Paper short abstract:

Mental-health activist service 'survivors' live with the shadow of biomedicine. While striving to assert their autonomy, the biomedical system positions them as incapacitated. This is the context in which they come together to build alternative worlds and make spaces to ‘go through madness’ together

Paper long abstract:

This paper is based on ethnographic fieldwork with groups of mental-health activists in London. As past or current patients of the National Health Service, activists self-identify as 'survivors', 'evaders' and/or ‘ex-users’ of formal mental healthcare. These terms express how engagement with services has left activists with a profound sense of grievance. Activists decry the dominance of the biomedical model, invasive managerial systems, and the insensitivity of clinical encounters, many of which involve violence. The lingering affective and phenomenological presence of biomedicine in activists’ lives manifests as a shadow. Whilst activists strive to assert their autonomy and competence and call out epistemic violence and injustice, the biomedical system positions them as incapacitated and vulnerably dependent, in turn discounting their concerns and corroding their sense of independence. This is the context in which activists come together to forge their own modes of healing through worldbuilding. Worldbuilding is the everyday relational and spatial practices and ways of being which are founded on mutual support and indeterminacy. Building healing worlds around these attributes allows activists to enact alternative social and political imaginaries. In the process, activists seek to re-frame their lives and relationships by making spaces to ‘be’ and ‘become’, and to ‘go through madness’ together.

Paper short abstract:

For Juan Marconi, psychiatry's purpose was to become a collectively owned resource. This required a transition from institutions to "community" and from capitalism to a classless society. I will use his work to discuss current notions of participation and community in mental health research

Paper long abstract:

Regardless of the barriers limiting service-user engagement and community involvement in mental health research, the principle of participation has gained broad support. Increasingly, international agencies expect participation from the projects they endorse worldwide.

When the selection of projects depends on their participatory character, a structural need for criteria emerges. To maximise their chances, researchers will adapt their projects to these criteria. Funded projects will share an increasingly standardised and ethnocentric understanding of participation, community and politics in the mental health field.

Can this cycle be challenged? Rather than proposing a superior alternative, this paper examines a contrasting case in the complex and diverse history of participatory mental health research. Juan Marconi's seminal project for a "Cultural Revolution in Mental Health Programmes", developed through the 1960s and 1970s in Chile, is introduced. For him, the idea of "revolution" expressed the dialectical relationship between transitioning from psychiatric institutions and towards "communities" and a transition towards a classless, socialist society. The challenge for psychiatry was to place itself in the hands of the masses, becoming a collectively owned resource.

Although Marconi's utopian version of mental health reform -and the socialist project as a whole- clashed against a dictatorship that lasted 17 years, his ideas demonstrate the multiple configurations, trajectories, and ambitions that participation has mobilised in different eras and geographies. This includes the ambition of articulating our response to mental illness with a broader struggle for a fairer society.

Paper short abstract:

After being mutilated by the State during the yellow vest protests (France), a group of citizens organize to seek truth, justice and recognition of the violence they have suffered. Through their struggle they create bonds and practices of care that repair and make their daily lives habitable again.

Paper long abstract:

At the end of 2018, the augmentation of petrol prises provoked the rise of the yellow vests in France. Through the daily occupation of roundabouts in suburban areas, and weekly protests in the centre of Paris, the movement of the forgotten voiced the unrest of low and middle classes in the country. The movement, labeled as violent by the State and the media, met harsh repression from the police, with a count of 36 protesters mutilated during the manifestations. Those affected, endure till the present day the psychological, physical and social consequences of the wounds inflicted on them. Although the mutilated have access to State health services, they are refused official recognition as victims, situation that is experienced as further physical pain. This paper is based on a year of ethnography amongst the association that musters people in this situation. This has allowed me to observe how lack of recognition enacts an exclusion from the community of the nation for my interlocutors. Also observing how the creation of a network of mutual aid, serves to create the acknowledgement the State is unable to provide. Moreover, my interlocutors voice an understanding of each other's pain and loss, which leads them to feel in their own bodies the hurt of the others. Indeed, the incorporation of the poisonous knowledge (Das,2007) of State violence bolsters care practices between them, allowing the creation of a community that serves as an alternative social project, and that helps heal social wounds present before the mutilations.

Paper short abstract:

This paper draws on case studies focusing on generational and gendered norms and relationships of care in a London Somali community that shaped the consumption of khat - a mild stimulant drug - before it was banned in the UK in 2014. Some relationships can make care transgressive but no less genuine

Paper long abstract:

A common thread running through contemporary studies of care brings into focus action and practice, which is localised and ethical, and often characterised by indeterminacy, fragility, and messiness of everyday life. Yet, as Emily Yates-Doerr (2014) has noted, seeing care as localised might overlook how being careful in one situation can end up being “devastating in another.” Care can sometimes come close, or be perceived as coming close to harm, disregard, and carelessness. It is at this juncture that I situate my analysis of khat consumption and mental health in a London Somali community. This paper draws on case studies focusing on generational and gendered norms and relationships that shaped the consumption of khat - a mild stimulant drug - before it was banned in the UK in 2014. Biographies and motivations of khat consumers and others around them revealed how relationships can make acts and practices of care transgressive but no less genuine. Therefore, the meaning of care can be understood not only in terms of localised practices, concerns and technologies oriented toward caring from the outset, but also as acts that are not easily identifiable as care and come to challenge what is considered as morally justified and dutiful. Perhaps, more than any other forms, the relationships that resort to transgressive acts of care reveal exactly the human vulnerability that is expressed in a dialectic between need and the assurance that we are or will be cared for as well.

Paper short abstract:

The paper explores the creative economic and therapeutic activities of community psychiatric nurses working in conditions of pharmaceutical scarcity in rural southwestern Ghana, by focusing on generally neglected/concealed practices such as informal drug supply and pharmaceutical gifts and debts.

Paper long abstract:

Drawing on ethnographic fieldwork carried out between 2013 and 2022 in Nzemaland (Ghana), this paper proposes a reflection on the ways in which community mental healthcare is performed and reframed by community psychiatric nurses dealing with pharmaceutical scarcity on a daily basis.

Psychopharmaceuticals constitute the main therapeutic solution offered at the district hospital psychiatric unit where I carried out my research. Though in the last few years I could observe considerable improvements in terms of resources as compared to the early days of my fieldwork (i.e. doubling in the number of staff employed at the unit, reduction of drug shortage episodes, higher availability of second generation drugs at more accessible costs), the everyday practice of mental health nurses is still marked by a scarce and ‘erratic’ psychopharmaceutical supply that forces them to invent creative solutions to meet their patients’ needs, but also to continuously face professional and ethical dilemmas.

In dialogue with classic and more recent perspectives in economic anthropology, the paper will focus specifically on the informal economies of mental health care that emerge in the interstices of formal healthcare service provision. By focusing on practices that are often neglected and/or concealed in public health services such as informal drug supply and pharmaceutical gifts and debts, I propose to explore, in their contradictions, the ‘charismatic’ relationships nurses establish with their clients. By doing so I aim to complexify discussions on the ‘commodification’ of health and to interrogate the place of community mental health care in this kind of dynamics.

Paper short abstract:

This paper focuses on the recently institutionalised and relatively underexplored role of peer support workers in NHS community mental health care. Occupying a space of liminality between institution and service users, they creatively carve out spaces to engage in mutual caregiving practices.

Paper long abstract:

Recently institutionalised in NHS community mental health care, the role of peer support worker has subsequently gained traction in the largescale randomised controlled trial of Peer-supported Open Dialogue in the UK. Under this model, peer support workers both contribute to facilitating meetings with service users and their families alongside other clinicians during a crisis, while working more informally with service users on a one-to-one basis. While recruited by the NHS to channel their lived experience of mental illness, service use and recovery with existing service users, peer support workers often find themselves caught between the conflicting demands of service users and the wider institution. Facing inordinate personal and professional barriers in occupying this liminal space, peer support workers creatively carve out spaces at the crevice between institution and community, to engage in mutual caregiving practices.

Drawing on experiences from the author’s dual role as anthropologist and peer support worker in a community mental health team delivering Open Dialogue (an improvised research methodology carrying its own ethical dilemmas), this paper details alternative spaces for mutual caregiving ranging from swinging in the park, to ice skating, to gallery outings, to baking birthday cupcakes. Re-directing anthropological thought on friendship and hospitality toward mental health settings, this paper argues that through resisting the risk-averse institutional culture that posits strangers as a potential source of danger, genuine therapeutic relationships can be formed. Once peer support workers and service users alike share the same moral universe, a step towards recovery and social connectedness is made.

Paper short abstract:

This paper considers outreach workers who “tinker” within programmatic logics that obscure conditions of homelessness and mental illness. We argue that “visibilizing” complexity includes a “political clinical work” that incorporates “irrationality” into interventions, at their creaky interstices.

Paper long abstract:

In the wake of the Covid-19 pandemic in the United States, homelessness, and its conjunction with severe mental illness, has become an increasingly visible social crisis. Yet, public policy interventions into this social crisis often take the form of disciplinary measures, obscuring the matrix of conditions that make homelessness and mental illness entrenched problems in the United States, and under-resourcing programs designed to care for these persons.

This study describes the work of a set of outreach workers addressing homelessness in Los Angeles, considering how frontline practitioners create an ethic of care for homeless and mentally ill individuals sometimes with and at other times “counter” (Davis 2018, Pinto 2019) to the programmatic logics they work within. We consider how these practitioners “tinker” (Mol, Moser, Pols 2010) within the interactional contexts in which they operate, working in ways they perceive as effective and ethical/just/caring. At times, they exhibit a kind of necessary “crankiness” (Slaby, Mühlhoff, Wüschner 2017), positioned at the at the creaky “interstices” (Lovell 2007) of programmatic logics.

We argue that in order to “visibilize” kinds of psychic subjectivity generally “invisibilized” within the American social welfare system, these practitioners practice a kind of “political clinical work” (Giordano 2014), which institutes forms of “irrationality” not specifically sanctioned by programmatic logics. By doing so, practitioners operate in ways at times “commensurable” and other times “incommensurable” (Matza 2018) with American capitalist logics, as they are embedded in the social welfare programs we consider.

Paper short abstract:

This paper uses visual ethnography to imagine end-of-life care among socially abandoned people in a hospice with late-stage HIV/AIDS and co-existing mental illness.

Paper long abstract:

Amidst the global critique of purely pharmaceutical modes of treatment for mental illnesses, there has been increased emphasis on the role of expert clients and lay workers, particularly in resource-limited settings in the form of task-shifting and task-sharing. Further, the ‘treatment gap,’ has been sought to be replaced by the more comprehensive measure ‘Mental Health Care Gap,’ which includes psychosocial and physical health care gap in addition to the existing treatment gap (Pathare et al., 2017). Care, being a highly subjective and dynamic phenomenon, how it is enacted and understood depends as much on the context as on the actors and their local worlds. In this photo-essay, I use visual ethnography to the trace how care is construed among the residents of a hospice for terminally ill people with HIV/AIDS in Gujarat, India¬ – a zone of social abandonment (Biehl 2013, Datta. G 2016). By pairing the photographs with ethnographic vignettes, I show that still photographs, made by ethnographic listening and not doing, could provide insights into community care, that exists as a world simultaneously within and beyond institutionalized palliative and mental health care services. Such visual ethnography I argue, could also be used to imagine and inform care by transforming the gaze of the reader, apart from documenting human suffering.