November 2007. London. Central London. London West 1. The King’s Fund head offices on Cavendish Square. It is overcast grey with a light cold wind brushing past the people hustling along the streets. We have travelled up from Dorchester on the
Virgin train for two hours or more and arrived at Waterloo to beetle our way through
the underground: Bakerloo Line to Oxford Circus, then walk the wrong way and hurriedly retrace our steps. And there is the King’s Fund building. We walk in and are greeted with badges to identify us, to keep us under surveillance as Foucault might see it, the social Panoptican, for there lies power. I look at the badge the greeters give me and shudder: ‘Richard Peacocke. Service User. North Dorset
Primary Care Trust’ it says. Bloody hell, bloody ‘service user’! I thought this had all
been sorted out ages before.
Flashback to a cold January day in 2006 in Manchester, with the same team attending a conference arranged by these same people. We are in a spacious
conference room in a large hotel. The walls are a golden beige, the carpet patterned in blue, red, and gold, and the floor to ceiling curtains are a deep red velvet. Our tables are circular, covered in starched white table cloths supporting drinking glasses and white cups and saucers (from the coffee break); jars of sweets; half-empty bottles of water, both fizzy and still; covered in discarded paper and art materials; pens and pencils; white plastic folders at our elbows. The room is host to about a hundred people, or more, all in groups around similar tables. The air is fresh and clean, warm and comfortable, and there is a quiet hum of muted conversations as we wait for the King’s Fund’s Enhancing the Healing Environment (EHE) team to begin their presentations.
We are given conference ID badges and we wear them as we are told. I am the ‘Service User’, with a ‘Publicity Officer’ from the Strategic Health Authority, a ‘Lead Nurse’ and two ladies from ‘Estates’ as the rest of our ‘EHE’ team for Forston Clinic near Dorchester. Each badge denominates the person and identifies the
workspace - except mine which might have said ‘Dorset Mental Health Forum’ or ‘Voluntary Sector’ or similar, but actually says ‘Service User’. I find this to be
somewhat off-putting but accept it.
I am reminded of the DayGlo incident of a little while before. Debbie from Dorset County Council Training Department approached us in DMHF for assistance in running a series of courses around a stepped programme of mental health education. We sat with Sue one sunny day in the Forum meeting room and thrashed out a working agreement and plan of action. I recall the sun and sharp shadows slanting across the large sash windows as we sat around the table. Sue was very nervous in those days and Debbie was unsure of her way forward. Fortunately, I was feeling quite well for a change in that I was able to think clearly without the usual mash of unbidden thoughts and emotions running through me making any job at least twice as difficult to accomplish. I was also physically quite well, which was unusual for me at that time. This meant that I had no problems in engaging fully with the other two. We planned a comprehensive programme and set about delivering it.
The first course day was the most fraught with all those strangers in a professional setting, staring and waiting for our pearls of wisdom. What on earth could I tell them that they didn't know already? Who was I to lecture at these workers? Debbie
seemed keen that I express my views the way I wanted to, but which views would be acceptable? The only lecturing I had done had been in the Army 20 years previously. I was not even sure on how to start no matter how the delegates would receive me. I fell back on my trust in Debbie. She had assured us that all would be well, that the delegates would be gentle with us, and I kept in mind as I prepared to engage with the group.
The attendees, like most attendees since, were mostly women of varying ages, all waiting patiently. There were no men in this first session but, subsequently, men would make an appearance. Most of the audience looked interested in what was about to happen, but some looked like they might nod off. I didn't much mind if anyone dropped off, or even left, as I thought that the course was for their benefit and not mine. Of course, I was naïve at the time and did not recognise the benefits I would accrue as a lecturer.
history of DMHF and its doings. This lasted for 10 to 15 minutes. I then said what I was currently diagnosed with, and how I was suffering from that, and how it affected my social life. We then discussed how common my reactions and so on were. Here, I drew on my experiences working and living among sufferers of the effects of mental distress on their life. The second half lasted another 10 to 15 minutes talking about the stigma attached to being a mental health patient, or service user, and ended with any questions.
At the end of the class we would collect up the response forms and see what aspects of the morning or afternoon had gone particularly well. I was astonished to see that several class members named me and my bit as the best part overall! I thought Debbie might be disappointed that they did not mention her major teaching role, but she was delighted and saw these comments as a vindication of her work with us. Surprisingly, though, one lady suggested in her feedback that I should have worn a badge denominating me as a service user so that everyone would know what I was. We did laugh at that, imagining a large Day-Glo orange star on my breast pocket, but a serious point was also underlying this: that sometimes, no matter how hard you try, the stigma of mental illness will persist, even in these supposedly enlightened
workers, and even after an afternoon of being lectured at on this very subject.
Anyway, back to the topic in hand. I was approached some months before, in about September 2005, as a SUR, and asked if I would like to take part in a long piece of work to redesign and rebuild Forston Clinic’s Electroconvulsive Therapy (ECT) suite. Having already nursed there in the past, I knew that suite was long overdue a substantial modernisation and the Dorset Primary Care Trust (PCT) had taken the opportunity offered by the King’s Fund to get their hands on £30,000 funding to help bring arts into health areas and at the same time upgrade the facilities. All the PCT had to do was supply a dedicated team and some money. This was where I came in, because the King’s Fund wanted service users to be involved from the start. I agreed to take part and, so, now find myself, after a couple of shorter chats, in this
Manchester hotel for the three-day long conference.
I notice other people have similarly distinguishing badges and that some of the delegates are staring intently to see the status of people before speaking to them. I
decide that, apart from reinforcing the stigma associated with being a ‘service user’ that these badges are also constraining the free flow of information between
delegates at a more subtle level. “So,” I think to myself, “what shall I do about it?” I decide to hold my counsel until the end of the conference so as to see what others think.
‘But I don’t want to go among mad people,’ Alice remarked.
‘Oh, you can’t help that,’ said the Cat: ‘we’re all mad here. I’m mad. You’re mad.’
‘How do you know I’m mad?’ said Alice.
‘You must be,’ said the Cat, ‘or you wouldn’t have come here.’ (Carroll, 2007, pages 56-7)
I fall back on my admittedly limited training and decide to consult. The first people I ask are my own group and they report that the designations, as far as they are
concerned, are redundant and should be removed. I agree and set out to ask others. One of the first people I meet is another ‘service user’, who is very nervous and grey and retiring. I am not sure why he has come to the conference if he is too ill to take a proper part and, indeed, the next day he is gone back to wherever he came from. I continue among the delegates and ask anyone who will stand still long enough to say what they think. Most people who express a preference, as they say on the adverts, say that the designation is redundant - but they still look intently at mine, offering the lie to their statements.
This goes on for the rest of the three days, among team building tasks and communal meals and drinks parties in one or other of our rooms with one of the ladies hanging out of windows to smoke cigarettes, as the hotel is totally non-smoking. We are up early and finish late and the strain of it all is telling on me. My physical health is not great and I am feeling very rundown by the end. Happily, my mental health is steady and I don’t have to drop back on the effort front.
Just about the last thing we do before mounting our Trust minibus for the journey back home is to have a mass meeting where questions can be asked of the organisers
and suggestions put to them. This is my moment.
Me: I would like to ask a question.
I am on my feet before I can decide that a hundred or so people staring at me might be a bad thing.
Me: I would like to ask why we are designated as to our jobs or positions on our
name badges. Surely, it would be enough to say where we are from and our name?
Lady: Why do you ask?
A kindly lady’s voice reaches across the room to include me and everyone else, to wrap us in its velvet.
Me: The designation I have is as a service user. Other people have their jobs,
high and low. These false distinctions are entirely worthless and divisive.
I’m quite proud of myself, blushing slightly.
Me People see them as barriers to full and free … getting together.
I end having lost the last word and sit down again. I find this always happens. I start off well and finish lamely, but the point seems to have been accepted.
I hear no more and we all depart to our various homes.
It is June 2006 and our team is on the road again, this time to London to take a part in the King’s Fund’s celebrations for some award or other. We are in their head offices in Cavendish Square and have all been issued with name badges. I look at mine closely and am approached by the kind lady from Manchester.
Lady: Hello, Richard. How are you?
I said that I was fine and looking forward to the event.
Lady: You might notice that job designations have been left off the badges this
time. We thought about what you had said and felt you were entirely correct, so left them off.
I feel vindicated and happy that this big organisation has listened to a service user’s voice and acted on it. The lady moves away back to the posh lady someone says is the Minister for Health, who cuts the huge, square, white-iced cake with the EHE logo on it and the celebration commences. We all get a bit tiddly on the high class Champagne and are glad we are not driving back to Dorset.
Now I am back here in that same place and the badges are back to what they were. I see the kindly lady from before and move through the crush towards her.
Me: I was wondering…These badges. They are as they were before. Have you
changed your minds?
To say I am puzzled is only part of it. I am hurt and surprised as well. The lady sees this.
Lady: No. We haven’t changed our minds but the new Minister’s security team
insisted, nay demanded we keep the job descriptions or he wouldn’t have attended.
She snorts, that’s the only word for it. Snorts in derision.
Me: I am sorry to hear that.
I am sorry, as it seems that this is a step backwards brought about by the security forces unconsciously wanting to tighten their control of us. I am sorry that a man
should fear that which the woman before him had accepted.
The power in the heirarchizied surveillance of the disciplines is not
possessed as a thing, or transferred as a property; it functions like a piece of machinery. And, although it is true that its pyramidal organization gives it a “head,” it is the apparatus as a whole that produces “power” and distributes individuals in this permanent and continuous field.
M. Foucault, ‘The means of correct training’ page 192.
*
It is all down to presentation in the end, isn’t it? How a person presents can have wide consequences on how he or she is perceived. Partly this presentation is imposed on us. Hence the use of badges, describing in clear terms who we are and where we stand in the hierarchy. This must give fearful power holders a sense of comfort and control they don’t really deserve as manipulators of a power embodied in society as a whole rather than as wielders of a power embodied by them, as puppet masters almost, controlling society’s strings by means of the acceptance and agreement of the majority of people. Gone are the days of the God-derived power of Royalty and, as Foucault went to great lengths to explain, come are the days of power residing within and throughout society itself. The manipulation of this energy is what
determines who are the ‘Power Brokers’ in society today and, as the Arab Spring and the fall of the Communist Eastern Bloc have shown, this can change at the blink of an eye.
It had the opposite effect on me in that I recognised that it was another way of stigmatising me. It made it seem as if being a mental health service user was a full- time job, equivalent to being a Nurse Practitioner or an NHS Manager – a
designation of perceived worth. If they had wanted to describe my role within the team, they could have asked me for a title. In fact, they decided unilaterally to impose a title on me. This is what I found disturbing, that the King's Fund would turn out to be so much like other organisations I had met. I had really thought they
would be different and would have the service users’ feelings in mind when planning events and working with us. To give them their due, they altered their badges after I had pointed out the perceived error. That they have to change them back again at the behest of the security detail looking after the new Minister is a reflection on the security officers and their mindsets. Obviously, more work needs to be done but these people are notoriously difficult to engage.
As I said, it is all down to presentation in the end. If one is presented, and presents well, then the effects of stigma can be minimised, although they will never be totally wiped out. The next vignette in my narrative focuses on this.