Experiential Knowledge and Professional Knowledge

The issue of validity of knowledge, which occupies an area of philosophy termed epistemology, is of great importance (Higgs and Titchen 1995). Knowledge in western philosophy has been frequently classified into two main categories: propositional knowledge and non-propositional knowledge. Propositional knowledge is derived through research and scholarship whereas non-propositional knowledge is derived mainly through practice or experience. According to Higgs and Titchen (1995), a hierarchical relationship exists between propositional and non-propositional knowledge, with propositional having a higher status. Schon (1983) reports that in the early 20th Century professionals established their schools in universities with the purpose of gaining prestige. This led to professional activity being conducted in an instrumental problem solving way, which was made rigorous by adopting a scientific theory and technique. An influential epistemological movement during the first part of the 20th Century was logical positivism or logical empiricism. Logical positivists argue that the only source of true knowledge is objective observation and that it has to be based on rational arguments that follow a logical scheme (Carnap 1966). Since then, many scholars have considered scientific knowledge as a supreme form of knowledge, as it utilises objective scientific methodologies and rational arguments. As a result, experiential knowledge was viewed as being invalid due to its lack of objectivity, verifiability, universality or rationality. However, according to Caron-Flinterman, Broerse and Bunders (2005), changes occurred in the thinking about knowledge in the middle of the 20th century, and these insights led to the developments of new, realistic perspectives in relation to knowledge and truth. For example, patient‘s experiential knowledge may not be deemed as invalid by contemporary scholars, since the existence of one absolute truth is denied, emphasising instead the socially constructed or contextual character of all knowledge, scientific knowledge included. From a

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pragmatist‘s perspective, philosophical concerns about ‗how the world really is‘ is rejected, but recommends the philosophical importance of what is profitable or useful.

2.4.1.1 Professional Expertise

Higgs (1993) describes a profession as an occupational group that is able to claim a body of knowledge distinctive to itself, whose members are fit to practice competently, autonomously and with accountability, and whose members contribute to the development of the profession‘s knowledge base. According to Popkewitz (1994), the view of the expert practitioner is that they are the most reliable authority and source of knowledge regarding the nature of the reality it deals with, and assumes that people in society should trust in this expertise without question. In the medical profession, especially in the area of mental health there was, and perhaps the expectation still prevails that patients should passively consume medical diagnosis and advice without posing any resistance to such an expert opinion. Higgs and Bithell (2001) assert that it needs to be recognised that the idea of ‗expert‘ and ‗expertise‘ are socially constructed

The process of professionalisation is the historical and political emergence of occupational groups as professions. This process is one of the main features of today‘s society, involving the establishment of formal entry qualifications based upon education and examination, and the development of regulatory bodies which can admit and discipline members (Bullock and Trombley 1988). Benner (1984) contends that within the context of professionalisation, expertise implies the possession of an exclusive body of knowledge, and a highly developed level of skill which for the most part is not shared with, or taught to patients or other non-professionals. Expertise carries with it a high degree of status and privileges, and expert judgments are held to be incontestable by others of a lesser status. Professionalisation, as an historical process, reflects an aspiration of professions to attain privilege and status, particularly medicine. In the traditional medical model, the relationship between the health care

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professional and service users is one fraught with inequality, in which the service user fulfills the subordinate role of the patient. Patients are expected to place their trust in the professional‘s judgment and follow the prescribed treatment, any challenge of the professional‘s opinion is not welcomed, and the patient is often classified as ‗awkward‘ or ‗non-compliant‘ as a result. The authority of expert opinion in health care is no longer unchallenged; service users are challenging paternalistic cultures indicating that there is an additional knowledge base.

2.4.1.2 Experiential Knowledge

Every person has experiential knowledge and draws upon it so some degree, however, the context of this study relates to the particular experiential knowledge of mental health service users. Borkman (1976) describes experiential knowledge as a primary source of truth learned from personal experience. This knowledge or insight is gained from direct participation in a situation. ‗Experiential knowledge‘ denotes a high degree of conviction as it is a primary source of truth learned from first-hand experience. The experiential knowledge of service users challenges the ‗specialist knowledge‘ of professionals, which was once unquestionable. According to Beresford (2003), the concept of experiential knowledge is generally used in relation to service user involvement to mean knowledge that is based in first-hand real life experience. Another term that is sometimes used to describe such knowledge is ‗authentic‘. Experiential knowledge is thought of as being distinctly different from other types of knowledge that healthcare professionals might draw upon as it is solely based on life experience rather than academic or professional knowledge. Borkman (1976) discusses the major differences between professional and experiential knowledge. In contrast to professional information, experiential knowledge is pragmatic rather than theoretical or scientific. Moreover, the experiential perspective is different from that of the professional knowledge, partly because of the different relationships each has to

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the problem. The professional is trained to treat a problem and provide care to the person; in addition, the professional has a financial and career interest. The person experiencing the problem first hand has a different set of interests in the way the problem is defined and the strategies to resolve it. He or she is personally experiencing physical, mental, emotional difficulties with his or her social networks and identity and material interests involved. Beresford (2003, p.22), holds a similar opinion and hypothesises that knowledge originating from this direct experience delivers more reliable knowledge: „The greater the distance between direct experience and its interpretation, then the more likely resulting knowledge is to be inaccurate, unreliable and distorted‟.

Acknowledging the legitimacy of experiential knowledge promotes the voice and expertise of marginalised groups which have largely been silenced. Feminism, educational, critical theory and emancipatory research are all different perspectives but they are helpful in understanding the relevance of experiential knowledge. The purpose of this section is not to talk about the difference of each of these perspectives, but rather discuss the contribution made by each to experiential knowledge. According to Cotterell and Morris (2012), feminist thought challenges a view of people as singular objects in the way that traditional science can do, and it also sees the development of this ‗scientific‘ knowledge as a means of domination by privileged groups in society. Feminist thought is part of a political struggle with a central debate being about the significance of being a woman and the place of female experience, and the contribution it makes to knowledge. Feminism argues that many individual voices and many forms of knowledge arise and form collective knowledge. Tanesini (1999) suggests that different knowledge sources need to be invited, in a participatory way, so that all experiences are taken into account. Here, the suggestion is that with marginalised knowledge, no one group is claiming that their knowledge is superior;

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therefore the groups can move to consider the varied world and the common thread that connects their experiences. Beresford (2003) has highlighted how a history of being marginal, of being unheard and of being discredited takes a great deal of effort to overcome as does seeing one‘s own experience and knowledge as important and equal to others in more dominant groups. The work of Paulo Freire has been influential in the development of critical inquiry. Freire‘s (1972) area of interest has primarily been concerned with raising awareness about the empowerment of the oppressed. Cotterell and Morris (2012) report that it can be difficult to access the knowledge that marginalised groups possess, as people in such a position possibly may feel that their knowledge is unworthy and therefore question the legitimacy of articulating their own knowledge. Cotterell and Morris (2012) assert that there is a clear link between the work of Freire and emancipatory research and critical theory, as they both share a common agenda in relation to people‘s political context, empowerment and equality. Critical theory is ‗critical‘ in relation to its stance in challenging claims made by scientific or traditional knowledge. It aims to unmask beliefs and practices that restrict freedom, justice and democracy in some way. Habermas (1972) has argued that the knowledge interest involved in critical theory is emancipatory and is focused on unmasking ideologies that maintain the status quo by restricting the access of marginalised groups to the knowledge that oppresses them. The aim of critical theorists is to investigate into accepted processes and structures that underpin society and shape everyday lives in an inquiring and critical way. They see knowledge as not only about finding out about the world, but also about changing it (Cotterell and Morris, 2012). Overall, these different perspectives are helpful in understanding the relevance of experiential knowledge and in the promotion of the voice and expertise of marginalised groups.

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Professionalism as an ideology embodies appealing values such as autonomy, competency and standards, which are a result of evidence based practice. Higgs and Titchen (2001) believe that if health care professionals solely work from a scientific knowledge base then views of practice, the methods used to problem solve and the criteria adopted to evaluate progress will focus mainly on prevention of illness and objectively measurable outcomes of interventions. Higgs and Titchen assert that the outcome of such an approach may have limited relevance to the individual needs of service users. Prior (2003) acknowledges that patients can have extensive knowledge of their own life and the conditions in which they live but argues that for the most part, lay people are not experts. They are rarely skilled in areas of medical fact gathering, or in the business of diagnosis. In addition, they can be wrong about the causes, course and management of disease and illness. Prior believes that individuals with lay knowledge do have expertise of their own bodies, but they are evidently not experts. Lay knowledge is not sufficient to truly understand the technical complexities of disease causation, its consequence or management, partly because experiential knowledge is idiosyncratic and limited (Prior 2003). Professional knowledge brings an expertise that is evidence based. Evidence based ensures quality and standards in education, and strives towards producing competent practitioners. While acknowledging the considerable contribution of professional knowledge, experiential knowledge can also be an added facet for professional education. The experiential knowledge of service users brings a knowledge that is steeped in the lived experience. This experience can open the student‘s minds to the social, emotional, psychological and other related human experiences that arise as a result of mental health difficulties. These stories and anecdotes can humanise the experience of mental distress. It can be argued that both professional knowledge and experiential knowledge have a part to play in the education of health care professionals and therefore the contribution of both

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should be drawn upon. Faulkner and Thomas (2002) are of the opinion that a marriage of two types of expertise is the essential ingredient of the best mental health care: expertise by experience and expertise by profession.