Can Two Wrongs Make a Right?

SERVICE USERS, carers, and professionals disagree about the nature of mental disorder in startling new revelation!” On first appearances Fulford and Colombo’s use of linguistic-analytic and empirical methods to demonstrate this point may not seem as if it is telling those in the mental health world anything that they do not already know. The bipolar/dialectical axis (choose your preferred term depending on your ideological position) with the anti-psychiatry movement at one end and the biogeneticists at the other is both well-known and welldocumented. Yet it is precisely that flippancy, and the practical implications that flow from it, that make this work so fundamentally important to the theory, application, and experience of mental health practice at the beginning of the twentyfirst century. Discussions about different models of mental disorder usually play themselves out in arguments within services, or between services and service users and informal carers, about the most appropriate approach to take in addressing a service users needs, or in abstract discussions (often over a drink after work) about the nature of mental health and mental health problems. From blood and fur flying in the bull pit, to swallows endlessly chasing their tails high in the sky. Sadly, the results of this all too often are bitter and unresolved conflicts, different parties digging themselves even further into defensive, entrenched positions, and the least powerful (usually service users) suffering the most as a consequence. Both sides believe the other to be wrong yet cannot convince them of this; an example, albeit with slight variation, of two wrongs not making a right. Rarely are the debates grounded in a constructive, creative, and problem-solving approach on a day-to-day basis, partly because hitherto there does not seem to have been either sufficient empirical evidence to base this upon, or the conceptual as well as practical tools with which to grapple with the issues. Generally speaking, mainstream research in mental health has tended to focus on issues such as symptoms and treatment interventions (James and Burns 2002). However, surveys of service users’ views still show considerable problems in the way services are received and experienced by users (Rose 2001). Other surveys, together with user-led research, such as Strategies for Living at the Mental Health Foundation, have also shown how the focus of users’ concerns maybe very different to that of service providers (Faulkner and Layzell 2000; Nicholls et al, 2003; Repper 2000). Indeed, a piece of research carried out in the 1990s, which would probably still hold true today, showed that service users prioritized practical issues such as personal finance, housing, and social support, whereas professionals saw issues such as treatment and monitoring as being the highest priority (Shepherd, Murray, and Muijen 1995). Combining this, one might well argue that there is fairly clear evidence of the “