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Searching for a Rose Garden: challenging psychiatry, fostering Mad Studies

  • Alice Salomon University of Applied Sciences Berlin


Searching for a Rose Garden is an incisive critique of all that is unhelpful about sanestream understandings of and responses to mental distress. Drawing on world-wide survivor activism and scholarship, it explores the toxicity of psychiatry and the co-option and corruption of survivor knowledge and practice by the mainstream. Chapters on survivor research and theory reveal the constant battle to establish and maintain a safe space for experiential knowledge within academia and beyond. Other chapters explore how survivor-developed projects and practices are cultivating a wealth of bright blooms in the most hostile of environments, providing an important vision for the future. Referencing Joanne Greenberg’s book I Never Promised you a Rose Garden, this collection demonstrates the challenge, determination and successes of the authors in working towards a paradigm shift in the understanding of madness and distress. This landmark text is essential reading in the emerging field of Mad Studies. See more at:
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... This climate sharpens antagonisms within the psychiatric establishment (see the debate in World Psychiatry, 2019) and gives rise to in-house initiatives to humanize psychiatry. However, there is a significant difference between long-term efforts to scrutinize and challenge psychiatrization as a dominant social response to madness and distress (e.g., Szasz, 1961;Burstow, 2015;Russo and Sweeney, 2016) on one side and attempts to limit its scope to a reasonable number of "severely ill cases" on the other. The latter approach is exemplified in the following statement by Beeker et al. (2021): "While individuals with minor disturbances of well-being might be subjected to overdiagnosis and overtreatment, psychiatrization could also result in undermining mental healthcare provision for the most severely ill by promoting the adaption of services to the needs and desires of the rather mild cases." ...
... The contested presumption of the biomedical nature of madness and distress remains implicit in the work of many critical psychiatry scholars who seek to engage in "less psychiatrizing forms of psychosocial support" (von Peter et al., 2021) or routinely assume the existence of "apolitical or irreducible distress" (Logan and Karter, 2022). This kind of subtle but persistent othering subverts efforts to eradicate the psychiatrization of human experience as a matter of principle (LeFrançois et al., 2013;Burstow et al., 2014;Russo and Sweeney, 2016;Beresford and Russo, 2021), regardless of its spreadand despite circumstances that can turn "mental illness" into an acceptable explanatory framework that legitimizes medical "solutions" to the complexities of living. The latter trend is acknowledged as "bottom up psychiatrization" (Beeker et al., 2021;Logan and Karter, 2022) but overlooks the many intersections of knowledge-making processes in which top-down and bottom-up psychiatrization merge. ...
... Given the extremity of mental health issues provoked by both the pandemic and the war in Ukraine, we clearly need to find ways to tell Mad stories in music education. I deliberately use the term "Mad" throughout this argument as a way of both "claiming disability" (Linton, 1998) and "reclaiming madness" (Russo, 2001(Russo, , 2016 as a politicized identity. Using this term also allows me to participate in Mad Studies. ...
This article considers challenges and possibilities that narrative researchers in music education might encounter when attempting to recount stories of Madness. Narrative restorying often follows a three-dimensional space structure that includes the commonplaces of temporality, sociality, and place (Clandinin, 2016; Clandinin et al., 2016; Clandinin & Connelly, 2000). Mad stories, however, do not easily restory into this structure. I center my own experiences of being bipolar to explore how such experiences particularly disrupt dimensions of temporality and sociality and assert that narrative researchers might learn to make room for Madness when telling stories. Moreover, I reflect on the impact of sanism—the oppression that Mad people experience—on Mad stories. In considering how narrative researchers might make space for Mad stories, I offer an expanded four-dimensional narrative structure alongside critical storytelling and draw upon the work of Patricia O'Toole (1994) and Roberta Lamb (1993–1994) to explore how researchers might represent such stories.
... In this context, several measures which aim at countering some of the negative effects of psychiatrization have been suggested or applied on a relatively small scale, such as introducing stepped diagnosis (Batstra and Frances, 2012c), implementing open dialogue as a less psychiatrizing means of psychosocial support (von Peter et al., 2021), advocating alternative frameworks to psychiatric diagnosis (Baumgardt and Weinmann, 2022), limiting the influence of psychiatric corporate interest and pharmaceutical companies (Frances, 2013;Cosgrove and Whitaker, 2015) or, with a growing importance, fostering user-involvement in research and care (Gillard et al., 2010;Wright and Kongats, 2018;Beeker et al., 2021b). Nevertheless, a far wider array of aspects of psychiatrization has been described in non-medical disciplines, such as anthropology, critical psychology, sociology or Mad Studies, using different theoretical frameworks, methodologies, and terminologies (LeFrançois et al., 2013;Behrouzan, 2016;Jain and Orr, 2016;Russo and Sweeney, 2017). Research on psychiatrization heavily draws on the existing body of scientific research on medicalization (Zola, 1972;Illich, 1974;Conrad, 1992Conrad, , 2005Conrad, , 2007, biomedicalization (Clarke et al., 2003), pharmaceuticalization (Fox and Ward, 2008;Abraham, 2010;Jenkins, 2011), therapeutization (Furedi, 2004;Sommers and Satel, 2005), and psychologization (De Vos, 2010;Gordo Lopez and De Vos, 2010;Haslam, 2016). ...
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Background In the light of high incidences of diagnosed mental disorders and the growing utilization of mental healthcare services, a progressing psychiatrization of society has been hypothesized as the underlying dynamic of these developments. Mental healthcare institutions, such as psychiatric hospitals, may play a decisive role in this. However, there is a scarcity of research into how psychiatrization emerges in hospital settings. This paper explores whether the emergency department (ED) can be considered as a site where psychiatrization happens, becomes observable, and which factors in the context of the ED may be its potential drivers. Methods Two cases as encountered in an interdisciplinary ED will be presented in the following in an anonymized way. Although the cases originate from individual consultations, they can be considered as prototypical. The cases were collected and discussed using the method of interactive interviewing. The results will be analyzed against the backdrop of current theoretic concepts of psychiatrization. Findings The ED can be seen as an important area of contact between society and psychiatry. Decisions whether to label a certain condition as a “mental disorder” and to therefore initiate psychiatric treatment, or not, can be highly difficult, especially in cases where the (health) concerns are rather moderate, and clearly associated with common life problems. Psychiatrists' decisions may be largely influenced in favor of psychiatrization by a wide array of disciplinary, institutional, interpersonal, personal, cultural, and social factors. Conclusions The ED appears to be a promising field for research into the mechanisms and motives through which psychiatrization may emerge in mental healthcare settings. Psychiatrists in the ED work within a complex sphere of top-down and bottom-up drivers of psychiatrization. Encounters in the ED can be an important step toward adequate support for many individuals, but they also risk becoming the starting point of psychiatrization by interpreting certain problems through the psychiatric gaze, which may induce diagnoses of questionable validity and treatment of little use.
... Researchers Brown and Jones note the problem, exemplified in conventional psychiatric research, that such formal engagements seek to correct: "the consenting research subject at once symbolically concedes 'understanding' of his or her disorder to the academic researcher while at the same time reifying his or her position as an informant or provider of data that will only become 'externally valid' once it has been combined with dozens of other narratives, reports or data points and 'transformed' by expert clinical scientists" (Jones and Brown 2013). Survivor led research, a participatory research framework led by those with experiences of madness, distress, and/or treatment, is an example of such formal critical engagement, one which seeks to correct the systematic exclusion of those who have lived experiences in the production of knowledge about those very experiences by centering their voices, priorities and perspectives (Sweeney et al. 2009;Russo and Sweeney 2016). Speaking to the critical engagement required for such research, Alison Faulkner, drawing on Jasna Russo and Diana Rose, acknowledges that "for survivor research to transform knowledge, those involved need more than the experience of being mad or of using services" (Faulkner 2017, 513). ...
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As participatory research practices are increasingly taken up in health research, claims related to experiential authority and expertise are frequently made. Here, in an exploration of what grounds such claims, we consider how feminist standpoint theory might apply to the psy sciences. Standpoint theory claims that experiences of marginalization and critical engagement can lead to a standpoint which offers an epistemic advantage within a domain of knowledge. We examine such experiences of marginalization and critical engagement in the mental health system, as well as evidence for epistemic advantages resulting from these experiences. This evidence, found in the identification of problematic assumptions and the development of new tools and theories in the field, grounds our argument that standpoint theory is indeed relevant to the psy sciences and that many of those that have experienced marginalization and engaged critically have an epistemic advantage when it comes to knowledge production. The implications of this argument are significant: those who have attained a standpoint within the psy sciences ought to be included in research and given both tools and funding to develop research programs. However, we must be weary of the risks of tokenization, cooptation, and essentialization that are likely to accompany such a transformation.
... Furthermore, there is some ethnographic research detailing a few of psychiatrization's mechanisms at work in specific countries and groups worldwide (38)(39)(40)(52)(53)(54). Theoretical and experiential accounts of psychiatrization are also evident in psychiatric user and survivor scholarship, the burgeoning area of Mad Studies (55)(56)(57), and, of course, the classic antipsychiatric literature of the 1960s and 70s (58)(59)(60)(61). Recently, there have been several campaigns and publications addressing medical overdiagnosis and disease-mongering in general but lacking a special focus on psychiatry (62)(63)(64)(65)(66). Conceptually, psychiatrization unfolds as a co-production of various psydisciplines (psychology, psychotherapy, psychoanalysis) from which mostly synergistic processes of dispersion of psyknowledge, concepts, and vocabulary are derived (67). ...
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Purpose: Worldwide, there have been consistently high or even rising incidences of diagnosed mental disorders and increasing mental healthcare service utilization over the last decades, causing a growing burden for healthcare systems and societies. While more individuals than ever are being diagnosed and treated as mentally ill, psychiatric knowledge, and practices affect the lives of a rising number of people, gain importance in society as a whole and shape more and more areas of life. This process can be described as the progressing psychiatrization of society. Methods: This article is a conceptual paper, focusing on theoretical considerations and theory development. As a starting point for further research, we suggest a basic model of psychiatrization, taking into account its main sub-processes as well as its major top-down and bottom-up drivers. Results: Psychiatrization is highly complex, diverse, and global. It involves various protagonists and its effects are potentially harmful to individuals, to societies and to public healthcare. To better understand, prevent or manage its negative aspects, there is a need for transdisciplinary research, that empirically assesses causes, mechanisms, and effects of psychiatrization. Conclusion: Although psychiatrization has highly ambivalent effects, its relevance mainly derives from its risks: While individuals with minor disturbances of well-being might be subjected to overdiagnosis and overtreatment, psychiatrization could also result in undermining mental healthcare provision for the most severely ill by promoting the adaption of services to the needs and desires of the rather mild cases. On a societal level, psychiatrization might boost medical interventions which incite individual coping with social problems, instead of encouraging long-term political solutions.
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This article reports on the findings from a small-scale co-produced qualitative study on experiences of distress caused by the war in Bosnia and Herzegovina (BiH). Inspired by the emerging interdisciplinary field of Mad Studies, the study is novel and unique in two ways. First, it prioritises social understanding and interpretation of madness and distress. Second, an emphasis is placed on experiential knowledge. Beyond interviews with 20 people who experienced distress due to political conflict, this included contextualisation of the study in the knowledge generated through survivor research and within the field of Mad Studies. Study findings highlight the social causes and consequences of distress caused by conflict, such as war-related violence, gender-based violence, experiences of poverty and corruption. Participants stressed the importance of safety and support within their own home, mutual and supportive relationships with their families, friends, other people who experienced distress, the broader community and opportunities to do everyday activities they enjoy. In terms of professional support, the findings suggest that poverty alleviation and protection of people’s right to self-determination through access to human rights advocacy and representation may be as relevant as non-coercive community-based services. This indicates that support for distress caused by political conflict need not be different from any other support for people who experience distress. Emphasis should be placed on survivor-run initiatives and non-coercive, community-based support which addresses social causes of distress and enables people to exercise self-determination.
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Aim A range of residential supports is available for young people experiencing mental health challenges. One Australian example is the Youth Residential Rehabilitation Service, which provides up to 12 months of intensive psychosocial support in a residential setting to young people aged 16–25 experiencing serious mental health challenges. This paper aimed to add to the scant literature on these services, describing the experiences of young people and staff members across the duration of a stay. Methods This study drew on collaborative autoethnography to engage and centre the direct lived experience of young people who had lived, and staff who had worked, in a Youth Residential Rehabilitation Service. Results We identified three phases that young people typically journey through during their stay at the service. The Arriving phase was marked by appropriate referrals, a warm welcome, a period of settling in and the development of trusting relationships. The Discovering phase saw young people identifying and enacting their strengths, hopes and values. Community connections were a focus of the Continuing phase as lives after service exit were envisioned and created. Conclusions Drawing on collaborative autoethnography methods represents one approach to amplify the voice of young people in service design and evaluation. This paper richly described some of the possibilities and complexities of the Youth Residential Rehabilitation Service experience, which can be used to inform the service's pacing and structure of support.
In this chapter, I write from the perspective of a survivor researcher: from the perspective of being an ex-user and survivor of mental health services alongside having academic qualifications. I focus on the vital role that personal narratives play in the lives of people deemed mad and the value of the knowledge that emerges when people have safe spaces in which to share their stories. I outline the role and value of the experiential knowledge that emerges from shared experiences and how this can be developed and validated through peer support, activism and survivor research. I outline the many challenges faced in the struggle to have our knowledge recognised as valid knowledge in its own right. Finally, I touch on the potential for Mad Studies to carry the baton into the future: through severing the links both with biomedical sciences and Patient and Public Involvement (PPI) and creating new links across different disciplines.
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