Smoke and Mirrors
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’.
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