The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State

1. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Mark Cresswell Sociology School of Social Sciences University of Manchester Tel: 0161 2753853 E-mail: mark.cresswell@manchester.ac.uk

2. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State ‘Psychopolitics’ – Peter Sedgwick (1982) • Radical constructivism ‘all illness is deviance’ • But hostile to ‘anti-psychiatry’ (Goffman/Szasz/Laing/Foucault) Why? • Deconstructing categories leads to ‘nihilism’

3. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State So: What matters is that humans can make ‘claims upon the society in which they live’ So: Categories- even epistemologically contentious ones like ‘mental illness’ - are potentially democratically productive because they allow us to ‘make claims upon the society’ in which we live.

4. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Apparently, the issue of “rights” must rear its head here, as one typically late-modern form which “making a claim upon the society in which we live” assumes is the very assertion of “rights.” I mean this in two senses:

5. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State • ‘negative liberty’ – freedom from abuse, incarceration, forced treatment etc. ‘positive liberty’ – freedom to do something i.e. receive a service, a treatment, have adequate housing, income etc. 2. ‘experiential rights’ – the right to have one’s experience + identity recognised

6. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State • The claim to an ‘experiential right’ was classically formulated by Peter Campbell of the organisation Survivors Speak Out: ‘[a] growing number of mental health service recipients…are choosing to describe themselves as ‘survivors’. This is partly because we survive in societies which devalue…our personal experiences…But it is chiefly because we have survived an ostensibly helping system which places major obstacles across our path to self-determination’ (1992: 117) ‘[a] growing number of mental health

7. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Moreover, given that the psy-complex, as an institutional complex comprising medical, psychiatric, psychological discourses etc., are simultaneously welfare state apparatuses, that is to say resourced and regulated by aspects of the state, it would seem that the state must have a significant role to play in both the recognition of ‘rights’ and redress against their violations.

8. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Self-harm Survivors in Britain, 1986-2006 • ‘Deliberate Self-Harm’ (DSH) – non-fatal self-injury/self-poisoning • Social movement arises from the psychiatric survivor movement and feminist activism

9. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Organisational forms: • Bristol Crisis Service for Women • National Self-Harm Network • Action, Consultancy & Training Group

10. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Major achievements of the self-harm survivor movement: • Exposing the ‘moral code’ of medicine/psychiatry • the self-harmer is discriminated against in psychiatry/A&E • punishment rituals (being treated without anaesthetic) • pejorative lexicon (‘attention seeking’ etc.)

11. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Therefore the need for ‘rights’: 2 questions • What ‘rights’ do deliberate self-harmers possess in A&E? In other words: are their ‘rights’ as ‘pure’ as the accident victim’s? 2. Does psychiatry have the ‘right’ to reject the self-harmer? Can they refuse to treat the self-harmer?

12. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State ‘Rights’ as formulated by the National Self-Harm Network (1995): • ‘Any necessary treatment for self-inflicted injuries should be a right’ (Pembroke, 1995: 13, emphasis added – problem#1). • ‘Moral judgement should not affect clinical judgement’ (ibid., emphasis added – problems 1&2). • ‘Treatment should not be dependent upon the individual agreeing to psychiatric intervention’ (ibid. – problem#2). • ‘A patient with self-inflicted injuries has the same rights as other patients’ (ibid., emphasis added – problem#1). • ‘Pain relief should be given the same priority as any other patients’ (ibid., - problems 1&2) • The self-harmer has the ‘right to a second opinion’ (NSHN, 2000: 44 - problems 1&2) • The self-harmer has the ‘right to go to another hospital’ (ibid. - problems 1&2).

13. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Lobbying the State: • 1995 – DOH • 2002 NICE & Clinical Guideline 16 • 2006 NIMHE

14. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State The ‘failure’ of these attempts exposes the epistemological gap between the ‘experiential rights’ of a social movement and the ‘double whammy’ of the powerful professionals (e.g. RCP and their ‘evidence base) and the beaurocracies (quangos) of New Labour

15. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Back to the question of ‘rights’. Marx ‘On the Jewish Question’ (1843) – human rights are a manifestation of capitalist ideology – they reduce us to ‘individual monads’ But! This has been challenged within Marxism by Claude Lefort

16. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State Lefort: ‘Does the struggle for human rights make possible a new relation to politics?’ Yes! Lefort argues that ‘human rights’ properly conceived presupposes human relatedness – to support my freedom of expression is simultaneously to acknowledge yours

17. The ‘Rights’ of ‘Self-Harm Survivors’ and the Role of the State The challenge for ‘survivor’ movements, then, is to disprove Marx – to turn the potentially limiting ‘I’ of liberal economy into the ‘WE’ of collective action