Critical and historical accounts
Psychiatrists, psychologists, service users and academics came together at Leeds Trinity University in March 2016 for the first joint conference of the History and Philosophy of Psychology (HPP) Section of the British Psychological Society and the UK Critical Psychiatry Network (CPN). With a welcoming address by David Pilgrim, Chair of the HPP section, the two-day conference heard papers covering themes on the histories of psychiatry, institutions, service users, diagnosis, interventions and recovery. Professor Gail Hornstein and Dr Joanna Moncrieff were welcomed as the two keynote speakers for the conference.
Huw Green from the City University of New York gave one of the opening papers, citing his account of why the construct of ‘schizophrenia’ continues to exist. Green argued that the construct of schizophrenia provides a hermeneutic ‘illness’ framework that enables some people to make sense of their experience, particularly if they feel alienated by modern psychosocial accounts. The diagnosis, Green argued, will continue to persist unless an alternative construct accounting for unusual experiences is accepted by both service users and clinicians.
In an opposite vein, Dr Luc De Bry spoke as both a scientist and a father as he reflected on his rejection of his son’s diagnosis of schizophrenia, a rejection that took father and son to Lapland and to the work of the Open Dialogue approach to voice hearing. De Bry, referring to models such as The Healing Homes of Sweden and The Self-Made Recovery Road, advocated a holistic approach for healing from psychosis, centred on acceptance and love. Drawing on a historical perspective, Alison Torn’s paper on a 17th century firsthand account of unusual experiences highlighted the importance of acceptance and consensual validation of experiences as pivotal to recovery. Constructs of recovery were also central to the final paper of the first session, as forensic psychiatrist Andrew Shepherd drew on narratives of those diagnosed with personality disorder and their clinicians to argue that recovery is a negotiated process of sense making; a process enacted through the therapeutic relationship.
In her keynote address, Gail Hornstein explored meanings of expertise and lived experience. She argued that abandoning the professional hold on expertise and acknowledging ‘not knowing’ can liberate professionals, providing a dialogical space for the ‘acceptance of otherness’ and different perspectives. Both ‘experts-by-training’ and ‘experts-by-experience’ are testimonies to real people’s lives, a plurality of voices that is inherently valid.
John Hall led a symposium on the changing roles of mental health professionals. Critical and historical accounts were presented on mental health nursing (Peter Nolan and Niall McCrae), mental health social work (Sarah Matthews), occupational therapy (Jonathan Leach and Mathijis Lucassen) and clinical psychology (John Hall). Completing this inter-disciplinary symposium, psychiatrist Tom Harrison brought the presentations together for a conference discussion. A number of interesting debates were raised, such as whether nursing belongs in the field of mental health, whether people suffering from mental health problems should be encouraged to work, and how research and applied psychology might be most effectively integrated.
Ending the first day, Diana Rose (King’s College London) presented a paper addressing historical and current approaches to service user-led research, highlighting the influence of UK research in this important field. Rose introduced the fledgling discipline of Mad Studies, which is gaining momentum in Canada and the UK. This field has its foundations in critical theory and addresses the over-reliance on the medical model that has been seen in research traditionally.
Dr Colin Hendrie (University of Leeds) gave one of the first papers of day two of the conference, with a critical account of the failure of the pharmaceutical industry to develop novel antidepressants. With no significant progress in 60 years, Dr Hendrie claimed that bad science – in the form of reliance on the fundamentally flawed chemical imbalance theory and use of inadequate animal models - was impeding good mental health care. Critiquing current interventions was also the focus of Dr Gillian Proctor’s paper, where she discussed the political context of working within IAPT (Improving Access to Psychological Therapies). In contrast to the philosophy of IAPT, the politics and bureaucracy surrounding its delivery have led to it being contracted out to private companies, with counsellors often working on zero hours contracts. Dr Proctor questioned whether it is possible to retain values of individuality within a relational model of counselling, without the therapist becoming an agent of social control.
Dr Joanna Moncrieff gave the keynote address for day two, exploring the medication of distress through the use of psychoactive substances. Highlighting the artificial distinction between the use of recreational or illicit drugs and prescribed drugs (with the dominion at discourse that the former are ‘bad’, whilst the latter are ‘good’), Dr Moncrieff traced the history behind the pharmaceutical industry filling the gap left by governmental legislations on self-administered psychoactive substances. A convincing argument was made for a more balanced, rational framework for understanding the effects of mind-altering drugs, without a simplistic advocation of licit drugs and the demonisation of illicit drugs.
The final afternoon heard papers on the history of service users. Caitlin Jenkins presented her qualitative study exploring service users’ experience of psychiatric diagnosis. Interviewed participants reported diagnosis experiences as complex, multi-faceted and evolving, and neither wholly positive nor wholly negative. Attention to the power of language, discourse and meaning and their relationship to power within the clinical encounter was cited as pivotal. Anna Arabskj followed with her firsthand account as a mother of a son with psychosis. In her moving personal letter titled ‘Dear psychosis’, Anna detailed the impact of psychosis on her relationship with her son, and went on to describe the roles Soteria and Open Dialogue played in enabling her son to reclaim his life from psychiatry. Jeanette Copperman from the Open University explored the social history of women’s mental health activism, which is presently being mapped through a documentary and oral history project, with the aim of creating a publicly available digital archive.
The conference ended with papers exploring the role of mental health in popular culture. Dr John McGowan looked at the shift in representations of ‘madness’ in film, from ‘mad as bad’ (e.g. Anthony Perkins in Psycho) to ‘mad as sick’ (e.g. Bradley Cooper in Silver Linings Playbook). Dr McGowan questioned whether ‘mad=sick’ offers any improvement form the ‘mad=bad’ representation, with its reinforcement of the medical model and disputed biological basis. Katherine Hubbard (University of Surrey) gave an engaging final paper on psychology and superheroes, drawing on the narratives and visual iconography of the superheroes ‘Wonder Woman’ (my own personal favourite!) and Rorschach (from Watchmen 1987) to explore how psychology and mental health is ‘looped’ into popular culture. Hubbard advocates looping of popular culture back into psychology too, noting it is a rich source of data that firmly belongs in psychological research.
Ending the conference, there were numerous suggestions about how the professional and academic groups of HPP and CPN, together with service users can collaborate in future conferences and seminar series, a conversation we hope to continue.
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