“I Didn’t Feel Valid as a Human Being”
A Gendered Analysis of Women’s Experiences and Resistances to Involuntary Mental Health Treatment
Keywords:
Mental health, gender-based violence, feminist theories and research, involuntary mental health treatmentAbstract
Involuntary mental health treatment is when a person undergoes an unwanted intervention in a hospital or in the community due to an authorised medical officer deeming the person to be ‘mentally ill’ or ‘mentally disordered’ (NSW Government, 2021). The Mental Health Act NSW (2007) frames involuntary mental health treatment as a ‘necessary’ and ‘effective’ approach to supporting people experiencing mental distress. This study critically engages with women’s experiences of involuntary mental health treatment, exploring the potential implications of a biomedical and carceral response to women’s distress. Six women with experience of involuntary mental health treatment in NSW were involved in my Honours project. In alignment with both feminist and critical mental health frameworks, semi-structured, in-depth interviews were chosen as they provide a loose structure and allow for flexibility to discover new areas of significance identified by women (Dcruz & Jones, 2013). The project was approved by the University of Sydney Human Ethics Committee.
All women involved in this study described involuntary mental health treatment as a profoundly harmful experience which produced ongoing implications. Women described the ways in which psychiatric and gender oppressions intersected to perpetuate the silencing of women. Collectively and individually, all women displayed acts of resistance towards psychiatric and patriarchal hegemony. Three major themes were identified in the analytical process: The Censorship of Knowledge; The Censorship of Emotions; and The Censorship of Acts of Resistance.
References
Ackerly, B. A., & True, J. (2020). Doing feminist research in political and social science. London: Red Globe Press.
Allsopp, K., Read, J., Corcoran, R., & Kinderman, P. (2019). Heterogeneity in psychiatric diagnostic classification. Psychiatry Research, 279, 15–22. https://doi.org/10.1016/j.psychres.2019.07.005
Archer, M., Yasmine, L., & Sethi, F. (2016). Women in acute psychiatric units, their characteristics and needs: A review. BJPsych Bulletin, 40(5), 266–272. https://doi.org/10.1192/pb.bp.115.051573
Australian Institute of Health and Welfare. (2023). Involuntary Treatment in Mental Health Care. https://www.aihw.gov.au/mental-health/topic-areas/involuntary-treatment
Braun, V., & Clarke, V. (2012). Thematic analysis. In H. Cooper, P. M. Camic, D. L. Long, A. T. Panter, D. Rindskopf, & K. J. Sher (Eds.), APA Handbook of research methods in psychology (Vol. 2, pp. 57– 71). American Psychological Association.
Breuer, J., & Freud, S. (1956). Studies on hysteria : by Josef Breuer & Sigmund Freud. Hogarth Publishing.
Butler, J. (1990). Gender Trouble, Feminism and the Subversion of Identity. Routledge.
Carers NSW. NSW Carers (Recognition) Act 2010. https://www.carersnsw.org.au/facts/carersrecognition-act n.d.
Chesler, P. (1972). Women and Madness. Avon Books.
Cohen, B. (2013). Psychiatric Hegemony: A Marxist View on Social Constructionism. In F. Davies & L. Gonzalez (Eds.), Madness, Women and the Power of Art (pp. 3-24). Oxford: InterDisciplinary Press.
Cohen, B. (2017). Routledge international handbook of critical mental health. Routledge.
Crenshaw, K. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43 (6), 1241–1299.
Daley, A., Costa, L., & Beresford, P. (2019). Madness, violence and power: A critical collection. University of Toronto Press.
DCruz, H., & Jones, M. (2013). Social work research in practice: Ethical and political contexts. SAGE Publications.
Diagnostic and statistical manual of mental disorders : DSM-5-TR (5th edition, text revision.). (2022). American Psychiatric Association Publishing.
Fine, M., Torre, M. E., Burns, A., & Payne, Y. A. (2007). Youth research/participatory methods for reform. In D. Thiessen & A. Cook-Sather (Eds.) International handbook of student experience in elementary and secondary school (pp. 805-828). Springer Science & Business Media.
Fook, J. (1999). Reflexivity as method. Annual Review of Health Social Sciences, 9(1), 11– 20. https://doi.org/10.5172/hesr.1999.9.1.11
Foucault, M. (1980). Power/Knowledge. Harvester Wheatsheaf: New York.
Fricker, M. (2007). Epistemic injustice: power and the ethics of knowing. Oxford University Press.
Fullagar, S., O’Brien, W., & Pavlidis, A. (2019). Feminism and a vital politics of depression. Springer.
Helfrich, H. (1999). Beyond the Dilemma of Cross-Cultural Psychology: Resolving the Tension between Etic and Emic Approaches. Culture & Psychology, 5(2), 131–153. https://doi.org/10.1177/1354067X9952002
hooks, B. (2000). Feminism is for Everybody. Cambridge: South End Press.
Howe, D. (1994). Modernity, postmodernity and social work. British Journal of Social Work, 24(5), 513-532.
Huss, E., & Bos, E. (Eds.). (2022). Social work research using arts-based methods. Policy Press.
Jaeger, P. T., Jennings-Roche, A., Taylor, N. G., Gorham, U., Hodge, O., & Kettnich, K. (2023). The Urge to Censor: Raw Power, Social Control, and the Criminalization of Librarianship, The Political Librarian, 6(1), 1 - 20.
Jordan, J. T., & McNiel, D. E. (2019). Perceived coercion during admission into psychiatric hospitalization increases risk of suicide attempts after discharge. Suicide and Life-Threatening Behavior, 50(1), 180–188. https://doi.org/10.1111/sltb.12560
Kokanović, R., Brophy, L., McSherry, B., Flore, J., Moeller-Saxone, K., & Herrman, H. (2018). Supported decision-making from the perspectives of mental health service users, family members supporting them and mental health practitioners. The Australian and New Zealand journal of psychiatry, 52(9), 826–833. https://doi.org/10.1177/0004867418784177
Karban, K. (2017). Developing a health inequalities approach for mental health social work. British Journal of Social Work, 47(3), 885–992. https://doi.org/10.1093/bjsw/bcw098
Lafrance, M. N. (2007). A bitter pill: A discursive analysis of women’s medicalized accounts of depression. Journal of Health Psychology, 12(1), 127–140. https://doi.org/10.1177/1359105307071746
Lather, P. (2004). Critical Inquiry in Qualitative Research: Feminist and Poststructural Perspectives: Science "After Truth". In K. deMarrais & S. D. Lapan (Eds.), Foundations for Research: Methods of Inquiry in Education and the Social Sciences (pp. 203-216). Lawrence Erlbaum.
Lee-Evoy, J. (2019). Institutional oppression and violence as self-defence. In A. Daley, L. Costa, & P. Beresford (Eds.), Madness, violence, and power: A critical collection (pp. 286–294).
LeFrançois, B. A., Menzies, R., & Reaume, G. (2013). Mad matters: A critical reader in Canadian mad studies. Canadian Scholars’ Press.
Lenette, C. (2022). Participatory Action Research: Ethics and Decolonization. Oxford University Press. https://doi.org/10.1093/oso/9780197512456.001.0001
Levenson, J. (2017). Trauma-Informed Social Work Practice. Social Work (New York), 62(2), 105–113. https://doi.org/10.1093/sw/swx001
Lynch, J. (2017). Reframing inequality? The health inequalities turn as a dangerous frame shift, Journal of Public Health, 39(4), 653–660. https://doi.org/10.1093/pubmed/fdw140
Marmot, M. (2017). Social justice, epidemiology and health inequalities. European Journal of Epidemiology, 32(7), 537–546. https://doi.org/10.1007/s10654-017-0286-3
Maylea, C. H. (2017). A rejection of involuntary treatment in mental health social work. Ethics and Social Welfare, 11(4), 336–352. https://doi.org/10.1080/17496535.2016.1246585
McIntyre, A. (2008). Participatory action research. Los Angeles, California: SAGE Publications.
McKeown, M., Scholes, A., Jones, F., & Aindow, W. (2019). Coercive practices in mental health services: Stories of recalcitrance, resistance and legitimation. In A. Daley, L. Costa, & P. Beresford (Eds.), Madness, violence, and power: A critical collection (pp. 263–285).
McTaggart, R. (1997). Participatory action research: International contexts and consequences. Albany, NY: State University of New York Press.
Morley, C., & Stenhouse, K. (2021). Educating for critical social work practice in mental health. Social Work Education, 40(1), 80–94. https://doi.org/10.1080/02615479.2020.1774535
Moulding, N. (2015). Gendered violence, abuse and mental health in everyday lives: Beyond trauma. Routledge.
NSW Government (2021). Mental Health Act 2007 No 8. https://legislation.nsw.gov.au/view/whole/html/ inforce/current/act-2007-008.
Phillips, R. (2015). Feminist Research and Social Work. In JD Wright (Ed.), International Encyclopedia of the Social & Behavioural Sciences, pp. 935–941. Routledge.
Probert, J. (2021). Moving toward a human rights approach to mental health. Community Mental Health Journal, 57, 1414–1426. https://doi.org/10.1007/s10597-021-008309
Prytherch, H., Cooke, A., & Marsh, I. (2021). Coercion or collaboration: Service-user experiences of risk management in hospital and a trauma-informed crisis house. Psychosis, 13(2), 93–104. https://doi.org/10.1080/ 17522439.2020.1830155
Quiros, L., & Berger, R. (2015). Responding to the sociopolitical complexity of trauma: An integration of theory and practice. Journal of Loss and Trauma, 20(2), 149–159. https://doi.org/10.1080/15325024.2013.836353
Read, J., & Harper, D. J. (2020). The power threat meaning framework: Addressing adversity, challenging prejudice and stigma, and transforming services. Journal of Constructivist Psychology, 35(1), 1–14. https://doi.org/10.1080/10720537.2020.1773356
Rose, D. (2021). Critical qualitative research on ‘madness’: Knowledge making and activism among those designated ‘mad’. Wellcome Open Research, 6, 98. https://doi.org/10.12688/wellcomeopenres.16711.1
Rose, D. (2023). Is there power in Mad knowledge? Social Theory & Health, 21(4), 305–319. https://doi.org/10.1057/s41285-023-00194-y
Ross, D. (2018). A social work perspective on seclusion and restraint in Australia’s public mental health system. Journal of Progressive Human Services, 29(2), 130–148.
Scanlan, J. N., Still, M., Radican, J., Henkel, D., Heffernan, T., Farrugia, P., Isbester, J., & English, J. (2020). Workplace experiences of mental health consumer peer workers in New South Wales, Australia: a survey study exploring job satisfaction, burnout and turnover intention. BMC Psychiatry, 20(1), 270–270. https://doi.org/10.1186/s12888-020-02688-9
Sims, R., Michaleff, Z. A., Glasziou, P., & Thomas, R. (2021). Consequences of a Diagnostic Label: A Systematic Scoping Review and Thematic Framework. Frontiers in Public Health, 9, 725877–725877. https://doi.org/10.3389/fpubh.2021.725877
Smith-Rosenberg, C. (1972). The hysterical woman: sex roles and role conflict in 19th-century America. Social Research, 39(4), 652–678.
Soininen, P., Välimäki, M., Noda, T., Puukka, P., Korkeila, J., Joffe, G., & Putkonen, H. (2013). Secluded and restrained patients’ perceptions of their treatment. International Journal of Mental Health Nursing, 22(1), 47–55. https://doi.org/10.1111/j.1447- 0349.2012.00838.x
Soros, E. (2021). I call this institutionalized rape. TOPIA: Canadian Journal of Cultural Studies, 43, 71–80.
Steinmetz, K. (2020) She coined the term ‘intersectionality’ over 30 years ago. Here’s what it means to her today. Time. https://time.com/5786710/kimberle-crenshaw-intersectionality/.
Stringer, E. T. (2007). Action research (3rd ed.). Sage Publications.
Thorburn, K. (2019). Family inclusive practice in mental health in NSW: evidence check. Inside Out & Associates Australia.
Tseris, E. (2017a). A feminist critique of trauma therapy. In B. M. Z. Cohen (Ed.), Routledge international hand- book of critical mental health (pp. 275–281). New York: Routledge.
Tseris, E. (2017b). Biomedicine, neoliberalism and the pharmaceuticalisation of society. In B. M. Z. Cohen, Routledge International Handbook of Critical Mental Health (pp. 224–233). London: Routledge International Handbooks.
Tseris, E., Hart, E., & Franks, S. (2022). “My Voice Was Discounted the Whole Way Through”: A Gendered Analysis of Women’s Experiences of Involuntary Mental Health Treatment, Sage journals, 1-19, https://doi.org/10.1177/08861099221108714
Ussher, J. (2011). The madness of women: Myth and experience. Routledge.
Vaid-Menon, A. (2020). Beyond the gender binary. Penguin.
Watson, J., Maylea, C., Roberts, R., Hill, N., & McCallum, S. (2020). Preventing gender- based violence in mental health inpatient units. ANROWS.
Women’s Health Victoria (2019). Spotlight on trauma-informed practice and women. https://womenshealthvic.com.au/resources/WHV_Publications.
World Health Organisation & United Nations. (2023). Mental Health, Human Rights and Legislation: Guidance and Practice. https://www.who.int/publications/i/item/9789240080737