Encounters with psychiatric institutions

1. Madness and CivilizationStarting a dialogue with and about madness in IrelandLydia SapounaSchool of Applied Social StudiesUniversity College Cork, Ireland

2. Encounters with psychiatric institutions Leros Psychiatric Hospital Greece Our Lady’s Psychiatric Hospital Cork The universality of Leros? We closed it and we are leaving. 6.5.93. Goodbye

3. Foucault’s Madness and Civilization; a framework to problematise, in a systematic way, mental health thinking and practice • Psychiatry as ‘a monologue of reason about madness’ • Problematising the ‘self-evident’ in psychiatric knowledge and practice. • Investigations into the making of psychiatric knowledge can be critical and transformative • Biomedical approaches: one truth among many • Increasing articulation of different ‘truths’ by people with self-experience of distress.

4. Background to the emerging user movement in Ireland • increasing articulation of concerns about current responses to human distress: • inhumane physical conditions in hospital units • over-reliance on and excessive use of medication • lack of meaningful community-based alternatives to hospitalisation • involuntary treatment • abuse of professional power • lack of information and choice in relation to ‘treatment’ options failure to capture the complexity of human experiences • bio-medical approach at best provide temporary symptomatic relief, but may compound, exacerbate and even cause further deep distress

5. Such approaches can be Critical Transformative • Question dominant knowledge and practice in mental health • construct new ways of knowing and understanding human experiences of distress • Validity of self-experience

6. Such approaches can also break the silence of ‘madness’ moving it from nothingness to community engagement and visibility, often celebrating the ‘gift’ and ‘normality of madness’

7. Critical and transformative approaches in Ireland: Individual examples of campaigns and innovations • Human rights: Campaign to delete section 59b of the 2001 Mental Health Act • Peer Advocacy: Irish Advocacy Network • Community Development: West Cork Mental Health Services • Housing: Sli Eile social housing project • Mental Health Trilogues • Such campaigns, initiatives and new approaches remain quite isolated and fragmented events, and have not yet achieved to significantly influence the bigger scheme of mental health thinking and practice at a national level.

8. Origins of the Critical Voices Network Ireland CVNI • Critical Conferences organised by Schools of Nursing and Applied Social Studies 2009 & 2010 to provide a platform for new thinking/ideas/approaches in mental health • CVNI emerged out of these deliberations as a coalition of service users, carers, professionals, academics, national campaigning and advocacy groups, all looking for a mental health system not based on the traditional bio-medical model • A democratic space with no hierarchical structures, open to everybody who wishes to join its discussions

9. Culture of CVNI (work in progress) • Confidentiality • Equality – no hierarchy • Include all voices • Respectful attention to those who may be quieter than others • Welcome diversity • Treat ourselves and others with respect • Make decisions by consensus • Roles within the group are there to serve the group • Espouse and encourage creativity and spontaneity.

10. CVNI events • Annual critical perspectives conferences in University College Cork • Public talks and seminars including: • American medical journalist Robert Whitaker (author of Mad in America, Anatomy of an Epidemic) • Professor of Social Work David Cohen (critical perspectives on ADHD) • Health Action International; seminar on conflicts of interest concerning the relationship of the pharmaceutical industry with science and medicine

11. CVNI Networking Activities • Facebook page: http://www.facebook.com/groups/Irishnetworkofcriticalvoicesinmentalhealth/ • E-list: criticalvoices-subscribe@working4recovery.com • Website: http://www.criticalvoicesnetwork.com/ • Quarterly national meetings • Regional meetings (East and South) • Networking groups focusing on areas such as: • Setting up hearing voices groups • Residential crisis facilities • Testimonials project • Cultivating activism • Human rights and legal issues such as forced ‘treatment’, capacity legislation, advanced directives

12. Concluding remarks: Starting a dialogue with and about madness? • Creating a space where different and sometimes conflicting voices can be heard and respected rather than silenced • Not an easy exchange as positions of certainty are challenged! • Opportunity for change through understanding the Other, telling stories, making sense of experiences, reconstructing and validating previously silenced meanings

13. Concluding remarks: Starting a dialogue with and about madness? • Foucaults classic text can be a tool to : • think systematically about professional power • question diagnosis of normality-medicalisation of human distress; DSM V has just been approved by the APA! • ask systematic questions about the nature of what we do in mental health rather than focus on questions of resources • Shake certainty of professional truths, thus providing an opportunity for transformation towards a more democratic, person-centred, respectful response to human distress

14. Thank you! l.sapouna@ucc.ie