“Finding hope in the lived experience of psychosis: Reflections on trauma,use of power and re-visioning psychiatry”: Book review

Drs Patte Randal and Josephine Stanton (2022), two exceptional women and accomplished psychiatric professionals, authored this duo-ethnography, “Finding Hope in the Lived Experience of Psychosis: Reflections on Trauma, Use of Power and Re-visioning Psychiatry”. The book offers personal and insightful perspectives into the experience of and recovery in serious mental illness. Dr Randal has a lived experience of recovery in what psychiatrists would usually call psychosis, or as she prefers, ‘extreme states’, with its onset in her mid-twenties. Both authors achieved postgraduate degrees before completing medical studies and then pursuing psychiatry in Auckland, New Zealand. Their dynamic professional journeys are placed in the context of their evolving personal lives and values, balancing professional pursuits with personal obligations and demands such as relationships, marriage, motherhood and mental health.

We accepted the authors’ invitation to review this book because of our interest in psychiatry training and our association, either as trainees or educators, with the psychiatry training programme based in Auckland. We have reviewed this book through the lens of contemporary psychiatry education where the recovery model and trainee self-care form part of the Royal Australian and New Zealand College of Psychiatrists’ training curriculum, and accordingly whether the book has added value for psychiatry trainees.

Dr Randal’s dynamic interaction between her own lived experience of extreme states and her experience as a psychiatric doctor allows for a unique and candid perspective, exposing the inner shortcomings of training programmes and mental health systems. The symbolism behind Dr Randal losing her voice is compelling and multi-dimensional, speaking volumes to the institutional limitations and power imbalances that rendered her powerless and speechless. With the remarkable support of her female psychiatry colleagues through her extreme states, she realised her dream of implementing the ‘Re-covery’ model in a psychiatry rehabilitation unit. In a parallel process, Dr Randal was able to support people with serious mental illness by utilising the therapeutic relationship, effectively promoting optimal recovery and well-being. Despite times of tension arising from the bi-directional impacts between her lived experience of extreme states and her career and relationships, her resilience and personal value in human relationships persevered and shone through. By reinstating and promoting this voice for others, she also recovered her own voice along the way.

Dr Stanton’s humility and openness to learning from lived experiences sets an example for future practitioners to adopt a more holistic and person-centred approach to mental health care. Epistemic injustices in mental health are exposed, emphasising the importance of acknowledging people living with mental health problems as credible narrators of their experiences, thereby advocating for a change in the associated negative attitudes and stigma. Her initial discomfort and powerlessness in the face of restrictive and overly biomedical practices early in her training is relatable. Yet, her capacity and commitment to harness this discomfort and transform this towards powerful advocacy at both individual and systemic levels is inspiring, enabling the clinical, cultural and systemic changes required to support this paradigm shift towards more recovery-oriented practice.

The authors’ personal and professional friendship reinforced the importance of forming connections with our colleagues during our training, bonds which often last for our professional lifetime. These relationships are not only crucial for personal resilience but are also instrumental in shaping a more empathetic, person-centred model of care. As three male reviewers, we wondered whether male mental health practitioners have the same quality relationships that contribute towards these external resilience resources, and what more could be done to encourage these connections?

The authors should be commended for their honesty in revealing some very private moments in their lives. Moreover, their lived experiences have informed their roles as clinicians, researchers, educators and advocates in the field of psychosocial support for people with serious mental illnesses. Psychiatry trainees have much to learn from this capacity to reflect, a critical skill of being a psychiatrist, and be open to integrating personal self-care and growth with professional development.

While the book introduces alternative models of understanding and care, a noticeable Western bias permeates these narratives. This is reinforced through their respective stories written as rather individualistic journeys, echoing Western constructs that prevail in psychiatric and social discourse. Indeed, the rejection of Chinese philosophy by Dr Randal’s doctoral thesis examiners exposed the likely early, systemic Western influences shaping her journey. Limited references to Taoism and Eckhart Tolle are otherwise overshadowed as the book misses an opportunity to explore Eastern and Indigenous frameworks of non-duality and collectivism and how they apply to mental health.

In parallel, the authors deftly reshape psychiatry, advocating for a compassionate and empowering treatment shift. They highlight lived experiences as crucial lessons for navigating mental health challenges and boldly challenge existing institutional and systemic practices towards more recovery-oriented and human rights–based approaches. Yet, while such historical pendulum swings in psychiatry, such as between psychodynamic and biological reductionism, are well-captured, the book seemingly inadvertently repeats this history. At times, the book tends to oversimplify complex formulations of extreme states, relying almost exclusively on past personal events to arrive at bold assumptions for explaining their experiences. Rather, the book would benefit from greater exploration of the interaction between these bi-directional mind–body perspectives and in the context of wider social, spiritual and collective contexts. This would lend itself to the complexity and limitations of current epistemological frameworks, conveying humility and the need to balance these natural and social sciences, adding further conviction towards the book’s central message regarding the value of finding hope in the lived experience of psychosis. However, the lack of nuanced discussion and integration between these realms detracts from the book’s overall balanced approach.

Recognising the authors’ foundation within a primarily male-dominated psychiatric programme prompts us to engage in a candid assessment of our own potential unconscious biases. As male psychiatric doctors, we acknowledge the importance of acknowledging these biases as a potential limitation in our evaluation of this work.

In conclusion, this collaborative effort effectively weaves academic theory, qualitative work and the authors’ own backgrounds to create a genuine and profound narrative that connects with readers on a deeper and personal level. We would highly recommend this book to psychiatry trainees and fellow psychiatrists. By offering critiques of the institutional complexities and power dynamics within mental health systems, the authors challenge readers to reflect on their roles and reconsider their practices within mental health care, ultimately paving the way for more compassionate and effective care. The authors’ personal stories inspire us to reflect on our own journey and to re-evaluate the balance and integration between our professional and personal stories. Their stories also remind us of our passion for connecting with people living with mental illnesses, something which can often be overshadowed and lost by institutional and systemic pressures. The impact of this collaborative work therefore extends beyond academia, sparking crucial conversations for the next generation of mental health clinicians towards fostering positive change within the mental health community.