[Making meaning of mental distress; discourse analysis of service-users' narratives]. / Betekenis geven aan psychische problematiek; discoursanalyse van ervaringsverhalen.

BACKGROUND: Processes of meaning-making are central to personal recovery in mental distress. Scientific inquiry of meaning-making is scarce within psychiatry, while it has the potential to better attune care to the lived-experience and views of service-users. AIM: To gain insight into how service-users make meaning of mental distress; how this meaning is shaped by mental health discourses, and how these discourses influence the search for identity and recovery. METHODS: Qualitative study of service-users’ narratives (N = 25) from the Psychiatry Story Bank. Narratives were collected through an open interview and analyzed with discourse analysis. RESULTS: We identified four patterns of meaning: Mental distress as ‘weakness’, as ‘social isolation’, as ‘necessity for care’ and as ‘disconnection’. Disposal - and integration - of various discourses apparently helped participants to find meaning, attuned to their recovery phase and the particular recognition they pursued. The quest for recovery was complicated when they experienced a clash between their own meaning-making and dominant ideals in care. CONCLUSION: Caretakers can stimulate the creation of helpful meaning, by attuning to their patients’ context, recovery phase and plea for recognition. Awareness of the effects and limitations of their own assumptions on mental distress is of importance as well.

[The bitter pay back--perverse financial incentives in healthcare]. / De bittere vergelding. Over perverse financiële prikkels in de zorg.

This article analyses the stimuli that arise from the current design of the healthcare system. Hospital care is fragmented into an endless series of interventions and subsidiary interventions that are parts of chains, lines of care, care trajectories and care protocols. Each intervention has its own logic and quality standards. And each of these interventions not only bears an estimate of the intensity of care but increasingly a price tag as well. These interventions are vitally important because they form the basis for the declarations of costs. Consequently this set-up provides a perverse incentive that elicits greed and meanness. Three factors underlying this are discussed in this article: a meritocratic culture, Taylorism in the care process and misplaced market thinking.