Participatory Observation with a Psychotic Patient

A researcher is present at an acute psychiatric ward to carry out participatory observation and possibly interviews with patients.

Ida is a young woman who has been admitted to a closed unit at the acute psychiatric ward for the first time. She is psychotic with delusions and paranoid thoughts. Over the course of a little more than a week, she improves rapidly, and discharge is approaching. A couple of days before she is discharged, the researcher asks if Ida would be willing to be interviewed. Ida agrees, and they make an appointment for the following day. Ida says that she believes she has something important to share about her experiences of being psychotic and hospitalized in an acute ward for the first time. The next day, however, she seems evasive. When the researcher gently refers to their interview agreement, Ida says that she thinks it would be better if the researcher asked some of the other patients instead. The researcher intuitively feels that she should keep her distance and leave Ida alone. Shortly after, Ida is discharged.

The researcher is uncertain about how to interpret what happened. She wonders whether she was too intrusive. She had been eager to gather data from Ida, who had seemed like a reflective woman able to contribute valuable information. Ida is readmitted after a couple of weeks. She now appears very ill. She speaks incoherently and paces restlessly and unsteadily around the ward. She is unkempt and unable to dress or feed herself. But she remembers the researcher well. In consultation with the staff, the researcher decides this time to keep her distance from Ida, so as not to disturb or frighten her. At the same time, they agree that the researcher should not leave the ward altogether, as this might make Ida uncertain about what has happened and why. Ida appears frightened and distressed, and the staff face a demanding task in creating a sense of safety for her.

One day, Ida approaches the researcher in the corridor and says clearly and insistently, almost shouting and pleading: “Can’t I please be allowed not to take part in the research project? Please!” The nurse present, who witnesses the situation, tells the researcher that this shows how ill Ida is. Ida believes the researcher is conducting “measurements”—secret monitoring and recording—and begs not to be made a victim of hidden experiments.

• Does participatory observation in an acute psychiatric ward impose an unacceptable additional burden on patients, especially on psychotic patients who are vulnerable because of their unclear grasp of reality?
• Or can encountering a researcher interested in their opinions and experiences be a positive experience for patients with limited autonomy, freedom, and capacity to consent?
• In this case, can the researcher assign value to the consent that was initially given by the patient? Could that consent have been more informed and rational than what lay behind her later refusals?
• Could the researcher have provided more detailed information about the project, or would that have burdened and confused the patient even further?
• Can potentially valuable knowledge generated in a project justify a burden on patients, as expressed here both directly and indirectly?

Read more:

• Persons with mental disorders