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.
“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.
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.