title: Enacting appreciations: beyond the patient perspective.
abstract: The "patient perspective" serves as an analytical tool to present patients as knowing subjects in research, rather than as objects known by medicine. This paper analyses problems encountered with the concept of the patient perspective as applied to long-term mental health care. One problem is that "having a perspective" requires a perception of oneself as an individual and the ability to represent one's individual situation in language; this excludes from research patients who do not express themselves verbally. Another problem is that the idea of "talk" as a representation of the world ignores the fact that talk is also performative in the world: it requires, at least, the ability to deal with an interview situation. To think up alternative ways of including patients as subjects in research, I develop an approach that takes this performativity as a starting point. Analysing practical situations and activities, I argue that patients enact appreciations, making known what they like or dislike by verbal or non-verbal means in a given material environment, in situations that are co-produced by others. Thus, subjectivity is linked to situations and interactions, rather than just to individual characteristics; to "patient positions;" rather than "patient perspectives".
authors.affiliation: Trimbos-instituut, Postbus 725, 3500 AS Utrecht, Netherlands. jpols@trimbos.nl
authors.forename: Jeannette
authors.initials: J
authors.lastname: Pols
mesh_terms: D001294:Attitude to Health; D003144:Communication Barriers; D005260:Female; D006801:Humans; D007407:Interviews as Topic; D007802:Language; D008134:Long-Term Care; D008297:Male; D008605:Mental Health Services / Q000941:ethics*; D010358:Patient Participation; D012649:Self Concept; D014705:Verbal Behavior