Truth and reconciliation: a welcome dialogue
| Date | 11 December 2017 |
| Pages | 332-334 |
| DOI | https://doi.org/10.1108/MHRJ-10-2017-0045 |
| Published date | 11 December 2017 |
| Author | Helen Spandler,Mick McKeown |
| Subject Matter | Health & social care,Mental health |
Truth and reconciliation: a welcome
dialogue
Helen Spandler and Mick McKeown
Abstract
Purpose –This paper is an author’s reply to the article by Cresswell (2017) critiquing the originalpiece by
Spandler and McKeown (2017) on truth and reconciliation (T&R) in psychiatry. The pape ra ims to discuss
this issue.
Design/methodology/approach –It continues the dialogue about the nature of reconciliation in mental
health services and reflects on distinctions between the nature of historical abuses within the asylum system
and the need to understand and prevent further harm within contemporary services.
Findings –Whilst the authors acknowledge the tension between reconciliation and democratic debate they
suggest that the process does not have to mean agreement or acquiescence. They reaffirm their optimistic
belief that better mental health services are possible and appreciate that true reconciliation is a process that
will require both debate and the building of constructive alliances.
Originality/value –A grassroots T&R process might be a form of transitional justice which does not negate
the need for wider social and policy changes, but may actually help achieve it.
Keywords Transitional justice, Truth and reconciliation, Survivor/worker alliances
Paper type Viewpoint
At the outset we would like to thank Mark Cresswell for taking the time to carefully read and
respond to our case for a grassroots truth and reconciliation (T&R) process in psychiatry
(Cresswell, 2017; Spandler and McKeown, 2017). We appreciate the opportunity provided by
the editors to reply in kind and hope that this exchange represents the kind of respectful dialogue
we seek going forward. We are pleased that our paper has encouraged such discussion
(see also Carr and Taggart, 2017). We will try to respond to each point Mark raises, in turn.
The first criticism is that we blur the boundaries between contemporary and historical abuses in
psychiatry and that our advocacy of T&R rests on forced psychiatry within an asylum system of
care. On the first point, we believe that the boundaries between historical and contemporary
mental health systems are blurred, for precisely the reasons Mark highlights, i.e. that coercion
continues in post-asylum-based mental health systems, both within psychiatric units and the
community. Therefore, there has been no clear historical “break”between an oppressive asylum
system and a non-oppressive post asylum system. We thoroughly appreciate the complexity of
contemporary psychiatry but believe that psychiatry has always been complex, diverse and
multi-faceted. Therefore, we accept that the continuation of coercion in psychiatry complicates
any simple demarcation of a pre- and post-oppressive system.
However,on the second point, that would only be a problemif our calls for T&R rested solely on the
basis of historicalabuses in the asylum system, which it does not,for the reasons above. Having
said that, even if it did, historical abuse would be more than a good enough reason for a
post-asylum process similar to post-apartheid T&R. However, we think the need for T&R is
twofold: to apologise for and understand past abuses, butalso to contribute to an understanding,
and prevention of,contemporary abuses and harm. We absolutely agree thatthis process would
need to involve the broad range of mental health professionals, not just hospital-based
psychiatristsand nurses. For this reason, we have talkedto a range of professional groups about
this process (including approved mental health practitioners, community psychiatric nurses and
Received 16 October 2017
Revised 16 October 2017
Accepted 16 October 2017
Helen Spandler is a Reader in
Mental Health at the
Department of Social Work,
Care and Community,
University of Central
Lancashire, Preston, UK.
Mick McKeown is a Reader in
Democratic Mental Health at
the School of Nursing,
University of Central
Lancashire, Preston, UK.
PAGE332
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MENTALHEALTH REVIEW JOURNAL
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VOL. 22 NO. 4 2017, pp. 332-334, © Emerald Publishing Limited, ISSN 1361-9322 DOI 10.1108/MHRJ-10-2017-0045
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