Experience as ‘expert’ knowledge: A Critical Understanding of Survivor Research in Mental Health

Voronka (2016) critically analyzes the risk of strategic essentialism while considering ‘lived experience’ as expert knowledge. Although strategic essentialism seems to be a useful category to create political solidarity among a marginalized group, it also holds the risk of essentializing experiences, and thus works against the same premises from where critical questions against dominant knowledge systems begin. While recognizing this risk, Voronka also discusses its contextual usage while dealing with a constituency—the survivors of the mental health system—that is fragile. In this commentary, I bring a few points for further discussion. Does lived experience create ‘expert’ knowledge? Whose experiences are we talking about as ‘expertise’? Voronka addresses the sites of privileges where lived experience becomes ‘expertise,’ knowledge bodies that are marked by White civility. Her analysis brings critical questions on the intersections of race, class, religion, region, sexuality, and other particularities into the forefront of the discussion.

The emergence of ‘lived experience’ as a valid analytical category in mental health user/survivor research has a long history in its various negotiations with dominant mental health system, particularly biomedical psychiatry (Burstow, 2004; Crossley, 1999). In the dominant paradigm of biomedical psychiatry, users’ experiences with mental health systems are reduced to quantifiable accounts without looking into the everyday contexts of their subjective life world. Dorothy Smith (1990) argues that the usual process of reasoning about mental illness goes as follows: a situation causes stress, leading to mental illness, which then causes one to seek psychiatric assistance. This model assumes that mental illness is an objective social state that exists before the treatment and can be treated through invasive biomedical intervention. China Mills (2014) draws our attention to the way psychiatrization grips onto the everydayness of various distress conditions. When biomedical psychiatry exists as a dominant force, how do we then make sense of the lives of individuals who have been diagnosed, labeled, and ‘treated’ by the dominant mental health system, particularly biomedical psychiatry? How do we understand the embodied experiences that serve in a variety of ways to substantiate the particularities of individuals that define their conditions of distress? What, if any, can the embodied experiences of distress contribute to the knowledge base of the mental health system of ‘treating’ it?

Burstow, LeFrançois and Diamond (2014) demonstrate the epistemological violence embedded in the diagnostic process of biomedical psychiatry, and how it effaces all embodied particularities of subjective experiences and deny the entry of noncodified knowledge in the hierarchical mental health system. Smith (1990) argues that, in the ‘relations of ruling,’ doctors, nurses, and administrators learn and reproduce a particular set of bureaucratic and professional practices and terminologies that become part of their essential frame of reference, particularly when they treat patients and make crucial diagnostic and administrative decisions. The subjective sufferings of distressed individuals are transformed into a set of neutral ‘facts,’ which can then be categorized and ‘dealt with’ by the organizational apparatus empowered to handle such cases (Smith, 1990). The emergence of critical voices such as the survivor movement subverted this ‘relations of ruling’ to a great extent by challenging the standpoint of the ruling class and positioning the ‘everyday world as problematic’ (Smith, 1987). This is linked crucially to any discussion we have on experience and expertise based on experience. I illustrate this with an example from my fieldwork in India.

In 2003, I attended a community mental health camp in Kerala, a Southwest coastal state in India, as part of my doctoral research fieldwork on women and mental distress. I met Beena, a young plantation laborer, who attended the camp. I observed that, in the clinical setting, her narratives of distress—such as constant fear, feeling of someone chasing her while returning from work, and severe depression—got translated through mediated authoritative textual account of the Diagnostic and Statistical Manual of Mental Disorders as ‘paranoid schizophrenia.’ During my conversation with Beena, she narrated that while returning from the tea plantation, where she worked as a daily wage laborer before her distress condition, someone chased her. Beena was extremely scared to go back to work after...