Medicine and Power Module

Medicine and Power Module

Green Chinese takeaway boxModule Takeaways

  • Appreciate systemic power imbalances in the mental health system between those who provide and those who use services
  • 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

Three green gears working togetherModule Artefacts

Green measuring tapeModule Assessment

Using module artefacts 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:

  • Doreen Befus
  • Ya’Ya Heit
  • Lori E.
  • Alistair Scott-Turner
  • Dana Allan
  • Irit Shimrat

Green hand-held magnifying glassModule 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, even though the radical shift from institutional to community mental health meant that the sites where power was exercised evolved and new professional players came on board. We included materials in this module on the history of state-sanctioned sterilization, legal in Alberta until the 1970s, as a compelling case study of the abuse 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 echoed the concerns of scholars writing about mental health professionalism and power, stressing 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.

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. 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.