Helpful and Fluid Spaces

Okay so we are suggesting that certain types of spaces not (yet) enclosed, or fully enclosed, by psychiatric, psychological and psychotherapeutic logics can be beneficial. That point was hopefully evidenced above. However, helpful spaces that can be so useful for mental distress are actually hugely variant in nature. After all, we could be talking here about a walking group in the countryside, a cooking class, tantric meditation, a cycle repair workshop, a community choir, a local social or community club, a community art class or other education classes. It could be yoga, music or a mutual support group. It could be an advocacy and information service for people using benefits, debt guidance, employment advocacy or advice on local facilities for a disabled family member. Or just sitting down with other people in a space and that isn’t your house. What, if anything, do these helpful spaces share other than such abstractions as humanity, compassion, connectedness and practical information? Is there something that is key to allowing all of these things to occur in these spaces or indeed something that is produced in all of these spaces? We would argue in this final section that there is, and to understand it requires us to think about the very nature of how we understand and perform mental distress as a social ‘thing’.

Annemarie Mol67 foregrounds practices so that objects like ‘distress’ are not passive things to be seen from different perspectives. Instead, they come into being and disappear with the practices within which they are manipulated. That is, objects can be differently enacted in different practices and in the different sites that these practices occur.68 She talks of an ontological approach which rejects the absence of the body’s physical reality where the body has been sacrificed at the realm of meaning. This approach foregrounds practicalities, materialities, events and what is done in practice. Mol and Law allow us to explore the notion of spatial types.69 Rather than ‘the social’ existing as a single spatial type, they believe that the social can perform different types of space. They discuss the way that objects, such as embodied distress, can exist in different types of spaces depending on the nature of the networks which enact these objects.

Conventional contemporary biomedical psychiatry positions extreme distress essentially as immutable disorders. And while these disorders may change over time, they don’t effectively change in one single time point over different social contexts. For instance, patients whose distress is called ‘clinical depression’ are patients with ‘clinical depression’ regardless of whether they are sitting at home, at their desk at work, inside a psychiatrist’s office or at a local art class. They may experience these places differently, they may act differently in these contexts but in effect they remain patients with clinical depression across space. Here distress as the object of interest is an essential immutable in a given time point.

However, we would say that distress as an object is not an immutable disorder as is routinely held in biomedical psychiatry. As it moves from the centre to the periphery of the biomedical network, for instance from the psychiatrist’s or GP’s office to a local social club, the truths which form it become progressively less reliable.69 The space in which the object of distress moves behaves rather like a fluid. Mol and Law suggest that some social spaces take a fluid form.69

In helpful spaces where mental health practitioners and expertise are absent, the people in these spaces still encounter a given shape of distress and still go on working, relating and sharing with distressed people. Many in those spaces will not carry the conceptual tools that make distress a certain thing, and some will; some will carry versions of distress that appropriate some elements of its shape in biomedical settings. In many of these spaces there will be no psy technologies and treatments and so detecting specific versions of distress is not urgent or important. In some locations in the fluid spaces, distress is enacted in a certain way and with certain implications; in other parts of the fluid space, it will be enacted differently with different implications. Helpful spaces are those that embrace the fluidity of distress. Helpful spaces allow fluid objects to be non-visible or visible in different ways; they fix few if any rigid boundaries around objects. Unlike terrains of biomedicine which seek to hold objects in rigid spaces within rigid networks of relations, definitions, roles, expectations and narratives, helpful spaces do no such thing. It is for this reason that they so often allow the flourishing of so many of the factors key to well-being—agency, connectedness, humanity, benevolence, support and safe space.

But now what have we got to say about the arenas of biomedicine? One might say that the practices, technologies and institutions of psychiatry have sought to enclose distress, to constitute it, fix it, and measure it as something that can be acted upon. One might suggest that they have had great success in the sense that their apparatuses have largely achieved ‘ownership’ of distress but great failure in their attempts to fix boundaries around objects that are fluid and move in fluid spaces, resulting in an utter misunderstanding of the nature of distress and spatial conditions necessary for amelioration. However, presenting such a picture is to simplify the activities of most of psychiatry to the point of obfuscation. This is because psy spaces are themselves not uniform, rigid and boundaried. These spaces themselves are fluid, perhaps less so than other social spaces, but there is fluidity in the spaces of psy with great variation in the degree to which practitioners constitute the object of distress and great variation in how they do, or do not, mobilise the enclosing, fixing and constituting apparatuses of distress through the biomedical framework.

Psy spaces have fluidity and with this fluidity comes possibilities. Some psy spaces recognise and observe the fluidity of distress and make visible very different versions of the object than others. These might be said to have beneficent properties encompassing humanity, benevolence and compassion. And many helpful informal spaces are infused with discourses of psy, of the apparatuses that encourage boundarying and the fixing of distress in some way or another. The point is that distress is a messy, fluid object that moves, transforms, fixes, is reconstituted, is invisible or is differently visible in different spaces. The spaces that offer the greatest potential for helpfulness are those that will ultimately be most useful. There is no linear relationship between these properties and a notion of well-being or recoveries. While these spaces are promising, they offer no promises for recoveries because distress is too messy an object that one cannot pin down to cause and effect. Helpful spaces offer conditions of possibility that offer greater promise than those that are not. No more, no less.

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