Toward Heterotopia? Service User Collaboration in Mental Health Research

Researchers explore the challenges and possibilities of collaborative research with service users in psychiatry and mental health.

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Increasing attention is being paid to research studies and knowledge production in the psy-disciplines that emphasize collaboration between service users, experts, and researchers.

A new study led by Timo Beeker at the Brandenburg Medical School Theodor Fontaine charts the challenges and possibilities of collaborative research in psychiatry, confronting the assumed boundaries between academic “experts” and consumer/survivors of psychiatric services.

Drawing on Foucault’s concept of a heterotopia – or an “other space” where the effects of real-world power hierarchies, such as those between psychiatrists and service users, are diminished – the authors suggest that through intentional and reflective collaborations, collaborative research in psychiatry may provide a vehicle for growth and transformative social change. They write:

“Collaborative research may be a field in which many of the often-subcutaneous aspects of power in psychiatry and society as a whole crystallize and thus become visible. Hence, the omnipresence of power in collaborative research might rather constitute an opportunity than a challenge, opening up a laboratory for observing social power.”

Even when there are mechanisms in place to question, for example, forced medication treatment, power imbalances favor mental health professionals. The medical model often used in psychiatric research exacerbates these power imbalances by obscuring the impacts of social disparities on mental health. Working collaboratively with service users and people with lived experience of mental challenges, however, can redress power imbalances through the development of alliances with marginalized groups and community interests.

As this work confirms, collaborative research studies develop their own dynamics for navigating and addressing imbalances of power in the research environment. The researchers were participants in Germany’s PsychCare program, whose overall goal is the comparative evaluation of the efficacy and efficiency of psychiatric hospitals’ new “Flexible and Integrative Treatment” strategies. As the authors note:

“The fundamental questions of collaborative research are inextricably interwoven with the personalities of the researchers and the interactions among them. … Collaborative projects … are designed to clash, as tensions and frictions are likely to appear, but serve as important vehicles towards a shared understanding and personal growth.”

Thus, while navigating different personalities and manifestations of structural and social power could prove difficult and uncomfortable, group processing and discussion of these issues within the research team led to “substantial epistemic gains.”

Of note, the research team members with lived experience of psychiatry were able to acknowledge that their “seemingly ‘private’ knowledge constitutes a valuable resource for research and could be useful to many others as well.” Such realizations within the collaborative context might provide the key to accessing what Foucault called “heterotopia”: a place where the manifestations of structural power relations are first made visible and then diminished through the group’s creation of a socio-cultural “other space.”

The authors conclude by posing “one fundamental question … if (and how?) the quasi-utopian experiences made in this other-space can be transferred into the real world and translated into real social progress.”

 

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Beeker, T., Gluck, R.K., Ziegenhagen, J., Goppert, L., Janchen, P., Krispin, H., Schwarz, J., and von Peter, S. (2021). “Designed to Clash? Reflecting on the Practical, Personal, and Structural Challenges of Collaborative Research in Psychiatry.” Frontiers in Psychiatry. https://doi.org/10.3389/fpsyt.2021.701312 (Link)

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