Coding, Indexing and Analysis

A range of views exist over how coding ought to be done, with some following strict conventions on a code or two per sentence, implying significance in each sentence. Through familiarisation, I had already noticed the existence of different styles with some speech being precise and densely populated with significance whilst others were sparse with an occasional gem. I therefore began the process of coding, scanning each line for content with each code being simply a label for words or phrases denoting some significance in participant experiences. I was searching for references to substantive things such as particular incidents, behaviours, practices or structures (organisational or mental), values or principles in treatment that seemed important to participants. I also looked for expression of strong feelings in treatment or within interview which conveyed significance, such as problems in communication or relationships. Examples of coding from patients about relationships and psychiatrists about understanding of psychosis are reproduced in Appendix 3. The hundreds of codes derived from all the transcripts were organised together with my sense of the issues raised, to develop two separate frameworks for the participants. Ritchie & Lewis (2003) advise upon the need to stay with description at this stage for purposes of sifting and sorting, rather than interpretation or explaining. Developing the Framework categories therefore is akin to drawing the tree under which all the participants’ responses fall, with each main branch having several sub-branches. A

priori concerns as well as emergent data are included in the Framework. The conceptual framework for patients’ responses consisted of four main indices, namely:

• Personal and psychiatric history

• Experiences within statutory health networks • Experiences in external networks

• Changes in narrative since diagnosis.

Personal and psychiatric history, for example included significant life experiences prior to and

post diagnosis and how patients understood them. Experiences within psychiatric networks on the other hand was a sub-index within Experiences within statutory health networks which described negative and positive feelings and experiences from their NHS treatment.

A separate conceptual framework for data from the psychiatrists had four main indices, namely: • Understanding self and psychiatry

• Understanding psychosis • Managing problems • Impact of paradigm.

All the transcripts were labelled with tags derived from the conceptual framework and used to represent all of the data in a matrix. The sheer quantity of raw data meant that it could not be presented verbatim and was therefore summarised and charted, with each column representing a sub-branch of the Framework, with uniform representation from each respondent. I produce samples of the charted Framework in Appendix 4. A strength of this method is the analytic flexibility available to investigate data through such representation. Researchers can move back and forth between layers of abstraction and raw data, within a column and across respondents, to ensure that the increasing conceptual refinement remains valid.

Gradually, after a long period of immersion in the emergent data and various stages of categorisation and abstraction, a conceptual scaffold began to develop. This needed to be something upon which the final descriptive and explanatory accounts could hang and was achieved by using the matrix to stay in touch with the raw data and my own experience of the

interviews. I focussed upon my research question of understanding the conflict in psychosis treatment in order to find patterns and make sense of the meaning my participants tried to convey. Though it was sometimes addressed, mostly I was not explicitly told why relationships were difficult. I sought understanding and patterns by interpreting statements using my experience and psychological and philosophical knowledge. Qualitative research is a process of intersubjective meaning-making through imagination, interpretation and conceptual input, not through accessing experience directly (Parkinson et al. 2016). At first, I mined the data to try and understand the two sets of experiences separately using the two frameworks. Painstaking summaries of data along every branch of each framework were produced, for example, patients’ experiences in external networks or psychiatrists’ understanding of psychosis. I then expanded my writing to include quotes from participants. As the raw data was understood better, patterns became visible gradually and helped move me towards greater abstraction and bring both groups under this single conceptual scaffold, which I reproduce, in Appendix 5.

• Understanding psychosis • Understanding human ontology • Working with human complexity • Significance of relationships • Systems design issues.

In Appendix 6, I provide samples of relevant sub-indices and their data source as evidence of my audit trail. At an advanced stage of the analysis, it seemed that unmet needs on both sides were leading to frustration and creating the conflictual relationships. From the start, it had been clear that both patients and psychiatrists wanted and needed relationships as part of the treatment. The lack of nurturing relationships was an obvious problem that the data threw up. Other issues were more obscure, such as the repeated reference by both sides to the neglect of the inherent complexity in psychosis, coinciding with complaints about the tendency to simplify everything. Further detailed investigation of the raw data, for what got lost through simplification or neglect of complexity revealed the answer to be the existential needs for meaning and hope. This recognition enabled me to arrive at most of my core concepts. As I paid attention to the patients’ use of terms such as paradigms, world-views or ‘a different

language’ and the psychiatrists’ difficulties in ‘being with patients’, the contributions of systemic elements in the neglect of ontological complexity became clear. This became my fourth and last core concept. Taylor (1971: p. 5) wrote: “But how does one know that [an] interpretation is correct? Presumably because …….. what is strange, mystifying, puzzling, contradictory is no longer so”. Although a disheartening puzzle at various points, I could suddenly see a clear shape to the messages being delivered by my respondents.

I produce examples to demonstrate the process of refinement in arriving at the core concepts ‘Patients’ need for relationships’ and ‘Psychiatrists’ need for hope’ in Appendix 7.