From Models to Logics: A Critical Lens for Understanding Conflicting Perspectives on Madness and Mental Distress in Community Mental Health Services

A diverse range of explanatory models for mental distress (including biomedical and social perspectives) are utilised within community mental health services. This has led to enduring tensions and conflicts amongst practitioners and service users over ways of understanding distress. Drawing on an empirical study (Moth, 2022), this paper aims to theorise the social and political forces, collectivities and interests anchoring these contested knowledge claims, and examine how socio-political processes associated with contemporary neoliberal policy agendas are reshaping the ways that explanatory models are articulated and acted upon within this setting.

The paper addresses these aims in two stages. The first is to extend the framework of emergentist Marxism (EM), a form of critical realist morphogenetic approach, by drawing on recent conceptual work on subsumption, sedimentation and temporality. The second is to apply this temporalised EM framework to the empirical findings of the study in order to identify the situational logics and associated directional tendencies (Archer, 1995) shaping knowledge and practice within community mental health services. Two such tendencies, ‘biomedical residualism’ and ‘ethico-political professionalism’, will be identified and their role in enabling and/or constraining various conceptualisations of, and responses to, mental distress by practitioners and service users will be illustrated.

Drawing on this framework, the paper will conclude that there is a need to move beyond a reductionist focus on the ‘models’ with which particular professionals and service users identify in community mental health services. Instead, it will advocate a ‘logics’ approach which offers a more contextually situated understanding of what professionals and service users think, articulate and do within this service setting, recognising how interactions between concepts, contexts, interests and actions shape everyday experiences, practices, conflicts and processes of change within this setting.