Service user involvement, authority and the ‘expert-by-experience’ in mental health

Abstract

This article re-examines the politics of engagement of the UK mental health service user and survivor movement by focusing upon the mental health ‘expert-by-experience’. Using qualitative data, I illustrate how the service user and survivor movement is able to draw upon an experiential authority that is rooted in practices of self-help and peer-support. I do this by bringing an experimentalist reading of self-help and peer-support practices into dialogue with a model of traditional authority. As such, the personal can be linked up to the political in ways that emphasise the value of self-help and support practices as forms of political participation, while highlighting modes of engagement that are predicated on the capacities, rather than the needs, of the movement.

Keywords:

• experiential authority
• positive critique
• experts-by-experience
• mental health
• self-help
• service user involvement
• survivors

Notes

1. At http://www.bipolaruk.org.uk [Last accessed 13 May 2012].

2. At http://www.hearing-voices.org [Last accessed 13 May 2012].

3. There is another important thread to the history of recent government policy, concerning the development of mechanisms for coercing mental health service users in the name of ‘public risk’. Notably, service user representatives working with the Department of Health in 1998 infamously resigned upon realising that the introduction of compulsory treatment orders was non-negotiable (Tait and Lester 2005). By 2002, the Mental Health Bill (DoH 2002) clearly framed mental healthcare issues in terms of risk to the public instead of service user rights.

4. See, for example, ‘The Doctor Who Hears Voices’ documentary, available at http://www.channel4.com/programmes/the-doctor-who-hears-voices [Last accessed 15 October 2011].

5. This is a finding from seven interviews with national and local members of two self-help and peer support group networks, the Hearing Voices Network and Bipolar UK.

6. See Archibald (2007) for a four-way typology.

7. For the remainder of this paper I emphasise expertise-by-experience that emerges in relation to working on experiences of mental distress. Other kinds of expertise-by-experience exist in mental health, such as the subtle expertise of dealing with psychiatrists, of engaging efficaciously in service user involvement mechanisms and so forth. I suggest that all these different, repeated and shared experiences provide crucibles for developing an expertise-by-experience, and would benefit from being understood in the same way that I am developing here in relation to the engagement with mental distress.

8. This is evident from their websites, and concurs with interviewees from both organisations.

9. Such a process is reminiscent of Simmel’s vitalism. See Simmel (1971).

10. For more details, see http://www.psychminded.co.uk/critical/marius.htm [Last accessed 10 July 2011].

11. Cf. Brigstocke et al. (forthcoming), where the authors develop a sustained critique of the framing of experience-based authority as necessarily traditionalist, in the sense of orientated upon the past.

12. Honig (1991) asks her readers where the weight of authority can come from, if not from a transcendent ground?

13. ‘Community’ in this sense is immanent to collective, shared practices of self-experimentation. This way of conceptualising community incorporates disagreement and discord between selves in a different way than Kirwan’s (2013) claim that ‘community’ exists in its absence or retreat. Nevertheless there may be a fruitful conversation to be had between these positions.

14. I leave a question hanging: given that self-help groups are often defined in an ideal-type sense as non-hierarchical spaces of mutual trust (e.g. Lindow 1994, Borkman 1999), how do we understand the empirical fact that certain members of the groups have greater influence over others, and that this influence is not a kind of persuasion between equals but an authority grounded in different experiences, and itself grounding a difference in power?

15. See http://www.intervoiceonline.org/2007/6/28/an-exercise-in-how-to-replicate-the-experience-of-hearing-voices [Last accessed 15 October 2011].

16. qua styles of thought (Hacking 1982).

17. Moreover, we should be wary of dichotomising self-help and medical approaches – Bipolar UK for example is largely accepting of a medical model approach to ‘bipolar disorder’ (the clue is in the name …).

18. For example, see Foucault (1984) on the task of construing modernity as an ethos rather than an epoch. We might then ask, what is the ethos proper to the experiential authority of the expert-by-experience?