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Issues in Mental Health Nursing, 28:1087–1103, 2007

Copyright c Informa Healthcare USA, Inc.


ISSN: 0161-2840 print / 1096-4673 online
DOI: 10.1080/01612840701581206

A DISCOURSE ANALYSIS OF THE


CONSTRUCTION OF MENTAL ILLNESS IN
TWO UK NEWSPAPERS FROM 1985–2000

Brodie Paterson, PhD, MEd, RMN, RNLD


University of Stirling, Stirling, Scotland, UK

This study explored the discourse of mental illness


contained within two UK newspapers over a 15-year
period, excluding those stories that mentioned any reference
to a diagnosis. Using frame analysis, a form of discourse
analysis, ten distinct frames were identified and classified
into “stories.” These ten stories were categorized as:
foreign, legal, drug, feature, trauma, tragedy, community
care tragedy, social policy, inquiry report, and
sports/celebrity stories. Each frame is described and the
potential influence of such frames on both social policy and
nursing practice is discussed.

Discourse analysis encompasses an influential analytical and method-


ological tradition related to a number of different disciplines, ranging
from linguistics to ethno methodology and social psychology (Coulthard
& Montgomery, 1981). This study used a subtype of discourse analysis
called frame analysis developed by a number of authors since the 1980s,
including Snow and Benford (1992) who used it to analyze social move-
ments, Gamson, Croteau, Hoynes, and Sasson (1992), who examined
political communication, and Entman (1993), whose work deconstruct-
ing the use of frames in the production of news. The work of these
authors provided a particular source of inspiration for this research. The
use of the term “frame” in the social sciences originates in the work of
Erving Goffman (1974) who contended that we use frames in order to
make sense of our life experiences. In his description, frames are internal
cognitive structures consisting of systems of classification and rules of

Address correspondence to Brodie Paterson, Department of Nursing and Midwifery,


University of Stirling, Scotland, UK, FK9 4LA. E-mail: b.a.paterson@stir.ac.uk

1087
1088 B. Paterson

interpretation. According to Goffman such frames allow us to “locate,


perceive, identify and label” (p. 21) the diverse phenomena we may en-
counter throughout the course of our lives. The frames deployed in the
process are not solely internal but in large part a product of individuals’
socialization into their culture, a process in which the media may play
a substantial role (Donati, 1992). Gamson (1985) argues that the news
media in some societies come to occupy a central role in the production
of cultural meaning because of their role in establishing, maintaining,
and redefining frames that encompass both the nature of the broader cul-
ture and those dimensions specific to individual issues such as mental
illness.
The role of the news media, and particularly newspapers, in rela-
tion to mental illness is a focus for contemporary debate with accusa-
tions that the media play a key role in the creation and perpetuation of
the stigma associated with mental illness (Anderson, 2003). Those who
support, if only implicitly, a causal effect between newspaper representa-
tions and public opinion are especially concerned about representations
of violence perpetrated by people experiencing mental illness (Stout,
Villegas, & Jennings, 2004). They assert that a disproportionate num-
ber of newspaper stories feature mental illness in a narrative in which
a perpetrator’s violent acts are explained with reference to his or her
mental illness and/or previous hospitalization (Cutcliffe & Hannigan,
2001). Representations of this nature, they complain, create and main-
tain an association between mental illness and violence in the public
consciousness that perpetuates the stigma associated with mental illness
(Angermeyer & Schulze, 2001). Stigma has a marked influence on the
lives on many people living with mental illness as it can be associated
with increased social distance and hinder efforts to promote inclusion
(Link et al., 1999). It may even delay help-seeking for people expe-
riencing mental illness, thus increasing the severity of the illness and
increasing the risk of suicide (Wilkinson, 1994).
Critics of this position assert that while widespread beliefs by the
public in a relationship between mental illness and violence may be a
reality, such beliefs are a product of long-standing culturally embed-
ded beliefs that newspapers reflect rather than create (Anderson, 2003).
Further, they argue that newspapers do not necessarily represent mental
illness solely or even predominantly in a context of violence (Stuart,
2003). Mental illness, they observe, can form a theme in a range of
stories in which diverse themes such as resilience and recovery feature
prominently (Byrne, 2000; Harper, 2005). There have, however, been
recent calls for a systematic exploration of the range of narratives in
which mental illness may be featured (Sieff, 2003).
Framing the Narrative 1089

Rogers and Pilgrim (1996) suggested that the historical division of


care where the severely mentally ill, typically the “psychotic,” were
cared for within institutions while the “neurotics” remained within the
community has been blurred by community care. Divisions do continue
but in a conceptual rather then physical form. One forum where such
divisions are most evident is in distinctly different patterns of media cov-
erage. The psychotic, they assert, are typically associated with themes
of dangerousness and threat. The neurotic, in contrast, are represented
with themes of vulnerability (Rogers & Pilgrim, 1996). Reducing the
story of mental illness to one solely involving diagnostic categories, if
only by default, ignores the potentially significant number of stories in
which mental illness may form a central theme, but where there is no
reference to a diagnosis. Such stories are important not only intrinsically
but also because newspaper stories that do not contain reference to an
identifiable diagnosis may represent a significant proportion of newspa-
per stories featuring mental illness (Coverdale, Nairn, & Classen, 2002;
Wahl, Wood, & Richards, 2002).

PURPOSE OF THE STUDY

This study presents the results of a framing analysis that focused on


the (London) Times and Guardian (London) covering the period De-
cember 1, 1985–December 1, 2000. The materials selected (complete
articles) were obtained via a Lexis Nexis search (search terms “mental”
and/or “illness”). The use of the term “mental illness” in the context
of this study is a convenience, reflecting the terminology prevalent in
the newspapers and does not indicate acceptance of a medical/disease
model. The search produced, after exclusion criteria had been applied
(reviews, obituaries, advertisements, stories in which mental illness was
not a significant theme), a total of 3185 article and letters, 2121 in the
Guardian and 1064 in the Times (66.6% and 33.4% of the total sample,
respectively). Where a diagnosis was evident Schizophrenia (18%), De-
pression (12%), Personality Disorder (4%), and PTSD (3%) were the
most frequently occurring diagnosis. However reference to any diagno-
sis was absent in nearly 50% of the stories analyzed prompting interest in
the nature of those narratives. The selection of two “broad sheets” (i.e.,
the Times and the Guardian) and the exclusion of the “tabloids” might
be questioned given it is often the tabloids’ coverage that is accused of
sensationalizing the issue of mental health and violence (Crepaz-Keay,
1996). The strategy is justified in this instance by concerns over the
news agenda of the English tabloids, particularly their “aggressively
1090 B. Paterson

down-market style of presentation” and “focus on sex, scandal, violence


and right wing populism,” seemingly exemplified by the Sun (Jenkins,
1992, p. 19). This focus would suggest an inveterate tendency to report
violence involving people with mental illness in the most lurid form.
The “quality” newspapers, in contrast, might be expected to include
a more diverse range of narratives providing therefore a richer source
of data.
This research was conducted as part of a larger longitudinal study
examining potential changes in the balance of the discourse of represen-
tations of mental illness the results of which are not reported here. This
aspect of the study analyzed newspaper representation of mental illness
qualitatively, seeking to uncover the diverse narratives of mental illness
and identify the underlying frames integral to these narratives.
In Goffman’s (1974) original description, frames are internal cogni-
tive structures consisting of systems of classification and rules of inter-
pretation. Gitlin (1980, p. 7), however, linked the concept of frames to the
discourse of newspapers arguing that they “enable journalists to process
large amounts of information quickly.” Such packaging also serves to
place the information in the context of a story whose narrative is thereby
more readily understood by its intended audience. As Gamson and
Modigliani (1987, p. 143) observe, frames provide the “central organis-
ing idea or story line that provides meaning” for the events. This is the
classic social function of storytelling. Two aspects of the framing process
are particularly important: “selection” and “saliency” (Pan & Kosicki,
1993, p. 55). Selection refers to the choice made of certain “aspects of a
perceived reality” (Entman, 1993, p. 52) and, by implication, the filtering
out of other potential stories (Herman & Chomsky, 1994). Those selected
stories are then “made more salient” (Entman, 1993, p. 52) by the frame
used, which “selects some aspects of a perceived reality in such a way as
to promote a particular problem definition, causal interpretation, moral
evaluation and/or treatment recommendation” (Entman, 1993, p. 52).
The experience of the “audience” consists, though not necessarily or
even ordinarily, of single stories but also of exposure to multiple repre-
sentations of different aspects of the story, via a range of media (e.g., a
news story heard on the car radio, a reference in a soap opera, or a news-
paper headline glanced upon). Seale (2003, p. 518) suggests that it is as a
result of such fragmentary exposure that “we learn the conventions of the
overall media story, which has certain regular features.” Audiences over
time may indeed become so familiar with the conventions of individual
frames that they are able to suggest with some accuracy the structure
and focus of actual stories when exposed only to fragments (Benthall,
1993).
Framing the Narrative 1091

METHOD

Framing as a process encompasses the means by which a story is rep-


resented, but it also includes the underlying “internal structures of the
mind that are involved in the creation of the story by both the journalist
and members of their audience (Kinder & Saunders, 1999, p. 74). Jour-
nalists themselves are not immune to the effects of frames and may be
as susceptible as their readers to internalising such narratives as reality
(Kinder & Saunders, 1999). Such frames may come therefore to effect a
series of predefined narratives structures that are applied to mental illness
thus constituting how it will be represented in a particular newspaper or
even culture.
Karpf (1988, pp. 28–29) identified seven distinct frames, which he
suggested characterise newspaper coverage of wider health issues. These
included the breakthrough (scientific discoveries leading to potential
new treatments); the disaster (health consequences of earthquakes, fires,
explosions, or accidents); the ethical controversy (for example, surrogate
mothers, test-tube babies); the strike (health service dispute or political
debate); the epidemic (its course and treatment); the official report or
speech (government or medical), and the scandal an example of which,
she notes, was violence by psychiatric or rather ex-psychiatric patients.
This aspect of the overall study used a model of the media framing
process developed by Entman (1993, p. 52). He suggested that the pro-
cess of framing an issue has four elements: (1)Problem definition (what
is happening with whatever results in terms of costs and benefits); (2)
Cause diagnosis (who or what is causing this situation); (3) Moral judg-
ment (what is the motive); and (4) Suggested remedies (what solutions
are identified).
As Entman (1993) suggests, a single sentence within a story may
fulfill more than one of these functions while many sentences can be
irrelevant to the overall process of framing. Further, while all four ele-
ments can be observed in many frames this does not mean that all four
aspects will be discernible, whatever the frames or context in any given
story (Entman, 1993). Neither is it always necessary for every aspect
of a frame “to be literally outlined in the text. The mention of some or
even one element may be sufficient to prompt the recall of the whole
set” (Donati, 1992, p. 141).

FINDINGS

By means of a process of continual reflection and refinement, a se-


ries of ten distinct categories, or frames, featuring mental illness were
1092 B. Paterson

arrived at, some featuring a number of variations or subtypes. Each is


identified and discussed in turn. This reflection included presentations
of earlier versions of these categories to the European Violence in Psy-
chiatry Research Interest Group and to colleagues whose comments are
gratefully acknowledged. The category Foreign Story (see Table 1) refer-
ences mental illness outside the UK and reflects significant international
news coverage in both the newspapers concerned. The two subtypes,
“The Asylum and War” and “Asylum and Social Change,” both focus
on people with mental illness as victims. In the former this is because
of conflict, in the latter it is either the persistence of discriminatory atti-
tudes toward people with mental illness or economic hardship and social
breakdown in post communist Eastern Europe.
The Legal Story (Table 2) as a category originates in the context of
the English justice system. It contains three subtypes that attempt to
attribute responsibility for the disordered offenders’ behavior or their
ability to comprehend court proceedings. The first subtype, Legal Ar-
gument, determines these individuals’ competence to stand trial. In the
second subtype, the Court/Sentencing Report, the role of mental illness

TABLE 1. The Foreign Story

Subtype B: the asylum and


Subtype A: the asylum social change in eastern
Subtype and war Europe/ Africa
Problem People experiencing mental People experiencing mental
illness institutionalized, illness ill fed and/orcared
ill fed, and/or cared for for living in primitive
living in primitive conditions
conditions
Diagnosis of the cause War or other conflict has Poverty and/or lack of
led to a breakdown in “appropriate” (i.e.,
social order “Western
understanding”) of
mental illness
Moral Judgment Implicit/explicit suggestion People with mental illness
that they are innocent are seen as “innocents”
victims of the conflict requiring care and
Mental illness within the protection.
institution is contrasted
ironically with “real”
madness of war outside.
Remedies Peace Changed understanding
and/or foreign aid
TABLE 2. The Legal Story

Subtype C: the offender as victim


Subtype Subtype A: legal argument Subtype B: the court/sentencing report as well as perpetrator
Problem Competence to stand trial and/or An individual experiencing mental An individual experiencing mental
criminal responsibility for offense illness has done something seriously illness has done something
wrong usually homicide, serious seriously wrong usually homicide,
assault, or rape serious assault, or rape
Diagnosis of Mental illness may impair judgment to The individual has committed the act The individual has committed the
the cause the extent that the individual is unable because they were/are mentally ill act not just because they were/are
to take part in court proceedings rather than for any other any reason mentally ill, but also because of a
lack of care and/or services that
failed to identify and manage the
potential threat.
Moral People experiencing severe mental Society must be protected from those Society must be protected from
Judgment illness should not be punished for who represent a threat. Control needed those who represent a threat.
acts for which they cannot reasonably for persons’ own good Services that “fail” people with
be held responsible. Some serious mental illness are, however,
perpetrators may however try to use equally or even more culpable than
mental illness to escape punishment; the individuals they serve whose
this should not be allowed actions are a function of their
mental illness.
Remedies Due process The individual lacking insight into his The individual lacking insight into
mental illness, which was the primary his mental illness, which was the
cause of his behavior, must be treated primary cause of his behavior,
in conditions of security until “we” must be treated compulsorily if
can be sure “they” will never do it necessary. Services must be in
again. place to engage with people with

1093
mental illness to prevent offending.
1094 B. Paterson

as causal in the offending behavior has been established and the need
for the protection of society is emphasized. This category sometimes
appears in a hybrid form (subtype C), where the perpetrator is simulta-
neously represented as a victim of services, which have somehow failed
to protect the person from themselves. The perpetrator’s behavior, al-
though caused by mental illness, was to some extent also the respon-
sibility of whatever services failed to adequately monitor the person’s
condition or compel treatment. It is suggested that treatment might have
reduced the risk of the incident occurring.
The Drug Story (Table 3), characterized by its central focus on some
form of psychotropic medication, exists in three variants. One subtype
was confined to the business news sections of the two newspapers and
reflects its setting with a focus on the profitability of new drugs. The other
two subtypes appeared more often in the main news or feature sections of
the papers and contain opposing representations of the pharmaceutical
industry. In subtype A, The Breakthrough, the introduction of a new drug
is represented as an extremely positive development with the villain (i.e.,
those morally culpable, most often the government) accused of failing
to fund the novel treatment. In subtype C, The Side Effect, the drug
company is characterised as the villain in a narrative whose focus is on
side effects.
The Feature Story (Table 4) focuses on the impact of mental illness,
but the category is differentiated into two subtypes. In the first, The
Family and Mental Illness, the narrative is based around the effects of
the mental illness of one member of the family, usually a child or parent,
but sometimes a partner. The second subtype is told in the first person
from the perspective of the individual with mental illness and can contain
a number of diverse themes. These include the symptoms of mental
illness, the negative consequences of illness on their employment and
relationships, problems with treatment, and their experience of stigma.
Such stories can however, also feature positive accounts of individuals’
experience of treatment, personal resilience, and family and community
support leading to recovery.
The Trauma Story (Table 5) is defined as a category by reference to
an event or series of events in the individual’s past. The category has two
subtypes differentiated only by context. In the Trauma Survivor Story,
the individual’s symptoms are described and the need for psychological
support emphasized. The second subtype adds only that neglecting to
provide such support may constitute negligence, and that those harmed
by such negligence should be compensated.
The Tragedy Story (Table 6) is somewhat unusual in this discussion
of frames in that a remedy for the problem identified is absent. Because
TABLE 3. The Drug Story

Subtype B: new drug Subtype C: drug treatment


Subtype Subtype A: new drug breakthrough will improve profits side effects
Problem A disease (most often Alzheimer’s, The drug company needs to be Drug based approaches to treatment
depression or schizophrenia) and its profitable are questionable and may have
effects on the individual and/or the family side effects that drug companies
would prefer remain hidden
Diagnosis of Current drug treatments are ineffective; Its share of the market for Drug companies are working in their
the cause new drugs will potentially improve condition Y is insufficient or interest not in the public’s interest.
treatment and transform lives the sector is unprofitable. New
product(s) or markets are
required
Moral The new drugs may be more expensive but Being profitable is good for the Drug companies’ tendency to
Judgment will improve or save lives. They should company, shareholders, and maximize profitability rather than
be prescribed; government should find the ultimately the public, because the public good is unethical
money profits will fund new research
Remedies Funding for drug research and prescribing Develop and market new drugs Restrict prescribing, demand
of the new, improved drug independent monitoring of drug
trials and justice for those affected
by side effects

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TABLE 4. Feature Story

Subtype A: the family Subtype B: personal


Subtype and mental illness stories/experiences of illness
Problem The impact of illness on the The impact of illness on an
family of the sufferer including individual or individuals,
the experience of receiving including the experiences of
services receiving services and recovery
Diagnosis of Lack of resources Lack of understanding and
the cause knowledge by family, friends,
or the wider community
Remedies Resource provision Tolerance, understanding,
acceptance

the perpetrator is deceased, calls for punishment are redundant and the
judgment is one of personal tragedy, a terrible event for those involved
but one of no significance for society as a whole.
The remedy advocated within the frame provided by the Community
Care Tragedy (Table 7), in contrast, demands changes in the nature of

TABLE 5. The Trauma Story

Subtype A: the trauma survivor Subtype B: the compensation


Subtype story claim
Problem An individual has survived a An individual has survived a
tragedy, but was or is still tragedy, but still bears the
scarred by the experience psychological scars
Diagnosis of Exposure to certain categories of Exposure to certain categories of
the cause events may result in a events may result in a
proportion of exposed proportion of exposed
individuals developing individuals developing
pathological reactions pathological reactions. Either
exposure should have been
prevented, but negligently was
not, or the psychological
aftercare, which would have
prevented trauma developing,
was negligently not provided
Moral Victims (i.e., those affected) Such failings were remiss
Judgment should be helped
Remedies Those traumatized should have Those harmed as a result of
access to treatment negligence should be
compensated
Framing the Narrative 1097

TABLE 6. The Tragedy Story

Problem A named individual has committed suicide, sometimes


accompanied by the murder of their children or other
family members; it is thought the balance of their mind
was disturbed
Diagnosis of the cause Mental illness
Moral Judgment Personal tragedy
Remedies Absent

social policy. This stems from the explanation provided for the event that
attributes responsibility not to the perpetrator, but to the implementation
of the policy that allowed such events to happen. The event is represented
not as a personal tragedy, but as symbolic of a wider social problem that
constitutes a risk to the welfare of the wider community.
References to individual events are noticeable by their absence in the
first subtype of the Social Policy Story (Table 8). The Policy Announce-
ment subtype is generally adapted from government press releases. As
such they tend to avoid reference to individual events in favor of a discus-
sion of what the new policy will achieve. The second subtype, Attacks on
Policy, originate outside government from mental illness interest groups,
clinicians, trade unions, professional organizations, or other politicians.
The Inquiry Story (Table 9) has its basis in the requirement imposed
on National Health Service Trusts In England to hold an independent
inquiry into homicides committed by a person who has had contact with
specialist mental health services in the preceding six months. These
were made mandatory in England and Wales in 1996 by Health Service
Guideline (HSG(94)27). These were initially criticized as being polit-
ically motivated and designed to reassure the public rather than serve

TABLE 7. The Community Care Tragedy

Problem An individual known to be experiencing mental illness has


committed homicide, involving a member of the public
Diagnosis of the cause The care and support the perpetrator received were
inadequate because of failings in the implementation and
resourcing of community care (and not the failings of
staff involved)
Moral Judgment Preventable injustice perpetrated against the victim but also
the perpetrator, by those responsible for the
implementation of the policy in such a manner
Remedies Change the manner in which the policy is implemented
1098 B. Paterson

TABLE 8. The Social Policy Story

Subtype A: policy Subtype B: attack on policy calls


Subtype announcements for new policy/change of policy
Problem Problem has been identified in a Present policy is not working
given area
Diagnosis of Policy vacuum or problems with Policy is not working because of
the cause current policy identified problems
Moral Government should govern, thus It is the duty of government to
Judgment it must provide policy guidance govern. Failure to act to resolve
situation identified would be
remiss
Remedies New/Revised policy New/Revised policy

any clinical purpose. Ironically it has been suggested that they were ul-
timately “counter productive by reinforcing the association in the minds
of the public with respect to the link between mental disorder and the
perpetration of violent crime upon strangers” (Peay, 1996, p. 21).
The Sports/Celebrity Story (Table 10) is defined by its focus on the
association between fame and illness. The narrative suggests that the
pressures of fame and/or to perform are too high and depending how
sympathetic the image of the celebrity/sports person is, calls for com-
passion and respect for the individuals’ privacy are made.

DISCUSSION

Entman (1993, p. 52) observes that framing draws our attention to


four aspects of the process of communication, “the communicator, the
text, the receiver and the culture.” The media, including newspapers,

TABLE 9. The Inquiry Story

Violence perpetrated by someone experiencing mental


Problem illness is a consequence of their mental illness
Diagnosis of the cause Violence as a consequence of failings by professionals to:
Predict violence, communicate with each other/other
services, listen to relatives, act promptly, enforce
compliance medication, and/or warn relatives
Moral Judgment System failure
Remedies Reorganization, learning
Framing the Narrative 1099

TABLE 10. The Sports/Celebrity Story

Problem A named sports person (e.g., a football player or other


celebrity) is affected by mental illness
Diagnosis of the cause Pressure to perform
Moral Judgment The pressures on high profile public figures are too high
Remedies Acknowledge human frailty, extend compassion

form only one element of the discourse, and frames exist in multiple
dimensions. These include those formed as result of an individual’s own
experiences, the original discourse produced by involved or interested
individuals or groups on a theme, media interpretations and represen-
tations of debates between such groups, and media generated images,
where the visual image can form an important aspect of the discourse
(Fisher, 1997). In addition there are those cultural tools that people use
to make sense of both original discourse and media translations of that
discourse (Gamson et al., 1992). Finally, as Gamson et al. (1992) notes,
there remains that which constitutes common knowledge in a given
culture. The relationships among the discourses contained within news-
papers, those in the broader culture, and those within the consciousness
of individuals is therefore perhaps best construed as dialectical (Gam-
son & Modgliani, 1989). This perspective acknowledges the potential
influence of frames but also recognizes that all frames are “temporally
variable and subject to reassessment and renegotiation” (Snow et al.,
1986, p. 476). Socially situated actors may play an active rather than
just a passive part in these negotiations (Snow et al., 1986)
Media frames including those contained within newspapers remain
a significant and important element of the discourse on mental illness
because they can affect the day to day lives of people with mental illness,
public opinion, and in some instances, perhaps even the priorities of so-
cial policy (Paterson, 2006). Blumler and Kavanagh (1999) suggest that
the debates conducted in media-constructed public spheres, including
newspapers, reflect a process they term “mediatization” in which, pol-
icy is increasingly made in the media. The process can involve attempts
by social movements to promote an alternative frame to one that has
been previously dominant in order to evoke a change in public opinion
and/or social policy in a given area (Snow et al., 1986; Snow & Benford,
1988). Paterson (2006) suggests that the emergence of violence per-
petrated by people with mental illness in the UK as a social problem
was, in part, the result of the emergence of what was initially a novel
frame, that of the Community Care Tragedy. This superseded the previ-
ous frame, which had characterized such events as essentially accidents
1100 B. Paterson

(i.e., personal tragedies for the participants involved but of no wider


social significance). The new frame constructed them as preventable
injustices perpetrated upon innocent members of the public. Injustices
moreover, which the frame exercising moral judgment, attributed to
politicians recklessly pursuing an unsafe version of community care
(Paterson, 2006). Despite opposition and attempts to promulgate al-
ternative narratives, including a narrative of negligent practitioners the
Community Care Tragedy became the dominant narrative, leading to an
increasingly negative policy image. In doing so it opened up the policy
network to new voices pursuing new agendas—In this instance, con-
cern for the victims of community care tragedies, thereby increasing the
likelihood of policy change (Rose, 1998). Changes in the media frames
involving mental illness are therefore potentially significant for social
policy (Loseke, 1995). Any change in the priorities of social policy, such
as that exemplified by the prioritization of public safety in English men-
tal health policy, is also however highly likely to have an influence on
the priorities of practitioners and, via their practice, on the experience
of their patients (Holloway, 1996).
This paper has focused on those aspects of the discourse in which a
diagnosis does not feature. Those seeking change also may target the
discourse of mental illness involving diagnosis. Healy (2002) suggests
that media stories associated with diagnostic categories may be partic-
ularly susceptible to deliberate manipulation by drug companies. Such
companies can seek to promote the existence and/or diagnosis of partic-
ular disorders and crucially, frame these disorders as requiring treatment
by psychoactive drugs rather than talking therapies.

CONCLUSION

This study has examined and identified significant elements of the


discourse around mental illness in the media whose nature and potential
influence had not previously been explored. Findings add substantively
to what is known about how mental illness is depicted in the media
and what dictates the nature of such representations in terms of the
available frames. Future studies of media representations, of mental
illness, and of the potential effects of such representations whether on
public opinion, the social policy agenda, or the priorities of practitioners,
must now engage with this newly revealed diversity. It is, however,
important to recognize that this newly revealed diversity does not imply
greater flexibility in terms of the available frames or in the demands
arising from these frames for moral judgment and an identifiable culprit
Framing the Narrative 1101

rather than an exploration of moral ambiguity. The media production


process with its focus on “selling stories rapidly, succinctly and in an
interesting way” transforms events into news using frames as templates
(Lalani & Carlyle, 2006, p. 3). The complexity inherent to many stories
involving mental illness may be difficult to reconcile with such demands,
posing significant challenges for those attempting to promote alternative
frames.
Validity in qualitative research, as in this application of frame anal-
ysis, raises a series of questions (Potter & Wetherell, 1994). These in-
clude what constitutes scholarly inquiry in the application of a method
but also speak to more fundamental questions. For the purposes of this
study validity was interpreted from a postmodern perspective (i.e., it dis-
carded the concept of an objective reality to validate knowledge against)
(Lyotard, 1984). Instead validity was interpreted as a process of choosing
among competing interpretations that were each understood as poten-
tially falsifiable and of critically exploring the relative credibility of the
claims made (Polkinghorne, 1992). Thus the validity of the findings
presented is dependent upon their ability to provide a comprehensive
and coherent explanation of the variation in the phenomenon analyzed
(i.e., English newspaper narratives featuring mental illness from 1985–
2000). The range of narratives and the nature of the frames employed
to structure the discourse of mental illness in the media may show sig-
nificant variation between different countries and over time, and further
research is necessary to determine whether the frames identified have
wider currency internationally.

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