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Finding Partnership The Benefit of Sharing and the Capacity for

Complexity
Michaela Amering
Philosophy, Psychiatry, & Psychology, Volume 17, Number 1,
March 2010, pp. 77-79 (Article)
Published by The Johns Hopkins University Press
DOI: 10.1353/ppp.0.0272

For additional information about this article


http://muse.jhu.edu/journals/ppp/summary/v017/17.1.amering.html

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Finding Partnership:
The Benefit of Sharing
and the Capacity for
Complexity
Michaela Amering

Keywords: recovery, empowerment, trialog, user involvement, schizophrenia

Is There Ignorance and


Arrogance? In Psychiatry? In
Medicine?

dding insight to injury is the paraphrase psychiatrist Pat McGorry (1992)


coined for his reproach of pushing for
insight or acceptance of diagnosis without
carefully taking into account the complexities of
the individual situation, context, and needs. That
must be about the kind of behavior Marga Reimer
has in mind in her paper on treatment adherence in
the absence of insight, which depicts mental health
professionals characterized by arrogance against
the common sense of motivating compliance by
perceived or anticipated benefits on different everyday life levels, but instead trying to get people
to believe in a mental illness such as schizophrenia
and wishing them to want treatment for that in
the form of medication.
In addition, Reimer presents examples from
general medicine to make her point that adherence
follows perceived or anticipated benefits instead
of being a result of insight into a medical model
of illness and McGorry (1992) also suggests that
2010 by The Johns Hopkins University Press

disregard for the active role that patients may


play as reflected in psychiatry in terms such as
case management and compliance is a failing
which extends to mainstream medicine and probably to most systems of human service delivery.
On the other hand, Bill Anthony (2006), one of
the most eminent experts on psychiatric rehabilitation and recovery in a personal report on his
own medical illness, multiple sclerosisMS, and
the assistance he has been receiving in connection
with it, describes the MS-Community as exemplary with respect to instilling courage and hope,
continually providing information and opportunities for exchange, and for never questioning a
persons ultimate freedom of choice. In contrary,
in mental health care he does not experience the
medical profession as acting with full respect
and support for its patients and suggests a great
deal more work and transformationespecially
concerning coercive treatmentsahead to follow this example. Similarly, it has been suggested
that psychiatry should be better integrated into
medicine to overcome stigma and discrimination
of psychiatric health problems and interventions.
A pertinent example of an initiative in this direction is the proposal of a fusion of mental health
and incapacity legislation to arrive at ethically
consistent legal situations with regard to invol-

78 PPP / Vol. 17, No. 1 / March 2010

untary treatment across medicine (Dawson and


Szmukler 2006).

Is There Something Called


Schizophrenia? And How
Much Longer?
Reimers main exampleschizophreniais the
diagnosis that poses some of the greatest problems
to the field and to the recognition of psychiatry
as a scientific medical discipline. The current
concept as well as the term schizophrenia will
probably not be around much longer; a century
of schizophrenia is enough (Kelly and Murray
2002). Suggested solutions for the problems of
the diagnosis of schizophrenia concern the urgent
complement of the categorical with a dimensional
approach (Allardyce et al. 2007), a change also
put forward as one of the essential remedies to
undermine the stigma of mental illness that is often
exacerbated by clinical diagnosis (Corrigan 2007).
Such a move would also clearly help against the
still prevalent experiences of users of services and
their families and friends, whose hopes and dreams
have been crushed and whose resilience has been
undermined by clinical situations, which in times
of psychotic crises, not only forced diagnoses but
also prognosesoften scientifically unfounded
on them (Amering and Schmolke 2009).

Is There a Solution? Can


We Use Our Talents? And
Those of People With a Lived
Experience of Mental Health
Problems and Care?
Clinicians as well as scientists know that health,
illness, and recovery occur in complex ways and
contexts. People faced with mental health problems clearly realize the complexities of their situation and are especially motivated to appreciate
the variety of factors and interactions that need
to be integrated to arrive at a valid assessment.
Ideally, the therapeutic relationshipessentially a
partnershipholds a formidable chance of sharing
efforts and creating the wisdom for finding and
facing the truths necessary to develop solutions
that can uphold and work in line with the complexities of human life.

I would argue that psychiatric professionals are


certainly part of the puzzle as described by Reimer,
but that we also do have essential capacities to
be part of solutions, especially now as recovery
orientation as the new guiding principle of mental
health policy is reshaping our scientific and clinical
responsibilities (Amering and Schmolke 2009).
Patient self-determination, individual choice of
flexible support and opportunities, interventions
to promote empowerment and hope also in the
long-term, as well as assistance in situations of
calculated risk are new indicators of quality of
services. In contrast with a deficit model of mental
illness, recovery orientation includes a focus on
health promotion, individual strengths, and resilience. New tools and new rules for a partnership
approach emerge allowing to tap the full potential
of diverse experiences and forms of evidence. New
forms of clinical collaborations include shared
decision making (Patel et al. 2008) and crisis
and advance agreements (Amering et al. 2005;
Henderson et al. 2008). Cooperations outside
therapeutic relationships concern participatory
and user-led engagement in service development
and evaluation as well as in mental health research
(Wallcraft et al. 2009).
Exciting, new developments include shared
work on value-based therapeutic and diagnostic
efforts, such as 3 Keys to a shared approach in
mental health assessment in the UK (The National
Institute for Mental Health in England [NIMHE]
and the Care Services Improvement Partnership,
2008) and the revision processes of international
diagnostic manuals (Sadler and Fulford 2004).
Thousands of people in the German-speaking
countries regularly participate in trialog groups
and psychosis seminars (Amering et al. 2002;
Bock and Priebe 2005) and interest into this innovative initiative is spreading fast internationally. In trialog groups, users, carers, and mental
health workers meet regularly in an open discussion forum that is located on neutral terrain
outside any therapeutic, familial, or institutional
contextwith the aim of communicating about
and discussing the experiences and consequences
of mental health problems and ways to deal with
them. The groups also function as a basis and
starting point for trialogic activities on different
levels (e.g., serving on quality control boards) and

Amering / Finding Partnership 79

different topics (e.g., a work group on religion and


psychosis) and activities (e.g., a trialogic training
seminars for police officers with regard to interacting with people with mental health problems).
Trialogs are inexpensive, a great number of people
seem to benefit from participation, and the movement has certainly brought about concepts and a
language different from the still widely prevalent
narrow discourse of the medical model of mental
health and illness. It is a new and exciting form
of communication, an opportunity to gain new
insights and knowledge, an exercise for interacting beyond role stereotypes, and a training for
working together on an equal basisaccepting
each other as experts by experience and experts
by trainingskills essential for recovery-oriented
work and for the involvement of users and carers
in therapeutic and service development decisions
(Slade et al. 2008).
The current convergence of the interests and activities of service users and those of mental health
professionals is a central element in coming to an
understanding of these new developments. Most
conceptual and political considerations and decisions have evolved from collaborations between
people with and without a lived experience of
mental health problems and the psychiatric service
system. Recovery-based practice is the synthesis
of professional and lived experience knowledge
bases, and is not simply an additional aspect to
the way we already deliver services. If recoverybased practice knowledge is to be authentically
developed, then it will require constant attention
to the synthesizing of professional and lived experience knowledges, ultimately fusing into a shared
knowledge base (Glover 2005).

References
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