New Book: Madness Contested: Power and Practice

Thank you for the opportunity to join the blog and to give an outline of the recent book Madness Contested. My belief is that we need to radically rethink how we make sense of people who experience extreme emotional states, are distressed, and have beliefs, or act in ways that other people find hard to understand. Despite sustained criticisms from academia, survivor groups and practitioners, the biogenetic model of madness prevails, shaping our very notions of what madness is, who the mad are and how to respond. This narrow view, at the heart of the psychiatric system, is misinformed, misleading and fraught with tensions between the provision of care and the function of social control. I believe we can, and should, evolve and develop more creative and humane ways to provide support to people in need.

Madness Contested questions how we currently make sense of and respond to madness, and explores alternative and creative ways to understand and support people. It brings together nurses, survivors, psychiatrists, psychologists, practitioners, and service users who discuss and explore these areas. The first section analyses and questions the multiple functions, processes, forms of power and interest at play in maintaining dominant theories and practices. The second section explores alternative conceptualisations of madness, placing emphasis on practice that incorporates openness, modesty and a desire for equality. The book is available from PCCS Books and Amazon.

If you would like to discuss these issues further, I am on Twitter @Steven_Coles_ or I can be e-mailed on madness.contested@gmail.com or through this blog.

Warm wishes

Steven Coles

7 kommentarer:

  1. Sigrid (Styret)3/10/2013

    Thank you for your contribution! The view of extreme mental states as reactions to what has happened in the person's life, fits well with the understandings that our organization proposes. We want to challenge the medical model of psychological problems, which often is given the status as objective truth, and to work for a multi-faceted view of these problems, where the person who experiences the problems he or herself must be seen as the most important person to define the problems.

    The book looks really interesting, and I will definetely check it out. You are very much welcome to share more of your thoughts, research etc. on this field, in our blog!

    Sigrid Ramdal,
    Board Leader, NFPH

    1. Thanks Sigrid, it is good to hear that are similarities. Presenting psychiatric and psychological knowledge as fact and objective truth is very powerful, it quietens the importance of human experience as an important form of knowledge. Many people, including myself, have been very concerned with how psychiatric diagnosis is presented as a scientific process, despite the fact that it does not meet basic scientific standards such as reliability and validity.

      Service users are told they have "schizophrenia", more accurately they should be told "we would like label your experiences with a concept called schizophrenia. The label is: conceptually confused; it is not very scientific; many academics, services users and professionals contest it; it does not really tell us how to help you; it is based on circular reasoning it; and it will put your civil liberties at greater risk than those the in the general population. What do you think?"

      Diagnosis has little to do with fact, and everything to do with power - it is a powerful tool in establishing and sustaining relationships of power and concealing the meaningful nature of people's experiences. A lack of power is often what led to people's distress, including hearing voices and unusual beliefs, however diagnosis strips such experiences of all meaning and casts them as meaningless biological illnesses. I believe rather than looking inward, to biology and cognitive structure, we need to look outwards to the lives people have and the type of society we live in, including the distribution of power and resources. Only until we create a compassionate, just and fair society will we tackle the key causes of our discontent.

      Again thanks for allowing me to share my thoughts, I hope they are useful. I welcome other people's thoughts, arguments, and ideas - our understanding of ourselves should evolve and grow rather than stagnate. Steven Coles

  2. Sigrid (Styret)3/14/2013

    You have many good points in what you say about psychiatric diagnosis; and yet, one could ask if it could be problematic to present these views to people using mental health services, when it contradicts the "official view". Indeed, this can be very challenging for proffesionals working in a system that, as a whole, builds on this official, medical view. That is one of the reasons that NFPH, and many others, we hope, will continue to work for greater openness and flexibility in what counts as truth when it comes to psychological and psychosocial problems.

    Again, thank you for sharing your thoughts with us!
    Best, Sigrid

  3. Psychiatrc Diagnosis
    I think it can be hard for professionals who are questioning of diagnosis to speak up about their views - though speak up I feel we must. Though there are obvious anxieties in doing so - though I've found that if I share my views about diagnosis with other staff in mental health services: at worst I get ignored; at best others agree and share my concerns; and often it can lead to useful debate and discussion. A colleague and myself (The Art of Debate, Clinical Psychology Forum, Keenan & Coles, 2012) have set up a series of formal debates in mental health services we work within, which has included topics such as diagnosis. The debates have been attended by staff and service user and has led to really useful and interesting discussions. With service users, people need to be respectful to their views, including how important diagnosis is to them and how it functions practically for them. However, I do not feel it is not ethically justifiable, even for staff who are in favour of psychiatric diagnosis, to bestow upon people a diagnostic label as if it were a straightforward, robust scientific and technical entity. Those continuing to diagnose, some perhaps coerced into doing so by organisational systems and pressures, at the very minimum need to provide people with information regarding the difficulties inherent in diagnosis, its uncertain status and an outline of alternatives. This would create space for alternative explanations of madness to be heard and acted upon. For individual practitioners a first step to creating space so as to make madness meaningful involves informing people within services and their families that the professional conceptualisation of madness is contested. A group of us have written a critique of diagnosis (many other critiques exist) and starts to outline some key factors for developing an alternative to diagnosis, it is accessible for free at http://dcp-sigpr.bps.org.uk/document-download-area/document-download$.cfm?file_uuid=4A454829-9D2C-9ECE-B67A-BFC1B363D0BF&ext=pdf

    I think it is great that your organisation is working towards greater openness and flexibility in what counts as truth - this is a key issue in mental health services. We need far more reflection and critical examination of what counts as knowledge, this would then allow more space for a range of types of knowledge, in particular the importance of service user, survivor and patient 'knowledges'.

  4. Sigrid (Styret)3/17/2013

    You are definetely right about the service users' right to be informed about the limited truth value of diagnosis, as well as the importance of discussing these issues with one's colleagues. I still think speaking up about this could be difficult, depending on your position in your workplace; your education/profession, length of service etc. It is our hope that our organization can provide support to people working in this field, as well as service users, who share these views. And - organizing debates on these themes actually seems like a really good idea...!

  5. If you would like a copy of the debate article e mail me on madness.contested@gmail.com. Your organisation sounds really interesting, in what ways do you support to staff and service users? I am always interesting in new ways of supporting a questioning perspective; I believe there is a lot to question in current mental health systems and wider society, and we need to explore and develop new ways to understand and support people who have suffered from the sharpest of what society has to offer. It is harder as individuals, either staff or service user, to question dominant ideas and practices. People often feel angry about their treatment in mental health services and in society, however, our tendency in an individualistic society is to turn inwards and feel unable to alter these circumstances - alone we are limited to alter the world around us. However, we are more powerful if we stand together; it is really important for people who are angry at services and society to come together, so to act together to try to bring about change. In the age of the internet we have opportunities to make such communal protest to cross national borders. Instead of isolated individuals whispering - "Jeg er sint på psykiatrien", we can shout "vi er sinte på psykiatrien". Warm wishes Steven Coles @Steven_Coles_

  6. Sigrid (Styret)3/24/2013

    Thank you Steven! We are a rather new, and still a pretty small organization, but already we hope we through our blog and newsletters show members and others that we are quite a few people sharing these views. We are also planning to organize meetings and lectures where people can meet and discuss some of these topics. And of course, the journal "Tidsskrift for psykisk helsearbeid" provides research articles, as well as giving both professionals and survice users the opportunity to express their views.

    I will e-mail you about that article - it may be of interest and inspiration to us!


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