Patient Voices and Social Movements: The Crossleys’ on Habitus and the Antipsychiatry Movement by Guy Shefer

In our October session, we discussed two papers which are both related to the antipsychiatry and mental health ‘survivors’ movement (unlike references to survival of other illnesses such as cancer, the term ‘survivor’ in this context refers to people who see themselves as survivors of interventions by psychiatry). The main paper we discussed was ‘Patient’ voices, social movements and the habitus; how psychiatric survivors ‘speak out’’, by Michele and Nick Crossley. We also discussed Nick Crossley’s paper ‘R. D. Laing and the British Anti-Psychiatry movement, a socio-historical movement’.

We started the discussion with a brief overview of the habitus theory. I introduced its aim to incorporate both structure and agency by suggesting that an individual action can be improvised and skilful but is never entirely unstructured. Rather it is influenced by that person habitus. The habitus, to use Nick Crossley’s words, ‘is the active residue or sediment of his past that functions within his present, shaping his perception, thought, and action and thereby molding social practice in a regular way’. It consists of lifestyle, values, expectations, dispositions, schemas, forms of know-how and competence, all of which function below the threshold of consciousness.

While the authors embrace Bourdieu’s habitus theory, they argue that Bourdieu ignored the generative role of agency and the creativity and forms of innovation in practice, which generate  ‘transformation of habits’. Their paper about patients voices is a demonstration of how such transformations occur and in order to explain this transformation they refer to what they call oppositional habitus.

The paper compares two collections of testimonies of people who were diagnosed with mental illness and who mainly wrote about their encounters with the psychiatric system. The first book, ‘The plea for the silent’ is from 1957 and was edited by MPs. It is based on letters and complaints which they received from people in their constituencies who were detained in mental hospitals at the time. The second, ‘speaking our mind’ is from 1996 and is edited by and includes contributions from people who define themselves as mental health ‘survivors’. The Crossleys point to the various ways in which these two texts demonstrate the huge transformation in how people with mental illness present their arguments about mental illness and its treatment, and how their expectation differ in terms of how what they say is to be accepted by the readers.

The paper suggests there is a series of considerable differences between the two books and these can be found in their titles, content, language, presentation of the contributors and so on. All these differences depict the new ‘patient voice’ as much more confrontational, collective, unapologetic, phrased with reference to more general social categories like gender or race. The new voice, the authors argue, challenge the authority of professionals to diagnose and treat them in such a way that one can identify a whole new critical discourse on Psychiatry emerging. The authors use habitus theory to explain how several different social and political processes helped transform the patients’ habitus, voice and expectations in this regard.  The second paper is a more historical analysis of the origins and early stages of the antipsychiatry movement as it was developed by some leading psychiatrists, especially R.D Laing in what Nick Crossley calls the ‘revolt from above’.

One of the issues we discussed was whether the recent, more critical voice that the authors identified in the 1990s book is ‘the’ new voice of mental health patients (or at least, as they argue, their effective voice) or rather it is just a voice and not necessarily representative one. Many of us in the group felt that while it is definitely an important voice, there are other contemporary voices of people with mental illness who, for example, may not challenge the authority of professionals to diagnose and treat them but focus on less radical aims of improving the communication with psychiatrists. Some commented that it may not necessarily be a linear process but one that may occur in ‘waves’. The paper (written on 2001) reflects a voice that was maybe more dominant in the 1990s while today the patients’ voice(s), or at least some of them, may be less radically critical(?).

We also discussed the role of health sociologists and anthropologists in the current era, on the background of the more ‘revolutionary’ work of Laing or Goffman. Some people mentioned the work of some of contemporary academics who are involved in a more militant ‘action research’ than many of us,  although some thought  that not all researchers may be up for what it requires to be involved in this kind of action research.  In response to this point participants also pointed to the important role of anthropologists in exposing  and capturing the more mundane, nuanced everyday problems or concerns that people may have with regard to some aspects of their life, concerns that may be not traumatic or life changing enough to induce them for independent action but still deserves research attention. In this regard different views were expressed in regard the issue of the health anthropologists’ role in ‘giving voice’ to vulnerable population where some thought this may be part of the anthropologist role in some contexts, others thought such a perceived role as paternalistic and unrealistic.

Finally we discussed some similarities between the trends that were described in the paper regarding people with mental illness to other groups such as people with autism or, in a different way, to people who fight cancer.

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