Capturing versus Enclosing Distress
Research shows that from the early 1980s to 2002 prescription drug sales tripled to $400bn worldwide; between 1993 and 2002 NHS prescriptions grew from 1,884,571 to 15,500,000 for Selective Serotonin Re-uptake Inhibitor (SSRI) antidepressants and from 3500 to 161,800 for Ritalin.4 Over the last 40 years the diagnostic criteria for Attention Deficit Hyperactivity Disorder (ADHD) widened such that nearly 50 % of children now satisfy ADHD symptom criteria.4 As academics we tend to take very dichotomous approaches to statistics like these. In fact we are obsessed by dichotomies or conceptual wrestling matches. We have done it through this book with the formal versus informal, statutory versus non-statutory, biocognitive versus social, and abusive versus therapeutic. And to be honest we feel a bit bad about it. Because important things get lost in these simplifications. The inpatient facility above does a number of things. We could view the activities through some of the standard dichotomies above but it’s more useful not to. You could argue that it sedates, incarcerates and traps them and/or that it gives them space and relief. You could also argue that the facility puts them in contact with professional carers understood as warm, empathic, and supportive and/or short- tempered, dismissive or neglectful. They might experience themselves talked about as patients, given a diagnosis by groups of qualified people who scrutinise them, try out different sedatives and/or experience most care practices in there as little more than friendly chat and the delivery of access to television and cigarettes. You could say that for many distressed people who end up in here, they simply just need a breather from relentless and difficult proximal life events and people. Perhaps some or all of these happen. But make no mistake, there is no magic.
If we think back to our community singing chapter, Eddie had a regular activity where he could just ‘be himself’. As we saw throughout that chapter, some might think that singing is a fairly banal activity but one that holds a special place in society. Here, group singing on a regular basis helped alleviate some of the distress people experience in contemporary life. It enabled people to shift their central focus from their distress to something different, build self-confidence, or simply embrace the upbeat nature of collective singing and the joy of music. And there was no magic there either.
For the many problems resonant within our contemporary therapeutic culture, good things are experienced in formal therapeutic spaces. We are pretty well positioned by now to pick out the bad things that happen but less so when it comes to recognising and naming the good things that happen in more formal environments of mental health care. When the technological paradigm of biocognitivism is used as the lens through which to study formal psy practice, we can miss the opportunities to make visible the real humanity, expertise and care practices that recognise the ordinary humanity of the therapeutic relationship—one that is a source of solidarity rather than a mechanistic technology of change.5 But it is when formal mental health practitioners operate on the assumption that they are curing static illnesses that demand the tools of expert practitioners that so many ‘non-compliant’ service users are likely to engage in deceit and subterfuge when managing relationships with psychiatric services.6
Yet we are still dogged by an inability to articulate what works and why, and we have tended to pursue the solution to this issue through the reification of inadequate dichotomies (that we have also been guilty of reifying to meet our own ends at times in this book). When you look at Bike Minded, this issue stares us in the face. What was interesting about the experiences of the people on Bike Minded was why ‘the atmosphere’ appeared so key. The atmosphere was Rogerian in a sense that has been lost in many of the psychotherapies. On a project like Bike Minded, the atmosphere that so many spoke of was the realisation of unconditional positive regard, empathy and non-judgementalism, as ends in and of themselves. And there were other things that didn’t lend themselves to the static disorder model and the randomised control trials that maintain its prominence—friendliness, openness, patience, stillness, silence and status. There was a sense of safety and refuge. For some there was a sense of escape7 that wasn’t separate or peripheral, but central to what people talked about as their recovery.
For the parents who turned up at Amaze, it wasn’t deep-seated trauma that needed to be worked through, nor negative thoughts or feelings that needed to be challenged, nor rampant neurotransmitters that needed to be culled (although various sedatives certainly eased the path). The issue at hand for people who have found themselves ensconced in our individualising, often pathologising, and sometimes helpful mental health system, is that the problems they faced were, on the whole, practical, social, relational and financial. What was clear from the accounts of the parents was that they needed support, advice, information and companionship. They needed to be respected and listened to, have their knowledge privileged in the various consultation processes that they found themselves party to. They needed greater financial support, flexible employment opportunities and meaningful respite. A worthwhile psychology of distress needs to embrace the demystification of the psy colonies, where clinical predicaments are interpreted in a way that people know there is nothing they could have done. That they are not to ‘blame’ for their distress and that it is possibly not within their grasp, or the grasp of an expert, to fix.5 That they don’t need to be fixed using complex techniques, rather they just need a bit of a hand.
What these case studies of informal spaces highlight is that what can be so useful for mental distress is actually hugely variant in nature. It could be a singing group, a cycling group, an organisation to support parents of children with complex needs and/or a sedative. It could be an advocacy and information service for people using benefits, debt guidance, a tantric encounter, employment advocacy or advice on local facilities for a disabled family member. Or it could be just sitting down, with other people in a space that isn’t your house.
What we have tried to show in this book is how we can understand and experience mental distress as a social ‘thing’. Here though, the social isn’t a single type; its form is fluid and when objects and the social spaces through which they emerge and travel are understood as fluid, it allows us to focus on what is done in practice, in different settings. Objects like distress are not passively immutable. They are actively brought into being dependent on the practices through which they are enacted. Different practices in different sites create different things.8
This book has sought to act as a celebration of spaces and situations that fix few, if any, of the rigid boundaries attempting to contain fluid distress. Unlike terrains of biomedicine which—at least in theory if not always in practice—seek to hold objects in rigid spaces within rigid networks of relations, definitions, roles, expectations and narratives, informal spaces tend to do this less. But the technical paradigm is a territorial endeavour that has reached far and wide, often perforating the spaces and settings that we have called nominally ‘informal’ in this book. We have set up a nice easy demarcation between fluid possibilities and active informal settings, and the rigid psy forms of knowledge and spaces of passivity. But what of spaces where the formal and informal breaks down? For instance, peer support groups led by a therapist inside a community group? Or an advocate from the mental health charity Mind working in the Unemployed Centre Families Project? Or a GP doing social prescribing? Or an advocate in an inpatient facility getting someone some cigarettes on the way up for a chat? Some informal settings have practices that fix fluid objects using the apparatuses of the psy institutions and some psy spaces have fluidity, and with this fluidity comes possibilities perhaps not recognised by the critical fetishists. And so what to do?