Justice, Respect, and Recognition in Mental Health Services

This chapter raises a key question for the interdisciplinary study of health and justice: is dialogue possible between theoretical models and first-person testimony about the harms caused by injustice? To consider this question, the chapter examines the claim that disrespect—the systematic devaluation of others in a way that excludes them from reciprocal social relations—is a form of injustice. The philosopher Stephen Darwall and social theorist Axel Honneth conceptually elucidate the links between justice, respect, and recognition. Their normative arguments offer a high-order conceptual framework for recognizing people’s equal worth as human beings (and the harmful effects of denying such recognition). This chapter compares their abstract frameworks with a landmark autobiography by a founder of the psychiatric survivor movement. The search for commensurability between these texts exposes the precise difference between experience-far and experience-near genres of ethical expression. This chapter adopts a similar approach as DeBruin et al. (this volume) in examining popular cultural discourses in light of formal theory. Both chapters take seriously the lay narratives and forms of ethical argumentation that circulate outside the academy. Both envision a plural ethics of justice and health that acknowledges how ordinary people interpret and respond to institutionalized oppression in health-care services.

Psychiatric Survivors and Experiential Rights

Human rights may be categorised as belonging to ‘three generations’: political, social and ‘solidarity’ rights. This paper considers this schema theoretically, deploying the example of the ‘psychiatric survivor’ movement in Britain in support of its central claims. Psychiatric survivors comprise groups of psychiatric patients who have campaigned both for political and social rights in addition to a singular form of ‘right’, which is referred to here as ‘experiential’. The paper clarifies the meaning of the ‘experiential right’ and, drawing upon aspects of social theory, considers how it is to be understood in the context of the ‘three generations’ schema.

Beyond the counter-narrative

The discourse of the medical model of mental illness tends to dominate people’s conceptions of the origins and treatments of psychopathology. This reductionistic discourse defines people’s experiences of psychological distress and recovery in terms of illnesses, chemical imbalances, and broken brains. However, the master narrative does not represent every individual’s lived experience, and alternative narratives of mental health and recovery exist that challenge our traditional understandings of normality and psychopathology. Guided by the method of interpretive interactionism, we examined how psychiatric survivors position themselves in relation to the medical model’s narrative of recovery. In its inception, the psychiatric survivor movement created a counter-narrative of protest in opposition to the medical model’s description and treatment of psychopathology. Since then, the movement has moved beyond the counter-narrative and has constructed an alternative narrative; one that is not defined in opposition to the master narrative but instead participates in an entirely different discourse.