Last week I attended a meeting of the BSA Mental Health study group in Wolverhampton. The day was entitled:
Social movements and sociological knowledge on Mental Health: Where are we now?
The day was divided into four sessions with a final summary discussion and synthesis led by one of the group organisers:
- The contribution of the survivor movement to sociological knowledge on mental health and ways forward for the movement
- The women’s movement and sociological knowledge on mental health
- The trade union movement and sociological knowledge on mental health
- Social models
There were some fascinating and challenging talks during the day. I thought I would use this blog to share some reflections on the day’s experiences.
Survivor vs mental health service user vs client
A number of varying terms were used during the day to describe those who access, or have accessed mental health care. Varying interpretations of this experience highlighted the idea that one survives the experience, or that one accesses services with a view to receiving support. Interpretations were presented often in the form of a critique of the perceived dominance of biomedical interpretations of mental distress.
This represents something that I continue to struggle with – what is the nature of mental disorder or distress? Does it represent an illness – that is a pathological state where one is predisposed to the development of distressing experiences resulting from inappropriate regulation of mood and interpretation of cognitive processes? Or does it represent a response to trauma – a universal experience that if we are all exposed to sufficient stress our defences and experiences will become more and more pseudo-pathological in nature?
For me the second of these models is more appealing and closer to the experiences of people I meet in clinic. Is there a problem with this model that it implies a degree of weakness however – that you are having these experiences means that in some way you have failed to manage the experience of life? I don’t think argument holds water in that our response to stress is determined by a plethora of different factors over which we have no control – to say that mental distress represents weakness is to me, in this context, nonsensical.
Is there a certain seductiveness to an alternative, more biomedical, interpretation however? If our experiences are the result of genetic disposition activated through environmental stimuli there is little space for feelings of weakness or inadequacy – we are in no way at fault for weakness that is inherited? I am concerned by this argument in that I feel it may lead to a fatalistic interpretation of experience? I’m not sure about this but I feel that in some way this may lead to an externalisation of distress into the symbolism of “illness”.
What do I take from this reflection and the seminars relating to it on the day? I think the greatest concern for me – and the one that, I think, leads to the concept of psychiatric survivor, is that if we adopt an “illness” approach too fully we risk divorcing the individual from their past experience, their life world, and positioning them solely as contextless object. By subsuming a person’s experiences and desires within labels and symptoms of illness there is a real risk of us damaging their identity through our biomedical interpretation.
Discomfort as a psychiatrist
During much of the day I felt somewhat uncomfortable to be a psychiatrist in the audience of these presentations. This may partially reflect the tone of some of the talks where work was presented with the specific aim of:
to go for the jugular of psychiatry
I am concerned that my discomfort represented a form of self-centredness however, after all what was being shared was the experiences of those who had accessed psychiatric care – was it primarily the reversal of power from clinician to client that left me uncomfortable?
Reflecting on the experience afterwards I’m left wondering whether there was a sense of dislocation with the experience. Much of what was said on the day was familiar to me from my own reading and thoughts and as such I felt connected to the material in that sense, however this connection felt slightly rejecting in that I was a psychiatrist and therefore positioned as a straw-man representation of the biomedical interpretation of experience. But in identifying with the discourse on this day and in the academic literature where does that position me as a psychiatrist in relation to my professional body and peers? Ultimately though I am left uncomfortable with my own discomfort (as a double negative should that not become a positive?) My discomfort was caused partially by people with negative experiences of mental health care – I am discontented with the fact that their negative experiences left me feeling somewhat ashamed.
Discomforting indeed – definitely one for intense discussion with the dog whilst out on a long walk…