"Power makes us sick": How Mental Health Activists in London Heal through Indeterminate Worlds

This thesis is based on 13 months of ethnographic fieldwork with groups of mental-health activists in London. As past or current patients of the National Health Service, activists self-identify as 'survivors', 'evaders' and/or 'ex-users' of formal mental healthcare. These terms express how engagement with services has left activists with a profound sense of grievance and disquiet. In accounting for their views, activists decry the dominance of the biomedical model, the invasive managerial systems, and the insensitivity of clinical encounters, some of which involve force. They also protest that access to welfare benefits is determined by mental-health assessments. I explain the lingering affective and phenomenological presence of biomedicine in activists' lives by describing it as a 'shadow'. This shadow manifests in activists' histories and narratives and also informs and unsettles their present. Reliant on a system of mental healthcare whose tenets they reject, activists are caught between conflicting subjectivities. While activists strive to assert their autonomy and competence and call out epistemic violence and injustice, the biomedical system positions them as incapacitated and vulnerably dependent, in turn discounting their concerns and corroding their sense of independence.

This is the context in which activists come together to forge their own modes of healing by building indeterminate worlds. Worldbuilding is the everyday relational and spatial practices and ways of being, which in the case of mental-health activism are founded on mutuality and indeterminacy. Building healing worlds around these attributes allows activists to enact alternative social and political imaginaries, or live 'the change they wish to see'. In the process, activists seek to re-frame their lives and relationships by making spaces to 'be' and 'become', and to 'go through madness' together. Thus, activists resist the drive toward coherence or consistency in mental health services; this allowing them to prefigure a more subjective, inclusive and adaptive approach to mental distress that permits plurality, alterity and autonomy. In other words, activists heal according to their own terms. This is not to imply that activists' relational practices are invariably consensual and cooperative, since mutuality, and indeterminacy entail much complexity, contradiction and much uncertainty. Moreover, when activists experience the suffering of others, this can become enmeshed, and even indistinguishable from their own distress. Nevertheless, I conclude that conflict and mutual hurt are not simply sources of suffering, since they also generate a sense of safety and connection and as such, are constitutive of the kind of mutuality activists enact. In making this case, my thesis contributes to debates in medical and political anthropology as well as mental health and Mad studies.