Mixed Bag #21: Diana Rose on Mad Knowledges and Epistemic Collisions
“Mixed Bag” is a series where I ask an expert to select 5 items to explore a particular topic: a book, a concept, a person, an article, and a surprise item (at the expert’s discretion). For each item, they have to explain why they selected it and what it signifies. — Awais Aftab
Diana Rose, PhD, is a retired academic, a leading figure in user-led research, and was the world’s first Professor in User-Led Research at King’s College London. She was born and raised in a semi-feudal economy in the North of Scotland. She made it to university and then had two academic careers. The first centered on social psychology, language, and feminism, but was terminated by the mental distress that had been with her all her adult life. She spent the next 10 years in and out of hospital, ‘living in the community,’ and never expecting to work again. At the same time, in these 10 years, she became heavily involved in activism. She was in the right place at the right time. The UK government wanted to involve ‘patients and the public’ in research. And so a source of stigma became a qualification for one job in particular. This first job comprised peer evaluation of services by the ‘most vulnerable.’ In 2001, she was approached to go to the Institute of Psychiatry as ‘Co-Ordinator’ of the Service User Research Enterprise (SURE), a team of user/survivor researchers. In 2013 she became the Professor in User-Led Research at King’s College London. She retired in 2020 and now lives in France. Her latest book is Mad Knowledges and User-Led Research (2022), published by Palgrave.
Diana Rose: After spending a lifetime immersed in these issues, I have come to the conclusion that Mad Knowledges, as and when they develop, are on a collision course with what counts as knowledge for mainstream ‘psy’. I will look at this in two ways — through the idea of epistemic injustice and through language.
Miranda Fricker identifies two types of epistemic injustice: testimonial and
hermeneutical. Testimonial injustice concerns not being a credible knower and is often discussed in the context of the clinical encounter. Hermeneutical injustice refers to the absence of a publicly available narrative through which to articulate a position. Sometimes this is referred to as the hermeneutic ‘gap’ or ‘lacuna.’ It is therefore inherently social. One can see then how the argument works. The clinical encounter is positioned as an ‘interpersonal event’ (it isn’t, but never mind) and therefore the injustice is perpetrated on the individual patient or survivor. In discussions about psychiatry, and philosophy around psychiatry, most focus has been on testimonial injustice. This is crucial, but not enough.
For me, hermeneutic injustice is far more important. By hermeneutic injustice, Fricker means injustice at the level of understanding, the constraints that make it almost impossible to develop a new way of interpreting experience. The dominant field of meaning around mental health in the West today is ‘psy’ — psychiatry and all the little ‘psys’ attached. The kinds of explanations that it proposes are hegemonic, which means that it is extremely difficult for those who are the subject of psychiatry to develop new ways of understanding their experience. Hermeneutic injustice operates not just at the individual level but socially, across both everyday knowledge and the understandings available to those with “mental health problems.” Psychiatry, I have argued elsewhere, has no theory of the social (D. Rose & Rose, 2023). Silent on the social, psychiatry is therefore silent on the question of hermeneutic injustice, which, if recognized, has the potential to bring about massive change in the way we understand “mental health.” Hence the collision.
The dominant field of meaning around mental health in the West today is ‘psy’ — psychiatry and all the little ‘psys’ attached. The kinds of explanations that it proposes are hegemonic, which means that it is extremely difficult for those who are the subject of psychiatry to develop new ways of understanding their experience.
This is doubly important for survivor researchers such as myself. We are
treading on the very thing that epistemology takes as its subject — knowledge.
Our knowledge of our own situation is devalued and does not really count as knowledge. Mad scientist maybe; oxymoron definitely.
In speaking of language, I am speaking already of ‘discourse’ and ‘meaning’. I do not mean that only meaning matters. Materiality, poverty, racism, and patriarchy spill over us but they also are suffused with meaning — controversially so.
One reason hermeneutic injustice is so hard to challenge is that language embodies and generates styles of thought which historically gain the status of ‘truth’ and therefore embody power. Psychiatry is a perfect example. Against this, or even at a tangent to it, I have proposed ‘Mad Knowledges’ and this mixed bag represents both its lineaments and its hinterland (D. S. Rose, 2022) I propose that Mad Knowledges exist in a different epistemic space to ‘psy’ and that these two spaces are in a relation of collision.
Before I get to my five items, I want to mention an object, a window. It is the one above the bed which I shared with my two sisters. In the winter, it being Northern Scotland, this window was thick with frost in the morning and icicles hung. No curtains, no blinds, just bare wood and glass. Perhaps the necessary and sufficient conditions for being a window. Popping my head above the blanket, my breath turned to droplets of ice.
But this was also a window metaphorically, a window on the world of my childhood and youth, and it was not a pleasant one. What later I would learn to call xenophobia, patriarchy, homophobia, and ableism abounded. As did alcohol. These things were normal or at least normalized in the society that surrounded me. Literally and otherwise, it was both freezing cold and hot with rage. I resolved to get out. Quite by accident, my route out was the university — a mysterious place where the children of professionals went. But, unlike today, it was free and I even got a grant. I thought I could leave it all behind and in a way I did for certainly the worlds collided.
Person/Movement – Feminism
Psychiatry focuses unremittingly on the individual. Mad Knowledge is about collective experience and this is one key to the epistemic collision. So I will choose a movement, not an individual: feminism. When I first encountered it, it stood against everything I had learned about woman’s place in the world. With many other faces, it links to the present musings intellectually — through standpoint epistemology. Sandra Harding proposed that the knowledge we create is shaped fundamentally by our position in the world (Harding, 1992). Feminist standpoint epistemology is not a matter of essentialism, something intrinsic to being a woman, it is achieved through discussion and reflection, political reflection, on our own and others’ ‘experience’. The mainstream calls this relativism but at the same time it denies it has its own positionality, with so many fundamental presumptions. But they are another element in this epistemic collision, because Mad Knowledge does not embrace their fundamental assumptions: the universal, the objective, value-freedom, and generalizability. The knowledges produced by those of us who are deemed mad operate in quite a different register, a different epistemic space. Of course, feminism is not just intellectualism. I made my peace with my mother’s oppression by patriarchy on her death bed. But the subjective dynamics of knowledge must not enter the canons of science.
The article is Noam Chomsky’s critique of BF Skinner’s behaviorist account of language, originally published in 1959 and reprinted in 1980 in Volume I of Readings in Philosophy of Psychology. Chomsky shows that Skinner’s behaviorist account of language in terms of ‘reinforcement’ (positive or negative, that is, reward or punishment) is reductionist and mechanistic. He argues that language is a system and that form (syntax) is as critical to meaning as content (semantics). “Colorless green dreams sleep furiously.” A nonsense sentence — something out of Alice in Wonderland. Yet because it follows the rules of syntax we can ‘make sense’ of it. Chomsky’s is a long and complex paper but to me it was like a breath of fresh air and it started a long fascination with language. In many ways, Chomsky was wrong though — he too thought in terms of universals and (oddly, given his politics) his ways of thinking about language entailed no notion of power and domination. But that paper made these critiques of language possible. His argument broke normal science and ushered in a plethora of ideas, supportive and not. I doubt many people know of Transformational Generative Grammar these days, but they do know about performativity (well, people who read Judith Butler)
Book – Nikolas Rose, The Psychological Complex (1985)
The book is called ‘The Psychological Complex’ and was written by my partner which some people will think is a bit of a cheek. It is a ‘history’ of psychology with a difference. The standard work on the history of psychology was long considered to be a textbook by Edwin Boring, and boring it is. Predictably, it argues that psychology arose out of a long tradition of philosophy, when it embraced experimental methods and the empiricism of the laboratory. Nikolas Rose turns this on its head and argues that the discipline of psychology emerged from practice, from interventions in institutions such as education, the work place, the family and of course those practices concerned with changing minds and governing conduct. Psychology was an expertise for the management of persons before it became an academic endeavor — a ‘complex’ of practices designed, and this is important, to produce ‘normal’ subjects and to rank them in relation to social norms. Psychiatry was, and is, no different. Mad Knowledge sits outside the psychological complex: we demand our voice and claim our truths while ‘psy’ tries to silence us, to reform, recuperate, and reframe, and even to lock us up. It is here that hermeneutic injustice finds its place because psy dominates the world of mental health hegemonically, obliterating attempts to forge our own discourse, to tell it as it is from our (collective) standpoint and not just in terms of ‘mental health’ but far beyond.
Mad Knowledge sits outside the psychological complex: we demand our voice and claim our truths while ‘psy’ tries to silence us, to reform, recuperate, and reframe, and even to lock us up.
The Psychological Complex was based on Nikolas’ PhD and it took him 10 years to write. Those were the days of endless debates, reading groups and tiny journals like our own Ideology and Consciousness. He ran up a huge bookshop bill in the course of it. I sold my white sports car to settle his debt. Every story has an underside.
Concept – Structural Violence
My concept is that of ‘structural violence’ and this section is longer than the others, I warn you. Structural violence refers to social structures that do harm, and the notion is relevant here because mad people inhabit violent worlds. I believe this could be useful to Mad Knowledges but I am having a bit of trouble with it, which will no doubt get me into trouble too. My problem lies in what counts as ‘harm.’ An extension of this is the implication that all harms are violent. Because it seems to me that just sometimes things are ‘recruited’ to that concept when really they are just an example of ‘life is tough!’ What is the difference between ‘injury’ and ‘life is tough’?
The one I have thought about most is gender. I had a longstanding argument with someone about #MeToo. She said a hand on the knee by a man was on a continuum with rape. In that case most women in the world have been harmed by men or patriarchy, and that may be so, but I want a concept that is much more specific, that picks up the kind of damage that I am interested in. Anyway, we are very ambivalent in the West because we talk about “sex workers” to give sex work the same value as any labor and consent applies as far as it applies to any labor. Then you could say capitalism is structural violence, but that is not specific enough, it has to harm people in the sense of bringing about poverty or other tangible injuries. A concept is no good if it applies to everyone (except the capitalist class in this case, but then we just have a binary) and it evidently doesn’t because not everybody belongs to an excluded group. All women? All women may be disadvantaged relatively but Hilary Clinton has more in common with Bill Clinton (good and bad) than she does with a woman who has lost her source of income because of rape (Horn, 2020).
So, are we subject to structural violence at an epistemic level? I think we would have to be specific. In the field of knowledge, the further you go from the mainstream, the more likely you are to be harmed, in the form of outcomes such as loss of job, but it is quite tricky to determine what gets included in ‘psychological harm.’ It touches on the whole issue of identity politics. Some people want to recruit themselves to madness because in some circles claiming such an identity now can be an asset. It’s risky but mostly I don’t think they are being harmed — the opposite. Then again, their madness is usually pretty light and acceptable. I used to think that to be mad was simply a matter of self-identification, but now I feel that having had a course of antidepressants or living on lettuce leaves for six weeks when you were 14 just doesn’t cut it. This is no doubt a sensitive and challenging matter. I could, of course, be much more specific and define harm only in terms of so-called “serious mental illness” (and intersections), but that has problems of its own.
This brings us to the question of whether epistemic injustice, an issue of knowledge and ethics, entails harm and injury? Or maybe ‘cause’ is not the right word. But I think you could make such an argument. And because survivor researchers are in the very domain that epistemic injustice is about – knowledge – they are threatening in a very specific way, and this leads to all kinds of kickback by the mainstream. Including the sustaining of the hermeneutic gap we are trying so hard to fill. At base, the mad are not considered human (to the extent that Western Enlightenment ties notion of humanity to notions of rationality), and that is the ultimate injury (the situation is even worse for colonized black and brown people).
Of course, epistemic injustice around madness doesn’t just apply to academia but the context matters. You can be locked up for life if you ‘cannot think’ in the manner society expects you to. These different contexts have in common a system of classification, of diagnosis and treatment and everything that both constitutes and supports this apparatus. This system harms from outrageous ‘treatments’ (I had insulin coma therapy in 1971) to enforced CBT (which you have to accept in the UK welfare system, at least if you wish to avoid destitution). Epistemic harms are injuries at the level of knowledge – actual and potential – but they involve materiality, the body. At the same time, being systematically devalued as a knower is harmful. And then we hit fuzzy boundaries. For who am I to say that someone’s subjective experience of harm is ‘really’ an example of a tough life? And it is complicated when the narrative becomes weaponized. This raises a philosophical question which I will not answer: can you be wrong about your own experience?
Surprise Item – Sign Language
Language again. I am a sign language user. I grew up amongst Deaf people, my brother is Deaf as was my grandfather. The freezing North I referred to at the beginning contained the only school for Deaf children in the whole of the Highlands and Islands of Scotland so most were boarders. You could argue that Deaf people are subject to epistemic injustice because of their language.
A story. A professor at the London School of Economics was teaching us GH Mead. According to Mead (he’s not alone), language arises from gestures. Also, according to Mead, we have ‘selves’ because we can hear ourselves speak and thus reflect on our own consciousness. Well, Deaf people cannot hear themselves speak – they can’t hear and they can’t speak (because they have never heard, not because they are ‘dumb’). So according to this Professor, Deaf people have no selves and sign language is a bundle of gestures. Well, I was too scared to take him on despite being incandescent. Not having a self is another way of saying you are not human. But he was plain wrong about sign language. There are some iconic signs but by and large sign language (there is a sign language for every language) is a system of symbols, structured by its own grammar and, surprise, surprise, it contains pronouns. The ‘I’ is not absent. If this distinguished Professor had known anything about sign language, he could not have made such a fundamental error about Deaf people’s knowledge of themselves.
A psychologist once told me my family was a tragedy. Not just because of my alcoholic father, but also because of my Deaf brother. I argued with him at length. I relayed this to my (wonderful) psychiatrist who replied, “they are not too good with gay people either.” Normalization is everywhere and it denies some groups the status of humans.
After spending a lifetime immersed in these issues, I have come to the conclusion that Mad Knowledges, as and when they develop, are on a collision course with what counts as knowledge for mainstream ‘psy’.
The Enlightenment defined humans in terms of their capacity for reason, and rational thought and being human are close together in the modern thought, at least in the West. It also suppresses our development of our own discourses, sometimes by omission. But our rationalities are emerging, and they are matters not just of mind but also of body, so the whole mind/body split we attribute to Descartes has a little problem.
I do regard the war of the words as serious, but words are not just words, I hope I have shown. David won after all against Goliath (read psychiatry). But that’s a bit patriarchal. If we were to put it in a sentence, and this is not original, we need to radically broaden what it means to be human and that means a plurality of corrections of hermeneutic injustices.
PS. My father agreed with the psychologist. My parents had three girls in three years, and this was a source of deep disappointment. It was made worse for him when his son, a late addition to our family, turned out to be Deaf. My father never learned a single sign to communicate with his own son. It’s hardly a shock that I hold communication to be highly important and its absence or skewing to be a sign of things gone very wrong, not just mistaken but shot through with power. Which brings us back to psychiatry.
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