‘Smoke and Mirrors’ (2)

Part 2:

It is my intention to use the word ‘distress’ to refer to mental ill-health throughout. This seems safer as the use of mental ill-health seems such a loaded descriptor and somehow suggests an equation with ‘sickness’. Distress, on the other hand, implies a range a sensations – from mild – to – severe.

(c) Unsplash, Morgan Basham

I also have no wish to be seen as someone who denies that biology may play a part in distress, and it is beyond the scope of this blog to say much more just now, except that, Cromby, Harper and Reavy (2013) have explained my thinking in such a way that it will be helpful to cite some of their thoughts here, thus:

“… (it is) not that biology is irrelevant to distress, but that, in most      cases biology does not seems to be the primary cause of distress … overall patterns of  biological features (are not) .. present in every person given a particular diagnosis, and none… is confined exclusively to persons given that diagnosis. Indeed, some are observed in people with NO (my emphasis) psychiatric diagnosis whatsoever … (and)… Whenever it seems as though a primary biological cause of distress might have been identified, alternative explanations are always available, contradictory evidence is always present and methodological errors … are relatively common…”                                 (Cromby, J. Harper, D. & Reavey, P. 2013,  p:78)

This post will show how it is that we are told that distress is a pathological phenomenon and how and why it is that this idea was promulgated by the medical profession initially  AND thereafter by the pharmaceutical companies. We will be coming on to look, in Part 3 at Big Pharma and how these ideas have gained prominence over social context and social constructs.

The ‘smoke and mirrors’ of the 21st Century will be becoming clearer; I hope, especially in regard to issues of mental distress. And, in time, you may never look at things the same way again. I fervently, and  hopefully believe  you will begin to understand, once armed with the truth, that you DON’T have to experience distress in the way you do, and the best way out of the struggle is to talk to someone, not to take expensive and unnecessary medication.

So, let’s start from the beginning. Jacqui Dillon, who has lived experience of distress puts the notion of being unwell into its real context when she explains “… the experiences, feelings and possibilities of our personal lives are not just a private matter of personal preferences and choices but are limited, moulded, defined and delimited by the broader political and social context…”(Dillon, 2011 in Rapley, et al, 2011 p:141).

Jacqui here, is actually referencing her belief that the ‘personal cannot be, ever, other than politically developed’ (ibid, p:141), and she links this awareness to her recognition of the efforts of women’s liberation during the 1960s. Those of you who are aware of Jacqui’s back story will know that she was abused, sexually, physically and emotionally and that her experience of distress arose from this, and the chapter referenced in the previous paragraph tells her story.

There are a number of sub-plots to the ‘smoke and mirrors’ story, which is just as well since this blog is episodic, rather than book length.

In due course, I will be releasing the blogs already written as podcasts, and from that point on offering both blog and / or a podcast will allow subscribers to choose which format suits them best. I hope you like what I am trying to do, by the way.

(c) Unsplash, thanks Morgan Basham

We can all be forgiven for thinking that knowledge is objective, true and out-there; stuff for us to learn; be told about, to read about, to grab on to and to ‘KNOW’ and so on. However, the rub is  that like most other aspects of social-life, knowledge is a social construct.

As Bruner suggests, the reductionist thinking behind, for instance, the science of psychology, leads us to view issues of the mind as simple; merely a matter of “…causal explanation and prediction..” (Bruner, 1990 p:xiii), leading us to know why they might happen, once, and then again, and again some more, relentlessly.

In the first part of ‘smoke and mirrors’ I cited work by Mary Boyle about the psychiatric and psychological refusal that exists to include context as important when thinking about distress. In this blog, Bruner adds to our thinking, I believe, showing that context is important, when he explains that if all we seek to do is ‘insist upon explanation in terms of “causes”, (this) bars us from trying to understand how human beings interpret their worlds, and how we interpret their acts of interpretation … if … the object (is) the achievement of understanding, why is it necessary … for us to understand in advance of the phenomena … especially when … a … causal explanation forces us to artificialise … to a point almost beyond recognition …?'(ibid p”xiii).

As Scheler has it, there is “… some sort of relationship between thought and an ‘underlying’ reality other than thought …”(Scheler, in Berger & Luckman, 1966, p:18). So, to my way of thinking, ‘thought’ as referred to above, is the (putative) ’cause’ of the distress, and the ‘reality other than thought’ is the reality of the context in which the thought is had, and that is the reality of the distress; not in its manifestation, rather some other factor (context) that facilitates the distress.

Reality, says Anselm Strauss of George Herbert Mead’s thinking, ‘…is always in the present, that the past refers to “that conditioning phase of the passing present which enables us to determine conduct with reference to the future which is also arising in the present” (Mead, In Strauss (Ed), 1977, p:xxix). So reality is now; it (reality) has been shaped by the past, just as the future will be shaped by what happens in the futures current present. Context cannot be ignored, and the present is the only place that we can assess whatever it is that ails us. And without acknowledging context we cannot hope to begin to make sense of whatever is happening  – and neither can the psychiatrist.

And this has been the fundamental problem that has dogged science for ever, as far as I can see: science’s Procrustean mission to make things fit some strange theory held by someone about something. In the case of those for whom this blog is intended, that is those people who have received a medicalised diagnosis which tells them that the answer to their distress lies in some mythical pathology, that the fault lies with them and some quirk of psychological ‘fate’. An internalised quirk at that: innate and determined by our genes or some other, ‘natural’, predisposition.

Wilhelm Greisinger, the German known as the founder of biological psychiatry decided, in 1867, that ‘…patients with mental illness were individuals with brain or nerve diseases. In Vienna, Theodore Maynert, who taught Freud, was more interested in the frontal lobes of cadavers, than his living patients…’ (Appignanesi, 2008 p:107).

In the same year (1867), Henry Maudsley published ‘Physiology and Pathology of Mind’. Maudsley was a ‘…proponent of the physical basis of all mental illness …’ (ibid p:108) as well as someone who believed that ‘insanity’ (sic) was to do with heredity; and was, thus, genetic in nature.

Steven Rose (1999) explained that the ‘…history of biology, as a discipline, has given excessive authority to reductionism, which collapses higher level accounts, such as social or behavioural ones, into molecular ones. Such reductionism becomes crudely ideological (my emphasis) when applied to the human condition…'(Rose, 1999. accessed 23.09.2018).

Distress doesn’t become more ‘determined’, by internal factors, than these two men, Greisinger and Maudsley, could make it. You are your genes, and if these predispose you to ‘distress’, then so be it.

Except that both behavioural genetics and molecular genetics have been shown to be flawed in the assertions they appear to allow researchers and proponents in both camps to make.

Behavioural genetics is that science that attempts to study correlations between diagnoses and their relations to genetics. The best known studies of which are, according to Cromby, Harper and Reavey (2013, p:78) studies of twins. However, and I urge you to read their conclusions, evidence shows that the majority of twin studies are ‘flawed’ and significantly fail to show any supposed correlates between genetics and distress, that would allow anyone to use, with absolute confidence,  the binary expression, x is present therefore y is the likely outcome. See also (Joseph, J. 2003, ‘The Gene Illusion: Genetic Research in Psychiatry and Psychology under the Microscope’ PCCS Books).

Additionally, we have Molecular genetics, the study of genes using biological tissues, carried out through chemical processes and computerised analyses, which allows for samples to be magnified and then their DNA to be ‘explored’ (Cromby et al, 2013, p:81) citing (Joseph, J. 2006, ‘The Missing Gene: Psychiatry, Heredity and the Fruitless Search for Genes’, NY, Algora). Except that, whilst this move was hailed as the one that would unlock the role of genes in the development of distress, per se, we have, as Cromby et al, say, ‘… No breakthroughs  … and if anything the goal of identifying ‘genes for’ distress seems to receded even further…’ (Cromby et al, ibid p:81).

However, having said all this, and doubtless having real people shouting at me and telling me that you “know how I feel, so why don’t you go away” or some such. Can I just add that there is undoubtedly something of the biological in the whole question of distress and it is to be found in what has come to be called ’embodiment’.

Rom Harré (2002) has it that, in looking at the role of biology in distress, if indeed one agrees it has a role, we should, in all likelihood, look at biology not as the ‘cause’ of distress, rather as the ‘enabler‘ of distress. As he suggests, and as is noted by Cromby et al, (2013)…’As humans we are embodied creatures, so there is a clear sense in which the biological systems of our bodies are necessary to enable our experience – all our experience …’ (ibid p:89).

This seems to me to be a reasonable role for biology to take, especially when we all seem to be calling for those who ‘experience’ distress in some form or other to come forward and talk about the ‘meaning’ their distress has for them.

And, if they expect their experiences of distress to be taken seriously, it is not up to me to suggest that the causes of their distress are only to be found somewhere ‘out there’.

However, context is crucial in the causation of distress and embodiment is crucial in the manifestation of that distress. And I say this because our understanding of the meaning of ‘how we feel’ is a social construct. Which will be the theme of my next blog in the ‘smoke and mirrors’ series.

Paul

References:

Appignanesi, L.  (2008) ‘Mad, Bad & Sad: A History of Women and the Mind Doctors from 1800 to the Present’ Hachette Digital  Kindle Edition

Bruner, J.(1990) ‘Acts of Meaning’ Cambridge, Mass  Harvard University Press

Cromby, J. Harper, D. & Reavey, P. (Eds. 2013) ‘Psychology, Mental Health and Distress’ London Palgrave

Dillon, J. in Rapley, M. Moncrieff, J & Dillon, J. (Eds, 2011) ‘De-Medicalizing Misery: Psychiatry, Psychology and the Human Condition’ London Palgrave

Harré, R. (2002) ‘Cognitive Science: A philosophical Introduction’  London Sage

Joseph, J. (2003), ‘The Gene Illusion: Genetic Research in Psychiatry and Psychology under the Microscope’ PCCS Books), in Cromby, J. Harper, D. & Reavey, P. (Eds. 2013) ‘Psychology, Mental Health and Distress’ London  Palgrave

Joseph, J. (2006), ‘The Missing Gene: Psychiatry, Heredity and the Fruitless Search for Genes’, NY, Algora, in Cromby, J. Harper, D. & Reavey, P. (Eds. 2013) ‘Psychology, Mental Health and Distress’ London Palgrave

Rose, S. (1997). “Lifelines: biology, freedom, determinism”. Behavioural and Brain Sciences (1999) 22, 871 – 921  Accessed on-line 23.09.2018 at www.researchgate.net/publication/12031918

Scheler, M. ‘Die Wissensformen und die Gesellschaft'(1960): in Berger, P. and Luckman, T. (1966)  ‘The Social Construction of Reality: A Treatise on the Sociology of Knowledge’ London Penguin

Strauss, A. (1977) Ed, in Mead, G. H. (1977) ‘On Social Psychology’ Chicago  Chicago University Press

 

 

 

‘Smoke and Mirrors’ (1)

Smoke and Mirrors

Part 1:

Mental Wellness is a place, I guess, we’d all like to aspire to be. Trouble is, the getting there isn’t always as straightforward as we suppose it to be.

Throughout the Twentieth Century, the growth in pathologised and medicalised treatment of mental health issues has left us sicker than we ever thought we’d be. This unhelpful and sickening characteristic of the medicalisation of life – in all senses of the word ‘sickening’, has a name … Iatrogenesis. Which, in common with most useful words, comes from the Greek;  ‘Iatros’ meaning “Physician” and ‘genesis’ meaning “origin”, resulting in, therefore, ‘…The disabling impact of professional control over medicine …’ (Illich, 1975, p3).

The growth, in what Illich comes to call the (The Age of) ‘Disabling Professions’ (Illich et al. 1977), is starting towards the close of the Twentieth Century; an age when ‘ … people had “problems”, experts had “solutions” and scientists measured imponderables such as “abilities” and “needs” … (ibid.11). And, whilst this is, and will prove to be an issue, as will be discussed later in this piece; the most concerning thing about Iatrogenesis, and the latter, ‘disabling professions’ for Illich is a “… passive public …”(ibid.11) because Illich sees the solution as being with the ‘layman’ (sic), the ordinary person in the street. He thinks that a passive person is unlikely to change anything and this will undoubtably prove dangerous in the long-run.

Is it our fault if we, as lay people, do not challenge the expertly driven, professional findings of people to whom we ascribe huge power; for our purposes, psychiatrists, psychologists, therapists of all stripes? Clearly it is, sadly, and I say that, not as a lay person, but as a clinical hypnotherapist and counsellor. However, I think that, like a number of much higher profile practitioners across the psy field, my perceptions are changing, and have changed, as I’ve practised what I practise.

In part, I should add, my perceptions began changing as a result of my professional background. Unlike many psychological practitioners, of whatever kind, I am not psychologically trained.

I am a teacher, I identify as a teacher, and I identify as a teacher trained in the social sciences. A social scientist, if you like. So, for better or worse, I come at this whole question of Iatrogenesis as someone who has never made a diagnosis, nor assessed anyone, nor judged, nor anything else towards or about a client; potential client or friend who has come to me asking for some kind of help.

Instead, I start by knowing, deep-down and in my whole sense of being, that I’m NOT an expert, because, simply put, how can I be?  This self-knowledge causes me no embarrassment, I recognise that CLIENTS are the experts, at the very least, in their own lives. And, not only that, I recognise that these ‘lay’ experts have their own histories, their own stories, and everything else that frames the person they are.

The power for change is theirs; the power to remain unchanged is theirs too. All people like me should expect to do, is walk with them for a while.

Does this make a difference, taking a non-expert, not-knowing stance in someone else’s life? Actually, I’ve already said it does, above, and they will have heard it, when I ask them at the start,  ‘what would be helpful for me to do in this meeting, and how would you know it had been helpful?’

They hear someone asking them, for their advice; for their knowledge and understanding, and insights into themselves;  and also for their wishes for THEIR future. And then we begin.

In my experience it doesn’t feel like therapy, it doesn’t look like therapy; it isn’t threatening, or undermining and it certainly doesn’t give me the opportunity to tell them what I think is wrong with them, nor what they ought to do to put whatever it is right.

It does have a name, this process, it is called Solution Focus Brief Therapy, or at least it’s my take on sfbt. And I do it with the client fully awake or in a focused state (some might call it trance-like, I dislike that term since it is loaded with the fear of a power imbalance).

Ok, I’m getting ahead of myself, and I’m guessing that out of the 700+ modes of therapy there will be others that offer similar attributes. I’m truly only really qualified to talk about the hybridised modality I use: sfbt-hypnotherapy.

The lay person then and why, I believe, there isn’t the bigger fight, yet, to take the meds out of mental health.

Thus, on to ‘Smoke and Mirrors’. How come they play such a big part in our lives, this smoke and mirrors ? Primarily, I believe, it’s because we are conditioned to believe that the medical professions would not mislead us, knowingly, would they? Mislead us into believing that mental distress is individualised and rests solely upon  some malfunctioning pathology,  something wrong with the individual, something within the person?

Professor Emeritus Mary Boyle might disagree with the common-sense understanding of the beneficence of the medical world when it’s applied to psychological issues. After all, she suggests that “…  both the impact of peoples environments and their life experiences, as causes of emotional distress, and the social significance of these connections will have to be made more prominent, (yet, my inclusion) … both psychiatry and clinical psychology … avoid giving prominence to people’s contexts … are psychiatry and clinical psychology actually rather fearful of (people’s – my addition) context? …” (Boyle, in Rapley, et al., 2011 p27).

Especially when she goes on to point out that research indicates that what happens to and around people in their day to day lives, plays a huge role in people developing ‘..emotional distress and behavioural problems…'(ibid. 27)  And, further, that, without acknowledging context (social, environmental and cultural), it becomes impossible for psychiatry and clinical psychology to present research in the neutral way it ought to be presented ( ibid.27)

And so we come to what I see as the crux of the matter and why medicalising mental health issues makes no, objective, or other kind of sense, and hence, gives rise to smoke and mirrors.

It is that culture and the resulting society, frame our lives. A refusal to accede to this given, by the psychological / psychiatric world, and thus not allowing the contextualising  of distress to enter this frame,  appears to evidence the smoke and mirrors of the title of this piece, which  now come clearly into play. Worryingly a huge number of people in power appear not to have read or thought about the way ‘life’ is socially constructed, or because it clashes with their form of mainstream thinking …

And it is through this ‘social construction’ that we can begin to make sense of the different areas of ‘life’; for instance, ‘knowledge’, and begin to understand how even this, a major aspect of life, is manipulated, tout court, to mean what those with power want it to mean.

For the purposes of this essay I will leave the reader with a couple of references to be going on with. However, I do intend to return to how ‘social construct’ theory can help the smoke to dissipate and the mirrors to become less cloudy, in due course.

Mannheim (2015, 1936) is given credence for this expose of power obfuscating the role and nature of ‘knowledge’, in my opinion, when (Wirth,1936, in Mannheim, 2015, 1936 p.xiv) in his preface to the book,  comments that “…the powers that have blocked and retarded the advance of knowledge … still are not convinced that that the advance of social knowledge is compatible with what they regard as their interests …” and Professor Wirth then goes on to explain that Professor Mannheim, in the book he is prefacing, goes on to ” … trace … the specific connection between interests groups in society, and the ideas and modes of thought which they espoused … which direct activity towards the maintenance of the existing order …”(Wirth, 1936, in Mannheim, 2015, 1936p.xxiii).

One of the reasons for the psychological world’s reluctance to talk about context, possibly? So that we don’t question the validity of the medicalisation of mental life, perhaps?

(If interested, see also “The Social Construction of Reality” Berger, P & Luckman, T 1966, Penguin and Goffman, E “The Presentation of Self in Everyday Life, 1959, Penguin: for starters).

Harper and Speed make it abundantly clear that those who have lived experience of poor psychological health WILL experience  social injustice … “…This injustice impacts upon their social, economic and political lives … furthermore, the acquisition of psychiatric diagnoses may also present barriers to full-time employment; or create barriers to housing (Social Exclusion Unit, 2004, in Speed et al, 2014). These barriers to full social, political and economic participation can be characterised as a problem of redistributive justice (Fraser, 2000)…(Harper & Speed, in Speed et al, 2014 p40). And, as they go on to say, ‘distress reflects broader social inequalities, as does their experience of mental health services …'(ibid. p.40).

And as Moth suggested, in a conference presentation made in Liverpool, England, in June 2018, the results of these broader inequalities also show themselves differentially in how people with mental health issues are regarded by those in power. For instance in the move towards seeing ‘work’ as a cure for mental health issues; especially where the neo-liberal tendency lends itself to seeing ‘welfare’ and ‘benefits’ as creators of dependancy (ibid. 2018).

Moth, is not alone in flagging up this neo-liberal tendency towards seeing work as a cure all. Especially as there is evidence that the ‘…political ideology, beliefs and values of governments … and corporations…’ (WHO, 2007), when it comes to health, cannot be thought of as a ‘financial or a technical value-free process’ ( ibid. p101). Nor could the assumption be made, common-sensically, that ‘workers and employers share an interest and responsibility… (which assumption, my addition) is inherently flawed since it ignores the power imbalance and the existing conflict of interest in which only one party controls the means of production…’ (Muntaner and Eaton, 1998; Milgate et al, 2002 in WHO 2007, p101), and this ‘one party’ isn’t the workers.

Mental ill health, in this context, seems to exist in a kind of system of parallels, where mental health leads to exclusion from work, with all the concomitant difficulties that brings – economic, social and so on. And yet, being in work brings the equally notable risk of ill-health through the risk and stresses that exist in work-place settings.

The WHO (2007) report cited above is quite explicit about this, and flags up why it is, patently, a nonsense to ignore contexts; even if context here is seen to be related a single dimension of social and cultural life, in this case, work..

To return to Mary Boyle., avoiding context is seen by her as allowing psychiatry to focus on ‘distress’ and convert distress and problem behaviour to ‘symptoms’ and ‘disorders’ and to focus entirely on these and their associated diagnostic categories (ibid, p28).

Whilst for clinical psychology the ‘…focus is on intrapsychic attributes. Psychology has invented a great many of them, usually expressed as abnormalities and deficits, to characterize people who use psychiatric services…’  (ibid. p.28).’ So, in looking into research, for psychiatry seeks the answers to ‘psychopathology’ and then determines that an ‘.. exclusive focus on individuals, these discursive and research practices involve and produce a (further my addition) avoidance strategy: looking for causes in brains and minds and not in people’s lives (ibid. p.29)…’ Thus, effectively denying the ‘humanity’ of those behind the stories of distress.

Smoke and Mirrors will continue to look at the social contexts, the nature and role of social construction, and the role of neo-liberal ideology and power behind the anti-social (that is locating issues within the individual and not society) attribution of distress and the location of ‘fault’.

References:

Boyle, M. (2011) ‘Making the World Go Away, and How Psychology and Psychiatry Benefit’ in Rapley,M, Moncrieff, J & Dillon, J (Eds)(2011)-Medicalizing Misery: Psychiatry, Psychology and the Human Condition Palgrave Macmillan UK. Kindle Edition.

Berger, P & Luckman, T.’The Social Construction of Reality’ (1966), Penguin, London

Goffman, E ‘The Presentation of Self in Everyday Life’, (1959), Penguin London

Illich, I, Zola, I K., McKnight, J. Caplan, J. & Shaiken, H.(1975) Disabling Professions’  Marion Boyars, New York & London

Moth, R (2018) Personal Communication

Muntaner C, Eaton WW, Diala C, Kessler RC, Sorlie PD. ‘Social class, assets, organizational control and the prevalence of common groups of psychiatric disorders. Soc Sci Med. (1998);47(12):2043-53’ and  Milgate N, Innes E, O’Loughlin K. ‘Examining the effectiveness of health and safety committees and representatives: a review. Work. (2002);19(3):281-90. in  WHO, (2007) ‘Employment Conditions and Health Inequalities: Final Report to the WHO Commission on Social Determinants of Health (CSDH)

Social Exclusion Unit, (2004) ‘Mental Health and Social Exclusion’, Office of the Deputy Prime Minister, London in Speed, E., Moncrieff, J., and Rapley, M. (Eds. 2014) ‘De-Medicalizing Misery II: Society Politics and the Mental Health Industry’ Palgrave Macmillan, Basingstoke, UK

Wirth, L. in Mannheim, K, (1936, 2015) ‘Ideology and Utopia’ Martino Publishing, Mansfield Centre CT, USA

It’s OK to Ask for Help

If You Want to Be You, Is That OK?

Sitting Here Thinking Thoughts and This Came To Mind.

Many, many people think thoughts – some are good, happy thoughts and some are less so. The problem is that people become upset at the ‘less so’ thoughts and think that if they’re not thinking the ‘happy thoughts’ something is wrong with them.

Trouble is, it’s exhausting thinking happy all the time.

So, if we accept that sometimes our thinking is a bit off beam, and, in truth, it’s OK to be thinking a bit off-beam, we’ll be happier in the long-run.

Now, if you’re thinking is a bit off-beam and it goes on to be a lot longer off-beam than you’d like – that is, it becomes troublesome, gets in the way of the the happy thinking you know you’re capable of; do something about it …

That’s easy for you to say, you’re a therapist … Fairy snuff and well said; however, I’m not the only one. There are shed-loads of therapists about.

Some, like me, are trained therapists; the majority are people you may not recognise as therapists, however they are still there, threading their ways through life, to their hearts content and not always knowing it…

These ‘hidden; therapists are likely to be

  • your partner
  • your parents
  • your siblings and extended family
  • your friends (best and otherwise) and friends of friends
  • your neighbour or other community members
  • the boss and other colleagues (co-workers)
  • the taxi driver
  • service users (of all kinds); ex and current
  • charitable organisations
  • etc.,  (you fill in the blanks, makes the blog way too long to include everyone I CAN think of – it’s your turn to add a few …)

and finally, fully paid-up, trained bods, like me.

So, whatever you do, TALK to someone.

Sometimes, in the  thoughts competitions that occur in our heads, the biggest bullying thoughts can overcome the littler, quiet thoughts that sit tight and quiet, waiting for the hullaballoo to die down, afraid that someone might laugh, point or make fun, or even WORSE – and there is a worse – tell you to PULL YOURSELF TOGETHER YOU.

Time for selective deafness and out the door to find someone who will LISTEN, and take you seriously, and try to help.

ONLY YOU know what you truly need. However, with the help of an empathic, friendly friend, well, they can help you to bring up the volume of your quiet thinks, way above the level of the unpleasant thoughts and you drown them out. You WIN…

So, please remember it is OK to be a bit don sometimes, it’s when it becomes overwhelming that some help might be useful.

Don’t be silent – ASK FOR HELP, it’s all around you, I promise.

Paul