Medicine and Power Module

Module Takeaways

• Appreciate systemic power imbalances in the mental health system between those who provide and those who use services
• Recognize how these power imbalances are maintained by interconnected systems of oppression based on gender, sexuality, race, and other social categories
• Understand that human rights are fundamental to ethical and compassionate care
• Recognize the value of treating the whole person, and the critical importance of incorporating lived experience, history, and culture in creating respectful equitable patient-practitioner partnerships

Module Components

• Art, an artist’s statement and interview excerpts expressing the experience of a bisexual, Black Biracial woman diagnosed with Bipolar Disorder-Type two, trying to navigate and change a system that was not built for her.
• A series of Letters to Professionals written by young people setting out key aspects of how best to support youth mental health.
• Documents, audio commentaries, and a powerful personal story illuminating the history of sterilization in Canada.
• A 5-minute puppet show on the importance of healing systems that treat the whole person. Created by Lori, a community expert.
  
• An autobiographical sculpture with a provocative title, created by two community experts with a sincere wish for healing partnerships in mental health
  
• A 6-minute video depicting “Question Man,” the ultra ego of a patient struggling for a sense of self.  Created by community expert Irit Shimrat.

Module Assessment

Using module components as a starting point, ask students to write a 250-word letter as a compassionate practitioner of today. Student letters should explain how power imbalances in the mental health system can lead to errors in practice, and then propose an alternative scenario that treats the whole person and exemplifies a respectful and equitable patient-practitioner partnership.  Ask students to address their letter to one of the following people featured in the module:

• Ashley T.
• Doreen Befus
• Lori E.
• Alistair Scott-Turner
• Dana Allan
• Irit Shimrat

Module Learning Lens

Question: What’s the difference between a Doctor and God?
Answer: God doesn’t wake up in the morning thinking he’s a Doctor.

These kinds of (not entirely funny) jokes point to a generalized and ambient understanding that physicians – including mental health practitioners – hold a tremendous amount of power compared to the patients whom they serve.  Historically and today, laws, professional structures and political decisions have reinforced practitioner power and interconnected systems of oppression within mental health services rooted in gender, sexuality, race, and other categories. Over time, as sites where psychiatric power is exercised have evolved and new professional players have come on board, this grid of intersecting oppressions has remained as a central feature of the system. We included materials in this module on the history of state-sanctioned sterilization, legal in Alberta until the 1970s, and on experience of a post-millennial bisexual, black bi-racial woman diagnosed with bipolar disorder-Type two. Both sets of artefacts demonstrate the erroneous assumptions of professional and state power in the pursuit of alleged good mental health.

The “expert” knowledge of professionals is seen to confer on them the ability to make decisions that are in the best interests of patients; at the most practical and applied level, many non-physicians find medical jargon incomprehensible, feeling intimated or uncertain during times of vulnerability or illness, unable to offer dissenting or self-assertive perspectives. This is certainly something that our project community experts feel deeply because they really live with this power imbalance every day. All described oppressive experiences accessing mental health services. Some of the participants spoke eloquently about what they called the “Psychiatric Gaze,” a kind of all-consuming and utterly exclusionary attitude levelled towards people with non-normative mental health profiles: the mental health issue became the sole and primary issue by which a person was understood, eclipsing all other nuances and realities. Others in the group stressed that the current focus on mental health issues as biological pathology means the social, political and economic factors impacting a person’s life are ignored. But whatever shape this oppression takes, it isn’t just about using mental health services, it is also about race, class, sexuality, gender, immigration status – to name some of the many interconnected factors that shape such encounters.

Overwhelmingly, community partners in this project – all of whom had lived the realities of medicalization – believed that professionals should acknowledge the impacts of their decisions on patients and also the many possible inequities in the physician-patient relationship. People with intimate and lived understandings about the power of medicine felt those with that power should work in partnership with patients. They identified three common trends in the practices of mental health practitioners which they have experienced as disempowering: professional authoritarianism, lack of holistic forms of treatment, and lack of respectful communication.

It is absolutely the hope of people who worked to develop this module, and who gave their voices, stories and time to create these teaching resources, that new generations of mental health professionals, advocates, critical social theorists and practitioners will be aware of the power imbalances that historically – and to a great deal contemporaneously – dictate medical and healthcare relationships. The hope is that through this knowledge, the power can be disrupted.