A new paper by Anna Bergqvist, an Associate Professor of Philosophy at Manchester Metropolitan University, makes a philosophical case for both the moral and scientific value of the inclusion of lived experience in mental health research.
This approach, she suggests, does not detract from the scientific objectivity of the discipline but rather enhances it by integrating a relational understanding of patients’ experiences. Her work, intersecting aesthetics, moral philosophy, and the philosophy of psychiatry, brings a unique perspective to the understanding of mental health, challenging the traditional boundaries between subjective experiences and objective science.
Bergqvist writes:
“The mistake, I argue, is to think that a commitment to listening to the patient voice in the process of perspective taking implies a threat to ‘objectivity’ in clinical practice and the very concept of evidence in the philosophy of science more generally.”
Instead, she argues “that narrative experience and ‘patient perspective’ should be understood as an ongoing dynamic partnership working between the different stakeholders’ knowledge perspectives.”
By highlighting the importance of lived experience and challenging the notion that its inclusion reduces scientific objectivity, she opens up new avenues for a more inclusive and relational approach to mental health research.
In her paper, Anna Bergqvist advocates for a transformative approach to mental health research, emphasizing the importance of lived experience and challenging traditional views, prioritizing individual autonomy and objective clinical expertise.
Bergqvist’s argument centres around the concept of ‘narrative particularism,’ a framework that places patient narratives and experiences at the heart of mental health research. Moving away from the traditional biomedical model, which often prioritizes clinical expertise and standardized treatment, her approach calls for a dynamic partnership between patients and clinicians.
Her narrative particularist framework champions a relational and co-creative methodology, focusing on patient values and experiences as central to understanding mental health. This shift towards a more patient-centric approach signifies a departure from older models of medical ethics, favouring a dynamic partnership between patient and clinician where personal narratives play a crucial role.
A key aspect of Bergqvist’s paper is its challenge to the entrenched belief that patient experiences undermine the objectivity of mental health research. Contrary to this, she posits that a relational understanding of patients’ experiences is crucial for a comprehensive view of mental health.
Bergqvist addresses the evolving landscape of medical epistemology, where narrative understanding and individualized care are becoming increasingly important alongside evidence-based practices. Bergqvist further advocates for moral particularism in mental health care — a principle that considers each patient’s unique context and circumstances in clinical judgment.
The paper also explores the complexities of shared decision-making, stressing the significance of self-ownership, personal identity, and responsibility in the recovery process. This aspect of Bergqvist’s work underscores the importance of collaborative care, seeking a more democratic and equitable form of psychiatric treatment.
Bergqvist proposes that understanding and incorporating the patient’s voice into mental health research enriches scientific validity and clinical practice. She challenges the notion that including patient perspectives diminishes objectivity, instead advocating for a relational process devoid of an ‘outside’ perspective.
Additionally, Bergqvist delves into the asymmetry in stakeholder voice and power between ‘expertise by experience’ and professional training in psychiatry. She emphasizes the importance of recognizing the normative aspect of knowledge in psychiatry to avoid falling into value relativism or constructivism. The paper also highlights the connection between lived experience and the psychiatric significance of the personal self, touching on topics like agency, selfhood, and personal identity in psychiatric diagnosis.
Bergqvist concludes with a call for an integrated approach to mental health care that respects diverse perspectives and emphasizes ethical communication in clinical practice.
Her work paves the way for a more inclusive and empathetic approach to mental health, recognizing the value and complexity of individual experiences in the field.
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Bergqvist, A. (2023). Shared Decision-Making and Relational Moral Agency: On Seeing the Person Behind the ‘Expert by Experience’ in Mental Health Research. Royal Institute of Philosophy Supplements, 94, 173-200. doi:10.1017/S1358246123000243 (Link)
Editor’s Note: Part of MITUK’s core mission is to present a scientific critique of the existing paradigm of care. Each week we will be republishing Mad in America’s latest blog on the evidence supporting the need for radical change.
Thank you Justin for bringing Anna Bergqvist’s work to my attention. As a Mathematician, philosophy does go hand in hand. However, I would argue that within mental health, there is very little SCIENTIFIC objectivity. Both Dr Hartner and Dr Theurer have hi-lighted the erroneous assumptions and wild speculations that occur within psychiatry. Research is on-going for looking for bio markers of Mental Health disorders. The divide between physical and mental health needs to be very seriously addressed.
Yet, why are there NO standard blood tests ordered in Mental Health ? Why do psychiatrists FAIL to recognise physical illnesses with neuropsychiatric symptoms ? Alec Grant, a retired psychiatric lecturer has perfectly voiced how students are TRAINED. Patients are JUST known by their DSM value, then NON-SCIENTIFIC social judgements are ADDED such as ‘chronic’, ‘lazy’ and ‘devious’. Contexts of their lives are totally ignored and are irrelevant.
I have listened to many patients who are stuck in the Mental Health system. One example is a psychiatrist insisted a person must go to the gym because the patient was wearing a pair of shorts, a vest and trainers. The so called professional had failed to realise that the midday sun meant it was about 25 degrees C outside. I have learnt of psychiatric disorders being diagnosed within 5 minutes. However, I know that in a court of law of a judge throwing a case out of court. The plaintiff was claiming Unfair Dismissal and had stated that a Secretary yawning was a sign of racism. I find it comparative to DSM labels. Quite simply, if you are Human, a psychiatrist can find any DSM value for you.
These can be challenged. Decision making requires ASTUTENESS and a rationale must be provided to explain how they can to their CONCLUSION. Good History taking and DID THE PSYCHIATRIST EXCLUDE OR INVESTIGATE PHYSICAL ILLNESS ? No.
Throughout ALL the literature from Government policies, procedures and Laws, to MIND Legal, Advocacy Support Services, Specialised Mental Health Solicitors, to the Databases, – ALL of them stipulate Person Centred Care and Shared Decision Making. What happens in Practice is the polar opposite. Psychiatrists and Mental Health workers throw out ALL rule books. They wrongly believe they are above the law. They say whatever they like to a patient, they can write whatever they feel like in their notes, they can prescribe or increase medication, they can take away someone’s freedom. They can get their colleagues on board, involve the Legal system and Police when simply, maybe the Psychiatrist themselves are just having a BAD DAY.
Just as one example, written in a patient’s notes was ‘Rapport established easily.’ This was the ‘so called professional’s highly inaccurate perspective. At a later date, that so called worker, had to attend a FITNESS TO PRACTICE TRIBUNAL. When their Governing Body learnt that the patient was very physically disabled, they were more than willing to investigate why a patient was repeatedly NOT LISTENED TO.
By all accounts, MH Services INSIST that voluntary work is how people RECOVER. In this particular case, the patient could barely dress themselves and had a carer for their NEUROLOGICAL DISEASE. The Equality Act (2010) stipulates REASONABLE ADJUSTMENTS. It was NOT ACCEPTABLE to the PSYCHIATRIC TEAM that this person had chosen to STUDY and obtain more QUALIFICATIONS from the comfort of their home.
Psychiatrists nor those in Mental Health see a person’s identity. They are just a number.
Kind regards