Therapists: how to join the network

If you are a therapist and would like to join the FPN, we ask simply that you share our
commitment  to  providing free or very low fee open-ended therapy to people on low incomes. See the statement on the home page of our website. There are then three steps to joining:

1.   Tell us you are a qualified counsellor or psychotherapist, and are registered with a professional body

2.   Send the following details, which will be posted on our directory of therapists, to Andy Metcalf at andymetcalf62@gmail.com

  • Your style of Work…….ie Psychotherapy/Counselling/Couples Work
  • Your qualification/registration… ie UKCP/BACP etc
  • Your postcode
  • Your contact details … email or phone number or both
  • Any other details you would like to mention

After your details are posted, the conditions of the work with a client who contacts you from the FPN  directory (free or a low fee, frequency, holiday breaks, etc)  are for you and the client to negotiate within the frame of your private practice.

3.   When you feel the time is right,  write a brief profile piece explaining why you have come to join the network and what it means to them. Find examples here.

If you have any other questions please do get in touch with Andy Metcalf.

Thanks

Recovery In The Bin – Letter to Luciana Berger

Please take the time to read and support this letter from a User Led Mental Health Activist Facebook Group campaigning for social justice and equality . Attached are the Recovery In The Bin network’s 18 Key Principles, if you wish to know more.

Dear Luciana Berger – Shadow Minister for Mental Health,

We are writing to you to raise our concerns and priorities for Governmental Mental Health care and provision in the UK. We enclose the first of a number of our “position statements” we intend to send to you.

We are a User Led Mental Health Activist Facebook Group campaigning for Social Justice and Equality in MH care and practice, with a focus on critiquing and challenging mainstream ‘recovery’ ideology. At the time of writing our membership stands at 474 and this is growing by the day.

We believe ‘recovery’ has been colonised by MH services, commissioners and policy makers. We reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by marketisation language, techniques and outcomes. Some of us will never feel “Recovered” living under these intolerable and inhumane social pressures.

We believe access to quality housing and disability benefits designed for mental health claimants would give people a stable and secure environment to raise their quality of life and health. This would enable efforts towards going back to study, work IF people choose / aspire to this and allowing people to volunteer indefinitely and claim benefits if this improves their quality of life and MH – recognising how valuable this work is to society.

Our first “position statement” is about the Welfare State and Social Housing, and follows this letter.

We will cover the following issues: –

Work Capability Assessment (WCA)

Benefit Sanctions

Personal Independence Payment (PIP)

Employment

Voluntary Work

CBT in Job Centres

Social Housing & Homelessness

We look forward to hearing from you about the matters we have raised.

Yours Sincerely,

Recovery In The Bin

Copy:

Jeremy Corbyn MP and Leader of Labour Party.

John McDonnell MP and Shadow Chancellor.

Owen Smith MP, Shadow Secretary of State for Work and Pensions.

Mental Health Resistance Network.

Social Workers Action Network (SWAN).

Psychologists Against Austerity.

Critical Mental Health Nursing Network (CMHNN).

Critical Psychiatry Network.

Disabled People Against Cuts (DPAC).

The Peoples Assembly.

Statement on the Welfare State and Social Housing

Work Capability Assessments (WCA)

  • The Work Capability Assessments (WCA) for Employment Support Allowance (ESA) appear to be weighted in favour of those with physical disabilities, and often fails to take into account fluctuating conditions, common to mental distress, such as anxiety and depression.
  • Access to welfare advisors and advocacy workers has been severely reduced due to cuts to funding, services and the legal aid budget.
  • We are aware of a number of deaths related to the “reforms”, including recent reports that a coroner has ruled that the WCA contributed directly to the suicide of a claimant, and that steps need to be taken by the DWP to prevent further such incidents. (The Independent 20.9.2015).
  • We believe the WCA needs to be abolished as a matter of urgency.

Benefit Sanctions

  • Sanctions remove the very means of existence, and as a consequence the related death toll is rising.
  • Those in the ‘Work Related Activity Group’ face huge cuts to their benefits in the near future, even if they manage to avoid being sanctioned.

Personal Independence Payment (PIP)

  • PIP is not MH orientated and self-harm/suicide risk factors have been removed from criteria.
  • MH claimants struggle to obtain the necessary medical evidence because MH services are now short term, and once discharged no specialist reports can be secured.
  • Loss of DLA/PIP to MH claimants who are not in receipt of ESA because they’re doing some part-time work or self-employment will be rendered unable to continue working or plunged into poverty, being under immense pressure to work more hours, which could lead to mental distress and deterioration. 

Employment

  • There are approximately 700,000 vacancies and 2 million (possibly more if you count those who are sanctioned/on Workfare) applying for those 700,000 vacancies, therefore the maths don’t work here.
  • It’s evidenced that Workfare doesn’t work and only provides massive profits to private companies using public funds and plunges more people into sanctions/food banks.
  • MH claimants have been and are being targeted as the ‘low hanging fruit’ (their description) in the full knowledge that MH (and Learning Difficulties) has the lowest employment rates.
  • Temporary and zero contract hours shift work is evidenced as being bad for anyone’s mental (and physical) health, but this looks set to become more common for MH claimants who are at threat of sanction/workfare.

Voluntary Work

  • We often carry out highly valued long term voluntary work within Trusts, University’s and Charities, so chosen voluntary work (with appropriate evidence) needs to be considered as an additional outcome to employment, as for some people that’s the most ‘doable’, maintaining the best ‘stability’.
  • Voluntary work gives a person greater flexibility, and provides less pressure to paid work when s/he is not feeling up to it.
  • MH claimants have had benefit claims stopped/reviewed for doing voluntary work (even when organised by own MH Trust & MH professionals have had to intervene by advocating that it’s part of their treatment).

Cognitive Behavioural Therapy (CBT) in Jobcentres.

  • We believe getting back to work, especially after many years of unemployment, due to MH complexities, is unlikely to be resolved by a “quick fix” such as CBT.
  • Many of these initiatives are being piloted in Labour controlled authorities. For example, in June 2015, Service Users protested outside the Streatham Job Centre, which had been identified as a site for trialling the introduction of CBT inside Job centres.

Social Housing & Homelessness

  • Some Councils/Housing Associations are losing over 90% of their stock, and letting agencies/private landlords don’t want tenants on housing benefit. This is a significant factor with respect to the increasing levels of homelessness that should not be acceptable for any Government.
  • Very vulnerable mentally distressed people are ending up sleeping rough because of refusal to join groups in high support mental health housing, which means they have refused an offer of housing and are deemed voluntarily homeless.

The privatisation of mental health: how good services are turning in favour of the rich

by Elizabeth Cotton, Middlesex University

The Care Quality Commission, the independent regulator of all health and social care services in England, recently produced a sobering report about the crisis in mental health services, with A&E staff attitudes bearing the brunt of criticism about failed care.

However, the Guardian’s recent ClockOff survey found that those working in health are the most stressed in public service – 61% say they are stressed all or most of the time.

Mental health has always been the poor cousin in public services and these reports are not about failures of individual compassion or positive thinking, but the impact of precarious work on all of our states of mind.

Take the psychotherapy profession. A 2015 report about a deterioration in public psychotherapy provision found there had been a 77% increase in complex cases, yet 63% of clients reported that NHS therapy was too short to do any good.

Insecure jobs and the growth of contract and agency labour, unwaged labour, and the retreat into private practice are linked to changes happening in the NHS that have left a fragmented and confused system of healthcare that even the leadership finds difficult to manage.

Rise of the agency

The advent of agencies is nothing new in healthcare but with the massive rise in demand for mental health services, NHS cuts and the waiting lists of between six and 18 months for talking therapies, we are now seeing the creation and expansion of private contractors and employment agencies for therapists. Because of the intense insecurity of agency work and the fear of blacklisting of individual therapists, professionals don’t want to talk about this growth of third parties in mental health and, as a result, not much is known about them.

The growth of contract and agency labour is part of a national campaign to downgrade mental health services. Under the NHS’s Increased Access to Psychological Therapies (IAPT) the main bulk of services are low intensity “well-being” programmes, based on a diluted model of Cognitive Behavioural Therapy. This service is delivered by “psychological well-being practitioners” (PWPs), a formalised and standardised role with intense targets of eight to ten satisfied clients a day. Under this system, if a patient does not pick up the phone for an initial assessment within the allotted 15-minute time period they are referred back to their GP, presumably to wait for a further six months.

Running out of time for mental health?
‘from www.shutterstock.com’

This model of well-being, to be clear, can under no description be considered as therapy. Although most of the people working as well-being practitioners are highly qualified, their job is not to provide a space where patients can actually say what is on their mind. The work is scripted and always leads to one compulsory outcome which is that everyone feels well. Those who offer more support, mainly through giving more time and going off-script, are forced to keep this secret from employers because it breaks their contract of employment, leaving them to carry the full ethical and clinical consequences of their interventions.

To add insult to injury, tucked away in the 2015 budget is the proposal that increased access to psychological therapies should be introduced to 350 job centres in the UK. It’s a psychologisation of poverty, where unemployed people are forced by precarious PWPs to internalise a global economic and social crisis. In this scenario its hard to imagine who needs the most help, the client or the clinician.

A growing percentage of such services are provided by contractors and labour agencies who are literally buying up the growing NHS waiting lists. As with all externalised employment relations, it is not just the contract of employment that gets passed over to third parties, it is also the responsibilities of employers.

Internships and honorary psychotherapists

The most important part of your training as a psychotherapist, along with your own personal therapy, is to carry out clinical work. In order to train as an adult psychotherapist and become an accredited member of a professional body you have to work part-time, usually one to three days a week for between four to eight years.

The problem is that trainees are not paid. There is currently no comprehensive data on how many psychotherapists work unwaged as “honoraries”, but with an estimated 6,000 psychotherapists training every year, a conservative estimate is that 2,000 full-time jobs in mental health are covered by unwaged workers. This includes a substantial percentage of the psychotherapists working for the NHS, the big third sector providers such as Mind and many local mental health charities providing clinical and well-being services in the UK.

Professional bodies are complicit in this system of unwaged work leading to the curious situation that the bodies charged with building a sustainable profession are currently not able to do that. If there is a political cause worth fighting for it is to make the demand for our professional bodies to organise a platform to negotiate wages.

There are some who work full time and do the training on top, but like other areas such as the media and arts, it means this profession is open primarily to people from families affluent enough to support them. This is not to say that rich people make worse therapists, but it does raise important questions about class and power.

Turning to private practice

Then there are the therapists employed directly by the NHS. In most cases the days of “permanent” contracts are over, cuts in funding and increasingly short funding cycles mean many jobs are fixed and short term.

Most NHS services are understaffed, particularly in child and adolescent mental health services leading to an emerging gold rush for private contractors and agencies. The insecurity of NHS workers has profound implications for workplace fear, creating cultures where clinicians are reluctant to raise concerns about patient care. Despite the important debate going on now about raising concerns, in the NHS the reality is that precarious workers are unlikely to speak up for fear of victimisation and job loss.

Many experienced psychotherapists have retreated to private practice, unable and unwilling to navigate a broken system. Many make enough money to live, but only having spent most of their working lives in the NHS with their pensions intact. This generation will retire within the next five to ten years leaving behind a whole generation of self-employed practitioners, who will never earn enough to cover the basics of pensions or sick pay. Private practice does offer massively needed services and a careful assessment and referral can make the difference between life and death, but it increasingly means that services are accessed only by those that can afford it.

The current economic argument for mental health services is based on the unacceptable working conditions of thousands of mental health workers. From psychological well-being practitioners, to psychologists in job centres, to the clinicians employed by Maximus and Atos to carry out welfare assessments, working in mental health poses significant risks to both clients and clinicians. As long as psychotherapists are working quietly and diligently under precarious conditions, the NHS as an employer will never respect the people who work for it. In a context of deteriorating mental health services, the fact that psychotherapists are an unorganised and silenced group of public servants is a matter for both professional and personal ethical concern.

This column looks at the reality of our health and care systems from the perspective of those working to deliver services. Please send us your stories from the frontline.

The Conversation

Elizabeth Cotton is Senior Lecturer at Middlesex University.

This article was originally published on The Conversation.
Read the original article.

MHRN Open Letter on Streatham Jobcentre protest 26th June: coercive CBT to get welfare claimants “back to work”

Open letter from the Mental Health Resistance Network

mentalhealthresistancenetwork@gmail.com

  

MARCH ON STREATHAM JOB CENTRE – FRIDAY 26TH JUNE, 1.30 pm

MEETING POINT: STREATHAM MEMORIAL GARDENS, STREATHAM HIGH ROAD/ STREATHAM COMMON NORTH, LONDON SW16

STREATHAM JOB CENTRE PLUS: CROWN HOUSE, STATION APPROACH, LONDON SW16  6HW

* A pilot project to bring CBT (Cognitive Behavioural Therapy) into Job Centres starts at Streatham Job Centre Plus in June 2015.

* In the same month, Lambeth “Living Well Hub” for Community Mental Health Services is due to open in the same building.

*Mental Health Resistance Network is unhappy with these developments which are part of the government’s brutal “back to work” agenda.

*Mental Health Resistance Network has called a demonstration which will march on Streatham Job Centre on Friday 26th June.

*Mental Health Resistance Network is circulating an open letter to relevant individuals, charities and professional organisations stating our position and asking them to join us in our condemnation for these developments.

 

Mental Health Resistance Network is organising a demonstration to take place at Streatham Job Centre Plus on Friday 26th June 2015, protesting against the opening there of Lambeth’s principal community mental  health centre  (“Living Well Network Hub”) the following Monday.

Streatham Job Centre also, from June 2015, hosts the first pilot of the DWP’s scheme to provide psychological therapies – specifically Cognitive Behavioural Therapy (CBT) – at Job Centres for people suspected of having mental health problems. This is the first of ten pilot schemes in advance of a national project planned to begin in January 2016.

We are calling on you/ your organisation to state your position on these issues, and we hope join us in our condemnation of these developments.

As mental health service users, we are extremely unhappy with these developments. We deplore the government’s brutal “back to work” agenda, which is a front for cutting disabled welfare benefits for the most vulnerable. Mental health service users are understandably terrified of Job Centres and the threat of losing their benefits through Sanctions, or degrading and unfit-for-purpose Work Capability Assessments. With the main point of access to Community Mental Health services in Lambeth on the 3rd floor of a Job Centre, many of us will feel too frightened to ask for the help and services we need, and lose contact with services altogether.

Mental health service users are already reporting higher levels of fear, anxiety and anguish as a result of the increasingly difficult welfare benefits system, which is linked to an increasing rate of suicides. This situation will be exacerbated by the new developments.

We should not be put under pressure to look for work unless we feel capable. The competitive, profit-driven and exploitative nature of the modern workplace is not suitable for people whose mental health is fragile. But the location of the Network Hub at Streatham Job Centre put us under such pressure if we try to use mental health services.

Experts agree that CBT does not work for everyone; that psychological therapies are ineffective if they are forced on people; and that they need to take place in safe, unthreatening environments. We do not think making people have CBT at Job Centres will make anyone magically “fit for work.” We are concerned that people will be Sanctioned (i.e. have their benefits stopped) if they do not co-operate with this “therapy” either out of principle or because they are not well enough. “BACK TO WORK THERAPY” IS NO THERAPY AT ALL!

Additionally, we are concerned that this amounts to an extension of the coercive powers of the 1983 Mental Health Act amended 2007. Whereas at present people can only be forced into “treatment” under in-patient Sections of this Act or by Community Treatment Orders, making welfare benefits and by extension housing conditional on agreeing to psychological treatment broadens the principle of compulsion.

We condemn the involvement of  IAPT in this attempt to make people undergo “therapy” at Job Centres, which we believe goes against professional ethics. We are also unhappy that psychiatrists, occupational therapists, nurses, social workers and other mental health professionals are also expected to work at Streatham Job Centre, again compromising their professional ethics, and we call on individual staff and collective agencies representing them to publicly oppose this development.

For more information contact:

mentalhealthresistancenetwork@gmail.com

 

Facing psychological coercion and manipulation has become a daily part of claiming benefits

Felicity Callard, Durham University and Robert Stearn, Birkbeck, University of London

Curing unemployment is a growth market for psychologists. Job Centres are becoming medical centres, claimants are becoming patients, and unemployment is being redefined as a psychological disorder.

Made-up ailments such as “psychological resistance to work” and “entrenched worklessness” feature in ministerial speeches and lucrative Department for Work and Pensions (DWP) contracts, without attracting a murmur of protest from professional psychologists.

Psychological explanations for unemployment – the failings of the maladjusted jobseeker – isolate, blame, and stigmatise unemployed people. They reinforce myths about “cultures of worklessness”; they obscure the realities of the UK labour market and the political choices that underpin it. The same is true of psychological prescriptions for treating unemployment.

Interventions

People claiming benefits are already subject to psycho-interventions through mandatory courses designed to promote “employability” and “job readiness”. And as we show in a new paper published in Medical Humanities, “positive psychology” is pervasive in Job Centres (the newly privatised Behavioural Insights Team has trained more than 20,000 Job Centre staff. A narrow set of approved psychological and personality traits are widely touted as essential to getting and keeping a job: confidence, optimism, positive, aspirational, motivated, and infinitely flexible.

Positive psychology is pervasive in Job Centres.
Employment by Shutterstock

Motivational “messaging” targets both staff and claimants, and is set to intensify. The 2015 budget sets out government plans to put therapists in job centres this summer. Online cognitive behavioural therapy will also be provided, in order to “improve employment outcomes” for claimants with mental health conditions. (Some of the many problems with these approaches have recently been discussed in The Conversation.)

The “change your attitude” message of positive psychology is enforced by unsolicited “positive thinking” emails sent to claimants, and in mandatory “employability” training courses promising to help with “self-esteem, self-confidence and motivation”.

Employability, workfare and sanctions

People on benefits are made to take part in various pointless and humiliating psychological group activities (like building paper clip towers to demonstrate team work), or take completely meaningless and unethical psychological tests to determine their “strengths”. But the goal is not a job with pay that you can live on. Instead, this is an intensive “change your attitude” programme, which – along with other forms of workfare – is designed to force people off benefits.

Workfare is a name for the different kinds of “work-for-your-benefits” schemes, exported from the US, which have spread to many rich democracies over the last two decades. In the UK, unemployed people are forced to work unpaid for a charity, business, or local authority in order to continue to be eligible for benefits (both Job Seekers’ Allowance and Employment and Support Allowance – the benefit paid to sick and disabled people).

Workfare also includes coaching, skills-building and motivational workshops, and schemes that are part training course, part unpaid work placement. Failure to take part in these schemes may result in harsher or more demanding workfare activities or benefit sanctions.

High Court ruled unpaid work schemes like Poundland’s were lawful.
Pittaya Sroilong, CC BY

Sanctions amount, as David Webster has recently argued, to a “secret penal system”. Entrenched, arbitrary, and unaccountable, they deprive people of the money they need to eat and live. Workfare – backed by sanctions – also ensures a steady supply of free labour, replacing paid jobs, further depressing wages, and creating a claimant workforce without the legal status and rights normally given to workers. The unemployed person is a generator of income for everyone except themselves.

At the same time, assessing “employability” and enforcing activities said to increase it is now a central function of workfare, stimulating the growth of a state-sanctioned, state-contracted industry heavily influenced by – and reliant upon – psychological “magic” .

“Employability” isn’t a set of skills or attributes required for a specific job or job offer (receptionist, bus driver, call centre operator, care worker). Rather, it is about personality and emotions: achieving a generic upbeat state; having the characteristics, attitudes and habits of “the sort of person who can get a job” – the familiar roll call of confidence, self esteem, motivation and aspiration so celebrated by the CBI, as they lament the absence of these “job ready” attributes in young people leaving school or university and identify “a positive attitude as the key foundation of employability”.

Attitudes to work

This means that “attitude to work” – boosted by confidence courses and assertiveness sheets – becomes a legitimate basis for deciding who is and who is not entitled to social security and a condition placed on receipt of benefits.

In the past, conditionality related to things like refusing to take a job after receiving three offers of work. This was hardly beyond criticism. Now, the supposed absence of positive affect can trigger some form of sanction. “Lack of work experience or motivation” is one of the criteria for being sent on a Community Work Placement – six months’ unpaid community service for 30 hours a week.

Esther McVey, former minister of state for employment, talked about targeting people who are “less mentally fit, bewildered, despondent”, and about the difference between those who are “apprehensive but willing” and those who are “reticent but disengaged”. While unfit claimants will be sent on “more intensive coaching”, those who are “optimistic” can be placed on less rigorous regimes. This is how the DWP will decide who is to be punished with “extra support” – 35 hours a week at a Job Centre.

Medical professionals as state enforcers

The 2015 Conservative manifesto stated that claimants who “refuse a recommended treatment” may have their benefits reduced. This attempt to co-opt medical professionals as state enforcers is what led to the first protest by psychologists. However, while campaigns such as Psychologists Against Austerity have focused on the psychological impact of welfare reform, there has been little mention of psychology’s central role in disciplining and punishing people claiming benefits, or of the ethics of psychological conditionality.

Notwithstanding the UK’s low pay, no pay economy featuring a growing number of precarious, exploitative and part-time jobs, what employers want is “enthusiasm” and workfare is designed to ensure they get it. The “engage” training module will help job seekers achieve “a mindset that appeals to employers, assertiveness, confidence, understanding the benefits of work, motivation and coping with low mood”. In the Job Centre and at the premises of private training providers these positive psychological imperatives – frequently laughable in themselves – are plugged into a violent and coercive sanctions regime.

Substituting outcomes

The frameworks used for DWP evaluations of workfare schemes overwhelmingly focus on their psychological benefits. The explanation psychology offers, the treatment it delivers and legitimates, and the kinds of outcome it recognises, are also specified in DWP contracts worth hundreds of thousands of pounds (Focus the Mind, Achieve your Potential, Engage for Success). A programme for JSA/ESA claimants older than 50 even aims to persuade people that age discrimination doesn’t exist.

These developments raise important questions about the ethics of extending state surveillance – and state-contracted surveillance – to psychological characteristics. Psychology can offer a powerful critical perspective on these kinds of compulsion. But pressing issues of accountability and complicity have not been addressed by professional psychological bodies, in spite of persistent lobbying from anti-workfare campaigners. Boycott Workfare says that BACP – which sets standards for therapeutic practice – has been silent, and that they are still waiting for a statement from the British Psychological Society (BPS). Far from addressing the validity or ethics of assessing claimants for “psychological resistance to work”, BPS put out a press release noting that tests should be undertaken by qualified staff.

Psychological coercion and manipulation are part of the day-to-day experience of claiming benefits. It is time the profession took a stand against them.

Co-author Lynne Friedli is a researcher with Hubbub, an interdisciplinary project of scientists, public health experts, clinicians and humanists funded by the Wellcome Trust and run from Durham University, with support from the Max Planck Institutes and the University of York.

The Conversation

Felicity Callard is Director of Hubbub (The Hub at Wellcome Collection) and Reader at Durham University.
Robert Stearn is PhD candidate in English and Humanities at Birkbeck, University of London.

This article was originally published on The Conversation.
Read the original article.

Turn illness into weapon: Mental distress from a Socialist perspective Bruce Scott

This article was written as a response (partly) to an article that came to my attention that was posted on the Common Space website[1] concerning “mental health”[2].

It is laudable that the aforementioned Common Space article and many such similar articles[3] [4]show concern for the “mental health” of our citizens; it is also let us not forget, Mental Health Awareness Week[5].

However I have grave reservations on several issues with this campaign for “mental health” which are routinely overlooked.

Primarily, the discourse of “mental health” or “mental illness” is not all it is cracked up to be. In other words, the biological model of “mental health” is not watertight and it remains to be seen, and most likely will remain firmly remaining to be seen. The evidence of organic substrates attributed to the cause of “mental illness” is nowhere near to that of physical illness. In fact they are incomparable from a scientific point of view; for example see the work of Healy (2003)[6], Joanna Moncrieff (2003)[7], Boyle (2002)[8] , and Kutchins and Kirk (2003)[9].

Secondly, the neuro-cognitive imperialistic discourse of mental disorders is misleading and excludes other discourses of conceptualising mental distress. There are thousands of years of philosophy and numerous other alternative psychotherapeutic and psychoanalytic practices which deal with “mental distress” in rather different ways, which do “work”, but are hardly amenable to the “rigorous” nature of “evidence based medicine”. See the work of the philosopher Martin Heidegger [10] for example and his critique of the positivistic, biologic, and psychological approach to mental distress.

Certain discourses, for example, the Diagnostic and Statistical Manual of Mental Disorders[11] (one of the main dogmas which create the deployment of the concept of mental illness) destroy other ways of conceptualising meaning making regarding mental distress. The symbolic (language) of the DSM discourse is regarded as cast iron; words are taken as entities, these entities are taken as facts, and as a result of the proliferation of DSM diagnoses in the media, the DSM discourse becomes solidified into the symbolic/language of the public. However, such a covering-over and domination of the symbolic prevents one from contributing to the meaning-making of the world. What the systematisers cannot accept is that there may be many meanings or even that there is no final meaning; why is the realisation of a questionable or imperfect symbolic such a terror? Is it such a terror? For many it is a terror; we live in a society where risk prevention is paramount, where avenues of alternative thought and searching for alternative meaning are outlawed, and where the questioning and traversing of ideological borders (e.g., patients questioning the psychological and psychiatric masters’ ideas about the psychological and neurochemical basis of mental disorder) are forbidden and not taught in any of our state educational contexts.

Karl Marx alluded to this situation of alienation[12]. Alienation has certainly occurred in work or labour especially in the 21st century (e.g., McJobs & Zero hours contracts), but also most certainly in our productivity regarding our subjectivities; we have depression, we have OCD, we have ADHD etc. Our products or our productions of our psyches are limited within narrow confines; in other words, we produce or are coerced to produce subjectivities in relation to the dominant congnitve-neuro imperialistic discourse of “mental illness”. As Gilles Deleuze and Felix Guattari (authors of Capitalism and Schizophrenia; Anti-Oedipus[13], and, A Thousand Plateaus[14]) would argue, we have been territorialised by the machines of capitalist discourse to only produce subjectivities which place mental distress within an individual context; the individual is to “blame”, ones faulty cognitions or neurochemistry is to blame and we need experts to fix this. After all the state needs workers who blame themselves, put themselves at the mercy of the psycho-experts to rehabilitate them, but never to question the socio- economic ideology. Yes austerity causes distress, but please do not call it exacerbating existing “mental illness”. That is not the whole story, or an accurate story.

So, while I wholly understand the need and desire to campaign for those in mental distress, we have to be very careful what we demand (As a side issue though, are we all not in some form of distress, especially in Scotland due to the punitive nature of austerity politics? We do after all now have the Tories as the new bosses!). Jacques Lacan, the French psychoanalyst, who had quite a few things to say about the ravages of capitalism, warned about asking the masters (Government) for change. He said beware what you ask for, because all you will get is a new master; here is a harsh lesson for aspiring developing subjectivity and consciousness in light of the glut of campaigning for “mental health” at this poignant time.

The situation in Scotland regarding “mental health” is paradoxically not very healthy, and not likely to get healthy if we continually ask for the limited menu what is on offer.

As Siobhan Tolland (2012)[15] in the Scottish Left Review argues:
“In 2010, the Scottish Government quietly abandoned its commitment to reduce antidepressant use within Scotland. The original commitment came amidst a wave of concern and worry that ten per cent of Scots were taking antidepressants, and the SNP promised to promote alternative treatments. Recommending this abandonment, the Scottish Government Audit Committee suggested that the reduction commitment did not reflect the complexity of treatment options within Scotland. Importantly, it argued, recent research concluded most GPs were prescribing appropriately anyway. Thus concerns over the high use of antidepressants within Scotland were unfounded.”

And she continues:

“At present the mental health strategy, Towards a Mentally Flourishing Scotland is under review, but the abandonment of that commitment is a cause for concern. And abandoning it on the basis of the Aberdeen University research is extremely concerning for it accepts a very controversial view of mental illness that reduces complex emotions to a single biomedical cause. Depression, for instance, is caused by chemical or biological abnormalities of the brain, and should be treated accordingly. Accepting the study’s conclusion that GPs were prescribing appropriately then means they also accept Depression is biomedical in origin. As a consequence, it promotes antidepressant medication above, say, counselling, CBT[16] or even exercise.

The biomedical view additionally prevents any social analysis of unhappiness or desperately low mood, and medicalises these problems. It ignores the correlation between poverty, inequality and poor mental health, for instance. Research suggests that poor mental health is caused by poverty, for instance, with Bristol University suggesting that as many as 50 per cent of people in poverty have signs of depression. Reverting to a biomedical discourse of poor mental health prevents these social and economic connections from being established, citing responsibility on the individual’s biology, and not society.  And thus any sense of collective social responsibility for our health and welfare is abandoned. We don’t need to change society to make it more mentally healthy, we just need doctors and scientists manipulate the brain.”

Tolland also highlights the worrying links, associations with pharmaceuticals companies which in part ignores other discourses about mental distress:

“….by 2011 the SNP was openly promising to open NHS Research Scotland up to the pharmaceutical industry. This involved a mission to double the economic contribution of life sciences and accelerate growth with an emphasis on business and institutional collaboration. Promoting health seems pretty absent against this language of business interest. One example of such a promise was a joint partnership with companies carrying out clinical trials which involved streamlining the ‘regulatory approval processes’, meeting the open demands of the ABPI. Since Psychiatry and Neuroscience are proposed areas for NHS Research/industry development, the biomedical influence of mental health and illness seems pretty inevitable.”

But it must be reiterated even the so- called utopia of Cognitive behavioural therapy (CBT) and related technological therapies, even if they were more available, do not address the neuro-cognitive imperialism of mental distress. We are more than cognitions and more than psyches or subjectivities to be “fixed”. David Pavon-Cuellar[17] argues for this case using the work and ideas of Jacques Lacan, the founder of Lacanian psychoanalysis, to bolster his argument.

“Lacan is not a psychologist, but a psychoanalyst. He is a radical psychoanalyst who drastically rejects psychology. This rejection of psychology is constitutive of Lacanian psychoanalysis, which has been aggressively constructed against psychology, especially Ego-psychology and other psychological deviations from psy­choanalysis. For Lacan, psychoanalysis must resist psychology. Psychoanalysis must not let itself be absorbed, employed, or con­taminated by psychology. In short, psychoanalysis must avoid psychology.

The term “psychology” usually has a negative connotation in Lacanian discourse. Here, as the case may be, psychology implies misinterpretation, misrepresentation, illusion, deception, manip­ulation, trivialization, and so on. These implications synthesize elaborate Lacanian denunciations of psychology. Among these denunciations, there is one that seems to be directly connected to the position of Marx in Lacan. It is the denunciation of the complicity between psychology and capitalism. This complicity is emphasized in 1965, in the twelfth seminary, when Lacan explicitly maintains that “all modern psychology is made to explain how a human being can behave in the capitalist structure” (Lacan, 1964-1965, 09.06.65). Lacan does not simply say that psychology explains how a human being behaves in the capitalist structure. What Lacan says, is that psychology explains how a human being can behave, or how it is possible for him to behave in the capital­ist structure. At stake here is the possibility of human behaviour in the reality of the capitalist structure……Psychology produces wellbeing, comfort, adaptation. It produces adapted workers, or happy workers, that is to say, good workers. But these good workers are also real sub­jects whose interest proves to be, thanks to Marx, opposed to that which produces them as good workers in order to enable their exploitation. Thus, in the Marxian pole, the workers are essen­tially “opposed” to the pole of psychology and other “means of production” as “form of existence of capital.

Ultimately, the Lacanian opposition between Marx and psychol­ogy expresses the Marxian fundamental conflict between Work and Capital, which can also be lacanianly understood as a conflict between the truth of work and the capital of knowledge. But this conflict is not reducible to an opposition. Capital is not only op­posed to Work, but also generated by Work. The truth of work is the truth of capital. It is the truth of the capital of knowledge. Yet knowledge cannot know its truth. It cannot control or man­age it, even if it is supposed to control and manage it. Even if the truth should theoretically not resist knowledge, it intrinsically resists knowledge. So the resisting truth appears as a symptom, a hysterical symptom of the irresistible knowledge. It emerges as a real symptom of a purely symbolic system. This symptomatic emergence is just another name for the subversive revelation. Ac­tually, in a Lacanian perspective, we may say that the Marxian revelation of truth is subversive because the revealed truth is a hysterical symptom that has no place in the obsessive normality of Modern knowledge.

The revelation of truth is subversive because it is symptomatic. But there is another reason why the revelation is subversive. It is subversive because the revealed symptomatic truth of enunciation is also the unbearable truth of exploitation, alienation and prole­tarianization of a real subject completely reduced to the suffer­ing workforce that generates the enunciated symbolic value. This truth is obviously frustrating. It is also comprehensibly revolting. This is also why its revelation may be subversive. The Marxian revelation of the truth is subversive, for example, because it can­not reveal the generation of capital without revealing the revolt­ing situation of exploitation, alienation and proletarianization of those whose workforce generates capital.”

Conclusion:

We have a long way to go, for those of us, all of us, in mental distress, to subvert the master-slave dialectic of the cognitive-neuroscientific imperialistic and alienating discourse of “mental illness”. “Mental illness” is holed up in all the nooks and crannies of the establishment; universities, psychiatry, psychology, pharmaceutical companies, and also in certain psychotherapeutic fashions (e.g., Mindfulness[18]) who want a piece of capital pie. Mental distress is far more than an alert to an illness to be cured by a pharmaceutical straight jacket (i.e., drugs), or a program of thought control (i.e., cognitive behavioural therapy).

As this article is partly inspired by Jean Paul Sartre and in honour of his ideas, it is fitting to leave the last word to him. This is a quote From Sartre[19] to the Socialists Patients Collective[20], a radical Socialist anti-psychiatric movement in Germany.
“Dear Comrades,
I read your book with the greatest interest. In it I found not only the sole possible radicalization of anti-psychiatry, but a coherent practice which aims at replacing the so-called “cures” of mental illness. To put things generally, what Marx called alienation-a general fact in capitalist society – you have given the name illness. It seems to me that you are right. In 1845, Engels wrote in Situation of the Working Class: “[industrialization has created a world in which] a race can only exist once it has been dehumanized, degraded, rendered physically morbid and lowered to a bestial level both intellectually and morally”. As atomizing forces applied themselves to systematically degrading a class of men into sub-men, from the exterior as well as the interior, one can understand how the ensemble of persons of whom Engels spoke has been affected by the “illness”; it can be grasped at one and the same time as an injury that wage-earners are made to suffer, and as a revolt of life against this injury which tends to reduce them to the condition of object. Since 1845 things have changed profoundly, but alienation remains and will remain as long as there is a capitalist system; since it is, as you say, the “condition and result” of economic production.”
Illness, you say, is the only form of life possible in capitalism. The psychiatrist is at once a wage-earner and a sick person like everyone else. The ruling class has simply given him the power to “cure” or intern. Obviously, the cure cannot, in our regime, be the suppression of the illness: it is the capacity to continue producing all the while remaining ill. Thus in our society there are the sane and the cured (two categories of ill persons who are unaware of themselves, and who observe the norms of production) and, on the other hand, the identified “ill persons”– those whose disturbed revolt places them outside the conditions of production and against the wage given the psychiatrist. This policeman begins by outlawing them, in so far as he refuses them their most elementary rights. He is a natural accessory to atomizing forces: he considers individual cases in isolation, as if psychoneurotic disturbances were the characteristic detects of certain subjectivities, their particular destinies. Thus bringing together ill persons who seem to look alike as singular beings, he studies diverse behaviours-which are only effects-and the connection between them, thereby constituting nosological entities that he treats as illnesses and then submits to a classification. The ill person is thus atomized in so far as he is thrown into a particular category (schizophrenic, paranoiac, etc.), in which are found other ill persons with whom he cannot relate socially, since they are all considered as identical exemplars of the same psychoneurosis.”

Bruce Scott 

[1] Retrieved from: https://commonspace.scot/articles/1312/mental-health-treatment-three-times-more-likely-among-people-from-deprived-communities-says-new-study
[2] It will hopefully become clear that I am critical of the term “mental health” as I feel that it is conceptually, from a philosophical, medical, psychological, and Socialist perspective, inappropriate.

[3] Retrieved from: http://www.theguardian.com/society/2015/apr/17/hundreds-of-mental-health-experts-issue-rallying-call-against-austerity

[4] Retrieved from: http://www.heraldscotland.com/news/health/leading-psychologists-warn-of-dangers-of-further-austerity-policies.124990661

[5] This article was written the week commencing 11th May 2015 which was mental health awareness week.

[6] Healy, D. (2003). Lines of evidence on the risks of suicide with selective serotonin reuptake inhibitors. Psychotherapy and Psychosomatics, 72, 71-79.

[7] Moncrieff, J. (2003). A comparison of antidepressant trials using active and inert placebos.

International Journal of Medicine, 12, 117-127.

[8] Boyle, M. (2002). Schizophrenia: A scientific delusion? 2nd Edition. Oxford, Routledge.

[9] Kutchins, H., & Kirk, S.T. (2003). Making Us Crazy: DSM – The Psychiatric Bible and the Creation of Mental Disorders. The Free Press, Washington D.C.

[10] Heidegger, M. (2001). Zollikon Seminars. Protocols-conversations-letters. M. Boss (Ed.). Translated by F. Mayer & R. Askay. USA: Northwestern University Press.

[11] Diagnostic and Statistical Manual of mental Disorders: Fifth Edition (2013). American Psychiatric Association.

[12] Marx, K. (1964). Economic and Philosophic Manuscripts of 1884, pp-106-19. International Publishers Co. New York.

[13] Deleuze, G., & Guattari, F. (2004). Anti-Oedipus: Capitalism and schizophrenia. London, Continuum.

[14] Deleuze, G., & Guattari, F. (2004). A thousand plateaus: Capitalism and schizophrenia.London, Continuum.

[15] Tolland, S. (2012). Prozac Nationalism. Scottish Left Review, 70, pp-19-19.

[16] Cognitive behavioural therapy.

[17] Cuellar, D. P. (2011). Marx in Lacan: Proletarian truth in opposition to Capitalist psychology. Annual Review of Critical Psychology, 9, pp70-77.

[18] Mindfulness has become the next big thing in the cure of “mental illness”. It is however, flawed in its ideological constructs, and is consumed by the neo-liberal capitalist project for its own advantage. See: http://www.theguardian.com/healthcare-network/2015/may/14/mindfulness-mental-health-treatment-nhs

Indeed, the philosopher Friedrich Nietzsche warned of this development in western society when he declared that the West would be engulfed in a watered down Buddhism. See Nietzsche, F. (1974). The Gay Science. Translated by Walter Kaufmann. Ontario Canada, Random House.

[19] Jean Paul Sartre quote: Reproduction from The Journal of the British Society for Phenomenology, Vol. 18 No. I, January 1987, pp. 3-5-From the Book; SPK: Turn Illness into a Weapon (The Preface).

[20] From http://en.wikipedia.org/wiki/Socialist_Patients’_Collective: “The Socialist Patients’ Collective (in German: Sozialistisches Patientenkollektiv, and known as the SPK) was a patients’ collective founded in Heidelberg, Germany, in February 1970, by Wolfgang Huber. The kernel of the SPK’s ideological program is summated in the slogan, “Turn illness into a weapon”, which is representative of an ethos that is continually and actively practiced under the new title, Patients’ Front/Socialist Patients’ Collective, PF/SPK(H). The original group, SPK, declared its self-dissolution in July 1971 as a strategic withdrawal.

The SPK assumes that illness exists as an undeniable fact and believe that it is caused by the capitalist system. The SPK promotes illness as the protest against capitalism and considers illness as the foundation on which to create the human species. The SPK is opposed to doctors, considering them to be the ruling class of capitalism and responsible for poisoning the human species. The most widely recognized text of the PF/SPK(H) is the communique, SPK – Turn illness into a weapon, which has prefaces by both the founder of the SPK, Wolfgang Huber, and Jean-Paul Sartre.”

Recovery In The Bin

This User Led group is for MH survivors and supporters who are fed up with the way colonised ‘recovery’ is being used to discipline and control those who are trying to find a place in the world, to live as they wish, trying to deal with the very real mental distress they encounter on a daily basis.

Recovery In The Bin 18 Key Principles, agreed and adopted by group members on 6th February 2015.

• We oppose the ways in which the concept of ‘recovery’ has been colonised by mental health services, commissioners and policy makers.

• We believe the growing development of this form of the ‘Recovery Model’ is a symptom of neoliberalism, and capitalism is the crisis! Many of us will never be able to ‘recover’ living under these intolerable social and economic conditions, due to the effects of social and economic circumstances such as poor housing, poverty, stigma, racism, sexism, unreasonable work expectations, and countless other barriers.

• We believe “UnRecovered” is a valid and legitimate self-definition, and we emphasise its political and social contrast to “Recovered”. This doesn’t mean we want to remain ‘unwell’ or ‘ill’, but that we reject the new neoliberal intrusion on the word ‘recovery’ that has been redefined, and taken over by market forces, humiliating treatment techniques and atomising outcome measurements.

• We are critical of tools such as “Recovery Stars” as a means of measuring ‘progress’ as they represent a narrow & judgemental view of wellness and self-definition . We do not believe outcome measures are a helpful way to steer policy, techniques or services towards helping people cope with mental distress.

• We believe that mental health services are using ‘recovery’ ideology to mask greater coercion. For example, the claim that Community Treatment Orders are imposed as a “step towards recovery”.

• We demand that no one is put under unnecessary pressure or unreasonable expectations to ‘recover’ by mental health services. For example, being discharged too soon or being pushed into inappropriate employment.

• We object to therapeutic techniques like ‘mindfulness’ and “positive thinking” being used to pacify patients and stifle collective dissent.

• We propose to spread awareness of how neoliberalism and market forces shape the way mental health ‘recovery’ is planned and delivered by services, including those within the voluntary sector.
• We want a robust ‘Social Model of Madness’, from the left of politics, placing mental health within the context of the wider class struggle. We know from experience and evidence that capitalism and social inequality can be bad for your mental health!

• We demand an immediate halt to the erosion of the welfare state, an end to benefits cuts, delays and sanctions, and the abolishment of ‘Work Capability Assessments’ & ‘Workfare’, which are both unfit for purpose. As a consequence of austerity, people are killing themselves, and policy-makers must be held to account.

• We want genuine non-medicalised alternatives, like Open Dialogue and Soteria type houses to be given far greater credence, and sufficient funding, in order to be planned & delivered effectively. (No half measures, redistribution of resources from traditional MH services if necessary).

• We demand the immediate fair redistribution of the country’s wealth, and that all capital for military/nuclear purposes is redirected to progressive User-Led Community/Social Care mental health services.

• We need a broader range of Survivor narratives to be recognised, honoured, respected and promoted that include an understanding of the difficulties and struggles that people face every day when unable to‘recover’, not just ‘successful recovery’ type stories.

• We oppose how ‘Peer Support Workers’ are now expected to have acceptable ‘recovery stories’ that entail gratuitous self-exploration, and versions of ‘successful recovery’ fulfilling expectations, yet no such job requirements are expected of other workers in the mental health sector.

• We refuse to feel compelled to tell our ‘stories’, in order to be validated, whether as Peer Support Workers, Activists, Campaigners and/orAcademics. We believe being made to feel like you have to tell your ‘story’ to justify your experience is a form of disempowerment, under the guise of empowerment.

• We are opposed to “Recovery Colleges” and their establishment, as a cheap alternative to more effective services. Their course contents fall short of being ‘evidence based’, and fail to lead to academic accreditation, recognised by employers.

• We believe that there are core principles of ‘recovery’ that are worth saving, and that the colonisation of ‘recovery’ undermines those principles, which have hitherto championed autonomy and self-determination. These principles cannot be found in a one size fits all technique, or calibrated by an outcome measure. We also believe that autonomy and self-determination, as we are social beings, can only be attained through collective struggle rather than through individualistic striving and aspiration.

• We demand that an independent enquiry is commissioned into the so-called ‘Recovery Model’ and associated ideology that it stems from.

We call for our fellow mental health Survivors and allies to adopt our principles, and join us in campaigning against this new ‘recovery’ ideology by non-violent protest. We know our views about ‘recovery’ will be controversial, and used by supporters of the ideologies behind ‘recovery’ colonisation to try to divide us. However, we seek to balance the protection of existing services valued by Survivors with agitation for fundamental change.

Join us at Recovery In The Bin Facebook Group.

1

Middle Class Solutions To Working Class Problems Is Why Charities Like MIND Keep Getting It So Wrong

Originally posted by  13th February 2015

didnt-go-to-work-todayIain Duncan Smith must be pissing himself.  A report released at the end of last year by mental health charity MIND could not have gone further in endorsing the core ideas that lie behind his bungled and brutal welfare reforms.

The report is titled “We’ve Got Work To Do” and claims to demand ‘fundamental reform’ of the workplace and social security system to better support people with a mental health condition.  Sadly it is calling for nothing of the sort and is underpinned by the exact same lies and toxic assumptions that have driven both Tory and Labour welfare reforms.

Just like the DWP, MIND have adopted the flawed medical consensus that work is good for your health. The charity does acknowledge that this isn’t actually always true, but falls short of saying that work can be bad for your health, instead arguing that “inappropriate or poor quality work can have as negative an effect on people’s mental health as not being in work”.  They base this opinion on research carried out in Australia that found that “the mental health of those who were unemployed was comparable or more often superior to those in jobs of the poorest psychosocial quality.”  In other words work can be worse for your mental health than being unemployed, rather than just equally bad as MIND claim.

It is not nit-picking to point out the discrepency between what this research found and what MIND say it found because it reveals the charity’s opinions to be based on ideology, not facts.  This same factual slippage occurs elsewhere in the report when MIND begin by saying that most people with mental health conditions want to work, which later becomes everyone with a mental health condition wants to work. The truth, as revealed in the footnotes to the report, are that only around 58% of people out of work due to a mental health condition strongly agreed they wanted to return to work whilst 20% did not feel they were well enough.

These two distortions – or let’s call them lies – have allowed the despised Work Capability Assessment, benefit sanctions and workfare all to be misrepresented as ‘support’ or ‘help’.  In truth these measures destroy lives.  The medical consensus that work is good for you does often not apply to those on the lower end of the income scale who face being forced by Jobcentres into the kind of work likely to make them ill.

MIND’s Chief Executive Paul Farmer claims at the beginning of the report that there have been “improvements in how people with mental health problems are supported”, although it is unclear what they are. There then follows an emotive story about someone’s journey through the benefit system after leaving work due to depression.  This is actually where their journey would stop, because unless they could provide reems of medical evidence to the Jobcentre they would be disallowed benefits for giving up work.  That this reports begins by misrepresenting the benefit system as it currently functions just shows how removed these giant disability charities have become from the lives of those they claim to support.

Instead the ‘fundamental reform’ they call for is actually more of the same or worse – such as the dangerous idea that sensitive health information from the Work Capability Assessment should be passed over to Work Programme providers like A4e and G4S.  This is like your boss having access to your medical history and appallingly MIND seem pretty relaxed about this as well.

Much of the early part of the report is taken up by calling for improvements in the working environment for people suffering mental ill-health.  Which is fine, everyone wants that, except greedy employers who worry it might cost them money or who harbour nasty little prejudices about mental health.  According to MIND themselves this is about 40% of them.  Yet one of MIND’s recommendations is that the Maximus run ‘Fit To Work’ service – the new telephone helpline which will be used to certify time off instead of GPs – should more effectively engage with employers.  About the only decent thing about Fit To Work, which is designed to bully people back into the workplace before they are better, is that currently you have the right to keep your boss out of any discussions.

The final part of the report discusses what future welfare-to-work schemes should look like for those with a mental health condition.  The charity are calling for “new specialist scheme for people with mental health problems on
ESA”.  A scheme which should be run by those who “have expertise and experience of working with people with mental health problems”.  And here lies the real reason for this report.  It’s a fucking advert to any incoming Labour Government to give MIND a lucrative contract to run a new welfare-to-work service.

There is no longer any doubt that endless Atos assessments, workfare and benefit sanctions are creating a crisis in the lives of those with a mental health condition.  The tragic death toll rises ever higher.  Yet nowhere in this report does MIND call for these brutal policies to be scrapped.  Even if MIND were handed a contract to be nicer to people on ESA this would still leave those who have been found fit for work abandoned and dumped onto mainstream unemployment benefits alongside those whose condition is at yet undiagnosed.  On twitter yesterday MIND claimed they couldn’t call for sanctions to be scrapped for people who are unemployed because it wasn’t a key issue.  If your mental health condition isn’t bad enough to be able to claim ESA then tough shit seems to be the charity’s response if you get sanctioned.

The thing is, naked profiteering aside, MIND are not bastards.  They have dedicated front line workers who don’t get paid anywhere near enough and are sincere committed people.  Workers who would probably agree that benefit sanctions and the Work Capability Assessment should be scrapped immediately.  They see the carnage that is being caused everyday.

The problem is that reports like these are overseen and commissioned by highly paid charity executives who live lifestyles that their service users and lowest paid staff can only dream of.  These lifestyles lead them to make assumptions based on their own distorted experience of the world.  Over time they become unable to avoid inflicting solutions to the problems faced by working class people based on their own middle class values because that is all they know.  Often these solutions are utterly bizarre, like the boss of homelessness charity Thamesreach Jeremy Swain’s obsessive belief that the biggest problem facing homeless people is that beer is too cheap.  You read that right.  Too cheap.

It is near impossible for someone on a huge salary who does a job they love to understand why someone may not feel up to working at present.  That, to someone like MIND Chief Executive Paul Farmer, really does seem like madness. Likewise charity bosses have no real understanding of why it might be dangerous to allow other bosses to snoop around your health records.  Bosses think bosses are lovely people who would never abuse their powers – or at least not without a damn good reason.  And bosses know best, they tell each other that all the time.

Charity bosses in particular have their own view of themselves as benevolent experts confirmed everyday by politicians and journalists who would far rather talk to them than someone on the dole.  Their whopping salaries provide further proof of their own ability.  As do arse-licking middle managers who continually tell them how wonderful and clever they are, to their faces at least.  So Paul Farmer must be is right because he’s Paul Farmer and MIND are right because they are MIND and anyone criticising them just doesn’t understand.  Because they are not experts.

That’s how MIND alongside other disability and anti-poverty charities can so easily dismiss the demands of grassroots campaigns comprising of disabled people and benefit claimants.  Groups which are more or less united in calling for benefit sanctions and the WCA to be scrapped completely.  These people are not experts.  At worst they might even be service users.  And you don’t want them getting too uppity.  Before you know where you are you’ll have working class people running organisations together to address working class problems.  Then there’d be nothing at all for poor Paul Farmer to do.    He might even have to get a real job.

Please sign/share/tweet the petition Benefit Sanctions Must Be Stopped Without Exceptions.

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There it is – poem by Jayne Cortez

THERE IT IS

And if we don’t fight

if we don’t resist

if we don’t organize and unify and

get the power to control our own lives

Then we will wear

the exaggerated look of captivity

the stylized look of submission

the bizarre look of suicide

the dehumanized look of fear

and the decomposed look of repression

forever and ever and ever

And there it is

 

(1982)

What’s wrong with psychiatry and how we might change things

British psychologist Gary Sidley and US reforming psychiatrist Peter Breggin discuss Gary’s journey of disillusionment with the NHS “mental health” establishment, and then freely indulge their thoughts and fantasies about what an ideal “mental health service” would look like. Find it here.

Gary Sidley’s new book is now available Tales from the Madhouse PCCS Books

Current psychiatric practices are based on pseudo-scientific assumptions that are barely more valid than those of witchcraft and demonic possession that dominated society’s approach to madness in bygone centuries. In Tales from the Madhouse, the evidence for psychiatry’s deficiencies are comprehensively reviewed, and disturbing anecdotes from the author’s 33 years of practice in mental health illustrate how these failings are currently playing out within psychiatric services throughout the UK and beyond.

Find his blog here.


Happiness and the capture of subjectivity

The Happiness Movement and the capture of subjectivity

I am a kind of paranoiac in reverse. I suspect people of plotting to make me happy.

~ J.D. Salinger              


In November last year (2014), I went to an Action for Happiness event in central London. It was organised to mark the publication of Thrive: the Power of Evidence-Based Psychological Therapies by Richard Layard (a founder of Action for Happiness) and David Clark[1]. Conway Hall was full. The authors spoke for twenty minutes each and took questions from the floor. The occasion was a celebration of the marriage of Layard’s campaign for government action to promote psychological well-being, Clark’s championship of CBT and the resulting roll-out of the IAPT programme. Having failed to get a question or comment into the Q & A session, I wrote to the event organiser with my thoughts on the happiness movement, CBT and IAPT in the context of neoliberal capitalist society. This is a version of the thoughts I put together on the idea of happiness as a campaign slogan for social change, in response to the event and the email exchange that followed.

I want to say first that despite my misgivings about the happiness movement[2] (a term I am using to cover a number of political and cultural initiatives campaigning for the promotion of happiness over economic growth on government policy agendas, here and worldwide), I recognise that it does have a life-giving intention and a commitment to social change.

Nevertheless, I feel very uncomfortable with ‘happiness’ as a goal and/or a campaign banner slogan, and especially with the way it is being linked with ‘mental health’. I will say a bit more about that in a moment. I am also unconvinced that either Action for Happiness or the authors of Thrive are really interested in the social and economic causes of psychological distress. The focus of Thrive is clearly on the subjective, despite its notional critique of some aspects of capitalist society and culture.

On the marriage of happiness and the evidence-base of CBT and IAPT – the issue closest to my heart and experience as a psychotherapist – I am afraid I am disgusted and dismayed. Here, I am focussing on idea of ‘happiness’. Its linkage with CBT and IAPT deserves a separate discussion, especially given the peculiarly disingenuous nature of Layard and Clark’s book in its celebration of the success of “evidence-based” therapy.

Is happiness a valid common good?

As an organising banner for social change, happiness is a simplistic concept. It is labile.

A huge range of things and experiences make me feel happy at one level or another. My iPad, my new VW Polo, losing half a stone, my relationship with my wife and children, a pint of cider, women I fancy on the street, many moments in my consulting room, the cormorant fishing the canal, a decent pair of nail clippers, a new gadget for my bike, my friendships, having a few thousands in a savings account, not being 18 again, etc, etc make me happy.

Happiness needs ground to have substance and value – a context in space, time and relationship. Being happily married is not in the same cosmos as being happy with my chocolate bar. Being happy looking at pornography is something very different from being happy that death has come to me at last! Happy to have survived that awful accident is not related to happy I caught that bus. The Skidelskys talk about all this in “How much is Enough?[3]. So do many of the academic critiques of the happiness and well-being movement.

Capitalism of course sells us happiness all the time, and is adept at recognising changing social mores and fashion as opportunities to make profit selling back to us our quest for happiness.

Coca-Cola is probably the best-selling source of happiness throughout the world – perhaps because it is the ‘real thing’. Bisto gravy sells the happy family to the UK. Apparently, Christmas advertising on TV in 2013 generated ten times more happiness then anger.[4]

Happiness is modern capitalism’s most important sales pitch. It makes money by attaching its products and services to our desire to be HAPPY. It markets a version of society in which happiness is the primary – in fact, the only – goal in life that matters. In its neoliberal incarnation, it excels at selling us the promise of happiness, as it immiserates a significant proportion of the population.

So when Action for Happiness and Lord Layard assert self-reported happiness to be a primary social good to be prioritised by political policy-makers, I want to ask what is it that distinguishes their happiness from the happiness that sells us goods and services, and can make us feel good about our lived experience? Why is their version of happiness not simply a sales pitch for CBT, physical exercise, buying Thrive, positive thinking, meditation, group facilitation, mindfulness, life coaching, spiritual training, advice on nutrition, etc, etc?

Is happiness actually a valid common good, taken out of the complex contextual debate of what gives meaning to our lives?

Happiness and mental health

What kind of context does the connection with mental health give to happiness? If mental health is thought of as states of mind that can be negative or positive, and happiness is defined as having a positive state of mind, then the link Richard Layard and others have been making between unhappiness and untreated mental illness has a very obvious popular appeal. If we focus on helping people develop more positive states of mind, more people will feel happier and suffer less mental illness. Focus on helping people feel happier, and they will have more positive states of mind and less mental illness.

No-one, of course, thinks that mental health is just a state of mind. We all know that what gets called mental health is in fact a complexity of lived experience involving subjective and objective conditions, personal history and circumstances, as well as social, economic and political history, and circumstances, personal opportunities and socio-economic opportunities. Mental health is, by definition, in terms of lived experience, a misnomer in all sorts of ways – for example, it involves a mind/body split which more and more people see as unhelpful; it associates psychological life with the mind and thinking – a sort of Cartesian fantasy of who we are as human beings; in other words, it tends to separate subjective states from lived experience and circumstances; it also tends to treat the psychological and the subjective as symptoms of the individual rather than the collective.

Meanwhile, the ‘health’ in mental health tends to think of the psychological realm in the same categories as physical health and medicine. We think of medicine as a science. We assume an objective norm of the healthy body, in relation to which sickness is a deviation to be cured. Medicine has an evidence-base close to the natural sciences – anatomy, bio-chemistry, x-rays and scans, lab-work, microscopes etc, etc. Illnesses are diagnosed and treated on the basis of scientifically evidenced efficacy.

We know that, to an important but under-acknowledged degree, evidence-based medical science has its limitations. Any doctor will tell you that much of medicine is trial and error, diagnosis is often a process of elimination, cure achieved by the placebo of a pill or an empathic ear. But most of us will accept that to a very significant degree the evidence-base of medical science works for us as far as the body is concerned.

This just is not the case for working with psyche – emotions and emotion-laden thinking, negative fantasies, repetitive cycles of anxiety and fear, emotional conflict in relationships, lack of self-esteem, martyrdom, harsh self-judgement, depression, self-loathing etc. Much of what might be diagnosed as mental illness is not something comparable with symptoms of physical illness. The “norm” for every human being, if there is one, is to have experience and symptoms of all psychological disorders in some shape and degree. We all get anxious, depressed, obsessive, paranoid, addicted, aggressive, cut off, manic, psychotic to some degree or other, at some time or another.

The diagnosis of mental illness is a hugely contentious business among psychologists, psychotherapists and counsellors, and psychiatrists. Many of us are very concerned at the growing industry of diagnosing psychological suffering and distress as mental illness – across the spectrum of severity of symptoms. Critical psychiatrists all over the world have protested at the mushrooming and distortions of diagnostic categories in the DSM5.[5]

Psychiatrists and psychotherapists with a social perspective on psychological distress are increasingly wary of the diagnosis of depression and anxiety as mental illness rather than either the sickness of society or a reasonable response to social and economic deprivation and exploitation.[6]

For many counsellors and psychotherapists, depression and anxiety are part of the human condition, as much to do with the existential struggles of identity and emotional/ethical conflict as any diagnostic category of mental ill-health.

But whatever we think about the term mental illness, what exactly is the connection between that and happiness?

Is happiness a natural binary of depression or anxiety? “I used to be depressed/anxious, now I’m happy”? What about “I used to be depressed, but now my life feels more meaningful”. Or “less empty”. Or perhaps “looking back, I can see that getting depressed has made me more appreciative of the other people in my life”. Or “I see now that this stuff I call depression is a mixture of a number of things – rage, loss, fear. I feel more alive recognising these feelings, though I wouldn’t call it ‘feeling happy’”. If I feel less anxious or depressed, frightened or violent, cut off or manic does that mean I must feel happier? Maybe, but unless I give you some context, it would be very simplistic of you or anyone else to assume so. Happiness is not the primary goal of life. And suffering is certainly one of its everyday ingredients.

None of this is to deny that there is an awful lot of psychic pain in the world that people need help with. Nor that much of this suffering is unrecognised and stigmatised, and that help is often in short supply.

Psychological and material well-being

But if, for the moment, we allow that having more happiness than unhappiness in your life is a rather good thing – for you, those around you and society in general; if, therefore, we would like to influence society to attend more to what it is that helps us feel happier with life; if we also allow, for the moment, that psychological suffering is a major indicator of unhappiness, that it is more widespread than is normally acknowledged, and therefore society and government need to attend to it; then we need to know something about what psychological suffering is and what causes it, in order to develop policies for change.

One of the most common themes of mental ill-health is the familiar dichotomy of nature and nurture. Does mental illness originate from within, or from without? Is it more to do with genes, or more to do with environment? Is it located more in the individual/subjective/personality/inner world, or more in the collective/objective/inter-personal/external world?

The link between psychological well-being and socio-economic well-being is complex. The autonomy of the individual and the collective realms needs to be respected while at the same time recognising their interdependence. In terms of national policy, it matters how we understand this relationship, where we put the emphasis, and therefore how we pitch campaigns to improve psychological well-being.

On the Action for Happiness website[7] and in Thrive, the interwovenness of the psychological, social and material are acknowledged, but the emphasis is distinctly on the genetic and the subjective. This for me distorts and undermines the integrity and value of the use of words like happiness, well-being, mental health and therapy. If the focus of people’s sense of well-being is pulled too far away from social, economic and political reality, it begins to lose touch with real lives and moves towards the realm of ideology, marketing, and public relations.

On the website, the emphasis is on the individual, his/her genes, personality and subjectivity as something quite independent of material circumstances, social class, ethnic background and so on.

With a quick scan of the site, I can only find one example (I am sure there may be others) of a more nuanced conception of how material and psychological well-being are intertwined, [8] and this is not an Action for Happiness document it seems.

On the AfH site’s front page there is a pie-chart “Our Happiness is not Set in Stone”:

ImageGen.ashx

Although our genes influence about 50% of the variation in our personal happiness, our circumstances (like income and environment) affect only about 10%.

As much as 40% is accounted for by our daily activities and the conscious choices we make. So the good news is that our actions really can make a difference.

Though “the pie” says “Genes and Upbringing”, the text reduces this to genes. Confusing! Upbringing, of course, is family background, childhood, family dynamics and its social and economic circumstances. I put these factors in “environment”, not “genes”. Moreover, despite the fashion for genetic and neuroscientific theories of emotional and psychological states of mind, the jury is still way out for many of us on simple equations of genes and psychological states. The assertion of a significant connection between depression and inheritance is still precisely that – an assertion. So for example, the Human Genome Study has produced no evidence so far for a “depression gene/s”.[9]

In Thrive, Layard and Clark do offer a somewhat more nuanced discussion of the genetic/environment relationship in their chapter 7 – What causes mental illness? But genes still come first, and in the “genetic” section they make the unfounded claim for scientific evidence of a gene/depression connection. Thriving (being happy) is primarily associated with subjective states of mind, located within the individual, rather than a more realistic and holistic picture of a relationship between internal and external worlds. The obstacles to individual thriving are primarily negative states of mind that the individual can remove or moderate through positive thinking and positive actions. The social and economic causes of psychological ill-health are consistently underplayed, to my mind.[10]

This downplaying of the social, political and material contexts of subjective states involves sidestepping overwhelming evidence over decades that economic and social deprivation is a major cause of psychological ill-health. See, for example:

  • The WHO 2014 report on the social determinants of mental health worldwide.[11]
  • The Institute of Health Equity and Michael Marmot on the impact of the Coalition’s austerity policies in London, published in 2012.[12]
  • The American Psychological Association’s Resolution on Poverty and Socioeconomic Status 2000.[13]
  • The Royal College of Psychiatrists 2004 paper Poverty, social inequality and mental health.[14]
  • The Mental Health Foundation’s working paper of 2013.[15]

In their chapter on the causes of mental illness, the authors of Thrive devote the first nine pages to talking about genes.[16] There is one page on childhood, and just over one page on job loss, stressful work environments, physical illness and disability. The two pages on social class and income argue that these are not causal factors in the aetiology of psychological ill-health. The section on what makes mental ill-health persist goes back to genes and innate personality.

The final section, on the nature of society, identifies four factors affecting well-being across a society – the level of corruption, freedom, trust and social support. Financial inequality and poverty are dismissed. Ideologically-led policies of social and economic exploitation, the debasement of democratic processes, and the exploitation of the majority by a political and financial elite are not discussed, nor are the structures of power in society generally.

The neoliberal turn of capitalism

For me, it is this marginalising of the socio-economic in favour of the genetic and individual subjective that puts Action for Happiness in danger of becoming a palliative to neoliberalism rather than a real challenge to it. Without more context in the realities of people’s lived experience, happiness feels like a sort of social soporific. Happiness becomes a rather insipid goal in life, rather like a drug – soma in Huxley’s Brave New World.

Since Margaret Thatcher’s premiership, and revitalised with a vengeance by this Coalition government, neoliberal political policy has propagated a devastating increase in most of the socio-economic, cultural, ethical and political conditions that nurture psychological distress and suffering. Current political policy-making manufactures depression and anxiety, if you like.

It seems perverse to me for happiness campaigns like Action for Happiness to want to influence government policy towards reducing levels of anxiety and depression without coming out very strongly against current government policies that are having a devastating effect on the nation’s ‘mental health’.

So, while Thrive devotes space to the social side of mental ill-health, it is careful to say little about social class, adult and child poverty, waged poverty, the cuts in social security – including disability allowances for the mentally ill, policies like the bedroom tax, the consistent fall in real wages, the growth of zero-hour contracts, the growing shortage of affordable homes, the crazy rise in private rents in London, policies forcing families out of central London, food banks, the cuts in mental health budgets (20% higher than cuts for physical health budgets over the next five years, despite “Parity of Esteem”), the stigmatisation of asylum seekers and more.

And here is a final thought on this particular issue.

According to Jack Carney’s piece in Mad in America (2012)[17], before the 1980s, academic studies of the relationship between social deprivation and mental illness concluded that the former was the primary cause of the latter. With the rise of neoliberalism, studies have generally concluded the opposite – that mental illness causes social deprivation. The implications for neoliberal governmental policy are obvious. Define the problem as one of mental illness, treat it as an individual affliction, and carry on creating a society that celebrates inequality, social injustice and environmental devastation, in the interests of the global market.

[1] 2014 Penguin

[2] Not to be confused, of course, with Coca-Cola’s “Happiness is Movement” campaign in 2014 – http://www.coca-colacompany.com/videos/happiness-is-movement-ytbn3bc63pz38

[3] Robert and Edward Skidelsky (2013) How much is enough? Money and the good life Penguin, chap.4

[4] For more, see https://freepsychotherapynetwork.files.wordpress.com/2014/11/blank-9.pdf

[5] See an NHS review of the issue here http://www.nhs.uk/news/2013/08august/pages/controversy-mental-health-diagnosis-and-treatment-dsm5.aspx

[6] For example, http://dxsummit.org/archives/2032

[7] http://www.actionforhappiness.org

[8] http://b.3cdn.net/nefoundation/bb8366694aa033e578_vvm6bfv3t.pdf

[9] See for example, http://www.ncbi.nlm.nih.gov/pubmed/23290196

[10] David Harper argues a similar case regarding Action for Happiness in the Guardian here http://www.theguardian.com/society/2012/feb/21/sad-truth-action-for-happiness-movement

[11] http://www.instituteofhealthequity.org/projects/social-determinants-of-mental-health/social-determinants-of-mental-health-full-report.pdf

[12] http://www.instituteofhealthequity.org/projects/demographics-finance-and-policy-london-2011-15-effects-on-housing-employment-and-income-and-strategies-to-reduce-health-inequalities/the-impact-of-the-economic-downturn-and-policy-changes-on-health-inequalities-in-london-full-report

[13] http://www.apa.org/about/policy/poverty-resolution.aspx

[14] http://apt.rcpsych.org/content/10/3/216.full

[15] http://www.mentalhealth.org.uk/content/assets/PDF/publications/starting-today-background-paper-3.pdf.

[16] Pagination from the Kindle edition.

[17]  http://www.madinamerica.com/2012/03/poverty-mental-illness-you-cant-have-one-without-the-other

Other resources:

William Davies The corruption of happiness 18 May 2015  in OpenDemocracy

A fascinating article. The comments on happiness as a choice put me in mind of the fantastic (and often misrepresented) film ‘No’ by Pablo Larrain (2012). The film documents the overthrow of General Pinochet in Chile by a campaign using the tagline ‘happiness is coming’ (which the film frequently equates with Cola adverts). It offers a fascinating and deeply cynical perspective on the seamless persistence of neoliberal ideology despite the overt change in the head of state.

Mental Health Charter – the Social Work Action Network

A Charter for Mental Health

Mental health services have reached a crisis point. The problems are so acute that even the government itself has been forced to acknowledge them. In response the Social Work Action Network (SWAN) has developed A Charter for Mental Health. The idea for the Charter emerged from debates at recent SWAN conferences. However it has been developed in discussion with a range of individuals and groups both within and beyond SWAN including service users and practitioners in mental health services. The Charter describes reasons for the current crisis and suggests what needs to be done to resist and build alternatives. It seeks to be a starting point for discussion and action rather than a definitive statement. SWAN invites those who support the broad perspective described here whether as an individual or on behalf of service user and community groups, campaigns, trade unions and services to endorse the Charter but also to develop further resources from it. More importantly we hope the Charter will be a useful campaigning tool for activists to help build alliances of resistance and to contribute to the development of more and better support for those with mental health needs.

1. The problems

The crisis facing service users

The support on which many service users rely is being brutally cut as a result of the government’s austerity policies. This includes closure or reductions in the availability of community services alongside increased charges, time limited support and reduced funding for user-led organisations. Meanwhile the government’s welfare ‘reform’ programme is creating poverty through draconian measures such as the Work Capability Assessment, implemented by private healthcare firm ATOS, and the Bedroom Tax. These policies are having catastrophic effects. Service users’ networks of support are being damaged, and levels of stress are escalating. The result is increased anxiety and fear and a rising incidence of suicide and self-harm.

The onslaught faced by mental health workers

Practitioners are facing ever-increasing caseloads and enormous demands to meet targets, with little organizational support to prevent isolation and burnout. These workload pressures limit the space to listen and work in person-centred ways with individuals, families and communities. Swingeing cuts to community services and in-patient facilities mean that workers are reduced to crisis intervention. This results in delays for those in need of support often with tragic consequences. It also marginalises preventative work and reduces the support available to little more than medication.

The role of the market

The introduction of payment by results is creating a ‘throughput’ approach that means short-term therapy and medical model drug interventions are prioritized over longer-term talking treatments and other forms of family and social support valued by users and carers. The growing presence of private sector providers such as Virgin Care also diverts scarce NHS resources away from frontline support and into corporate profits.

The pre-occupation with negative risk

Services are increasingly focused on risk management, monitoring of medication ‘compliance’ and controlling forms of intervention. This is particularly acute for service users from black and minority ethnic communities who have inferior access to support services and are more likely to be subject to community treatment orders or forensic interventions.

Austerity, welfare reform and inequality

While the government says mental health and wellbeing should be given the same priority as physical health care their programme is creating unprecedented levels of mental distress. Austerity and welfare reform are contributing to the rising tide of inequality, itself a cause of increasing mental health need in society. As a consequence Coalition policy is both increasing levels of mental distress and simultaneously, through cuts and the market, restricting the support available to those most in need.

2. What is to be done?

• More user-led support and social approaches

Recent years have seen growing demands by service users for greater choice and control through person-centred and user-led forms of support. This is a result of campaigning and activism. Progress on this will require a greater shift towards social approaches and the creation of enabling environments. These recognize and challenge the barriers faced by those experiencing mental distress in a number of areas such as employment, housing and education. Social approaches mean the removal of obstacles to the inclusion of family, friends and community in responses to mental distress. It means support for social participation and contributing lived experience to practitioner education programmes, along with full commitment to user-led organisations, services and forms of mutual support.

• Challenging discrimination

Challenging all forms of discrimination including sexism, racism, homophobia and ageism as well as the demonization of welfare claimants is also crucial. This includes the stigma faced by mental health service users in society. However, while work continues to make anti-oppressive approaches, social perspectives and user and carer involvement a reality, cuts to collective services and individual support jeopardise this positive change.

• Overcoming conflict and obstacles to participation

Mental health workers would like to work in more relationship-based and person-centred ways. Meanwhile service users and carers are demanding more social and community- oriented support. Herein lies the potential for shared interests. But in the mental health field these may seem difficult to achieve. Historically the medical profession wielded the power to define and treat ‘mental illness’ in biomedical ways. This led to the growth of service user movements who challenged this focus and to conflict between psychiatrists and other mental health workers who rejected medical dominance.

• Resources of hope: joint campaigns and struggles

Yet realization that cuts, privatisation and a target-driven culture in mental health services are negatively impacting on service users, carers and different groups of workers in similar ways is breaking down older divisions. This opens up the possibility of joint struggles. Recent campaigns against cuts have increasingly been built on alliances between service users, practitioners and their trade unions. Whilst such campaigns may start with a focus on opposing cuts, the struggle frequently raises questions about how services should be organised and run. The recent victory of a user-led campaign against mental health cuts in Salford that was supported by trade unionists ensured not only that the service was saved with decent staffing levels but also that it was more democratically and collaboratively run in partnership with service users.

• More and better support

We need more alliances such as this to stop cuts and privatization and ensure people are not denied access to properly resourced community and inpatient services. However it is not enough to save services as they are, we want them to be better. This means services shaped by users with democracy and participation at the centre. Interventions based on social approaches and that challenge discrimination. Support driven by social justice rather than the profit motive. Joint campaigns by service users, carers, practitioners, trade unionists and activists have the potential not only to defend but also to transform services. SWAN invites you to join us in this struggle. The following demands are a starting point for realising these goals.

3. What we demand

  • Stop the closures or reductions in community-based support and day services
  • For relationship-based mental health support: achieved through increased staffing ratios, limits on the size of caseloads, less form-filling, bureaucracy and targets and more administrative support
  • Increase the availability to service users of individual and group therapies, community and user-led support and reduce the emphasis on medication
  • No to early withdrawal of support services from users due to ‘throughput’ care pathway models linked to payment by results
  • Ensure services are staffed with properly trained practitioners and peer-support workers employed on permanent not temporary contracts
  • Guarantee service user involvement in the training and continuing professional development of all mental health workers
  • Develop services in line with the principles of social approaches – remove obstacles to family and community involvement; facilitate safe spaces for service users to regain confidence and skills as a basis for moving into the mainstream; support users’ social participation though volunteering and civic involvement
  • Extend the availability of person-centred support to service users, no cuts to individual budgets and no increased charges for community services
  • Repeal the bedroom tax and stop the evictions
  • An end to welfare cuts and ’reform’; withdraw the Work Capability Assessment
  • Remove multinational corporations such as ATOS from the welfare sector
  • No to privatization and outsourcing of NHS, community and welfare services – for public services not private profit
  • Stop the cuts of inpatient services; improve inpatient provision through a better environment, improve staff ratios; guarantee of a local placement for anyone admitted to hospital
  • More funding for the development of alternatives to inpatient services such as user- led crisis houses
  • An end to the use of community treatment orders (CTOs)
  • An end to institutionalized discrimination in mental health services: reducing disproportionate rates of admission and compulsory detention of people from black and minority ethnic (BME) communities; increase access to culturally appropriate services; improve gender sensitivity of services and safety of women on acute inpatient wards For more information and to endorse the Charter contact:
@SWANsocialwork (#MHCharter);
mentalhealthcharter@gmail.com
SWAN: tiny.cc/gwhcdx; W: socialworkfuture.org

Group Analysis Therapy – a therapy for our time?

Much of what we know about groups and the power of group therapy we can ascribe to the pioneering work of W.R Bion and S.H Foulkes, during and after the second world war. With this in mind, is it time again, as we did then, to consider group therapy being a therapy of our time? Today, it is not the threat of totalitarian regime from overseas that drives the distress that people feel but a pervasive culture of distilled fear of the “other” proliferate by today’s political classes which permeates the self and instills such anxiety.

Whether it be: ‘The need for austerity’, ‘The war on terror’, the fear of ‘Mass Migration’ or attacks upon the so called ‘scrounging indigenous benefit claimants’. The results are the same – that anxiety is increased, our sense of wellbeing is eroded, relationships suffer and social cohesion is attacked. The threat may not now be now from the Nazi’s, but an enemy that threatens us regardless.

Whilst this fear of the other is perpetuated, it is an uncomfortable truth that narcissistically driven gain, with its associated personality traits, is often afforded the status of being the highest of personal achievements. Conversely, collective, relational or just groups that promote sharing or creative thinking within non-hierarchical, non-financial orientations are given something far less than the status they deserve.

With this in mind, is it time to think about the group and it’s power to both inspire and hold the most intense feelings once again? But also is it time to challenge the individual to think about their personal entitlements, fears and anxieties over and around the other? Perhaps now, such as then, reconnection to group processes is required.

It was S.H Foulkes who gave the greatest trust to the power of the group to hold the most distressed, and in turn gave us the best understanding of the origins of that distress and the processes that underlie it.

For Foulkes and his acolytes, in the early days of ‘Group Analysis’, often it would be group processes rather than individual that would be relied upon most heavily to manage the most distressed. In those days in the Northfield hospital, it was the trauma of war (what we now know as post traumatic shock disorder) that was being treated and it was the group itself that was the main therapeutic medium for that treatment.

To understand how this medium was and is so therapeutically useful, we have to go further into Foulkes’ theories of the individual and the construction of the self. Whilst Foulkes was a classically trained analyst in the Freudian tradition, he had within his theoretical model of ‘Group Analysis’ a radical concept and departure from the orthodoxy of psychoanalysis. This he called ‘The Matrix’- a symbolic and hypothetical web of unconscious communication and meaning that we are all a part of, that permeates and shapes the person from their earliest moments.

The importance of this concept was that he saw individuals not as individuals per se, but as connected to a much wider net of socio-political and psychological process, whereby the individual was influenced and created by the environment and relationships around them. With this, the individual was seen not to communicate solely for themselves but as a ‘nodal point’ of communication for the wider system that included the personal.

In fact, Foulkes struggled so much with the notion of the individual that he thought that distress and neurosis emanated from its very formation. Or as Foulkes himself put it:

The deepest reason why patients………. can reinforce each other’s normal reactions and wear down and correct each other’s neurotic reactions is that collectively they constitute the very norm from which they deviate.  (S.H Foulkes 1948).

Reading Foulkes, we can begin to understand the need for the group and people’s places within it. As the socio-political influences of the day reinforce the need for greater perverse individualism and narcissistic gain, both the individual and the society at large experience greater levels of neurosis, creating a self fulfilling negative feedback loop that feeds and consumes itself equally. For Foulkes, it was only connecting and remaking contact with those larger social processes that alleviated the personal and social neurosis.

In the therapeutic world, perhaps the harshest of criticisms is, rather cruelly, that of ‘denial’. And it is this Foulkes was charged with. Foulkes’ highly positive schema of the individual within groups, reconnected to the matrix that in their individual state they had deviated from and become distressed, was considered far too utopian for some of this contemporaries and followers. It is true to say that Foulkes had no schema for the anti-group or destructive phenomena that occurs in groups. It was perhaps W.R. Bion who could describe more fully the destructive elements within group life and with it present something of a dichotomy in group thinking.

Bion, in his theory of groups, was able to differentiate when groups were working and when they were not. When processes were creative and when they were stuck. Bion described this as the theory of “Basic Assumption Groups”. Using his theory to think about groups, we are able to differentiate when a group is working – engaged in its primary task of overcoming and understanding neurosis – and when it is not – that is, has become a “basic assumption group”. Bion, essentially an analyst trained in the Kleinian school, was able to identify when anxieties were high and the group had fallen into an unconscious defensive position. In such a position, the group relies heavily from within its number on dependency figures, in the unconscious hope that the individual or pair will rescue it from its neurosis. Differently to Foulkes, it was the personal unconscious stimulated by the presence of the group, and the imponderables therein, that inspired the group to amalgamate into a split position and defend against its primary work task.

While personally I find the theory of groups fascinating and could spend far more time exploring than this piece allows, I want to return to the central point that groups are both able to inspire and hold the a strongest of feelings. I asked the question, ”is group therapy a therapy for our time?” And whilst there is obviously no definitive answer to this question, what is important is that therapy in our time should have a way of reflecting on the type of processes that inspire the kind of anxieties that people suffer with and illustrate that their origins are not always from within. Our therapeutic understandings need to be able to place a person in the socio-political context that permeates the individual, and both give an understanding of what inspires anxieties and make conscious how those anxieties come to reside there in the first place.

In addition to this, therapy needs locate us within our own personal potential to split and inspire in us a greater understanding of what influences our splitting. There resides within us an understandable desire for a charismatic leader(s) to rescue us from our most primitive fears, a desire which drives us to project not just the worst of ourselves, but also the best of ourselves into the other – depleting our own internal resources. It is group analysis and group therapy that can most usefully offer this in my understanding.

Lastly, there is a brief point referred to earlier regarding narcissism. I made the point that in our time often what can be described as serious narcissism and self entitlement is celebrated and defended within our society – the banking crisis and the defence of those that maintain it, whilst scapegoating the poor, being the most obvious of the current examples of this. However, in groups it is my experience that narcissistic processes either within a group’s membership or within the therapist themselves remain unchallenged. Actually, group analysis has a unique unfathomable way of both inspiring a person’s narcissistic traits to be present and challenging them when they do. However, that is another paper altogether. But needless to say, the benefits of challenging the cult of narcissism would have far reaching positive outcomes.

I started with a point that what we know about groups was inspired by the need to treat the sufferers of the worst conflicts the world has known. Today, conflict – whist not as explicit as the wars of the 20th century – is waged in ideology and economics as much as conflict with weapons. As such, I believe the group is required to illustrate the processes that underpin the split positions that allows for such sadism, and at the same time acknowledges that, like then, there are many distressed people traumatised by those same processes. Groups are ideal to support and hold the most serious of traumas.

Michael Caton

Replacing mental health diagnosis with understanding real people and the difficulties of everyday life

Eric Maisel writes:

And who isn’t in the middle of calamity? Forget about world wars. What is it like for the quarter million women diagnosed with breast cancer each year and the one in eight women threatened by it? What is it like for a gay youth in a fundamentalist town? What is it like for a workingman or workingwoman living in a tract home in Amarillo, Queens, or Dayton? What is it like for a writer with no publisher, a painter with no gallery, a musician with no gigs? What is it like for an obese man or an obese woman with no sex life? What is it like for the millions who hate their jobs, the millions with no job, the millions who cringe when their mate enters the room, or the millions who have aged into invisibility?

Against this backdrop of mental stress, distress, and misery, we are supposed to stand “mentally healthy,” as if life were a lark and as if sweet smiles were not only our birthright, but also an obligation. Why should we be smiling? Why should we be “mentally healthy,” whatever that phrase is supposed to mean? For the whole history of our species, until very recently, your drinking water could kill you. In our age of good drinking water—which is only a reality for some percentage of our species—we have only had world wars and nuclear weapons to contend with. And what is life like for someone living under a dictator, where you can vanish for speaking? And how pleasant is your boring, taxing job? How pleasant, for that matter, is your own seething mind, packed with worries, regrets, resentments, and to-do lists?

But you are supposed to keep smiling. You are supposed to stay positive. No matter that every human right is a fight that must continually be fought for. No matter that in this modern age of plenty, which advertising tells us comes with beautiful homes, beautiful cars, and beautiful bodies, insomnia is an epidemic, obesity is epidemic, sadness is an epidemic, and meaninglessness is an epidemic. You must not notice the machinations of the powerful: none of that should affect your mental health. You must not notice your aging, your illnesses, or your mortality: none of that should affect your mental health. You may not even look in the mirror and announce that you might strive to be a better person: none of that!

Read the full article here