Hearing voices - anthrogogies of politics in psychiatric rehabilitation

Clubbs Coldron, Benjamin (2021) Hearing voices - anthrogogies of politics in psychiatric rehabilitation. PhD thesis, University of Nottingham.

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Abstract

In this thesis I investigate how policies aiming to enhance and increase opportunities for political participation for people with mental disabilities are currently being implemented in residential psychiatric rehabilitation. These practices form part of the implementation of the United Nations Convention of the Rights for Persons with Disabilities (UNCRPD) article 29 – the right to equal opportunities to participate in public and political life.

In answering how Article 29 is substantiated, I deconstruct the micro-social interactions relevant to politicisation in psychiatric treatment and the effect policy implementation has on constituted identities and social roles available to service users and staff. Politicisation refers to the mechanisms by which people become politically aware or engaged to act politically. These mechanisms, in observation, were fundamentally pedagogical. This raises a number of important complexities which inform a theoretical discussion of power, benevolence, indoctrination and empowerment.

The evidence presented in this thesis indicates that ethical and political environments in mental health services, whether imposed by staff or co-produced with service users, determine exclusions and inclusions in political life through processes of social recognition. Particular roles are naturalised in the mental health treatment process. The doctor patient ‘act’ required within institutional settings can often frustrate attempts to expand and enhance opportunities for service users and providers to adopt political identities and be recognised respectively as political citizens.

At one level, this study demonstrates that practices of politicisation face significant challenges when implemented in psychiatric rehabilitation. Many mental institutions did not practically implement any positive support for political inclusion. Even in the three pioneering facilities studied there was low uptake of voting rights by service users who appeared broadly to lack motivation, access to information and resources, and opportunities to engage in political discourse. Staff appeared to accord low priority to political action and expression. They sometimes elevated electoral participation to a characteristic of mentally healthy ways of being and applied didactic pedagogies of citizenship and ethics. Staff and service users alike appeared to be disempowered and disenfranchised by strict adherence to particular rituals, traditions, identities and roles attached to the mental institution.

At a theoretical level I argue ethical worldviews, in the sense of conceptualisations of what the good life is or should be, influence capabilities to exercise political agency and action. Psychiatric services, in their everyday functions, appear to impose ethical worldviews on service users. Pedagogical approaches in supporting political inclusion ranged from didactic banking approaches based on rehabilitative intervention, to co-constructivist and dialogical approaches based on humanistic, person-centred recovery. Political empowerment in the former approach is understood as in the gift of staff and practitioners but in the latter as a process of co-construction.

A Foucauldian theory of power and Butlerian theory of co-constructed identity is applied and adapted to the empirical data in an iterative process to under-stand how policies of political inclusion are implemented. Based on this analysis, as well as engagement with debates in educational philosophy about indoctrination and empowerment in adult education, I conclude that spaces in which law, policy, and institutional ritual are denaturalised facilitates and encourages connectedness, co-production and conflict. Such spaces are in turn productive of political opportunities. Greater opportunities to engage in conflict and cooperation with other citizens, in spaces where the significance of the law and psychiatric epistemology is reduced, appears vital in the case of people being treated in mental rehabilitation to enable staff and service users to play at, and develop, political identities and capabilities.

These findings have radical implications for the mental health law, policy and practice and speak to an inherent contradiction at the heart of the UNCRPD. Participation rights such in the UNCRPD attempt to redistribute power from the top down so that people with disabilities can exercise greater agency. This views power as a resource owned by powerful actors and distributed through law. By using legal mechanisms premised on that very conceptualisation of power, and by addressing states and mental health service providers as the principle actors in stimulating political change, UNCRPD implementation can have the unintended effect of reducing the political agency of people with mental disabilities. By contrast, understanding political inclusion, and by extension mental health care itself, as a process of dialogical education represents a more promising way forward in substantiating participatory rights.

Item Type: Thesis (University of Nottingham only) (PhD)
Supervisors: Bartlett, Peter
van der Eijk, Cees
Kinton, Mat
Keywords: Mental disability, Mental health problems, Mental health, Mental health challenges, Psychiatry, Rehabilitation, Political rights, Right to Vote, UNCRPD, Article 29, Participation, Political inclusion, Political education, Citizenship, Public life
Subjects: K Law > K Law (General)
Faculties/Schools: UK Campuses > Faculty of Social Sciences, Law and Education > School of Law
Related URLs:
URLURL Type
https://onlinelibrary.wiley.com/doi/full/10.1111/jpm.12678UNSPECIFIED
Item ID: 64601
Depositing User: Clubbs Coldron, Benjamin
Date Deposited: 05 May 2021 08:41
Last Modified: 05 May 2021 08:45
URI: http://eprints.nottingham.ac.uk/id/eprint/64601

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