Do We Throw the Baby Out with the Bathwater?
So far in this chapter we have provided the reader with what appears to be a relatively unproblematic flaying of the precepts and practices of mainstream psychology and psychiatry. Such mainstream conceptualisations suggest a version of distress that fits with how people are broadly thought about in society. Most people are rational, reasoned thinkers who exist in a state of wellness, and that disorders, diseases or illnesses are the things that are responsible for stopping people being rational and well. As such, we need doctors to diagnose and treat these disorders so that they can get better and get back to being rational-thinking, well people.
So far our critical story has largely denigrated the conceptual and empirical basis of this system. We make the point that psychiatrisation prepares people very little for community life.50 It overlooks the intrapsychic and intersubjective processes that contribute to a sense of self,51 and constitutes an infinite variety of ‘have to’s’ that are thrown at people before they can reach some elusive ideal of normality52 and where cure and recovery seem to be promised. When one treatment fails, another is initiated ad infinitum until the ‘right’ treatment is found to cure ‘ill’ people, and professional psy people are the only ones able to define the distress, make these choices and give these treatments.
However, what we don’t do is address other difficult issues thrown up by any wholesale rejection of psy. Some of these could be summarised as follows.
- • It’s currently considered to be all we have.
- • The current system is replete with well-meaning, passionate and tireless supporters of suffering people.
- • What use is this conjecture for people/families/carers who are working through a crisis that, at its most extreme, could end with the death of a suffering person? Isn’t such conjecture just an intellectual luxury that means little to those and their loved ones in crisis?
- • What about the good that this flawed system does? What about the people who have been helped/supported/cajoled/understood and stood alongside with, and who as a direct result have emerged from the immense suffering?
This current system is all we have but it doesn’t need to be all that we have. People, unless sectioned, have the option of not engaging with traditional mental health services. However, when people are exhausted, confused, immiserated and suffering, and everyone around them tells them that they need help, and that they need to contact their GP for support, and where they see very few alternatives on the horizon, they very often do feel that their single option is to start or indeed resume their trajectories as mental health service users. But it need not necessarily be this way. A well-known critic of psychiatry, Thomas Szasz, understood distress as problems of living that we all have to get on with and resolve as fully responsible moral agents.53 If we collapse the authority of psychiatry we are left with a range of difficult scientific, ethical, legal and political challenges which are obscured by psychiatric theory and practice. However, there are growing alternatives that provide meaningful context-specific support instead of de-socialised diagnoses. For instance, peer recovery workers and recovery colleges are becoming commonplace, where you don’t always need to take on the identity of a patient to receive support and guidance.54 Here the focus is on rebuilding lives rather than reducing symptoms that are worked on by ‘experts’ and ‘patients’. We need to stop diagnosing non-existent mental illness and recognise that our primary role is in supporting well-being.54
In the next chapter we rethink some possible social- and community- based alternatives to the traditional biomedical approaches and explore why, thus far, such alternatives haven’t been incorporated into mainstream care. The current biomedically dominated mental health care system is replete with problematic disorders, medications, problematic pharmaceutical links to practitioners, and panels which create the disorders. It is replete with singular narrow and profoundly problematic notions of recovery, and with some fundamental misunderstandings of suffering and recoveries. It is characterised by a problematic privileging of the individual over the social in both the genesis of distress and the constitution of distress. However, it is also replete with passionate, committed, effective and tireless people doing invaluable work with people who are distressed. And some people benefit from psychotherapeutic encounters. Some benefit from the respite that some medicines give at some points in their lives. But many will not. Many will suffer horribly on such medications and many won’t be interested or find useful the practice of talking therapy.
However, we do not need to buy into the idea of the discrete and disordered individual at the mercy of their neurotransmitters/nega- tive thoughts and feelings/hearing voices. We do not need to accept the conceptual and ideological baggage that comes with the dominant psy discourse to make sense of why having space and respite from lived experiences of misery can be useful, or why some medications might be useful sometimes or indeed why sitting in a room with an empathic, nonjudgemental and insightful human being might be useful. Some physicians give medications to impact specific neurotransmitter pathways to treat or cure socially constructed ‘disorders’ and end up helping by simply numbing somebody for a while. Some therapists seek to mobilise complex psychoanalytic or cognitive behavioural technologies and end up being effective because the other person likes talking to them.
It is our contention that we have been pointing our theoretical and critical energies in the wrong direction. We have been supporting, critiquing, exploring and providing evidence for highly specialised theoretical technologies that dominate our professional disciplines, and in so doing supporting and legitimising the need for the exclusivity of a single or multiple, very closely related professionalised approaches to the care of distressed people. Instead, what we should be doing is to consider the multiple forms of expertise, the ‘everyday magic’ as resilience researchers might call it, mobilised on a daily basis by friends, loved ones, carers, colleagues and community organisations. There really are many other social spaces that are hugely effective for distressed people, and we don’t require the de-socialised, medi- calised, ethically compromised, disempowering and conceptually limited concepts of the mainstream psy industries. However, before we get to explore some of these spaces, the following chapter will attempt to examine how such spaces might be good for mental health well-being.