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- Convenors:
-
Keira Pratt-Boyden
(University of Kent)
Neil Armstrong (Oxford University)
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- Discussant:
-
Liana Chase
(Durham University)
- Format:
- Panel
- Sessions:
- Friday 21 January, -
Time zone: Europe/London
Short Abstract:
Psychiatry is often seen to enforce an epistemic regime on its subjects, yet is subject to various counter strategies which increasingly recognise patient experience as truth. How might ethnographers negotiate multiple competing truths in psychiatric systems whilst retaining hermeneutic integrity?
Long Abstract:
This panel will discuss the methodological, epistemic and ethical challenges encountered when anthropologists seek to generate knowledge in a setting where knowledge is deeply contested. Psychiatry is often seen as the vanguard of neoliberalism, enforcing its episteme on its subjects through labelling, monitoring and responsibilisation. Some service user researchers seek to push back against this, presenting collaboration and coproduction as the solution to hegemonic biopower. Others try to sidestep the system and create service evader communities where their truths can find a home and are not challenged. Psychiatry itself is subject to audit cultures, such that diagnoses are superseded by bureaucratic categories such as 'care clusters,' and 'good health' by Key Performance Indicators.
The panel will consider how ethnographers might negotiate these competing epistemes. Does methodological agnosticism force ethnographers to become the arbiter of truth? How is the distinction between emic and etic, local knowledge and analytic terms, to be maintained? How should ethnographers respond to patient reports of misconduct, malpractice and clinical negligence, or equally of clinicians disclosing professional dilemmas and moral compromises?
Accepted papers:
Session 1 Friday 21 January, 2022, -Paper short abstract:
Can psychiatry democratise knowledge, embrace multiple truths and place non-expert dialogue at the heart of clinical decision-making? A multi-discipline team ethnography of Open Dialogue in the NHS as a complex polyphony of ambition and practice raises methodological and ethical challenges.
Paper long abstract:
As an approach to mental healthcare services that is gaining worldwide interest, Open Dialogue is often presented as a response to the ‘epistemic and hermeneutical injustice’ of which psychiatry stands accused. Open Dialogue aims and claims to demote psychiatry’s expert interpretations and give central place to dialogue among clients, family members and clinicians; to displace the usual diagnosis-treatment nexus into a wider relational field and to reshape professional and patient roles and hierarchies. Its commitment to polyphony implies recognition of different knowledges around mental healthcare. How are such goals realised when Open Dialogue is provided within public healthcare systems constrained, among many things, by the specific demands of clinical governance, patient record systems, performance indicators, graded posts and understaffing? This paper, by an anthropological research team (whose members include clinicians, and individuals with lived experience as service users and carers) draws on on-going ethnographic research with an Open Dialogue (OD) community mental health team in inner London to address varied and sometimes conflicting truths around mental health care. From fieldwork as OD practitioner-ethnographers, the authors describe diverse truth claims that surround things like diagnoses, medication, trauma narratives, the meanings of Open Dialogue itself, and methodological challenges and strategies of knowledge production/writing by an internally diverse team holding the tension between the dialogical refusal to interpret and anthropology as an interpretive discipline.
Paper short abstract:
Writing an anthropology of depression is a task burdened with the methodological and analytical sense of unease. Shall experience of those suffering with depression be treated as the exclusive instance of the truth versus the psychiatric conceptualizations of depression?
Paper long abstract:
Medical anthropologists often look for the truth about a certain condition from within the illness narratives. Much along the phenomenological strand, the category of experience is elevated as directly reflecting that, what is. While attending to experience can reveal important contexts related with the illness, critiques of this approach point e.g. to the analytical risks inherent in the approach like individualization/universalization of the narrating subject. In this paper is to ponder about the methodological challenges that arise in tackling the experiential content of depression - in the search for the truth.
Based on 5 problem-centred interviews with people experiencing depression, I argue that the difficulty in trying to establish what depression is, consists in separating the experience and the cultural idiom of suffering. Perhaps the truth about depression, if there is any, comes neither from the diagnostic manuals nor from the narratives and can only be reconstructed by attending to multiple voices, including alternative psychiatric research on the physiological mechanism of depression. The aim of this paper is thus to shed light on the epistemic unease and serious methodological concerns related with writing anthropology of depression. I claim that critical discourse analysis could be a useful method to tackle the public discourse on depression vis-à-vis the narratives. The analysis contributes to the emerging sociology and anthropology of depression in Poland, however its impact is not limited to the Polish scholarly circles. By advancing the methodological self-awareness, it can provide a possible model for study of depression and other conditions.
Paper short abstract:
The anthropology of mental health is beset by representational problems. Investigations of power inequalities can be undermined by the production of new inequalities and new modes of exclusion. Drawing on ongoing collaborative work, I consider whether and how coproduction might be an answer.
Paper long abstract:
Medical anthropology is seen as having the methodological and theoretical resources to address power inequalities in mental health research. Indeed, ethnographic work can be framed as an intervention, just as biomedical treatments is often framed, but in this case of ethnography, the patient is mental healthcare itself. But ethnographic methods bring with them fresh inequalities and asymmetries and risk introducing a new means by which patient voices are suppressed. Coproduction has recently been seen as a means of correcting these imbalances and decentering the anthropologist as the arbiter of truth. This paper considers these claims in the light of ongoing collaborative ethnographic work. I reflect on the strengths and shortcomings of coproduction and suggest ways that is might become an accepted way of working in the emancipatory project of medical anthropology.
Paper short abstract:
This paper reflects on ethical dilemmas during fieldwork with mental health service survivor/ evader activists. Activists argue that researchers and professionals change and determine their realities. I examine debates of an ontological nature where the production of knowledge is deeply contested.
Paper long abstract:
This paper reflects on ethical dilemmas during fieldwork with mental health service survivor/ evader activists. According to activists, they struggle to be believed, both by mental health professionals and more broadly (including by friends and family). Many report that their beliefs about the world are often pathologized; their experiences denied by health professionals. Some activists try to publish about injustices and iatrogenic harm experienced during mental health treatment, but these are often designated to grey literature. The bias to pathologise the experiences of people with severe and enduring mental health struggles has been described as epistemic and hermeneutic injustice – the key concern being that researchers and professionals change, predict and determine service user’s realities.
This paper examines the ethical dilemmas of doing fieldwork in conditions where the production of knowledge is deeply contested and with people for whom the politics of representation is of critical importance. Debates about the denial of experience are of an ontological nature. I also reflect on the ‘responsibility’ of the ethnographer; can ethnographers respond to patient reports of misconduct, malpractice and clinical negligence further than examining them as ethnographic evidence?