Creatures Of Each Other? Reflections On The Mutuality Of The Construction Of Boundaries/Barriers Between Society And The Mentally Ill

This paper evokes events at a psychiatric day clinic as illustrative of a theory that whilst on the conscious level the aim of community psychiatry is the care and rehabilitatation of people with mental illness its unconscious function is to fashion a barrier of mystification and separation between public and patient. This clinic was the subject of a doctorate and a book ('From Asylum to Anarchy') by Claire Baron. Though the only observable 'anarchy' was organisational, arising from the staff group of the Day Clinic enacting an omnipotent group phantasy, Baron evokes the vulnerability, fragmentation and need for structure of the patients in her argument for increased administrative hegemony and the curtailing of professional autonomy. That the patients' behaviour throughout the affair was constructive, appropriate and 'normal', and judging by the high attendance of this traditionally 'hard-to-engage' group 'the new venture' was offering something attractive and useful, was lost on participants and subsequent commentators. From this curious myopia, characteristic of mental health services rhetoric, indicates an unconscious relationship between the experiential framework of patients diagnosed with 'serious enduring mental illness' and specific aspects of community psychiatry. I suggest an unconscious phantasy of the broader social milieu - enacted through the service - maintains a status quo through creation of a technologically-validated 'otherness' of the mentally ill. The 'new venture' at Paddington Day Clinic, in its refusal of this and its attempt to engage with the 'other' - both within patients and within the institution - threatened this reassuring cultural phantasy and was terminated by the NHS establishment on the rationale that it was not adequately monitored and controlled. Distancing of the patient was reasserted through intensified organisational technologies of audit, systems governance, hierarchical dominance and justified by definition of the patient as biologically dysfunctional. These instrumentalising pseudo-scientific technologies in the mental health services, far from moving human relations away from irrationality, reify praxis into process, constructing a new organisational defence against unconscious primitive group anxiety. The contemporary, supposedly rational, scientistic paradigm, based in pharmacological control, systems governance, audit and evidence-based practice is more irrational, more defensive, more ritualistic than were former notions of demonic possession or 'illness' involving more - not less - mystification than historically-constructed 'otherness' (Ingleby).