Journal of Mental Health

ISSN: 0963-8237 (Print) 1360-0567 (Online) Journal homepage: http://www.tandfonline.com/loi/ijmh20

Narrative research on mental health recovery: two

sister paradigms

Gabriela Spector-Mersel & Evgeny Knaifel

To cite this article: Gabriela Spector-Mersel & Evgeny Knaifel (2017): Narrative
research on mental health recovery: two sister paradigms, Journal of Mental Health, DOI:
10.1080/09638237.2017.1340607

To link to this article: http://dx.doi.org/10.1080/09638237.2017.1340607

Published online: 24 Jun 2017.

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ISSN: 0963-8237 (print), 1360-0567 (electronic)

J Ment Health, Early Online: 1–9

ß 2017 Informa UK Limited, trading as Taylor & Francis Group. DOI: 10.1080/09638237.2017.1340607

REVIEW ARTICLE

Narrative research on mental health recovery: two sister paradigms

Gabriela Spector-Mersel1 and Evgeny Knaifel2
1
School of Social Work, Sapir College, Hof Ashkelon, Israel and 2The Spitzer Department of Social Work, Ben-Gurion University of the Negev, Beer-
Sheva, Israel

Abstract Keywords
Background: Despite the breadth of narrative studies on individuals with severe mental illness, Mental health recovery, narrative, narrative
the suitability of narrative inquiry to exploring mental health recovery (MHR) has not been research, narrative paradigm, recovery
examined. paradigm, severe mental illness
Aims: (1) Examining the appropriateness of narrative inquiry to studying MHR; (2) assessing the
extent to which narrative studies on MHR conform to the unique features of narrative research, History
as a distinctive form of qualitative inquiry.
Methods: Review of empirical, theoretical and methodological literature on recovery and Received 2 August 2016
narrative inquiry. Revised 9 May 2017
Results: Considering the perspectives of recovery and narrative as paradigms, the similarity Accepted 21 May 2017
between their ontology and epistemology is shown, evident in 10 common emphases: meaning, Published online 23 June 2017
identity, change and development, agency, holism, culture, uniqueness, context, language and
giving voice. The resemblance between these ‘‘sister’’ paradigms makes narrative methodology
especially fruitful for accessing the experiences of individuals in recovery. Reviewing narrative
studies on MHR suggests that, currently, narrative research’s uniqueness, centered on the
holistic principle, is blurred on the philosophical, methodological and textual levels.
Conclusions: Well-established narrative research has major implications for practice and policy
in recovery-oriented mental health care. The narrative inquiry paradigm offers a possible path to
enhancing the distinctive virtues of this research, realizing its potential in understanding and
promoting MHR.

Introduction In addressing the first question, we offer a framework

accounting for the appropriateness of narrative research to
The popularity of narrative research in studying recovery
studying MHR. Our point of departure is that the recovery
from severe mental illness (SMI) has increased in the last
and narrative perspectives both constitute paradigms, as they
couple of decades (e.g. Kirkpatrick, 2008; Rhodes & de Jager,
comply with the definition of a paradigm as ‘‘a set of basic
2014; Roe & Davidson, 2005). This has been the result of
beliefs’’ which ‘‘represents a worldview’’ (Guba & Lincoln,
acknowledging the value of illness stories, as well as socio-
1994, p. 107). More specifically, the recovery and narrative
political and academic processes occurring in the field of
perspectives both comprise the two fundamental dimensions
mental health. The extensive body of narrative studies has
that form a paradigm: ontology, which refers to the nature of
expanded the understanding of mental health recovery
the human being and of reality (e.g. unified? constructed?),
(MHR), contributing considerably to empowering individuals
and epistemology, which considers the relationship between
with SMI and developing appropriate services and practices.
the knower and the known, i.e. the ways through which we
In effect, the knowledge generated by narrative studies has
understand ourselves, others and the world (e.g. via our
played a central role in establishing the recovery paradigm in
senses? by interpretive processes?).
the field of mental health. Despite the importance and breadth
The narrative paradigm adds methodology to these
of this corpus, the suitability of narrative research to
dimensions, turning it into an inquiry paradigm. Unlike
exploring MHR has been largely taken for granted, and not
conceptions of narrative research that focus on the practi-
subjected to deliberate examination. In this article, we take up
calities of the investigation, the notion of the narrative
this challenge, asking two questions: (1) Is narrative inquiry
paradigm (Spector-Mersel, 2010), by which we mean the
particularly suitable to exploring MHR? And if so, what are
narrative inquiry paradigm, stresses that these practicalities
its special virtues in this context? (2) Do narrative studies on
are closely bound to philosophical premises. The narrative
MHR conform to the unique features of narrative research, as
paradigm shares commonalities with other interpretive para-
a distinctive form of qualitative inquiry?
digms within qualitative research, but it also embraces
Correspondence: Gabriela Spector-Mersel, School of Social Work, Sapir particular theoretical underpinnings and corresponding meth-
College, D.N. Hof Ashkelon, Israel. E-mail: gabrielasm@013.net odological principles, making it a distinct paradigm (Spector-
2 G. Spector-Mersel & E. Knaifel
Mersel, 2010). Building on this conceptualization, we high-
light the notable similarity between the philosophical foun-
dations (in ontology and epistemology) of the recovery and
narrative paradigms, which makes them ‘‘sister’’ paradigms.
This resemblance, we suggest, designates narrative method-
ology as an ideal vehicle for exploring MHR.
To engage with the second question, we review narrative
studies on MHR, examining whether they conform to the
narrative paradigm. This attempt suggests that currently, the
underpinnings of narrative inquiry, centered on the holistic
principle, are blurred, on three levels. On the philosophical
level, many of these studies draw on general interpretive
premises, disregarding the specific philosophical narrative
groundwork. On the methodological level, non-narrative
methods are frequently employed in data generation and
analysis. On the textual level, what are taken to be illness or
recovery narratives do not necessarily conform to the criteria
of narrative/story (we use these terms interchangeably), thus
constituting non-narrative data. While valuing the existing
narrative studies for tapping into the experiences of persons in
recovery (PiR), we believe that the potential of narrative
research in contributing to the field has not yet been realized
fully. We thus urge its continuing implementation, but with a
deeper appreciation of its uniqueness.
We start with a background on narrative research on MHR,
subsequently introducing the recovery and narrative para-
digms. We then address the philosophical closeness between
these ‘‘sister’’ paradigms, by referring to 10 shared emphases:
meaning, identity, change and development, agency, holism,
culture, uniqueness, context, language and giving voice. We
illustrate how each emphasis might be reinforced by
scrutinizing stories of and about PiR, thus contributing to
recovery-oriented mental health. Against this backdrop, we
look at the corpus of narrative studies on MHR, showing that
narrative inquiry’s uniqueness is often discounted. We
conclude by stressing the distinct value of narrative research
in promoting recovery-oriented practice and policy, offering
the narrative paradigm as a potential guideline for enhancing
its contribution.
Narrative research on mental health recovery
Following the narrative turn, narrative research entered
almost every discipline in the human sciences (Riessman,
2008). In health studies, this process was manifested in
acknowledging illness stories as a major source for under-
standing the experiences of individuals with chronic illnesses
(Frank, 1995; Kleinman, 1988). The entry of narrative
research into the sub-field of mental health also drew on
valuing illness stories, but it was supported by more specific
processes. Personal stories of service users constituted a
socio-political power that supported de-institutionalization
and the development of community mental health care, as
well as consumers’ movement (Kirkpatrick, 2008).
The expansion of community services was entwined with a
move from the medical model previously ruling the field,
focusing on pathology, to the recovery paradigm, that
emphasizes the empowerment and well-being of persons
with SMI (Anthony, 1993). This paradigm shift called for a
change in research in the field. Whereas the bio-medical
J Ment Health, Early Online: 1–9
model coincided with the positivistic paradigm, the recovery
paradigm requires different research practices centering
on service users’ experiences, meanings and goals (Farkas,
2007). Consequently, qualitative methodologies expanded in
mental health research, emphasizing subjectivity and unique-
ness, and focusing on processes of illness and recovery rather
than on their outcomes (Davidson, 2003; Stuart et al., 2017).
Among the qualitative traditions applied, narrative
research has been popular in exploring MHR (see Davidson
et al., 2010). Within this perspective, several studies
examined published autobiographies of PiR (Jacobson,
2001; Ridgway, 2001). Others elicited self-narratives of
persons with SMI, looking at aspects of illness and recovery
expressed in them: insight into mental illness (Ogden, 2014;
Roe et al., 2008), illness experiences (de Jager et al., 2016;
Hoy, 2014), reconstructing a positive sense of identity
(Brown, 2008; Carless & Douglas, 2008; Saavedra, 2009),
turning points along the recovery process (Adame &
Knudson, 2007; Song & Shih, 2009; Thornhill et al., 2004),
and factors contributing to recovery, both personal (Kidd
et al., 2009; Lysaker et al., 2010; Salyers et al., 2013) and
socio-cultural (Knaifel & Mirsky, 2015; Borg & Davidson,
2008; Donnell & Sosulski, 2013).
The rich insights provided by narrative studies contributed
significantly to developing recovery-oriented mental health
care. On this basis, sensible policy was designed (Farkas,
2007; Roe & Davidson, 2005) and practical tools of
assessment (e.g. IPII, STAND; Lysaker et al., 2002, 2010)
and interventions (e.g. Yanos et al., 2011) were developed.
Despite the significant role of narrative studies in under-
standing and promoting recovery, the appropriateness of
narrative inquiry to exploring MHR has not been methodic-
ally appraised. In our attempt to contribute to this aim, we
suggest that this suitability starts with a philosophical
closeness between ‘‘sister’’ paradigms. To elaborate this
resemblance, we first make the case for the claim of two
paradigms, briefly portraying each.
The recovery paradigm
For the last 30 years, recovery has constituted the major
theoretical and practical framework in mental health care. Of
the various meanings attached to the concept (Davidson &
Roe, 2007), the notion of a recovery paradigm is widely
accepted (e.g. Ellison et al., 2016; Jenkins & Carpenter-Song,
2005), implying ‘‘a set of basic beliefs’’ that form ‘‘a
worldview’’ (Guba & Lincoln, 1994). Specifically, the
conceptual framework surrounding the process of recovery
may be considered a paradigm, as it addresses the funda-
mental paradigmatic dimensions: ontology and epistemology.
In the context of MHR, the ontological question is: What is
the nature of mental illness and of recovery, and who are
individuals with mental illness in recovery? The epistemo-
logical question would be: How do we know about MHR?
What kind of knowledge is available for understanding
recovery processes among individuals with SMI? Let us
consider each dimension.
In contrast to the bio-medical model, that premised a
unified and universal profile of health and illness, the
recovery ontology emphasizes that these phenomena are
DOI: 10.1080/09638237.2017.1340607
socially, culturally and individually constructed (Ellison et al.,
2016). This conception undermines the dichotomy between
health/‘‘normal’’ and illness/‘‘non-normal’’, postulating a
continuum between these conditions (Slade & Longden,
2015). For example, hearing voices can be conceived of as an
acute mental health problem for some people, while for others
it may represent an adaptive function (Boumans et al., 2017).
The idea of multiple truths is therefore suggested, implying
that understandings of recovery vary between individuals, and
there is no single definition of its success (Slade & Longden,
2015). Multiplicity exists also within PiR, as what it means to
be ‘‘ill’’ or ‘‘functioning’’ can vary across the lifespan. A
further ontological premise is recovery being multifaceted,
involving various dimensions, including personal, familial
and socio-cultural ones (Davidson & Roe, 2007).
Accordingly, PiR are not necessarily defined as persons
whose psychiatric symptoms have decreased or disappeared
(clinical recovery), but rather as individuals who despite the
presence of symptoms can reconstruct a positive sense of
identity and a meaningful life (personal recovery) (Slade,
2009).
According to the recovery epistemology, PiR constantly
interpret themselves, their situation and their environment
(Stuart et al., 2017). The meanings they confer upon the self,
others and the illness are shaped by inner characteristics
(personality, agency), and outer features (culture, social
contexts). Within this complex web, PiR perform a unique
dialogue which directs their recovery journey (Davidson
et al., 2010). These interpretative processes occur principally
through the stories that individuals tell about themselves and
the world (France & Uhlin, 2006; Kirkpatrick, 2008).
Recognizing the importance of meaning-making, recovery
epistemology premises that ‘‘[t]he ultimate arbiter of recov-
ery is therefore the person living with the experience’’ (Slade
& Longden, 2015, p. 4). Rather than being based upon
professional knowledge and definitions, as diagnosis and
prognosis are, recovery emphasizes the feelings and experi-
ences of individuals with SMI (Farkas, 2007). In this view,
recovery can occur with or without professional help
(Boumans et al., 2017), and can be based on conventional
forms of treatment, as well as on ‘‘personal medicine’’
(Deegan, 2005).
The narrative inquiry paradigm
Narrative inquiry is a highly diverse field, rooted in different
disciplines and theoretical traditions, and embracing a wide
range of methodologies (Bamberg, 2016; Hatavara et al.,
2013; Tamboukou et al., 2013). Hence, there is no single
definition of narrative research and significant variations exist
among studies identifying themselves as such (Riessman,
2008). Unlike conceptions of narrative research as a meth-
odology (Denzin & Lincoln, 2011), the notion of the
narrative paradigm (Spector-Mersel, 2010) considers it a
full-fledged research world view, that binds the ‘‘hows’’ of
investigation to its ‘‘whats’’ and ‘‘whys’’. The narrative
paradigm, crystallized since the narrative turn, is considered
one of the interpretive paradigms of qualitative research, thus
sharing similarities with them, both regarding to philosophy
(constructed realities, subjectivity), and methodology
Narrative Research on MHR 3
(induction, naturalistic approach). Yet, it embraces unique
ontological, epistemological and methodological characteris-
tics implying a distinct paradigm. Following, we delineate the
cores of these dimensions (for an extended outline, see
Spector-Mersel, 2010).
The narrative ontology conceives of social reality as
primarily a narrative one. This entails an intimate relationship
between story and life. As Bruner (1987) asserted, ‘‘narrative
imitates life, life imitates narrative’’ (p. 692). The multi-
layered relationships between life and narrative draw on the
temporal dimension underlying both (Ricoeur, 1984). The
narrative ontology highlights the primary functions of stories
in human existence. Through narratives, we remember the
past and imagine the future (Freeman, 2010), construct a
sense of identity and continuity (McAdams & Bowman,
2001), interact with others (Bamberg, 2006, 2016) and learn
our culture (Baldwin, 2013). These varied functions draw on
the narrative’s holistic nature, evident in its converging past,
present and future; action and consciousness; uniqueness and
culture (Bruner, 1987).
The narrative epistemology maintains that we comprehend
ourselves, others and the world through subjective and
culturally rooted processes of meaning-making, occurring
via narrative. Narrative knowing (Polkinghorne, 1988) is
offered as a primary mode of human thought (Bruner, 1987)
and an organizing principle of human experience (Sarbin,
1986). Narrative interpretation operates through processes of
selection (Spector-Mersel, 2011; Rosenthal, 1993), embedded
in various contexts (Spector-Mersel, 2011; Zilber et al., 2008)
and influenced by cultural meta-narratives (Baldwin, 2013),
social factors and psychological motivations.
Like narrative ontology and epistemology, narrative meth-
odology derives its distinctiveness from the narrative. The
data of narrative inquiry naturally consist of stories. Diverse
as these may be – life stories or defined self-narratives
(Spector-Mersel, 2011), big or small stories (Bamberg, 2006),
written or oral ones – they all conform to basic criteria that
distinguish them from other kinds of texts (e.g. description or
argumentation). A narrative is typically defined as a text
comprising characters, a plot, temporality and a point
(Riessman, 2008). Regarding data collection/generation,
some studies collect already told/written stories (e.g. pub-
lished autobiographies), or, influenced by small-story-
research (Bamberg, 2006; Georgakopoulou, 2007), stories
told in everyday interaction. Yet, personal interviewing
remains the prevalent mode for generating research stories.
Narrative interviews aim at allowing participants’ fluent
narration. Thus, they often begin with an open question,
subsequently encouraging narration with minimal or no
interference (Josselson, 2013; Rosenthal, 1993; Wengraf,
2013). Concerning data analysis, despite the variety of
perspectives (Riessman, 2008; Robert & Shenhav, 2014),
models for interpreting narratives typically follow a narrative
interpretive lens (Spector-Mersel, 2014). Drawing on the
narrative holistic ontology, this lens is characterized by a
holistic interpretive strategy, comprising five principles:
treating the story as a whole unit; regard for content and
form; attention to contexts of production; analysis of both life
and story; and employing a multidimensional and interdis-
ciplinary lens (Spector-Mersel, 2011).
4 G. Spector-Mersel & E. Knaifel
A perfect fit: the narrative and the recovery
paradigms
We consider the narrative and the recovery paradigms
‘‘sister’’ paradigms, given the philosophical closeness
between them. To make this case, we address 10 shared
emphases. With respect to each, we suggest how scrutinizing
stories of PiR may contribute to recovery-oriented mental
health care. Some of these emphases characterize other
qualitative paradigms too. This is not surprising, given the
commonalities existing among the interpretive paradigms
(Denzin & Lincoln, 2011). However, taken together, the
following emphases most markedly typify the foundation of
the narrative paradigm – and, we propose – of the recovery
paradigm too.
Meaning
SMI typically undermines the meanings of self, others and
even one’s mere existence (Estroff, 1989). Finding new
meanings is thus a major task in recovery (Stuart et al., 2017).
Its achievement can reduce pain and promote personal
change, enabling individuals to live in a more fulfilling
manner, perhaps even growing from the crisis (Roe &
Davidson, 2005). Since meaning-making takes place princi-
pally through narrative (Polkinghorne, 1988), stories play a
crucial role in constructing meanings of illness and self.
Examining stories of PiR offer valuable insights regarding
these meanings, pointing to the possibilities, and impossi-
bilities, of preserving meanings that were central before the
illness (Ridgway, 2001). This knowledge is vital to design
interventions aiming to assist PiR create satisfying meanings.
Identity
The symptoms of SMI, the traumatic hospitalization that
typically accompanies it, and the stigma about people with
psychiatric disabilities – all pose a threat to sufferers’ positive
and coherent self-perception (Estroff, 1989). Accordingly,
constructing a coherent sense of self, that expands beyond the
illness and is founded upon non-stigmatic anchors, is a major
focus in the recovery paradigm (Leamy et al., 2011). Identity
constitutes a main concern in the narrative paradigm, too. The
concept of narrative identity presumes that the stories we tell
about ourselves convey who we are and how we conceive
ourselves, others, and the world. Narratives do not only reflect
identities, but also create them (Bamberg, 2006). Re-building
a positive sense of identity in the face of SMI is thus primarily
a process of ‘‘re-storying’’ the self (Freeman, 2010).
Scrutinizing self-narratives of PiR can open up strategies
for constructing acceptable and coherent identities in the face
of a severe life change (Roe & Davidson, 2005). This
knowledge is valuable in developing narrative practices
endeavoring to assist PiR resisting stigma and re-constructing
positive and coherent identities (Yanos et al., 2011).
Change and development
Recovery is depicted as a transformative and dynamic
process, through which individuals not only learn to accept
their illness and find strategies to manage it, but also discover
new strengths and abilities (Davidson et al., 2010).
J Ment Health, Early Online: 1–9
The journey of recovery is non-linear and is marked by
changing meanings throughout (Anthony, 1993). These ideas
coincide with conceiving of self-understanding as historically
emerging, evident in, and made possible by, the narrative’s
diachronic nature (Gergen & Gergen, 1983). By connecting
life events into a temporal whole, we make sense of how we
evolved from what we were in the past to what we are at
present (Polkinghorne, 1988). In this understanding, the
meanings of events and facts (e.g. the illness) are constantly
revised and ‘‘re-written’’ retrospectively (Freeman, 2010), as
is the basic story-line. A formerly tragic narrative can modify
into a romance; a plot of contamination can turn into a
redemptive one (McAdams & Bowman, 2001). As narrative
methodologies are most attuned to temporality, they offer a
suitable mode to explore the trajectory of recovery. It is not
surprising, then, that many narrative studies on MHR
comprise the notion of a transformative journey (Rhodes &
de Jager, 2014). Moreover, empirical evidence indicates that
as people move towards recovery, both narrative content and
form change (France & Uhlin, 2006). A thorough under-
standing of these changes is vital to developing tools for
assessing and enhancing the recovery journey.
Agency
Systematic reviews of studies on MHR identify self-deter-
mination and active process as major characteristics of
recovery, linked to empowerment, personal responsibility
and control over life (Leamy et al., 2011; Rhodes & de Jager,
2014). Self-agency and autonomy assist individuals to cope
with their illness in the way they choose, encouraging their
involvement in designing mental health services (Farkas,
2007). An agentic premise underlies narrative philosophy,
too. Unlike the mechanistic approach to self-conception, the
narrative perspective is reflective, emphasizing the individ-
ual’s active construction of self-understanding (Gergen &
Gergen, 1983). Within this view, ‘‘re-writing’’ the self
(Freeman, 2010) in the face of SMI is an active reflective
process. Carefully examining recovery stories might reveal
the ways in which this agentic journey is carried out, as a
platform for planning interventions.
Holism
This principle, considered the hallmark of narrative inquiry
(Riessman, 2008; Wertz et al., 2011), constitutes a central
focus in the paradigm of recovery, too (Ellison et al., 2016).
Deeming PiR whole individuals, not only sufferers from
psychiatric symptoms, recovery-oriented services are person-
centered rather than pathological-centric (Farkas, 2007;
Slade, 2009). This requires addressing the complex inter-
actions between the individual’s personality, strengths and
abilities, the illness’ symptoms, and socio-environmental
factors (Davidson et al., 2010). Lysaker et al. (2002)
demonstrate a holistic conception of recovery when suggest-
ing that ‘‘[a]wareness or denial of illness is a story embedded
in a larger life story which is, by necessity, inextricably linked
to a variety of past successes and failures as well as to future
dreams and expectations’’ (p. 198). Scrutinizing narratives of
PiR within a holistic perspective, enables a comprehensive
appreciation of their experiences and identities, addressing
DOI: 10.1080/09638237.2017.1340607
the illness as only one factor among others (Deegan, 1996).
Drawing on such understandings, holistic assessments and
interventions can be planned.
Culture
Narrative epistemology affirms that self-narratives are framed
against meta-narratives (Baldwin, 2013). Usually, the latter
are (unconsciously) imitated, but at times they are resisted,
forming counter narratives (Andrews, 2004). The centrality
of culture is emphasized also in the recovery paradigm
(Ellison et al., 2016). Indeed, the very phenomenon of mental
illness is prone to cultural construction, evident in its
changing meanings across time and cultures. Culture influ-
ences the diagnosis, the illness experience, coping behaviors,
and treatment responses (Kleinman, 1988). Differences
between self-narratives of PiR from diverse ethno-cultural
groups (e.g. Knaifel & Mirsky, 2015; Mizock & Russinova,
2013) indicate that MHR is culturally dependent. This
recognition is vital, because in the case of people with
mental illnesses the meta-narratives at play are often
discriminatory and stigmatizing (Kirkpatrick, 2008).
Studying personal stories can reveal where and how cultures
restrain PiR’s possibilities to construct legitimate selves.
Building on these insights, practitioners can develop ways to
assist PiR in resisting limiting meta-narratives and forming
counter-narratives.
Uniqueness
The recovery paradigm stresses that each PiR is unique
(Kirkpatrick, 2008), and that recovery is ‘‘a deeply personal,
unique process’’ (Anthony, 1993, p. 15). Uniqueness under-
lies the narrative paradigm, too. Personal stories reflect the
particular meanings we impart to ourselves and others, and
our characteristic mode of expression. As such, they are a
proper means to tap into PiR’s uniqueness. Differences
between stories reveal various modes of conceiving oneself in
the face of an illness (Ogden, 2014; Roe et al., 2008).
Appreciating this variation is encouraged by the fact that
‘‘narrative inquiry is grounded in the study of the particular’’
(Riessman, 2008, p. 11), thus ‘‘[p]articipants are viewed as
unique individuals’’ (Josselson, 2010, p. 873). Respecting
uniqueness is crucial in exploring MHR, to avoid a unified
conception of PiR and of paths of recovery. PiR’s stories teach
us to respect pluralism and difference, cautioning us from
offering the one and only path towards a ‘‘proper’’ recovery
(Jacobson, 2001).
Context
Narrative epistemology underscores that stories are always
situated in various contexts (Spector-Mersel, 2011): macro –
the broad socio-economic, political and institutional condi-
tions in the larger society (i.e. services available), micro – the
teller’s life circumstances (i.e. family support), and immediate
– the narration’s time, place, audience and setting.
Accordingly, attention to contexts of production constitutes
a criterion of ‘‘good enough’’ narrative inquiry (Riessman,
2008). Similarly, the recovery paradigm stresses that both
illness experiences and processes of recovery are context-
Narrative Research on MHR 5
dependent (Davidson 2003). To illustrate, parenting can
advance recovery among women with SMI, for it enables a
socially valued identity. However, in the contexts of poverty
and violence, parenting can become a source of daily stress
and delay recovery (Carpenter-Song et al., 2014). Studying
PiR’s stories can yield a thorough understanding of how
identities and experiences are shaped by different contexts.
Language
The ‘‘turn to language’’ in the social sciences acknowledged
that words are not transparent windows, but rather they
convey meanings. This recognition heavily influenced narra-
tive epistemology, and, consequently, narrative methodology.
Interrogation of how events are storied is considered a
criterion for ‘‘good enough’’ narrative inquiry (Riessman,
2008), requiring the examination of the stories’ linguistic
features. In the recovery paradigm, attention to language is
evident in challenging terms rooted in the medical model.
Thus, ‘‘mentally ill patients’’ has been replaced with
‘‘individuals with mental illnesses’’, ‘‘service users’’,
‘‘mental health consumers’’ or ‘‘psychiatric survivors’’
(Adame & Knudson, 2007). Similarly, ‘‘crisis’’ has replaced
‘‘deterioration’’, and ‘‘recovery’’ – ‘‘remission’’ (Slade,
2009). Examining narratives of PiR can yield a comprehen-
sion of the linguistic barriers faced by them, assisting
consumer movement to design empowering alternatives.
Giving voice
Narrative research promotes social change by giving voice to
marginalized groups (Josselson, 2010). This is particularly
pertinent in the case of PiR, given the oppressing meta-
narratives that silence their voices and the paternalist
perspective that previously ruled the field of mental health.
Publishing PiR’s stories enables them to influence practice,
research and policy (Jacobson, 2001; Ridgway, 2001),
reinforcing their socio-political position and challenging the
professionals’ power as the sole authority. Compared to other
kinds of qualitative data, personal stories hold a special
quality, due to which they can serve as change agents (Frank,
1995; Kirkpatrick, 2008).
Appreciating the role of narrative research in giving voice
to PiR should recognize the complexities embedded in this
endeavor. The project of five qualitative researchers analyzing
an interview (Wertz et al., 2011), is enlightening in this
regard. McSpadden’s multifaceted reactions to her story’s
analyses, and the researchers’ subsequent responses, point to
the dilemmas regarding issues of ownership and interpretive
authority. These dilemmas, suggests Josselson (2011), emerge
from the gaps between the ‘‘authority of experience’’ – the
participants’ understanding of their lives – and the ‘‘authority
of expertise’’ – the researcher’s analysis of these lives. The
intricacies contained in this gap and the practices required to
manage them, are to be taken seriously by researchers
endeavoring to empower PiR by publishing their narratives.
Rethinking narrative studies on MHR
Given the multifaceted resemblance between the narrative
and the recovery paradigms, one may wonder, whether two
6 G. Spector-Mersel & E. Knaifel
separate paradigms are being considered, or rather only one.
Either way, what seems to be evident is that the narrative
paradigm offers a fruitful framework for researching MHR.
Has this recognition materialized in the empirical realm?
Specifically, is the narrative paradigm followed in narrative
studies in the field? Our review suggests that, generally, this is
not the case. The uniqueness of narrative research, as a
distinct mode for understanding and studying human beings,
is often fuzzy in three aspects: philosophical, methodological
and textual.
Regarding philosophy, some narrative studies on MHR do
not lay any theoretical foundation for the use of narrative,
presenting it as a mere tool for collecting data (e.g. Brown,
2008; Jenkins & Carpenter-Song, 2005; Lysaker et al., 2010;
Song & Shih, 2009). Other studies do posit a philosophical
basis, but one comprising general premises characteristic of
interpretive research, such as subjectivity, multiple realities,
and dependence on culture and context (e.g. Donnell &
Sosulski, 2013; Hoy, 2014; Mizock & Russinova, 2013; Ridge
& Ziebland, 2006). In both cases, the unique ontology and
epistemology of narrative inquiry, is overlooked.
The disregard of narrative research’s uniqueness, found in
the philosophical domain of narrative studies on MHR, is
evident also in the methodological sphere. This is not
surprising, for ‘‘methodology is enacted philosophy’’
(Jackson, 2006, p. 278). This dual omission is apparent with
respect to holism – the hallmark of narrative inquiry. Ignoring
holism as an ontological premise is echoed by its being
neglected in the major methodological phases of research:
data generation and analysis.
To generate the research data, most studies on MHR
employ personal interviews. Like other in-depth interviews,
narrative interviews are open-ended and extended. What
primarily characterizes them, however, is their endeavor to
generate stories. This entails two considerations. First, the
opening question – ‘‘the little q question’’ (Josselson, 2013)
or the SQUIN: ‘‘single question aimed at inducing narra-
tive’’ (Wengraf, 2013) – should invite stories, rather than
other kinds of texts. Practically, this requires a question that
implies a temporal depth. Moreover, narrative interviews
usually start by referring to experience, rather than cognitive
or emotional responses, that tend to elicit non-narrative
texts. As Davidson (2003, p. 63) stresses, ‘‘rather than
asking a person to explain his or her experience to us, we
are asking him or her to share his or her experience with us:
to tell us stories about his or her life as he or she lived it’’.
This recognition is not typically employed in narrative
studies on MHR. A prototypical example is the opening
question: ‘‘What did you and your family understand by the
term work and what did work mean for you?’’ (Kennedy-
Jones et al., 2005, p. 126) – that calls for an argumentation,
not a narrative.
The second feature of narrative interviewing is allowing a
‘‘free’’ telling, with minimal guidance. Josselson (2013)
offers the metaphor of the dance, depicting the narrative
interview as ‘‘a way of moving with the participant’’
(pp. 7–8). ‘‘If, as interviewers’’, she clarifies, ‘‘we think
of ourselves as askers of questions, our participants will
give us answers framed in terms of our questions. If, however,
we think of ourselves as. . . catalysts for and recipients of
J Ment Health, Early Online: 1–9
stories, we will elicit the narration of stories. . .’’ (p. 11).
Accordingly, following the initial invitation for a story,
narrative interviewers typically support the flow of narration
with minimal or no intervention, introducing questions only
when the spontaneous narration is concluded (Rosenthal,
1993; Wengraf, 2013). This principle is not the rule in
narrative studies on MHR, which characteristically conduct
active dialogues (e.g. Anderson, 2010; Carless & Douglas,
2008; Roe et al., 2008). The resulting text is highly co-
authored, for it is heavily influenced by the interviewer’s
interventions. More essentially, a questions-and-answers
exchange inhibits the construction of a whole, necessary to
compose a story. It interrupts the story’s sequence, thus
impeding the articulation of its consequence – the two basic
attributes that define narrative (Riessman, 2008). The non-
narrativity of the interviews – a methodological facet –
naturally affects the textual level, putting into question the
narrativity of the data generated.
Data analysis is where the uniqueness of narrative research
is most disregarded in narrative studies on MHR. The holistic
interpretive strategy (Spector-Mersel, 2014) is frequently
overlooked, particularly two of its implications. The first –
treating the story as a whole unit, termed also holistic
analysis (Lieblich et al., 1998) – is considered the funda-
mental distinction between narrative analysis and other forms
of qualitative analysis (Josselson, 2011; Riessman, 2008). A
holistic analysis is contravened in narrative studies employing
statistical methods to analyze PiR’s stories (e.g. Lysaker et al.,
2002; Roe et al., 2008; Salyers et al., 2013). Although
valuable knowledge is gained by these analyses, in terms of
narrative interpretation something essential is lost. For Schiff
(2013), when employing reductive-quantitative measures that
turn narrative characteristics ‘‘. . .into variables and transform
the interpretation of text into a statistical equation. . . [w]hat is
lacking is an understanding of what these stories mean in the
lives of persons. . .’’ (p. 257). More often, though, the holistic
strategy is ignored by employing qualitative – but not
narrative – analyses. Grounded theory (Glaser & Strauss,
1967), in its variations (e.g. Charmaz, 1995), is the prevalent
mode of analysis utilized in narrative studies on MHR (e.g.
Anderson, 2010; Boumans et al., 2017; Kidd et al., 2009;
Ridge & Ziebland, 2006). This classical qualitative analysis is
based upon categorical analysis (Lieblich et al., 1998), which
‘‘breaks up’’ the story, thus representing an a-holistic, indeed
de-narrativizing, strategy (Spector-Mersel, 2011).
Contravening the holistic analysis does not merely concern
methodology. Isolating parts of the narrative – either
variables, as in statistical analysis, or categories, as in
grounded theory – contests the holistic epistemology, that
maintains that various aspects of experience are intertwined in
the narrative, hence cannot be understood separately.
Regard for both content and form is the second principle of
the holistic strategy that is often overlooked in narrative
studies on MHR. Analyses of PiR’s stories characteristically
focus on their content, usually referred to as ‘‘themes’’ (e.g.
Borg & Davidson, 2008; Brown, 2008; Salyers et al., 2013;
Wisdom et al., 2008). Aspects of form, such as linguistic
features, story genres, temporality, coherence and complexity,
typically remain unattended. Here too, this tendency does not
only contravene the holistic methodological imperative. More
DOI: 10.1080/09638237.2017.1340607
essentially, it disregards the holistic epistemology, according
to which content and form constitute complementary channels
of expression (Lieblich et al., 1998; Riessman, 2008).
Encouragingly, exceptions to these characteristic features
do exist. These studies build on narrative ontology and
epistemology, and follow holistic methodology in generating
and analyzing PiR’ stories. One example is Thornhill et al.’s
study (2004), which draws on narrative philosophy to
understand the experiences and life-trajectories of individuals
recovering from psychosis. Narrative accounts were elicited
by an open question that implies a temporal depth: ‘‘You
could tell me something about yourself and what has brought
you to the point of sitting here talking to me about recovery?’’
(p. 185). The stories were examined, attending both to their
content (‘‘core narratives’’) and form (language, genre and
tone), consequently identifying distinct narrative genres:
escape, enlightenment and endurance.
Another example is Saavedra’s study (2009), which
explored recovery processes among individuals with SMI
living in supportive housing. Drawing on the epistemology
that ‘‘the stories that we tell about ourselves. . . are the basic
instruments we use to build our social identity’’ (p. 164), life
narratives were generated following an open invitation:
‘‘Could you tell us about your life?’’. These were scrutinized
holistically, addressing autobiographical information, seman-
tic content, verbal structure, pauses and turn taking. This
analysis provided comprehensive insights into the transform-
ations throughout the participants’ illness experiences and
identities, as well as socio-cultural and contextual factors
influencing their recovery.
These studies and others (e.g. de Jager et al., 2016;
Lachman, 2000; Ogden, 2014) seem to follow the narrative
paradigm, although not explicitly addressing it. The unique-
ness of narrative inquiry is notably expressed in their
philosophical groundwork, type of data and methodological
procedures, making them good models to be followed.
Conclusions
Acknowledging the central role of narrative studies in
promoting recovery-oriented mental health care, we examined
the suitability of narrative research to study MHR.
Considering the recovery and narrative perspectives as
paradigms, we pointed to the similarity between their
ontology and epistemology, evident in 10 common emphases:
meaning, identity, change and development, agency, holism,
culture, uniqueness, context, language and giving voice. We
suggested that the philosophical resemblance between these
‘‘sister’’ paradigms makes narrative methodology a fruitful
framework to accessing PiR’s experiences and identities.
Drawing on the narrative paradigm (Spector-Mersel, 2010),
we reviewed the existing corpus of narrative studies on MHR.
We showed that central features of the first – primarily,
relating to the holistic principle – are often discounted,
philosophically, methodologically and textually. The unique-
ness of narrative inquiry as a specific mode of investigation is
consequently blurred, restricting its potential in exploring
MHR.
To a large extent, in studying MHR ‘‘narrative’’ is referred
to as a general metaphor for subjectivity and ‘‘narrative
Narrative Research on MHR 7
research’’ as fairly synonymous to qualitative research.
These tendencies, found also in other disciplines, may be a
result of the popularization of these concepts (Baldwin, 2016;
Riessman, 2008), and, perhaps, the ‘‘celebratory stance’’
(Atkinson & Delamont, 2006) towards them. Focusing on the
importance of illness/recovery stories has possibly caused us
to celebrate stories of PiR, often conflating ‘‘qualitative’’ and
‘‘narrative’’ and sometimes at the expense of following a
clear philosophical grounding and a meticulous methodology.
As a possible path to enhancing the distinctive virtues of
narrative research, realizing its potential in exploring MHR,
we offer the narrative paradigm (Spector-Mersel, 2010).
Within this framework narrative research is considered a
specific qualitative endeavor, that comprises a particular
theoretical foundation and precise resulting principles of
investigation. This direction coincides with Rhodes and de
Jager’s call ‘‘to develop a tradition of rigorous research for the
analysis and archiving of stories if changes to public policy
and professional practice are to be sustained’’ (2014, p. 100).
As illustrated throughout the paper, well-established
narrative research has much to offer recovery-oriented
practice and policy. Based on narrative studies, narrative
interventions can be designed to help PiR ‘‘re-write’’ their
selves (Freeman, 2010), creating satisfying meanings and
more positive and coherent identities. Indeed, the merits of
narrative research in exploring MHR rest considerably in the
notion of ‘‘re-’’ found at the heart of both the recovery and
narrative paradigms. Narrative studies portray PiR as multi-
faceted whole persons, encouraging holistic tools for assess-
ment and intervention that respect the interconnectedness
among diverse factors. The systematic scrutiny of oppressing
meta-narratives facilitates the construction of counter-narra-
tives. Narrative studies demonstrate the uniqueness of PiR, as
well as the variations in recovery paths, promoting indivi-
dualized practices and services. Understanding the contexts in
which narratives of recovery are embedded can help practi-
tioners and policy makers remove structural obstacles. The
careful attention to linguistic barriers in both personal and
collective stories is crucial to developing empowering alter-
natives. Lastly, narrative studies play a principal role in giving
voice to service users, thus enabling them to influence policy
and change stigmas.
In light of these far-reaching advantages, it would be
worthwhile to expand narrative research to presently under-
researched populations. These include PiR who do not use
professional help and those from non-Western cultures. Given
its holistic principles, the narrative paradigm is especially apt
for studying individuals who are recovering not only from
mental illness, but also from other social adversities and
traumatic life events. For instance, those suffering from a dual
diagnosis (e.g. substance use disorders), double stigma (e.g.
LGBT community), double risk for social exclusion (e.g.
immigrants and ethnic-racial minorities) and marginalization
(e.g. poverty, homelessness).
Despite the manifold merits of the narrative paradigm in
studying MHR, we do not contend that it is the only
appropriate means for this aim. MHR has been explored from
diverse interpretive paradigms and qualitative traditions,
eliciting valuable insights. Yet, given the substantial affinity
between the recovery and narrative paradigms – indeed, their
8 G. Spector-Mersel & E. Knaifel
‘‘sisterhood’’– we believe that research following the narra-
tive paradigm constitutes a particularly valuable vehicle for
understanding and promoting MHR.
Acknowledgements
Grateful thanks are extended to the anonymous reviewers for
their constructive suggestions and comments on a draft of this
article.
Declaration of interest
No potential conflict of interest was reported by the authors.
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