Academic and cultural contexts

Anthropology of Suicidology employs Greg Dening’s description of academic disciplines to develop a perspective on suicidology that understands it as a culture.  The original version of the paper was written for the annual conference of The Australian Sociological Association (TASA) in December 2004, where it was submitted (successfully) for one of the conference ‘student scholarships’.  The referees’ report from TASA called for a change in title to A Sociology of Suicidology, which I reluctantly agreed to at the time, but its original title is restored in the expanded version of the paper here.  For me, an anthropology suggests more strongly the intersubjective cultural aspects of a community that is once again first-person, only this time it’s the plural first-person ‘We’.

It was suggested to me numerous times during my research to consider the work of Michel Foucault to critique the social, historical and political structures of suicidology.  Although I acknowledge Foucault’s approach, the most important knowledge I have to contribute to any analysis of suicidology is of someone who has been on the first-person, subjective, receiving end of its discourse.  I view suicidology ‘from the inside’, rather than as a detached, dispassionate, objective observer.  As seen in Phenomenology of Suicidality, I research and write primarily from the first-person perspective – the view from Mad Culture – not as a sociologist or historian, and certainly not as a suicidologist as currently defined by the discipline.

I also agree, up to a point, with Derrida’s critique in Writing and Difference (Derrida 2001) of Foucault’s Madness and Civilisation(Foucault 1967).  Derrida argues that in attempting to write a history of madness that does not objectify, imprison and silence it, as psychiatry does, Foucault falls into the trap of a different kind of objectification of madness.  Foucault seeks to give madness the authority to speak on its own terms and in its own language – a noble aim – but he does this from an objectifying, third-person, rationalist perspective.  Derrida claims Foucault “attempts to write a history of madness itself without repeating the aggression of rationalism” (Derrida 2001 p 40) but that he ultimately and inevitably fails.  Where I disagree with both Derrida and Foucault, and why Foucault’s noble aim is inevitably doomed (as Derrida rightly points out), is that both authors assume that the defining characteristic of madness is irrationality.  Moreover, both Derrida and Foucault privilege rationality – and a very objective rationality at that – as superior to other forms of knowing, understanding and communicating.  Mad Culture – and my thesis – disputes both these prejudices.

The next paper in this exegesis, Integral Suicidology, gives a more formal definition of the first-person intersubjective, cultural ways of knowing and third-person, objective, social ways of collective knowledge.  Before we get there, it is useful to contrast the culture of suicidology (and most mainstream approaches to mental health in general, and psychiatry in particular) with that of Mad Culture.  It is necessary to stress again, as I do in Phenomenology of Suicidality and in Integral Suicidology, that the first-person subjective knowledge is not being proposed as a substitute instead of third-person objective knowledge, but rather as well as.  It is no longer tenable for suicidology (and mental health in general) to continue to dismiss and exclude first-person knowledge from the discipline.  Integral Suicidology (and also Bridging the Spirituality Gap in the appendix) further argues that spiritual ways of knowing must also be brought into our understanding of suicide as a crisis of the self.

Currently, Mad Culture is primarily a social change, human rights movement that is working to a mostly political agenda and only just beginning to establish an academic discourse around the lived experience of madness.  It sees itself in the tradition of similar movements of recent times, such as the civil rights movements of indigenous and coloured people, women’s liberation and feminism, Gay Pride, and also other disability movements that have achieved so much for the rights and dignity of these communities.  The political catchcry of Mad Culture around the world is ‘Nothing About Us Without Us’, which immediately speaks of the demand for the first-person voice of madness to be heard as part of the public debate on mental health.  It also has echoes of the feminist political slogan that ‘the personal is political’, which has since become a recognised and established theme in feminist academic discourse.  And it resonates with much of the postmodern discourse around how we conceptualise the ‘other’, including the social, historical and political forces that often demonise, marginalise and silence those who are different, as Foucault and others have analysed and described.  Despite the criticisms of Foucault above, he must be acknowledged for his work in helping to create the possibility of academia opening its doors to Mad Culture.  But the time has come for us to speak on our own behalf.

Arguing the politics of Mad Culture is not the subject or purpose of this thesis.  My aims are: to argue the validity and importance of first-person and spiritual ways of knowing for understanding suicidality; to demonstrate their absence from current thinking about suicide in suicidology; and to propose ways that these gaps can be addressed.  To do this it has been necessary to identify the absence of something of significance in the literature of the discipline, which can be a difficult task though I believe the papers in this exegesis, along with Thinking About Suicide, achieve this.  Similarly, the absence of Mad Culture perspectives from academic suicidology – and academic mental health in general – is also easily overlooked.  Given that I locate my work within Mad Culture, as well as phenomenology, some discussion of Mad Culture as a robust social and political discourse, with an emerging academic voice, is necessary for understanding an important context of this thesis.

My first encounter with the term ‘Mad Culture’ was in Stopovers On My Way Home From Mars by Mary O’Hagan (O’Hagan 1993).  O’Hagan is a pioneer of Mad Culture who has gone on to become one of three Mental Health Commissioners in New Zealand.  Like many other mad activists, her work over many years has mostly been to fight for the human rights of the mad and to campaign for improved mental health services that include greater ‘consumer participation’ in all aspects of mental health policy.  Another pioneer is Judi Chamberlin, whose book On Our Own: Patient-Controlled Alternatives to the Mental Health System (Chamberlin 1978) is considered a classic of Mad Culture.  Other pioneers of Mad Culture who have inspired my research include David Oaks from the US, founder of the MindFreedom human rights organisation (www.mindfreedom.org), and Sylvia Caras, also from the US, who set up and administers the ‘People Who’ group of internet communities (www.peoplewho.org).  Further inspiration (and context) for my research comes from people such as Mary Nettle in the UK, the current Chair of the European Network of Users and Survivors of Psychiatry (ENUSP), and Peter Lehmann from Berlin, whose book Coming Off Psychiatric Drugs (Lehmann 2002) I contributed a chapter to prior to commencing this PhD.

In Australia, many mad colleagues inform, sustain and inspire my research.  The Victorian Mental Illness Awareness Council (VMIAC) is the ‘peak body’ run by and for mental health consumers in the state of Victoria where I live.  In many ways, VMIAC has been the home of Mad Culture for me during my research – as Victoria University has been my academic home.  Under its Director, Isabell Collins, the staff and membership of the VMIAC have been the local context of my research and the community that reminds me of why I do the work I do.  (They have also kept me grounded when I’ve drifted off into the heady atmosphere of academia.)  Nationally, the Australian Mental Health Consumer Network (AMHCN) has informed my understanding of Mad Culture through, amongst others, its patron Janet Meagher, current chairperson Helen Connor and deputy-chair Gwen Scotman.  But I especially wish to acknowledge two people who have been mentors and guides for me during my research – Merinda Epstein and Cath Roper.  Merinda recently won an award from the Australian Human Rights and Equal Opportunities Commission (HREOC) for her many years of service articulating the first-person (consumer) perspective on mental health.  And Cath works as the Consumer Academic at the Centre for Psychiatric Nursing Research and Practice (CPNRP), a job title that I hope we will see much more often in the future.  Merinda and Cath have helped me learn how to celebrate my madness – and Mad Culture – and around them a small group of mad activists has emerged who call themselves insane australia, with a bat as its mascot and the motto ‘Batty Is Beautiful’.

Internationally, my primary association with Mad Culture is through the World Network of Users and Survivors of Psychiatry (WNUSP –www.wnusp.org).  Mary O’Hagan was one of the founders of WNUSP and in 2004 I had the good fortune to attend its first international congress in Denmark where over 250 wonderfully mad people from 50 countries met for four days of Mad Culture discourse.  WNUSP is primarily a human rights organisation that seeks to give voice – first-person voice – to the lived experience of madness.  Its major current project is as an accredited NGO at the United Nations, where one its Co-Chairs, Tina Minkowitz, a mad human rights lawyer from the US, leads a delegation participating in the UN Convention on the Rights of People with Disability.  As well as arguing for the human rights of the mad, Tina and the team at the UN are finding strong support from other disability organisations that are in many ways more advanced than Mad Culture in their own struggles for disability human rights.  As with the history of feminism, the (physical) disability movement now has the robust, lively and independent academic discourse that is only beginning to emerge for Mad Culture.  I acknowledge Tina Minkowitz now for informing and inspiring my research, along with her two WNUSP Co-Chairs, Iris Hoelling from Berlin and Moosa Salie from South Africa, and also the WNUSP Board representatives for the Asia-Pacific region – Mari Yamamoto (Japan), Chris Hansen (New Zealand), and Bhargavi Davar (India).

This brief survey of Mad Culture is not just an acknowledgement of those who have inspired my own work.  It tells a little of the history, literature, participants and politics of Mad Culture, picking up on Dening’s description of an academic culture that I used to analyse suicidology.  It shows that Mad Culture is an extensive community with an already robust discourse, primarily around issues of human rights but also on greater consumer participation in mental health.  This is the culture that is the background context for my research, a stark contrast to the culture of suicidology.

Although Mad Culture already has this robust social and political discourse, its development as an academic discourse is still in it early stages.  But we are not entirely without some significant voices in academia that speak from the first-person perspective on mental health issues.  In Australia, Cath Roper has already been mentioned as a Consumer Academic at CPNRP in Melbourne, and Kathy Griffiths is Director of the Depression and Anxiety Consumer Research Unit at the Centre for Mental Health Research at the Australian National University.  And Emma Pierce is another mad inspiration for me as a fellow PhD student working with themes of madness, suicidality and spirituality after self-publishing several books, including her own story of madness in the brilliantly titled Ordinary Insanity (Pierce 1987, 2002),.  Another brilliantly titled (and entertaining) book from a local ‘nutcase’ is Gas Smells Awful – The Mechanics of Being a Nutcase by journalist and radio personality Helen Razer (1999).  And the published works and performances of Sandy Jeffs also inspire me, with her first-person poetry of madness, such as Poems From The Madhouse (Jeffs 1993).

In the US, Judi Chamberlin is currently a researcher at the Boston University Center for Psychiatric Rehabilitation.  Other consumer-survivor researchers include Diana Rose at the Service Users Research Enterprise (SURE) in the Institute of Psychiatry at King’s College in London, Pat Deegan at the University of Kansas, and Larry Davidson in the Department of Psychiatry at the Yale School of Medicine, to mention just a few.  In New Zealand there is the research of Julie Liebrich, Mary O’Hagan’s predecessor as the consumer-survivor Mental Health Commissioner in New Zealand, who dares to argue so boldly and so eloquently for the need for spirituality in mental health (Liebrich 2004a, 2004b).  These and a growing number of other consumer-survivor researchers are also part of the cultural context (recalling Dening’s description once more) of my research.

It should not be assumed that all the people mentioned above embrace the language of madness and Mad Culture as I do.  Some mental health consumers, or psychiatric survivors, still regard madness as a pejorative term and it would be inappropriate of me to suggest that all these people identify with Mad Culture.  I know from their public statements that Mary O’Hagan, Judi Chamberlin, David Oaks, Peter Lehmann, Chris Hansen – and my mentors Merinda Epstein and Cath Roper – certainly do, but some of the others may not.  What all these people do have in common is their own first-person experience as a consumer-survivor and an understanding that the first-person knowledge of mental health difficulties (or madness) is essential knowledge that is largely absent from the current discourse on mental health.

Difficulties with the language we use to identify ourselves is evident in the PhD dissertation of Linda Morrison.  Now published as a book, Talking Back to Psychiatry: Resistant Identities in the Psychiatric Consumer/Survivor/Ex-Patient Movement (Morrison 2005) is a major contribution to the academic discourse of Mad Culture that examines its history and politics, primarily in the US.  The title captures again the cry of the first-person voice to speak for ourselves and claim our own identity and discourse.  It also indicates the language difficulties in how we identify ourselves in this discourse.  In Australia, the mad are usually referred to as mental health consumers, while in the UK the term ‘service user’ is used, sometimes abbreviated to just ‘user’.  Others prefer to identify as a ‘psychiatric survivor’, sometimes shortened to ‘survivor’, though this has been a problem for me in my work because suicidology has appropriated this word to identify those bereaved by suicide, something that contributed to my feeling invisible to suicidology when I first encountered it.  Yet others prefer to identify as ex-patients, so that all these possibilities are sometimes abbreviated as C/S/X, as in Morrison’s dissertation.  Another useful reference that would perhaps be a good companion for Morrison’s thesis is Professor Gail Hornstein’s extensive ‘Bibliography of First-Person Narratives of Madness’ (Hornstein 2005).

One further example of Mad Culture at work, and its emergence in academia, is a recent conference in Milan on Mental Health: the Consumers’ View.  The conference was held by the World Association of Psychosocial Rehabilitation (WAPR), which is not a consumer-survivor run organisation – indeed it seems to be led mostly by psychiatrists.  Consumer-survivors are all too familiar with conferences where the experts and others talk ‘about us without us’, but on this occasion WAPR made sure that over half of the speakers invited – and their expenses paid – were consumer-survivors.  Another aim of the conference was to help develop the consumer-survivor community in Italy so that of the 400+ people who attended (nearly double what they expected) over half were consumer-survivors, and not charged a registration fee to attend the conference.  Most of the consumer-survivors invited to speak at the conference were invited through WNUSP, but also some from ENUSP and a few others.

Through my association with WNUSP I was invited to speak on the ‘consumer view on research’, one of the four themes for the conference.  The first thing that must be said about the conference is that it was a safe space for consumer-survivors to give voice – first-person voice – to their experiences and knowledge.  It was not ‘our’ conference, but our collective voice was clearly the strongest voice there, making it a safe space to tell our stories, whether academic ones or otherwise.  This is in stark contrast to most other mental health conferences I’ve attended, where I have felt isolated and intimidated, such as my unpleasant experiences at the Suicide Prevention Australia (SPA) conferences described in Anthropology of Suicidology.  Recalling Dening’s description of academic culture once again, we see that the prevailing culture in mental health, with its ‘politics of exclusion’, typically marginalises and silences the first-person voice.  On this occasion though, our voices were heard.  To appreciate the response to the various presentations (including my own), and also the other conversations that took place at the conference, it is useful to recall the fourth step of validation in the phenomenological method described in Phenomenology of Suicidality.  In this ‘community of the adequate’ among my peers who also spoke from the first-person perspective of madness, there was considerable intersubjective validation – phenomenological nods – for the many challenges heard at this conference to the dominant, predominantly medical, discourse on mental health.  It is true that the academic argument and the political struggle often overlapped and at times were blurred – exactly as it was in the early days of women’s liberation and feminism.

One of the problems for Mad Culture in academia is that many of the current consumer-survivor researchers work in schools of psychiatry or psychology (or similar) where a medical or clinical perspective can limit what research questions are asked and how they are researched.  In the absence of our own academic schools, conferences and other forums, the opportunities to develop the academic discourse of Mad Culture are still rather limited.  Unlike the WAPR conference in Milan, we typically have to beg at the door of other disciplines to try and be heard, and often find this door is tightly closed to us.  We find, again following Dening’s description of an academic culture, that we are only permitted into the discourse when we conform to the “acceptable forms of evidence, acceptable questions, acceptable criteria of judgments, [and] acceptable languages of communications” of the discipline.  When an academic discipline regards first-person research as not valid or ‘real’ research, as suicidology does, then the vital first-person voice is inevitably marginalised, silenced and excluded – as it is in suicidology.

This parallels (again) the early days of feminism where women had to fight a political struggle in order to be heard, but now we see a range of women’s studies departments and courses in our universities contributing to the robust, lively and independent discourse of feminism we have today.  A comparison has been made among my mad colleagues that academic Mad Culture today is at the stage feminism was before, say, the publication of The Female Eunuch, which I think is a reasonable approximation.  And as with feminism in the 1960s, or women’s liberation as it was aptly called then, the major activity of Mad Culture is currently mostly in the political arena.

This brief review of Mad Culture identifies the context of my own research, even though there is currently only a minimal presence of Mad Culture in academia.  The distinguishing characteristic of Mad Culture is that it speaks from the first-person perspective of the lived experience of madness.  This makes it very different from other critical voices in the history of madness and psychiatry.  Mad Culture is sometimes perceived (and often dismissed) as part of the ‘anti-psychiatry’ movement that includes R.D. Laing, Thomas Szasz, Loren Mosher, Peter Breggin and others.  Although the work of these people, and others such as Foucault, is an important part of the history and context of Mad Culture finding its voice, all these critics of psychiatry speak from the third-person perspective.  Mad Culture welcomes the continuing critical discourse from dissenting voices within psychiatry, psychology and sociology, but this can never be a substitute for the first-person voice.  Our ‘sister’ social change, human rights movements have all recognised this and have all gone on to establish substantial first-person academic discourses around civil liberties, feminism, gay rights and (physical) disability.  Mad Culture has not yet quite achieved this, but it is inevitable that it will with the support of the strong and growing voice of the wider Mad Culture movement.  It is time for us to speak for ourselves.

In broad terms, my research is within the social sciences, which seems a more appropriate academic and cultural environment for Mad Culture research than schools where third-person, ‘objective’ science dominates.  My thesis argues for more mad research, and in many ways the social sciences would be the natural home for this.  There is currently a proposal before the Australian government for a Centre for Consumer Perspective Studies to develop a curriculum for bringing more of the consumer-survivor perspective into the education of the mental health workforce.  This would be a big step forward for the mental health system, but my thesis argues for a broader research agenda that addresses more than just the delivery of mental health services.  Some mad colleagues suggest that we need Mad Culture courses and departments in our universities similar to feminist ones, which I would support.  But a better approach might be to develop courses and departments of ‘First-Person Studies’, in which Mad Culture would be one of many lively discourses.

Thus far, this exegesis has looked at two distinct ways of knowing that are relevant to the understanding of suicidality, though both are largely neglected by suicidology.  First, the individual, subjective knowledge of suicidality ‘from the inside’ is given voice inThinking About Suicide, with Phenomenology of Suicidality arguing for a greater place for this voice in suicidology.  Second, as shown in Phenomenology of Suicidality, collective, intersubjective knowledge is the means for validating individual, subjective knowledge.  Bringing these two knowledge domains into suicidology would go a long way towards addressing the gaps in the discipline identified in Anthropology of Suicidology.  But another way of knowing – spiritual knowledge – is also absent from suicidology and a phenomenological approach would only partially address this gap in the discipline.

I said earlier that spiritual ways of knowing could, in some ways, be seen as a particular kind of first-person knowledge, and that suicidology needs to open its doors to the first-person voice before we can begin to bring spiritual wisdom into the discipline.  Many people, though, would still regard first-person phenomenological knowledge as mental knowledge.  But as Thinking About Suicidedescribes in detail, spiritual ways of knowing are very different and quite distinct from any mental knowledge.  To address the absence of spirituality from suicidology we need a conceptual model that recognises its absence and is capable of integrating spiritual wisdom with other forms of knowledge (including traditional third-person knowledge) in a more comprehensive and coherent framework.  The Integral Model of the American philosopher Ken Wilber achieves this and is the model used in the next paper, which proposes an Integral Suicidology.

The original version of Integral Suicidology was presented at the 2003 conference of Suicide Prevention Australia (SPA) – within the theme of Finding meaning to sustain life: The place of spirituality in suicide prevention – and was published under the title ‘Self, Soul and Spirit – Suicidology’s Blind-Spots?’ (Webb 2003).  The version here, with a new title, is substantially the same but with some minor revisions after a very recent (July 2005) conversation with Wilber to prepare it for publication in a forthcoming issue of the Integral Institute’s Journal of Integral Theory and Practice.