Author: Robin

The Survivor Movement

November 22, 2024

The survivor movement can be considered as the means through which those who have been defined as Mad have organised to resist psychiatric oppression. This is particularly the case when it has involved self-organised, grass-roots initiatives which can form as learning opportunities and inspiration for further movements against the cultural dominance of the current psychiatric system.

 

A Brief History

People have been critical of asylums since their inception, however collective and organised resistance in the form of survivor involvement only have evidence from the 20th century onwards. That is, original movements in the 19th century were drawn from social elites who looked to draw attention to the processes through which people were deemed clinically insane and their improper treatment once inside. This was prevalent between around 1845 and the 1860s but then burnt out for around a century.

The 1960s and 1970s saw near-simultaneous formation of self-organised campaigns among psychiatric patients and ex-patients. Some of these groups coalesced around radical professionals of the time (such as R.D. Laing and David Cooper) whilst some distanced themselves. The most significant group to form in Britain was the Mental Patients Union (MPU), which was started by social workers. MPU, representing patients and rejecting medical orthodoxy, was defined by an ethos of self organisation. 

Other groups that came before included the short-lived Scottish Union of Mental Patients and the looser network of People Not Psychiatry. Building on other autonomous movements at the time, one organisation CAPO (Campaign Against Psychiatric Oppression), which formed in 1985, was known for adopting a punk ethos and the direct-action tactics of radical political groups. It is from the actions of all these groups that a growing advocacy movement developed and language was altered to begin to reflect ‘service users’ and ‘survivors’ instead of ‘patients’. Activism continues in the current guise of Mad Pride and Mad Studies.

 

Activist sources and the history of psychiatry

Researching the survivor movement can be a way of uncovering an alternative history of psychiatry, which places those at its heart at the core of analysis. This promotes agency of the psychiatric subject and undermines narratives which construct them as a by-product of a clinical gaze. The problem however arises in uncovering source material, due to the ephemeral and temporal nature of movements. This means stories often come from the privileged type of story teller in the form of middle or upper class biographies, instead of conceptualising the survivor movement as a whole and situating it in the lived histories of ordinary people. 

 

Activism and the practice of history

It is important for activists to assert their own histories so they are not lost in the footprints of the dominant cultural narrative. They can show the impacts activist involvement can have and how rights now enjoyed are not an inevitable consequence of history but needed to be fought for. Furthermore, this contributes to a recalibration of the kinds of knowledges which are seen as credible in wider discussions around Madness. History is rarely the telling of facts but serves to culturally construct our understanding of the present by shaping our understanding of the past.

Structure and Agency

November 22, 2024

Any social/sociological understanding of a phenomenon or concept needs to interrogate the tensions which exist between seeing behaviour as structurally determined and the capacity of individuals to bring about change. It is perhaps more optimistic to view agency as something we all have access to but this often comes up against the reality of the resources or lack of that we are able to utilise in our pursuit of change. The result can be a sense of disempowerment, in which it becomes difficult to know where to direct attention in order to realise new ways of being in the world.

 

Agency

One way of encouraging a purposeful view of agency is by seeing it as brought about by ‘meaningful choices’ and how individuals acting with intentionality serve to undertake goal-directed behaviours which have an impact on their surroundings; such a view can be considered an ‘orthodox’ view of agency. Examples of this view include humanist ideologies (which see society as the totality of intersubjective relations between individuals) and ‘rational actor theory’ (which as a form of homoeconomics assumes agents will be rational in the sense they will be driven by ‘economic’ motives).

The problem with such views is that they fail to account for either the social constraints that may prevent people from undertaking certain actions or the extent people cooperate for collective purposes. This means orthodox perspectives on agency neglects the impact of power in mediating the possibility and scope of relational exchanges, so advocating for such theories can implicitly benefit those with power by failing to subject them to the necessary scrutiny. 

 

Structure

Structures can be considered as ‘supra-individual’ phenomena that exist in defining the parameters of communities and wider society. Structures are often not well defined but analysis of them can lead to deterministic views of human relations, undermining the efforts individuals and collectives make to bring about changes to interpret and redefine the ‘rules’ (explicit or otherwise) which determine the makeup of social life. There are a range of different structures, some more clearcut, such as the law but some more abstract, including the social construction of Madness. 

A critical realist perspective sees these as existing external to any individual, with them having powers, tendencies and potentials regardless of who is embedded within them. Consequently an analytical dualism is required which separates people from the structures they operate in, however such a theory fails to consider how structures come about and how they change over time. This is because it does not account for a dialogical or intersubjective perspective, with these being seen as a secondary concern. 

 

A middle way?

Philosophical ideas surrounding ‘situated practices’ have sought to breach the divide between structure and agency. These ideas take different forms but tend to recognise people as initiating actions but respecting that these are in some way defined in scope by the mediating effects of the structures they operate within. 

One means of perceiving this is to take the approach of Norbert Elias (1978) who theorised that the social ‘bondings’ which exist between people, both in a moment of interaction and where we share some perceived common trait or purpose, are as real as people themselves. It is from this that communities and societies are built and it means unintentional interdependencies lie at the heart of everything we do, having the impact of constraining our perceptions, purposes and actions of the future. As such power and subjectivity are interlinked in complex networks acted out through our agency. Whilst such an approach can be theoretically useful, it does risk collapsing at different points into a view which promotes the sanctity of either agency or structure, whilst it has been argued it fails to critically respond to the ways in which power is concentrated up.

To build beyond this it has been proposed that we begin to see agency as a relational and not an individual phenomenon. This involves a perspective shift to see structures not as external to each of us but built into the very fabric of how we interact with the world. Consequently structures stop being objective facts but are instead filtered through our subjective realities before being mediated in the intersubjective realm.

 

Structure and Agency as constructs

It is important to respect that ideas surrounding structure and agency are themselves constructs with historical pathways. That is, they are both defined by individuals in a moment they encounter them and so the products of agency, but this is in some way defined by wider social expectations of the meanings of the word, so they are structurally constructed in a way that has changed over time. 

Consequently one way of undoing the complexities of dividing structure and agency is to respect that they are analytically distinct categories. This allows somebody to indicate instances in which they see an agency operating without necessarily determining the impact on an existing structure. Likewise outlining how structures may impact people without being deterministic can be a useful conceptual tool. In other words whilst interdependent, the concepts can have autonomy from each other.

To best achieve this it is important to consider what the goals of any action are and potential constraints that may prevent them from happening. This can encourage targeted responses to potential bottlenecks of action, which can be challenged to prevent people from being limited to achieve the change they want to. This encourages a pragmatic view of structures as ongoing material processes open to change. 

A Social Model of Madness and Distress?

November 22, 2024

Mental distress and its diverse manifestations tend to be poorly understood, with them more likely to be associated with fear and danger and exist with a context of an individualised medical discourse. This is a negative way of looking at people’s lives, blaming them for their problems as it paints them as somehow deficient or deviant and so undeserving of compassion.

The reality is that mental distress is a complex issue which affects people in different ways. A fact which should undermine any simplistic one-size-fits-all attempts to understand it and needs to always be related to broader social and environmental causative factors. By challenging narrow medicalised views of distress and incorporating social factors into conversations can lead to better understandings and attitudes towards those who have suffered. This can encourage better personal support. 

There has however been less development of a social model of Madness and distress than there has been in regards to disability. However, to counter concerns that the psychiatric system is more interested in control than care, there is the need to develop a transparent system based on the views of the recipients. This would look to balance the need to restrict behaviour that becomes dangerous or a nuisance to others with how people want to live. Achieving a means of supporting people to live the lives they want requires an understanding of any barriers they may face in the community, including around perceptions of mental distress and how this is filtered by power. This encourages a view which moves beyond seeing mental distress as purely situated at the individual level but something which is impacted by the wider perceptions and behaviours of wider society. 

One of the benefits of a social model of Madness/distress is that it can be a means through which to increase collaboration in order to bring into the open the experiences of those who have suffered and in particular where this has been exacerbated by experiences of discrimination or oppression. That is, rights-based initiatives often require collective action and a social model can be one means of beginning to organise. It is however important to navigate this sensitively, respecting how every person has a different experience of distress and that those who have suffered should not be considered as a group that is separate and distinct from society.

Power

November 22, 2024

Many people come to Mad Studies after having endured a difficult relationship with psychiatry. This can come in many forms, often involving an explicit experience of being subjected to violence as one’s liberty is denied, but can continue in more subtle forms, such as a lack of credibility to know oneself. What all these experiences have in common is that they require the utilisation of power to make an individual feel at best uncomfortable, if not retraumatised. Any consideration of Mad Studies therefore needs to begin to conceptualise power, no easy undertaking with debates having been raging for centuries but one we will look to dip into as a starting point for offering a potential guide for wider Mad narratives. 

This is because whilst typical conversations tend to see it as something wielded down upon people, it can also be thought of as something that can be built from below in order to challenge unjust ways of currently doing things. This is rarely a simple one-directional process but involves a complex interplaying of different ideas and interests. Service-user involvement for example whilst being on face value a positive development for diversifying perspectives within the mental health system has faced charges of co-opting survivor voices and using them as a form of legitimising tokenism instead of a way of bringing about meaningful change. 

 

A Strategic Model of Power

John Gaventa has used an idea of a ‘power cube’ which considers how power operates on different levels (local, national, global) and in different spaces (closed, invited, claimed/created) and forms (visible, hidden and invisible). This allows for a multidimensional understanding of power, which sees the ways in which it operates, both from above and below, changing depending on the specific context. Consequently we can be encouraged to reflect on how different arenas may pose different possibilities and challenges so we can direct the ways in which we want to most appropriately bring about change.

The ideas of different forms of power are developed from Steven Lukes’ analysis. It encourages us to dig deeper than the visibly apparent facts, for example the powerful can set the agenda and decide who attends, but can also steer discussion and outcomes and on the invisible level shape the ideology of conversation. Ideology is a complex term but impacts on the psychological boundaries of participation, affecting the norms of entering into a space and contributing. It often limits what people are able to bring to a given table. All these forms of power operating together have the effect of deciding on the ultimate perceptions of a social body, both around what is happening and what can be done to change it in the future. This has been conceptualised in relation to the mental health field in regards to medication for example. 

This shows the importance of creating and claiming spaces, as they can give people the resources to gain their own ‘power within’. This is defined as creating a sense of self-identity, confidence and agency that can increase resilience and lead to political actions which challenge the powerlessness felt in more contested spaces. Ideally this can also lead to a ‘power with’ in which people can collectively begin to organise to bring about change.

Compassionate Conflict

November 22, 2024

When we risk upsetting somebody it can be difficult to disagree, going against our impulses to be liked. Yet in order to realise growth we need to be able to work through things which make us feel uncomfortable so that we can avoid misunderstandings and be able to challenge behaviours that we disagree with. It also serves Mad ideals to seek to understand people and the difficulties they may be facing, even if this does not mean that we go on to agree with them.

One aspect of conflict that can be difficult is when we interpret internal feelings as signs of external threat. This can escalate concerns, undermining the ability to engage in dialogue to find a resolution. One means of doing this is to shut somebody out, for example by labelling them as abusive for disagreeing with us. It is unhelpful to describe such situations as abuse which would more appropriately be described as disagreement or conflict. The distinguishing factor being whether somebody has power over somebody to exert control on their lives or cause them harm. If they do not and we label something as abusive, this not only exacts a harm in itself but also trivialises the very real situations in which abuse plays out.

Conflict can be a dynamic and healthy process in the right moment, allowing people the opportunity to develop and grow. Normalising conflict encourages a discursive attitude to problem solving, which makes space for and humanises those with which we can disagree so that constructive dialogue can be achieved which aims for resolutions. Of course this does not mean we should disagree for the sake of it but that we should aspire to be able to communicate our boundaries assertively. This is not always as straightforward as it could be, with power working in complex and multidimensional ways which impact on our confidence and sense of self, but offers a hopeful narrative for developing an empowered perspective.

This can also be an important concept to bear in mind when somebody may be behaving in a way that we find difficult. It encourages us not to shun them or involve punitive approaches of control but, as long as it is safe to do so, invites us to understand people. Compassionate conflict becomes a means of seeing somebody in their full complexity and so humanises them, even if we go on to decide we have no space for them in our lives.

 

Further Reading

Stories and Storytelling

November 22, 2024

The stories we tell have huge implications for the life we lead, structuring both our internal and social realities in different ways. In fact the stories we tell every day create an intersubjective reality which is arguably the single most important factor in leading to our species finding itself where it currently does. Our thumbs also come in useful.

So what does this have to do with Madness? The answer is two-fold, with the stories we tell having implications for the constitution of our inner life and for how we interact with others. From this angle Mad Studies becomes a countercultural story challenging the limitations of a psychiatric system which too often seeks to define people without stopping to think or ask what the impacts might be.

Understanding this it becomes important to ask what stories are and the purpose they serve. A view which can allow us to offer critiques when stories become limiting or damaging to people. Stories are in themselves amoral and within them people can find themselves side-lined as characters instead of fully fledged human beings. This contradicts a Mad philosophy which sees every human as deserving dignity and the possibility to travel on a journey towards their flourishing.

 

What are stories?

What constitutes a story is broad, including the works of Shakespeare but also any instance in which information is shared. This might appear as an overgeneralization but when information is considered as a gateway between what is objectively happening out there and what we are subjectively perceiving it becomes apparent that, whether or not grounded in facts, communicating information is never an encompassing reflection of something but a cherry picked understanding. It is a story we have chosen to tell.

To summarise, a story is a partial rendering of our internal or external reality which has implications for how we make sense of the world. We can now consider how this plays out in the psychiatric realm.

 

Stories and psychiatry

One of the most clear examples of storytelling is diagnosis. The intention of this is not to critique diagnoses which can be enjoyed and distrusted by people often at the same time but to consider what the implications of being on the receiving end of one might be.

Considering a diagnosis as a partial rendering of somebody’s lived reality should not be controversial, where there is likely to be disagreement is the extent to which they reflect a truth that can be validated as existing separate to human interference. Whilst this topic is welcome to further discussion here we will just consider the implications of being made a character in other’s expectations. Whilst this is not something which happens in a unified manner, but impacts on people dependent on particular relational dynamics, we can as an example consider the ways in which it shapes the relational space between a psychiatrist and their patient. With diagnoses potentially limiting the capacity for therapeutic engagement to occur from both sides.

Despite being the fundamental means through which we communicate and come to cooperate in a mutually agreeable fashion, as partial renderings of reality, stories are also always limiting. Therefore whilst psychiatric diagnosis as defined by the ICD and DSM series are the current dominant means of making sense of mental distress considered to be ‘abnormal’ they can have implications for how people experience the world. This is because they render expectations on individuals which are too often presented as cast iron limitations to somebody living in a way they would like.

Although this may sometimes be considered a ‘realistic’ structuring of somebody’s world it also risks falling victim to the damaging effects of labelling, in which individuals become trapped in psychological or social boxes which they struggle to break out. Consequently, like a character in a book destined to suffer the same fate whenever somebody flicks through the pages, psychiatric diagnoses can enforce on somebody a limiting view. A view which undermines their capacity to experience or be seen to experience the world as a multifaceted and complex individual with a raft of different desires, reactions and expectations. In this sense, a more nuanced capacity of the individual as a ‘knower’ of themselves is denied or limited; a form of epistemic injustice.

This problem is particularly pronounced when psychiatry hangs on to being an objective arbitrator of reality, setting strict boundaries of social acceptability and lacking the reflexive capacity to see not only how people can change but how the cultures we all live within are fluid and constructive. This relates to how stories are not a passive reflection of the world we live in but fundamentally shape it, meaning we can change reality if we begin to respect the impact of the stories we tell and go about altering them accordingly.

 

How can seeing the role of storytelling in psychiatry help?

It is a regular occurrence in the modern day to see stories that find their roots in science as infallible. Science being seen as a stern rendering of an objective reality detached from any subjective or intersubjective interference. Without resorting to a totalitarian postmodern relativism we can however see little sense in this idea, with all scientific understanding being born out of the inner worldviews of fallible human scientists. Whilst the nuances of this debate could fill a library, giving it a brief cameo opens up some of the fundamental concerns people hold towards psychiatry, not only as a discipline but as an intersubjective institution.

This is because whilst science can often get close to closing the gap between the external world and our internal collective understanding of it, this is not something that has been possible in psychiatry through any quantifiable measure. So whilst the 1990s were declared the ‘decade of the brain’ and mass amounts of funding have been chucked at neuroscience ever since, we still find ourselves as a species with little direct proof for chemical imbalance theories of mental distress or any specific aetiological markers which could be considered to constitute ‘illness’.

This raises problems surrounding the legitimacy or lack thereof of the stories we currently allow to dominate about what mental distress is and how we can prevent it. Moreover, question marks begin to surround any harm caused by these stories and the extent to which they undermine the notion that psychiatrists are agents of care not control.

Encouraging a view in which the stories we tell are not carved into stone tablets but are culturally constructed and contested and so open to change can encourage a more reflective and malleable psychiatric system. This can encourage those who work within it to offer more attuned support, less bound by seemingly arbitrary parameters.

 

Further Reading