Conclusion: Some Reflections on Ron's Experience at Bike Minded
‘What then must we do?’ This is the question David Smail19 asked when faced with the central conundrum of psychotherapy. Thus, although the clinic was far from the most appropriate site to address psychological distress, it would be barbaric to subscribe to some form of hyper-liberal, Szasz-esque closure of all therapeutic institutions. And so he concluded that we cannot escape the clinic. Ron’s story above was a fictional summarising of the accounts told to us by the users and volunteers from the Bike Minded project. What do these experiences offer the conundrum that Smail and others wrestle with?
What was interesting about the experiences of the people on Bike Minded and what was so key was ‘the atmosphere’. The atmosphere was Rogerian in a sense that has been lost in many of the psychotherapies. As Smail notes, Carl Rogers focussed on unconditional positive regard and empathy but in so many psychotherapeutic encounters, these have come to be instrumental tools mobilised to achieve change, to move clients from A to B. On a project like Bike Minded, that atmosphere that so many spoke of was the realisation of these factors, unconditional positive regard, empathy and non-judgementalism, as ends in and of themselves. The people who went on rides were not being subject to remote technologies of change that extolled clients to assume responsibility for whatever their set of life circumstances had deposited upon them as embodied suffering.
As Smail notes, much of the time, change is exactly what clients cannot do and not because of incompetence or a lack of motivation. Inherent in the way that projects like Bike Minded operate is an appreciation of this. It is easy, as we frequently do in this book, to compare and contrast the formal and informal settings where psychological care is experienced. But where therapy works best is exactly where a regular bike ride for people with mental health problems is also at its strongest. It is when there is an acknowledgement of the ordinary humanity of social relationships and their mobilisation as a source of solidarity rather than as a setting for instrumental change projects.
The beneficent properties of everyday human encounters exist when compassion and positive regard can be routine and which allow relief to be an emergent product of social relations in a social context7 that is mercifully free of the tyranny of a fixation with change. Bike Minded highlights how assemblages of people, machines and processes can coalesce into an informal milieu that confers positive identities, feelings of acceptance5 and feelings of being involved; through which some degree of subjective change is often an emergent property.
There is no such thing as recovery. That is not to say that people don’t move from states of extreme distress through time to states of wellness. They do. Just that there is no consensus over what recovery actually means to people who are suffering.20 Divesting ourselves of the enlightenment fantasy that we can, through our evidence-based tools, heal sick people with mental health disorders does not mean that we cannot usefully support and help people. Instead an understanding that ‘environments of recoveries’,20 where complex people with embodied pain can be held by interpersonal environments for a period, seems appropriate. Indeed, ‘environments of recoveries’ off individuals a space in which they can contribute, be useful, be distracted, be accepted and treated as an equal, providing them with ‘places to be’21 which are embroiled with much needed support. These environments can happen in a multiplicity of places, settings, people, experiences of refuge and escape, to experience a supported socialisation where they are not invisible but not observed,21,22
with experts and non-experts, and they can be impeded in just as many places, settings and relationships.
Places emerge through social interactions but also through a myriad of interactions between people, machines, textiles and vehicles,23 and most therapeutic landscapes involve movement away from an everyday domestic location. But recovery can’t be done to people, Recovery involves learning new ways to perceive and interact with the environment, acquiring new skills, the reawakening of hope after despair, no longer seeing oneself primarily as a person with a psychiatric disorder and reclaiming an at least fleeting positive sense of self,24 moving from alienation to a sense of meaning and purpose. Environments can be created that may help some people, some of the time. Bike Minded was one such environment.