Mental illness recovery, self-responsibilization, and relational agency: – a discussion of practice ambiguities and collective spaces of possibility

In this paper, I question and problematize the individualization of self-responsibility in mental illness recovery. With reference to the work of Stetsenko (2013) and Edwards (2005; 2010) among others, the paper seeks to explore and discuss how individual and collective responsibility is intimately intertwined and, subsequently, consider the implications in relation to social-psychiatric practice.
To empirically ground the discussion, the paper draws on participant observations from Bethel House, a Japanese social-psychiatric facility, where the main motto is “By myself, with others”. Here, work is centered around ‘tohjisha kenkyu’, a collective, explorative approach to mental illness, anchored in a strong community of practice. This points to the necessity of prioritizing meaningful social communities in social-psychiatric recovery work in order to enable and facilitate the development of (self)responsibility, as a core feature in the recovery process. I propose that thinking with CHAT might help us in this endeavor.


Extended abstract:
In Denmark, the recovery paradigm has moved from a critical user’s movement perspective to become integrated in the political agendas for psychiatry. This implies the implementation of recovery schools, recovery mentors, peer-to-peer programs, along with the integration of peer workers in the psychiatric sector. All of this is intended to install hope and support people’s individual recovery journeys. And albeit this is in many regards a very positive development in the field, it also comes with ambiguities relating to 1) how to comprehend recovery, and 2) how to facilitate it. E.g., in recent years a significant body of critique has arisen regarding recovery as a prolongation of a neoliberal governing rationale (Harper & Speed 2012, Oute 2016, Hansen 2008). Regardless of the reading of the recovery-paradigm, self-responsibilization seems to be part of it: in the original paradigm, the development of self-responsibility was a critical response to the paternalism of a disenfranchising psychiatric system. In a neoliberal reading, self-responsibilization is an inevitable part of the ‘projectification’ of the self (implying self-optimization) (se also Rose 1999; 2009).

From a CHAT perspective, this fosters questions regarding the dialectical nature of self and subjectivity, and hence how to comprehend – and facilitate – recovery and the development of (self)responsibility, without individualizing neither mental illness issues, nor recovery.
To address some of the issues that this entails – and what perspectives for future practices arise when thinking with CHAT – in this paper, I will explore the community of practice at Bethel House (Hokkaido, Japan) where they explicitly work with the development of self-responsibilization without disconnecting it from a collective effort (see also Ishihara 2013; Mukaiyachi, Kono, Kodama & Hoshino 2019; Nakamura 2013). Here, Stetsenko’s (2013) notion of ‘collectividual’ is helpful in comprehending (self)responsibilization as a dialectical subjective and collective relation.
I will draw on my own empirical work at Bethel House in order to, from a CHAT perspective, draw forth some of the central aspects of their work and use this as grounds for discussing the perspectives to further develop a Nordic (social)psychiatry. Here, Edwards (2005;2010) notion of ‘relational agency’ becomes central, just as a notion of ‘(dis)connecting activities’ (Karpatschof 1989; Pedersen 2019).

There is no doubt that recovery is an important movement and a much-needed historic development and paradigmatic shift in psychiatric work, but my concern is that – in line with criticisms presented by amongst others Schön, Denhov & Topor (2009), Topor, Borg, Di Girolamo & Davidson (2011), Harper & Speed (2012) and Topor, Larsen & Bøe (2020) – that unless we take a critical stance in relation to how ‘recovery’ is implemented in practice, we risk subjecting people suffering from mental illness issues and/or psychosocial problems to the same ‘locked’ societal positions as earlier, however under other and less transparent headings. In so doing, we risk replacing a paternalistic disenfranchisement with an individualistic responsibilization for matters that are beyond the disposition of the person. Or we risk rephrasing complex societal issues as individual lack of motivation or engagement. In this paper, my aim is therefore to critically address and aspire to overcome some of these issues, by means of a CHAT-perspectives, with the hope of inspiring new critical questions as well as new forms of psychiatric practices.


References:

Edwards, A. (2005). Relational agency: Learning to be a resourceful practitioner. International Journal of Educational Research, 43(3), 168–182.
Edwards A. (2010): Being an Expert Professional Practitioner: the relational turn in Expertise. Dordrecht: Springer
Hansen, T. (2008). Selvudviklingens opkomst i psykiatrien. I: Brinkmann, S. & Triantafillou, P. (ed.), Psykens historier i Danmark. Frederiksberg: Samfundslitteratur.
Harper, D. & Speed, E. (2012): Uncovering Recovery: The Resistible Rise of Recovery and Resilience. Studies in Social Justice. Volume 6, Issue 1, 9-25. https://doi.org/10.26522/ssj.v6i1.1066
Ishihara, K. (2013): Philosophy and Development of Tohjisha-Kenkyu (Japanese). I: Ishihara, K. (ed.): Study of Tohjisha-Kenkyu (Japanese), Tokyo: Igakushoin. 『当事者研究の 研究』医学書, 12-72
Karpatschof, B. (1989). Galskaben, psykiatrien og virksomhedsteorien. In M. Hedegaard, V. R. Hansen and S. Thyssen (Eds), Et virksomt liv – udforskning af virksomhedsteoriens praksis (pp. 104–20). Aarhus: Aarhus University Press.
Mukaiyachi, I., Kono, T., Kodama, C. & Hoshino, Y.:(2019): Understanding your own words: Identifying patients with schizophrenia using the program of Tojisha Kenkyu. In: Murakami, K., Cresswell, J., Kono, T. & Zittoun, T.(red.).: The Ethos of Theorizing. Canada, Captus Press,
Nakamura, K. (2013). A disability of the soul: An ethnography of schizophrenia and mental illness in contemporary Japan. Cornell University Press.
Oute, J. (2016): Lovprisning af pårørende. Inddragelse og ansvarsforskydning i psykiatrisk behandling. Social Kritik, nr. 148, december 2016
Pedersen, S. (2019): When Young Adulthood Presents a Double Challenge: Mental Illness, Disconnected Activities and Relational Agency, in: Hedegaard, M. & Edwards, A. (eds.). Supporting Difficult Transitions: Children, Young People and their Carers, London: Bloomsbury Academic, p. 221-240.
Rose, N. (1996): Inventing our selves – Psychology, power, and personhood. Cambridge University Press
Rose, N. (1999). Governing the Soul: The Shaping of the Private Self (2nd ed.) London: Free Association Books.
Schön, U. K., Denhov, A., & Topor, A. (2009). Social relationships as a decisive factor in recovering from severe mental illness. International Journal of Social Psychiatry, 55(4), 336-347.
Stetsenko, A. (2013). The challenge of individuality in cultural-historical activity theory: “Collectividual” dialectics from a transformative activist stance. Outlines. Critical Practice Studies, 14(2), 07-28.
Topor, A., Borg, M., Di Girolamo, S. & Davidson, L. (2011): Not just an individual journey: social aspects of recovery. International Journal of Social Psychiatry. Vol 57(1): 90–99 DOI:10.1177/0020764010345062
Topor, A., Larsen, I.B., & Bøe, T.D. (2020): Återhämtning – från personlig reformering till social förändring. Published on the website www.madinsweden.org on 05.04.2020. https://madinsweden.org/2020/04/aterhamtning-fran-personlig-reformering-till-social-forandring/).