Living Through Exposure to Toxic Psychiatric Orthodoxies

1. Living Through Exposure to Toxic Psychiatric Orthodoxies Exploring narratives of people with ‘mental health problems’ who are looking for employment on the open labour market Griet Roets Co-authors: Kristjana Kristiansen, Geert Van Hove & Wouter Vanderplasschen British Disability Studies Association 3rd Annual Conference Lancaster, September 2006

2. Based on… Roets, G., Kristiansen, K, Van Hove, G., Vanderplasschen, W. Living Through Exposure to Toxic Psychiatric Orthodoxies: Exploring narratives of people with ‘mental health problems’ who are looking for employment on the open labour market. Accepted for publication by Disability & Society.

3. Introduction For people with long-term ‘mental health problems’, it seems almost impossible to attain a status as respected adult workers (see Beresford, 2001; Wilson & Beresford, 2002). This phenomenon is echoed in the Belgian situation, see recent findings from a preliminary inventory examining the public-service supported employment network (ETS) in the East-Flanders region of Belgium (Roets, Ramboer, Verstraeten, Vanderplasschen, De Maagd & Van Hove, 2005).

4. Based on Roets, G., Ramboer, I., Verstraeten, M., Vanderplasschen, W., De Maagd, M., Van Hove, G. (2005) Op zoek naar werk mét mensen met psychische problemen. Verslag van een vooronderzoek in de Provincie Oost-Vlaanderen, Orthopedagogische Reeks Gent, 22.

5. Central purpose of our inductive/exploratory research design and analysis • To gain insight about what happens in these failed efforts to obtain employment • To think critically about ways to understand this exclusion from a service recipient’s perspective; their voices and lived experiences provide us with seldom recognized yet valuable sources of knowledge (Beresford, 2000; Jacobson & Greenley, 2001; Trivedi & Wykes, 2002; Wykes, 2003; Rogers, 2003, Kristiansen, 2004, 2005; Borg & Kristiansen, 2004).

6. Methodological approach • Life story research/narrative inquiry (Goodley et al., 2004) allows participants to steer the direction of what information is collected. Subjective reports from people with long-term ‘mental health problems’ as an epistemological path remains contested in the traditional field of mental health (research) (Davidson, 2003; Deegan, 2003). • When the personal becomes political, one might be able to make connections between biographical accounts and wider structural economic relations (Barton, 1998; Thomas, 1999).

7. Participants • Five people who had used/were using ETS, period November 2002 to January 2004 • 1 woman and 4 men • Age range of 23 to 42 • None were married, none had children • All had received a variety of mental health diagnoses, often coupled with other problems (f.e. drug abuse) • All had received treatment and medication, typically including hospitalization for long periods of time

8. Research process • Need for interviews to take place in informal settings: participants were encouraged to speak freely of lived experiences, present situations (often unexpected glimpses into living life at society’s margins), social relationships, important turning points (such as reasons for moving), worries, hopes and dreams. • Most expressed concern about ‘telling the truth’, fearing disapproval or reprisal. It was crucial to emphasize that the researcher had no personal interests or obligations in the service system.

9. Analysis • Thematic-phenomenological approach influenced by postmodernist thought, maintaining a critical perspective (Skrtic, 1995; Corker & French, 1999; Corker & Shakespeare, 2002). • Inductive, exploratory and interpretive analytic approach; exploring life stories of participants and ethnographic accounts of the researcher for recurrent themes.

10. Five central findings (1) Losing the game before it starts (2) Internalising the vicious circle of victim-blaming (3) Moving from control overload to a life with inadequate supports (4) Passing from crushed dreams back to passive inactivity (5) Signs of resilience and resistance

11. (1) Losing the game before it starts Participants have typically had a starting point of disadvantage; people told about years of deception and distrust in the helping system “I think because I live in psychiatric care units, that people fear me. I have the feeling people see me as a lunatic. Somehow, psychiatry marks us.” Now, statements they made often have been used against them as signs of their pathology; exposure to ‘toxic psychiatric orthodoxies’ (negative prejudices, stigma, stereotypical discourse) A participant had asked his support worker if he had been a burden for him, and was told (in a somewhat laughing tone): “Yes, when you started, I didn't believe you were capable of anything at all!”

12. (2) Internalising the vicious circle of victim-blaming The jobseeker’s culture prioritizes having a job as an individual obligation, expecting survivors to meet high targets, playing a role in the process of how an individual comes to believe in his/herself and learns to attribute fault and responsibility (alienating effects). When describing his initial assessment phase, a participant said: “They clear you through customs control. You get examined, to see if you can work under pressure…too much stress for me, and then I can't select what's important. But surely it’s my own fault! So I just come back with my tail between my legs, thoughts raging through my head: will I ever be able to work again?”

13. (3) Moving from control overload to a life with inadequate supports Many users and survivors of the psychiatric system have been in settings that were heavily regulated and controlled. They then moved (or more typically were moved by others) to settings where the type and adequacy of support is insufficient in light of the many new challenges, novelties, and uncertainties. When talking about life outside the hospital and trying to meet people and form relationships in addition to seeking employment, a participant told us: “I have no comrades. I only have staff (at the psychiatric residence). And they know very little about me.” Yet he feels all the responsibility placed on one’s own shoulders: “You don’t get much support. That’s about the only thing I dare to say about support around here. You have to take all the initiative, do it all yourself.”

14. (4) Passing from crushed dreams back to passive inactivity Survivors are mainly expected to take any job, regardless of actual credentials, past work experiences, or work conditions and quality demands. In the end, survivors’ hopes and dreams often become crushed. They face a high drop-out from their personal trajectory plans in maintaining jobs. Returns to (periods of) inactivity are common, and survivors at loose ends are often caught in the psychiatric system again. Back in a residential psychiatric facility with employment-seeking as its major mission, a participant told us: “I had sports, volleyball and occupational therapy, and conversations, like with the psychologist. They do keep you occupied.”

15. (5) Signs of resilience and resistance In the narrative tales of everyday life struggles, we found many signs of resilience. Resilience is a sort of inner strength to be able to withstand tough times, pressures, shocks, and defeats. Life has its ups and downs, and tough times are not necessarily pathological or even unusual: “I was deeply down in the dumps, but I refused to see anyone from psychiatry, refused residential placement. The only thing you can be sure about there is people complaining about their problems and illnesses. When I didn't want to live anymore, I also had my own way out: my pets! They brightened me up. I have three guinea pigs and a parakeet. My birdie!” In addition to resilience, there were many expressions of protest and resistance, revealing other sorts of strengths

16. Concluding reflections (1) Survivors give birth to alternative, plural understandings and interpretations of life with madness and distress. This challenges the long-standing assumption that disability precludes growth and prevents people in attaining full citizenship in their communities. Failures should be placed in the surrounding environment. Little surplus value from the labour power of disabled people is accorded in the competitive regular labour market, instead exploitative and exclusionary labour demands dominate.Unable to satisfy current criteria for employment, people with ‘mental health problems’ are often excluded from participating in capitalist production. On account of this non-participation, we contend that they are constructed as unemployable. In that sense, survivors’ search has neither rhyme nor reason.

17. Concluding reflections (2) We need to question and challenge bourgeois capitalism that permits only a small minority (read: white, heterosexual and able-bodied male) to exercise the freedom to choose. We reject the paradigm where finding successful employment is seen as a goal that must await cure. An illuminating idea might be that citizens have the right to employment and a reasonable standard of living which entails a shift away from laissez-faire capitalism. (Re)introduction and individualised, flexible supports into accepting and acceptable environments is a fundamental premise to build on a fair employment ethos.

18. Roets, G., Vanderplasschen, W., De Maagd, M., Van Hove, G. (2006 – in press) Exploring Success Stories of Survivors with a Paid Job on the Regular Labour market: identifying dynamics of recovery-oriented case management. Orthopedagogische Reeks Gent.