Truth and reconciliation in psychiatry: a response to Spandler and McKeown
| Date | 11 December 2017 |
| Published date | 11 December 2017 |
| Pages | 324-331 |
| DOI | https://doi.org/10.1108/MHRJ-09-2017-0041 |
| Author | Mark Cresswell |
| Subject Matter | Health & social care,Mental health |
Truth and reconciliation in psychiatry:
a response to Spandler and McKeown
Mark Cresswell
Abstract
Purpose –The purpose of this paper is to critique Spandler and McKeown’s recent advocacy of a truth and
reconciliation (T&R) process in psychiatry.
Design/methodology/approach –A critique of a recent paper in Mental Health Review Journal.
Findings –That Spandler and McKeown’s advocacy of a T&R process in psychiatry can be criticised from a
number of inter-related practical, political and ethical perspectives.
Originality/value –The present critique contributes to the ongoing debate about the desirability of a T&R
process in psychiatry.
Keywords Democracy, Forced psychiatry, Testimony, Truth and reconciliation
Paper type Viewpoint
Introduction
Helen Spandler and Mick McKeown’s (2017) recent paper in this journal on the prospects of a
truth and reconciliation (T&R) process in psychiatry was strong and thought-provoking. Although
this response offers seven criticisms against their arguments in favour of T&R, it accepts that the
paper establishes the terms of the current debate around T&R and, as such, is a significant text
for activists, academics and professionals. It demands close attention. In response, I write as
a sociologist of psychiatry in the UK in the post-Second World War period and, in particular, as a
historian of the user/survivor social movement from the 1970s onwards[1]. The goal of the
response is to contribute to the debate around T&R.
Spandler and McKeown’s argument
Spandler and McKeown’s argument can be summe d up briefly. T&R, canonically repre sented
by the South Africa n Truth and Reconcil iation Commissi on, was a collectiv e form of public
apology and truth-telling about social injustice specifically motivated by a desire for peace and
nation-buildin g in one post-aparthe id society. As Spandl er and McKeown (2017, p. 84 )
observe, its aim was “res torative rather than retributive justice, providing amnesty for
perpetrators and reparation for victims”. They acknowledg e a difference in the ap plication of
T&R to psychiatry in that there has never been a public apology for or collective recognition of
psychiatric injustice either by a nation-state, supra-national organisation ( for example the
United Nations) or t he institution of psychiatry i tself. Nevertheless, they ar gue for a “grassroots”
version of T&R in the absence of such recognition and they provide some recent examples in
which “new spaces for […] dialogue”(Spandler and McKeown, 2017, p. 87) have been opened
up between survivors and mental health workers, leading to new and mutually beneficial
“understandings ”. A strong aspect of Spandler and McKeown’s argument is t hat they
anticipate most possible objections to T&R: that there has been no public apology for social
injustice therefore T&R cannot really “get off the ground”; that workers might feel alienated by
the T&R process and not engage with it; that the analogy with other human rights abuses
(such as apartheid ) is inappropriate ; and that T&R is just a man ifestation of “ther apy culture”
Received 16 September 2017
Revised 16 September 2017
Accepted 11 October 2017
Mark Cresswell is a Lecturer at
the School of Law and
Criminology, University of West
London, London, UK.
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MENTALHEALTH REVIEW JOURNAL
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VOL. 22 NO. 4 2017, pp. 324-331, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-09-2017-0041
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