title: Caring conversations - psychiatric patients' narratives about suffering.
abstract: OBJECTIVE
  The aim of this study was to increase and deepen the understanding of how psychiatric patients in conversations with nurses narrate their experience of suffering.
  
  
  METHODS
  Data were obtained in the years 2001-2002 by audio recording of 20 individual caring conversations between eight patients and three psychiatric nurses at a psychiatric outpatient unit in Sweden. Before the data were gathered the study was approved by a local research ethics committee. The methodology is inspired by the hermeneutics of Paul Ricoeur. The data is given a naïve reading which is followed by two structural analyses which explain the text. Finally, the structural analyses and the pre-understanding are confronted in a critical reflection.
  
  
  RESULTS
  In the patients' narratives, suffering was at first concealed under a façade that helps the patient to cope with suffering and with shame. As they moved along to a turning point, something happened that made them able to risk everything, i.e. their very selves, but also gave them the possibility of regaining vital parts of themselves that where lost when the façade was constructed. As they took the suffering upon themselves, they grew to be fully visible as human beings and healing was possible as a re-establishment of the interpersonal bridge. This not only meant that the sufferer became open for relationships with others or an abstract other, but also that an opening in the relationship with themselves occurred.
  
  
  CONCLUSIONS
  If psychiatric patients are allowed to narrate freely they develop different plot structures, which can either hide or reveal suffering. Patients who could establish an answer to the why-question of suffering could also interpret their suffering in a way that enabled growth and reconciliation. In order to do so, they had to abandon the shelter of the façade and confront suffering and shame. This turning point opened them up to life-sustaining relationships with themselves as well as with abstract and concrete others.
authors.affiliation: Department of Caring Science, Faculty of Social and Caring Science, University of Abo Akademi, Abo, Finland. lennart.fredriksson@lg.se
authors.forename: Lennart
authors.initials: L
authors.lastname: Fredriksson
authors.forename: Unni A
authors.initials: UA
authors.lastname: Lindström
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001294:Attitude to Health; D004645:Empathy; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications*; D008875:Middle Aged; D033262:Narration; D009723:Nurse-Patient Relations; D015404:Nursing Methodology Research; D011568:Psychiatric Nursing; D011569:Psychiatric Status Rating Scales; D012648:Self Care / Q000523:psychology; D012752:Shame; D013315:Stress, Psychological / Q000150:complications / Q000517:prevention & control / Q000523:psychology*; D013548:Sweden