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I'm going to venture some thoughts on psychiatry, activism/advocacy & change that hopefully *de-center* medications. (Thread.) https://twitter.com/shayla__love/status/1298646511333638146
(1) whether we're talking about increased rates of disability since de-institutionalization or influences on 'recovery,' arguably the central forces are not medications at all but policy--specifically re social welfare, healthcare, jobs and the economy, housing
(2) Notably, not only did the repeal of the Community Mental Health Act devastate services but also 90s era 'workfare' (welfare) reforms; & many facets of the US disability benefits system & the ways in which disability, poverty and race have become entangled.
Helena Hansen and colleagues work, including 'Pathologizing Poverty' ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920192/) providers very helpful insights into the ways in which reconfigurations of disability-driven welfare policy have impacted poor communities
(3) Wrt psychosis, humility is a requisite: there is so much we don't know/haven't figured out. & what we're really talking about is a sprawling, heterogeneous set of conditions/experiences. My question, w humility, how do we respect/honor the full range of these experiences?
Places to start: resisting any tendency to 'generalize' given the many probable causal pathways involved, underlying mechanisms, & sociocultural influences on conceptualization, service access & personal response.
Thoughtfully acknowledging the social consequences of claims that over-step extant science & risk invalidating difficult personal choices--eg risks of 'pill shaming', of elevating/moralizing certain treatment choices over others (cd be therapy, peer support, spirituality, meds)
(4) Wrt to folks w ongoing, significant disability: Acknowledging that they are almost never part of the conversation, that the heterogeneous nature of 'madness'/disability easily leads to new hierarchies even w/in activist circles. Also deep forms of racial marginalization.
On this cf Jayasree Kalathil & my Unsettling Disciplines ( https://muse.jhu.edu/article/648225/summary) and my Inconvenient Complications ( https://www.researchgate.net/publication/267096813_Inconvenient_Complications_On_the_Heterogeneities_of_Madness_and_their_Relationship_to_Disability)
And @DianaRose160 and Jayasree's Power, Privilege & Knowledge ( https://www.frontiersin.org/articles/10.3389/fsoc.2019.00057/full)
(5) When it comes to making change happen, of course I'm a researcher, so one thing I'd argue we need is systemic efforts to build up research capacity w/in the service user community, and meaningfully co-produced research; good research is slow, systematic, critical & thoughtful
To do this we have to sort through an incredibly complex set of power relations/hierarchies, we have to ask a lot of hard questions, we have to be able to make sacrifices. And the difficulties really can't be overstated.
(6) We also need to address other "inconvenient" intersections such as offending-violence-incarceration-disability & sort through what IMO remain very unworked through feelings/assumptions about 'offenders' on all sides. (This is just one example; global mental health is another)
(7) To wrap up: I'd love to see more dialogue about the above, actively de-centering 'debate' that revolves around medications & diagnosis or at least making room for these other issues, contexts, considerations that exert such profound influence over in public sector MH.
