TALKING BACK TO PSYCHIATRY: RESISTANT IDENTITIES IN THE PSYCHIATRIC CONSUMER/SURVIVOR/EX-PATIENT MOVEMENT by Linda Joy Morrison BA, University of Massachusetts at Amherst, 1975 MSW, University of Pittsburgh, 1985 MA, University of Pittsburgh, 1995 Submitted to the Graduate Faculty of Faculty of Arts and Sciences in partial fulfillment of the requirements for the degree of Doctor of Philosophy University of Pittsburgh 2003 UNIVERSITY OF PITTSBURGH FACULTY OF ARTS AND SCIENCES This dissertation was presented by Linda Joy Morrison It was defended on March 3, 2003 and approved by Joseph S. Alter Mark B. Ginsburg John H. Marx Kathleen M. Blee Dissertation Director ii © Copyright by LINDA JOY MORRISON 2003 All Rights Reserved iii TALKING BACK TO PSYCHIATRY: RESISTANT IDENTITIES IN THE PSYCHIATRIC CONSUMER/SURVIVOR/EX-PATIENT MOVEMENT Linda Joy Morrison, PhD University of Pittsburgh, 2003 This research shows that activists in the consumer/survivor/ex-patient (c/s/x) movement develop a range of resistant identities in response to their encounters with psychiatry. Looking beyond the apparent distinction between “consumer” and “survivor,” components of a unifying survivor narrative are seen to underlie their resistance to assuming a totalized “mental patient” identity. A shared sense of injustice and betrayal of trust motivates people to identify with movement goals and values, which emphasize talking back to the power of psychiatry, rights protection and advocacy, and self-determination. Activists share a collective identity yet enact their concerns along a continuum from conservative to radical, according to their position in relation to psychiatric treatment and their relative levels of resistance and patienthood. iv ACKNOWLEDGEMENTS I wish to thank all the people who made this project possible and encouraged me to do the work. Many thanks to my friends in the movement who have shared their lives and passions in order to help me understand. I owe it all to you. I am forever grateful to those who insisted that I finish, especially Kathleen Blee, David Maines, Lynetta Mosby, Jo Reger, and Richard Stamps. Thanks to Cynthia Schellenbach and Abdi Kusow for their good will and support. Thanks especially to the people who inspired me but are no longer here to share the joy: Nancy Abel, Jim Alles, Jack Barry, Diana Forsythe, Ron Gibson, Joyce King, Fred Koloc, and Steve Sapolsky. I hope they are smiling somewhere in peace. Thanks to the dear friends who helped me through it: Suzanne, Paul and Rachel, Penny and Phil, Kellee and Saul, Jean-Luc, Ken and Brad, dear patient Fred who was so supportive, and Jeff who proved it was possible. Many thanks to all the activists, who know the work is not over yet. To my daughter Anna, whose mom has been a student nearly all her 23 years, thanks for letting me finish first. And above all I thank my parents, Alan and Joy, who believed in me. v TABLE OF CONTENTS Chapter One: From Sick Role to Social Movement ....................................................................... 1 Introduction................................................................................................................................. 1 A Complex Social Movement..................................................................................................... 2 A Different Point of View........................................................................................................... 3 Historical Background of the Research ...................................................................................... 5 Chapter Two: Literature Review ................................................................................................. 10 The Sick Role............................................................................................................................ 10 Sick Role: The Chronic Variant................................................................................................ 12 Implications for Psychiatry....................................................................................................... 13 “Good Patients” and “Bad Patients”......................................................................................... 16 Labeling and Secondary Deviance............................................................................................ 17 Encounters with Resistance ...................................................................................................... 21 Deviant Identity as Political: Anspach and Beyond ................................................................ 22 Talking Back: Challenges to Expert Authority........................................................................ 24 Self-Help Alternatives .............................................................................................................. 26 A Radical Self-Help Position.................................................................................................... 27 Understanding Resistance......................................................................................................... 28 Talking Back as Claiming Voice .............................................................................................. 29 Voice, Power & Knowledge ..................................................................................................... 30 Subject/Object Relations........................................................................................................... 35 Social Movement Literature ..................................................................................................... 37 Literature of the Movement and its Interlocutors ..................................................................... 39 Chapter Three: Research Design and Methodology ..................................................................... 42 Choice of Research Methods .................................................................................................... 42 Institutional Review Board ....................................................................................................... 43 Gaining Approval.................................................................................................................. 43 A Special Population............................................................................................................. 44 Other Ethical Issues .............................................................................................................. 45 Fieldwork: Participant-Observation......................................................................................... 46 Gaining Entry........................................................................................................................ 46 Background:...................................................................................................................... 46 Entering the Field:............................................................................................................. 47 Reflexive Aspects:............................................................................................................ 49 Field Settings ........................................................................................................................ 50 Contributions of Fieldwork Experience................................................................................ 53 Relations with “Normals”:................................................................................................ 53 Workshop Leader: ............................................................................................................ 55 Behind the Book Table:.................................................................................................... 56 Community Involvement ...................................................................................................... 56 vi Making Contacts:.............................................................................................................. 56 Attending Meetings: ......................................................................................................... 57 Consumer-Provider Dialogues: ........................................................................................ 58 Ethical Issues ........................................................................................................................ 59 Emotions ............................................................................................................................... 59 Insider Status Issues.............................................................................................................. 60 Distance: ........................................................................................................................... 60 Whose Side Are We On? .................................................................................................. 62 Validity Issues: ................................................................................................................. 63 “Insider” and Disclosure Issues:....................................................................................... 63 The Activist Researcher Position: .................................................................................... 64 Leaving the Field .................................................................................................................. 65 Interviews.................................................................................................................................