Integrating 'mental illness' and 'motherhood': the positive use of surveillance by health professionals. A qualitative study.

BACKGROUND: Sociologists have long recognised the social control functions of different social institutions. Nurses, however, often appear more comfortable with formulating their roles in altruistic terms.

OBJECTIVES: In this paper, we examine the relevance of Foucauldian concepts, in particular that of surveillance, to an understanding the relationship between healthcare professionals (especially nurses) and their patients.

DESIGN: We use the concept of 'interactional frames' to analyse data from qualitative interviews with mothers who have a mental illness.

SETTINGS: The research, from which the data in this paper were taken, was carried out in a largely urban area of south-east Wales, in the UK, during 2001 and 2002.

PARTICIPANTS: The participants were 11 women, each with one or more children, all of whom were under the care of their local Community Mental Health Team.

METHODS: The paper draws on findings from a wider study of the influence of child-care responsibilities on access to services for women with mental health problems. Data were generated through individual, semi-structured interviews, carried out and transcribed by one of the authors (BD).

RESULTS: Women produced accounts of their mothering practices which acknowledged the norms of 'good' mothering. They spoke about the need for 'impression management' in their clinical encounters, both those in which they were the patient and those undertaken on behalf of their children. The data showed health professionals moving between frames in which the woman was a mother and in which she was a person with a mental illness, and integrating the two frames to the woman's benefit.

CONCLUSIONS: Women who are mothers and who are also users of mental health services face particular challenges in managing the contradictory aspects of their dual identity. Health professionals can use their disciplinary power in a positive way, to help women in this task.