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Madhouse and the Whole Thing There: A PhD Story

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Edited by Stephanie Taylor, Monday, 7 Sept 2020, 16:53

School academic Dr Simon Clarke, Lecturer in Critical Mental Health, has just successfully completed his second PhD. This is unusual (should we now call him 'Doctor Doctor'?) and the PhD is additionally unusual because it utilises the method of autoethnography. Here Simon demonstrates an autoethnographic approach in a series of short extracts.

It’s the usual routine in my job as a clinical psychologist in the UK National Health Service (NHS), first thing in the morning: drop my bag and coat on the desk; exchange pleasantries with the few team members in this early; turn on the computer; go to the kitchen to make a coffee; check emails (not so bad, but it is still 8am); open the patient data system; swipe my card in the card reader; pick up the to-do list.

First action: respond to the care co-coordinator’s query from yesterday evening. I search for the client on the system. It barely even registers that the client has a vaguely similar name to mine.

Until, emblazoned on the screen, somewhere near the bottom of the returned searches: my name, address and date of birth.

I stare at the screen for a few seconds in wry disbelief. I have been taken back for a moment.


In the car, in the car park, outside the clinic. Privacy needed. I am on my mobile phone to the Data Protection Manager. Yes, that’s right I say. No, I didn’t open the record on the online system. Yes, I know I could lose my job if I did that. I wave nervously as a colleague walks past into the clinic with a client in tow. Yes, I say back to the Data Protection Manager, I was a patient in the 1990s and I now work here for the same mental health service. Yes, I recovered. You haven’t come across this kind of a case before? A pause. OK. Well…how can I get hold of my notes then? I don’t know what’s on the system and I’m concerned that my colleagues could access them. A Subject Access Request? Yes, I would. Very much. Thanks.


The large package, 404 pages, sits with me on the passenger seat all the way home, as if it were a person. When I get home, my wife is waiting for me. I carry the large package to my chest like a baby.

It’s here I tell her, dropping the fat package on the table. We unwrap it together. The A4 cardboard box that was inside the package sits on the table.

Are you going to open it then? She asks.

I’m not sure, I say. I then open the lid and start rifling through the first few pages.

God, there’s so much of it, she says. Her fingers pull out one sheet from the pile – PATIENT PROPERTY LIST. Tears well up in her eyes. It’s like you were going into prison. You were just a kid. A kid scared out your mind.

I’m not ready to read it, I say. I don’t think I can handle it. It was such a shit time. Could you put it back in the box? Maybe I’ll look at it later.


I’m still not sure what I want to do, I tell my PhD supervisor. I think I know what I want my PhD to be about, but I am not sure how to do it. I want to look at psychosis and the experiences of using mental health services, but I don’t think I want to use a conventional psychological approach.

What’s wrong with a conventional psychology approach? He smiles.

I don’t know, I reply, conscious that I might be overstepping a boundary. It’s just…I pause and take a breath. Psychology deals with what it calls empirical ‘data’. Either quantitative or qualitative – it doesn’t matter, the process is the same. There is something that you ‘find’ that is ‘real’ which is more ‘real’ than what you as a ‘subject’ might ‘experience’.

But the more you abstract from the experience, the less real it becomes. Psychology has many layers of this abstraction from the subject of experience – to responses from a questionnaire, to data in a data set, to results from a statistical inquiry. Or themes from an interview – also taken from experience, by a researcher, with their preconceptions and bias, filtered, extrapolated and ultimately fitted into a format consumable for an institutional process, that is often a million miles away from the original experience. Frank (2005) mentions this when he talks about the dangers of chopping up stories into data.

But it’s more than that, I continue. Narrative research reconstructs experience to fit a neat trajectory. All of the messiness is ironed out, all of the uncertainty, and confusion, and pain. The story is presented in a nice, neat linear way: beginning, middle, end. But’s it’s not like that. Not when you go crazy. Maybe not even when you’re sane.

He smiles, and then laughs. So, it’s a question of authenticity then?

I guess so.

Why not do an autoethnography then? He says.

I’m not sure what that is, I reply.

It’s a research method. You use your own experience as data to look at culture, to interrogate.


What’s wrong? Asks my wife.

Nothing, I say. She throws me a look.

I sigh. I’ve finished writing out my experiences and memories as bullet points. I now need to write them up as an autoethnography, as a narrative.

So, what’s the problem?

It’s just…the one perspective seems to rule. I write my experiences down, but what does it matter? So what? Who cares?

She shrugs. Look at other perspectives then. What about your clinical notes?

It’s an interesting idea, I think.


You’re doing a PhD? My mother asks. But don’t you already have one?

I have a Doctorate in Clinical Psychology, I say. A DClinPsy. It’s a professional doctorate. This is different. It’s research.

OK, she replies. I don’t think she quite gets it, but I can see she’s intrigued. Why are you doing it?

I guess I’m just interested in things. There are some questions I need to answer. And PhD will give me the research training I need to answer them. Having a PhD will also be good for my career, as well, I end somewhat lamely.

What’s it about? She asks.

I take a deep breath inside – I’m not sure how she will feel about this. It’s about madness, I say. And authenticity. It's about that time when I was in hospital as a teenager. I’m doing something called autoethnography. It’s where you use your own experience. A bit like autobiography, but more focussed.

She is silent for a good few seconds. Her expression is inscrutable.

Did you know I kept a diary of that time? She says. Another pause. Do you want it for your research?

I can’t believe she’s just offered me this. I wasn’t expecting this. I want the diary, but it also feels like quite a responsibility to her. That would be amazing, I say. Are you sure?

Yes, if you think it will help. I haven’t read it since I wrote it, to be honest. I don’t really want to read it.

I don’t really expect her to give me the diary, but on our way out several hours later, she disappears. When she returns, she hands me a blue A4 lined textbook. Here you go, she says. You really think it will help?

I’m sure it will, I say, awed. Thank you.


I sit at the same table as I sat three years’ ago when I first collected my clinical notes. They are on the left; my mother’s diary in the centre; my hand-written recollections of the same events on the right.

And that, I think, is the crux of the matter. Much narrative research in mental health is based on the first-person perspective only, which can, if unchecked, lead down the same back-alley of mainstream psychology in its stubborn refusal to jettison the atomised, individualised self.

The failure of such a self is its inability to acknowledge that we are inescapably and unutterably social, to our very core. Our experience is not our own. For good or for ill, we are what we are to the people who live with us, and who we love, and sometimes who we hate. We are the product of what other people make us to be, and what we make of them.

It’s like Patty Lather (2009) said, “authenticity is much more complicated than singular, transparent, static identity categories assumed to give the writer a particular view” (p. 20).

I think about the people involved in my story: the clinicians who detained me, with all of the best intentions I suspect, but which left me broken and traumatised for many years afterwards; my family, who suffered with me, helpless, but who also contributed, unconsciously and unknowingly, to my distress; my wife, who worked with me to get these experiences down on paper; the therapeutic community, who helped me get my life back; and, finally, my PhD supervisors who guided me and helped me to recognise and give voice to the different people and perspectives around me. My subjectivity is shared amongst them.

And yet… it is a wry irony, and a deep paradox, that, ultimately, the ‘buck stops here’: one person with a pen and a pad, trying to make sense of all of this complexity.

But I don’t think about these complexities too much, just yet. I put pen to pad. I begin to write.


[This blog post contains excerpts from my PhD and from a paper published in Qualitative Research in Psychology. Whilst all the events took place, some dramatic license has been taken with the details for the sake of narrative continuity.]



Clarke, SP 2018 'Madhouse and the whole thing there', Qualitative Research in Psychology, vol 15, no. 2-3, pp. 247-259, DOI: 10.1080/14780887.2018.1429989 

Frank, A 2005, ‘What is dialogical research, and why should we do it?’, Qualitative Health Research, vol. 15, no. 7, pp. 964–74. 

Lather, PA 2009, ‘Against empathy, voice and authenticity’, in AY Jackson & LA Mazzei (eds.), Voice in qualitative inquiry: challenging conventional interpretive, and critical conceptions in qualitative research, Routledge, London, pp. 17–26.


Read about Simon Clarke's work here http://www.open.ac.uk/research/people/spc459



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