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Author Manuscript Running Head: DETERRITORIALISING MENTAL HEALTH 1 2 TIM BARLOTT (Orcid ID : 0000-0002-7868-783X) 3 4 5 Article type : Original Article 6 7 8 9 Destabilising social inclusion and recovery, and pursuing deterritorialising lines of flight in the 10 mental health sector 11 Tim Barlott1,2, Lynda Shevellar2, Merrill Turpin1 and Jenny Setchell1 12 1 School of Health and Rehabilitation Sciences, The University of Queensland 13 2 School of Social Sciences, The University of Queensland 14 15 Abstract 16 People who have been diagnosed with serious mental illness have a long history of confinement, 17 social stigma, and marginalisation that has constrained their participation in society. Drawing 18 upon the work of Gilles Deleuze and Felix Guattari, we have used the concepts of: assemblages, 19 major and minor and deterritorialisation to critically analyse two pervasive and ‘taken-for- 20 granted’ assemblages in mental health: recovery (including clinical recovery, social recovery, 21 and recovery-oriented practice) and social inclusion. Our analysis explores how dominant and 22 oppressive forces Author Manuscript have been entangled with liberating and transformative forces throughout both 23 of these assemblages – with dominant forces engaging in ongoing processes of capture and This is the author manuscript accepted for publication and has undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/1467-9566.13106 This article is protected by copyright. All rights reserved DETERRITORIALISING MENTAL HEALTH 1 control, and transformative forces resisting and avoiding capture. In pursuit of social 2 transformation for people categorised with serious mental illness, deterritorialisation is posited as 3 a potential way forward. To have transformation in the lives of mental health service users, we 4 present the possibility that ongoing, disruptive movements of deterritorialisation can unsettle 5 majoritarian practices of capture and control. 6 Keywords: Deleuze; Guattari; mental illness; mental health services; micropolitics; recovery; 7 social inclusion; social transformation 8 9 10 Caught in the winds of dominant social forces, people categorised with serious mental illness are 11 often relegated to the margins of society. With little room to manoeuvre, their trajectory is often 12 controlled and their participation constrained. In our paper, we unsettle some of the dominant 13 processes that are entangled in the lives of people with complex mental health challenges, and 14 seek a more liberating way forward. 15 In recent years, mental health statistics have been operationalised to normalise mental illness. 16 For example, 1 in 5 adults in the United States are said to experience mental illness every year, 17 with 1 in 25 adults experiencing a serious mental illness (National Institute of Mental Health 18 2016). Similar statistics are produced and reproduced internationally, giving credence to the 19 widespread view that mental illness touches everyone and is a normal aspect of everyday 20 experience. While normalisation of mental health challenges may be applauded as a means of 21 combatting stigma, such simplification also ignores the experience of people whose everyday life 22 is stifled by ongoing discrimination, social isolation, marginalisation, disadvantage, and control 23 that constrains their participation in society (Sayce 2015). There are those who experience 24 persistent, socially disruptive thoughts and behaviors, and are subject to ongoing control and 25 regulation within the mental health sector (Sayce 2015). They lack recognition and 26 representation, valuedAuthor Manuscript activity, income, and political voice (Ware et al. 2007), their belonging 27 and value in society are conditional on their ability to act more ‘normal’ (Hamer et al. 2014). This article is protected by copyright. All rights reserved DETERRITORIALISING MENTAL HEALTH 1 Sociologists have tended to view mental illness as a label attributed to people whose behaviours 2 and thoughts deviate from societal norms and values (Bessa 2012). Mental illness in 3 contemporary Western society is primarily identified and categorised according to diagnostic 4 criteria found in the Diagnostic and Statistical Manual of Mental Disorders (DSM), developed by 5 the American Psychiatric Association (Bolton 2008), and the International Classification of 6 Diseases (ICD), developed by the World Health Organization (Clark et al. 2017). People whose 7 behaviours and thoughts deviate from societal norms in a way that seriously impairs their social 8 functioning (for example, scoring below 60 on the Global Assessment of Functioning) are 9 categorised with what is currently termed ‘serious mental illness’ (Kessler et al. 2003). Serious 10 mental illness typically includes the following diagnoses described by the DSM and/or ICD: 11 schizophrenia; schizoaffective disorder; bipolar disorder; major depression; and some instances 12 of anxiety disorder (Ruggeri et al. 2000). While mental illness continues to be normalised, with 13 certain forms of mental ill-health considered a part of normal human experience, serious mental 14 illness demarcates those who are decidedly outside of the norm. For clarity of argument, we will 15 use the term ‘serious mental illness’ throughout this paper, but acknowledge that this 16 categorisation is one of the ways in which mental health service users are controlled and othered. 17 Through this paper, we aim to rethink dominant approaches in the mental health sector, utilising 18 the conceptual lens of philosophers Gilles Deleuze and Felix Guattari to envision 19 transformational possibilities for people categorised with serious mental illness. 20 CONCEPTUAL LENS – DELEUZE AND GUATTARI 21 Gilles Deleuze and Felix Guattari began collaborating in 1969, initially authoring a two-book 22 project titled Capitalism and Schizophrenia (Colebrook 2002). These books offered critiques of 23 capitalism, modernity, structuralism, and psychoanalysis, providing a complex set of concepts 24 useful for analysing the social world. Scholars have identified that “rigorous engagement with 25 the work of Deleuze and Guattari” has enabled researchers to think differently about issues, 26 creating opportunities for social transformation (Mazzei & McCoy 2010, p. 503). While their 27 work has been exploredAuthor Manuscript extensively in social, cultural and feminist theory, and in the fields of 28 art, film, and media studies, there has been limited engagement with their work in mental health 29 scholarship. This article is protected by copyright. All rights reserved DETERRITORIALISING MENTAL HEALTH 1 To analyse the dominant approaches in the management of mental illness, this paper employs 2 Deleuzio-Guattarian concepts of: assemblage, major and minor, and deterritorialisation. The 3 idea of assemblages is used to conceptualise the interconnected nature of social formations, 4 major and minor is used to examine social inequities and stratifications within assemblages, and 5 finally, deterritorialisation provides a way to think about transformative processes. After 6 reviewing these three concepts, we then employ them in an analysis of two dominant mental 7 illness assemblages: recovery and social inclusion. Consistent with Deleuzio-Guattarian 8 terminology, in the remainder of this paper we refer to the dominant approaches in the mental 9 health sector as mental illness assemblages. 10 Assemblage 11 Deleuze and Guattari emphasise that the social world features complex webs of interconnection, 12 which they refer to as assemblages. They assert that no single thing (be it human or non-human, 13 physical or non-physical) exists in isolation, and that nothing can be understood without an 14 analysis of the complex arrangement of interrelated parts (Deleuze & Guattari 1987). No singular 15 subject (e.g., an individual) can be understood in isolation “because a whole other story is 16 vibrating within it” (Deleuze & Guattari 1986, p. 17). Assemblages are continually changing as 17 webs of interconnection fluctuate over time – their complexity grows as each is also a part of 18 other mutually influential assemblages. The concept of assemblages acknowledges the 19 “irreducible complexity” that characterises the social world (DeLanda 2006, p. 6). Assemblages 20 are not understood simply through the identification of interrelated parts, rather, by exploring 21 processes of social production (Deleuze & Guattari 1987). In other words, it is not enough to 22 simply name the parts of an assemblage. It is the manner by which they are created, how they 23 work, and what they do that is of interest. Assemblages are fluid and constantly changing - the 24 mental illness assemblages analysed in this paper are not static, but are an evolving arrangement 25 of systems of thought, ideas, environments and people, as will be shown later in our discussion. 26 Major and Minor Author Manuscript 27 The Deleuzio-Guattarian concepts of the major and the minor are useful for understanding the 28 hierarchical nature of the social world, and to our analysis of mental illness assemblages. Before 29 discussing these concepts, we would like to acknowledge the common use of dualisms in the This article is protected by copyright. All rights reserved DETERRITORIALISING MENTAL HEALTH 1 work of Deleuze and Guattari, and draw attention to
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