I attended a conference last week in Leeds, the BIGSPD 16th annual conference. I was able to present a paper there describing themes emerging from a systematic review I’ve carried out as part of my PhD – I’ll put the presentation on my other, PhD related, blog site.
For this blog I wanted to think about a theme that ran throughout the conference for me – personal narratives, and who owns them?
The conference opened with a keynote speaker discussing the public health implications of personality disorder. This presentation grounded itself firmly in the discourse of reports such as that available at 1001 critical days.The talk presented, for example, the famous ‘deprived’ child’s brain and used this as an example as to why we must engage in preventing childhood neglect. Now I have a number of issues with the use of this image, some of them are neatly outlined here, but I obviously wouldn’t for a moment argue that investing in social measures to reduce childhood poverty and overall inequality in society is a bad thing. My problem is that the tone of this introductory talk set itself squarely within the neuroscientific understanding of mental distress. I’ve argued previously in this blog previously that as we are biological beings, of course, all our experience is grounded in biology – however the commonly used neuroscience discourse often overlooks or minimises the importance of psychological and social mechanisms in the expression of mental distress. This can be important as anti-stigma campaigns which adopt a neuroscientific discourse may actually be precipitating a worsening public attitude towards some mental health diagnoses [RCPsych paywall].
One of the difficulties that I have with a biological understanding of mental distress is that it immediately conveys authority and power to those with access to technological interventions – i.e. professionals. This was quite neatly summed up in a keynote presentation looking treatment options for individuals who receive a diagnosis of ‘borderline’ personality disorder. In this talk the speaker argued that it was his (gender was important in this context as he was giving an example of working with a female client around ideas of identity) role as the clinician to correct her dysfunctional manner of thinking. I find this position, as a clinician, quite uncomfortable. When we are working with survivors of trauma, as was the case in the example he cited, what authority do we have to define the correct manner in which they should address their trauma? To my mind we can not hold this privilege as while we can attempt to develop empathetic understanding this can only ever be an approximation of their mental state and experience.
This theme was nicely offset by another presentation I attended discussing ‘Theatres of trauma’ – where two survivors of psychosis presented their experience in the form of a performance – suggesting that having a ‘stage’ on which to develop your understanding of experience was important and the role that the ‘professional audience’ must play in this. Despite this brilliant presentation however I would argue that the conference was dominated by a clinical understanding of personal distress, often accepting the construct of personality disorder at an entirely uncritical level, which to me is problematic.
Overall this was a good opportunity to meet some new people – which I enjoyed. However the dominance of biomedical narratives is to me quite problematic… I think it raises issues around who has the right to ‘own’ a narrative – obviously it belongs to the individual, but how much can it be controlled by people in positions of authority?