The photo-instrument: an instrument of meaning
giving
for consumers of psychiatric services
|
Introduction
The poet Les Murray once said that
“Nothing is said before it is dreamt in words
and nothing is true that comes to us in words alone.”
That’s why we need images and music and
movement or dance. Photos give us an image where language sometimes is not
enough to express what people experience. Images and text can reinforce each other and have the surplus quality of
the metaphore: a powerful message is created in imagery.
Example of a symbolical photo
made by Elize: “Two different ways of looking at things: half full or half
empty.”
In the photo-groups we organized in three psychiatric
hospitals in the eastern provinces of the Netherlands during the years
2004-2008 we used an approach based on the self-experiences of consumers. We
have designed a structured way of working with photos that were made by
consumers themselves. Central to our approach is how a consumer experiences
(aspects of) his daily life. In the lives of consumers illness or mental
disorders have played a role and often still do. However, there are so many
other things that are of importance. Where these are overshadowed by illness
they deserve to be put into the picture again.
This is what our approach tries to achieve. It aims at facilitating a
process of meaning giving that creates an awareness of a ‘valued life’, that
is: there is more to life than being a patient with a mental illness.
We have called our approach the photo-instrument.
The photo-instrument
Consumers come together in a group with weekly
sessions over a period of 8 weeks. Every participant receives a disposable
camera and an assignment: to make photographs of what is important to him/her
or what he/she holds as dear. Photos can be made of people, things, animals
(pets or instance), hobbies or even a place that is special to you. The photos
are developed and printed. In the next session of the photo-group they are
returned to the participants with the request to sort them out and group them
together according to one’s own wish and understanding. Then the photos are
glued on to sheets of photo carton and the groups of photos are tagged. Next the participants are interviewed about
their reasons to group photos together and also which photo of each group is
most meaningful in relation to the tag that each group has received. Differences
between photos are further explored, as well as associations and projected
feelings. In this way a deeper level of values and emotions can be explored. Everything
that is told and explained by the photographers is noted down, processed by the
therapist as text after finishing the session and then printed. The next
session these prints are handed to the participants for correction and supplementation.
In the course of the next sessions participants are asked to select three
photographs with text for enlargement and exhibition. Participants are then invited
to actively cooperate in preparing the exhibition and take upon tasks.
There are two rounds. In the second series of 8
sessions participants receive again a disposable camera and a new assignment.
The assignment focuses now on the near future: make photographs of something
that you wishes to become or to attain ánd what is needed to realize your wish.
This series is again rounded off with an exhibition.
Empowerment
The stories consumers tell are embedded in a relation with caregivers conducting the photo group in which consumers are in control. Which photos and accompanying text will be exhibited is up to the photographers themselves. They have the régie. For caregivers or therapists conducting the photo-group these choices can be a starting point for a dialogue with participants. Basically, however, the subjective experience that goes with the photos is listened to and accepted in its own right. The photo-story is validated as a personal narrative that deserves to be recorded and shown to others. This idea calls upon consumers to claim more autonomy in representing themselves. The photo-instrument helps them to realize that mental illness and a life story don’t necessarily overlap. You can live a valued life even when you are suffering form a severe mental illness.
Dirk: “An empty
terrace. When I hear voices (hallucinate) then I can’t sit among other people,
because
I talk to my
voices.”
Rehabilitation
In a second round of the photo group the focus on valuable things in life
is extended to wishes and ambitions. We zoom in on the near future and what is
needed to realize a chosen wish. What are the necessary skills? What obstacles
stand in the way? From whom do they need support? Thinking and talking with
each other about these aspects contributes, so we assume, to a larger readiness
and goal awareness. Readiness is an
important feature in rehabilitation theory. The photo-story eventually shows a
person with his goals and plans. In this way consumers rehabilitate
themselves from a suffering person into
someone who acts upon intentions. Showing the photos and the accompanying story
to others creates a kind of ’committment’, as could be observed with many
participants The photographer can be asked to answer the promise and intention
of his message. Caregivers can attune their guidance plans to what their
clients have expressed in their photo-stories.
Photographs lend themselves to an exploration
of feelings. Photography is often seen
as an objective representation of reality. This illusion of objectivity masks
the fact that most people project their own reality on to the image. “The truth
is in the eye of the beholder” The concreteness of the photograpic image works
as a kind of bridging device that makes people talk about their inner life.
Memories, experiences and present wishes, emotions and ambitions flow more
easily from reflecting on self-made photographs. The fact that the participants
conduct their storytelling in own régie and are in control protects them from
the risk of second traumatisation. The structured and graduated (dosed) way of
working with expressed meanings makes it more easy for participants to handle
the otherwise difficult and emotionally process of storying traumatic
experiences from mental illness and hospitalization. The assignment for making photographs focuses
on a ‘valued life’ and is formulated in positive terms. There is ample room for
reflection of losses that one has incurred or traumatic experiences but within
the context of finding own strength in the perspective of a ‘valued life’.
Social skills
Making photographs is an occasion for
practicing social skills, as, for instance, when you have to ask permission for
shooting a picture of someone. While you are busy making pictures others will
respond. You will have to go out and find your own places to photograph. It
activates and involves people with what goes on in their environment. When
photographs return from the photoshop most people like to show them to others. Photographs
are shared to admire the results. Photographs are also favourite as give-aways.
Last but not least, the organization of a
photo-exhibition offers chances to practice other social skills. For instance,
one of the participants can deliver an opening speech. Every participant can
contribute in his/her own way to make the exhibition night a success.
Jan
Sitvast
lecturer University of Applied Sciences Utrecht (HU)
jan.sitvast@hu.nl
Publications:
Sitvast JE, Abma TA, Lendemeijer HHGM, Widdershoven GAM. (2008). Photo stories,
Ricoeur, and
Experiences from Practice: a Hermeneutic Dialogue. Advances in Nursing Science,
vol. 31. 3, 268-279.
Sitvast JE, Abma TA, Widdershoven GAM. (2010). Façades of Suffering:
Clients’Photo stories About
Mental IllnessArchives of Psychiatric Nursing, vol. 24,
5, 349-361.
Nursing Ethics, 2011, vol. 18, 4,
583-595. DOI
10.1177/0969733011408047
Sitvast JE, Abma TA, Widdershoven GAM. (2011). Living with severe mental illness: perception of sickness
Journal of Advanced Nursing,67(10), 2170-2179.
Sitvast JE, Abma TA, Widdershoven GAM. (2011).The
Photo-Instrument as a Health Care Intervention Health Care Analysis, published
online 20 may 2011.DOI 10.1007/s
10728-011-1176-x
