The following post is by Jonathan Gadsby, and is a report on a conference that he attended following an invitation to the CMHNN by one of the supporting organisations, the Social Work Action Network (SWAN). SWAN are the social work equivalent of the CMHNN (more information can be found on their website.)
Thank you to all those who continue to express an interest in the network and in writing for us. Please continue to contact us. We are looking for nursing stories, stories of being ‘nursed’, book reviews, discussion of content already on the blog – anything which you feel represents something of what it means for mental health nurses to be critical of their own work or the context of that work. We would also be very pleased to hear about local groups that nurses are involved with that re-think or challenge the status quo of mental health work.
Yesterday I attended a conference at Liverpool Hope University, Psychopolitics in the 21st Century. The purpose of the conference was to consider the 1982 book, Psychopolitics, by left-wing activist Peter Sedgwick (1934 – 1983). The conference was also supported by Asylum Magazine and by Psychologists Against Austerity, which began life as a pre-election campaign group but now see an on-going role for themselves; David Harper explained that Wilkinson and Pickett’s 2009 book, The Spirit Level, exploring links between inequality and health across the globe and within nations, continues to be an inspiration to them, as is the work of the late David Smail. Sedgwick’s work was movingly introduced to us by his daughter, Michele.
It may be that readers are familiar with SWAN and familiar with Sedgwick. I have to say that in 15 years as a nurse interested in critical ideas about mental health I had not encountered either. It is precisely this kind of exposure to new people and ideas that I hope this network will enable, and I was delighted to accept the invitation to go.
Finding myself in the midst of a group of critical social workers considering the ideas of a radically left-wing thinker was a new experience for me. Despite the fact that I have been reading some authors like David Graeber and David Harvey this year it is still novel for me to meet people who are steeped in Marxism and see mental health services as part of a society which they understand through an explanatory framework of capitalism. There seemed to be an almost tacit understanding that no fundamental solutions to the problems of mental health could be found in a society in which individuals were alienated from each other by the power of capital and that meaningful improvements in mental health services would be only possible through significant change in society.
Discussion of illness and wellness centred not so much on whether these were legitimate words to describe distress, or whether the knowledge of psychiatry could stand up to its critics, but rather it was whether these terms were necessary for people in need to make demands upon the state. In one discussion, despite the fact that probably none of the participants felt that psychiatry represented a legitimate science, several people felt that those in distress could best be helped through the language of disability rights while at the same time recognising that the ‘disability’ was not really their own but rather a product of the society and the state. I have witnessed this theme within the Hearing Voices Movement, with the same agonised sense that there is a powerful contradiction between a project of liberating voice-hearers from the labels of mental illness but at the same time wondering if they need to use the label of disability to claim those rights.
I came away from the day with a strong sense that Peter Sedgwick was a person whose work I need to read further. For an introduction, see the helpful article Reading Peter Sedgwick in 2015 by Ann and Alex Davis of Birmingham University. His arguments with Thomas Szasz are very interesting. His criticisms of the way that those on the left of politics may deny the existence of mental illness is not what might be expected. This (I felt) led to a logic in which detention under the Mental Health Act was seen as a flawed but necessary part of state intervention, but that forced treatment was much less legitimate.
Sedgwick’s prediction that the views of the Left (that mental illness is a social construction and not a ‘real’ illness, for example) would be used by the Right as a justification for the cutting of welfare provision seems to have been entirely borne out in the last few years: The Recovery Movement in the 1990’s represented a (largely peer-led) understanding that diagnoses of mental illness need not be a ‘life-sentence’, which was then adopted as part of the mission statements of mental health teams in the language of recovery-orientated practice, but is now arguably leading to an expectation that services should be withdrawn at the earliest possible time and that ‘lack of recovery’ is another part of the way in which mental health service-users fail. It might therefore be argued that ‘Recovery’ has, in just twenty years, gone from being an emancipatory movement of service-users to a being a stick to beat them with. There was a suggestion at the conference that this kind of theme had the potential to bring service-users and mental health workers together against the common enemy (of capitalist Neoliberal politics). Speaker Helen Spandler (Asylum Magazine) informed us that many service-users who may have formerly found illness models oppressive now see their psychiatrist as their ally, in that they have an explanatory framework which suggests on-going care at a time of service cuts.
However, Rich Moth (SWAN) told us that
“the question of resource allocation is necessary but not sufficient part of [Sedgwick’s] Psychopolitics. We need to think about what kind of services we want, and approach the subject of power relationships, wider social and political determinants. We need more and better services”.
Moth also described the current state of the NHS mental health service as under “the imposition of market disciplines through targets and terror…. Converting public health care funds into private profits.”
A question from the floor by Phillip Thomas, protagonist of the Critical Psychiatry Network (and author of Psychiatry in Context: Experience, Meaning and Communities) brought to our attention the recent article by Friedli and Stearn in the BMJ (free to view) which expresses horror at the suggestion (amongst other things) of employing psychological interventions within job centres.
Speaker Tad Tietze informed us that another of Sedgwick’s predictions was that the logic of Szasz would empty hospitals and put the same people in prison, presenting graphs which show that is precisely what has occurred. My sense is that Szasz remains the most known of the 1960’s anti-psychiatrists amongst mental health nurses and so it was striking to be in a room in which there was a very clear critical psychiatry sentiment but considerable disgust with Szasz and his right-wing libertarian politics.
A very thought-provoking day. SWAN’s next annual conference will be in Bristol next April.
Sounds like an interesting conference, Jonathan. Like you, I’m not familiar with Peter Sedgewick or SWAN, so it is really helpful to hear about them here.
I’m curious about the premise that a Marxist, radically left-of-centre political context would markedly enhance the mental health of the population. I’m receptive to such ideas, and open to persuasion – if there is clear evidence of this link, I’d be keen to read about it. I’m familiar with the strong association between socio-economic inequality and mental health problems, and this makes sense. Also, power differentials are undoubtedly a prominent contributor to human misery and suffering. What I struggle with is the question as to whether a radically different political context would eradicate these inequalities/power differentials or simply replace them with another raft of non-capitalist injustices that are no less toxic in providing a fertile soil for the emergence of mental health problems?
I’d be keen to hear other people’s views on this.
Thanks for your comment, Gary.
I think your questions are my questions, really, and the following is more of a personal response than a very informed one.
I feel that there there is a turn amongst the critical voices in both psychiatry and psychology to look towards societal power and capital as drivers of the situations which create mental health problems. I don’t think it was a coincidence that Phil Thomas was at the same conference. The British Psychological Society conference later this year (for those who can afford it!) is going to be looking at the work of David Smail, and David Smail was a very radical thinker indeed and there is no doubt that his work has been the midwife of community psychology and the group Psychologists Against Austerity. I first heard about him by reading the book, Madness Contested, Power and Practice, Coles et al., 2013, which I know you have cited in your own writing. It seemed to me that every other chapter was written by someone else who had read Smail and had their minds blown! I went off and bought his books and felt similarly, although I have talked with community psychologists who, as much as they love Smail, feel very unclear where he leaves them as people trying to help. But it is undeniable that there is something in Smail and his focus (and similar thinkers) which brought people from the Critical Psychiatry Network, The Critical Mental Health Nurses Network, critical psychologists and critical social workers all into one room, even if the focus of the day was Peter Sedgwick.
For me, one question is whether to view power and money in society as something which people weald (and therefore problems of increasing inequality are problems primarily of selfish people and perhaps their unintended consequences), or whether there is something about power and money which has a sort of life or agency of its own. Is the problem capitalism, a human ideology to do with money, or is it actually something more fundamental to do with the way money works, the way it presses us to assign monetary value to all interactions, even ones which in the past would never have been thought of as financial transactions? The more freedom given to the market to direct our lives, the more we seem to follow money down a route which is not freeing or neutral at all. Money seems to have its own purposes, almost. Does the world make more sense if we see money as the puppet or the puppet-master? David Graeber (again, I mentioned him above) describes money as something the state uses to isolate individuals and make them responsible for debt, which he describes as violence, servitude. I have to say that I don’t yet have the tools I need to think properly about people like Graeber, but I see a sort of parallel with psychiatry – that it seems to act as a way in which the state and society can locate problems within the bodies of individuals which really don’t make sense as individual problems, hence the need to concoct spurious science and spurious treatments to justify what is going on.
Even the turn towards narrativity is in effect a turn towards a more situated self, a more social understanding of the individual and of individual experience, and I have the same questions about narratives. I have heard people described as ‘experts’ in the field of narrativity in mental health talk about narratives as if they are not a great deal more than ‘my personal story’. However, a much more interesting idea comes in considering whether these narratives are really ‘ours’ at all. Many writers about narratives begin to describe them as forces in their own right, some even move into describing them as material. This seems to lead towards ideas where ‘agency’ is not so much something that individuals can possess, but that there are ‘agentic forces’ that we may become connected to, or as Michael White (somehow I think White is as radical as Smail but much more hopeful) would have said, we become ‘recruited into’ narratives.
I think both of these ideas – that capital has a sort of power of its own, that narratives exist outside of persons – are leading me towards the left of politics, and leading me to think that only the more left-leaning explanations of distress/experience/individuals in society really work in trying to answer questions about why there is ‘an epidemic of mental illness’. Perhaps another way of saying this is that I, like so many others at the moment, seem to be waking up to the idea that ‘mental illness’ is not so much a concern/practice of science as of power (not that the two are separate). It seems to me that the people I met at SWAN view the world in this way. Like you, I am not sure if we need a ‘revolution’ (and just to make sure I am not being unfair, no one at the SWAN conference used that word!), but I feel that without thinking about capital and social forces in the way that Marx did (so far as I am able to speak with any authority on Marx!) we miss out on a way of understanding the world and our experiences which seems to be an explanation we are in need of.
Weirdly (for me), one of the things which is resonating most strongly with me at the moment is Pope Francis’ recent writing on the environment/inequality/capitalism. Certainly he seems to be incomparably wiser than our elected leaders.
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Personally, I think is very easy to get wrapped up in the politics of healthcare, which directs us away from the individuals that we are here to help. No political party has had the will to truly improve the lives of the mentally ill. Getting involved in the politics of health distracts clinicians from the real work at hand and isn’t particularly very helpful. I am also sure that the average consumer doesn’t care too much for Marx or anyone else, whilst they are chemically coshed!! I believe that it doesn’t really matter which side of the political spectrum one is attached to, its what we do and how we can do it, with good grace and great ethics!!
Thank you for your comment(s). I think that the personal is political, that nursing is personal and therefore nursing is political. I think that ethical considerations are also political ones. For example, many political theorists would say that Western politics is dominated by arguments about which is better, ethics of freedom or of equality? What I don’t think is that nursing is therefore party-political. Well, not quite. The Equalities Act 2010 is legislation which would not have been championed by a Conservative government, and it speaks directly to some of the ideas above, and many nurses I think find it a moving document. Psychologists Against Austerity probably have no members who are not voting Labour or Green, and would certainly not agree with you that politics is a distraction to clinicians from the real work – they would most definitely say that a lot of clinical work is a distraction from the real politics, and they are a mixture of compassionate, well-read and thoughtful people. All of this is complicated.
But I agree (and I suspect Gary would too) that if the answer to ‘how can I help this person in front of me?’ = ‘socialist revolution’, then there is something practical missing! In a way, these are exactly the issues I attempted to look at with the article about the Recovery Star… and I was careful to say that the Recovery Star may well have helped people and shouldn’t simply be dismissed. If you haven’t already, I really suggest reading some David Smail.
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