“Theorising deep experiential knowledge in the context of evidence-based practice: Raising political questions,” by Tehseen Noorani
Thomasina Borkman, Magnus Karlsson and I have co-authored an article published online in the journal Evidence & Policy that offers the concept of ‘deep experiential knowledge’ to describe the knowledge generated when many people’s experiences are collectivized through the sharing of stories over time. In 1976, Thomasina introduced the term ‘experiential knowledge’ in her study of self-help groups. Over forty years on, we wanted to return to and elaborate upon this concept, again using self-help and mutual aid groups (MAGs) as ethnographic sites.
In our article, we argue that the ‘old-timer’ of a MAG has a different kind of knowledge than the ‘newcomer’ to the group. While the newcomer knows only their own story, the knowledge of the old-timer entails the collectivization of stories, woven together, revealing patterns of difference and repetition in relation to the problems that groups form around. We call this collectivized and narrative-based knowledge ‘deep experiential knowledge’ (DEK). The article offers examples to describe the nature of DEK, how it is generated, and some of the ways that people with experiential knowledge attribute DEK to one another. We end the article by offering some implications of taking this kind of knowledge seriously for models of evidence-based practice.
The article’s main target audience is policy-makers and academics invested in the evidence-based practice framework. It aimed to challenge both tokenism and the use of celebrities in ways that are counterproductive for the meaningful involvement of those with experiential knowledge in the improvement of healthcare systems. At the same time, Thomasina, Magnus and I came to our collaboration with different disciplinary affiliations, perspectives and epistemologies. I want to take the opportunity of this blog post to offer some critical reflections of my own, which I hope will stimulate further dialogue about the idea of DEK, while revealing some challenges of interdisciplinary collaboration.
Overall, I view this article as offering an analytical contribution to understanding knowledge collectivization, one that serves as a corrective to how evidence-based practice has been theorised and operationalised, and not a political contribution that necessarily leads to the making of a better world. Early in the article, in pursuit of an ‘ideal type’ that we could explore ethnographically, we define MAGs in certain ways, such as involving peer-led group structures not beholden to external frameworks. But this is suggestive of a purity to experience, when the latter ought to be treated as situated within matrices of wider power relations, including material and discursive cooptation by healthcare multinationals (cf. Mohanty, 1984; Scott, 1991). The importance of the careful and tactical facilitation of MAGs could have illuminated this – facilitation that ensures, for example, that dominant themes are not voluntarily perpetuated at the expense of other experiences that are silenced. Thus while DEK may indeed form within these sites and ought to be taken seriously as a kind of epistemic achievement, it may not work to liberate those who acquire it or otherwise come into contact with it from wider ideologies or hegemonies. In the article we tried to warn against MAG cooptation by emphasizing the need at a societal level to cultivate a plurality of MAGs with distinct DEKs, but this is no guarantee against the emergence of wholly coopted knowledges.
A second concern with our attempt to articulate DEK and laud it as an achievement is that it threatens to devalue other experiential knowledge as ‘shallow’, risking a return to a time (indeed, one that still exists!) where certain people’s voice, dignity, desires and understandings are ignored and neglected. On this, we suggest in the article that there needs to be an (uneasy) alliance between universalist discourses (demanding we acknowledge everyone’s voice), often couched in rights-based language, and the authority that comes with having a deeper experiential knowledge. But the threat remains, plus it is an additional concern if the only way to guard against that threat is to call upon universal individual rights, which themselves problematically reinforce an image of the autogenic and optimising liberal individual.
A third concern with our argument is that it may overlook a more important political fight – demanding and establishing more survivor and user-driven research, enabling more and more experts-by-experience to enter research positions, and getting their multiple expertises recognized. This would be about embracing the hybridity of knowledges and the mediating power of those occupying more than one role (cf. Kalathil and Jones, 2016), rather than introducing new terms (such as DEK) that seek to pit knowledges against one another, bringing new hierarchies with them. One might respond that it’s not an either-or, but it is hard to deny the feeling of being short on resources (including time, attention, money and authority) with which to change the systems that are not working as we would want them to.
I think it is important to attempt to articulate a concept like DEK. For my part, it was motivated by acknowledging that we will never get rid of hierarchies, and so we may not want to pretend that we are doing so, reiterating once again the lessons of Jo Freeman’s (1970) classic essay, The Tyranny of Structurelessness. By making hierarchies between levels of experiential knowledge explicit and accountable, we can discuss and challenge them. I also hoped the article would be timely in seeking to capacitate mutualism at a local level – offering legitimacy for MAGs working directly in communities, as repositories of situated wisdom, rather than looking for external structures of public and patient involvement to operationalise MAG knowledge. The article also calls for attending to other sites for the generation of DEK, outside of the bounded space of the MAG. However, seeing these as the fruits of an analytical contribution, I hope the reflections in this post also prompt related political questions, concerning the radicality of experience in contemporary times.
Thanks to Rachel Jane Liebert and Will Hall for helping me think through some of the issues raised in this post.
References: Freeman, J. (1972-1973) ‘The Tyranny of Structurelessness‘, Berkeley Journal of Sociology, 17, 151-164. || Kalathil, J. and Jones, N. (2016) ‘Unsettling Disciplines: Madness, Identity, Research, Knowledge’, Philosophy, Psychiatry & Psychology, 23)3/4), 183-188. || Mohanty, C.T. (1984) ‘Under Western Eyes: Feminist Scholarship and Colonial Discourses’, boundary 2, 12(3), 333-358. || Scott, J. (1991) ‘The Evidence of Experience’, Critical Inquiry, 17(4), 773-797.
Tehseen Noorani is a Marie Curie fellow in the Department of Anthropology and a member of Hearing the Voice, Durham University. His interests lie in the phenomenological, epistemic and sociopolitical character of extreme experiences, and how these are made sense of across different ‘consciousness cultures’. He is currently writing a monograph tracing the renewed scientific and therapeutic interest in psychedelic experiences in the global North, exploring implications for theories of psychopathology and approaches to mental health care.