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.