We are very grateful to Dr Alec Grant, who has contributed the following post. Alec is Reader in Narrative Mental Health in the School of Health Sciences, University of Brighton. He originally trained as a mental health nurse in the 1970s, then as a cognitive behavioural psychotherapist. After teaching and writing in these areas for many years, his academic work is now informed by his narrative research. We find his view that “…institutional psychiatric treatment spaces create possibilities for already damaged bodies to perpetuate unkindness on other bodies” to be one of the most simply provocative statements we have yet published.
Alec made contact with us through this website, and we very much hope that readers will continue to do so. The website is now being viewed by hundreds of separate individuals every week, mostly in the UK, Ireland, the USA, and Australia – and 32 other countries! We feel that this website is beginning to do precisely what we hoped it would do – bring together people who identify as critical thinkers about mental health nursing and start to describe the shape of our interests and concerns. This is making its way into the planning we are doing for our next event, which will be on the 9th of September in Birmingham, UK. Tickets and further details will soon be available on this website, so, if you have not already, please click ‘follow’ to make sure you find out about it in good time.
As a scholar engaged in narrative inquiry in mental health, I place emotionality, relationship and embodiment centre stage in my research, writing and teaching. I do so from a broadly feminist concern about the need for all people involved in state mental health systems to be increasingly kinder to each other. My standpoint position is informed by my ‘hybrid’, mental health academic/professional-survivor of the institutional psychiatric system, identity and lived experience.
The work of myself and my co-writers/researchers is often complex theoretically, so this blog post strips it down to what I think is its central message (I’ve included a few selected references at the end for those of you who may be interested in reading our work in greater depth, and following up citations in it).
It seems to me that institutional psychiatric treatment spaces create possibilities for already damaged bodies to perpetuate unkindness on other bodies. Mental health nurses and other state psychiatric workers are systematically stripped of their capacities to be kind through, among other things, being neoliberalised, classed, gendered, Psydisciplined, and socialised to institutional psychiatric custom and practice. On this basis, many then proceed to pass on extra helpings of human misery to many mental health service users, already burdened with large dollops of this.
This is done through a process of simultaneous environmental and narrative colonisation of users. Institutional psychiatric stories, and corresponding activity, are carried out in the name of psychiatric ‘business as usual’. These stories often ghettoise, medicalise, stigmatise, dignity-strip, humiliate, degrade, de-humanise, discriminate against, trivialise, silence, abuse, ridicule, biographically assault and insult, ignore, de-privatise, life-decontextualise, institutionally racialise and sexualise the lives of users in a process which I have described as narrative entrapment. Many service users, sometimes re-defining themselves as survivors, then attempt to re-story themselves in ways totally independent, and often rejecting, of the psychiatrised stories that were once told about them. This is true for myself and the people I write with.
All of this is, of course, often denied by liberal-humanist writers and practitioners, who blame the problems I describe above on the ‘few bad apples’ in an otherwise healthy tree. This signifies for me the ways in which mental health humanists violate in a different kind of way. They sentimentalise and romanticise the service user in a manner that both denies the exercise of power and constantly celebrates some imagined triumph of personal agency over structure. In the language of humanism, mental health organisations are simply regarded as benign bricks and mortar structures; a kind of neutral environmental backdrop for the practice of ‘caring’ or Tidal modelling.
In my view, this is exactly why mental health nurses and other workers in this field need critical social science to help them re-imagine their professional identities and moral purpose.
Grant A. 2014. Troubling ‘lived experience’: A poststructural critique of mental health nursing qualitative research assumptions. Journal of Psychiatric and Mental Health Nursing. 21 544-549.
Grant A, In press. Demedicalizing misery: Welcoming the human paradigm in mental health nurse education. Nurse Education Today.
Grant A., Biley F., Walker H. (eds). 2011. Our Encounters with Madness. Ross-on-Wye: PCCS Books.
Short N, Grant A, Clarke L. 2007. Living in the Borderlands; writing in the margins: an autoethnographic tale. Journal of Psychiatric and Mental Health Nursing. 14: 771-782.
Grant A, Leigh-Phippard H, Short N. 2015. Re-storying narrative identity: a dialogical study of mental health recovery and survival. Journal of Psychiatric and Mental Health Nursing. 22: 278-286.
Thanks very much Jonathan and CMHNN! Alec
Sent using BlackBerry® from Orange
The integrity of Mental Health Nursing as a coherent current and future discipline has been constantly undermined in recent years. What’s happening locally in the UKreflects what’s happening internationally (see eg MHNAUK emails, papers in JPMHN). The cultural contexts for this are, I believe, the inter-related biomedical, economical, political and policy drivers towards the generic nurse. I think this is connected to the lived experience locally of genericised teaching and work roles of many mental health lecturers, with, at least in my university, little felt sense of a coherent mental health academic and research group.
The international emergence of counter-hegemonic paradigm shifts in ‘mental health’ also need to be closely attended to. Demedicalisation is directly linked to the rise of the Narrative Paradigm (which also links to the emergent health humanities paradigm). In this context, narrative is situated both as a therapeutic resource and the basis for formulation-based understandings of human misery, supplanting biomedical diagnostic ones (see my recent papers discussing all of this in detail).
Related to, and fuelling, these paradigm shifts is the emergence of critical mental health movements. Locally, we have the SSiMH (Seeking Sense in Mental Health) student group – see their work in latest edition of BJRHSc). Nationally, the CMHNN (Critical Mental Health Nurses’ Network) is gathering strength (very well done Jonathan and all!). At an international level, see also the work of Critical Psychology and Critical Psychiatry. My work which feeds into all of these movements.
NMC generic and MH nurse-related policy fails to speak to much of the above, so will need to be critically engaged with in curriculum development and mental health teaching
LikeLiked by 1 person
I enjoyed your post on the Mad in America website and thanks for your feedback. I am all for moving forward mental health nursing student education and I wonder what the solution is and how we, as a group of like-minded clinicians/ academics can do this? It is great to discuss the topic, but it also needs some forward movement and action. Anyone interested?