Capturing Recovery: The Role of Photographic Methods in Mental Health Research

Instead of solely focusing on biomedical and measurable outcomes, mental health recovery now centres around individual experiences, emphasising the importance of living a fulfilling life despite illness (Anthony, 1993; Barker, 2003; Jacobson, 2001; Leamy et al., 2011). This shift has promoted more research into personal experiences of mental distress recovery (Beck et al., 2012; Eisenstadt et al., 2012; Kukla et al., 2014). Concurrently, there's been a surge in the use of visual methodologies, such as photography, painting, and drama (Beart et al., 2015). Photography, particularly in our digital age, uniquely captures and symbolises multifaceted experiences, offering profound insights into the journeys of those with mental distress (Erdner & Magnusson, 2011; Sandhu et al., 2013; Thompson et al., 2008). Although several reviews address photography's therapeutic and research roles in mental health, there's a noticeable research gap regarding its specific application in recovery research (Milasan et al., 2020). Recognising this, a systematic review which is a summary of previous research on a topic could be beneficial to assess the efficacy, outcomes, challenges, and limitations of using photography as a research tool.

 

Summary of Milasan et al. (2020) - The big picture of recovery: a systematic review on the evidence of photography-based methods in researching recovery from mental distress

 

Method

Milasan et al. (2020) conducted a systematic review of qualitative and mixed-methods studies (studies collect non-numerical data), exploring subjective experiences of individuals with mental health problems using photography-based methods for recovery. This review employed a replicable design using the SPIDER framework (Cooke et al., 2012) (i.e. Sample, Phenomenon of Interest, Design, Evaluation, Research type) to guide the review stages. The SPIDER framework is useful a useful search strategy for finding research to answer a mixed-method and qualitative research question. This framework can show the greatest specificity for every database and explain complex processes such as patients' perceptions, experiences, attitudes, and opinions. Preliminary literature searches were performed on the two international systematic review databases, so researchers can observe that there might be a lack of existing research or comprehensive reviews on a particular area of study. The final search strategy was applied to six cross-disciplinary electronic databases (CINAHL, MEDLINE, Web of Science, Scopus, PsycINFO, Arts & Humanities), capturing various perspectives on recovery. Every step of the search, including adjustments and decisions, was chronologically documented for transparency and reproducibility. Studies were then screened, and the relevant ones were thoroughly reviewed by multiple researchers to ensure alignment with the review's aim. Finally, 15 qualitative and mixed-methods studies were selected, covering a broad age range (from 9 to 70 years) and a variety of population characteristics. These studies were analysed using Thomas & Harden's (2008) thematic synthesis approach which is often used to analyse data in primary qualitative research. Current systematic review use of this type of analysis to bring together and integrate the findings of multiple qualitative studies.

 

Results 

The results indicate that recovery research predominantly uses photovoice and photo-elicitation as photographic techniques. Photovoice empowers underserved groups to convey their recovery experiences, frequently prompting community-based social actions. Photovoice offers a dual benefit: it aids in knowledge generation during research and its dissemination, with the potential to influence local communities. This empowers participants, allowing them to act as co-researchers and influence research design and the depiction of their recovery experiences. Additionally, photo-elicitation, which incorporates photos into interviews to stimulate profound emotions and dialogues, is favoured for its depth and introspection over traditional interviews. Four themes were identified through thematic analysis, revealing outcomes of using photography in recovery research: enhanced understanding, collaboration and empowerment, situatedness, and storytelling. Specifically, enhanced understanding means that photography can provide detailed understandings and descriptions of participants' thoughts and feelings about recovery. Moreover, collaboration and empowerment suggest that photography can be a collaborative and empowering tool where participants actively contribute to knowledge generation. Furthermore, situatedness means that photography can help in examining recovery in connection with physical environments. Finally, storytelling refers that photographs are valuable for telling stories and conveying experiences. These themes highlight the depth and nuance with which photography can capture and convey mental health experiences and recovery narratives.

 

Limitations

Milasan et al. (2020)’s systematic review suggest that the primary photographic methods used are photo-elicitation and photovoice. There are four key themes emerged from photography-based studies: enhanced understanding, collaboration and empowerment, situatedness, and storytelling. This review highlights photography as a important tool, not only for understanding recovery from participants' perspectives but also in aiding their recovery journey.

However, this study might have some limitations. First, this systematic review only focused on studies with language is English, possibly overlooking cultural nuances in using photography in recovery research. Second, the literatures were identified by working collaboratively throughout the review process. However, double-blind screening which refers to a process where two independent reviewers assess the eligibility of studies without knowing each other's decisions could have improved the review's systematic approach. Third, this review only included qualitative and mixed-method studies, however, incorporating quantitative studies might offer a more comprehensive, accurate and comparable view of using photography in recovery research. Thus, future review should broaden its linguistic scope, adopt double-blind screening, and include quantitative studies for a comprehensive understanding of photography in recovery research.

 

Implications

The results of this review suggested that photography as valuable contributions in recovery research. First, photography can be an important methodological tool with potential to contribute to conceptualising recovery from the research participants’ experience. Specifically, through photographs, participants can express and depict their personal experiences and interpretations of recovery in ways that might not be possible through just words or traditional methods. This also offers researchers a richer and more nuanced understanding of what recovery means from the viewpoint of those experiencing it. Moreover, photography might address the limitations of verbal interviews, making it easier to verify data and understand recovery in context. Furthermore, it also allows participants to gain profound self-awareness, boosting empowerment, self-worth, genuine research involvement, and community engagement, all of which can foster their recovery.

 

Additionally, this systematic review also suggested some limitations in the current recovery research, implying methodological improvements in future research. First, some studies blur distinctions between photovoice and photo-elicitation or inadequately describe their integration, causing challenges in comparative assessments. Second, many studies have not detailed their analytical processes sufficiently, affecting the research's credibility. Third, many studies focus solely on verbal information, potentially undermining photography's role in interpreting recovery. Finally, the results from research using photographic methods varied widely due to diverse study designs and views on recovery, making the synthesis process challenging.

 

Overall, this systematic review suggested that photographic methods in recovery research provide accessible and interactive tools for mental health researchers to creatively and empoweringly explore individual perspectives on recovery. We can fully feel the power of photography. It is not just for memories, but a powerful tool that can capture and express the complex emotions and experiences related to mental health recovery. However, there are also some limitations current review, including focused solely on English-language studies, literature identification was collaborative and only qualitative and mixed-method studies included. Therefore, future review research might expand linguistic range, use double-blind screening, and integrate quantitative studies for a comprehensive view. 

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References

 

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Beart, K., Barnard, A., & Skelhorn, H. (2015). Visual methodologies in mental health. The Journal of Mental Health Training, Education and Practice, 10(3), 170–179. https://doi.org/10.1108/jmhtep-11-2013-0037

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Beck, R., Heffernan, S., Law, H., McCusker, M., Bentall, R. P., & Morrison, A. P. (2012). Subjective judgements of perceived recovery from psychosis. Journal of Mental Health. https://doi.org/10.3109/09638237.2012.710765

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Erdner, A., & Magnusson, A. (2010). Photography as a method of data collection: Helping people with Long-Term Mental Illness to convey their life world. Perspectives in Psychiatric Care, 47(3), 145–150. https://doi.org/10.1111/j.1744-6163.2010.00283.x

 

Jacobson, N. (2001). Experiencing recovery: A dimensional analysis of recovery narratives. Psychiatric Rehabilitation Journal, 24(3), 248–256. https://doi.org/10.1037/h0095087

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Kukla, M., Lysaker, P. H., & Roe, D. (2014). Strong subjective recovery as a protective factor against the effects of positive symptoms on quality of life outcomes in schizophrenia. Comprehensive Psychiatry, 55(6), 1363–1368. https://doi.org/10.1016/j.comppsych.2014.04.022

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Leamy, M., Bird, V., Boutillier, C. L., Williams, J., & Slade, M. (2011). Conceptual framework for personal recovery in mental health: systematic review and narrative synthesis. British Journal of Psychiatry, 199(6), 445–452. https://doi.org/10.1192/bjp.bp.110.083733

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Sandhu, A., Ives, J., Birchwood, M., & Upthegrove, R. (2013). The subjective experience and phenomenology of depression following first episode psychosis: A qualitative study using photo-elicitation. Journal of Affective Disorders, 149(1–3), 166–174. https://doi.org/10.1016/j.jad.2013.01.018

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