Thick Descriptions and the Lived Experience of Mental Health Challenges
The vital question is most often not if a particular kind of symptom is present, but what it means and why it is suffered. Causes for painful symptoms and deviant behaviors could be biological as well as psychological or cultural, but they always come together by way of the person who suffers from them.
USEFUL IN ANSWERING QUESTIONS AROUND WHAT THICKER CONVERSATIONS about spirituality might look like is Clifford Geertz’s idea of thick descriptions. For Geertz, thick descriptions provide cultural context and help outsiders understand the meaning people place on actions, words, things, and situations. They are intended to provide enough context to enable those outside a particular situation to find meaning in the articulations of cultural experience.2
In the first chapter of his book The Interpretation of Cultures, Geertz focuses on the role of the ethnographer, a person who observes, records, analyzes, and interprets cultures. Interpretation of signs is the gateway into the meaning of a culture. To be authentic, such interpretation must be based in thick descriptions that help people see all the possible meanings. Geertz uses the example of the wink of an eye. At one level this is simply a muscular action that rapidly closes and opens a person’s eyelid. However, at a thicker level, the one winking may be “practicing a burlesque of a friend faking a wink to deceive an innocent into thinking conspiracy is in motion.” To understand the meaning of any particular wink, it is necessary to describe, interpret, and understand the culture in all its rich, thick fullness. Thick descriptions allow such description, interpretation, and understanding to occur.
The sociologist Norman Denzin notes that thick description “does more than record what a person is doing. It goes beyond mere fact and surface appearances. It presents detail, context, emotion, and the webs of social relationships that join persons to one another. Thick description evokes emotionality and self-feelings. It inserts history into experience. It establishes the significance of an experience, or the sequence of events, for the person or persons in question. In thick description, the voices, feelings, actions, and meanings of interacting individuals are heard.”3 Thick descriptions are necessary for deep understanding to occur. They provide a detailed account of a situation, phenomenon, or culture, an account that pays careful attention to the forms of behavior, language, interpretation, and relational dynamics. The thicker or richer the description, the broader the range of possibilities for interpretation, understanding, and action. Thick descriptions give the reader the opportunity to engage more deeply with the situation and, in so doing, begin to resonate with the issues in ways that thin descriptions simply cannot. Thick descriptions are multidimensional and rich in their verisimilitude; that is, they seem to be true or have the appearance of being real. Thick descriptions lead to thick and rich interpretations. Thick and rich descriptions and interpretations lead to thick and rich practices.
Nancy C. Andreasen is a prominent neuroscientist and psychiatrist whose book The Broken Brain: The Biological Revolution in Psychiatry4 was a key text in psychiatry’s movement from psychoanalytical to biological understandings of mental health challenges in the 1980s.5 Although her strong biological position seems to stand at odds with some of the critique I offered in the previous chapter, she seems not to be completely bound by the hegemony of reductionist biological explanations. In her paper titled “DSM and the Death of Phenomenology in America: An Example of Unintended Consequences,”6 Andreasen contends that one of the unintended consequences of the introduction of the DSM criteria has been “the death of phenomenology.”
In line with our previous comments on Jaspers’s and Sims’s perspective on the importance of thick descriptions for psychiatry, Andreasen notes that psychiatry has a long and rich history of descriptive psychopathology, a history at whose center have been phenomenological thinkers such as Martin Heidegger, Edmund Husserl, and Karl Jaspers. Psychiatrists such as Jaspers saw great benefit in constructing deep and thick descriptions of psychopathology that could provide in-depth understanding of the phenomenon of mental disorder. In so doing, they hoped to provide rich and thick possibilities for understanding, and thus more compassionate intervention. Andreasen points out that this kind of phenomenological approach to psychopathology has died with the implementation of the DSM criteria. The original creators of the DSM, she says, did not claim that it was definitive in containing the final, all-encompassing truth about mental disorder for psychiatry. They intended it to be seen as a perspective to guide clinical practice rather than an explanation that excluded other ways of describing and acting. Its authors recognized that it was a “best effort,” a solid attempt to capture some aspects, but not every aspect, of people’s mental health experiences.
What happened, though, at least in the United States, is that the DSM has been used more as a checklist than as part of a shared search for thick descriptions of people’s mental health experiences. The DSM was originally intended to highlight only some characteristics of a given order. Andreasen notes that the DSM criteria
were never intended to provide a comprehensive description. Rather, they were conceived of as “gatekeepers”—the minimum symptoms needed to make a diagnosis. Because DSM is often used as a primary textbook or the major diagnostic resource in many clinical and research settings, students typically do not know about other potentially important or interesting signs and symptoms that are not included in DSM…. DSM has had a dehumanizing impact on the practice of psychiatry. History taking—the central evaluation tool in psychiatry—has frequently been reduced to the use of DSM checklists. DSM discourages clinicians from getting to know the patient as an individual person because of its dryly empirical approach.7
The DSM certainly offers information about mental disorder. But if we assume that what it tells us is adequate for understanding, then we have a problem. From this perspective, we can see exactly why my psychiatrist friend didn’t feel he needed to engage with his patients at any depth. Phenomenological engagement with thick descriptions was simply not a part of his worldview. The DSM may function more or less effectively as a general map of the terrain, but if we try to use it as a comprehensive guide to the territory, we will quickly become lost in the forest.8
To negotiate the territory effectively, we need a guide who is not functioning at a high level but is walking with us on the ground, noticing firsthand the details, the bumps, curves, turns, and hedges, that make the journey of mental health interesting, difficult, and complex. Andreasen suggests that we resurrect phenomenology; by returning to the rich and thick descriptions highlighted by people like Jaspers and Sims, we can more adequately capture the fullness of people’s mental health experiences as they are lived out within the lives of real, meaning-seeking human beings. This does not mean rejecting other forms of description. It simply means starting in a different place and allowing that starting point to mark out, shape, and form the parameters of the journey and the ways we use, discern, and work with other descriptions.
As I read Andreasen’s paper, I began to see that the development of a phenomenological attitude might be a good way of founding a theological investigation that takes seriously the various descriptions of mental health challenges that are available, but in addition seeks to create new descriptions based on thick accounts of people’s spiritual experiences. Such an approach would draw on the phenomenological tradition in order to create rich and thick description specifically focused on people’s faith lives. Such thick descriptions have the potential to open up new avenues for understanding faithful practices.
Phenomenology seeks to move beyond standard assumptions about the way things appear to be and, as Edmund Husserl put it, get “back to the things themselves.” The power of phenomenological description lies in its ability to describe the complexity of phenomena by getting behind the layers of theoretical assumptions that are placed upon them. This makes it possible to capture something of the lived experience of a phenomenon, that is, the experience as it is lived out prior to the later attribution of theoretical interpretations to it. Phenomenology asks us to put aside our presuppositions, plausibility structures, standard explanatory frameworks, expectations, and assumptions and return to look at the thing itself, the experience as it is lived rather than as it is theorized. For example, rather than asking the question: “What is a hallucination?” (a medical question), we might ask a slightly different question: “What does it feel like to experience voices?” (a phenomenological question). We put to one side our technical language such as “symptom” or “hallucination,” and its accompanying therapeutic or pharmaceuticals responses, and try to get back to the experience in and of itself—uninterpreted and lived. Using language such as “voice hearing” draws us into the phenomenological zone and opens up a different set of questions, a different type of description, and fresh possibilities for responding. Above all else, phenomenology urges us to remember that before there was a theory, there was an experience; before there was a category, there was a person having a meaningful experience.
Adopting a phenomenological attitude enables us to focus on understanding without forcing explanation. Explanation still has a place (although it may not be the role of theology to offer explanations), but our focus is on meaning and understanding, which takes us to quite different places and opens our journey up to new and fascinating possibilities.
In the following chapters, I take up Andreasen’s challenge and work toward resurrecting phenomenology as a significant dimension of theological reflection on the ways Christians experience mental health and ill health. This is not a formal exercise in phenomenological philosophy.9 Rather, my intention is to develop a phenomenological attitude that questions and challenges the “natural attitude” toward mental health phenomena. My focus will not be on describing pathology per se, at least not in a clinical sense. I am a theologian, not a psychiatrist, after all. My focus is not so much on eradicating or controlling pathology, but more on how people can live well with Jesus even in the midst of such experiences.
A good deal of the way we live our lives and engage the world assumes that the things we engage are simply there before us in an obvious and uninterpreted form, available to our understanding in their entirety “just as they are.” Many of us do not question the validity of the ways we see the world; we just assume that what we see is what is actually there. The “lifeworld”—or what we experience prereflectively, prior to noticing and interpreting it—is invisible to us most of the time. Edmund Husserl calls this everyday naïveté the “natural attitude.”10 To get behind our everyday assumptions, it is necessary to reduce the phenomenological range of our focus of attention. We do this via what he describes as phenomenological reduction (epochē), otherwise known as bracketing.11 Epochē is a Greek word meaning to suspend judgment or stay away from our normal commonsense ways of looking at things. Bracketing our assumptions does not mean that we pretend they do not exist. We cannot unknow the things we already know. To engage the process of phenomenological reduction, we begin by making our presuppositions and assumptions overt and clear. When we know what these things are, we can self-consciously put them to one side. We can then develop a consciousness of the ways our current knowledge impinges upon our ability to see things as they are. By reducing the lifeworld to a focus on specific phenomena, bracketing provides access to prereflective knowledge. We can then create rich, thick descriptions that help us see the thing in itself, untainted by our biases and prejudices.
Such bracketing is useful, for example, in getting behind the negative and stigmatic aspects of diagnoses and revealing cultural and religious accretions, caricatures, myths, and negative assumptions. As a basic technique, such an attitude is fine. However, in practice, it is impossible to bracket out our own experience. More than that, we actually need our experiences, biases, and prejudices in order to make sense of the world. Human beings do not come to understand things in a vacuum. There is no such thing as an uninterpreted experience. Understanding requires something more than just bracketing.
That “something more” is ourselves! Central to the approach I am developing here is the recognition that our own interpretative horizon—our history, who we are, where we have been, what we know, what we believe about the world, what is ingrained in us by family, friends, culture, science, and religion—is fundamental to the ways we interpret the world and make sense of any new experience. Knowing and understanding come not simply from bracketing our biases and prejudices but also from recognizing the importance of our biases and prejudices for how we interpret the world, and utilizing those biases and prejudices as integral aspects of the way we make sense of any given experience or phenomenon. Positively construed, our history, our biases, and our prejudices are not obstacles to knowledge and understanding but the conditions for our knowledge. As the German philosopher Hans-Georg Gadamer has put it: “to interpret means to use one’s own preconceptions to determine that the meaning of the text can really be made to speak for us.”12
The process of understanding is thus seen to be conversational and dialogical rather than the product of isolated, bracketed personal reflection. Bracketing and the phenomenological attitude are useful for clearing the ground and enabling certain forms of description. However, the interpretative dimension of description is of fundamental importance. We come to know the world as we allow our horizon of understanding—the boundaries and parameters of our current knowledge, experience, and understanding—to enter into dialogue with other horizons of understanding. This process of dialogue forms the epicenter of how we come to know things.
Horizons both link and separate us. At one level, our horizons are distinct. As such, they divide and separate us from one another. The horizon of psychiatry, for example, is separate from the horizon of theology, as are the horizons of psychoanalytical theory and psychology. There is, however, a conversational flexibility within our horizons that allows such differences, if the conversation is properly and hospitably managed, to become the context for creative dialogue and deeper understanding. Charles Taylor observes that horizons are not fixed or immovable: “Horizons can be different, but at the same time they can travel, change, extend—as you climb a mountain, for instance.”13 Horizons can be shaped, extended, and changed: “Gadamer’s concept ‘horizon’ has an inner complexity that is essential to it. On the one hand, horizons can be identified and distinguished; it is through such distinctions that we can come to grasp what is distorting understanding and impeding communication. But on the other hand, horizons evolve and change. There is no such thing as a fixed horizon. ‘The horizon is, rather, something into which we move and which moves with us. Horizons change for a person who is moving.’ A horizon with unchanging contours is an abstraction.”14 Knowledge and understanding come not through abstraction, distancing, and theorizing but through allowing the development of an openness to and awareness of other horizons that come from listening and hearing, not just talking. Such modes of listening and dialoguing help us to recognize and undo those aspects of our implicit assumptions that distort the horizon of the other. In this way we come to know the world not as an object to be mastered, fully fixed, conceptualized, and defined. Rather, we come to know things as we engage in dialogue with a variety of horizons of understanding. The delicate, patient, hospitable, and dialogical movement of interhorizontal conversation paves the way for understanding.
This is not an argument for relativism, that is, the suggestion that truth is always conditional and can be seen differently from a variety of viewpoints or perspectives: “Proposition p could be true from perspective A, false from perspective B, indeterminate from C, and so forth, but there would be no such thing as its being true or false unconditionally.”15 We simply want to point out that at different times and in different places, people ask different questions. Taylor illustrates this by reflecting on writing a history of the Roman Empire: such a history written in twenty-fifth-century China would be quite different from one written in twenty-first-century Europe. The difference is not because the basic propositions will have different truth claims and values. “The difference will be rather that different questions will be asked, different issues raised, different features will stand out as remarkable, and so forth.”16 In short, understanding is flexible and tentative, not because truth shifts and changes but because our understanding and questioning of the world shift and change as we encounter new things and engage with different stories and fresh horizons. Understanding is a matter of hospitable, dialogical conversation that avoids relativism and refuses to be drawn into implicit or explicit reductionism.
It is precisely this kind of hospitable, dialogical, phenomenological conversation that the remainder of this book will try to generate. In so doing, I hope to create rich and thick descriptions of mental health phenomena that will allow us to work out the unique and vital contribution that theology and the practices of the church can make in facilitating life in all its fullness for Christians who live with severe mental health challenges.
What follows might best be described as a hermeneutical phenomenological conversation informed by the phenomenology and hermeneutics of Husserl and Gadamer and designed to create thick descriptions of the spiritual lives of people living with serious mental health challenges. The conversation partners that will work together to produce the narratives and perspectives presented in the remainder of this book represent four primary horizons:
1 The horizon of the author
2 The horizon of Christians living with mental health challenges
3 The horizon of the field of mental health care
4 The horizon of Scripture, Christian tradition, and reflection on the life of the church
My horizon emerges from my life history, which traverses three professions: psychiatric nurse, ordained minister, and practical theologian. These three professions combined with my personal life mean that my listening and interpreting are inevitably formed in quite particular ways. This horizon inevitably influences the way I write, interpret, organize, and present the various ideas and texts that make up this book. For many years I worked as a mental health nurse, and latterly as a community mental health chaplain, working alongside people living with a variety of mental health challenges. Many of my most formative years were thus spent with people who saw the world differently than others did. When you spend time with people who see the world differently, you begin to see the world differently yourself. As a community health chaplain, I was charged with the responsibility to be with people living with severe mental health challenges who were moving from formal psychiatric care into the community.17 My job was to help them find a spiritual home. It was one of my most rewarding jobs. However, one of my biggest disappointments was that church communities could be just as stigmatizing and excluding as other communities. I realized very quickly how much work needed to be done in this area. I wish I could say that things are different thirty years on.
When I entered the world of academia in the early 1990s, I was given time and space to begin to think about these things in the light of who God is and who human beings are before God. I regard my nursing and chaplaincy experience as my place of formation, the place where I was shaped and formed to see the world in quite particular ways. My academic life has been my place of vocation—the place where I have, over time, discovered what God wants me to do with my formation.
This is the prehistory that I bring to this book. Throughout I have endeavored to remain aware of and reflexive about the ways my history has influenced my interpretation and presentation of the issues. I will leave it to you, the reader, to decide how successful I have been in that task.
The second horizon is of those living with serious mental health challenges. This is the phenomenological horizon that tries to get at people’s experience as it is lived, without being overly influenced by theoretical overlay and presumptions. This horizon is phenomenological in that it seeks to get at an understanding of the thing-as-it-is. It is interpretative insofar as the stories upon which I reflect require careful consideration and thoughtful interpretation. My burden as the author has been to try to represent people’s lived and interpreted experience as authentically and faithfully as possible. The core conversations in this book emerged from research interviews I engaged in over a two-year period with Christians who lived with major mental health challenges, namely, schizophrenia, bipolar disorder, and major depression, which are generally agreed to be among the most serious mental health challenges. They also raise particularly sharp issues for theology, practice, and understandings of the nature of humanness. These conversations are not intended to be representative of the whole breadth of mental health challenges, but they do raise issues that have clear relevance to a broad range of mental health experiences.18 If what follows is successful in developing rich, thick, and transformative descriptions of these forms of mental health challenges, it will, I hope, open the way for others to raise similar questions about other experiences of mental health challenges.
At a formal level, these conversations were qualitative research interviews—interpretive, phenomenologically oriented conversations intended to initiate open-ended inquiry into lived experience.19 As a qualitative study, insights gleaned from them were not intended to be predictive, or generalizable to the population at large. Rather, I wanted to understand the uniqueness of what people were experiencing and to allow what emerged from their experience to inform understandings of mental health, theology, and faithful practice. The people I spoke with were kind enough to gift their stories without insisting that their experience was common to everyone. They made no claim to be representative of anything or anyone other than themselves. My hope was that if I could capture something of the depth of their experiences and engage these experiences with Scripture, tradition, and the practices of the church, others would be able to resonate and identify with the experience in ways that might bring about spiritual understanding and faith-full response.
At another level, these were clearly spiritual conversations—disciples talking to a disciple about the things of God. The content of these conversations was deeply spiritual, focusing on the things that were of the most profound importance to both the storyteller and the story receiver. Like all conversations, these were interactive and dialogical engagements, with each of us participating in the cocreation of the narrative.20 Eileen R. Campbell-Reed and Christian Scharen suggest that such spiritual conversations take place within “an interhuman space”—a space where relationality and empathy emerge, as we allow the Spirit to indwell our thoughts and our conversation in ways that are intimate, surprising, and sometimes revelatory.21 These were spiritual people talking about the particularities of a living God within a context that was deeply spiritual. The social-scientific dimensions of the encounters gave structure and analytical space, which in turn opened up opportunities for shared spiritual experiences, fresh insights, and holy listening. Interviewing within practical theology is not simply information gathering; rather, it is gathering testimony and bearing witness to that testimony in ways that are authentic and faithful. My task as a practical theologian was to capture people’s testimony and do all that I could do to bear faithful witness to that testimony.
Alongside these voices, I occasionally draw on the voices of writers elsewhere who offer perspectives about their experiences with mental health challenges that can help us understand the issues more clearly and intimately. Together, these various voices open up fresh space and offer shards of hope that can help us understand faithfully and practice well in the area of mutual mental health care.
This is a broad horizon that incorporates professional disciplines that offer a variety of descriptions of mental health and ill health. In addition to psychiatry, this horizon includes allied health professions such as psychology, nursing, neurology, genetics, and so forth. It also includes other associated disciplines, in particular, anthropology and cross-cultural studies.
It is important to be clear that this book is not intended to be seen as arguing against psychiatry. Likewise, it does not attempt to offer an alternative to psychiatry. My intention is to be a critical friend and not a psychiatry basher. Simon Wesley, president of the Royal College of Psychiatrists in the UK, observes that psychiatry bashing comes from inside as well as outside of the discipline of medicine: “There is no psychiatrist in the land who cannot remember the reactions they received from some colleagues—especially the senior ones—when they announced that they wanted to pursue a career in psychiatry. A bit of humour is all very well, but behind this is something unacceptable—an implication that the best and brightest doctors are somehow wasting their time in psychiatry. This has to stop…. People with mental disorders—just like those with physical disorders—deserve the best minds to find new treatments and provide the best care.”22
Psychiatry bashing that comes from within medicine is just an extension of the stigmatization of mental health challenges that is rife in society. If psychiatrists are stigmatized, then so are those who receive treatment from them. Such stigma not only affects recruitment to the profession, it also further stigmatizes people with mental health challenges, who have more than enough stigma as it is. Doctors should know better! People deserve better. I see no reason why mental health professionals cannot be highly effective participants in God’s work of redemption. One of this book’s intentions is to tease out more specifically what that might look like. I will at points offer some critique of psychiatry, but always in the spirit of friendship and in the hope that together we can help people live out the fullness of life that Jesus promises.
The final horizon is the theological horizon. This comes to us via Scripture, Christian tradition, and reflection on the life of the church. This horizon brings the knowledge, wisdom, and experience of the community of the saints into dialogical conversation with the other three horizons, with a view to allowing theology to illuminate and be illuminated by the issues under discussion.23 Illumination refers to the work of the Holy Spirit as God strives to illuminate situations and experiences in the lives of believers in a way that allows us to grasp what we could not without such illumination and to respond in ways unavailable prior to our illumination. Saint Augustine describes illumination in this way: “When we lift up our eyes to the scriptures, because the scriptures have been provided by human beings, we are lifting up our eyes to the mountains from where help will come to us. Even so, because those who wrote the scriptures were human beings, they were not shining on their own, but he was the true light who illumines everyone coming into this world (John 1:9).”24
Some things of God can be observed and grasped via human intellect. Other aspects have to be received via divine illumination. Illumination is a gift, not an achievement. The Trinity, for example, makes no logical sense, but through the illuminating light of the Spirit, human beings can at least partially grasp something of its truth and live into its implications. Humans are limited in their ability to know God, partly because of the limitations of their senses, and partly because of the barriers that sin puts up. Scripture shines “the ray of divine revelation,” as Thomas Aquinas has put it,25 which makes the knowledge of God available to human beings. Illumination breaks down barriers and opens up space for seeing things differently, or, as the apostle Paul has put it, for the transformation of our minds: “Do not conform to the pattern of this world, but be transformed by the renewing of your mind. Then you will be able to test and approve what God’s will is—his good, pleasing and perfect will” (Rom. 12:2). Illumination reframes the world and throws fresh light on situations in ways that enable deep understanding, surprise, and enduring faithful action. When the horizon of Scripture and tradition is placed in dialogue with the other horizons, illumination transforms both theology and practice.
These are the four horizons that will shape and form the narratives and theological reflections that are to come: the horizon of the author; the horizon of Christians living with mental health challenges; the horizon of the field of mental health care; and the horizon of Scripture, Christian tradition, and reflection on the life of the church. If, as Charles Taylor suggests, understanding one another is the most important task of our age, engagement with these four horizons may be the beginning point for faithful understanding of mental health challenges and the development of descriptions that are rich, thick, godly, and truly illuminating.
1. Fredrik Svenaeus, “Diagnosing Mental Disorders and Saving the Normal,” Medicine, Health Care and Philosophy 17, no. 2 (2014): 241–44.
2. Clifford Geertz, “Thick Description: Toward an Interpretative Theory of Culture,” in Geertz, The Interpretation of Cultures (New York: Basic Books, 1973).
3. N. K. Denzin, Interpretive Interactionism (Newbury Park, CA: Sage, 1989), 8.
4. Nancy C. Andreasen, The Broken Brain: The Biological Revolution in Psychiatry (New York: Harper & Row, 1984).
5. Anne Harrington, Mind Fixers: Psychiatry’s Troubled Search for the Biology of Mental Illness (New York: Norton, 2019), chap. 4.
6. Nancy C. Andreasen, “DSM and the Death of Phenomenology in America: An Example of Unintended Consequences,” Schizophrenia Bulletin 33, no. 1 (2007): 108–12.
7. Andreasen, “DSM and the Death of Phenomenology,” 111.
8. This metaphor comes from Ian Hacking’s enlightening critique of the DSM criteria in his article “Lost in the Forest,” London Review of Books 35, no. 15 (August 8, 2013): 7–8, https://www.lrb.co.uk/v35/n15/ian-hacking/lost-in-the-forest.
9. I am not doing phenomenology in the way that a philosopher might. My intention is to use it as a perspective rather than as a strict method. Readers wishing to read some excellent phenomenology within this area written from the perspective of philosophy should explore the work of Mathew Ratcliffe and Eric Matthews: Mathew Ratcliffe, Experiences of Depression (Oxford: Oxford University Press, 2015); Ratcliffe, Real Hallucinations (Cambridge, MA: MIT Press, 2017); Eric H. Matthews, “Merleau-Ponty’s Body-Subject and Psychiatry,” International Review of Psychiatry 16, no. 3 (2004): 190–98.
10. Edmund Husserl, The Crisis of European Sciences and Transcendental Phenomenology, trans. D. Carr (Evanston, IL: Northwestern University Press, 1970).
11. Edmund Husserl, Cartesian Meditations (The Hague: Martinus Nijhoff, 1973).
12. Hans-Georg Gadamer, Truth and Method (London: Continuum, 1981), 358.
13. Charles Taylor, “Gadamer on the Human Sciences,” in The Cambridge Companion to Gadamer, ed. Robert J. Dostal (Cambridge: Cambridge University Press, 2002), 126–43.
14. Taylor, “Gadamer on the Human Sciences,” 136. The interior quotation is from Gadamer, Truth and Method, 304.
15. Taylor, “Gadamer on the Human Sciences,” 134.
16. Taylor, “Gadamer on the Human Sciences,” 135.
17. Readers interested in reading more about this mode of friendship ministry should see John Swinton, Resurrecting the Person: Friendship and the Care of People with Mental Health Problems (Nashville: Abingdon, 2000).
18. Over the period of the study, I spent time with thirty-five people living with the kinds of experiences highlighted in the book.
19. For a fuller understanding of the approach that I took in gathering and analyzing these interviews, see John Swinton and Harriet Mowat, Practical Theology and Qualitative Research, rev. 2nd ed. (London: SCM, 2017), especially chap. 4.
20. By this I mean that any narrative that is spoken and heard is created by two parties: the narrator and the listener. In the context of qualitative research, the researcher chooses the area, constructs the questions, and shapes the answers by the responses to what is said. The interviewee creates the narrative as he or she responds to the questions and assumed perceptions of the interviewer. So, together, the two parties create a narrative that is cocreated and “truth-like,” that is, it has verisimilitude.
21. Eileen R. Campbell-Reed and Christian Scharen, “Ethnography on Holy Ground: How Qualitative Interviewing Is Practical Theological Work,” International Journal of Practical Theology 17, no. 2 (2013): 245.
22. “Call for an End to ‘Bashing’ Psychiatrists,” Mental Health Today, February 29, 2016, https://www.mentalhealthtoday.co.uk/call-for-an-end-to-bashing-psychiatrists.
23. I am grateful to my friend and colleague Tom Greggs for his insight into how illumination might be a useful concept for practical theology.
24. Augustine, Homilies on the Gospel of John (1–40), ed. Boniface Ramsey, trans. Edmund Hill, vol. III/12 of The Works of Saint Augustine: A Translation for the 21st Century (New York: New City Press, 2009).
25. Aquinas, Summa theologiae 1.9 ad 2.