Conference Agenda

This symposium features work that takes a critical and psychosocial approach to issues of mental health and some ethical dilemmas that are raised by work that seeks to engage with the ‘experience’ of mental distress.

We are interested in research that is not only ‘critical’ and ‘psychosocial’ but also acknowledges that the experiences of mental distress need to be understood as fundamental to the phenomena of mental ‘illness and health’. Each of the papers presented here examines different ways of working that attempt to make claims to comprehending ‘experience’, but all raise their own ethical and epistemological questions. We will discuss autoethnographic methods that appear to very directly centre lived experience through authorship itself – but is not without its own epistemological questions. We look at the ethical dynamics of using methods that fuse therapeutic approaches within a research paradigm that explores ‘extremist states of mind’ and the significance of trauma. We explore methods that have attempted to grasp the experience of people who are in secure psychiatric and locked environments where means of expression can be severely limited. We also look at the dilemmas raised through the use of composite vignettes to present the lived experience of research participants.

This paper will argue that historiography can be an essential tool for understanding contemporary experiences of mental health and illness.

This paper will focus on the important categories of ‘personality disorder’ and in particular the diagnosis of ’borderline’. These categories have now become some of the most frequently used, and yet controversial, diagnoses associated with the mental health system. It can be noted that the diagnosis of borderline was born and established through the middle decades of the 20th century, but became popular only in the latter decades of the same century. It will be argued , with reference to archival material from early UK experiments in community therapy in the pre-second world war period, that the emergence of the diagnosis occurred amidst particular social anxieties (concerning unemployment and post-industrialisation) and webs of thinking that we would now classify as ‘transdisciplinary’, or psychosocial. Since then, processes of medicalisation have shorn of some of those meanings and assumptions leaving the diagnosis to impact, unhelpfully on our contemporary experience of ourselves. A historical perspective can help us reclaim more helpful understandings of ourselves and our current dilemmas.

Extremism has become a pressing issue globally, and research into its underlying causes and potential interventions is increasingly important. Qualitative methods, when combined with psychotherapy can support us to understand the interaction between the complex psychological and social factors underlying extremism. This can also help us understand the role of narratives in the development and perpetuation of extremist engagement by allowing individuals to construct, explore and reflect on their own stories.

However, integrating therapy and narratives in research poses several practical and ethical challenges. These include navigating power dynamics between researchers and participants, confidentiality and anonymity of participants, managing ongoing informed consent and acknowledging the potential for harm given the differences between the research and therapeutic roles and relationship and their corresponding obligations and limitations.

This presentation highlights some of these challenges as encountered within my ongoing research that integrates psychotherapy and a narrative approach to explore the role of trauma in extremist engagement. This can support researchers working with or considering working with similar methodologies or populations with ethical and practical challenges to consider when designing and implementing their research projects.

Researchers adopting qualitative methodologies – which centre participation and are concerned with equalising power dynamics - face particular challenges conducting research within secure environments characterised by strict hierarchies and a strict staff/patient binary. Secure mental health settings are tasked with both containment and transformation, with securely policing the border between institution and society and readying patients for return to the community. Such institutions can thus be theorised as a form of ‘rite of passage’, engaged in a process of transformation which both navigates and demarcates social limits. This paper draws on a case study of the ‘Graffiti and Wellbeing Project’ (GWP), an arts project in a UK secure mental health service, to explore how secure institutions manage the difficult emotions and histories of their patients. It is argued that forensic institutions largely attempt to manage their own transgressive, marginal status, and the abject experiences of patients, through a recourse to order, suppression and sublimation. The GWP, by contrast, succeeded to some extent in creating a liminal space for the expression and transformation of these same experiences. Complications of using qualitative methodologies within these institutions are also discussed.