This chapter looks at the emergence of ‘patients’, ‘clients’, ‘service users’, ‘survivors’ and ‘carers’ as distinct groupings and considers the associated opportunities and constraints inherent in these assumed or ascribed roles. It appraises power plays and imbalances and explores how these have served to variously include and marginalise. It reviews key aspects of the literature and examines the ways in which ‘patients’, ‘clients’, ‘service users’, survivors’ and ‘carers’ have been incorporated into policy platforms and practice scenarios. In all arenas concerned with policy and practice, terminology is important. How individuals and groups view themselves, and how they in turn are viewed and responded to, has significant implications. Throughout this book terminology will be subject to critical appraisal, but at the outset it is useful to outline some of the key issues surrounding much-used designations such as ‘patients’, ‘clients’, ‘service users’, ‘survivors’ and ‘carers’. The label ‘patient’ has acquired both legitimacy and credence through the acceptance and durability of the processes and practices of medicalisation. In clinical terms, a ‘patient’ has a medical problem which a range of medical professionals respond to, often by means of a process of hierarchical ordering linked to medical responsibility. There tends to be a duality of acceptance with the inevitable power imbalances being associated with the need for expert knowledge and expert intervention. However, these processes have been subject to deconstructive appraisal. Foucault (1979, 1981), for example, critiqued both the implied passivity of the ‘patient’, the processes by which individuals become ‘docile bodies’, and the legitimising knowledge and power regimes of the expert. Many authors have used his work to unpack the effects of medicalising practices (e.g. Fox, 1991) and have used genealogy to explore the forces which render particular social practices acceptable at particular points in time, enabling them to be both prescriptive and confining in terms of what is to be done and what is to be known (Foucault, 1981).
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