User empowerment 15

Whose story is it anyway?

(this article appeared in Openmind 100 November/December 1999)

Do we need a survivor history of madness?
Peter Beresford and John Hopton develop the radically different views they first expressed in Openmind last year

Dear John
As you know I believe strongly that if we as mental health service users/survivors are to take control of our lives and future, then we must regain control of our past. We have to write our own histories. The history of madness, psychiatry and of us as individuals has so far been dominated and controlled by others; by professionals, charities, politicians and researchers. The effects have been demeaning and destructive for mental health service users. They have harmed the way individuals come to see themselves and how other people see them.
I know you don't share this view, but how can you justify this, given the appalling ways in which mental health service users/survivors have traditionally been presented and their worsening treatment in the media and political debate now? Current discussion is almost entirely preoccupied with service users as dangerous, murderous and threatening. Mental health service users have to change this. PB

Dear Peter
I've not always expressed my views about a user-centred history of mental health services very clearly in the past, but I have no problem with the idea of service users/survivors writing their own histories. Indeed, I would be the first to concede that some terrible things have happened to people in the name of mental health care and psychiatry. Furthermore some of the histories of mental health services written by academics and mental health professionals overlook abuses that have occurred. Worse still, some of the accounts by mental health professionals are overly sentimental, and almost make psychiatric hospitals sound as if they are desirable places to be. In that sense, I think it's vital that service users develop their own historical accounts. What I have a problem with is the idea of survivors' histories being presented in one place and 'official' and 'academic' histories being presented elsewhere. JH

Dear John
I thought for a moment we were in agreement! But your last comment makes clear the gulf in understanding that survivors still have to bridge. You seem to be standing by your original comment which triggered this discussion that 'for service users to develop a competing historical narrative seems misguided' (OM93). The point is that it's not mental health service users/survivors who created the need to develop their own histories, but the 'official' or psychiatric history that has excluded them for so long. In reality, survivors' own views and accounts of their experience and perceptions have mainly been ignored and devalued for centuries. Their history has largely had to be a hidden and private one. Meantime, psychiatry and its allies established their own powerful organizations, colleges, journals and texts to perpetuate their versions of history and of survivors.

History is always written by the winners, and mental health service users have been cast in the role of losers. Now, as a movement of mental health service users has developed, the official doors have opened a little. I am all for collaboration, but this has really only happened because the user/survivor movement has been able to exert influence and make its presence felt. And, crucially, survivors have succeeded in getting their voices heard, establishing their places to express their views and record their personal and collective histories, where these could be developed on their own terms, unedited and unqualified. This has led to new ways of thinking and understanding about madness and distress; about psychiatric categories like 'schizophrenia' and large-scale social issues like self-harm and eating distress.
This is something to be proud of, not to regret. It means that there are now different ways of understanding madness and 'mental illness' and of addressing them. Writing its own history is one of the ways in which an oppressed group can challenge what is done to it. All the movements: women's, black people's, lesbians' and gay men's and disabled people's movements, have done this. It's another sign of the collective progress mental health service users/survivors are making. PB

Dear Peter
While user/survivor histories have indeed been ignored in official histories of psychiatry and mental health services, I would suggest that this reflects poor scholarship as much as it may reflect a deliberate attempt to ignore their side of the story. Much of the history of psychiatry and mental health services has been written by mental health professionals who have no formal training in historical research. Consequently, many such accounts have omissions, contain inaccuracies and incorporate analysis based on false assumptions.
Such mistakes are easily made when people do not know where to find appropriate archive material. Unless survivors/users developing historical accounts are properly qualified historians themselves, or are able to enlist the help of such people, they will inevitably make similar mistakes. Indeed, I have read some accounts by survivors/users which are near-perfect mirror images of some of the worst professional accounts. Whereas some professional accounts tend to imply that all mental health professionals are 'saints', some user accounts imply that all mental health professionals are insensitive and uncaring. I have no wish to hide the fact that there have been serious abuses committed in the name of mental health care, but I also want acknowledgement that some professionals have made important contributions to developing humanistic understandings of and responses to mental health services. In that sense, it's not the development of users'/survivors' historical perspectives which worries me. What does worry me is that the development of separate historical narratives by users/survivors will lead to a kind of propaganda war between the authors of 'official histories' and the authors of the user/survivors histories. This could result in each side selectively focusing on extreme but atypical examples to score points off each other, so that we get further and further away from a proper historical understanding of how we got to where we are now.
What I would like to see is a single archive or museum where oral testimonies from users/survivors would be side by side with oral testimonies from mental health professionals, together with various documentary sources and artifacts. If the testimonies of survivors/users tell completely different stories from those of mental health professionals, so be it. But I believe that we will never develop a truly accurate history of mental health services unless mental health professionals and survivors/users collaborate with properly qualified historians. JH

Dear John
There's barely a word you've written I disagree with - in theory - but in practice it doesn't work. History isn't neutral or just about expertise and techniques. It's about who writes and controls it. It's about power, inequalities of power and conflict. We mustn't deny this. The only difference between now and the past is that conflicts between psychiatry and service users are at last coming out into the open. A crucial first step for us as survivors is to have safe space to develop our own narratives and history (and survivors will tell of the good as well as the bad), before our history can be placed next to professional accounts. We also have much more to offer than 'personal testimony'. We have our own important analyses and ideas. Yours is not an argument for rejecting survivors' own history, but for ensuring survivors have more support to develop it. PB

Dear Peter
My concerns are based on two considerations. Firstly, I have a somewhat unfashionable belief in the quest for objective truths. Secondly, while I agree that history is always tied up with issues of power and control, critical writing on mental health generally (by academics, professionals and survivors) can be a little one-sided. For example, while many abuses have been committed in the name of behaviourism, many self-styled critical thinkers who attack it fail to engage with B.F. Skinner's argument that the form of behaviourism that he advocated was essentially humanistic.1 JH

Dear John
I can't agree with your last point, but what I think we have shown in this correspondence is that with good will there can be collaboration and this discussion can be taken forward. Here's hoping it now will be. PB

1. B.F. Skinner is the psychologist most closely associated with behaviour
modification - the rewarding of desirable behaviour and ignoring of undesirable. Behaviour modification has been attacked for being punitive and manipulative. However, Skinner argued against the use of punishment, and that behaviour modification was not manipulative because a client could shape a therapist's behaviour as much as the therapist could shape theirs.