Rivers of Blood and Babylon: An ethnography of social sufferingand resilience among Caribbean service users in London Open Access

Phillips, Kwame Matsimela (2014)

Permanent URL: https://etd.library.emory.edu/concern/etds/wd375x241?locale=en


Suman Fernando (2003) argues, "racial injustices and cultural oppression are felt most acutely" by Black and ethnic minority service users in the field of psychiatry. Research on the mental health services in the UK consistently find that Black and ethnic minorities are more often diagnosed as schizophrenic, more often compulsorily detained under the Mental Health Act, more often given high doses of medication, and more often dissatisfied with statutory services. The dissertation asks how the current treatment provided under the mental health system in London, England re-traumatizes Caribbean service users. To investigate this question, I gathered ethnographic data - through official interviews, conversations, participant observation and visual material - from more than 40 adult service users and 26 health professionals. The qualitiative, ethnographic research uses both visual and textual presentations of data in its approach and resulted in the production of four ethnographic films exploring themes of identity, community, resilience, voice and civil disorder.

The dissertation puts forward that for the Caribbean population in the mental health system, there is a pervasive problem of social suffering, both as a result of mental illness and of coming into contact with the mental health system, such that coming into contact with the institution of the National Health Service itself can be considered a risk factor for furthered suffering. I further propose that the psychiatric philosophy of containment held by the mental health services, linked with a societal culture of fear and stigma, and a history of political failure to implement, follow through on and maintain progressive components within healthcare policy, must be addressed and improved if any meaningful change for the better is to be effected. The research highlights continued tension in the relationship between service users and the medical establishment, with a general sense of resentment to the amount and administering of medication, the power afforded to medical staff, and the dominance of Eurocentric academic and medical classification at the expense of their own models and theories of illness.

Table of Contents

Chapter One: Introduction 1

Prologue: The Lucky Ones 2

Introduction 3

Research Question 5

Aims and Objectives 5

Summary of argument 6

Methodology 10

Research Design 10

Context 13

Analysis 20

Constraints of methodology 21

Contribution to anthropology 24

Chapter Two: Literature and Background 28

Introduction 29

Literature 30

Transnationalism and Identity 30

Media and Representation 37

Media and Blackness 38

Media and Mental Health 45

Policy and Practice 48

The Delivering Race Equality in Mental Healthcare programme 54

The Mental Health Act 2007 55

The 2010 White Paper and 2012 Health and Social Care Act 56

Social Suffering 57

Resilience 66

Chapter Three: Family Health Isis 78

Prologue 79

Introduction 79

Family Health Isis 80

Organizational Structure 81

Activities and Services 83

Additional Services 84

Referrals 86

The role of Isis in the lives of service users 86

The Isis space 90

The Move 96

Chapter Four: The Service Users 99

Prologue 100

A note on quotations 100

Introduction 101

Noel 103

Noel's Interview 105

David 110

David's Interview 111

Mary 117

Mary's interview 118

The Family Health Isis Men's Group 123

The Men's Group Interview 125

The Social Action for Health focus group 133

The SAfH interviews 134

Chapter Five: The Professionals 147

Prologue 148

Introduction 148

Academics 149

Professor Frederick W. Hickling 149

Professor Tom Craig 151

Professor Roland Littlewood 154

Dr. Dawn Edge 154

Dr. Frank Keating 157

Community workers 159

Juliana Frederick, Janice Williamson and Frederica Joseph 159

Ray Johnson 165

Dr. Yemi Oloyede 166

Caroline Morris 167

Directors 168

Estella Weston 168

David Pinder 172

Malcolm Phillips 174

Jan Oliver 177

Matilda MacAttram 179

NHS Professionals 180

Yvonne Coghill 180

Mary Clarke 185

Sean Cross 186

Chapter Six: The Photographs 189

Chapter Seven: On Social Suffering, Identity and Resilience 250

Prologue 251

Introduction 251

On Social Suffering 252

Social Suffering Defined 252

Social suffering as structurally violent 253

Social suffering as interpersonally experienced 260

Social suffering as caused or intensified by bureaucracy 263

On Identity 279

The Identity Narrative 279

Media and Identity 281

(Re)defining Black Identity 287

On Resilience 294

On Double Consciousness 294

On Voice and Agency 296

The Resilient Space 304

The Resilient Community 307

Chapter Eight: Conclusion 313

Prologue 314

Introduction 314

Recommendations 316

Change philosophy of containment 317

Utilize local knowledge and innovation 319

Facilitate service user agency 324

Use innovative methodologies and engagement 327

Bibliography 330

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