Marginality and psychiatry - two intersecting worlds: psychiatrist- and lived-experience perspectives

Against the background of strong social determinants and modulators on the incidence, prevalence, course and lived experience of the dominant western conceptualisation of 'mental illness', this text explores literature in the fields of subaltern/subaltern studies, precarity/precariousness, the relationship between precarity and mental health outcomes, as well as madness/Mad Studies. These fields of work offer key, under-explored insights into matters of importance for the practice of psychiatry at the clinical coalface and across society. In the discussion, the authors debate, from survivor/lived-experience and professional perspectives, whether a combination of autonomous, collaborating (and potentially competing and conflicting) (i) user-controlled organisations of mutual help, support, Mad Studies (as part of and in alliance with New Social Movements (NSMs)), and (ii) professionally-controlled systems of practice and research in the fields of psychiatry and mental health could work effectively together but also in some tension with each other. Engaging in dialogue and debate on these issues could help psychiatry and our broader understanding of madness and mental distress move forward.