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A Genealogy of (Bio)Political Contestation During the Reform of the Mental Health Act 1983 in England and Wales

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A Genealogy of (Bio)Political Contestation During the Reform of the Mental Health Act 1983 in England and Wales A genealogy of (bio)political contestation during the reform of the Mental Health Act 1983 in England and Wales Louisa Jane Cadman Submitted for the degree of DPhil Department of Geography February 2006 Contents Abstract Acknowledgements II Chapter One Introduction Chapter Two Methodology I: A genealogy of (bio )political contestation 45 Chapter Three Methodology II: Govemmentality, biopolitics and agonism 52 Chapter Four The demonstration 80 Chapter Five Human rights: bare life or life politics? 104 Chapter Six Testimony and the limits ofbiopolitical truth speech 135 Chapter Seven Conclusion 161 Appendix 163 References 180 A genealogy of (bio)political contestation during the reform of the Mental Health Act 1983 in England and Wales In 1997 the Department of Health announced their intention to reform the Mental Health Act 1983. Since publishing the first Green Paper in 1999, the proposed reforms have received major criticisms from virtually all 'stakeholders' in mental health care. This PhD offers a genealogy of (bio)political action during the process of reforming the Act. The focus is on the period from August 2002 to September 2003, with particular reference to the activities of self proclaimed 'service users' and 'survivors' in two independent protest groups: 'NO Force' and . Protest Against the Bill'. The methodological premise (chapters two and three) is born from something of a lacuna in post-Foucauldian governmentality studies which, although well posited, offer little in the way of advancing a genealogy of governmental contestation. My focus is twofold. Firstly, by advancing a (post)Foucauldian understanding of resistance - which, with respect to power, 'always comes first' (Deleuze 1988) - I aim to develop the relationship between 'biosociality' or 'life politics' (Rabinow 1996, Rose 200 I) and mental health law. Secondly, I seek to draw on the correlate of governmentality: agonism, taking it into governmental contestations in broadly 'liberal democratic' societies by focusing on what Tully (1999) calls "the free agonic activities of participation" (171). Together these advance my focus on agonistic 'games of truth' enacted during the reform process. This general methodological premise underpins my three major fieldwork chapters. Chapter four focuses on agonism in actu through the process of demonstrating (in the form of a protest march undertaken by No Force). Beginning with, as Barry (200 I) notes, the techniques and technologies "of telling and witnessing the truth" (176), I move through, and beyond Foucault, with respect to the importance of mediatisation and circulation in agonistic truth telling today. Chapter five expands on my understanding of life politics to offer a genealogy of the imbrications between human rights (law) and mental health (law) during the reforms. Here recourse to (human) rights is posited neither simply as a (dangerous) 'empty category' nor exemplary of an expanding 'vital life' but having a distinct genealogy emerging from problematisations in mental health law. Finally, in chapter six, I tum to the use of testimony from 'psychiatric survivors'. This form of biopolitical truth speech is not only illuminating of agonistic games of truth but also of that which is other to it (those who do not speak) and that what falls at the limits ofbiopolitical truth speech (for those who cannot speak). Acknowledgements Thank you to my supervisors Nicky Gregson and John Wylie for sharing their expertise, good humour and reassurance throughout. Those 'in the field' including Aidan, Anneke, Carrie, Dave, Lynn, Moira, Rowena, Sara, Simon and Symon. Some wonderful friends and housemates including Becky, Ben, Joanna, Julie, Laura, Liz, Lotte, Rach and Sharon. A special thank you to Matty, Har and Minder, and my neighbours Keith and Kathy. Finally a loving thank you to my family: Mum, Janine, Rob, Abigail and, of course, Millie. Without your support this thesis wouldn't have been possible. I dedicate this thesis to my Dad (1934-1998). II Chapter One Introduction 1.1 Introduction "I would like to suggest another way to go further towards a new economy of power relations, a way which is more empirical, more directly related to our present situation, and which implies more relations between theory and practice. It consists of taking the forms of resistance against different forms of power as a starting point. To use another metaphor, it consists of using this resistance as a chemical catalyst so as to bring to light power relations, locate their position, find out their point of application and the methods used. Rather than analysing power from the point of view of its internal rationality, it consists of analysing power relations from the antagonism of strategies" (SP: 211). "[T]he interplay of governmentalization and critIque has brought about phenomena which are, I believe, of capital importance in the history of Western culture ... [I]f governmentalization is indeed [the] movement through which individuals are subjugated in the reality of a social practice through mechanisms of power that adhere to a truth, well, then! I will say that critique is the movement by the subject gives himself [sic] the right to question truth on its effects of power and question power on its discourses of truth" (Foucault 1997a: 31-32). In his famous essay 'The Subject and Power' (SP) Foucault argues that we might focus on forms of resistance in order to bring to light power strategies. [ take Foucault's attention to resistance here as twofold. Firstly, the forms of struggle to which he refers - "oppositions to the power of men over women, of parents over children, of psychiatry over the mentally ill, of medicine over the population, of administration over the ways people live" (SP: 211) - provide a way to bring to light techniques of power and forms of subjectification (in the examples Foucault gives us, struggles against the 'submission of subjectivity' have developed with respect to historical forms of pastoral power). Secondly, the form of questioning itself, which concerns the self and the political present, "affirms the primacy of the present, of the event, of the contingent, and of the freedom thereby possible" (Dean 1994: 50). It is this second form of 'critical attitude', tied to particular problematisations of the self in a political present, which provides a way for Foucault himself to intervene. Indeed, towards the end of his discussion he suggests: "Maybe the target nowadays is not to discover what we are, but to refuse what we are ... The conclusion would be that the political, ethical, social, philosophical problem of our days is not to try to liberate the individual from the state and from the state's institutions but to liberate us from both the state and from the individualization which is tied to the state" (SP: 216). It is this dual focus on analysing forms of struggle to locate techniques of power, along with a concern with problematisations of the self in a political present, which instigated my interest in the political activities of self proclaimed 'service users' and 'survivors' during the reform of the Mental Health Act 1983. It is an interest which ties together two related fields. Firstly, the rise of what is often termed 'service user expertise'; that is an academic and activist related focus on forms of knowledge concerning the voice and experience of psychiatric 'service users' and 'survivors'. Secondly, the coexistence of a political field which, on the one hand appears to embrace this form of 'expertise', and on the other is caught within a legislative arena which, and with respect to the reform of the Mental Health Act 1983, circulates around discussions of dangerousness, homicide and suicide. It suggests, at the very least, that Foucault's intentions in The Archaeology of Knowledge against writing a history of the referent seems at its most pertinent today. Here polarised debates surrounding the inclusion and exclusion of the 'mentally ill', l which may have been relevant for 'institutional geographies', surely no longer hold . My focus, then, is precisely where these two histories meet - forms of governing madness and/or dangerousness through mental health law and forms of contestation which emerge through the rise of 'service user experts' and 'psychiatric survivors'. By focusing specifically on the actions of two protest groups during the reform process - NO Force and Protest Against the Bill (PAB) - my primary aim is to consider the I For a discussion on the complexities of 'social inclusion' see Philo et al (2005). who. in focusing on Training and Guidance (TAG) units in the Scottish Highlands for people diagnosed with mental health problems, suggest these are in-between spaces with different economic and social imperatives which "spin together in a manner hinting at deeper tensions in the so-called new deal for disabled People" (787). 2 conditions of existence for the 'service user' or 'psychiatric survivor' as a political subject (both the possibility for, and the limits ot). In the first instance, my interest in the constitution of madness as a form of enunciable experience resonates with Foucault's thoughts on sexuality in his genealogies of the 'desiring subject'. In the introduction to the Use of Pleasure. for example, Foucault emphasises that the aim of his work on sexuality was: "a matter of seeing how an 'experience' came to be constituted in modem Western societies, an experience that caused individuals to recognize themselves as subjects of a 'sexuality,' which was accessible to very diverse fields of knowledge and linked to a system of rules and constraints. What I planned, therefore, was a history of the experience of sexuality, where experience is understood as the correlation between fields of knowledge, types of normativity, and forms of subjectivity in a particular culture" (UP: 4 my emphasis). This trajectory connects Foucault's 'archaeologies' on the formation of the human sciences, his 'genealogies' on the power relationships which regulate these sciences, and the forms - or rather folds - of subjectification "within which individuals are able, are obliged, to recognize themselves as subjects of this sexuality" (UP: 4).
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