
Reasoning Related to Illness Experience
DANIELLE GROLEAU, ALLAN YOUNG, & LAURENCE J. KIRMAYER
McGill University
Abstract This article summarizes the rationale, development and appli-
cation of the McGill Illness Narrative Interview (MINI), a theoretically
driven, semistructured, qualitative interview protocol designed to elicit illness
narratives in health research. The MINI is sequentially structured with three
main sections that obtain: (1) A basic temporal narrative of symptom and
illness experience, organized in terms of the contiguity of events; (2) salient
prototypes related to current health problems, based on previous experience
of the interviewee, family members or friends, and mass media or other
popular representations; and (3) any explanatory models, including labels,
causal attributions, expectations for treatment, course and outcome.
Supplementary sections of the MINI explore help seeking and pathways to
care, treatment experience, adherence and impact of the illness on identity,
self-perception and relationships with others. Narratives produced by the
MINI can be used with a wide variety of interpretive strategies drawn from
medical anthropology, sociology and discursive psychology.
Key words ethnography explanatory models health behavior illness
narratives research methods prototypes qualitative interview
In this article we present the McGill Illness Narrative Interview (MINI), a
theoretically driven, semistructured, qualitative interview schedule
designed to elicit illness narratives in health research. The MINI can be a
Vol 43(4): 671–691 DOI: 10.1177/1363461506070796 www.sagepublications.com
Copyright © 2006 McGill University
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useful tool not only for research in medical anthropology and cultural
psychiatry but also in related fields including medical sociology, medical
geography, health psychology, public health, literary pathography, and
other disciplines that aim to understand health behavior or illness narra-
tives in sociocultural context. Working with the rich narratives obtained
with the use of the MINI may stimulate exchange between disciplines and
complement quantitative research methods.
In the first part of the article, we address the epistemological, disciplin-
ary and theoretical contexts in which the MINI was developed. We then
discuss the strengths and limitations of this instrument. As well, we outline
the steps that should be taken before interviewing in order to maximize
the validity and usefulness of the narratives produced. Finally, we provide
explanations of each of the sections of the MINI along with guidelines for
its use. A version of the interview schedule is reproduced in an Appendix.
The Narrative Turn: Contexts of Narrative-based
Research
The study of health behavior, illness experience and meaning can be
approached through a variety of research methods, disciplines and scien-
tific paradigms. While quantitative research methods have dominated
recent psychiatric research, they have significant limitations in capturing
the complexity of human behaviour and experience (Guba & Lincoln,
1994). In particular, quantitative measures tend to ignore the social and
discursive contexts in which individual and collective understandings of
illness experience emerge. Even the simplest, apparently straightforward
questions of epidemiological interviews may be interpreted quite differ-
ently by people who employ different cultural frames. Understanding the
meaning that individuals give to their experience may be crucial to explain
the statistical associated between variables observed in quantitative studies
of groups or populations.
Qualitative methods, in particular the narrative approach, are meant to
overcome some of the inherent limitations of questionnaire-based
research by studying health behavior as ‘a means of examining the ways in
which individuals make sense of their lives within a changing sociohistor-
ical context’ (Phinney, 2000, pp. 27–28). A variety of methods for quali-
tative research interviewing have been systematized and presented in texts
and monographs in recent years (Arksey & Knight, 1999; Holstein &
Gubrium 1995; Kvale, 1996; Mishler, 1985; Rubin & Rubin, 1995). Across
the wide range of available methods, qualitative interview research shares
a constructivist perspective that views the speaker or interviewee as
actively involved in meaning making (Holstein & Gubrium, 1995; Whitley
& Crawford, 2005).
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This constructive process has both internal psychological dynamics and
external social dynamics. The psychological dynamics include the ways in
which narratives are shaped by processes of memory and emotion regu-
lation and may undergo internal censorship, revision and reorganization
to maintain an account of self and others that serves the individual’s goals
and adaptation (Neisser & Fivush, 1994). As a result of these psychologi-
cal dynamics, narratives are always multilayered and polysemous, with
traces of their genesis in internal conflicts, biases, dissonance reduction,
and efforts to attain cognitive coherence.
The social dynamics of narratives reflect their use for communication,
social positioning and rhetorical influence. Narratives are always situated:
told from a specific social position, to someone for some reason (Harré &
Van Langenhove, 1999). As a result, the audience plays a role in the
construction of narratives, even in the case of private soliloquy, when there
may be an imagined audience. At the same time, narratives serve to repo-
sition the speaker and audience, claiming a social place and defending it
against challenges or efforts at displacement. Traces of the social dynamics
that give rise to illness narratives are found in the heteroglossia and the
specific strategies employed to give a narrative the rhetorical power to
influence others (Kirmayer, 2000).
In recent decades, there has been an enormous growth of narrative
research with diverse theoretical orientations and methodologies that
include studies that focus on the content of narratives, identifying
dominant themes relevant to social theory (Glaser & Strauss, 1967),
and studies inspired by literary theory that focus on the form of narra-
tives, where the interest lies in understanding their story-like structure
(Czarniawska, 2002; Riessman, 2002; Smith 2002). These different analyti-
cal approaches are grounded in various disciplines of the social sciences
and humanities, including sociology (Brown, 1977), literary theory
(Bakhtin, Medvedev, & Wehrle, 1991), anthropology (Geertz, 1973),
political science (Fisher, 1984), psychology (Bruner, 1990), philosophy
(MacIntyre, 1981; Rorty, 1991) and history (White, 1987). Although each
discipline has developed methodological strategies for narrative-based
research, more basic theoretical models and allegiances remain crucial to
the analytic and interpretive strategies and must be made explicit to avoid
conceptual biases and to resolve potentially conflicting results among
studies of the same subject (Wengraf, 2001).
Warren (2002) has argued that researchers who choose qualitative inter-
views over participant observation do so because their primary focus is on
establishing common patterns of meaning within certain groups or types
of respondents rather than examining cultural context per se. In this
perspective, qualitative interviewing can be a useful tool for studying
health behaviors such as treatment adherence or pathways to care within
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or between cultural communities. But the capacity to compare narratives
based on health behavior depends on the level of structure of the quali-
tative interview. Completely unstructured interviews may yield narratives
that are too different across subjects, making systematic comparison
impossible. For example, if a narrator does not produce a meaning relative
to one aspect of the health problem discussed, it does not necessarily mean
that he does not share the same meaning with another narrator who did
mention it. It may simply be that he did not address this specific meaning
because he was not explicitly invited to do so via a structured question in
the interview schedule. Structured interviews with open-ended questions
invite narrators to make statements on predetermined subjects without
limiting their potential answers to a predetermined set of possibilities (as
in the closed-ended questions typically used in quantitative research), and
thus allow systematic comparison across interviews,
Qualitative interviewing is a form of ‘guided conversation’ in which the
researcher systematically looks for and carefully listens to what is being
conveyed so as to hear the meaning’ (Kvale, 1996; Rubin & Rubin, 1995).
Qualitative interviews must therefore also contain at least some unstruc-
tured questions, otherwise narrators will not have the opportunity to tell
their story in their own way, thus limiting access to the sociocultural
processes that influence their experience. This type of analysis was initially
developed in literary theory but has since been widely used by researchers
in medical anthropology (Garro & Mattingly, 2000). It seems then, for the
purposes of comparison, and in order to access the sociocultural context
involved in illness experience, interviews must contain both structured
and unstructured elements.
Intensive, open-ended interviews have been a core methodology in
ethnography and medical anthropology (Kleinman, 1980). Although
narrative-based methods are increasingly recognized as a means of exam-
ining the multiple ways in which individuals make sense of their
symptoms and illness in health research, studies based on qualitative
methods are still uncommon in psychiatry (Whitley & Crawford, 2005).
Only a few reports have been published on qualitative interviews designed
to explore patients’ illness experience and health behaviors. Kleinmans
original set of questions developed to elicit explanatory models have been
widely used and adopted in both clinical and research settings (Kleinman,
1980; Kleinman, Eisenberg, & Good, 1978) but there has been little work
on how such questions actually function in the interview context.
Several interviews have implemented a mixed method approach,
incorporating both structured-quantitative and open-ended qualitative
components to facilitate systematic comparison. The chief example is the
Explanatory Model Interview Catalogue (EMIC; Weiss, 1997; Weiss et al.,
1992) which uses structured questions and an elaborate predetermined
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coding scheme to produce quantitative measures of symptom attributions
and other features of illness experience. The Short Explanatory Model
Interview (SEMI; Lloyd et al., 1998) was developed to provide a brief
method of assessing illness attributions and other aspects of explanatory
models. Such mixed method interviews have varying levels of structure
and may include checklists of symptoms and illness attributions. While
this allows systematic comparison it may not produce narratives of
sufficient spontaneity and depth to allow more intensive methods of
narrative and discourse analysis.
The McGill Illness Narrative Interview
The MINI, a semistructured qualitative interview schedule, was initially
developed to explore individuals’ illness experience in a community study
of help seeking, medically unexplained symptoms and use of mental
health services (Young & Kirmayer, 1996). The initial protocol was based
on Youngs experience with ethnographic interviewing in Ethiopian
communities and in primary care settings in Israel. The interview was field
tested and refined by discussion among the investigators and with six
interviewers (who had Masters-level training in anthropology, psychology
or social work) who conducted a total of 120 interviewers in English,
French or Vietnamese.
1
The MINI was subsequently adapted to explore treatment adherence
and delayed emergency room presentation in first-time postmyocardial
infarction patients (Groleau, Hudon, Lespérance, Rosberger, & Kirmayer,
2006, and the behavior and meaning systems of patients with hypereme-
sis gravidarum (Groleau, Jimenez, Zelkowitz, & Kirmayer, 2005). The
current version of the MINI represents the fourth major iteration in its
development. Although the questions included in the MINI reflect the
focus of specific projects on illness experience, symptom attribution, help
seeking and treatment adherence, the structure of the MINI emerged from
more basic assumptions about the nature of knowledge structures under-
lying illness narratives.
The MINI was initially developed in response to Youngs (1981, 1982)
critique of the explanatory model perspective in medical anthropology.
Young argued that there is a tendency in health psychology and medical
anthropology to suppose that lay accounts of illness experience form
logical and coherent schemas organized around causal attributions. On the
basis of his ethnographic work in community and clinical settings, Young
suggested that, in fact, individuals use multiple representational schemas
and modes of reasoning to produce illness narratives that are complex and
sometimes internally inconsistent or contradictory. In particular, Young
pointed to the importance in illness narratives of salient prototypes, which
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are used to reason analogically about one’s own condition, and to chain-
complexes (a term borrowed from Vygotsky, 1962, 1978), which involve
representations of association by contiguity and which are used to reason
metonymically (Young, 1981; see also Kirmayer, Young, & Robbins, 1994).
Studies have indicated that patients facing serious illness do not always
offer causal attributions for their illness (Weiner, 1985). Explanatory
models based on patients’ causal attributions of their disease reveal only a
small portion of the many representations that come into play with
regards to illness and health-related behavior (Groleau, 1998, 2005;
Groleau & Kirmayer, 2004; Groleau et al., 2005, submitted; Groleau,
Soulière, & Kirmayer, 2006).
2
Based on this more complex picture of illness representation, the MINI
was designed to elicit three distinct types of reasoning about or represen-
tations of symptoms or illness:
1. Explanatory models are based on causal thinking which may involve
conventional models, causal attributions or more elaborate models
involving specific processes or mechanisms (Examples: ‘I have a cold,
you know a virus’; ‘I had a heart attack because I was too stressed’;
‘I’m depressed because my boss has been harassing me for the past
year and it has really undermined my self-esteem’);
2. Prototypes involve reasoning based upon salient episodes or events in
one’s own or others’ experiences, which allow individuals to elabor-
ate the meaning of their illness through analogy (Example: ‘Last year,
my uncle and aunt died of lung cancer, so I got scared and decided
to quit smoking’);
3. Chain-complexes in which past experiences are linked metonymically
to present symptoms through a sequence of events surrounding the
symptoms without any explicit causal connection or salient proto-
type. (Example: Around the time of my divorce, I starting having this
pain in my chest. Then I got a cough that wouldn’t go away’).
Although these modes of reasoning tend to co-occur in any account of
symptoms or illness, they can be distinguished in interview transcripts and
reliably coded (Stern & Kirmayer, 2004). These three modes of reasoning
often coexist but they are not all equally stable. Repeated chain complexes
may come to constitute a prototype. Once an explanatory model is made
explicit, individuals tend to use it to organize their narrative and impose
a coherent structure and causal order on their memories of symptoms and
illness experience. Chain-complexes represent implicit learning and
procedural knowledge that is structured in terms of links or associations
without a specific model, image or prototype. As a result, they are largely
outside awareness; once an individual’s attention is directed to the chain-
complex, they tend to elaborate it as a prototype or assimilate it into an
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explanatory model. For this reason, the MINI is structured to elicit
chain-complexes first, followed by prototypes, and only then to explore
explanatory models.
Of course, prototypes and explanatory models are not only personal or
idiosyncratic but also refer to cultural models that are part of popular
theories of health. Such popular theories of health influence the adoption
of preventive and curative behaviors (Groleau & Kirmayer, 2004; Groleau
et al., 2005). However, in line with contemporary culture theory, the MINI
does not sharply distinguish between personal and cultural meanings,
which are intertwined in any individual’s account. The distinction between
these levels of knowledge and discursive practices can be determined by
additional explicit questions or, more effectively, by a research design that
allows comparison of interviews across groups of individuals from specific
cultural backgrounds or social positions.
The generic version of the MINI presented here can be used to explore
meaning and experience linked to any health problem, condition or event
and is not limited to symptoms, symptom cluster, syndromes, biomedical
diagnoses or popular labels. Depending on the research question, the
MINI can be used to compare individuals, categories of health behaviors,
or cultural groups. The narratives it elicits are largely retrospective
accounts of illnesses or symptoms experienced in the past but it may
include descriptions of ongoing symptoms and future concerns or antici-
pated events, as was done in a study of patients in the period immediately
following a first heart attack (Groleau et al., submitted).
Using the MINI
In this section we outline the steps and considerations in adapting and
applying the MINI to the study of specific health problems. In particular,
we discuss: (1) Preparatory steps in research design and interview modi-
fication; (2) negotiating the interview process with the patient; and (3)
conducting the interview, with notes on specific questions in the MINI.
The current version of the MINI in use by our research team is presented
in the Appendix.
Preparation
The MINI provides an overall structure and sequence of questions but
interviewers must improvise additional questions and probes to clarify
responses. Like any open-ended form of interviewing the MINI depends
on the interviewer’s understanding of the underlying research questions
and the broader conceptual framework guiding the inquiry. Training inter-
viewers in the use of the MINI, therefore, involves not only technical
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aspects of its use but also knowledge of the discipline and familiarity with
theoretical framework. Our experience with the MINI in different settings
suggests that extensive initial training of interviewers is crucial and should
be followed up by ongoing meetings between researcher and interviewers
in which process of the MINI is monitored, and audio and video record-
ings of completed interviews are reviewed.
Open-ended interviews guided by the MINI are lengthy: The time
required to complete the full interview schedule is an average of 2 hours
per participant but varies widely with the illness history, as the emotional
quality and interactional process of the interview. Some interviewees are
loquacious and require refocusing to stay on topic, others have difficulty
expressing themselves and require multiple interviews to build trust and
rapport and elicit a rich narrative.
One of the strengths of the MINI is that it allows for the exploration of
diverse meanings and ways or reasoning held by interviewees about their
symptoms, whether contradictory or complementary. As well, the un-
structured part of the MINI enables researchers to explore how personal
illness experiences of narrators are embedded in social processes and
cultural contexts. It also allows identification of idioms of distress and
popular labels linked to specific health problems and sociocultural
contexts (Groleau & Kirmayer, 2004).
Sampling must reflect these research objectives; this in turn will guide
the selection of participants according to whether they share a common
health problem or sociocultural background, or whether certain health
behaviors can be compared on the basis of participant narratives.
The MINI guides a conversation that produces narratives that can be
used to study individual illness meanings, modes of reasoning, historical
sequences, and the sociocultural contexts of illness experience. The MINI
does not produce a monolithic account of individuals’ knowledge and
experience of illness or symptoms. Instead, it aims to capture personal
knowledge and experience in its complexity, allowing for the internal
contradictions and inconsistencies often present in everyday life. In
subsequent data analysis, this complexity can be contextualized both in
terms of the interview process (e.g., how individuals construct and recon-
struct their account over the course of the interview vis-à-vis a specific
interlocutor) and in terms of larger social, cultural, political and histori-
cal contexts.
Negotiating the Interview Process
At the start of the interview, two important issues need to be discussed
and negotiated with interviewees: (1) The object or focus of the interview,
that is, what specific health problem (HP) will be discussed during the
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interview; and (2) the identity and social positioning of the interviewee
and interviewer.
Negotiating the object of the interview is fundamental and may require
time in order to reach a shared understanding of the focus of the conver-
sation. For example, a participant may experience symptoms not related
to the research question. Conversely, some symptoms such as ‘hearing
voices, although considered a symptom in psychiatry, may not be
considered a nuisance for some patients in a specific cultural context. The
idea here is to clarify with interviewees which symptoms will be discussed
and how they will be named throughout the interview. These symptoms
could be affective (e.g., sadness) or somatic (e.g., headaches), or a group
of symptoms related to an illness or disease recognized as such by biomed-
ical or even traditional nosology. Once the health problem and symptoms
are agreed upon, their actual names should be used in all subsequent MINI
questions.
The second key element to negotiate prior to the MINI interview is the
social positioning of interviewer and interviewee. This is important
because the unfolding process of the interview depends on the social
context. The way in which the interview process reflects the social context
provides a source of data rather than something to be eliminated from the
interview process (Warren, 2002; Wengraf, 2001). Luff (1999) points out
that interviewees and interviewers speak to each other not from stable and
coherent standpoints but from varied perspectives involving the socially
structured and historically grounded roles and hierarchies of their society
(see also Campbell, 1998). In this context, interviewers should acknowl-
edge their social identities such as class, gender, race, ethnicity, marital
status, age, family position, religion, education, sexual orientation,
professional status, and so forth (Schutz & Wagner, 1970). In the case of
an interviewer and interviewee from different societies this larger social
context may involve a history of colonization, domination or conflict that
will complicate the conversation. The information interviewees are willing
to disclose is greatly influenced by these social standpoints. It is therefore
crucial to acknowledge the latter rather than simply rely on supposition.
Although the social background of the interviewer may have been
disclosed at the beginning of the interview, interviewees may later
requestion the interviewer’s professional or family-related identities and
reorient the interview. It is usually helpful to accede to this request, as the
social positioning of narrators may change with the topic under discussion,
and hence require renegotiation. Our experience has shown that the inter-
viewer’s willingness to answer these questions not only creates an atmos-
phere of trust and confidence but also may help to clarify the sort of
information that is not disclosed because of social or professional status or
a social desirability bias on the part of the interviewee. In certain cases
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where an interviewee is found to be withholding too much information as
a result of social identity, power and position, the only solution may be to
replace the interviewer by one whose social status is deemed more appro-
priate in terms of gender, ethnocultural background or other salient aspects
of identity.
For interviewers coming from a clinical background, it is important
to emphasize that the MINI is not a clinical interview in which the
interviewer has the role of expert, but rather an ethnographic interview,
in which the interviewee is in the expert position. It is assumed that inter-
viewees are the most knowledgeable sources on the meaning they give
to their own illness experience. To conduct this type of interview, the
interviewer must adopt the position of the neophyte, listening respectfully
to learn about the experience of the narrator while inviting interviewees
to reason in different ways about their illness experience. The aim is ‘to
give primacy to the patient’s voice, to listen for meaning rather than for
facts, and to provide a relationship enabling the evolution of the patient’s
story’ (Sakalys, 2003, p. 228).
Conducting the Interview
According to Rubin and Rubin (1995) most qualitative interviews are
structured in terms of three types of questions: (1) Main questions that
begin and guide conversations; (2) probe questions that clarify answers by
reformulating them back to the interviewee or requesting further
examples; and (3) follow-up questions that pursue the implications of
answers to main questions. The goals of these three types of questions
should be kept in mind as the interviewer moves through the basic
structure of the MINI.
Section 1: Initial Narrative
The introductory section of the MINI is intentionally unstructured and
aims to collect a narrative organized by spatial and temporal contiguity of
events. If interviewees introduce a disease label, prototype or explanatory
model, it is noted, but the basic questions are repeated to encourage the
narrator to return to recounting the basic sequence of events associated
with their symptom or condition.
Questions 1–4 invite participants to produce an initial illness narrative
in such a way as to minimize the influence of a social desirability bias.
This is the least structured part of the interview. The aim here is to invite
participants to tell their story in their own way. Questions 5 and 6 are
probes that aim to ensure that interviewees tell the full narrative related
to their pathways to care (i.e., the use of medical services). This part of
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the interview can be fairly long for participants with many symptoms or
a lengthy illness history. Because the aim of the unstructured interview is
to allow interviewees to tell their story at their own pace and in their own
way, no time limit should be imposed at this stage of the interview
(Morse, 2002).
Section 2: Prototypes
Questions in this section are more structured and aim to elicit narratives
which reveal prototypical experiences of self and others, and how such
prototypes are used by the interviewees to reason analogically about their
health problem and related health behavior. Prototypes may be very influ-
ential for some participants and not for others. This may be because some
people predominantly use an analogical way of reasoning in relation to
their health problem and related health behavior; it could also be because
prototypical knowledge is experienced-based knowledge, rather than
theoretical or objective (Groleau et al., submitted). Also, it is knowledge
embedded in one’s own experience or that of a close one, endowing it with
an emotional significance which, for some people, gives it precedence over
rational or causal types of reasoning.
The purpose of this section of the interview is to gauge whether or not
participants are using prototypical experiences of self or of others, and
whether they are using them to reason analogically about their own health
problem and related health behavior. Question 7 elicits self-prototypical
experiences of participants. Questions 9, 11 and 13 aim at revealing family,
social and media prototypes, respectively. Questions 8, 10, 12 and 14 invite
interviewees to explore whether they reason analogically and how they
may be using prototypical experiences to explain their health problem and
related health behavior.
Section 3: Explanatory Models
This section aims to elicit explanatory model narratives of the inter-
viewees’ HP produced by a causal type of reasoning. Question 15 verifies
whether interviewees use an alternative label to describe their HP. This
question may, in some cases, give access to an idiom of distress or another
popular cultural construct related to somatic conditions not yet docu-
mented in the literature. Question 16 elicits the perceived cause(s) of
participants’ HP. Question 17 may uncover new information related to
attributions. Question 18 may help to clarify the bodily aspects of explana-
tory models, that is, how participants perceive their HP operating within
their organs and body. Bodily metaphors with a cultural significance may
emerge from this question. Questions 19 and 20 may stimulate an answer
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that gives access to a social context for the explanatory model. For
example, if one of the attributions for their HP is stress, participants
should be able to explain the social context of their stressful experiences
in a short narrative. Questions 21 and 25 aim to reveal whether a popular
label linked to participants’ HP exists in their social context, and if so, how
it contrasts with their own HP in terms of meaning, expected prognosis,
treatment and social expectancies (e.g., stigma or access to support).
Question 27 aims to clarify how participants’ explanatory models apply to
the story of their personal experience.
Section 4: Help Seeking and Service Utilization
This section of the interview schedule is optional and should be used only
if it is relevant to the research question. Its purpose is to invite interviewees
to produce, where applicable, a narrative of their experience with health
services and hospitalization, and their response to received treatment. This
section can be omitted if the focus of the study is limited to meaning and
experience of illness without paying attention to pathways to care or the
impact of biomedical services. If interviewees mention in Section 1 having
consulted a healer of any kind, the interviewer asks Questions 30–31 by
replacing the word doctor with healer. If patients consulted both a healer
and a medical doctor, the interviewer asks all questions in this section for
each type of healer or help. Questions 34–36 aim to invite narrators to
produce a rationalization for their health behavior in terms of incitements
and deterrents to compliance with treatment recommendations. This
rationalization may reveal important practical issues but, because it serves
to justify the individual’s actions, it may also obscure understanding of the
predominant individual and cultural meanings. Questions 36–39 explore
satisfaction with health care without asking the question directly to
minimize potential desirability bias. At this point, it is particularly import-
ant to put interviewees at ease in order that they provide truthful answers.
These questions are purposely asked toward the end of the interview to
allow sufficient time to create an atmosphere of confidence. Before asking
these three questions, interviewees should be reminded that the interview
is confidential and their identities will not be disclosed. This is particularly
important in cases where participants may fear offending a helper or
losing access to services.
Section 5: Impact of Illness
This section aims to explore the impact of the health problem on
narrators’ life in general and to see if and how they believe the illness has
led to changes in their identity and way of life since its onset. Questions
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39–42 aim to elicit a narrative that explores possible changes in identity,
roles and functioning that are linked to the health problem. This may be
particularly relevant if the problem is a chronic disease or mental illness
that, because of its nature, may provide a rite-of-passage or transforma-
tive experience for the narrator. As well, since health problems may require
substantial adaptations or accommodations by others, a changed sense of
self may originate in or be mirrored by these reactions. Questions 43 and
45 ask about ways of coping, social supports and other resources and can
be tailored to the specific domains of interest. In the case of afflictions that
confront patients with their own mortality, their illness experience may be
embedded in a spiritual narrative.
Concluding the Interview
The MINI ends with an open-ended question allowing the interviewee to
add anything they deem relevant. Depending on the course and conduct
of the interview other loose ends will need to be tied up to provide a
comfortable level of closure. This may include discussion and debriefing
on the specific purposes of the study and arrangements to provide later
feedback after the data are analyzed. This may be essential for purposes of
validation and, in some cases, to follow ethics guidelines for the use of
interview material.
Although for the purposes of systematic comparison it is important that
all questions of the MINI be asked of each participant in a study, the narra-
tives produced may be very lengthy. Participants should not be subjected
to a time limit or feel pressure to complete the interview as this will
truncate and distort their narratives. If the interviewee seems tired, it is
best to schedule another meeting.
Analyzing Data from the MINI
The MINI produces narratives that can be analyzed according to their
form or structure (e.g., genre, plot, characters, temporal structure, modes
of reasoning) or their content (e.g., themes, images, metaphors) at both
individual and collective levels. The collective level is identified as recur-
rent themes or structures among narrators from the same background or
in similar social positions, or through explicit links to popular theories of
health, and specific social contexts and relationships.
The transcript of the MINI interview should be viewed not as a static
snapshot of the individual’s current state of understanding of their illness
but as a record of the coconstruction of meaning over time. Meaning
making is central to the interviewing process and reflects: (1) Previously
acquired and organized interpretations of illness; (2) new reflections on
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illness experience prompted by the interview situation and specific
questions; and (3) the unfolding relationship of interviewer and re-
spondent. As Holstein and Gubrium (1995; Gubrium & Holstein, 2002)
point out, during the interview the perspective of respondents may shift
as they take into account the standpoint of others present in their story. A
shift in standpoint or emotional state also may occur when the interviewer
invites the respondent to reason in a different manner.
The verbatim transcript of the MINI interview allows for analysis with
a wide range of interpretive strategies drawn from critical and interpretive
medical anthropology (Good, 1994), literary theory (Czarniawska, 2002;
Riessman, 2002; Smith 2002), grounded theory (Glaser & Strauss, 1967)
and cultural analysis (Quinn, 2005). Analysis of the form of narratives is
possible because, Section 1 of the MINI is unstructured and elicits an
illness narrative or story from the outset of identified symptoms and the
patient’s help-seeking behavior. The theory guiding the structured part of
the MINI concerns the multiple modes of reasoning and knowledge
structures (that can be individual or collective, e.g., popular theory of
health) that contribute to illness narratives, not the social themes they may
contain. For these reasons, the MINI also lends itself to a grounded-theory
approach, which focuses on thematic analysis for the purpose of building
social theory (Whitley, Kirmayer, & Groleau, 2006a, 2006b).
Regarding practical issues, our experience has been that some inter-
viewers tend to pursue certain topics more avidly than others (e.g., use of
traditional healers), serving to potentially signal their theoretical or
practical biases. In order to avoid large variation in the ways that inter-
views are conducted, it is thus important that interviewers receive
adequate training and close supervision over the course of a study using
the MINI. Training of interviewers should facilitate their understanding
of the theory guiding the use of the MINI and how this is related to the
research question of the ongoing project.
Conclusion
There is increasing recognition of the value of qualitative interview and
data analysis methods in psychiatry to access accounts of illness experi-
ence, explore individuals’ social and cultural worlds, and address basic
questions of meaning and validity in health measurement (Whitley &
Crawford, 2005). We have presented a method of eliciting illness inter-
views that may be of use in research and clinically applied medical anthro-
pology and cultural psychiatry.
The MINI invites narrators to explore different meanings and modes of
reasoning (metonymical, analogical, causal) in relation to their health
problem. It also permits the interviewer to determine whether or not
Transcultural Psychiatry 43(4)
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interviewees are employing popular labels or idioms of distress related to
their symptoms or condition (Groleau & Kirmayer, 2004). Finally, the
MINI is readily adapted to explore links between specific meanings and
health behaviors including: pathways to care, use of home remedies,
traditional healing and biomedical care (Whitley et al., 2006a, 2006b);
treatment adherence; adoption of health-promoting behaviors; satis-
faction with health care; impact of health problems on other domains of
life activity; and potential changes in identity (Groleau et al., 2006). The
rich data produced by the MINI can be used in many different ways
depending both on the researchers topic of interest, theoretical concerns,
and level of analysis.
Acknowledgements
The research discussed in this article was supported by grants from the Fonds de
recherche en santé du Québec, the Conseil québecois de la recherche sociale and the
Canadian Institutes for Health Research. We thank Rob Whitley for helpful
comments on an earlier version of this article, Sarah Darghouth for her work
reviewing the literature on methods for collecting illness narratives, and Jeffrey
Freedman for editorial help.
Notes
1. The first author (DG) was an interviewer in the original study and played a
central role in refining the initial questionnaires to make the flow more
natural and acceptable to a range of community participants.
2. For example, in a previous MINI-based study, in response to the questions
in this section, a patient revealed that her mother had a myocardial infarc-
tion (MI) similar to her own (Groleau et al., submitted). The prototypical
narrative of her mother also revealed that, although the latter had stopped
smoking, she suffered soon after from a second MI and subsequently lost
both of her legs and ultimately died of a third MI. The narrator used her
mother’s experience as a prototype to reason analogically about her own
health situation in the following way: There was no reason for her to stop
smoking after her own MI because, based on her mother’s experience, it
wouldn’t have made a difference.
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Appendix
McGill Illness Narrative Interview (MINI)
Generic Version for Disease, Illness or Symptom
Danielle Groleau, Allan Young, & Laurence J. Kirmayer ©2006
Section 1. INITIAL ILLNESS NARRATIVE
1. When did you experience your health problem or difficulties (HP) for
the first time? [Substitute respondent’s terms for ‘HP’ in this and subse-
quent questions.] [Let the narrative go on as long as possible, with only
simple prompting by asking, ‘What happened then? And then?’]
2. We would like to know more about your experience. Could you tell
us when you realized you had this (HP)?
3. Can you tell us what happened when you had your (HP)?
4. Did something else happen? [Repeat as needed to draw out contiguous
experiences and events.]
5. If you went to see a helper or healer of any kind, tell us about your
visit and what happened afterwards.
6. If you went to see a doctor, tell us about your visit to the
doctor/hospitalization and about what happened afterwards.
6.1 Did you have any tests or treatments for your (HP)? [The relevance
of this question depends on the type of health problem.]
Section 2. PROTOTYPE NARRATIVE
7. In the past, have you ever had a health problem that you consider
similar to your current (HP)?
[If answer to #7 is Yes, then ask Q.8]
8. In what way is that past health problem similar to or different from
your current (HP)?
9. Did a person in your family ever experience a health problem similar
to yours?
[If answer to #9 is Yes, then ask Q.10]
10. In what ways do you consider your (HP) to be similar to or different
from this other persons health problem?
11. Did a person in your social environment (friends or work) experi-
ence a health problem similar to yours?
[If answer to #11 is Yes, then ask Q.12]
12. In what ways do you consider your (HP) to be similar to or different
from this other persons health problem?
13. Have you ever seen, read or heard on television, radio, in a magazine,
a book or on the Internet of a person who had the same health
problem as you?
[If answer to #13 is Yes, then ask Q.14]
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14. In what ways is that persons problem similar to or different from
yours?
Section 3. EXPLANATORY MODEL NARRATIVE
15. Do you have another term or expression that describes your (HP)?
16. According to you, what caused your (HP)? [List primary cause(s).]
16.1 Are there any other causes that you think played a role? [List second-
ary causes.]
17. Why did your (HP) start when it did?
18. What happened inside your body that could explain your (HP)?
19. Is there something happening in your family, at work or in your social
life that could explain your health problem?
[If answer to #19 is Yes, then ask Q.20]
20. Can you tell me how that explains your health problem?
21. Have you considered that you might have [INTRODUCE POPULAR
SYMPTOM OR ILLNESS LABEL]?
22. What does [POPULAR LABEL] mean to you?
23. What usually happens to people who have [POPULAR LABEL]?
24. What is the best treatment for people who have [POPULAR LABEL]?
25. How do other people react to someone who has [POPULAR LABEL]?
26. Who do you know who has had [POPULAR LABEL]?
27. In what ways is your (HP) similar to or different from that persons
health problem?
28. Is your (HP) somehow linked or related to specific events that
occurred in your life?
29. Can you tell me more about those events and how they are linked to
your (HP)?
Section 4. SERVICES AND RESPONSE TO TREATMENT
30. During your visit to the doctor (healer) for your HP, what did your
doctor (healer) tell you that your problem was?
31. Did your doctor (healer) give you any treatment, medicine or recom-
mendations to follow? [List all]
32. How are you dealing with each of these recommendations? [Repeat
Q. 33 to Q. 36 as needed for every recommendation, medicine and treat-
ment listed.]
33. Are you able to follow that treatment (or recommendation or
medicine)?
34. What made that treatment work well?
35. What made that treatment difficult to follow or work poorly?
36. What treatments did you expect to receive for your (HP) that you did
not receive?
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37. What other therapy, treatment, help or care have you sought out?
38. What other therapy, treatment, help or care would you like to receive?
Section 5. IMPACT ON LIFE
39. How has your (HP) changed the way you live?
40. How has your (HP) changed the way you feel or think about yourself?
41. How has your (HP) changed the way you look at life in general?
42. How has your (HP) changed the way that others look at you?
43. What has helped you through this period in your life?
44. How have your family or friends helped you through this difficult
period of your life?
45. How has your spiritual life, faith or religious practice helped you go
through this difficult period of your life?
46. Is there any thing else you would like to add?
Danielle Groleau, PhD, is a medical anthropologist specialized in public health
and transcultural psychiatry. She is Assistant Professor at the Division of Social
and Transcultural Psychiatry where she teaches qualitative methods. She is also
Research Associate at the Culture and Mental Health Unit at the Jewish General
Hospital-SMBD. She is interested in cultural determinants of health behavior and
sociocultural determinants of medically unexplained symptoms. Her current
work focuses on vulnerable populations and maternal health. Address: Institute of
Community & Family Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital,
4333 Côte-Ste-Catherine, Montréal, Québec H3T 1E4, Canada. [E-mail:
danielle.groleau@mcgill.ca]
Allan Young, PhD, is Professor of Anthropology in the Departments of Social
Studies of Medicine, Anthropology and Psychiatry at McGill University. He is the
author of The Harmony of Illusions: Inventing Posttraumatic Stress Disorder
(Princeton, 1995). His recent publications include: ‘La psychiatrie à la recherche
d’un esprit post-génomique’ (Sciences Sociales et Santé, 2006), ‘Remembering the
Evolutionary Freud’ (Science in Context, 2006),Traumatisme à distance, résilience
héroïque et guerre contre le terrorisme’ (Revue Française de Psychosomatique,
2006), ‘When Traumatic Memory Was a Problem: On the Antecedents of PTSD’
(in Posttraumatic Stress Disorder: Issues and Controversies, G. Rosen, Ed., 2004),
and ‘L’auto-victimization de l’aggresseur: Un ephémère paradigme de maladie
mentale’ (L’Evolution psychiatrique, 2002).
Laurence J. Kirmayer, MD, FRCPC, is James McGill Professor and Director,
Division of Social and Transcultural Psychiatry, Department of Psychiatry, McGill
University and Director of the Culture & Mental Health Research Unit at the
Department of Psychiatry, Sir Mortimer B. Davis-Jewish General Hospital.
Address: Institute of Community & Family Psychiatry, Sir Mortimer B. Davis-
Jewish General Hospital, 4333 Côte-Ste-Catherine, Montréal, Québec H3T 1E4,
Canada. [E-mail: laurence.kirmayer@mcgill.ca]
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... Como instrumento metodológico para a obtenção das narrativas individuais, utilizamos a Entrevista Narrativa de Adoecimento McGill-MINI (Leal et al., 2016), que é um roteiro semiestruturado de entrevista qualitativa desenhado para suscitar narrativas de adoecimento em pesquisas em saúde (Groleau et al., 2006) A MINI foi projetada para ser uma ferramenta útil para pesquisas no campo da saúde, com o objetivo de compreender ou investigar o comportamento em saúde, ou a experiência de adoecimento e seus significados atribuídos, ligados a qualquer problema, condição ou evento de saúde de indivíduos e/ou grupos (Groleau et al., 2006). Diferente do modelo de entrevista de história de vida, que geralmente é composto somente por perguntas abertas, a MINI é um roteiro de perguntas semiestruturadas (que permitem a comparação sistemática das narrativas) com respostas abertas (que permitem ao entrevistado contar livremente sua história). ...
... Como instrumento metodológico para a obtenção das narrativas individuais, utilizamos a Entrevista Narrativa de Adoecimento McGill-MINI (Leal et al., 2016), que é um roteiro semiestruturado de entrevista qualitativa desenhado para suscitar narrativas de adoecimento em pesquisas em saúde (Groleau et al., 2006) A MINI foi projetada para ser uma ferramenta útil para pesquisas no campo da saúde, com o objetivo de compreender ou investigar o comportamento em saúde, ou a experiência de adoecimento e seus significados atribuídos, ligados a qualquer problema, condição ou evento de saúde de indivíduos e/ou grupos (Groleau et al., 2006). Diferente do modelo de entrevista de história de vida, que geralmente é composto somente por perguntas abertas, a MINI é um roteiro de perguntas semiestruturadas (que permitem a comparação sistemática das narrativas) com respostas abertas (que permitem ao entrevistado contar livremente sua história). ...
... Diferente do modelo de entrevista de história de vida, que geralmente é composto somente por perguntas abertas, a MINI é um roteiro de perguntas semiestruturadas (que permitem a comparação sistemática das narrativas) com respostas abertas (que permitem ao entrevistado contar livremente sua história). Existe uma preocupação em seguir o roteiro, composto por cinco seções e 46 perguntas, pois é a partir desse que o entrevistado é convidado a falar de um tema que a princípio ele não abordaria espontaneamente (Groleau et al., 2006). ...
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... A betegséggel összefüggő reprezentációk feltárására alkalmasak továbbá a kü-lönböző interjúmódszerek (Zhang et al., 2014;2006;Dong et al., 2016). Például a betegséggel összefüggő narratívák felmérésére szolgáló McGill Illness Narrative Interview (MINI; Groleau, Young & Kirmayer, 2006), a betegség sémákat feltáró The Schema Assessment Instrument (SAI; Lacroix, 1991). Ugyanakkor a tapasztalatok azt mutatják, hogy a verbális technikák nem mindig kellően hatékonyak a betegséggel összefüggő reprezentációk feltárására. ...
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A komplex gyógyító munka során kiemelten fontos a szomatikus betegek betegséggel kapcsolatos nézeteinek és attitűdjeinek feltárása. Kutatások bizonyítják ugyanis, hogy a betegségreprezentációk számos gyógyulással összefüggő folyamatra közvetlen és közvetett hatással vannak. A tanulmány célja bemutatni a betegségreprezentációk jellegzetességeit, valamint feltárásának lehetőségeit különböző kvantitatív és kvalitatív technikákkal. Továbbá esetek ismertetésével bemutatni a betegséggel kapcsolatos nézetek vizsgálata során nyerhető információkat. Az elméleti áttekintés során hangsúlyozásra kerül, a betegségreprezentációk szubjektívek, egyediek, és a betegséglefolyás során folyamatosan változnak, továbbá eltérnek a kezelőszemélyzet nézeteitől. Valamint, hogy a betegséggel kapcsolatos kogníciók befolyásolják betegségviselkedést, valamint a testi és lelki felépülés különböző faktorait, így ezek feltárása és szükség szerinti módosítása a gyógyító munka során fontos. A reprezentációk feltárására kvantitatív és kvalitatív módszerek is rendelkezésre állnak. A leginkább elterjedt mérőeszközök a Betegségpercepció Kérdőív (IPQ), valamint annak rövidített változata (B-IPQ), melyek a betegségpercepció különböző komponenseit tárják fel. Azonban a tapasztalatok azt mutatják, hogy nagyon hasznosak tudnak lenni a betegségreprezentációk vizsgálatában a különböző nonverbális technikák, mint például a rajztesztek. Ugyanis a betegséggel kapcsolatos gondolatokat és érzéseket nem könnyű a pácienseknek szavakba önteni. Ráadásul a különböző nonverbális technikák segítenek a kevéssé tudatos nézetek és attitűdök feltárásában. A betegséggel kapcsolatos érzelmi és kognitív reprezentációk mérését szolgálja a PRISM-D rajzteszt, mely segítségével mind kvantitatív, mind kvalitatív adatokat is gyűjthetünk. A tanulmány esetbemutatás részében két személy koronavírussal kapcsolatos reprezentációinak ismertetése történik meg, melynek során szemléltetjük, hogy a fenti technikák kombinált alkalmazásával milyen gazdag információk gyűjthetőek a reprezentációkról. A tanulmány felhívja a figyelmet a szomatikus betegek betegségreprezentációinak vizsgálatának fontosságára. Valamint hangsúlyozza ezen ismeretek oktatásának beépítését az egészségügyi és szociális szakemberek hivatásképzésébe és továbbképzésébe.
... The goal of the study was to and identify the needs and vulnerabilities regarding perceptions and experiences of trauma within the Bachelor of Nursing (BN) and Bachelor of Science in Psychiatric Nursing (BScPN) student populations within a western Canadian province. The McGill Illness Narrative Interview (MINI) methodology developed by Groleau et al. [4] derived from medical anthropology was utilized to better understand how, when, and under what circumstances graduates of BN and BScPN programs self-identify as being 'traumatized', and/or act on their experiences and feelings of clinical-related 'trauma'. All participants in the study described events that were deemed personally traumatic. ...
... The analyzed data were derived from the verbatim audiotaped interview transcripts, confirmed by each participant, and field notes taken during the interview. Data collected using the MINI lends toward a variety of mixed-method and qualitative analysis approaches including grounded theory and thematic analysis [4]. For the purposes of the research study, Braun and Clarke's [16] six-step approach to thematic analysis was used to analyze the data collected. ...
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Entry-level health care professionals are socialized to accept the norms and values associated with institutions in which violence and suffering is considered an anticipated and even routine and normalized part of frontline care. The objective of the study was to illuminate the subjective experience of psychological trauma in graduates from a baccalaureate nursing and psychiatric nursing program using the McGill Illness Narrative Interview, an ethnographic interview guide. Participants included graduates from each program in a western Canadian province who reflected back on their experiences of trauma as students and newly-graduated nurses within their first year of practice as a regulated health professional. Results: Six key themes were identified. Witnessing sudden change in patient or client status and unexpected death; Emotional labour; Faculty incivility; Sabotage, bullying and verbal abuse from the health care team; Exposure to physical violence and sexual inappropriateness; and Mobilizing supports. All exposures were linked to the participants’ definition of psychological trauma. Conclusions: The study findings highlight the power dynamic, abuses, and vulnerability between students, faculty, and their clinical counterparts without adequate recourse. There is a need to foster emotional intelligence, self-efficacy, and resilience when potentially traumatic and stressful experiences occur with student nurse and early-career nursing populations.
... Members of the committee identified as being from racialized communities and/or had expertise in working with racialized groups. Some questions were adapted from the McGill Illness Narrative Interview (Groleau et al., 2006;e.g. 'What other therapy, treatment, help or care would you like to receive?') and the Cultural Formulation Interview (Lewis-Fernandez et al., 2015; e.g. ...
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Studies from the United States and United Kingdom show that Black patients are disproportionately diagnosed with psychosis and receive excess coercive medical intervention. There has been little discussion of this topic in Canada, and of how coercive interventions may have influenced Black patient attitudes towards mental health services. To address these issues, semi-structured interviews were administered to five Black men with first-episode psychosis (FEP) to (a) explore their experiences with coercive interventions and (b) describe how these experiences may have influenced help-seeking behaviours. Interpretative phenomenological analysis (IPA) was used to analyze the data. Four core themes and four additional themes emerged from the interviews. Patients described loneliness, not being heard, police contact and forced medication as influencing their attitudes towards mental health care. Further research is needed to develop reparative strategies to encourage reflection about and awareness of coercive intervention among Black FEP patients.
... A experiência com fármacos é uma das dimensões da experiência do adoecimento, articulando-se a outras: sentimentos da pessoa, especialmente os temores sobre seus problemas; ideias da pessoa sobre o que está errado com ela; vivências corporais e mentais produzidas pelo medicamento e efeitos disso em sua vida cotidiana e relacional; o efeito da doença e tratamentos em seu funcionamento; suas expectativas em relação aos profissionais e tratamentos (GROLEAU, 2006;STEWART et al., 2010;LEAL et al., 2016). Jenkins (2012), ao pesquisar experiência de pessoas com transtornos mentais graves, em especial com diagnóstico de esquizofrenia, com os psicofármacos, desvelou o que chamou de "paradoxos experienciais": a frustração da recuperação sem cura, a persistência do estigma, a culpa inocente de viver com um "desequilíbrio bioquímico" e a escolha de ser "louco ou gordo" devido aos efeitos adversos dos medicamentos. ...
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Resumo A experiência do adoecimento é entendida enquanto dimensão subjetiva, estruturada socialmente, sobre a doença e suas repercussões pessoais, referidas ao campo das práticas, crenças e valores compartilhados. O grupo de medicação discutido neste estudo estimulou a produção de narrativas sobre a experiência do adoecimento para abordar o empoderamento do usuário, a partir do diálogo sobre uso e manejo de psicotrópicos. Trata-se de um estudo qualitativo, descritivo-exploratório. A questão de pesquisa foi: Como a experiência do adoecimento é apresentada nas narrativas dos participantes dos grupos de medicação? Vinte e dois usuários de serviços comunitários de saúde mental e cinco familiares destes participaram de duas reuniões do grupo de medicação e três grupos focais. A análise dos resultados materializou-se na perspectiva da antropologia médica e da psicopatologia fenomenológica. As categorias de análise deste artigo são: experiência de participação em grupos de medicação, experiência de uso e manejo da medicação, experiência com o adoecimento e diagnóstico. As narrativas produzidas indicaram que os diálogos em grupo sobre medicamentos subsidiam a formulação e o compartilhamento de significados atribuídos à experiência do adoecimento mental e de seu tratamento medicamentoso. Deste modo, os grupos de medicação reforçaram a atuação conjunta de profissionais, familiares e usuários, ampliando as possibilidades de cuidado sensível à experiência vivida.
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Resumo: Introdução: Nas últimas décadas, mudanças importantes ocorreram nas ciências médicas, abrangendo desde a criação de novas condutas terapêuticas até reformulações de práticas relacionadas ao ensino, sobretudo no que concerne ao desenvolvimento de habilidades que promovam uma melhor relação entre o profissional de saúde e o paciente. Nesse contexto, a medicina narrativa (MN) surge como uma importante ferramenta transformadora da prática profissional na saúde por utilizar diferentes estratégias de comunicação para compreender as vivências dos indivíduos quanto aos seus processos de adoecimento. Objetivo: Este estudo teve como objetivo conhecer como a MN tem sido abordada no processo de ensino-aprendizagem nas graduações das profissões da saúde. Método: Trata-se de uma revisão integrativa da literatura, baseada na pergunta “Quais são os impactos do uso da MN no processo de ensino-aprendizagem nas graduações da área da saúde?”. Foram incluídos artigos indexados nas bases de dados SciELO, LILACS, BVS e MEDLINE, publicados no período de janeiro de 2010 a junho de 2020 e disponíveis na íntegra. Resultado: Nove artigos foram selecionados e analisados, revelando que o uso e a aplicação da MN nas graduações das profissões da saúde são heterogêneos, com diferentes populações de estudo, metodologias de pesquisa, formas de abordagens e/ou cenário de aplicação. Contudo, a análise qualitativa evidenciou que a MN contribuiu de forma significativa para o processo de formação dos discentes e profissionais, estimulando o desenvolvimento de habilidades narrativas. Destacam-se a empatia na relação profissional de saúde-paciente, o respeito e reconhecimento da importância de outros profissionais da área no cuidado destinado à saúde e atitudes críticas e reflexivas nos cenários práticos, elementos que, na percepção dos sujeitos, só foram alcançados por meio do uso dessa abordagem. Conclusão: A formação do profissional de saúde requer competências narrativas que envolvem habilidades associadas à escuta e ao diálogo, bem como a capacidade de aprender e interpretar as vivências fornecidas pelos pacientes. No entanto, diante da escassez de estudos relacionados a essa temática, mais pesquisas são necessárias para melhor avaliar o uso dessa ferramenta como recurso didático nas graduações das profissões da saúde.
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Re-Visioning Psychiatry explores new theories and models from cultural psychiatry and psychology, philosophy, neuroscience and anthropology that clarify how mental health problems emerge in specific contexts and points toward future integration of these perspectives. Taken together, the contributions point to the need for fundamental shifts in psychiatric theory and practice: • Restoring phenomenology to its rightful place in research and practice • Advancing the social and cultural neuroscience of brain-person-environment systems over time and across social contexts • Understanding how self-awareness, interpersonal interactions, and larger social processes give rise to vicious circles that constitute mental health problems • Locating efforts to help and heal within the local and global social, economic, and political contexts that influence how we frame problems and imagine solutions. In advancing ecosystemic models of mental disorders, contributors challenge reductionistic models and culture-bound perspectives and highlight possibilities for a more transdisciplinary, integrated approach to research, mental health policy, and clinical practice.
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Opioid agonist medications, such as the buprenorphine‐based Suboxone, are becoming increasingly important tools for caring for people with opioid use disorders. Yet, whether at the level of the family, the clinic, or pharmaceutical companies, the circulation of Suboxone can involve forms of concealment, secrecy, and deceit, even as it is used to provide a vital form of care. In exploring the moral economies that shape the licit and illicit circulation of Suboxone in southwest Virginia, we aim to unpack the logics of obligation, care, and secrecy that emerge within a family network caught in a set of sociopolitical, economic, and therapeutic conditions. In exploring how Suboxone circulates at these different scales—in families, in clinics, and in the global pharmaceutical economy—this article shows how secrets lubricate the social, economic, and moral mechanisms through which relationships are sustained and substances circulate. [moral economy, secrecy, substance use, care, rural United States]
Article
Background In Sub-Saharan Africa, psychiatric care for severe mental disorders is scarce. This is especially true for people living in chronic poverty in rural areas. The way in which people with psychotic manifestations are socially perceived and treated remains under-researched, limiting the possibility of adapting services to their needs. Methods In May 2017, 29 semi-structured individual interviews with indigent people reporting psychotic-like experiences and 8 focus groups with members of their community were conducted in the rural region of Diébougou (Burkina Faso). Indigents were questioned on their subjective interpretation regarding these experiences. Community members were asked about their perceptions of people manifesting psychotic-like experiences. A thematic analysis was carried out. Results Three distinct conceptions of psychotic-like experiences were identified. First, these experiences were often understood as a reflection of a mental disorder involving evil supernatural entities. Second, some people were considered as possessing a faculty that conferred supernatural powers that could be used for healing purposes. Finally, psychotic-like experiences might also reflect a temporary disturbance for which no significant repercussions were raised. Conclusions This study suggests that certain manifestations qualified as psychotic according to the biomedical nosology seem to be considered differently from communities' perspectives. These experiences were frequently interpreted as being personal and not requiring medical attention or even as socially valuable faculties. Although psychotic-like experiences were not always perceived negatively, people who experienced them were reluctant to talk about them. This suggests that a form of stigmatization is associated with psychotic-like experiences.
Book
2001 introduction to in-depth semipstructured qualitative interviewing and to BNIM in paerticular. Unique in its conceptual coherence and its level of practical detail, it cov ers a full spectrum from the identification of topics and research questions, to the interviewing, to the answerin g of research questions, the compring and theorising of cases an d to strategies of writing-up presentations.
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This edited collection presents a range of heretofore unpublished, unavailable methods for the systematic reconstruction of culture from interviews and other discourse. Authors set the design and evolution of their methods in the context of their own research projects, and draw general lessons about investigating culture through discourse. These methods have largely grown out of the work of the cultural models school, and represent the approaches of some of the very best methodologists in cultural anthropology today. An impetus for the volume has been inquiries from researchers, many of them graduate students, about how to conduct the kind of research that cultural models theorists do. This is not a linguistics book; unlike approaches to discourse analysis from linguistics, this volume focuses on culture, treating discourse as a medium especially rich in clues for cultural analysis, and hence a window into culture.