‘It’s Not Fucking Rocket Science’

A follower of this blog has e mailed me after reading yesterday’s post ‘A Culture of Steady and Sustained Improvement???’ in which I discussed  the con that is ‘service user led research’. (I have discussed this elsewhere on the blog as well.) My correspondent has had a look at the websites of a few of these bodies who claim to be ’empowering service users’, from the National Centre for Mental Health Wales through to CAIS through to ‘Choosing Wisely’. He has experienced the glorious mental health services in north Wales for himself and makes the point that a far as he can see, everything that is being presented as ‘service user led research’ is already very well-established (quite true – it was all covered in classical sociological theory years ago and the travesty that is the current incarnation of ‘service user empowerment’ was effectively demolished by scholars like John Clark, Janet Newman and Theo Stickley virtually as soon as it reared it’s ugly head under Tony Blair’s administration). My reader questions the need for all these groups and organisations that are ’empowering service users’ and comments that ‘surely the straplines of these organisations should be part of a professional’s training, to make decisions in the best interests of the patient and as far as possible to involve the patient in their care and treatment and make decisions together. It’s not fucking rocket science’.

No it isn’t rocket science. The reason why ‘service user led research’ has grown legs instead of dying on the vine as it should have, is that the said ‘service user led research’ has been entirely colonised by mental health professionals who are building careers out of it in a way that service users are not and cannot. Two of the biggest names on a UK-wide level are Peter Beresford and Rachel Perkins. Peter Beresford was a former social worker who reconstructed himself as a specialist in service user led research and has got a Chair and an OBE out of it and Rachel Perkins is a clinical psychologist who was the former clinical director of Springfield Hospital at a time when the most appalling scandals were taking place there (I have detailed this elsewhere on the blog), who also reconstructed herself as a service user expert and now sits on the European Commission for Human Rights. Beresford and Perkins know exactly how grim the mental health services are but they have kept completely quiet about the most serious abuses. (As have most people in the Third Sector ‘speaking for service users’ – the one admirable exception is Matilda MacAttram, who campaigns on black mental health issues. Matilda is not afraid to talk about what is actually going on – sectioned mental health patients being tasered by police officers whilst they are actually in hospital, patients being choked to death whilst being ‘restrained’ by nurses, patients dying as a direct result of medical problems caused by the ‘medication’ that they have been forced to take…)

Of course, what mental health professionals who are conducting the ‘service user led research’ never bother to analyse is their dominant social position in comparison with the ‘service users’. Most of them are psychologists, psychiatrists, social workers or mental health nurses and do not have a good grounding in sociology, which is why they are committing such howlers. Any reader of Pierre Bourdieu would see immediately that the problem is domination. Thus the people carrying out the ‘service user led research’ are in a position to call the shots and it is of course they who publish the (sometimes very questionable) research. This has led to spectacles that my correspondent mentions, that of ‘service users’ being forced to travel miles and paraded in front of audiences by the person who is doing the ‘service user led research’. The service user is not in a position to refuse – they are dependent upon the professional or the professional’s network for their care and probably their welfare benefits as well. Saying no is not really an option. I witnessed this at Bangor University about five years ago. Professor Rob Poole, that psychiatrist from north Wales who is so committed to ‘service user research’, turned up at a research meeting with a ‘service user’ in tow to demonstrate just how dedicated he was. The service user didn’t know any of us, had never met most of us before and wasn’t given a chance to meet us before the meeting. She was led by Poole into a meeting with about a dozen experienced academic researchers around a table and asked to explain the ‘research’. She actually said ‘I’m so frightened that I can’t speak’. Poole did nothing at all to put her at ease – that was left to the Professor of Sociology and some of the other researchers. So how empowering was that? At about this time, the person who ‘co-directs’ the ‘Centre for Mental Health and Society’ along with Poole, Professor Catherine Robinson – now the ‘Academic Lead’ for the ‘service users and carers partnership’ with the National Centre for Mental Health – carried out some ‘service user research’ with Dr Richard Tranter. I was interested to see the outputs – all academics involved were cited in full with the service users referred to en masse as ‘and others’. So academics get Chairs, funding and salaries from their service user led research – the service users don’t even get their names on a publication. And they continue to be abused and neglected by some of the very people claiming expertise in ‘service user research’. I also came across a case of a ‘service user’ in south Wales who had been put under so much pressure to perform where the ‘service user led research’ was concerned that he completely buckled under the pressure. Unlike academics who take time off for stress, he didn’t have a salary to fall back on.

Mental health professionals doing rather better themselves from empowering service users than the users does have a history. There is a resurgence of interest in R.D. Laing at the moment and a film about him is shortly to be released. Now Laing trained and worked as a psychiatrist when the likes of T. Gwynne Williams worked as ‘superintendents’ of places like the North Wales Hospital Denbigh. Those institutions were dreadful and people were beginning to question them. Laing was very much sharper and charismatic than your average psychiatrist and he was able to build up a very big following indeed by ‘challenging psychiatry’. It certainly needed to be challenged and much of Laing’s published work is brilliant. But in the same way that Rob Poole is actually doing bugger all to empower service users, Laing’s commitment to liberating mental patients was limited. There was certainly a degree of exploitation – he and David Cooper would these days undoubtedly be considered to have been sexually exploiting, if not abusing, patients. Laing was also known to have walked away from some patients who proved to be a bit too difficult and was alleged to have had some hauled off to the sort of asylums that he built a career out of condemning. His own daughter ended up as an in-patient in a particularly dreadful institution, in fact I think it was the Royal Gartnavel Hospital, where Laing had worked himself. Members of his family allege that he abandoned this daughter to that institution. Many years ago I met someone who had known Laing at the height of his fame. This man had been a patient of his and had said that there was a great deal of neglect going on. He and other patients would have appointments with Laing and would be there waiting – only to be told things like Laing wouldn’t be available for their appointment  but he had been seen in the country within the last week, so they were expecting to see him soon. Not very liberating really when you’re suffering and you’ve waited months for the appointment. But of course Laing always said the right thing in media interviews – who was to know what was happening to the patients themselves? They weren’t giving lectures and being interviewed. And they weren’t writing the books – or indeed the medical records.

So saying the right thing can hide a very unpleasant reality. In 1999, I met someone who considered himself to be committed to ’empowering’ patients, attending all the right conferences etc. When he discovered that I knew the abusive thugs that were the Arfon Community Mental Health Team, he asked me why they were so unpopular among patients. I gave him a few examples – threatening to assault patients in their own homes, having them arrested on the basis of untrue statements made to the police etc. He told me that he couldn’t understand what was going on because he had met them at conferences and they came across as ‘very radical, followers of Thomas Szasz’. Szasz famously argued of course that mental illness doesn’t exist and likened it to the medieval witch crazes. I know how the Arfon Team used Szasz’s arguments – they used them to bully and neglect patients in a way that I don’t think Szasz meant his ideas to be used. ‘Suicidal? Well it’s your choice – go ahead and kill yourself.’ Free will! And patients of the Arfon Team did kill themselves – in great numbers. Keith Fearns the ‘team leader’ was so used to doing this that he failed to realise that people were taking notes. I know a member of Bangor University staff who was supporting a student with mental health problems who was threatening to throw himself off the Menai Bridge who was aghast when they spoke to Fearns only to be told ‘let him go and do it then – if he bothers me again I’ll section the little bastard’. Ah, a true champion of patients! All this in the name of Thomas Szasz…

My reader’s observations came at a most fortuitous time. Yesterday Dr David Healy tweeted a quote from one of the comments that he had received in response to his latest blog post. The quote was ‘Time to shift our focus from “chemical imbalances” to power imbalances’. I couldn’t agree more David. You had an awful lot more power than Karl Boothroyd did when his family called you out worried about his mental health – you found him out in the snow barefoot and declared him to be ‘as sane as I am’. He killed himself hours later. You had an awful lot more power than another patient who had tried to kill himself repeatedly after being refused treatment by the Hergest Unit when you told his partner that ‘he’ll carry on doing this until he kills himself’ after she went to see you in despair and asked you ‘what happens now’. And you had an awful lot more power than I did nearly twenty years ago when, without my knowledge, you told everyone at the Hergest Unit that if I arrived there I was not to be treated but was to be arrested instead. So yes, I’d agree that we should be looking at power imbalances instead of chemical ones. Your mate Richard Tranter knew that just before he fled to New Zealand when he glared at me, demanded to know who in the university I was talking to regarding what had happened to me at the hands of the mental health services and told me that I was a very powerful person. That was before I took delivery of 10,000 incriminating documents stretching back thirty years. It’s an experiment David! (But you don’t know when the experiment started do you…)  A three decades long ethnographic study of the UK mental health services. Mind you judging from his blog I think Healy’s worked that out in a way that poor old Poole et al haven’t. But then David isn’t as thick as them and his social skills are much better as well – which is how he has managed to build a career challenging orthodox psychiatry whilst up to his eye-balls in some pretty disgusting things. David Healy – a latter day Ronnie Laing! David has made a few snide comments on his blog about social scientists – if only he’d been a sociologist himself he would have seen all this coming… It’s all about domination David – in a purely Bourdeuisian way of course…

I am glad to say that in the last year or so I have read some very strong challenges to the smokescreen for abuse and failure that is service userdom, but it seems to be largely concerning groups other than people with mental health problems. Some of the best material that I’ve come across has been regarding people with learning disabilities, who are being exterminated by the health and welfare services in much the same way as people with severe mental health problems are. Perhaps healthcare professionals themselves haven’t got quite such a tight grip on that field of research. The outlook in mental health remains grim. Despite all the dosh being thrown at ‘service user led research’ in mental health, the one thing you will not find funding for or be able to place in health and social care journals is work exploring the abuse of patients by mental health professionals. I am not the only person to have noticed this. The feminist historian Professor Barbara Taylor wrote an excellent autobiographical account of her experiences as one of the last patients in Friern Barnet Hospital, ‘The Last Asylum’, and being an academic herself conducted an extensive search for literature in health and social care journals concerning abuse of patients in the mental health system – like me, she found hardly any. Because it just doesn’t happen does it…

Author: Sally Baker

I am a writer and a sociologist, originally from Somerset, but I’ve been based in Wales for most of my life. I had my first encounter with a mental health professional in 1984 at the age of 21. My GP described this man to my then partner – who also became a sociologist – as someone who had experienced ‘considerable success’. My meeting with this psychiatrist was a disaster and we attempted to complain about his insensitivity and highly inappropriate behaviour. That was the first time we were threatened and pressurised to withdraw a complaint against a mental health professional. This man is long dead – he was a retired psychiatrist from the North Wales Hospital Denbigh, T. Gwynne Williams, who was working shifts in the student health centre at University College of North Wales (now Bangor University). We discovered years later that this ‘successful man’ was notorious – he had been an enthusiastic lobotomist…

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