Well, since this is my blog, I thought I’d take it somewhere different this week. In the tweet world that I have recently joined – and am I glad I joined it – there appear to have been a lot of conferences? Conferences big and not so big, and with what appears to be a common theme (that may just be my understanding) running through them.
What is that theme? Well, it appears to be the theme that people living with ‘lived experience’ of mental health, are, still, not being listened to. There is still an almighty power vacuum between SUs and those who hold sway over how the clients ‘distress’ is both viewed and acknowledged, and then treated.
The power imbalance is enormous, unhelpful, frightening and above all, wholly unnecessary, it seems to me. If people listened to each other, a lot of people could be spared a lot of grief and trauma and retraumatisation. Possibly a lot of professionals would also need to come down off their high horses, take a bucket and shovel and clean up after themselves…
So, as someone who isn’t an SU; who isn’t struggling with distress or the lived experience of distress, rather, who is a counsellor and therapist, I thought I might stick my oar in and test the water.
You might want to know that I’m a social scientist (courtesy of my teaching degree) who happens to also be a solution focused brief therapist, a clinical hypnotherapist- Ericksonian – (UK registered), all learned later in life, and I was a special needs teacher specialist (social, emotional and behavioural issues, as it was called then, for 30+ years). Although I started out teaching humanities (history and geography) and that almost killed me.
My MA is in Inclusive Educational Practice and Curricula, and I spent a number of years working in young people’s secure settings. I’m also trained as a Restorative Justice and Practice practitioner and trainer and have worked across many schools as an RJP facilitator and trainer. I am also registered as ‘differently abled’ and have been, all my 65 years.
I am sorry (irony alert), that I don’t have a psychology background; mine is fully grounded in the sociology of ‘deviance’ (sic) and how we can learn to learn to include those who have this label applied, that is, anyone who isn’t ‘normal'(sic) … to me, I guess, by definition, if you’re not regarded as normal, then you must be deviant, somehow. And sadly that seems to be the milieu in which so many people who struggle with mental health distress, are stuck; being ‘not normal.’
I wonder, therefore, given my background, whether it would be ok to refer to myself as a ‘social psychologist’? Enough of that for now…
I guess it will probably be helpful to have an idea as to how the world views the labels ‘normal’ and ‘abnormal’ (or not normal, or deviant, or some other, value-laden label), so that we’re all on the same page. Remember, please, that labels are socially defined, by those with the power to get labels to stick. We call these labels, ‘ascribed’ – someone telling someone else ‘you are x, y or z’.
(c) Arthur Edelman
Okay, the picture above is a representation of what people (I say that advisedly) might think ‘normal’ looks like. However, in a short while we will have a closer look at what the difficulties of defining ‘normal’ might have to say about the concept. And, before we go any further, it is a concept, not a ‘truth’. One person’s normal is definitely another person’s not normal.
I’m going to start by giving rein to my social science background. As I said earlier, I would like us to agree a definition of what ‘normal’ might be, and what its opposite, ‘not normal’, might be thought of as?
Throughout time, it seems to me, different people have labelled different actions as normal or otherwise than normal. And, if we accept that premise as a statement of ‘fact’, we might ask ourselves a further two questions; who is doing the labelling, and why?
One of the great writers on ‘deviance’, a sociologist called Howard S. Becker, who was said to have founded a theory called ‘labelling theory’ will explain his thinking shortly; in his thinking he uses the same medical analogy that modern psychiatrists had started using in the early 2oth century – the suggestion that ‘deviance’ or ‘abnormality’ was pathological, within the body; an ‘illness’. So, Becker puts thus:-
“…A less simple but much more common view of deviance identifies it as something essentially pathological, revealing the presence of a “disease.” This view rests, obviously, on a medical analogy. The human organism, when it is working efficiently and experiencing no discomfort, is said to be “healthy.” When it does not work efficiently, a disease is present. The organ or function that has become deranged (abnormal – my choice) is said to be pathological…” (Becker, H, 1963, 1966, 1973, 1991).
You should note that he is not on the side of pathologising deviant behaviour at all, as the next bit will clarify.
Beckers style of sociology is called ‘interactionist’, that is (using Wikipedia) to help us be on the same page, since it is universally accessible:
“…In sociology, interactionism is a theoretical perspective that derives social processes (such as conflict, cooperation, identity formation) from human interaction. It is the study of how individuals shape society and are shaped by society through meaning that arises in interactions…” (Wikipedia, accessed 07/10/2018 on-line.)
Which is also helpful to us since interactionism tells us that ‘normal’ is amorphous, WHICH, however, comes to mean behaviour which the majority of people regard as acceptable behaviour; that which is NOT an infraction of the rules in some way. So, normal behaviour is socially acceptable, in other words?
And interactionism works because we need to understand things in a common-sense way and have the same views. Think about it, for a moment.
So, if you drink alcohol and get drunk, how different is that from smoking a spliff, snorting cocaine or doing other drugs and getting high? Well, we ‘know’ that getting drunk is something that lots of people do, they pay their taxes (duty) on the alcohol and some perceive it as a rite of passage. It only becomes a problem when someone becomes addicted to alcohol and ceases to function as a ‘normal’ colleague, husband, wife, father, mother etc.. other than that, what’s wrong with letting your hair down at the weekend?
Smoking weed, or crack, or using other drugs, on the other hand is regarded as de facto deviance; absolutely ‘not normal’ and something usually done as an outcome of criminal behaviour; that is, of illegal dealing, obtaining and end user using. No duty is paid, suppliers are usually gang members and the whole chain is seen as highly criminalised, never mind that it might be an individual using a couple of joints to relax after a busy week at work (or perhaps a line of cocaine, etc. for the same reason)
Either way, and some might regard these as simplistic examples, both things are defined differently, by different people and in different societies. The use of marijuana in some countries is legal and in some ‘decriminalised’. Alcohol is largely freely available and not at all illegal (other than in most Muslim states). So, we begin to see how interactionism helps trickle down ideas of normal, not normal, which is so defined by those with the power to do so; the phenomenon becomes understood in a ‘common-sense’ way and is viewed as such by the majority of people within particular societies across the globe.
(c) John Baker
(used with permission from unsplash)
Righto, Allen Frances, who was chair-person of the group who came up with DSM-IV, has written a great book, challenging those who have it that mental health is only ever biological; that it can be diagnosed and can then then be cured with pills, as with other pathalogical illnesses.
He says this, right at the start of the book: ‘Normal is losing all purchase— if only we look hard enough perhaps everyone will eventually turn out to be more or less sick…’ (Frances, A. 2013 p:3). Perhaps, we can but hope, not that everyone turns out to be sick, rather that we understand that everyone else isn’t, necessarily, ‘normal’ (sic).
You might well ask is this a good thing, or a very bad thing? And I suppose my answer would be, ‘it depends’ … As I understand it, the hopes around the DSM manuals (and DSM is shorthand for ‘Diagnostic and Statistical Manual), were that it could provide assistance to anyone who felt distressed, by allowing the psychiatry business to say what could be done to address that distress; make it better in other words.
It was with DSM-III (according to Frances) a ‘…very fat book that quickly became a cultural icon … and the object of undue worship as the “bible” of psychiatry. … (which) sets the crucial boundary between normality and mental illness …’ (ibid p:xii).
Problem is, as Frances says, ‘…The lesson is clear— we have far too much faith in pills, far too little trust in resilience, time, and homeostasis… (ibid p:33). Thus we create deviance where there was none, and we create ‘normal’ where it might not be warranted. As with everything in social and cultural life, it ALL depends on who is doing the labelling, and why. Which, questions are important because, the ‘power to label is the power to destroy …’ (ibid p:109.
Why would he say that? Generally, he holds that we, as human beings are hard-wired into being able to show compassion only for those who are like the majority (so called). This has a knock on effect of those who are labelled – that is, the not ‘normals’ amongst us, feel not only that we don’t fit, but that we are ‘damaged goods'(ibid p:109) with all that that implies..
And this damaged thinking, that often comes from being not only misdiagnosed, but also from being diagnosed at all, can lead to what are known as ‘self-fulfilling prophecies’. If you are …’told you’re sick, you feel and act sick, and others treat you as if you are sick … (and whilst) the role of being sick can be enormously useful when someone is truly sick … but the sick role can be enormously destructive when it reduces expectations, truncates ambitions, and results in a loss of personal responsibility…’ (ibid p:109).
So, are examples of ‘damaged thinking’ (cf:above) that is, ‘self fulfilling prophecies’, simply down to language games; or something more pernicious and scary?
Personally, I think the language games that some people are given to playing ARE pernicious and scary, especially when they are used to maintain a status quo, or rather, the status quo of the holders. As Harré has it, “…’people are what they believe they are’ … and what they believe they are is what the best authorities tell them they are …”(Harré, 1989, in Shotter, J & Gergen K, J, Eds, 1989 p:22). Now, he then goes on to explain that he is also aware that other natural belief systems also give rise to people believing they are what they think they are. And to my mind this is true. The media, in all its forms, is one way through which this happens.
However, it is also my contention that we also have to look at “… The concept (that, my addition) the person as a relatively autonomous self-contained and distinctive universe is said to reflect the sham and illusion that is the bourgeois individual, not its reality … for the … bourgeois individual (and others, my addition), whose integrated wholeness, unique individuality, and status as a subject with actual powers to shape events has become null and void…” (Sampson, E.E 1989, in Shotter, J & Gergen K, J, Eds, 1989, p:3).
Because, neither the individual nor society exist separately one from from the other: “…Rather, society constitutes and inhabits the very core of what passes for personhood: each is interpenetrated by its other…” (Sampson, ibid p:4). Society is a primary agent for social development, learning the rules etc., (I will talk about the role of education in a later blog). And is the stronger of the two phenomena, personhood and society, despite the apparent freedom we have to believe that we can, somehow, shape our own future.
We believe that we have agency, can choose x.y or z . However, Mead explained, almost 100 hundred years ago that this is fallacious, but good news if we can get a complicit and compliant society to follow on, just for now. As Mead says “… We are continually interpreting what we see by the something that is represented by possible future conduct. So, to understand what is appearing in experience, we must take into account not only the immediate stimulus as such, but also the response…(Mead, G H, 1936, in Strauss, A. Ed, 1956 p:68).
Now, some of you may happen to read Mead and may well read on in the tome cited from above; and be surprised to read that he talks about behaviourist psychology, about conditioned responses, such as Pavlov’s dogs did.
And, I guess you might think I’m peeing up the wrong tree (no pun intended). Except I don’t think I am, it’s just that it’s not fashionable to regard people as being conditioned into behaving in certain ways. Yet the evidence is all round us – see the rise of the anti-immigration movement, white supremacy etc. Ad agencies thrive on getting us to change and or at least, modify our behaviour; as do politicians and others of all stripes.
Anyway, I digress. Chomsky (2002) suggests that this has to do with who is allowed to identify a particular social, or political need, and about how that need is disseminated, in the appropriate way, to the masses (us).
One way of doing this is for those with power, (them), to convince those without power (us) that it is democratically useful if the masses are “…barred from managing of their own affairs…”(Chomsky, 2002 p:9) whilst the management and ownership of information must be tightly controlled (ibid, p:9).
And to do this we need to have a “…’specialised class’ of ‘responsible men’ who are smart enough to figure things out” (Lippmann, 1922 in Chomsky, 2002). Especially as he regarded the masses as a ‘bewildered herd’ (Lippmann, ibid p:9) whose role was to support the specialised class by voting them in, and then just becoming spectators. And so, I believe, it is with the modern take on psychiatric diagnoses, and things like DSM-V.
The doctors know best and we don’t; except we are now suffering from the greatest exposure to iatrogenesis we have ever been exposed to. Illich explains: “… physicians insist on the obvious: namely, that medicine cannot be practised without (my emphasis) the iatrogenic creation of disease. Medicine always creates illness as a social state…” (Illich, 1977, p:44).
Thus, if the psychiatrist diagnoses you with an ‘illness’ there must be an illness to diagnose, and one will be created – this is called iatrogenesis. This then legitimises the behaviour of the physician in treating that illness, so called. So, the physician decides what normal is or isn’t and what must, should, ought to be done about. From incarceration to ECT to tablets for whatever the iatrogenic illness you have is.
It is nearly all smoke and mirrors and the snake-oil salesmen continue in business and we still have to take ‘normality’ back; this is why we must ‘de-normalise’ normal.
You may be pleased to know, there is more to come.
Becker, H, S. (1963, 1966, 1973, 1991) Outsiders: Studies In The Sociology Of Deviance The Free Press Simon & Schuster New York
Chomsky, N (2002) Media Control: The Spectacular Achievements Of Propaganda (2nd Edition) Open Media Seven Stories Press New York
Frances, A. (2013) Saving Normal Harper Collins New York
Harré, R. (1989), Language Games and Texts of Identity, in Shotter, J & Gergen K, J, Eds, 1989 Texts of Identity Sage London
Illich, I, (1977) Limits to Medicine, Medical Nemesis: the Expropriation of Health Marion Boyars London
Lippmann, W (1922) Public Opinion in Chomsky, N (2002Media Control: The Spectacular Achievements Of Propaganda (2nd Edition) Open Media Seven Stories Press New York
Mead, G H, (1936), in Strauss, A. Ed, George Herbert Mead On Social Psychology 1956 University of Chicago Press Chicago
Sampson, E.E (1989) Deconstruction of The Self, in Shotter, J & Gergen K, J, Eds,(11989) Texts of Identity Sage London