Two CASE STUDIES: SUBJECTIVE ACCOUNTS OF DEPRESSION
Six Interpretative Phenomenology and Narrative Research
This book is the result of six years of research using an interpretative phenomenological approach. Interpretative phenomenological research is a methodological standpoint that seeks to gain knowledge through a hermeneutic approach. Hermeneutics involves a co-constituted process of inquiry and reflection that repeats itself over the course of a series of interviews and their analysis through the participation and reflection of both the researcher and the participants. “Knowledge,” in this context, is not a static entity that can be obtained as the result of objective pursuits, but is instead the result of a methodology that does not predetermine what that end goal is. The goal is a detailed exploration of a broad topic, rather than the pursuit of evidence for or against a “predetermined hypothesis of the researcher” (Smith & Osborn, 2003, p. 53). The process is the purpose, not the means to a desired or planned destination. This approach to research does not involve a process of reification of particular constructs in an attempt to predefine them. Misgeld and Jardine say,
To speak well, I must live with the practical possibility of becoming speechless; to understand, I must live with the possibility of no longer understanding. Hermeneutically conceived, such matters are not to be decided in general, once and for all, or alone. Hermeneutic inquiries are meant to develop, risk and accomplish the reciprocity of intersubjective understanding without obliterating the real differences between human beings which call for this effort. (1989,
The knowledge is, and cannot be extricated from, the very process of co-constructing meanings from subjective accounts and the interpretations thereof. The meanings derived from individual interviews can then be used to gain insights into a more general topic, in this case depression, by analyzing the material for emergent themes both within and across individual transcripts. Therefore interpretative phenomenological research does not seek to find objectivity or “truth,” as the subject matter derives its meaning from both participants in the research: from the participants’ subjective accounts; the researcher’s preconceived understandings, investments, areas of focus, and interpretations of the narrative; as well as the various ways in which these factors interact before, during, and after the interview process. Interpretative phenomenology is the process of attempting to co-construct meanings.
The following chapters are the result of this type of research and analysis. I entered each interview with my own ideas about what it means to be depressed based on my subjective experiences, my familiarity with literature on the subject, my clinical work with people suffering from depression, and any interviews I had previously conducted. These elements all contribute to where I locate myself within the research, and the notions I carry helped to shape my perspective and thus indirectly guided the interview process by affecting the questions I asked, the themes I pursued throughout the interviews, and the way that I listened to and interacted with the participants’ narratives. I could not help but shape the dialogue that ensued during each interview, and I am therefore a co-author of each explorative encounter. Similarly, each participant has a unique account of what it means to be depressed, and this, of course, is the focal point of this book. “The phenomenological approach . . . asks questions about how the world changes for someone who is depressed, how the very structures of time, space, and the taken-for-granted shift and break down” (Good, 2012, p. 26).
In describing their experiences, participants wove together an existential narrative of living with depression and its effects. In the analysis, certain themes emerged both within and between each transcript and these in turn helped to inform and alter my thinking about the subject. Therefore, interpretative phenomenology is a cyclical process of ongoing change. Researcher and participants contribute to the content and direction of the data which, in the process of analysis, has the capacity to alter the researcher’s and participants’ perspectives in an ongoing manner.
For this book, I interviewed five adults who identified themselves as suffering from severe and chronic depression. All participants were at least 18 years of age and from a wide range of demographic areas, including: age, marital status, religious affiliation, education level, socioeconomic status, career achievement, gender, ethnicity, and country of origin. Participants ranged in age from the mid-twenties to the late sixties. There were three women and two men. They ranged in relationship status: two were single, one was in a relationship, one was married, and one had been widowed. Participants were of Asian, African American, Caucasian, and multiethnic backgrounds. Some were born and raised in the United States, some were the first generation to live in this country, and some had emigrated from Eastern Europe. To protect confidentiality, pseudonyms have been used to refer to the individuals within the following chapters. Any information that might reveal a person’s identity has been disguised.
Analyzing individual stories by using an interpretative phenomenological approach is a complex process. Many have written on the difficulties of conducting ethical, qualitative, narrative work (e.g., Josselson, 2011; Borneman & Hammoudi, 2009; Doucet & Mauthner, 2008; Britzman, 1995; Fine, 1994; Behar, 1993 & 1995; Borland, 1991; Patai, 1987). As a person who believes that narrative has the power to create existential meaning, writing individuals’ stories into an interpretative analysis presents an array of complicated ethical and methodological questions that warrant further examination.
Initially, I set out to conduct research that would preserve each individual’s voice. I did not want to allow participants’ messages to get lost in a sea of jargon or data, and I wanted to give future readers of my work a sense of what it was like being with each person I interviewed. My goal was to not lose the meaning that each person was trying to convey by covering it up with my own expectations or assumptions. As I began to explore how each analysis might be written, however, I realized that the issue of narrative representation is much more complex than I had originally understood. As a result, I found myself asking more questions than I could easily answer.
For example, whose story is being told in narrative work? What aspects of participants’ stories get relayed to future readers and which parts of the narrative are eventually left out? More importantly, who am I to decide which elements warrant our attention and which become insignificant by their omission? I occupy a position of privilege as researcher and author, and with that position comes great responsibility. I want to remain “true” to the stories that participants told me because I feel I owe a loyalty to their perspectives. After all, they have lived the experiences and presumably engaged in a dialogue with me because they have a particular message to convey.
In a context where depressive states can come to represent what cannot be symbolized (or processed or mourned), and therefore have the potential to signify a loss of meaning, the process of using language in an attempt to communicate can have implications for existential struggles and self-representation. One of my fears is that any interpretation of mine that contradicts participants’ senses of themselves or their experiences could potentially have extremely negative, harmful effects. I do not want to become yet another person who has misunderstood some crucial aspect of their experiences. Keeping this in mind, however, it is important to note that I also have an invested interest in this work that brings with it the responsibility to use my experience, research, and position to contribute something to the current field of knowledge on depression in general, and in order to do this I cannot abandon or neglect my own perspective, as it is an integral component of this very process of investigation. What results from a meeting of two individuals can then no longer be said to be owned by either the original teller or the interpreter, as the story evolves throughout the entire process.
Josselson (2011) describes this as a dilemma between “the authority of experience” and “the authority of expertise” (p. 33). Her distinction that narrative work is about the interview experience in which the individual participates, rather than about the individual himself or herself, is very useful. What this means is that I have used particular anecdotes of the individuals whom I interviewed in an attempt to say something about the broader subject of depression in a more general sense. Although the questions that permeated my mind as I mulled over each story indicate a tremendous responsibility in doing this work, I am not defining a person’s life. I am describing an experience shared between two people and interpreting what came out of that meeting. In addition, what participants told me on the day of our interview about their experiences with depression may vary greatly from what they might tell me on another occasion and, looking back on what was said, they may feel like there were things that needed to be added or clarified in the original interview. There are many aspects to lived experience, and it is not possible to fully capture the multiple dimensions of an entire life in an interpretative analysis, nor is it possible to do so completely objectively, or in a way that is totally aligned with only one party’s subjectivity. Like Behar (1993) in her description of writing life narratives, I have come to realize that what results from one encounter is like a series of still-frame images that, when strung together, create a dynamic moving picture. But the way I organize those images differs from the way that another might organize them, and both these are likely different from the way that participants in narrative research see themselves.
I do not suppose I will ever be able to fully reconcile all of the difficulties inherent in conducting qualitative, narrative work. But my continuous selfreflection and awareness of these issues as I continue my research will have to be enough to keep me conscious of the significance of my words so that I may use them in a constructive manner. What I decided to do was to return to the participants after the interview with a transcript of our meeting so that they could make any additions, clarifications, or adjustments they desired (I obtained IRB approval to do this.) This also provided an opportunity for them to give a reaction to reading the transcript. In addition, after I wrote preliminary interpretative work, I returned with that to participants who were interested in reading it so that they were given a space to respond to my interpretations of what they shared with me.
As a person who has experienced my own form of subjective darkness over the course of many formative years, I recognize that I carry with me certain conceptualizations of what it means to be “depressed.” I cannot separate my own subjectivity from this matter, nor would I want to. With every life comes a series of experiences, and the ways in which these are woven together into a cohesive narrative form the core of the meanings that we ascribe to ourselves, our relationships with others, and our lives. Depression can at times make the telling of personal narratives more difficult, as what often accompanies it is a collapse in meaning on a massive, existential scale. Many have expressed despair and helplessness when in the depths of such a destructive state. Perhaps in my role as researcher and clinician, I am stubbornly holding onto a tentative sense of hope for each individual’s recovery in this regard. For I believe that it is in this endeavor, the struggle in locating one’s voice and making one’s story known, that the healing process can begin.