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Inclusion paradoxes in mental health: critical reflections on knowledge, (in)justice and privilege
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Full Text E-thesis Volume II
Date
2022-09-04
Authors
Sapouna, Lydia
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Publisher
University College Cork
Published Version
Abstract
This PhD thesis by prior publication speaks to and interrogates my engagement with mental health matters through a critical re-examination of the body of work submitted for consideration. The thesis is theoretically and politically located in the emerging field of Mad Studies, with a focus on epistemic justice and epistemic humility as expressions of prefigurative action.
This is a thesis about knowing and knowers. It highlights my contribution to critical knowledge in mental health, while also interrogating the extent to which this knowledge prefigures more democratic and epistemically just ways of knowing and practicing.
This is a thesis about the complexities, tensions and opportunities embedded in inclusion strategies in the mental health field. Adopting reflexive auto-critique as a methodology guides a double take on my engagement with mental health education, research, and activism. It also guides an examination of the nuanced politics of inclusion, innovation, and criticality in mental health. A reflexive auto-critique involves positioning myself in the making of inclusionary knowledge and practice, providing possibilities for insights into issues of knowing, privileging, engaging, and being an ally.
A common thread linking this body of work is a concern with the paradoxes of inclusion strategies in the field of mental health which, despite being heralded as solutions to social exclusion, do very little to disrupt dominant exclusionary responses to madness and distress. Through this body of work, and this thesis, I propose that innovation and inclusion can only be meaningful when challenging the power imbalances in the context within which they take place. The emerging field of Mad Studies provides a conceptual framework to inquire about knowledge and knowers, to consider issues of co-option and epistemic violence, to focus on pedagogies for unlearning, to ask questions about representational politics and the complexities of being an engaged academic and Mad positive ally.
This thesis is a product of my increasing unease about the appropriation and co-option of potentially radical ideas, such as recovery and service-user involvement, to serve institutional and professional interests. Moving beyond a critique of external systems, I consider how this appropriation and co-option can also happen, willingly or inadvertently, by critical initiatives, including my own praxis. I argue that criticality that fails to engage with the complexities of madness and distress can reproduce patterns of the exclusion it aims to eliminate. I examine how critical initiatives can privilege certain ways of knowing and therefore perpetuate power relations of superiority and epistemic injustice. I also consider how binary positions, including positions critical of dominant biomedical practice, can preserve a culture of knowing about rather than with and from Mad people, ultimately marginalising Mad knowledge. These are unsettling considerations but provide opportunities to unlearn by engaging with the complexities of Mad matters more deeply.
Through these considerations, the concept of prefigurative politics emerges as a central concern in this thesis. Genuine engagements with mental health matters need to model the changes we aim to achieve. Engaging with the tensions of inclusion politics, the complexities of Madness, and the unsettledness this engagement generates, can be a source of knowing through epistemic humility and a resource for networks of solidarity.
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Keywords
Mad Studies , Mental health , Epistemic injustice , Social inclusion , Activism , Psychiatric survivors
Citation
Sapouna, L. 2022. Inclusion paradoxes in mental health: critical reflections on knowledge, (in)justice and privilege. PhD Thesis, University College Cork.