Not being mentally ill

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Not being mentally illNick CrossleyPublished online: 19 Oct 2010.

To cite this article: Nick Crossley (2004) Not being mentally ill, Anthropology & Medicine, 11:2,161-180, DOI: 10.1080/13648470410001678668

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Nick Crossley*

NOT BEING MENTALLY ILL

Social movements, system survivors and the

oppositional habitus

Much of the social scientific work on psychiatry and mental health, from a variety ofcompeting perspectives, has focused upon power and the social construction of ‘mentalillness’. Very little attention has been paid to resistance or to the various ways in which‘patients’ or ‘survivors’ (as some now prefer to refer to themselves) have sought to sociallydeconstruct ‘mental illness’. This paper seeks to redress that balance by way of a detailedexamination of some of the key practices of resistance which have developed within thecontext of the UK mental health survivors movement. Using key concepts from Bourdieu’stheory of practice, it examines the challenge which survivors have mounted to the symbolicpower of psychiatry, and the resistance habitus which their opposition has given rise to.

Fourteen years ago I was diagnosed as schizophrenic; five years ago that waschanged to chronic schizophrenic; three years ago I gave that up and went backto being Ron Coleman.

(Coleman 1996, p. 11)

A great deal of work from many competing perspectives within the social scienceshas been devoted to analysing, tacitly or explicitly, the ‘power of psychiatry’. Thistheme has generated work from Marxists, feminists, Foucauldians and interactionists,to name only the most obvious examples. However, much less work has beendevoted to the analysis of resistance to ‘psychiatric power’. Resistance is oftenacknowledged but much less often studied, either in its individual or collective forms(on this distinction see Crossley 2002c). In this paper I offer an analysis of thecollective resistance to psychiatry mounted by the UK mental health survivormovement.

The data on which the paper is based are derived from open ended interviewswith 31 key players from the main ‘social movement organizations’ (SMOs hereafter)in the survivor movement, and a large archive of written and printed materialsproduced by these SMOs, which was compiled over the two-year period that the

*Correspondence to: Nick Crossley, Department of Sociology, University of Manchester,Oxford Road, Manchester, UK. E-mail: [email protected]

Anthropology & Medicine Vol. 11, No. 2 August 2004, pp. 161–180ISSN 1364-8470 print/ISSN 1469-2910 online 2004 Taylor & Francis Ltdhttp://www.tandf.co.uk/journals DOI: 10.1080/13648470410001678668

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1 6 2 A N T H R O P O L O G Y & M E D I C I N E

interviews were conducted. In previous papers I have used this data to map out thecomplex history of the movement and its relationship to wider currents of critique(Crossley 1998a,b, 1999a,b, 2002b,c). This paper will briefly recap some of thathistory. My central concern, however, is to examine practices of resistance; that is,the ways in which survivor groups have set about challenging the power ofpsychiatry; ways which, the archive suggests, have sedimented within the survivoractivist community, in the form of a resistance or oppositional habitus. Morespecifically, I focus upon those practices and habits of resistance which attackpsychiatric power at the point at which it impinges directly upon the subjective livesof those on the receiving end of it. This latter point requires brief elucidation.

Though ‘the mental health system’ comprises a vast material and technologicalinfrastructure, and though it embodies some of the most explicitly coercive practicesobservable in democratic societies (e.g. compulsory detention without trial andcompulsory treatment with mind altering drugs and ECT), much of the power ofpsychiatry is a symbolic power of definition and judgement, and its violence is thesymbolic violence of stigmatization and disqualification. These powers and processesare not strictly extrinsic to the agent subject to them. Mental distress is pre-definedin western culture by the discourses of psychiatry, whose reach has extended beyondthe realms of a professional clique into the domain of everyday discourse. Psychiatricschemas and practices enjoy a widely taken-for-granted status. As such they shape theperceptions/conceptions of the lay public, some of whom will experience psycholog-ical difficulties first hand, in relation to either self or significant others, and may thuscategorize self and other from the psychiatric point of view. Furthermore, thepractices of psychiatry and their symbolic power presuppose the taken-for-granted-ness of these schemas, with the legitimacy, compliance and complicity this affords.Psychiatric power derives, in large part, from the fact that psychiatric practices andschemas are recognized as (legitimately) powerful, and this recognition is equally theprecondition of the effective production and reproduction of those practices.

These practices and schemas, both lay and professional, do not merely diagnoseand treat the experiences and behaviours constitutive of ‘mental illness’. By engagingwith those experiences and behaviours (whether symbolically, behaviourally, pharma-cologically or surgically) they contribute to the shaping of both those experiences/be-haviours and the dispositions which underlie them.1 ‘Being mentally ill’, from thispoint of view, whatever organic and psychological states it may also entail, is botha social position and a socially shaped disposition or habitus. It entails the incorpora-tion of a social identity and a process of secondary socialization. Furthermore, it isa position/disposition which often leads to long-term social estrangement anddisadvantage; that is, symbolic violence. What I am concerned with in this paper are(some of) the ways and means that the survivor movement has devised for resistingthis power, resisting psychiatry by resisting ‘being mentally ill’ in this social sense.I am concerned with the strategies they have devised for ‘not being mentally ill’.2

Theoretically the paper is framed in terms of Bourdieu’s (1992b) theory ofpractice. This theory has been selected, in part, on the basis of its value as aframework for analysing social movements in general (Crossley 2002a–c, 2003) andmental health movements in particular (Crossley 1998a,b, 1999a,b, 2002b,c), butalso because it incorporates most of what is useful in the aforementioned perspectiveson power (interactionism, Marxism, etc.), whilst avoiding the problems that are

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N O T B E I N G M E N T A L L Y I L L 1 6 3

particular to each of them, respectively. Bourdieu’s conceptual toolbox and particu-larly his concepts of habitus and symbolic power, for example, are able to sensitizeus to the ways in which behaviour and experience are moulded in relationships ofpower, much as the work of the interactionists does, without attracting theproblematic connotations that attach to their concepts of ‘role’, ‘script’ and‘labelling’. Furthermore, Bourdieu’s framework, whilst sensitive to the social micro-cosm, also transcends that level, allowing us to focus upon the ‘bigger picture’ of themental health field at a national and even international level, in a way which is nottrue of the interactionists (Scull 1984). On the other hand, the advantages ofBourdieu’s framework relative to more macrocosmic approaches, such as the Marxistand Foucauldian approaches, are, first, that it is not restricted to this level either andcan focus in upon the microcosmic issues raised by the interactionists and, second,that Bourdieu’s concept of ‘field’ captures more precisely the dynamic, conflictual,pluralized and fluid nature of the world of mental health, past and present, than thosefavoured by Marxists and Foucauldians, respectively, i.e. ‘system’, ‘institution’,‘apparatus’ (dispositif), ‘technology’. The mental health world has never enjoyed thesettled and homogenous structure suggested by these latter concepts. It has alwaysmanifested the dynamism and plurality suggested by ‘field’ and still does.

This argument admittedly overlooks the considerable contribution of feministscholarship in this area (Busfield 1996; Russell 1995; Showalter 1987), and indeedmuch work done on race and power in psychiatry (Fernando 1991; Littlewood &Lipsedge 1989). I concede that the value of Bourdieu’s work in relationship to theexploration of questions of gender and race remains an open question. However, asthis paper does not deal directly with questions of race or gender I leave that as anopen question to be addressed at a later date.

From a Bourdieusian perspective the mental health system can be conceived ofas a ‘field’ in which competing agents have sought to establish a monopoly ofexpertise, authority and rights of treatment (Porter 1987; Scull 1993). In its earlystages of development this was a struggle between medical, legal and religiousgroupings (Porter 1987; Scull 1993). Moreover, it entailed a struggle between thesevarious groupings and a wider public who needed persuading of the value of theirinterventions. By the end of the nineteenth century, however, the medical professionhad won the aforementioned struggle for monopoly and succeeded in securinghegemony for its practices and schemas of classification (Porter 1987; Scull 1993).That madness is ‘obviously’ an illness, which requires the intervention of trainedmedics, had become a largely unquestioned assumption (‘doxa’). The recognition andcooperation of both the public and parliament, which the symbolic power ofpsychiatry presupposes for its effective operation, was attained. Psychiatry became ataken-for-granted feature of life which could rely upon the habitual complicity ofmost social agents for its effective operation. Not that conflict within the fieldsubsided. No sooner had medicine achieved hegemony within the field when otherpsy-disciplines began to stake their own claim to rightful participation. The challengeof these psy-professions, as Sampson (1995) had argued, effectively fractured thedominance of the medical profession. However, these later struggles, which continuetoday, were largely struggles within an already established field, struggles whichpresuppose belief in the psychiatric ‘game’; that is, the psychiatric illusio,3 and itsdoxic foundations.

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What we find in the survivor movement, by contrast, is a challenge to this doxaand illusio. Before we consider how this challenge has been mounted, however, itwould be useful to consider its own historical trajectory, in the form of the Britishsurvivor movement.

The British survivor movement: a brief outline

It is possible to identify acts of resistance and even resistance groups amongst thosedeemed insane for as far back into the historical record as one chooses to go(Crossley 1999a; Porter 1987). Wherever individuals are deemed insane, grouped assuch and differentially treated, the potential for resistance exists and the actuality canbe identified if one searches hard enough for it. Notwithstanding this, however, suchinstances of ‘sporadic resistance’ do not amount to social movement formation oractivism. To refer to a social movement we must be able to identify a relativelydurable network of agents and groups with mechanisms of communication andreproduction which sustain and transmit a culture of resistance. By this definition wecan date the mental health survivors movement, in Britain, to 1973, with theformation of the Mental Patients Union (MPU) (Crossley 1999a) – though this groupwere slightly predated by the formation of the Scottish Union of Mental Patients(SUMP)4 in 1971.

Formed around the Paddington Day Hospital in London, the MPU quickly grewin size, developing branches around the country. A national and self-perpetuatingnetwork was formed which could recruit psychiatric patients at the local level,linking them with other individuals and groups around the country and socializingthem into a radical resistance culture. An oppositional habitus, which we will discussbelow, was generated and disseminated in pockets of the (national) patient popu-lation. Furthermore, the MPU gave rise to a number of important spin-off organiza-tions who introduced diversity and further structure to the movement. The mostnotable of these spin-off groups was COPE (Community Organization for PsychiatricEmergencies), who subsequently reversed their acronym to become EPOC, beforechanging again to PROMPT (Protection for the Right of Mental Patients in Therapy)and then to the Campaign Against Psychiatric Oppression (CAPO). CAPO were ahighly visible group within early mental health politics whose efforts achieved a greatdeal of publicity for the movement as a whole.

A great variety of themes and activities were developed at this early stage of themovement. COPE and certain local MPU’s aimed to provide places of safety forindividuals in crisis (‘crash houses’), for example, and they published newsletters andmagazines. Other groups, particularly those based in hospitals, formed patients’councils with the intention of lobbying for change at the institutional or ward level.Campaigning was common across the network as a whole, however, and a numberof manifestos and lists of demands were drawn up, covering a wide range of issuesfrom the banning of ECT and the introduction of patients rights to choice andinformation, to the abolition of psychiatry itself.

These developments constituted a ‘revolt from below’ in psychiatry. They wereslightly preceded by a ‘revolt from above’, however, in the form of the anti-psy-chiatry movement; a movement involving psychiatrists and mental health

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practitioners themselves. The first wave of this movement, at least in Britain, can betraced to the network which formed around Ronald Laing and David Cooper in themid 1960s (Crossley 1998a). A second wave was beginning to take shape in the early1980s, however, and this wave became bound up with the survivor movement,contributing significantly to its history. A group of academics and mental healthpractitioners, some with direct links to Laing and Cooper, became involved in theEuropean Network for Alternatives to Psychiatry (ENAP), a network formed andinformed, in large part, by the ideas and activities of the emerging democraticpsychiatry movement (Psichiatria Democratica) in northern Italy. Out of this networka British group, the British Network for Alternatives to Psychiatry (BNAP), wasformed, and this network attracted interest from both ‘patients’ and professionals.

The activities of BNAP, in the early 1980s, revitalized a flagging survivormovement. They were also central in recruiting and ‘training up’ many of the figureswho would be central to the movement in the late eighties. The network becamedivided by conflict over mental health status, however, with some patients pushingfor a more separatist approach. The outcome of this was the ending of BNAP and theformation in 1986, following an important MIND conference (see below), ofSurvivors Speak Out (SSO) – an SMO which, paradoxically, also involved both usersand professionals. As their name suggests, this group was centrally concerned thatindividuals with a mental health label have a right to make choices and decisions forthemselves, a right to have their voices heard.

SSO, which was one of the key SMOs within the movement throughout the late1980s and much of the 1990s, folded in 1999. However, ex-members went on toform both Reclaim Bedlam and Mad Pride. Furthermore, a range of similarlydisposed groups had emerged by this time, most notably the United KingdomAdvocacy Network (UKAN), an umbrella organization which embraced and fostereda wide variety of groups. UKAN’s annual report for 1997/1998 listed 246 affiliatedgroups, many of whom were local support groups, some of whom were nationalcampaign groups, such as the anti-ECT networks SHOCK and ECT-Anonymous, andall of whom were committed to advancing ‘advocacy’ (see below) for survivors.

Running parallel to this history is that of the MIND organization. Formed in 1946from a fusion of three ‘mental hygiene’ charities, as the National Association forMental Health (Crossley 1998b), this organization played a largely conservative rolein relation to mental health services during the 1950s and 1960s. By the early 1970s,however, for a variety of reasons, it had adopted a civil rights agenda and becomevery active campaigning for patients rights. In the 1980s its trajectory began toconverge with that of the user movement, leading to a variety of exchanges of bothinfluence and resources, in both directions. On the one hand, for example, MIND(as the group became known, for campaign purposes, in the early 1970s) increasinglyadopted aspects of the user agenda, leading in 1989 to the formation of its ownsurvivor wing, MINDLINK. Secondly, it constituted a source of essential resourcesfor more radical SMOs, e.g. social networks, premises, publishing technologies andoutlets. Moreover, a number of more specific networks came out of the MINDstable, including the Hearing Voices Network and the Schizophrenia Media Agency(discussed below). Thirdly, because MIND was well established, respectable andfriendly, it served as an effective recruitment filter, pulling many future activists intothe field of mental health politics at a point when they were both innocent and shy

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of this field. Finally, MIND was important because, lacking the radicalism that somesurvivors call for, and being too paternalistic for the likes of some, it has served asan important sparring partner, affording user groups a target to organize around. Inthis vain we should mention also those organizations, such as SANE (Schizophrenia– A National Emergency) and the National Schizophrenia Fellowship (NSF), whohave argued both against the survivor perspective and against ‘liberalism’ in psy-chiatry more generally. These organizations have attracted considerable criticism andreaction from both user groups and MIND and, in doing so, have played a verycentral role in the shaping of the survivor movement. The provocation of these‘enemies’ has been an important stimulant for the energy, direction and innovationof the user movement.

It will be obvious, I hope, that the survivor movement is, or at least belongs to,its own dynamic ‘field of contention’, akin to the mental health field from which itemerges. Multiple groups and interests align, compete and conflict within this field,generating a complex social world of mental health politics. In what follows I wantto begin to consider some of the innovations and projects that have emerged out ofthe generative dynamic of this field and the effective resistance it has mounted toconventional psychiatry. There is clearly much that could be said about traditionalcampaigning activities, such as marches and petitions. However, my focus here, asnoted above, will be upon the various strategies mental health survivors have soughtfor ‘not being mentally ill’.

Symbolic power and diagnosis

The power of psychiatry is, amongst other things, a symbolic power to define, name,categorize and diagnose; to locate particular types of mental distress and deviancewithin a medical model of illness and to ensure, on this basis, that individuals fallingwithin these categories are treated ‘appropriately’. This is a power which dependsultimately upon ‘belief’. Psychiatrists must believe in their own methods, so too mustthe governments who grant them coercive powers to implement their decisions, andso too must the public who, in many cases, willingly and voluntarily submit selfand/or significant others to psychiatric and other medical regimes. This belief is notnecessarily explicit. It is not a matter of conscious opinion. It is assumed or doxic,as much embodied and embedded in the ways in which people act, their deferenceto the doctor, for example, as what they explicitly think about and reflect upondiscursively.

Many survivor activists report some initial acceptance of this medical model.They and/or their families had believed they were ill. They had visited a doctor.However, from its very inception the survivor movement has sought to challengeboth this symbolic power and the taken-for-granted acceptance of and belief in ‘themedical model’ that underwrites it. Through books and a variety of magazines thathave emerged in the course of the history of the movement, they have constructeda public sphere, wherein they have critically dissected psychiatric practice. They havechallenged psychiatric classifications and both identified and contested what they taketo be the role and power of psychiatry as an institution of social control.

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In the early days of the movement this challenge was often bolstered by recourseto alternative forms of symbolic power from outside of the movement. For example,activists drew upon the critiques of anti-psychiatrists, such as Laing and Szasz, whoseauthority as critics of psychiatry was largely dependent upon their psychiatriccredentials. Laing’s critique of psychiatry had added cultural/symbolic capital becausehe was a psychiatrist and ‘knew what he was talking about’. Similarly, they drewupon the work of sociologists (e.g. Goffman and Scheff) and philosophers (e.g. Marxand Foucault), whose critiques of society were consecrated and authorized byeducational institutions in that same society. Over time, however, partly as aconsequence of the growth of the movement, partly as a consequence of theintroduction of ‘consumer power’ in health services, the user voice has acquired adegree of symbolic power of its own. Survivors have been able to convert theirexperiences of mental distress and (mis)treatment into a form of cultural andsymbolic capital. The disvalued status of the patient is reversed within the movementcontext. Therein it constitutes authority to speak and vouches for authenticity. Theexperience of both distress and treatment, stigmatized elsewhere, has becomerecognized as a valuable, perhaps superior knowledge base. Survivors have laid aclaim, recognized at least within the movement itself, to know ‘madness’ and its‘treatment’ with authority, on the basis that they have been there and have survivedit. And at least some degree of recognition has been achieved beyond the movementcontext, in the wider mental health field. I return to this new found authority in thefinal section of the paper. Suffice it to say for now that it is recognized as a mixedblessing within the movement, not least because it can lead to an incorporation ofthe movement field within the broader mental health field and can lead to more vocalactivists being lured away from activism and towards a more conservative positionwithin that wider field.

The critiques levelled by the movement are important as moments in an ongoingcontestation of the claims of psychiatrists, within the alternative public sphereconstituted by the survivor movement, but they are equally important in the respectthat they have given birth, by virtue of their repetition and dissemination, to moredurable schemas and tools which allow survivors to deconstruct their own experi-ences, both of mental distress and psychiatry. They have generated a radical oroppositional habitus; a socially distributed and disseminated disposition to interpretone’s experiences differently, to challenge and to refuse to play the role required bypsychiatry; a disposition, as survivors see it, to think and see through the discourseof psychiatry and the medical model.

In part the schemas comprising this resistance habitus are deconstructive. Theyinclude rhetorical set-pieces, repeated in slightly different forms by different authorsthroughout the survivor literature, which reframe allegedly ‘insane’ experiences insuch a way as to reveal their sanity, for example:

I have been told again and again that I have a serious problem that needs to beeliminated with expert help. But now, I’m starting to think that my moodswingsare not an illness, but a strange and inexplicable minority experience that hasbeen captured, impounded and colonised by the psychocractic regulation ofreality. Like colonised indigenous people, I have been denied what is truly mine.The psychocrats with their right knowledge and their power have alienated mefrom my mood experience …

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How different my moodswings would have been if they were judged to be atalent rather than an illness. Or if 99% of the population had extrememoodswings instead of the 1% that do now? Society would be organised aroundthis vast ‘normal’ labile majority.

(O’Hagan 1993, pp. 18–19)

The quotation above, by leading survivor writer Mary O’Hagan, is but oneillustration of this. O’Hagan explicitly acknowledges that her deconstruction of‘normality’, which she now understands as a value judgement extrapolated from theexperience of the majority and reinforced by the authority of psychiatry, derives froma similar argument she found in the literature of the disability movement. And herappropriation of this deconstructive rhetoric has led to further appropriations onbehalf of her own readers. Reader activists learn from each other how, rhetorically,to unpick the claims of psychiatry, and they pass those skills on. Furthermore, shetrades upon notions of labelling and scapegoating which are repeated throughout thehistory of the movement and which have acquired a doxic character for manyactivists.

In addition to these deconstructive habits, however, the radical habitus of thesurvivor activist involves a variety of new and more positive schemas for makingsense of the experience of mental distress and its treatment. The survivor movementhas created alternative typifications and schemas of classification to those used inpsychiatry, which reflect a different and preferred manner of conceiving of it. Theterm ‘survivor’, and the related term ‘user’ (i.e. of psychiatric services), are the mostobvious examples.

The emergence of these alternative schemas was not immediate. One of the mostnotable features of the early SMOs in the movement, for example, is that, despitetheir questioning of the terms ‘mental patient’, ‘mental illness’, etc., they posited noalternative and continued to use those labels themselves. The names of two of theearliest groups, The Mental Patients Union (MPU) and Protection for the Rights ofMental Patients in Therapy (PROMPT), give a good indication of this. It was onlylater, in the mid 1980s, that collective dissatisfaction with the language of psychiatrycrystallized to the point of generating the impetus to cease using these terms:

… some of us who were in COPE and MPU got together in PROMPT, whichstands for the Promotion of the Rights of Mental Patients in Therapy. Thatcontinued until April ‘85 when it was decided we no longer wished to have thewords ‘patients’ and ‘treatment’ in the title. At my suggestion we decided tochange it to The Campaign Against Psychiatric Oppression (CAPO).

(Irwin in Van de Graaf et al. 1989, p. 4)

The alternative terms ‘user’ and ‘survivor’ also emerged at this time, as is illustratedin the name of Survivors Speak Out (SSO), who formed in 1986. The alternativeterm is used, according to an early SSO flyer, in an effort to transform both theconnotation and the denotation associated with the language of psychiatry:

The term survivor was chosen to portray a positive image of people in distressand people whose experience differs from, or who dissent from, society’s norms.

(SSO flyer 1996)

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From my interviews with key players involved in the formation of this group Ilearned that the naming of the group took up the best part of a weekend conferenceand that the term ‘survivor’ was by no means uncontested. And of course it isstill problematic in the eyes of some. Nevertheless, through repeated shared useand the wide dissemination facilitated by the aforementioned alternative media ofthe movement, it has achieved a habitual and taken-for-granted status. Where theterm ‘survivor’ was never used in the literature of the MPU and PROMPT,it is commonplace in the contemporary survivor literature (Crossley & Crossley2001).

It is not individual terms which make a difference, of course. A word can onlyfunction positively within the context of language games and shared forms of life,instituted by the movement, which allow it to do so. And different language gamesare invested with differing degrees of power (Bourdieu 1992a). Psychiatrists do notgenerally refer to ‘patients’ as ‘survivors’, whatever survivors may elect to callthemselves. Nevertheless, within its movement context the term ‘survivor’ functionsto create a very different image of the mentally distressed individual. In directcontrast to the passivity, weakness and dependence which ‘patient’ connotes,‘survivor’ connotes a sense of activity, independence, strength and courage. More-over, the term both breaks the direct link to illness, challenging psychiatriccategorization, and allows for the diverse range of adverse situations that ‘survivors’have survived. They are, as much of their literature indicates, survivors of ECT, ofmedication, of abuse at the hands of professionals, and of ‘society’s’ rejection andstigmatization of them. The negativity of these various experiences, ironically,contributes to the positivity of the identity because ‘survivors’ survived them ratherthan being victims of them.

We should note the significance of ‘advocacy’ at this point. The power of thepsychiatrists discourse relative to that of the survivor rests, to some degree, upon thefact that the psychiatrist’s discourse is sanctioned by the institution of psychiatry, theeducational system and the state. Many SMOs in the survivor movement haveeffectively sought to counter this, and bolster the power of their own discourses, byway of advocacy; that is, by way of an attempt to institute officially recognizedmechanisms which establish the right and practical possibility for survivors to have asay with regard to their treatment. Survivors Speak Out, for example, attempted,with varying degrees of success in different locations, to introduce a ‘crisis card’scheme. Participants in the scheme carried a card stipulating in advance how theywould like to be treated in the event that they enter a phase of mental disturbanceand are unable to articulate their needs clearly. They might, for example, indicate thename of a friend who they would like contacted and who could visit and representthem in consultations or tribunals. Or they might stipulate that they do not wish tohave certain treatments, on the basis of the adverse side effects of these treatments.Insofar as advocacy is accepted as a principal, and this is clearly very variable andnowhere advanced to a considerable extent, the symbolic power balance is slightlyaltered in favour of the survivor.

The oppositional habitus of the user movement also involves a range of further‘typifications’ (Schutz 1967), which function to redefine the experience of thesurvivor (Crossley & Crossley 2001). Many survivors make reference to the ‘system’

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or ‘mental health system’ in their discourses, for example, and in doing so bothposition themselves politically in relation to psychiatry and step outside of theparticularity of their own experience (e.g. of specific doctors and hospitals)to address the problems they have personally experienced at a more abstractand general level. The typification ‘system’ lifts the discourse from the levelof individual complaint to that of collective criticism and, by way of its negativeconnotation, contributes to a definition of the psychiatric situation as one ofpolitical conflict. Furthermore, there is evidence, as in other movements, of thereappropriation of more extreme forms of denigrated typification. Just asblack movements have reappropriated the term ‘nigger’ and lesbian movementsthe term ‘dyke’, so too mental health activists often make reference, in theirliterature, to ‘loonies’, ‘bins’ (and ‘loony bins’), ‘madness’ and ‘nutters’, as well as‘shrink’ and ‘quack’. The currently quite central Mad Pride group are one veryobvious example of this. As their name suggests, they seek to reclaim and revalue‘madness’.

These linguistic subversions might be taken as indications of the power of‘performativity’, a power described by Judith Butler (1990) and used by herin her critique of Bourdieu’s theory of symbolic power (Butler 1997). It is importantto bear in mind here, however, that these acts of renaming derive whateverpower they have from the broader movement context from which they emergeand the wider context of that movement. Had an isolated individual electedto call his or herself ‘mad’, independently of the context of a movement of othersdisposed to hear that claim as a subversion, it would not have worked. Indeed, eventhe rhetorical efficacy and symbolic power of the collective claim to ‘mad pride’would be greatly reduced in the absence of claims to ‘gay pride’, ‘queer nation’ and‘nigger power’. These claims cummulatively serve to legitimate the reappropriationof terms of abuse qua strategy. Furthermore, the efficacy of these subversivestrategies is very much dependent upon their recognition by mental health profes-sionals who, should they fail to read them as legitimate strategies of subversion, havethe institutional sanction to ignore them and/or read them as indications ofpsychopathology. As I have argued elsewhere, some early criticisms of psychiatry, bypatients, were read precisely as indications of a tendency to exaggerate andmisunderstand, rooted in mental illness (Crossley & Crossley 2001). The politicalefficacy of the survivor voice is proportionate to the symbolic capital of the survivorgroup. This is undoubtedly why ‘non-survivors’ played such a central role in the earlydays of the movement, when survivors had very little symbolic capital of their own,and it explains why, as I noted earlier, the early survivor movement tended to drawupon the prestigious voice of anti-psychiatrists, sociologists and philosophers in theircritiques.

These linguistic developments are significant because they indicate acollective redefining of the situation of the mentally distressed individual. Symbolicpower depends, for its effectiveness, upon certain situational definitions beingtacitly and habitually accepted and re-definition is therefore a central aspect ofresistance to it. It is not just the language of madness that has been reconfigured,however. In some cases, most notably the work of the Hearing Voices Network,the experience of madness itself has been addressed. This point must be brieflyunpacked.

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N O T B E I N G M E N T A L L Y I L L 1 71

Reshaping the voice-hearing habitus

The classical psychiatric response to auditory hallucination is to both search forbiological factors which are believed to be its cause and to seek to developinterventions (mainly chemical and psycho-surgical) which either dampen or elimin-ate ‘voices’. The ‘patient’ is discouraged from attending to their voices and expectedto ignore them if at all possible. The Hearing Voices Network (HVN) advocate adifferent approach. They were born, in part, out of the accidental discovery, byDutch psychiatrist Marius Romme, that many more people in the community ‘hearvoices’ than are ever troubled by the experience or come to the attention ofpsychiatrists. A sizeable number of individuals who hear voices live normal lives andhave never seen a psychiatrist. They deem their voices unproblematic and sometimeseven helpful. The implication that HVN activists have drawn from this is that ‘theproblem’ of auditory hallucination is not the fact of hearing voices but rather the wayin which individuals respond to that experience. If they interpret and respond to itnegatively or cannot cope with it then it is a negative experience but some people,seemingly without tuition, arrive either at ways of coping with the experiencethemselves or at more positive experiences of it. Furthermore, HVN activists haveargued that many other ‘symptoms’ experienced by those voice-hearers who havebeen labelled ‘mentally ill’ may be a result of their reaction to the voices, rather thanindependent problems. Hearing voices can make people feel paranoid, anxious andout of control. It can depress or confuse them and interrupt their sleep patterns.

Consequently, HVN encourage individuals to explore their voices and to workout ways of accepting and living with those voices (Romme 1996; Romme & Escher1993). Numerous pamphlets and even a workbook have been produced within themovement to aid this process (Coleman & Smith 1997). There is a strong emphasiswithin the movement, however, upon self-help and user organization. Individuals areencouraged to take control of their own voices, to ‘own them’ and to make senseof them in their own way. They are encouraged to devise coping strategies whichmay be borrowed from others but which represent a combination best suited to theparticular individual in question.

Those individuals that I spoke to, who belonged to this movement, testified toits effectiveness. Some noted a decline of voice-hearing, others simply that thedistress caused by the voices decreased. What is perhaps more significant for thepurposes of this paper, however, is the manner in which HVN effectively ‘decon-struct’ the experience of voice-hearing, practically, and strive to reshape it. In afashion not dissimilar to feminist consciousness raising they reflexively unpick thesedimented layer of perceptual, affective, cognitive and behavioural habits whichconstitute voice-hearing as a distressing experience. They seek to encourage newways of responding to the experience which constitute it either as more manageableor as more positive; ways which, when habituated, allow the individual to live withtheir voices.

I have argued elsewhere that Bourdieu’s concept of the habitus needs to bedeepened to allow for those instances where individuals seek, reflectively, to altersome aspect of it (Crossley 2001a,b, 2003). Such instances may be rare but they areimportant. This, I suggest, is one such instance. The practices of the HVN, at leastin those instances where they are successful, reshape the voice-hearers habitus.

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The significance of this is not restricted to the domain of health and psychology.As non-medicalized, non-pharmacological, self-help practices, the activities of HVNpose an important challenge to the authority of psychiatry and the economic interestsof the pharmacological industry. They overturn the psychiatric advice for patients toignore their voices insisting instead that the survivor become master over andauthority upon their voices, often without the intervention of psychiatrists at all. Thisresonates with a wider ethos of self-help within the movement, which encouragessurvivors to work together, helping each other and, if possible, thereby keeping eachother out of the reaches of unwanted psychiatric interventions. Furthermore, HVNseek to neutralize the fear that attaches to voice-hearing, thereby effectively under-mining a key affective support of psychiatric power. We ‘need’ psychiatry to theextent that we fear and disvalue ‘voices’, deferring to and delegating psychiatry todeal with them. If the fear subsides and there is a re-evaluation of voices then theneed for psychiatry reduces.

HVN don’t only work with and for voice-hearers, however. They work withfamilies, carers and professionals. Again, at this level, the work that they do functionsto challenge the process whereby voice-hearers become ‘mental patients’, unpickinghabits, assumptions and rules of thumb, in an effort to replace them with a morepositive form of practice. One example of the type of work which they do at thislevel involves role play. Non-voice-hearers are divided into groups of three or four,two of whom are required to have an ordinary mundane conversation whilst theremaining individuals stand to the side or back of one of the interlocuters,commenting in the manner of ‘schizophrenic voices’: e.g. ‘she’s lying, she hates you,she thinks you …’ The point of the exercise is to familiarize people who don’t hearvoices with the experience, allowing them to see how confused and anxious theybecome, how many ‘secondary symptoms’ they develop, when hearing voices. Thisallows ‘others’ to get closer to understanding the experience of the voice-hearer andthus, it is hoped, to be able to respond more appropriately to it. It is not simply thehabitus of the voice-hearer which shapes their negative experience of voice-hearing,it is argued, but equally the habitus of those around them and that habitus too mustbe changed. Indeed, the reactions of others are particularly important because, qua‘normal’, they are invested with far greater symbolic power.

We can unpack this point into two elements. In the first instance, processes ofself-change, that is, of transforming the habitus, cannot be solo efforts. Our habitusis a social product on a number of levels but not least because it is formed in contextsof social interaction which call for particular ways of acting, reinforce them and, assuch, constitute a considerable obstacle to change. Without the cooperation of othersand the consequent reconfiguration of contexts of action, intentional transformationsof the habitus are difficult. Therefore others must be persuaded to partake in theproject of change. Secondly, one of the key injuries which both psychiatry and widersociety might be said to inflict upon survivors is the symbolic violence of dis-qualification and stigmatization. The survivor is refused access to relations of mutualrecognition and mutual understanding. The assumptions which, according to Schutz(1967), ordinarily structure social relationships and interaction, assumptions ofsameness and reciprocity, are suspended in the case of the survivor, with theconsequences that they are estranged from the intersubjective fabric of the socialworld. Communication is not suspended in these circumstances, however. Rather,

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what is communicated is the refusal to communicate and the negative valuation, thenon-recognition which goes with it; a non-recognition which survivors may in varyingdegrees internalize and apply to their selves. They internalize the negative judgementswhich loved ones and authority figures make and communicate (either directly orindirectly). What the work of the HVN strives to achieve, in effect, is a bridging ofexperience between the survivor and her others which will facilitate the growth ofmutual understanding and, with that, perhaps recognition also. By subjecting carersto simulated versions of the experiences of users, putting the carer in the shoes ofthose they care for, they aim to expand the (habitual) perceptual and empathichorizons of the carer, such that a more intersubjective form of relationship can bebuilt. And the consequence of this is to help users to overcome one of the mostdamaging effects of the symbolic violence to which they are subject; namely, theirown negative self-perceptions.

However, this ‘struggle for recognition’, a struggle against symbolic violence,cannot be limited to the domain of carers. It also entails a struggle in the media field,which aims to engage the wider public. And it entails developments withinmovement networks themselves. In what follows I will attempt to elucidate theseaspects of struggle further.

Habitus, change and movement networks

Movement networks and groups have been a crucial context of interaction whereinsurvivors have been able to effect a transformation of their habitus. At one levelnetworks inspire, providing alternative role models, for example:

There are lots of users, people like […] and people in Survivors [Speak Out] thathave been around for years doing campaigning work. It makes you think it’smore worthwhile to be like them than to be sat in a day centre drinking tea andsmoking and doing not much.

(Interview 2)

More particularly, however, the collective pressure of the group, manifest in thepatterns of interaction it entails, puts pressure upon the agent to effect and sustainchange, at the same time reinforcing and recognizing that change. The groupconstitutes, collectively, a perspective which the agent internalizes, lending that agentboth a new vision of their self and a feeling of collective membership and strengthor esprit de corps (Blumer 1969). The process of consciousness raising is one formalway in which this is achieved. Informal processes are as important, however. Manyof my interviewees spoke of the dramatic effect which their first contact with a grouphad upon them, for example:

I do remember the group though. I do remember […] saying to me ‘Do you hearvoices? They’re real’. That was enough. That was my start up because that meantmy experience was being validated for the first time and that was probably thefirst step towards my recovery, was the validation of the experience, as a realthing. Not as a hallucination or something that doesn’t really matter but real.

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And I think that’s the same for a lot of people in Hearing Voices, thevalidation …

(Interview 3)

… then I came across an advocates group and at the time I thought perhaps ifthey look into this maybe something can be done. And that was really the point.I met this other chap, an advocate at the time, who had also had ECT severalyears before and it was wonderful to meet him because suddenly he wasbelieving what I was saying. And we just sat and talked and it was so good. AndI had several sessions of just going and talking about how I felt and how I hadbeen affected. […] So we thought, if there’s me and there’s him there must beothers. And then we came across another young woman.

(Interview 4)

It is acknowledgement by others, internalization of the confirmation they provide,that provides survivors with the strength to cope with the adversity of their situation.Their individual habitus embodies the wider habitus of the group and draws from itsstrength.

Interventions in the media field

The esprit de corps of the movement is a vital resource, essential to preserving themomentum of critique. However, the real struggle, as far as many survivors areconcerned, is with the wider public. It is the fears, anxieties and stereotypes of ‘thepublic’, in the view of many survivors, which leads to the stigmatization and isolationof those diagnosed ‘mentally ill’:

… we not only want to dispel the myths behind schizophrenia but we want topresent people with schizophrenia as people who are trying to lead normal livesin the community. And often because of the pressure they are put under bypeople who can’t accept people with a mental illness, its very hard to lead anormal life. It’s very hard to go about as a normal person. I’m a mother as wellas a schizophrenic and I have to pick my little boy up from school. I have to mixwith other school kids because the school kids come around for tea and thingslike that, and so far no one’s actually turned me down but they all know I’m aschizophrenic.

(Interview 1)

Negative public perceptions lead directly to stigmatization and also put pressure onpoliticians and psychiatrists to sustain a paternalistic and coercive line. It is the viewof many survivors that these fears, anxieties and stereotypes derive, in large part,from the media field. And it is argued that they are best addressed by way of anattempt to change the practice of journalists and scriptwriters. Almost every one ofmy interviewees commented upon the need to challenge media stereotypes andinformed me of projects designed to do this. Comments such as the following wereextremely common:

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The media does form opinions. Media kind of goes in gluts and loads because youcan have … I mean at one time it was the royal family was always the sexy issueand they could sell a lot of newspapers when they did things about the royals andthen there was road rage and then there was unruly school children. It kind ofgoes in this kind of fashion where they will take a group of people and work onthem for a while but schizophrenia keeps coming up all the time. They keepcoming back to schizophrenia.

(Interview 2)

Many SMOs, therefore, have sought both to effect critiques of media practice and tocampaign actively within the media field, for change. As the movement has grownand more specialized networks and SMOs have emerged within it, this has involvedthe emergence of groups devoted specifically to media interventions. The two mostimportant examples of this are the London-based Mental Health Media, and the (nowdefunct) Manchester-based Schizophrenia Media Agency. The latter of these groupsdevoted a large amount of energy to such activities as lobbying those journalists whopresent negative images of ‘mental illness’, encouraging programme makers andjournalists to involve survivors in the construction and presentation of stories, andtraining up survivors themselves to operate effectively in media contexts. As theirleaflet puts it:

SMA provides training in media skills; understanding the media; presentationtips; dealing with difficult questions; key messages; interviewee skills. Weprovide briefing papers and guidance leaflets on many aspects of schizophreniaand dealing with the media.

(Schizophrenia Media Agency leaflet 1995)

The emphasis upon skills is important because it acknowledges that playing the‘media game’ requires that one have a ‘feel’ for that game and the cultural capital(e.g. rhetorical and self-presentation skills) appropriate to it. In some cases this lessonwas learned bitterly. One founder member of the Schizophrenia Media Agencyexplained to me, for example, how her early collaborations with the media had fallenshort of her expectations because of her lack of know-how regarding the way storiesare put together. She did not know what to insist upon or be on her guard for:

… you can be misrepresented. I did a quite a good article for, I forget whichmagazine it was now. [name], I think or something like that. And this was a verygood article but we hadn’t discussed the headline and they called it ‘Don’t HateMe Because I’m A Schizophrenic’ and I thought, ‘oh that’s just failed, missed thepoint completely’. It’s not a question of love or hate. It’s just acceptance. So Iwas very disappointed in that. I didn’t realize they would use. I mean that’s asort of headline which is the very thing you are trying to avoid.

(Interview 10)

However, the lesson is learned from these experiences. And it is reproduced andtransmitted through the Schizophrenia Media Agency’s training sessions. The bitter

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experiences of one activist shape the habitus of those who follow her and the learningcurve thus functions as much at the group level as that of the individual.

As with the critique of psychiatry, there are two aspects to this form of mediaengagement. On the one hand activists confront the media directly and attempt towork within it to bring about change. They lobby. On the other hand their critiques,by virtue of repetition, have sedimented within the culture of the movement, in theform of a habitus which both enables and disposes the activist to ‘look behind theheadlines’ and deconstruct media messages. Like students of semiotics activists learnhow to unpick the threads of a media story and mount a critique of it. This is veryimportant as research suggests that many survivors themselves, outside of themovement community, are affected by media stories about ‘mental illness’, often tothe considerable detriment of both their ontological security and their self-esteem(Philo 1996). The tools of semiotic warfare counteract this symbolic violence.

It is also interesting, however, that activists’ critiques of media stereotypesdeploy typifications of their own regarding, for example, ‘the media’ and ‘thepublic’. Indeed, a noticeable feature of many of my interviews was the way in whichthe discourse of the activists was structured around an us/them relationship with themedia and the public. On one level this is important, both as a defence against thesymbolic injury sometimes inflicted by these groups and as a situational definitiondevice necessary to political engagement. However, there are dangers. Typificationcan further ‘other’ the other in such a way as to reduce the possibility of achievingthe relations of mutual recognition that are, in the final instance, a key aim of mostin the movement.

Professionalization and incorporation

The survivor movement, even in terms of its most modest aims, clearly has a longway to go. However, as a final point in this paper it should be acknowledged,returning to a point noted earlier, that the status of the survivor within the systemhas, to a degree, increased. Their experiences have been recognized, in some casesand to some degree, as forms of cultural capital. Some survivors, for example, havebecome mental health consultants – consulting to other survivors/groups but also toprofessionals and health authorities. One of my interviewees, who is himself a paidmental health consultant, estimated that there were at least 50 such active consultantsin the UK at the time of the interview (1997), a figure which he believed to be risingall of the time. This is due, in part, to the growth of consumer culture within health.However, it also due to the efforts of the survivor movement to establish their voice.

At one level this is a victory for the moment. However, as some consultants andactivists recognize, it changes the modus operendi of the movement in significant andnot always desirable ways. A political model is replaced by a business model. Userconsultants will charge a fee for their services, for example, even if their clients areother users. Some activists stress the positive dimension of this. One, referring tomoney paid by a health authority, for example, says:

being able to influence things is not about influencing people because you are oncommittees or on planning groups. Real influence is getting paid to do

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consultancies and getting paid big, getting paid proper money, good money,same as any other consultant in the country would get. Because if somebody pays£28,000 for a piece of work they ain’t going to ignore it, whereas often usersare pulled on to these planning committees where they just sit there as a memberof the planning committee and are basically ignored.

(Interview 3)

Being paid, in other words, is a sign of power and a guarantee that one is listenedto. However, it is arguable that survivors acquire a stake in the system in this way,which will lessen their readiness to challenge it. Furthermore, new opportunitieswithin the system inevitably draw some talented and motivated individuals away fromprojects which seek to challenge it:

… whereas in the old days, say before up until the last three or four years, therewere limited opportunity, if you wanted to do something. There were limitedopportunities and so working unpaid for SSO or UKAN seemed like somethingworthwhile doing. Now, if you are together enough and you know, confidentenough, you can go off and earn money … I mean I have been to places over thelast 15 years, I never would have got to if it hadn’t been the fact that I am quiteinvolved in the Survivor movement. So what I think it has done is, some peoplewho I think are, potentially might be leaders, have been sucked off into, youknow. You become a free lance worker and rather than working, you know, 10hours a week. Well the ideas of working 10 hours a week sticking envelopes forSSO or for UKAN suddenly seems to be much less attractive option. So I thinkwe are in a second phase.

(Interview 5)

Where the second phase referred to here will lead remains to be seen – althoughthere are indications that a new generation of ‘old fashioned radicals’ are takingshape, so the effect of this lure may not be quite so strong as the above-citedinterviewee fears. Nevertheless, the trend and the trap is clearly evident within thefield.

Conclusion

Social science has had a great deal to say about the way in which mental illness is‘socially constructed’. In this paper I have attempted to examine some of the waysin which is it is socially deconstructed, and the power of psychiatry thereby resisted, byactivists in the UK mental health survivors movement. Specifically I have attemptedto elucidate the practices which comprise the radical habitus of mental healthactivists, which allow them to live as ‘survivors’ rather than ‘mental patients’. Thesepractices include rhetorical devices for deconstructing the images of ‘mental illness’generated both within psychiatry and the media, as well as replacement schemaswhich bestow a more positive significance on those experiencing mental distress andits treatment. They include strategies for coping, individually and collectively, withsuch potentially distressing experiences as ‘hearing voices’, and indeed for selling

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these strategies back to psychiatry. I have also emphasized, however, that these formsof symbolic politics cannot be divorced from the broader collective and institutionalcontexts in which they operate, the recognition granted by a variety of significantothers (other survivors, family and friends, and professionals). In this respectsymbolic struggles within the psychiatric field face a difficult double bind which oftenadmits only of piecemeal and gradual success; survivors need to win recognition inorder to have a basis from which to level their struggles for recognition. Much moreresearch remains to be done in this area but I hope that this paper makes acontribution to a social scientific account of mental health which gives due credit tothe capacity for resistance and innovation amongst a marginalized group.

Acknowledgements

This paper is based upon data gathered from an ESRC funded project (00222187).Thank you to the ESRC for their support.

Notes

1 This is a position which is associated, in particular, with the labelling theories and,as such, it has been subject to extensive critique (e.g. Gove 1975). However, thereis good contemporary evidence to suggest a more moderate version of the thesis.The work of Link (1987; Link et al. 1987) is particularly important in this respect,but see also Nieradzik and Cochrane (1985), Piner and Kahle (1984), Shaw(1991), Socall and Holtgraves (1992), Sommers (1987) and Warner (1994).

2 The title is, of course, a play on the title of Scheff’s (1984) important book BeingMentally Ill.

3 All fields presuppose a ‘belief in the game’ in Bourdieu’s view, and he labels thisbelief ‘illusio’.

4 I wasn’t able to find much information regarding SUMP in my research. Insofaras they do not appear to have any direct connection with the flurry of groups thatfollowed the formation of the MPU, however, I do not think that they formed asignificant aspect of the growth of the survivor movement.

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Not being mentally ill