Some Possible Directions for the Future

Building Underwater Sea Empires

When we were children watching the various James Bond movies that repeatedly played on our televisions over the years, we were struck by a thought. The same thought each time. This was the case whether it was Max Zorin seeking to trigger an earthquake to flood silicon valley in order to take over the world microchip market (A View to a Kill, for those interested), Hugo Drax seeking to destroy all life on earth (Moonraker) or Stromberg pursuing his nuclear missile launch to destroy Moscow and New York City and hence triggering a global nuclear war (he would survive in an underwater sea empire of course). The same thought occurred—if they’d only been a little more modest in their aims, then there was a fair chance that their outcomes might have been a little more favourable. We can’t say in all honesty that James Bond was at the heart of our epistemological reflections when we sat down to write this book but what has become clear, now that we are at the end looking back, is that we never set out with the intention to ‘James Bond’ the world of mental health. Indeed our aims were far more modest and there are a number of reasons for this.

© The Author(s) 2017

C. Walker et al., Building a New Community Psychology of Mental Health, DOI 10.1057/978-1-137-36099-1_10

Firstly, attempts to smash the intellectual battlements of biocognitive psy activity often tend to verge dangerously close to replacing one restricted dogma with another—a trade for a reductionism founded on biology and cognitive activity for one focused on the social and economic world or on language. Straight from the off we were concerned that building a metaphorical undersea kingdom to survive the destruction of global biocognitivism might not be all that it’s cracked up to be.

Secondly, and crucially, when you set out to write a book that is critical in orientation, you tend towards supplanting the consistency of narrative on one reductionism with a consistent narrative on another. Academic parlance doesn’t typically reward hesitancy, uncertainty and disagreement between the authors. Most books present nice neat stories—x is bad, y is good, let’s change x to y. And all of the authors are on board with this change. For our book, all three of us were broadly on board but there was also tension, debate and compromise. Through the course of this book, we debated (a lot at times) the value of the idea of ‘therapeutic’, the utility of the Diagnostic and Statistical Manual of Mental Disorders (DSM) endeavour, the use of conventional psychotherapies or indeed what was actually happening when people received some form of treatment or intervention for mental distress. So we’re even not sure that we could necessarily agree on what our undersea kingdom should look like. Sure we could get past wallpaper and furniture, but the overall structure? That could be tricky. But we agreed on a lot too, enough to collectively write a book on rethinking some of the core ways in which we think about and ‘do’ mental distress work.

And the third issue was that, whichever way we decided to frame and problematise the formal activities of the psy institutions, we were faced with the fact that many people have experienced life-saving support from committed professionals, many of whose actual practice varies widely from some of the foundational biomedical and cognitive precepts that might be typically thought to inform them.

The quote below comes from Emma Shephard, who set up ‘CardTherapy’, a creative and therapeutic endeavour borne out of a severe period of postnatal depression that led to her and her seven-month-old child being admitted to a Mother and Baby Mental Health Unit:

I think it has been a multi-faceted approach to my recovery. I would say number one was the anti-depressant because that had an impact so quickly I would credit the drug first saving my life to be quite honest because it completely changed how I felt in such a short space of time that there was nothing else to credit. But you know it was almost like waking up so I can’t discount that and I think that the drug keeps me well now, I have tried to come off it twice unsuccessfully and you know there have been many different reasons for that—perhaps it wasn’t the right time, perhaps the drug is just so physiologically addictive that you just that it’s just a tricky one to get off, I don’t know, I don’t know, but it keeps me well. I also had really good therapy that was really painful to go through and again that helped me deal with another aspect of what had contributed to my depression so there was that. The drug worked on whatever was going on physiologically, the therapy helped deal with what was going on emotionally, the support from my husband helped me deal with things practically and then finally this (Card Therapy) has been like another piece of the puzzle towards me feeling completely recovered is this something I have come up with myself, something that is dependent on myself, something I am in complete control of and that, that feeds my own desire to you know get up and get on with my day gives me a focus is this so I think that they have all contributed in their own ways but just any one on their own wouldn’t have done it, wouldn’t have been enough but yea I feel like this is the final puzzle piece

Emma’s experience, as do our own day-to-day experiences and those of others represented in this book, ring forever in our ears. They potentially mess around with any crude reductionisms that we might have wished to mobilise in order to establish the ‘brave new world’ of informal antipsychiatry approaches to mental distress, as they do to any attempts we might have made to neatly demarcate what happens in formal biocognitive practices and the informal practices that we have discussed in this book.

And this is where Martha, our Martian in Chap. 2, didn’t exactly tell the whole story. Just as our Martian critiqued the one-size-fits-all approach to what constitutes ‘good’ evidence, how professional practice plays out and how we define people in distress, she herself was giving a ‘one-size-fits-all’ account to her Martian superiors. And they would have picked her up on the irony of this. Because they (and I’m aware that we are treading on thin ice by implying knowledge of Martian superior’s thoughts here) might have noted the reality that, while the discourses and practices of biocognitivism are prevalent and dominant and abusive and life-saving, they are also routinely misunderstood, subverted and reconstituted in the everyday practice of mental distress work. And as nice as it would be to have our cake and eat it, that is to render visible a fixed caricature of biocognitivist mainstream psy practice to take shots at while luxuriating in the diverse, holistic, fluid, beneficent and person- focused orientation of informal practices, we are going to have to work a bit harder if we are going to chart a way to rethink how we should support immiserated people.

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