Using personal experience in the academic medical humanities: a genealogy

The inclusion of personal experience in academic work, especially in the medical humanities, has increased markedly in the recent past. This article traces the roots of this development, arguing that it is not a simply off-shoot of ‘experts by experience’ in mental health, but has its own specific set of precursors and enabling conditions. Three of these are explored in detail, under the headings of ‘psychoanalysis’, ‘social history’ and ‘anthropology’. The continuing influence of psychoanalysis privileges the public expression of personal experience as a vital tool and site for self-development. Social history (from the 1960s onwards) takes ‘experience’ as its privileged object in understanding the past. The tools of twentieth-century anthropology animate much social constructionist and cultural history. This anthropology is based upon the ‘lived experience’ of the anthropologists, who immerse themselves into the life-world of the ‘natives’. The article concludes by cautioning against the unthinking or naïve use of experience as a sure foundation for work in the medical humanities, drawing upon the theoretical insights of Joan Scott, Judith Butler and Sarah Shortall.

in the sociology and history of medicine and psychiatry (e.g. Costa et al. 2012;Callard 2014).
In a related development, one of the most important changes in mental health policy and practice over the last two decades is the rise of the 'expert by experience'. This has been subject to significant scrutiny, particularly by practitioners connected to social work (Beresford 2002;Preston-Shoot 2007;Scourfield 2009;Noorani 2013). However, in both of these developments, the significance of the term 'experience' is elusive. Pinning down a comprehensive definition is difficult, yet it proliferates. Tehseen Noorani has argued that the 'experiential authority' of experts by experience is 'rooted in practices of self-help and peer-support'. Noorani traces this practice of 'user involvement' back to Community Health Councils in the 1970s, and then through the proliferation of satisfaction metrics in the 1980s (2013, pp. 51-52) Peter Beresford argues that it goes back to public involvement in land-use planning in the 1960s (2002, p. 95). Both Noornai and Beresford draw attention to how this involvement is given impetus and traction by the political philosophy of the 'New Right', with its emphasis on the 'active citizen' and the veneration of 'choice' as an organizing principle of social provision.
In the present article, I seek to contextualize the former development: the mobilization of personal experience in academic writing on mental health. In one sense, this phenomenon could be read as a relatively simple offshoot or outgrowth of 'expertise by experience'. In this reading, academics writing about mental health are simply taking their cues from experts by experience, and deploying their own experiences in their academic writing. Indeed some academic writers also publicly identify as experts by experience (for example Diana Rose and her position as the first Professor of User-Led Research at King's College London). However, I do not think that the relationship between the two is that simple. Two intertwined and contradictory threads inform the presence of 'experts by experience' in healthcare: consumer feedback on the one hand, and the critical-oppositional-survivor movement on the other (Beresford 2002). I do not see much of these in the mobilization of personal experience in academic work on mental health. Instead, I see the academic uses of experience emerging (primarily) out of three much broader and distinct, but overlapping developments. First, there is the continuing influence of psychoanalysis that privileges the public expression of personal experience as a vital tool and site for self-development. Second, there is the influence of social history from the 1960s that takes 'experience' as its privileged object in understanding the past. Finally, the tools of twentieth-century anthropology animate much social constructionist and cultural history. This anthropology is based upon the hard-won lived experience of the anthropologist, who immerses themselves into the life-world of the 'natives', experiencing this culture from 'the inside'. In all these senses, 'experience' becomes part of public, scholarly, and academic relevance.
This genealogy obviously misses out huge swathes of work on experience, from the phenomenology of Martin Heidegger (2010) and Maurice Merleau-Ponty (1962), to the standpoint feminisms of Dorothy Smith and Sandra Harding (e.g. Smith 1992;Harding 1992) Part of the reason for this is simply lack of space and expertise, but there is another more important reason. 'Experience' as deployed in academic work has a specific genealogy, specific roots. The term experience is so multivalent and ambiguous, each different set of uses requires a different genealogy. I am not starting at a generalized concept of experience and applying it to the academic work; I am starting at the academic work and tracing backwards. All the things that might conceivably fit under the term 'experience' in contemporary scholarship are too varied to have any coherence.
Many articles in this special issue involve insightful accounts of their authors' experience(s), for various analytical and rhetorical ends. Sarah Chaney's book on the history of self-harm, Psyche on the Skin (2017), is bookended by her experiences in a manner that enriches the argument, bringing issues into focus and situating her arguments with verve and immediacy. My point in attempting this genealogy is not to demean or diminish such deployments of experience. Instead, I seek to do two things. First, I want to ask how we got to a place where self-consciously bringing personal experiences to bear in academic work is even a question. For that, I'll flesh out the potted history flagged above, taking in psychoanalysis, social history and anthropology. Then I'll ask: what are the consequences of this? What happens when we make 'experience' a touchstone of academic writing?

How did we get here?
How has it become possible and acceptable to mobilize 'personal experience' in academic work? Ian Hacking notes that 'styles of reasoning create the possibility of truth or falsehood ' (1982, p. 56). Paul Rabinow-glossing this in the mid-1980s-adds that 'a style of thinking' is something that 'established the conditions for entertaining a proposition as being capable of being taken as true or false in the first place ' (1986, p. 237). So, being a historian, I want to do a history of the 'style of reasoning' or style of thinking' that allows us to use personal experiences in academic work. Through which logics or justifications do we come to give assent or refusal to this question? (I take this approach partly because this 'history of the question' is more interesting than my personal answer to that question, which is simply: 'if you want to do it, then do it-if you don't, then don't feel like you should').
My genealogy of this version of experience proceeds under the following headings: 'the cases of psychoanalysis', 'the foundations of social history' and 'the practice of anthropology'. In all three sections, I shall attempt to show how a particular reading of experience comes to the fore in ways that link it to the contemporary use of 'personal experience' by academics writing in the field of mental health. I shall then sketch out some of the consequences of this version of experience for academic writing.

The cases of psychoanalysis: making the personal public
One of the ways to crack open what 'experience' might mean in the medical humanities, and especially the history of psychiatry (which is my own area of expertise), is to analyse what a 'clinical case' is-as it isolates a patient and seeks to describe them in their individuality, whilst also connecting them up to much broader categories (as exemplars of this pathology, or that complication, for example.) One place to start with this is in the late nineteenth century with psychoanalysis. Much of this section draws upon John Forrester's brilliant paper 'If p then what? Thinking in cases ' (1996). Forrester sheds light on the kinds of thinking in psychoanalysis, what he calls 'thinking in cases'. Although Forrester's focus is predominantly upon psychoanalysis, he admits early on that 'psychoanalysis is only one culmination of a much broader movement whereby the life yields up its secrets'. He argues that bringing life systematically into focus 'appears to be closely linked with the very idea of the compilation of a dossier' (Forrester 1996, p. 11 'For a long time ordinary individuality -the everyday individuality of everybody -remained below the threshold of description. To be looked at, observed, described in detail, followed from day to day by an uninterrupted writing was a privilege… The disciplinary methods reversed this relation, lowered the threshold of describable individuality and made this description a means of control and a method of domination' (Foucault 1977, p. 191).
The individual, the biographical, materializes as part of a network of techniques (named 'disciplinary' by Foucault) that seek to know, to measure, to control. This is one of the sources of what we might call 'systematic' biography. But where does this become relevant for bringing personal experience to academic work? Here psychoanalysis becomes important: not only is quotidian biography ('the everyday individuality of everybody') relevant, but the telling of one's biography becomes relevant for its therapeutic potential.
Human beings become potentially known and self-knowing through biography (rather than, for example their profession or their family lineage). They also might be healed through the telling of their biography. Judith Butler argues that 'some have argued that the normative goal of psychoanalysis is to permit the client to tell a single and coherent story about herself that will satisfy the wish to know herself' (Butler 2005: 51).
Not just one's personal experience, but the telling of it, deploying it as coherent, for a particular end is central in psychoanalysis. Crucially, it involves making the experience public in some way. Forrester says that 'psychoanalytic discourse… attempts to render that way of telling a life public, of making it scientific [through] the case-history' (Forrester 1996, p. 10 (Forrester 2012, p. 74). When personal experience is used in the medical humanities, part of its relevance is that this experience is being mobilized in public, in published academic work. The experience that is central to psychoanalysis is therapeutic and public, as it is in uses of experience in the medical humanities.
Kaitlin Bell Barnett's book Dosed is based around the experiences of a number of people who take anti-depressants. Barnett admits that she is influenced by 'the fact that I have been taking various medications for anxiety and depression for over a decade ' (2012, p. 24). The book ends with the aspiration that it will 'encourage those who did grow up taking psychiatric drugs to share their ongoing experiences more openly' (Barnett 2012, p. 208). Barbara Taylor claims that her memoir/history hybrid The Last Asylum is about 'the work of turning the personal past into history'; she refers to herself as a primary source (Taylor 2014, p. 15). Something similar is going on in Anne Cvetkovitch's book Depression: A Public Feeling: 'If I wrote about depression in the third person without saying anything of my personal experience of it, it felt like a key source of my thinking was missing (Cvetkovich 2012, p. 17). Here experience is emphasized as a 'source' and Cvetkovich also uses the language of personal 'case history' which again acts as a bridge between 'personal experience' and public, academic work.
The logics of Taylor, Cvetkovitch Barnett begin to sound like discussions around therapeutic communities from the mid-20th century. Two pioneers of the therapeutic community, Wilfred Bion and John Rickman, publish a Lancet article in 1943 that opens with the claim that 'The therapy of individuals assembled in groups… sometimes it turns mainly on the catharsis of public confession' (Bion and Rickman 1943, p. 678). Therapeutic communities are not the only way this biographical, personal experience can become public and significant. Rhodri Hayward has shown how a biographical approach is key in twentiethcentury General Practice, bound up with psychological approaches. He notes that the founding 1900 issue of General Practitioner magazine cast the family doctor's insight in terms of 'biographical expertise' and that 'this historical familiarity' between doctor and patient 'was the basis for a new kind of psychological intimacy' (Hayward 2014, pp. 33-34). Biography and medicine are intertwined here too-one of the roots of the mobilization of personal experience in academic work.
Expressing one's personal experiences-a form of biographical narration-is bound up with a number of clinical, psychological and psychoanalytic frames of reference, which render this public use intelligible and possible. And thus we can see that the value of publicizing personal experiences becomes and remains relevant through a particular historical trajectory, as part of a particular historical context. None of this should read as invalidating the practice of deploying personal experience in academic work; it does show part of how we got to where we are. Public utterance now meshes with personal biographical insight in ways that only really take shape in the twentieth century. Thus, personal experience has traction in academic work. This is the first strand of the genealogy of the mobilization of personal experience in academic work.

The foundations of social history: experience as raw material
Now we arrive at the second strand of these roots of the whole question of the 'mobilization of personal experience'. A reading of experience for academic historians (the field with which I am most familiar) comes to the fore in Edward Thompson's toweringly influential The Making of the English Working Class (1963). In the preface to this foundational text of social history, Thompson begins to seriously revise the standard Marxist and materialist approaches to history. He argues that 'class' is not a structure or a category or a thing, it is 'something which in fact happens (and can be shown to have happened) in human relationships'. Elaborating on this, he claims that 'class happens when some men, as a result of common experiences (inherited or shared), feel and articulate the identity of their interests as between themselves… Class-consciousness is the way in which these experiences are handled in cultural terms' (Thompson 1963, pp. 8-9).
Experience here is central. Importantly it is a raw material, through which class emerges. Class and class consciousness are no longer simply functions of relations to the means of production (the orthodox Marxist view), but are built through shared experiences, as filtered through culture. This concept of 'experience' is therefore central to the new social history, or 'history from below', with which Thomson is associated. It is this kind of 'experience' that forms one of the foundations of the current practice of mobilizing biographical and personal detail in academic, historical work. It is this reading of 'experience'-as the personal, cultural raw material of identity-that we are looking for.
Thompson is a useful exemplar because of the reach and influence of his work, especially in history, but he is also used in work in the medical humanities that tackles the question of experience explicitly. In 1978, Thompson becomes even more explicit about experience when taking on one of the most influential Marxists of his time, French philosopher Louis Althusser. In his celebrated essay 'The Poverty of Theory' (1978), Thompson argues that '"Experience"… is breaking in and demanding that we reconstruct our categories ' (1978, p. 133). It appears as an agent for change when Thompson argues that 'there has been a pressure of real experience which has seemed to license the adoption of a particular language of social and political analysis, an ideological predisposition towards one vocabulary or another' (Thompson 1978, p. 100). Experience here saturates everything, and goes right to the heart of Marxism: 'experience is a necessary middle term between social being and social consciousness: it is experience (often class experience) which gives a coloration to culture, to values, and to thought: it is by means of experience that the mode of production exerts a determining pressure upon other activities' (Thompson 1978, p. 137).
'Experience' as we understand it is a founding category of modern social history, and a central component of Thompsonian 'history from below'. Roy Porter takes this notion to the history of medicine. At the end of his muchcited article 'The Patient's View: Doing Medical History from Below' he takes a disparaging shot at what he calls 'the "medicalization" theories of Foucault and Illich'. Porter mirrors Thompson in his distrust of large overarching systems of explanation, preferring to work at the individual or personal level Tellingly, neither Porter nor Thompson see 'experience'-this privileging of the personal-as such a system or theory. Unsurprisingly, Porter cites Thompson approvingly and claims that 'A people's history of suffering might restore to the history of medicine its human face' (1985, p. 194). Elsewhere in the article Porter claims that 'we need, for our various classes and communities, basic mappings of experience, their belief systems, images and symbols' (Porter 1985, p. 186). Experience becomes central to the writing of history and to the history of medicine.
Porter's call has been influential. To take just one example, Jonathan Andrews heeds the call in a way that links to Forrester's analysis of cases. Andrews uses records at Gartnavel Royal Asylum, Glasgow, to provide a sensitive analysis of 'how case notes and other asylum records become case histories… deployed for promotional and educative purposes, to generate public support and funding for the asylum' (Andrews 1998, p. 281). Alongside this sophisticated account of the use of case notes (and note again their explicit public function), he also argues that 'case notes constitute an especially important and extensive resource. They may provide the surest basis we have for understanding the changing nature of the experience of insane asylums since 1800' (Andrews 1998, p. 255). Experience and cases remain intertwined here.
Thompson is also influential in other areas. An important, complicated and rich article by Mark Cresswell and Helen Spandler, 'Academic Intellectuals and the Psychiatric Survivor Movement', cites Thompson in 2013, calling 'The Poverty of Theory' 'magisterial'. They argue that an academic should be '"deeply engaged". And deep engagement, far from being a philosophical problem, is a human practice -a "lived contradiction" involving all the unsettled relations which are subsequently engaged. A "lived contradiction" is a "lived experience"; and it is at the level of "experience" that its "evaluation" needs to be made.' (Cresswell and Spandler 2013, pp. 151-152) This is a difficult argument to parse, but clearly they see a problem with philosophical theorizing about experience-they set up a 'contradiction' between 'theory and experience', and favour a text that uses such personal experiences. They praise Kathryn Church's Forbidden Narratives: Critical Autobiography as Social Science (1995) for its inclusion of an account of 'personal breakdown' which enables her to have 'deep engagement' (Cresswell and Spandler 2013, pp. 148-149). Clearly they do not see their focus on 'experience' to have theoretical baggage or implications of its own. Thompson's critique buttresses 'expereince' and foregrounds it here; thus, it explicitly informs academic practice in the medical humanities.
So from these tangled threads of social history, class experience and culture, back to public case histories and psychological therapeutics, experience is again central. This forms something of a general and pervasive background upon which late twentieth-century valorizations of the 'experiences' of service users operates. The recasting of these experiences into 'experts by experience' and the mobilization of personal experience in academic work are both rooted in these developments. As 'experience' becomes such a valued category, indeed forming the bedrock for the discipline of history, this opens up the possibility for the academic's own experience to become relevant. If the object of one's academic enquiry is the experience of others, it is not a huge step to consider one's own experiences. (A set of prompts and influences that make that step more likely to be taken are considered below.) We can see this in anthropologist Emily Martin's book Bipolar Expeditions (2007) where she writes engagingly on the history and experience of bipolar disorder. She opens with the haunting lines: 'I have done ethnographic projects before, but none has tapped into my personal experience as deeply as this one did' (Martin 2007, p. 15). She wants to understand bipolar disorder 'in a broader cultural and historical context in order to shed light on the experience of having manic depression' (Martin 2007, p. 18). Here are the familiar strands of personal experience, linked to an understanding of historical and cultural context. In fact, the academic work she is doing, the 'history' and 'culture', are reduced to tools to understand the 'experience' of having had manic depression. The personal experience is deployed as an implied motive for writing the book. But it is not just that personal experience is used and mobilized here-the point of the book is to shed light on that experience. It is telling that Martin refers to ethnographic study, for this is the third plank of my account here. It is ethnography and anthropology that provide a strong set of influences and prompts for authors to deploy their personal experiences. Psychoanalysis brings personal experience into the realm of the academic, the realm of serious, useable, public knowledge; 'history from below' casts experience as the object of scholarship and the basis of class and culture. Anthropology brings the author's experience to the fore in a new way.

The practice of anthropology
Anthropology enjoys a remarkable surge in prestige in the early twentieth century, practised by W.H.R. Rivers, Bronislaw Malinowski, Margaret Mead, Mary Douglas, and others. Anthropological insight about the power of culture and environment in human life still forms the basis of many social sciences, and in fact underwrites many of the claims of postmodern and poststructuralist thought (Millard 2017;Millard, forthcoming). James Clifford's introductory essay in the influential anthropological collection Writing Culture (1986a) addresses perhaps the most crucial methodological technique in anthropology: participant-observation. Clifford argues that since the early twentieth century in anthropology 'the "method" of participantobservation has enacted a delicate balance of subjectivity and objectivity'. He claims that the 'ethnographer's personal experiences, especially those of participation and empathy, are recognized as central to the research process, but [in the early part of the century] they are firmly restrained by the impersonal standards of observation and "objective" distance' (Clifford 1986a, p. 13). This objective distance begins to give way, unevenly, to accounts that foreground personal experience as the century progresses.

Vincent Debaene has written an excellent book on French anthropology, translated into English in 2014 as Far Afield: French Anthropology between Science and
Literature. He notes such a shift in anthropological method in the mid twentieth century. The anthropological project is transformed from collecting objects and writing positivist classifications, to the idea that 'the anthropologist went to the field to immerse himself, to soak up another culture, to "live from the inside" the experience of the "native"'. This constitutes, according to Dabaene, a 'privileging of the personal, concrete and psychological aspects of field experiences' (Debaene 2014). Further, this section of Debaene's book can be found under the index entry: 'fieldwork, as lived experience'. The personal and lived experience are central, but this is not simply Thompson's 'history from below' or Porter's 'patient's view'-it is not simply the experience of the 'natives' that is the issue here. The anthropologist's self/personhood is implicated.
Clifford observes that since the 1960s anthropology has not been able to sustain the tension between the self-conscious participant observer, and the academic demands to adhere to the idioms of the physical sciences. He claims that this is shown by the emergence of 'self-reflexive "fieldwork account" [which is] Variously sophisticated and naïve, confessional and analytic'. In these accounts, 'the rhetoric of experienced objectivity yields to that of the autobiography and the ironic selfportrait' (Clifford 1986a, p. 14). In fact, Debaene's whole book is set up on the tension between the anthropologists' academic writing and the rising phenomenon of a more confessional, personal account of their voyages, something he calls 'the ethnographer's two books'.
Here we see another bridge-like the shift from 'case notes' to 'case study' described by Andrews-where the ethnographer's personal experience becomes more relevant in a public, published, scholarly setting. At first this relevance is uncertain in anthropology, as these experiences are packaged and published in different ways to the conventional scholarly outputs. As Debaene observes, it is a 'curious fact' that a particular group of ethnographers, trained by Marcel Mauss in the 1920s and 1930s 'wrote, upon their return, not only a scholarly study of the people they lived with but often a second book as well, a more "literary" work that did not adhere to the canonical forms of the scholarly monograph' (Debaene 2014, p. 4). This is not a new observation-historian of anthropology George Stocking has noted how 'the "self-reflexive" autobiographical account of fieldwork experiences has emerged as a distinct ethnographic genre' since the 1960s (Stocking 1992, p. 13). The author's self is deployed, first as an adjunct to scholarly work, and then as part of it. As Clifford writes in the 1980s '[t]he fieldworker, typically, starts from scratch, from a research experience, rather than from reading or transcribing' (Clifford 1986b, p. 117).
This anthropological move is not insulated from history and the humanities more generally (for more on this link, see Millard, forthcoming). (My focus is on history as it is my disciplinary home, not because I believe it to be the most important part of the humanities.) Martin Jay argues that 'the "thick descriptions" advocated by cultural anthropologists like Clifford Geertz and Victor Turner served as a vital inspiration [for historians]. Either as a site of mystification or a locus of resistance (or both at once), the "everyday" became a privileged arena for cultural historians with a critical bent and a distaste for rarefied discourses and exclusive institutions'. (2005, p. 243). Thus, experience becomes even more central to academic work, especially in history, but also in the social sciences and humanities.
This account-encompassing psychoanalytic cases, history from below, and anthropology is unashamedly partial; there is plenty more to say here, many other roots to this tendency and other routes through these influences. The point here is not to attempt being comprehensive, but to be tolerably coherent. To take just a few other examples, the rise of autobiography and its relation to history; the use of diaries as historical sources; recent discussions of what have been called 'egodocuments'. All these would be fruitful avenues to explore (see e.g. Paperno 2004;Hellbeck 2004;Aurell 2006;Wallach 2006;Fulbrook and Rublack 2010). To take an example from this list of works, Jaume Aurell seeks to use autobiographical texts as historiographical sources; he connects autobiographies written by historians to the histories that they write. He does this to 'examine to what extent the scholarly production of historians has been conditioned by personal experience' and he finds that, yes indeed, the 'ostensibly intellectual exercise' of writing an autobiography 'is actually more governed by personal experiences than previously believed' (Aurel 2006, pp. 426-427). We can see the mobilization of experience as a valued category of analysis-although this time not the author's own, but at one remove.
However, we should now recap and proceed to the implications. We began thinking in cases, drawing from Michel Foucault's dossiers and systematic biography, which becomes developed into a therapeutic instrument in psychoanalysis, although the public and practical uses of biographical experience also feature in general practice and therapeutic communities. The notion of experience also becomes the foundation for a new kind of (social) history, the object of a new way of writing about the past. This has the potential to make one's own experiences come into focus as part of academic history, and this privileging of experience has been taken up by some scholars looking at the history of mental health movements. Finally, anthropology and the immersion of the anthropologist in another culture keeps the self central, with the idea of using oneself as a tool, self-consciously and reflexively in academic work. The influence of this anthropological turn-especially using the work of Clifford Geertz-has been hugely influential in history and the humanities. The mobilization of personal experience by academics is one particular outgrowth of these historical threads; when academics use their personal experience in their published work, they are building upon these varied foundations, participating in this historical traditions.

The consequences of experience
So, what is the point of all this? Having sketched this history, what are the consequences of mobilizing personal experience in histories of mental health? In Giving an Account of Oneself, Judith Butler argues that whenever one gives such an account, it always 'takes place in relation to an imposed set of norms… There is… no self-making outside of the norms that orchestrate the possible forms that a subject may take' (Butler 2005, pp. 17, 19). One's self is always crafted with the resources available, within the contexts and conventions operation at the time. I have tried to expose part of these 'possible forms': three ways in which historical context bears down on the mobilization of biographical experience in academic work.
To sketch out the consequences, I want to lean on a fantastic essay by Joan Scott. All too often, Scott says, experience 'serves as a way… of claiming knowledge that is unassailable' (Scott 1991, p. 797). This kind of deployment of 'experience' is the one used by Kay Redfield Jamieson, international clinical authority on manicdepressive illness, and also someone who identifies as a sufferer from that illness. Jamieson has claimed that that 'I have become fundamentally and deeply skeptical that anyone who does not have this illness can truly understand it' (Jamieson 1995, p. 171). This is also precisely the kind of claim made in the name of experience by those in critical studies of autobiography, which sometimes treat experience in a puzzlingly uncritical manner, as 'peculiarly direct and faithful' (Olney 1980, p. 13).
Rather than closing down, I wish to pursue a scholarly practice where experience, in Scott's words: 'is not the origin of our explanation, but that which we want to explain' (Scott 1991;p. 797). Recently, Scott's essay has been parsed brilliantly by Sarah Shortall, who brings together Edward Thompson's notions of experience with those of the 1960s psychedelic counterculture. Shortall follows Scott in arguing that 'each appeal to the rhetoric of experience involves a choice as to what is authentic and central to that experience and what is ancillary to it-a choice which can always be challenged by competing claims to experiential authenticity' (Shortall 2014, p. 204). So as well as being historically contingent, there are costs and benefits to deploying experience; there is a certain politics of authenticity going on with experience; there are historical and intellectual structures (often hidden and unarticulated) that shape what experience does and what it signifies. The post-structuralist, genealogical, Foucauldian history that I try to practise is important to me because it exposes the vast intellectual and practical ways in which our most private inner life, our most potent experiences are always already parsed, structured and interpreted in ways that we do not choose. Butler and Scott are extremely helpful in teasing this out. Leon Antonio Rocha, in a recent analysis of Michel Foucault's engagement with the concept of experience, asks 'when we say we want to listen to and recapture marginalized voices, are we implicitly assuming to be able to hear these voices without the filter of power? Are we suspending our disbelief and thinking that there can be utterances that are not already saturated by power in some way? Are we pinning our false hope on some kind of "reality" to be recovered that is untouched or uncontaminated by power?' (Rocha 2012, p. 211) Whilst dissenting from the idea that all utterances are 'saturated' by power, I would agree that in order to speak at all, there must be some sort of platform, some sort of power in play. This power deserves our attention and our thoughtful critique, even if we are then to use it. I would hope that it doesn't need saying that making personal experience part of academic accounts requires significant courage in a society where mental ill-health is still stigmatized. It is an act of inclusion and solidarity that is to be lauded in many ways. But it also leaves something out, and this is crucial. Butler is clear on this: 'What is left out if we assume, as some do, that narrative gives us the life that is ours, or that life takes place in narrative form? The "I" who begins to tell its story can only tell it according to specific forms of life narration… If I give an account and I give it to you, then my narrative depends upon a structure of address. But if I can address you, I must first have already been addressed, brought into the structure of address as a possibility of language before I was able to find my own way to make use of it… the very possibility of linguistic agency is derived from a situation in which one finds oneself addressed by a language one never chose' (Butler 2005, pp. 52-53).
When we deploy experience, we depend upon huge sprawling intellectual systems that make this action intelligible. This is what Butler calls 'structures of address'. This ability to speak, to draw upon personal experience, to have agency, is not a simple assertion of power or individuality or influence. It is already only a possibility because it resides within structures of ideas that we have been tracing. Butler is clear on the fact that we are already embedded in these systems and should therefore take a look at them to see how they guide and shape what we are able to say. Joan Scott spells this out when talking about experience specifically. She writes that through 'this kind of appeal to experience as uncontestable evidence and as an originary point of explanation… these studies lose the possibility of examining those assumptions and practices that excluded considerations of difference in the first place. They take as self-evident the identities of those whose experience is being documented and thus naturalize their difference. They locate resistance outside its [experience's] discursive construction and reify agency as an inherent attribute of individuals, thus decontextualizing it' (Scott 1991, p. 777). Therefore, when analysing these 'structures of address', it is to find what they exclude, the assumptions that they are built on, the way that they naturalize difference. Jamieson's idea that one has to have experienced manic depression in order to truly understand it is actually a striking assertion of the essential difference of all those who have experienced manic depression. It might not always be helpful to put such a strong barrier in between humans, to put it mildly. Yes, 'experience' can deliver a sense of agency, and a voice and a platform from which to speak, but it is a precarious one; it is built upon a commonsense appreciation of essential difference that can as easily ensnare as much as it seemingly liberates.
An article by Lucy Costa et al. (2012) records and develops threads from 'a community event organized in response to the appropriation and overreliance on the psychiatric patient's "personal story."' They argue that these accounts have been appropriated to further the interests of mental health organizations, and in the process have become examples of 'disability tourism' and 'patient porn' (Costa et al. 2012, p. 85) They reproduce the testimony of one participant who attempts to use these narratives to focus upon systemic oppression.
In our research, if we listen only for the "lived experience" of individuals, and only for processes of illness and recovery-we will miss many other vital storylines. We need to complicate what we are listening for: to listen less for stories of healing and recovery and more for stories of resistance and opposition, collective action and social change. (Costa et al. 2012, p. 96) This is an important point, not because everyone should be looking for systemic oppression, but because it shows how 'lived experience' might obscure certain narratives or analytical outcomes, at the same time as it foregrounds others.
From the above consideration of 'experience' in academic writing about mental health, it is clear that the possibility of utilizing experience is constrained by history (i.e. only an intelligible tactic because of specific historical and cultural currents). It is also potentially constraining: built upon a profound sense of difference and division, marking off those who are 'experienced' in ways that are potentially stigmatizing. It seems ironic indeed that the inclusion of 'expertise by experience' might even be contributing to the stigmatization of those whose experiences are mobilized, by marking them off as essentially different and special. It certainly prevents us from asking about how difference is established in the first place, and how we might imagine (and then work towards) a world where these differences (between those with experience of mental health services, and those without) might become unnecessary.
Thus, when 'personal experience' is used in academic work, we should be aware of how implicated it is in a set of contingent histories, and how, through these histories, it comes with a tendency towards naturalizing difference. In this sense, its authenticity and interiority is historically specific and potentially hazardous. It can also be a powerful act of solidarity and courage in a context where mental ill-health is often stigmatized and hidden. I mentioned at the start that I don't think the deployment of personal experience in academic work is a simple offshoot of the rise of 'experts by experience'. This latter group has-as noted-been theorized as coming out of consumer groups (on the one hand) and the more adversarial and critical survivor movements (on the other). In contrast to this, I do think that academic deployments of personal experiences arise through the developments I have traced here: psychoanalysis, social history and cultural anthropology. It is also possible that these three threads also feed into expertise by experience; it is certain that similar pitfalls in the deployment of authenticity might also bedevil these experts. However, there is a limit to what can be attempted in a short article. As it stands, the preliminary genealogy to 'experience as deployed in academic work' is hopefully a useful beginning point; it is certainly not intended to be the last word. I hope to have started a conversation where instead of simply producing a history of personal experience in academic work, I have begun to sketch the conditions governing the way in which the relation to oneself can constitute the possibility of deploying such experience. 1