The mainstreaming of recovery

Guest post by Diana Rose ©2014 Journal of Mental Health

Diana Rose. (2014) The mainstreaming of recovery. Journal of Mental Health 23:5, pages 217-218.

Recovery is everywhere. I am not the first person to say it was invented by the service user/survivor movement (Deegan, 1988) and subsequently taken up by mental health professionals (Repper & Perkins, 2003). I will not repeat the quote by Anthony which everyone deploys (Anthony, 1993). This editorial seeks to make a stronger case by looking at how the recovery movement gained traction, especially in the English-speaking world, and what the consequences are both for mental health practice and society more widely. I will contend that what began as a liberatory discourse has become instrumentalised and mainstreamed such that it is aligned perfectly with our neoliberal present.

Who could be against recovery? The emphasis on hope is something with which I have no quarrel, having once been told that I had none. But the recovery movement interprets this in a particular way and it is with an ideological slant that will reappear throughout this editorial. Consider a piece of research, a collaboration with service user researchers (Crawford et al., 2011). This was a nominal group study seeking to find out how service users, with either a diagnosis of psychosis or affective problems, ranked outcome measures commonly used in trials. Here, I will consider the group with a diagnosis of psychosis. Their top-ranked outcome measure was of side-effects of medication: this is what mattered most to them in terms of the outcomes of interventions. The Recovery Star ranked in the middle. Service users were critical of measures of function, pointing out that not socialising with others or breaking connections with families was not necessarily dysfunctional but a way of protecting one’s mental health. My point is that such aspirations are not absent from the recovery movement and associated measures. For all that goals are meant to be “personal”, certain goals are not permitted. You can not decide to go to bed for a month.

I would argue that certain goals are not permitted because the recovery movement is shot through with what we can call “normalisation”. This concept originated in the learning disabilities field with Wolfensberger (1970), but not all people with learning disabilities liked the idea of being “normal”. Hence the advent of groups like “People First” in the UK. In the twenty-first century mental health practice, service users are encouraged to be normal. And now I will tell you a story. We can call it a “case history” of N = 1.

The story concerns a woman who was admitted to a “recovery house”. The reason for the admission was that she was on a high dose of chlorpromazine, had experienced postural hypotension and fallen face-first through a glass door thus sustaining facial injuries. She had been admitted to an acute ward previously and her consultant decided she could not be left alone and “needed nursing”. The ethos of the recovery house was indeed normalisation. No matter how distressed, the residents had to go about their daily business as normally as possible. There then arose a particular task. The woman ran out of one of her regular medications. The staff in the recovery house told her she must go and get a repeat from her GP as this was what she would normally do. It was a 20 mile round trip by public transport and she was distressed. There was a psychiatrist on the team but getting the prescription from him would not have been normal. She made it to the GP who was furious saying he could have faxed the prescription to the recovery house. Having completed the task, there ensued a conversation between the woman and one of the recovery house workers. The woman was in extreme distress but the response of the worker was upbeat “you succeeded, you achieved the goal, you got the prescription”. The woman discharged herself.

This is in fact what some call an “auto-narrative”. The woman was myself and I have several reflections. I have told this story in my teaching and one response is to say, “oh, but that’s not recovery: that is cruel”. I disagree. The ethos of the recovery house fitted perfectly with the kind of normalising discourse I discussed earlier. Second, only certain kinds of people could make it in the recovery house. They were nearly all middle class, younger women with depression or so-called “personality disorder”. All were of white ethnicity. This was in stark contrast to the make-up of service users in the acute ward who were on the whole poor men from BME groups with a diagnosis of psychosis. Finally, the staff in the recovery house was mostly new psychology graduates. They matched the demographic of the residents and it is interesting that the mainstreaming of recovery is happening at the hands of psychologists. My point is that not everyone can make it in recovery services so they become yet one more thing at which service users can fail.

Recovery is said to be “personal” (Slade, 2009); it is “deeply individual”. Why would anyone object to that? Because we are not isolated individuals, to put it bluntly. Focusing on the psychological make up of individuals, whether through depth psychology or CBT, is to dilute and render unimportant the social relations in which we are embedded and which shape and form us. In a real sense, we are those social relations. To some such statements are affronts. Modernist discourse has it that every individual is unique, a cluster of attributes special to each. Such sentiments lie behind the current rejection of “one size fits all” approaches, for example. I do not mean to advocate reverting to homogenous services in mental health but I do mean that mental health service users have something in common, something not too far away from capture by a specialist discourse and practice and marginalisation by mainstream society. And the recovery movement, I would argue, is becoming a substitute specialist discourse and practice and confronts stigma and discrimination precisely by reference to normalising individualism. Recovery Colleges, for example, include courses premised on the idea that mental illness can happen to anyone. This is despite decades of work on epidemiology and health inequalities.

Empirical work on recovery is increasing but still there are significant gaps. Writing in this journal Marit Borg and colleagues (Borg & Davidson, 2008; Borg & Kristiansen, 2004) have attempted to discover what recovery means to service users using qualitative methods. However, they have only interviewed people deemed “recovered” and so there is an absence of work on what recovery means to people who continue to struggle.

There is a small sociological literature on recovery which takes the form of commentary and critique and which is interesting. Harper and Speed argue that, paradoxically, a strengths model of the service user continues to imply a deficit model because the strengths at stake are there to remedy on-going deficits (Harper & Speed, 2012). This work is also in line with the argument above that we are not isolated individuals as it looks to collective existence and collective action to improve mental health services in a way that service users want. The importance of collectives to validate and reflect on experience is also stressed by Pilgrim (2009), who makes the additional point that we do not really know what goes on in recovery services. Manualised interventions will not tell us this and Pilgrim calls for “practice-near” ethnography.

One aspect of recovery discourse deserves special mention. This is the twin claim that every service user should work and that traditional services, such as day centres, encourage dependency. Work will set you free; the autonomous individual is in control. So does a recovery discourse align itself with both service reconfigurations and welfare benefits cuts. In the UK, service users are being discharged from secondary mental health services back to the care of their GPs in their thousands and for those who do receive a service it is now often time-limited. From a recovery perspective, while obviously not advocating neglect, shaking free of services at least ultimately is all to the good. There would appear to be no understanding that some service users seek continued support and, in the current climate in the UK, live in fear that they will be “found out” by officials in charge of government policy to get disabled people back to work.

A further aspect of some versions of recovery is the advocacy of peer support workers. On the one hand, peer support workers are claimed to have a special knowledge because they have experienced the treatments and services in which they now work to support others at an earlier stage of the recovery journey. Although in some ways a progressive move, two points can be made about peer support workers. First, they often find themselves in a position of tension because they have to fulfil two, sometimes contradictory, roles. They answer to two masters who require different things, that is, service users do not always want the things that clinicians prescribe (Fabris, 2011). But second, they are a subsidiary labour force commanding neither the respect nor the financial remuneration of mainstream staff. They are cheap labour. Some are not paid at all. So once again, we see an alignment between the financial restructuring of society and the recovery discourse. Peer support workers can be seen as part of the army of the Big Society.

So what am I proposing? Not a rejection of every part of the recovery discourse and practice. But we have to tackle head on the fact that our society is intolerant of difference. And people labelled mad are the most frightening group of the different because they threaten to expose the insanity that lies beneath the surface of all. Language is actually shifting in recognition of this. From “stigma and discrimination” to “marginalisation” to “social exclusion”; even to “oppression”. These shifts are interesting because they move us from the individual to the group. And my suggestion would be that we try to reclaim our rights at the level of the group. The normalisation that runs through the recovery discourse is focused on the individual. Group activity and campaigns were stronger 30 years ago than they are today with collectives such as “Survivors Speak Out”. Now it seems we do not wish to upset anyone. I suggest we be upsetting, that we use humour and that service users should take the lead in this rather than follow in the wake of recovery workers.

References
1. Anthony WA. (1993). Recovery from mental illness: The guiding vision of the mental health service system in the 1990s. Psychosocial Rehabil J, 16, 11
2. Borg M, Davidson L. (2008). The nature of recovery as lived in everyday experience. J Mental Health, 17, 129–40
3. Borg M, Kristiansen K. (2004). Recovery-oriented professionals: Helping relationships in mental health services. J Mental Health, 13, 493–505
4. Crawford MJ, Robotham D, Thana L, et al. (2011). Selecting outcome measures in mental health: The views of service users. J Mental Health, 20, 336–46 Abstract, ISI
5. Deegan PE. (1988). Recovery: The lived experience of rehabilitation. Psychosoc Rehabil J, 11, 11–19
6. Fabris E. (2011). Tranquil Prisons: Chemical Incarceration under Community Treatment Orders. Toronto: University of Toronto Press
7. Harper D, Speed E. (2012). Uncovering recovery: The resistible rise of recovery and resilience. Stud Soc Justice, 6, 9–26
8. Pilgrim D. (2009). Recovery from mental health problems: Scratching the surface without ethnography. J Soc Work Practice, 23, 475–87
9. Repper J, Perkins R. (2003). Social Inclusion and Recovery: A Model for Mental Health Practice. Nottingham: Baillière Tindall
10. Slade M. (2009). Personal Recovery and Mental Illness: A Guide for Mental Health Professionals. Cambridge: Cambridge University Press
11. Wolfensberger W. (1970). The principle of normalization and its implications to psychiatric services. Am J Psychiatr, 127, 291–7

The neoliberal writing on the wall: Ontario’s Basic Income Experiment

Guest post by RITB and Ontario Coalition Against Poverty member John Clarke

Since 2010, the UK has endured a political regime that can be considered a cutting edge of the austerity agenda. Through the film, ‘I, Daniel Blake,’ people around the world have become familiar with the institutionalised cruelty of the Country’s warped system of providing social benefits to those in need.

To those who endure sub poverty misery, the humiliating intrusion of the Work Capability Assessment and the ever present threat of the sanctions regime, the conclusion that anything must be better than the present set up is an easy one to arrive at. Disabled people who deal with a state bureaucracy that labels them scroungers and seeks at every turn to abandon them, can be forgiven for concluding that no alternative to the status quo could possibly be worse than that which they face today. The sheer brutality of the regime operated by the Department for Work and Pensions (DWP) can only make the notion of a secure and adequate system of universal income, freed of bureaucratic intrusion and moral policing, extremely alluring. This does much to explain the high levels of receptiveness to the notion of a Universal Basic Income (UBI).

In the UK, Basic Income is being considered in the context of a political break with the austerity consensus and the posing of an alternative to the agenda that flows from it. BI pilot projects have been called for in Fife and Glasgow *(1) and the Labour Party has established a working group to prepare a proposal on the concept, with a view to its being adopted as policy. Shadow Chancellor, John McDonnell, is very much behind this development. *(2) The emergence of a left leadership in the Labour Party and all the gains that it has made is looked to internationally with huge respect and admiration and there is a great deal of moral authority attached to the social policy proposals that it advances. For that very reason, a critical look at the implications of the basic income approach to reshaping systems of social provision is of particular importance. Very frankly, I must argue that it would be a profound mistake for the Labour Party to take that direction and, as an organiser with the Ontario Coalition Against Poverty (OCAP), dealing with an attempt to develop a decidedly neoliberal local brand of BI, I’m going to set out my case for this position.

Basic Income Left and Right

Before talking about the specifics of the emerging experiment with BI in Ontario, let me offer some observations on the general notion. Notwithstanding the fact that BI advocates will frequently present the idea as something that transcends political divisions between left and right *(3), there is a wide acknowledgement it can be proposed in regressive or progressive forms. *(4) A version that furthered neoliberal austerity would hinge on the inadequacy of the payment. Some right wingers accept universal entitlement, while some liberal or social democratic thinkers accept restricting it to those on low incomes but the neoliberal brand is always focused on preserving and enhancing economic coercion. Simply put, the payment must not impede the flow of workers into low wage precarious jobs and, indeed, it should function as a de facto wage top up for low paying employers. With wages partly paid out of the general tax revenues, pressure to increase minimum wages would be greatly reduced. Furthermore, the regressive wing of BI advocacy is most insistent that the envisaged payment would replace, rather than augment, other forms of social provision. In this regard, the notorious US political scientist, Charles Murray, sets out a particularly chilling vision *(5) and this has been echoed by the Canadian Fraser Institute *(6).

The more hard line left wing approaches to BI absolutely insist on the universality aspect but all progressive proposals are clear that the payment must be adequate. It must, in and of itself, ensure that basic needs and social participation are within the means of those receiving it. Indeed, given the frequent connection that is made to providing for those who are technologically displaced from their jobs, adequacy at this level is the essential consideration. *(7) An actual ability to withdraw painlessly from participation in the capitalist job market is envisioned *(8)

The problem with such ideas is that they take no account of how essential to capitalism a level of economic coercion is and give no thought to the societal balance of forces or the practical prospects of obtaining their goal of a UBI. After several decades of neoliberal austerity, with trade unions greatly weakened and social resistance hardly at peak levels, the prospects for major social reforms are not that good. However, a truly adequate, universal payment that freed millions of workers from the ‘tyranny of the labour market’ would be more than a reform. It would really be a question of the State handing over an unlimited strike fund and, as Pam Frache argues, “Simply put” no capitalist state will provide workers with the resources to go on indefinite strike.” *(9)

In an interesting blog piece, Paul Cockshott, in addition to looking at the potential costs of a UBI system in the UK, points out that the embrace of the idea reflects defeat and disorientation on the left. *(10) The hope of a social policy solution to the problems created by neoliberalism and the attacks associated with it is profoundly dangerous because that very ‘solution’ can so readily assume a form that furthers the very agenda that left BI advocates hope to escape. The institutions of global capitalism are taking an interest in Basic Income and the Davos crowd are even considering it. *(11) In Finland, a government that is moving in decidedly neoliberal directions suddenly assumes interest in BI and puts in place a test run that should alarm us. *(12) But let’s now turn to the model that is emerging here in Ontario and the warning it offers us on just the kind of directions BI can be taken in.

Ontario’s BI Test Run

Like other so called BI pilot projects, the one in Ontario is an imposter. I say this because it isn’t actually testing Basic Income. It’s really testing poor people. BI is a social policy that would be implemented across an entire political jurisdiction and that would have particular impacts on the society and its population. No such test is being undertaken in Ontario. The Government is simply going to provide enough income to a sampling of 4,000 poor people to make them a bit less poor and the predictable result will be that most of them will be a bit better off. So, the first thing we should note is that all of the focus on studying ‘outcomes’ is a cynical diversion that tells us nothing about the implications of BI as a neoliberal policy tool.

People in the UK, who may not be very familiar with the situation in Ontario, need to understand the context in which this pilot emerges. Under the federal system that exists in Canada, the governments of its provinces and territories have the greatest amount of decision making power when it comes to social benefit systems. In Ontario, we have a Liberal Government that has held power since 2003. Unlike the UK, where the Liberals went into a state of faded glory between the wars, their Canadian counterparts have remained front line contenders for political power. They function as a slightly nicer alternative to the Tories but can be trusted to manage things in a way the rich and powerful will find entirely to their liking. You might say they are what Tony Blair intended the Labour Party to be. Over the last fourteen years, the Ontario Liberals have allowed people on social assistance to get even poorer than they were when the Tories held power but they have perfected the art of always appearing like they are about to address the problem. They have held round after round of ‘poverty reduction’ consultations even as the scale and depths of poverty increased. The Basic Income pilot is, for them, a political windfall that enables them to go on promising jam tomorrow while providing nothing to day. Nearly a million people on social assistance, many of them disabled, will have their incomes kept well below the poverty line while a lengthy study of 4,000 people on the BI pilot unfolds.

While the pilot is largely motivated by the Liberal Government’s desire to keep people on social assistance in poverty, while shoring up their progressive credentials, it is also an experiment in designing a neoliberal model of Basic Income. The little brochure that announces it is rather thin on details *(13) but a memo sent out within the Canadian Union of Public Employees, Ontario Division *(14) and other information OCAP is party to on a confidential basis, gives us a fair sense of what is being cooked up.

Some 4,000 people, in three parts of Ontario, will be provided with BI payments over the next three years. A separate pilot will run in a selected Indigenous community. Their income will be set at around 75% of the Low Income Measure, with an extra payment for disabled people. 70% of those who are tested will be low waged workers and earned income will be deducted at a rate of 50%. As in Finland, while the pilot is means tested, the income will be provided with far fewer conditions attached to it than under present benefit systems. In my view, those in the neoliberal driving seat are happy to ease up on some of the bureaucratic intrusion precisely because they have been sufficiently successful in creating a scramble for low wage precarious work and simply don’t need it to the same degree. What they are more concerned to do is to extend income support to those on low wages in order to, in effect, provide employers with a subsidy, paid for out of the general tax revenues. The amounts provided under the pilot are clearly inadequate enough that no one would be free of the ‘tyranny of the labour market’ and the supply of low wage workers would be preserved. Indeed, a more widely applied BI system might well pay an even lower amount.

The above cited CUPE Ontario memo gives an indication of a very striking feature of the pilot. While people will face fewer conditions, many will also lose supports and services they currently rely on. People presently on social assistance who go onto the pilot will no longer have caseworkers and will be expected to ‘self navigate’ when it comes to accessing sources of assistance they would previously have obtained with the help of those workers. Moreover, a whole range of supplementary benefits will be lost, such as the Special Diet that provides additional income on the recommendation of medical providers. Medical transportation assistance and mobility devices will also become the responsibility of those who shift to the pilot. Disabled people, especially, might find, despite the additional BI income, that they are actually far worse off than if they had stayed on the Ontario Disability Support Program (ODSP).

The point that emerges here is that even as they roll out their showpiece test run that provides income to just a few thousand people and enables them to be far more generous than they would be if they were setting up a widely available programme, they are cutting back on other entitlements. I think it’s clear that the Ontario Liberals are establishing a model for a low paying, means tested income support system that is primarily concerned with subsidising low paying employers and that would be paid for by cut backs in other areas of social provision.

Left Welcome Mat for Neoliberal BI

Predictably, the Basic Income Canada Network sounds no alarm on the nature of the Ontario pilot and, indeed, will take an entirely supportive approach. The pattern has already been set among many progressive BI advocates is to present neoliberal models as ‘good first steps.’ *(15) In the UK, the advisor to the Labour Party BI working group is Guy Standing from the Basic Income Earth Network. He had contact with the Ontario Government’s BI advisor, helped the Finnish Government design its pilot and has presented to none other than the World Economic Forum at Davos. *(16)

As a regressive form of Basic Income, serving and facilitating the neoliberal agenda, is prepared, the deluded notion emerges that a progressive option is there for the taking. It is never really explained how this can happen but is simply taken on faith and I use that word very deliberately. Once it has been accepted that decades of neoliberalism and, indeed, the economic coercion of the capitalist job market can be neutralised with what Miles Krauter refers to as ‘emancipatory policy visions,’ *(17) then the realities of a class struggle that has not been going our way for some time seem very unappealing. Like Krauter, the Citizens’ Income Trust in the UK feels that a failure to believe that transformative BI can happen is to lack vision and to fail to offer any viable alternative. *(18) However, while the Fountain of Youth does sound a good deal better than dealing with getting old, it suffers from the problem of not existing.

The folly of believing that there is a social policy end run around neoliberal attack can’t be overstated. John McDonnell has suggested that a Labour Government could implement reforms that would outdo those put in place by the post war Attlee Government and ‘transform capitalism.’ *(19) As Theresa May’s wretched regime stumbles from crisis to humiliation, people all across the world are asking what can be achieved by a Corbyn led Labour Party. However, it seems to me that a policy that commodifies social provision, accepts low wages while topping them up out of tax revenues and that has the support of such reactionary forces globally, is far short of the ‘Spirit of 45.’

We’ve been retreating, rather than achieving reforms, for some decades but, if we are to consider the kind of measures that could be advanced and that working class people could mobilise to win, we can do better than become shoppers in neoliberal market place. We can demand free, expanded and accessible public services and fight for maximum worker and community control over them. We can demand systems of income support that are based on full entitlement, adequate income and that are purged of intrusive regulations and moral policing. We can fight for living wages, instead of offering subsidies to those who pay poverty wages. The neoliberal attack is taking up Basic Income as a weapon. We need to fight it instead of laying down a welcome mat.

1. http://www.independent.co.uk/news/uk/home-news/scotland-pilot-universal-basic-income-ubi-snp-fife-and-glasgow-scheme-a7505411.html

2. http://www.independent.co.uk/news/uk/politics/labour-sets-up-working-group-to-investigate-radical-idea-of-basic-income-john-mcdonnell-reveals-a7563566.html

3. http://basicincome.org/news/2017/03/joe-chrisp-basic-income-beyond-left-right/

4. https://www.theguardian.com/commentisfree/2017/jun/23/universal-basic-income-ubi-welfare-state

5. http://www.fljs.org/files/publications/Murray.pdf

6. https://www.fraserinstitute.org/blogs/be-cautious-about-ontario-s-basic-income-plan

7. https://medium.com/@parismarx/the-future-of-work-demands-a-basic-income-81f6df0bb7f1

8. http://basicincome.org/news/2016/09/13022/

9. http://rankandfile.ca/2017/04/19/the-basic-income-debate/

10. https://paulcockshott.wordpress.com/2017/01/25/what-is-wrong-with-the-idea-of-basic-income/

11. https://www.weforum.org/agenda/2017/01/why-we-should-all-have-a-basic-income/

12. https://www.jacobinmag.com/2017/01/ubi-finland-centre-party-unemployment-jobs/

13. https://files.ontario.ca/170508_bi_brochure_eng_pg_by_pg_proof.pdf

14. file:///C:/Users/OCAP%20Comp/Downloads/SSWCC_April%202017%20MSS%20Update%20re%20Basic%20Income%20Pilot%20Announcement_27Apr17%20(2).pdf

15. http://www.basicincomecanada.org/on_the_agenda_ontario_s_basic_income_pilot

16. https://www.weforum.org/people/guy-standing/

17. https://medium.com/@mileskrauter/working-to-death-leftist-critiques-of-basic-income-fail-to-offer-meaningful-alternatives-8fe2b8ebe6a

18. http://basicincome.org/news/2017/04/neoliberal-citizens-income/

19. http://www.independent.co.uk/news/uk/politics/labour-government-jeremy-corbyn-most-radical-ever-shadow-chancellor-john-mcdonnell-clement-attlee-a7041311.html

Freedom to choose? – a discussion

The following is based on a discussion on our Facebook group. We’ve taken what people have said, tidied up spelling, expanded abbreviations removed names. Every paragraph is a new point.

We have divided this post is into three parts for clarity 1) Choices and decisions, 2) Assisted suicide and 3) Recovery and Unrecovery.

Choices and decisions

Both ‘freedom’ and ‘choice’ are neoliberal fictions, the former a dangerous one right now

There is a difference between decision making and choice. Decision is a creative (or more accurately destructive) act, it is productive. Choice implies an externality. Something we are alienated from. A choice is proffered from the Other. The decision is the cut from those external choices. The power in diagnosis lies with the person making the decision, the psychiatrist, (or at least psychiatric discourse). The tantalising emancipatory light we are dangled in the deep is that we can take ownership of that decision. But to bite on that lamp is as emancipatory as thinking you are taking power at the till of a huge supermarket (that itself is one of many).

As I have said before it follows the same structure as M-C-M’ the general formula of Capitalism where decision making is M and choice M’ the commodity sold back after surplus profit has been extracted by the capitalist

All choice contains a loss.

I think it is importance to emphasise the importance of being able to make informed choices about treatment. Whilst the myth of chemical imbalance continues to be touted by psychiatry and the pharmaceutical industry many people continue to make choices based on misinformation. Psychiatric medication cause chemical imbalances rather than correct them and of course this may be helpful for some of us who are experiencing mental distress but don’t pretend to us that they have anything to do with curing mental illness even if they do help us manage our symptoms, especially whilst other options aren’t available to us.

Freedom to choose is an illusion. In psychiatry it is generally a form of ‘Sophie’s Choice’ where you are given options but they all benefit the provider of those options. And then responsibility is passed to the service user when things don’t work out because they ‘chose’ that path.

My choices seem to have been it’s either this or nothing and if you don’t agree you’re unreasonable. I have been offered things that won’t make a blind bit of difference just because that’s all there is.

I remember a service provider on CPD course I was teaching on telling me: ‘the more I hear the words ‘partnership’ and ‘choice’ – the more rigid and limited I see services becoming’

Choice, what choice?

Choice in MH is not just about choosing between pharmaceuticals as a psychiatric pharmacist once told me

I’d like to choose not to accept your diagnoses and to choose what treatments I won’t accept

True consent is only there are if you feel equally able to say yes or no

Change choice to privilege

Is free a reference to liberty, or is it a reference to the way our bodies and work are used once we are labelled?

Assisted Suicide

Another important thing I feel here is “choice” when it comes to assisted suicide… in this context choice becomes a measurable outcome because only if everything is offered can it be discussed in liberal terms…. not against assisted suicide, just against how people seem to be so pro it yet silent over mental health support. It’s an easier option, this normalisation worries me and is a big paradigm shift that is needed?

We don’t have that “choice” in the UK, but I think we should because it’s the ultimate “choice” anyone who really suffers should be able to make.

That’s a tricky one. I’ve always supported assisted dying (for anyone regardless of any illness) & I have membership of Dignitas myself. However I don’t want it to be as freely available as it is in the Netherlands & Belgium without social justice & support. I’d want to see all preventable social factors removed. On the other hand, I can’t see that happening any time soon & can understand some folk facing the prospect of long term fear/uncertainty over ability to exist wanting an alternative now

I agree, but what do people do in the meantime? Things are only getting worse, not better. It’s hopeless…

You know my view on balance I’d like to see the option available now, but at the same time I accept and respect all the opposition there would be from disability groups. If there was a vote I would vote in favour

Also, discussing in big concepts often forgets the individual.

Sure, I totally own my comments in context of my individual situation. I’m not speaking for anyone else.
Out of curiosity (only if people want to answer), who could see themselves consider assisted dying (for whatever reasons)?

Eventually yes

Yes I would but not just yet. I’d like to plan it well in advance.

Same here I would but have a few months to plan

Would anyone involve their relatives? And friends?

I’d want to find my cats a really good home before I checked out. They’re the only reason I haven’t already…

It wouldn’t be easy to involve relatives if it were accessed without a degenerative or terminal condition. I think many relatives might object

I would consider it and have, but see that this is the way our Government wants us to think and behave so for me I would vote no right now as I do believe it’s the gas chamber equivalent for Tories. I want other fights settled before I feel safe to fight that one. Have witnessed a doctor doing ‘bed clearances’ with morphine when I was a young nurse so it’s close to the bone for me.

I completely respect and honour your position. I have also seen the protracted death horror of the Liverpool Care Pathway

I’m unsure…. I only know that being non critical does more harm than good, the fact it seems like an ultimate taboo to be discussed..

Suicide is unacceptable…. assisted is

Assisted is dignified, painless and humane

A problem is that ‘assisted’ might open the door for ‘encouraged’ or ‘coerced’ – as we’ve seen with the commodification of ‘choice’ within personalisation – so whereas I support the right to die where when and how – it would require very strong safeguards against abuse by those with vested interests (eugenics politics family gain etc)

In the UK we need to include Futile Care Policies in this discussion – where a clinical team, according to their OWN observations and apparent research, prejudices and cost of supporting someone to continue to live (using their own assessment of quality of life), decide that only palliative care will be provided or that a future life-threatening event will not be treated. This is one element of the ‘slippery slope ‘( NORMALISATION ?) some disabled people protest about. This can be challenged though a judicial court order but trying to support a person (my late husband) in this situation and get all the necessary legal support is somewhere I and our daughter don’t ever wish to be again. It’s a real condition that someone who wants to live is denied it and some who wants to die is prevented. Loads of factors involved here!

Recovery and Unrecovery

I view current neorecovery as contemporary normalisation – infact that’s my new term: neorecovery to distinguish it from recovery

It’s a tough work reclaiming and distinguishing that from angst/anger/frustration. Last couple of days posts have really helped.

For me it’s not reclaiming as recovery never meant anything to me, it’s just differentiation

Yes, Foucault couldn’t have said it better

“Our body, our choice.” On all matters of Health, actually: “No bodily authority beyond me, no jurisdiction higher than my sovereignty.”

Freedom is more important than health as without freedom we lose our will to live.

That has never been truer than now

Choice – recover or stay ill. Which is why I stand for Unrecovery.

“Is dissociative voice hearing same as schizophrenia and madness?” – a discussion

The following is based on a discussion on our Facebook group. We’ve taken what people have said, tidied up spelling, expanded abbreviations removed names. Every paragraph is a new point.

HV = Hearing Voices

Apparently the distinction matters

Voice hearing is pretty similar regardless of diagnosis, main difference is 1) how person copes 2) any positive voice or any positive relationship to them at all in the mix. Dissociation occurs in many classified experiences I cannot see what is achieved by attempting to decide whether it’s ‘psychotic’ or not

Psychiatry loves to categorize Voice Hearing. HVM has done a lot of good in redefining those practices

Dissociation is not generally recognized by Psychiatry.

Yet I remember early HV interview/assessment schedules where dissociation was a part of them
This mistake has been made with services users diagnosed as BPD being told their voices are ‘pseudo’. Dissociation with VH occurs in people diagnosed with schizophrenia/psychosis and other diagnoses. Just address the experience!

Psychiatry defines ‘Pseudo’ Voices as being inside your head. But voices occur inside AND outside of the head for most people diagnosed with schizophrenia/psychosis.

Yes ‘pseudo’ Voices are not restricted to just BPD. It’s just the main one we hear about because they are treated so badly for it

I find the dissociative part the most ‘disabling’ aspect of voice hearing. I may accept at a level of discourse there is no single meaning for ‘schizophrenia’ as it does not represent a single biological disease that can be pointed to as representative of a larger set of symptoms, however until they sort out my social security right to financial support whilst ‘recovering’ autonomously from this disabling experience I am not going to get all evangelist about diagnosis whilst ignoring the concrete reality of the social and economic circumstances that people find themselves in, (unable to compete on equal terms in a job market that is getting harsher) due to these disabling symptoms and so am comfortable having it on my GP sick note to entitle me to ESA financial support and access to the ever more constrained, homogenised and smaller array of other services available to me on the NHS as a consequence of these symptoms that I cannot afford on the open market of complementary therapies.

Can someone explain to me what dissociative voice hearing means? I hear voices but I’ve no idea what “kind” they are…

I hear external voices (that is they come from outside my head) internal ones (they seem to be within my mind but seem alien. I also amongst external ones hear them in noises and ‘hear’ other people’s conversations about my ‘inner thoughts’.

However dissociation I experience as being unable to focus on what I am doing, or what the people actually talking to me using their mouths, in the same room as me, are saying. Where I am so caught up in dialogue with the voices I am unaware of what else is going on. I no longer get catatonic but I do dissociate.

Which comes first, the voices or the dissociation?

It might not always be clear cut, which comes first the HV or the dissoc, and it might not always occur in same order

I certainly relate to getting completely focused on the voices to the exclusion of everything else. I also have this inability to filter out background noise which can be overwhelming especially when combined with the voices.

Yeah voices turn up environmental sound volume for me

Unfortunately for the anti-med evangelists my meds lessen some of it. I have come off twice and been ok off until a bad experience happened and they got worse again, and so on meds to moderate them (they never fully go away) but meds are NOT a cure, it being in my mind both trauma and group dynamic communicative rather than biological, although clearly whilst experiencing these symptoms you brain chemistry changes, but there is no normal brain chemistry, so for some the meds work for others they don’t, but they are not the solution or cure, they are just temporary moderators whilst doing they therapeutic work.

Unfortunately because life stressors affect such things, then social factors from neighbours to environmental noise, to secure housing, to support network to financial situations affect this.

However if you are mentally well and have a low paid job you know full well these stressors are not ‘cured’ by work, so individual meritocratic recovery that negates class issues is just so much middle class wank.

I think they mean when people hear the voices of dissociated parts of self like in DID. I think the question was is hearing those voices the same as hearing voices when you aren’t diagnosed with DID

I have also been down this path, and this conversation would go into phenomenology, philosophy of consciousness including whose self memories are, but the upshot would be same above social and political argument.

I went down the Gestalt (Hal and Sidra Stone) voice dialogue path but making my voices ‘personal’ rather than ‘thoughts and ideas’ made my mental health far worse. For a start all the ‘personalities’ that latched on to the technique were ‘thicker’ than me, but were also a bit ‘Dunning Kruger’ with it, and so I started dissociating just saying ‘no’ to them far more than I used to when they were ‘voices’ or ‘thoughts’.

I tried voice dialogue it was disastrous my visual voices attacked me. You just cannot force voices to talk to others

Equally when one pops out unexpectantly it can be difficult if the prof has a fragile sense of self if the voices calls them a twat!!

Mine are real bastards – I’d rather not get into a discussion with them tbh.

“Great minds discuss ideas; average minds discuss events; small minds discuss people” This quote by Eleanor Roosevelt sums my experience up, from studying a PhD and having a clear mind thinking about interesting stuff after the dialogue method I ended up with a bunch of right wing ignorant conforming narcissist hostile gossips in my head

I find the gestalt thing can be exposing too

Would you say an internal voice is basically the same as an intrusive thought but with more of a coherent personality, like for example an inner critic that says the same phrases again and again like ‘you’re worthless’ etc? If not, I’m struggling to conceptualize the difference between the two things? Really interested in this discussion as I’ve heard about ‘internal voices’ for a while but have never really understood how they’re different from intrusive thoughts or my own experiences of having a psychopathic inner critic (esp when I’m triggered or ashamed) – if anyone could explain this it would be very helpful.

Good point – voices can be externalised intrusive thoughts

I do find myself wondering if it’s all basically the same thing but in slightly different flavuors – and if shrinks are over-complicating basically the same process by dividing it into all these subcategories and making each experience seem so distinct just because it’s a bit different on the surface. I could be wrong but it’s just something I’m thinking to myself more and more. I have never heard voices in a traditional sense but the more I listen to voice ‘hearers’ share what their voices actually say, the more I can relate to it, and some of the phrases are eerily the same as my inner critic, like identical in both their wording, motivations, and the situations in which they intensify and are triggered. The only difference is that they are ‘heard’ whereas mine is experienced more like thoughts.

I think there’s little difference in the VH experience whether we’re diagnosed with schizophrenia, psychosis, DID, even OCD, PTSD, BPD

Different variables sure

I suppose I can clearly distinguish between what I feel as my own created thoughts and those unbidden ‘voices’.

The idea of intrusive thoughts is slightly different and there is the idea of thought insertion, which is rarer but when I have experience what I would call ‘thought insertion’ then it is a horrible intrusive experience of feeling like someone else is trying to make you think something that is somebody else’s idea or belief about you, not your own, very controlling.

I get them inserting or dropping or merging their thoughts into mine and yes I’m clear they are not mine

But with regards ‘heard’ voices, I both get voices that are acousmatic, from no discernible source, that are not, shall we say, carried on soundwaves; voices that I can fully ‘hear’ as sound; and also voices carried on/with or through other sounds eg car wheels, birds twittering, other people talking (so physically present witnesses will hear them say something else)

The thought insertion is like someone kind of nudging you into an adjacent untruth. A bit like a leading question in law where a leading question implies guilt in the question so cannot be answered without complicity

I experience it as being aware gradually hang on that’s yours not mine, through to mental equivalent of physical force

Yes, it feels quite forceful sometimes, hard to explain what that feels like though, describing bodily sensations I mean
Mental rape

I have called it that too

I have screamed no means no at them. But they manipulate it that I am responsible for their behaviour

Worst case thankfully rare scenario, they push their words out my gob

Even if they are my reflection they are a reflection of the power disparity in the way I am treated

I mean in a group way. No single individual could possibly have that power

Yes because much has got into our fabric

Although individual personalities is not the way I relate to voices. Or rarely. Or rather never used to be.

Annoyingly the various (I have a large number of) phantasm/assemblages seem to insist on treating me as a distinct personality and that is where i have a problem as it is clear they do not know me and so inevitably they come across as prejudiced

Many are nomadic. There is an obvious logic that the less prejudiced they are the more they are ephemeral. Even when, and i will, unconsciously but seemingly intentionally, trigger them from my unmet needs they will pass on. They are momentary. And ironically these voices are, and always have been more numerous.

It is what comes across as intentional focus or gaze that is the real issue and because of it will necessarily always have a more bigoted source.

But how does one evade them once targeted without losing oneself as a passive docile conformist.

I once said to someone of all people to appease it is the most understanding. Why on earth would one wish to orientate oneself to appeasing the most bigoted as an ethical practice? I have the right to say fuck off you bigot. Leave us alone.

Interesting reading. I have never considered myself to hear voices but I definitely experience overwhelming intrusive thoughts, and inner conversation that is not my own self, speaking about me, but as though it is someone else. Like replaying something someone else has said about me.

Because a lot of the experiences sound similar or with a common thread, do people think they are on a spectrum that ranges from your own ‘lucid’ thoughts, ones you own and control, to full blown psychosis that controls you? Would this make daydreaming, spontaneous thoughts, and inner dialogue part of the spectrum – fitting within a ‘healthier’ range – and gradually going into the range that impairs functioning?

Where do you think disassociation would fit? The same spectrum? Different? Is there crossover?

*Note to self: Maybe joining HV Network would be useful after all… didn’t want to seem like a knob with ‘fake’ voices joining a group that didn’t apply to me

I would say yes to spectrum except it often implies a linear concept which is wrong.
‘Manifold’ is the word i would use but i don’t have quote to explain it. It is a moving topology in 4 dimensions. Brains have a manifold shape. But it is does not have to have the ordered shape chaos theorists like

There is overlap across experience, there’s not always a clear dividing line of ‘this is schizophrenia/psychosis/DID/PTSD/BPD’

Dissociative VH, psychosis VH, spot the difference?

It seems to me that psychiatrists and others want to have neat categories – self harm = BPD, voice hearing = psychosis, pref schizophrenia etc. when the reality for people is much more complex, as you have all described.

Psych’s would say antipsychotics produces a differential response

I often think in the end, we need to define our own experiences regardless of what psychiatry says and does. I guess that can be achieved by trying to create a level of distance from MH services. Of course that can be impossible sometimes when a crisis occurs. But ultimately, in my opinion, no one should have their experiences defined by someone else.