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Authenticity at the Northern Existential Group

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Edited by Meg-John Barker, Monday, 5 Dec 2011, 11:02

24th November 2011 saw the third meeting of the Northern Existential Group (NEG). This month our reading was a paper called 'A Road Less Travelled' by M. Guy Thompson. Based on the author's own relationship with R.D. Laing, the paper wove together biography of the famous 'anti-psychiatrist' with an account of his understanding of the concept of 'authenticity'. What did authenticity mean to Laing, and how well did he embody it within his own life?

This paper was a perfect one for the NEG as our discussions tend to focus on the personal and pragmatic issues of the concepts under consideration. Are these existential ideas something that we want to strive for in our own lives and, if so, how might we go about that?

Here we will briefly introduce R. D. Laing for those who are unfamiliar with him. We will outline the concept of authenticity as it is presented in M. Guy Thompson's paper, and then give a flavour of the NEG discussion on the topic.


R. D. Laing

R. D. Laing (1927-1989) grew up in Glasgow. He studied medicine there and became a psychiatrist in the British army. Later he trained and worked at the Tavistock clinic alongside the likes of Bowlby and Winnicott. Laing formed the Philadelphia Association in 1965 and set up a psychiatric community project at Kingsley Hall and later other locations. At PA houses patients with diagnoses of psychosis lived together in communities with therapists and other patients, and there was minimal use of the restraints or drug treatments which were commonplace in mental health systems.

Although Laing did not embrace the term 'anti-psychiatrist', his views about mental illness were – and continue to be – radically challenging to conventional views. Influenced by existential philosophy he questioned the idea of mental illnesses which could be diagnosed according to symptoms (although his opinion on whether there were real mental illnesses or not altered over time). Instead he saw the feelings and behaviours of people with 'mental illness' as expressions of their lived experience and valid attempts to communicate their distress.

Instead of locating mental illness in biology, he saw it as a response to, often contradictory, messages within the family and wider society. Indeed, at times he suggested that 'madness' may be a saner response than 'sanity' to the impossible double binds in which people are placed when their experiences are not allowed to be articulated. These ideas are covered in Laing's famous book The Divided Self.


Authenticity

Laing's ideas about authenticity are explicitly related to his theories of mental illness because he suggests that people erect false versions of themselves in order to conform to society, and that this is why they frequently become confused about who they are. For this reason, part of the ethos of Kingsley Hall, and the other Philadelphia Association houses, was to communicate without falsity. People were encourage to speak in all conversations as honestly and openly as they would in a therapy session, with no small talk. Laing's own style was frequently confrontational in attempt to break through falsity in communication.

Thompson distinguishes Laing's version of authenticity from the kind of 'pop' authenticity of US talk-shows and self-help books. This latter form of authenticity is rooted in the humanistic view that there is some core inner self that we can get in touch with, often through our feelings rather than our thoughts, and that this authentic self will be a nicer, more loving, person. Such an idea is based on both a dualistic splitting of emotions and thoughts, an optimistic vision of what human beings are 'naturally' like, and a theory of selfhood that is problematic from an existential perspective.

Laing's authenticity was based more on Nietzsche and Heideggers' versions of authenticity which did not link authenticity and ethics and which dispute the idea of any core self beneath what we construct. This existential form of authenticity involves a courageous facing of the inevitable anxieties of life. This includes going against societal norms when they conflict with this. Heidegger's position was that humans were inauthentic the majority of the time (seeking approval, validation, recognition and so on). We get our sense of identity and – along with it – inauthenticity from the crowd we (seek to) belong to, but it is possible sometimes to transcend this. This is not about getting at any genuine self (because the self is always constructed) but rather being aware of our general inauthenticity and acting in a way that does not attempt to fit in or to court favour.

Laing's authenticity, however, was intrinsically related to ethics because he saw human suffering as resulting from inauthenticity (particularly the double-binds it places people in). Therefore authenticity was a superior way of relating which involved loving another person without 'trespassing' on them or doing them violence by using them for our own narcissistic ends. This requires both the courage to open up to another person, and the awareness to see when you are in danger of trespassing (for example, by demanding that they conform in some way rather than being authentic themselves). This is the awareness that Laing saw as frequently absent in the mental health profession: those who think they are being helpful deny the thoughtless way in which they treat the vulnerable people they are caring for, and the demands they place on them to act in inauthentic ways.

From Thompson's summary it seems that Laing's authenticity includes the following elements:

  • Honestly owning up to our inauthenticity

  • Acting without regard for what others will think of us (rather than being a 'phoney' and adhering to social niceties)

  • Having the courage to stick to our principles rather than being hypocritical

  • Being brave enough to open up, authentically, to others

  • Being aware enough not to trespass on others, doing violence to them by denying their authenticity

 

Discussion

The rest of Thompson's paper – and much of our discussion – focused on whether Laing, himself, embodied the form of authenticity that he espoused. This is part of a wider question of whether such thinkers need to 'walk the walk as well as talk the talk' in order to be convincing, or for us to take up their ideas. We could see both positions on this. On the one hand, when the personal is political as it so clearly is in Laing's work perhaps his personal behaviour should be under scrutiny. On the other hand, all thinkers are likely to have feet of clay and we can question whether it is acceptable to use this to pathologise them and to dismiss their ideas, as has been done with Laing, Neitzsche and Heidegger.

Thompson points out that Laing's writing became increasingly pretentious and inaccessible over time, that he courted fame despite this surely being a form of inauthenticity, and that his behaviour became bullying and cruel in ways that alienated most of those he was close to. Again, this latter seems far from Laing's ideals of open-hearted communication and not trespassing on others, although it could be argued that he was deliberately trying to confront people with their own inauthenticity.

A classic example of this was in his exchange with the American humanistic therapist, Carl Rogers. Thompson tells the tale of the night before the organised debate between Rogers and Laing. Laing and his group invited Rogers and his group round to his home and then out to a restaurant. Laing told Rogers that his 'California nice-guy' act would make an authentic exchange impossible. Laing proceeded to get drunk and to shout out (about Rogers) 'he's not a man, he's a perrrrson!' (a sarcastic reference to Roger's book On Becoming a Person). Later he spat in the drink of one of Rogers' colleagues.

The NEG group spent much time considering Laing's idea that anger is the Royal Road to authenticity. Is niceness always inauthentic? Is it always authentic to strip away artificial niceness however much trespassing is required to do so? We found ourselves questioning why the so-called 'negative emotions' would be considered more authentic than the 'positive' ones. Is this another problematic dualism? Also, we noted the contradictions between two aspect of Laing's authenticity (in order to be authentic in this way one has to trespass on others, demanding that they be authentic according to his definition).

We wondered if Laing would have the same impact if he had not acted the 'trickster' in these ways: punching holes through inauthenticity. Then again, might he potentially have had more impact if he could have expressed his ideas in a way that was more palatable to people. Related to all of this there is the question of whether one person can ever really judge the authenticity of another.

In response to this latter, we reached the conclusion that we certainly can't judge the authenticity of another (there can be no objective measure of authenticity), but that equally that we cannot really trust our subjective sense of whether we are being authentic or not because we are likely to be a poor judge of whether or not we are in a form of 'false consciousness' (believing we are being authentic when actually we are simply saying or doing what is expected of us). There is also the question of whether it is always authentic to go against the norms and conventions around us. We considered Sartre's example of wearing a moustache when everyone else was doing so: Would it be authentic to sport such a moustache nowadays (as long as we weren't doing it for 'movember' – the charitable event where people grow moustaches for the month of November)? Even in going against convention are we still in relation to this and potentially even reinforcing it?

As often in our discussions we related Laing's ideas to gender. We considered how somebody with Laing's ideas and behaviours might have been treated if they were a woman, and this led us to consider whether it was possible for women to be seen as authentic in the same way that men could be, given the way that men are regarded as 'normal' humanity (according to Sartre, de Beuavoir and others), and the potentially harsher sanctions (internal and external) against women behaving authentically.

Another question we explored was whether authenticity may only be possible when all ways of being were open to us. For example, some of us felt that kind of anger that Laing displayed simply wasn't an option in our behavioural repertoire. Did that condemn us to 'inauthentic niceness'? We decided that there would always be limits and constraints on what was possible, but that authenticity was possible so long as there was some degree of choice over how we acted.

In the group there was a sense that it was valuable to hold both a Laingian and a Rogerian way of being. The question which we kept returning to was 'how far do you go?': How much do you flout convention and how much do you police yourself? These are important, and emotionally loaded, questions. 'Too far' in one direction can leave us alienated and alienating, 'too far' in the other and we can loose ourselves completely in the (contradictory) demands of others.

In a way the contradictory nature of Laing's version of authenticity can provide a helpful constant corrective: be honest and courageous, but in open-hearted ways that does not trespass on others. Of course it is impossible to know how our actions will be experienced by others, but if we hold these tensions when engaging with the world perhaps we will occasionally experience moments which at least feel authentic.

 

Questions to Consider

  • Do you agree with the components of authenticity that Laing identified?

  • Is inauthenticity implicated in human suffering?

  • Is anger the royal road to authenticity? Can we be nice and authentic?

  • If we are being authentic is it our task to point out the inauthenticity around us, and in others' behaviours?

  • Is authenticity equally open to everyone?

  • How can we know if we, or others, are being authentic?

  • Is authentic something to aspire to?

  • Does authenticity lie in our actions or in the reasons behind them?

  • How far do you go?

 

Find Our More

You can download M. Guy Thompson's paper here.

The international R. D. Laing institute is here.

The Philadelphia Association is here and has plenty of downloadable pdfs on existential topics.

The BBC documentary, The Trap, covers R. D. Laing's ideas in some depth, as does the documentary Just Another Sinner.

The website of the Northern Existential Group is coming soon!

 

 

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Six short posts about mental health 1: Biopsychosocial perspectives

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Edited by Meg-John Barker, Saturday, 29 Oct 2011, 16:54

A short while ago I was asked to take part in an Open University day about mental health for tutors. It was a good chance to give a workshop about self care and why that might be useful for both students and staff. But I was also given a lecture slot in the day. I decided to share some of my thoughts on mental health more broadly. I was nervous because this was the first time I had spoken on this topic specifically and I know that my ideas on it can be challenging to hear. However, the talk seemed to go well and led to some great discussions, so I've decided to share it here too.

The talk preceding mine set the scene very well as Saroj Datta gave us an update on the latest evidence regarding the interactions between genes and the environment in relation to mental health. Saroj was involved in the OU science course on mental health which takes a 'biopsychosocial' approach to the issue, and her talk demonstrated just how impossible it is to tease apart those elements: bio, psycho, and social (which is why they are combined into one word).

I already knew about 'neuroplasticity': the fact that the way our brains connect up changes over the course of our lives depending on the experiences we have (this is the way that we learn, of course, but we often forget this and regard brains as static and unchanging). Saroj presented evidence that there is also flexibility on a genetic level. Whilst the set of genes in every cell in our body remains fixed, whether they are 'switched on' or 'express themselves' is not. Animal studies have shown, for example, that a glucocorticoid receptor gene tends to remain switched off, leading the animal to be fearful and anxious, unless the mother displays nurturing behaviours (due to not being anxious herself) in which case it is switched on, leading to pups who are calmer and less stressed. This research is in its early stages, and needs to be treated with caution when applied to humans of course.

Human research supports the genetic-envionmental interaction, finding that, for example, rates of depression are high when a particular allele of a gene is present and someone has experienced three or more stressful life events, but lower if just that allele, or just the life events, are present. It is the interaction between genes and environment that is vital. There have been similar findings in relation to childhood maltreatment. However, it is important to remember that some people were still depressed without those particular elements in the place (either that gene allele, those life events, or the two together): so this is not the whole picture. Also there is unlikely to be any one single gene involved in any element of human behaviour, but rather many.

Saroj suggested that such 'epigenetic' changes are potentially reversible and it has been suggested that this, and neuroplasticity, may explain why there are multiple different routes to repair and recovery.

My own interest has been mainly about the social end of the biopsychosocial composite, but it is vital to remember that this is as impossible to tease apart from the rest of it as the bio end is. The ways in which the society in which we live understands, and treats, people, is vital to the way in which we understand and treat ourselves. And one of the main things our society currently does is to split apart the biopsychosocial in a deeply problematic way when understanding issues of distress or 'mental health'. This is something I will explore, in detail, in the next post.

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Six short posts about mental health 2: Why I don't like the 1 in 4 statistic

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Edited by Meg-John Barker, Sunday, 16 Oct 2011, 15:39

It is important to say, before I start, that here I am absolutely not doubting the existence of severe distress, or the toll that it can take on people who are struggling and those around them. Rather I am questioning the way that we currently categorise and work with such experiences, and the role of wider culture in them (which so often gets missed).

What sparked this line of thinking, for me, was a series of adverts a few years back under the Time to Change campaign about mental health, which was put together by the Institute of Psychiatry, Mind, and several other mental health organisations, with the aim of ending mental health discrimination. The adverts featured celebrities such as Stephen Fry and Ruby Wax speaking openly about their own experiences of distress, and many quoted the '1 in 4' statistic. For example, the poster with Stephen Fry on it said: '1 in 4 people, like me, have a mental health problem. Many more people have a problem with that.' Ruby Wax's said '1 in 5 people have dandruff. 1 in 4 people have a mental health problem. I’ve had both.'

Clearly the statistic was intended to raise awareness of the commonality of mental health problems and to decrease the stigma of those experiencing them. However, I feared that it was in danger of doing quite the opposite.

The 1 in 4 figure is problematic anyway as it is not clear where the figure actually comes from. Of the few studies which have found something like this figure, some have been measuring families rather than individuals, mental health has been measured in various different ways, and it is unclear whether we are talking about, for example, 1 in 4 people at some point during their life, or 1 in 4 people in the last year, or 1 in 4 people at any given point in time.

However, for me, the bigger problem is the potential impact of the figure. 1 in 4 suggests that 75% of the population do not experience mental health problems. That is a substantial majority. The danger is that this situates people with mental health problems as 'them' (compared to 'us' who don't have any such problems). As we know very well in psychology, the creation of any kind of 'us and them' situation increases, rather than decreases, likelihood of discrimination.

Most of us will experience some form of abuse in childhood (if we include 'bullying' by peers, which I think we definitely should); all of us will experience life events such as bereavement of a loved one in adulthood which tend to result in a period of high distress; not to mention the existential givens of life which we all struggle with. Given this, is 'ill or well' a useful model at all?

The common dichotomous understanding which I see amongst counselling clients, friends, and students alike when they are talking about their own – and other's - experiences of distress and suffering is as follows:

 

Either

I'm ill – I need help – it's not my fault

Or

I'm not ill – I don't get help – it is my fault

 

People commonly feel, deeply and certainly, that these are the only two possible places to be: ill or not ill, and that the other aspects presented here follow from that. Not only is this a splitting up of the unsplittable biopsychosocial which I mentioned in the previous post. It also suggests that there are only two options: biology or choice (social doesn't even come into it). Mental health problems are seen as an individual – frequently physiological - problem which requires treatment (commonly drugs, sometimes also therapy) to fix. However, if there is no evidence of such an individual problem (if no diagnostic label fits, for example, or if there is suspicion that they are not suffering enough) then the person cannot be ill and therefore any struggles must be their own fault.

This way of understandings things is problematic on all levels. It prevents many people with distress from admitting it because, if they do admit it, they will have to give up control, take on a victim/ill identity, and open themselves up to stigma and discrimination. Those who embrace diagnosis may be disempowered (due to the sense that they can't help themselves and must require expert help). They may feel that they have to take certain treatments (often drugs) because of the common idea that mental health problems are biologically caused and must be biologically treated, despite the question marks which still exist over whether, and how, such drugs work and whether they are the most appropriate way of addressing such issues in all cases (not to mention the vested interest of 'big pharma' in perpetuating this particular understanding). There is no room here for sociocultural explanations or for more complex involvement of personal agency.

Also, many people oscillate between the two positions as neither side really captures the complexities of human distress. This means that those who don't identify as having a mental health problem are haunted by the fear that perhaps there is something terribly wrong with them which needs fixing (and hiding this fear, and any signs that they might be struggling, puts them under immense pressure). Those who do embrace a label such as 'depression' are often haunted by a huge sense of guilt that maybe they are not really ill and maybe this is all their fault and they are totally to blame (which massively exacerbates any suffering they were already experiencing).

This puts people in a horrendous double-bind when it comes to speaking about their own, inevitable, distress and struggles in life. If we openly disclose as 'depressed', for example, (as many people did on the recent 'world mental health day') we run the risk of reinforcing this ill/well split such that those who do not embrace such an identity feel their struggles going unacknowledged and the pain of that invisibility. If we keep quiet about our distress, or resist such labels, then we can equally reinforce the ill/well split as we are read as 'well' by those around us.

We need to move to more biopsychosocial model of distress. We need to recognise that distress – in its various forms - happens for complex multiplicity of reasons, and that we can have a personal role in exacerbating and ameliorating it, but that acknowledging such a role does not mean that we are totally 'to blame' or 'at fault'. We need to understand that we can all access support rather than it being something only for a certain few, and that different things work for different people at different times. We need to challenge either/or illness/wellness dichotomies and to consider other possible models and metaphors for distress.

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Six short posts about mental health 3: Diagnosis

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Edited by Meg-John Barker, Sunday, 16 Oct 2011, 15:41

The common practice within the current mental health system when people are distressed is to diagnose them (to find the category in the DSM or ICD which best fits them) and to treat them accordingly.

In the previous post I said a lot about why people who are suffering might want to embrace a diagnosis of a mental health problem. In the next post I will say more about why practitioners may be wedded to this way of working with distress. Here I will outline some problems with diagnosis in general.

As I mentioned, for people who are struggling, diagnosis is often seen as the only option other than seeing themselves as totally 'to blame' for their own distress. Also, it may be the only way to access support and community, and to be taken seriously by employers and others whose understanding they may need as they are struggling. Given that this is the world we currently live in, it is important for those who are critical of diagnosis not to impose that on others. Rather we might explore, with them, the potential losses and gains of taking on a diagnostic label (something explored in the Open University counselling module). Common losses which people express are that no label fits them perfectly, that – if they do embrace a label - they feel trapped by it (that this is all that they are are all that they'll ever be), and that they are treated differently by other people.

Irving Yalom points out this problem with diagnosis, that it easily fixes people (the way that a kiln fixes a pot) and can prevent us from treating people as whole, complex human beings. Rather, it is easy for professionals to see people as a 'bipolar' for example, or as a 'borderline personality disorder' (assuming that that category is all that they are, and that this person will be the same as other people in that category). Actually there can be multiple diverse meanings for people who fall into the same category which it is vital to explore. Take agoraphobia, for example, which involves fear of being outside the home. This could be about a fear of social contact, a sense of shame about oneself, an oversensitivity to noise, a genuine concern around violent attack (racist or homophobic, for example), an inflated concern over the risk of crime, superstitious fear of an accident happening, worry over one's own capacity for anger and violence with others, or many other things (and combinations of things).

The point about fixing people is supported by the famous Rosenhan study 'on being sane in insane places' which was conducted in the 1970s. He got a group of people to present to psychiatrists. They didn't wash for three days and said that they heard the word 'thud'. All were admitted to hospital and all were diagnosed with schizophrenia (except one who presented to a private clinic who was diagnosed as manic depressive, which is telling about class and diagnosis). Once admitted, the people said that they were fine and didn't report any further symptoms. Nonetheless they were kept in for weeks at least and their behaviours were still read as ill or disordered. For example, queuing up for lunch early because they were bored was labelled 'oral acquisitive syndrome' and making notes was labelled 'compulsive writing behaviour'. Science writer, Lauren Slater, repeated the study in the early 2000s herself. She didn't get admitted, but was diagnosed and medicated by everyone she presented to, reflecting shifts in understanding and treating mental health problems.

Clinical psychologist, Richard Bentall, has pointed out the incoherence of many diagnostic categories: It is possible for two people, categorised in the same way, to have completely different clusters of symptoms. Some symptoms which are generally seen as signs of mental illness, such as hearing voices, are experienced by many people and are not always viewed as problematic.

Also, there are issues with the cultural and historical specificity of diagnosis. The classic example of this is the fact that homosexuality was included as a disorder in the DSM until 1973 and in the ICD until 1992. Other consensual sexual behaviours which are considered 'outside the norm' (such as fetishes, sadomasochism and transvestism) are still listed despite lack of evidence linking them to distress and calls for them to be removed.

This raises the question of to what extent diagnosis of disorder represents individuals being in conflict with the norms of society rather than a genuine pathology. There are many other examples of this. For example, the 'sexual dysfunctions' are categories for people who don't have the amount, or type, of sex that they are expected to have by wider society. Categories of 'premature ejaculation' and 'vaginismus' suggest that 'proper sex' involves penile-vaginal penetration.

We might also think about what things are classified as addictions and what are not (in relation to what is socially acceptable), or what forms of self-harming are pathologised (cutting and burning oneself, but generally not smoking, drinking to excess, risky sports or driving, or cosmetic surgery).

Many have argued that the high levels of diagnosis of depression in women (and the greater likelihood that distressed men will be criminalised as 'bad' whilst women will be pathologised as 'mad') are related to cultural expectations around femininity and masculinity. Also, black and minority ethnic people are more likely than white people to be diagnosed with 'severe' mental health problems and to be hospitalised and treated with drugs, arguably due to the western norms inherent in the diagnostic categories, as well as experiences of racism and social injustice.

Going back to Rosenhan's study we may regard the world that we currently live in as rather an 'insane place' (particularly given the current economic and ecological situation) and question what it means to respond 'sanely' to this. Winnicott famously said, of depression: 'The capacity to become depressed, to have reactive depression, to mourn loss, is something that is not inborn nor is it an illness; it comes as an achievement of healthy emotional growth...the fact is that life itself is difficult...probably the greatest suffering in the human world is the suffering of normal or health or mature persons...this is not generally recognised.' In recent goals for everybody to be 'happy' there is a danger that we pathologise, even more, quite reasonable forms of distress.

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Six short posts about mental health 4: 'Us and them' in mental health

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Edited by Meg-John Barker, Sunday, 16 Oct 2011, 15:42

Given the problems with diagnosis covered in the previous post, we might ask why practitioners continue to employ these, often without critical consideration, and to maintain a split between the ill and the well.

In her book, Users and Abusers of Psychiatry, Lucy Johnstone suggests that it is very tempting for mental health practitioners to treat clients or patients in an 'us and them' way because of how invested they are in the current system. There is the danger that, without such clear splits, their job security would be in danger. Also they would lose the sense of expertise and professional power that they have if, for example, there was a de-medicalising of distress or a de-professionalisation of support for people who were struggling. There is a danger, more widely, that those who have an investment in being seen as sane, in control, and professional require a comparison group of those who aren't (and this may play out in mental health systems, in families and other groups, and in society at large).

Christina Richards presents a further reason why it may be difficult for practitioners to shift away from an 'us and them' approach to distress. She argues that underlying a resistance to change might be a sense of: '“I have been doing things this way for years and will continue to do so as this way must be right (because if I have been doing it wrong for all these years look at all the pain I’ve caused/ time I’ve wasted/ good I could have done)”. It boils down to: “I can’t act in the future, because that proves I could have done so in the past”.'

This way of thinking can keep people very stuck on both sides of the 'us and them'. For practitioners it prevents critical exploration of their current ways of understanding and practising, and substantial revision of diagnostic manuals, etc. which have been used for so long. For clients or patients it makes it difficult to change in ways that might alleviate suffering because changing is seen as acknowledging that one could have changed previously (this is especially difficult because taking personal agency is seen as putting a person on the 'not ill' and 'all my fault' side of the dichotomy explored in my second post). The more time passes, the harder it can be to step away from the way you have been doing and seeing things. There is a kind of tyranny of consistency which would be helpfully addressed by a model which embraced the fact that people change over time and that it is okay to revise and adapt the way we used to see things or admit that we were wrong in the past.

Richards quotes the great sage, Esme Weatherwax, who said that 'Sin ... is when you treat people as things. Including yourself. That's what sin is.' Whilst, of course, we require some kind of language to describe, and make sense of, our experiences of distress, we need to be cautious of ways of understanding that function to trap people and to concretise things rather than enabling them to move. We also need to be alert to understandings which assume that the biopsycho can be disconnected from the social such that it is only the individual who is seen as disordered or malfunctioning, rather than wider systems, and only target treatment at the individual (rather than the family, the school, the organisation, the media, or wider culture, for example). The social aspect is something that I will explore further in the next post.

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Six short posts about mental health 5: Self-monitoring culture and distress

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A friend of mine recently posted a cartoon on Facebook which had Sigmund Freud saying 'before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, surrounded by assholes'. I responded that I thought this said something rather profound about mental health at the moment. Could it in fact be said that a key aspect of many experiences of suffering is the problem of being 'surrounded by assholes' or - to be more generous - being surrounded by damaging cultural messages perpetuated by those around us?

When I first started counselling I became very aware that virtually everybody I saw was convinced that there was something wrong with them that needed fixing, mostly based on the fact that - when they looked around themselves - nobody else seemed to be struggling the way they were. Conversations with close friends, and self-reflection, suggest that this is an extremely common feeling: that everybody else is managing fine so there must be something wrong with me. Of course, when I asked clients how they thought they appeared to other people they recognised that they generally put on a 'happy, managing everything fine mask' which probably gave off the impression that they weren't struggling either.

It strikes me that many experiences of depression, anxiety and other common mental health problems have a strong element of self-scrutiny and comparison to others in them (whilst, of course, I am wary of proposing any universal explanation because these experiences mean many different things to different people and at different times). Michel Foucault used Jeremy Bentham's Panopticon to explain how people self-police in contemporary society. In the Panopticon prison there is a tower in the middle and cells all around an outer circle, such that a guard in the centre could – at any time – be looking into your cell. Because of this, prisoners begin to monitor their own behaviour rather than having to have huge numbers of guards. This idea has been linked to the high degree of surveillance that we now have, meaning that we could – most of the time – be being watched or recorded.

Foucault suggested that contemporary culture worked in this way more broadly. People are encouraged to scrutinise and judge themselves at all times, with advocations to self-improve, to work on themselves, and to present a positive and successful self to the world. This is linked to consumerism which is all about seeing ourselves as lacking and needing something to fill that lack. Advertising, and many other forms of media, create fears (e.g. we might look bad, be out of date, or be a failure) and then offer products to allay those fears (e.g. beauty products, the latest fashion, recipes for success in various arenas).

Within such a culture it is no wonder that people would be particularly driven to constant self-scrutiny, comparison to others, and presentation of themselves as happy, satisfied and successful (even when they may not be any of these things). This shores up the 'us and them' that I wrote about in my second post. Rather than distress and suffering being an inevitable part of everyday life, it is seen as a problematic lack which must be addressed, and is probably outside of the power of the person who is suffering to address.

Perhaps the major challenge for mental health practitioners, counsellors and psychotherapists is the danger that our work can perpetuate this perception: creating new diagnoses and categories and offering an ever-increasing menu of products to fix these (at a price). Even the one-to-one therapy situation is at risk of exacerbating this sense that people are wrong and need fixing, given that one person (the client) is encouraged to express their distress to another person (the therapist) who is generally fairly quiet and certainly not expressing any of their own problems. This is not to say that therapists and counsellors should be inappropriately burdening clients with all their difficulties. But we need to find ways to challenge the idea that the client's struggles mean that there is something wrong with them, and the perception (which most clients have, even when they are therapists themselves) that the therapist has no struggles, or deals with them all perfectly.

Existential therapy includes the idea, not only that all people will inevitably suffer, but also that all responses to this suffering are sensible so long as we properly understand the person who is responding in this way. This, to me, is a very useful counter to the common assumption of something being 'wrong' and the person being flawed and lacking in some way if they do not respond in ways that are deemed culturally acceptable.

Permalink 4 comments (latest comment by Wren Tyler, Monday, 17 Oct 2011, 14:43)
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Six short posts about mental health 6: Alternatives - self-care and compassion for all

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Edited by Meg-John Barker, Sunday, 16 Oct 2011, 15:40

In the preceding posts I have argued for a complex understanding of suffering and distress which is very cautious of applying diagnostic criteria and of dividing people into 'ill and well' 'us and them' boxes. Perhaps a better model of distress is of a continuum which we all go up and down during our lives, and where we are not fixed at any given point. I've also emphasised the importance of not splitting up the bio, psycho, and social in our understandings of distress, and suggested that we must not neglect the social aspect of the biopsychosocial because societal ways of understanding people (which we internalise and which, no doubt, are represented on a neurological level) are involved in our difficulties. This is particularly the case in the way in which we are encouraged into self-monitoring, and in the way in which individuals who are in conflict with societal norms tend to be pathologised as disordered individuals.

If we resist the temptation to 'us and them' thinking then perhaps we can make more of a connection with people when they are distressed (rather than attempting to distance ourselves from them in ways that maintain them as 'them' and protect us from any sense that we might experience similar things ourselves). Then we might be able to ask questions such as 'what works for me when I am distressed?' which may lead to more helpful responses when others are struggling (although, of course, we must be cautious of assuming that everybody works in the same way that we do – perhaps the question is more like 'given everything that I know about this person, what might they be needing right now?') We might reflect, for example, on times when we've been under chronic stress or when a crisis has occurred in our lives.

Broadly speaking, when we reflect on what is unhelpful when we are distressed we might come up with things like: taking away the aspects which makes the person what they are (things that they regard as central to their identity such as work or relationships), removing people's sense of personal freedom and choice, and regarding them as inexplicable or baffling, for example questioning why they can't just stop feeling, or responding, in the way that they are doing. On the other side, we might find that what helps when we're distressed is not being overloaded with anything else, being treated kindly and patiently and being around those we feel safest with, being reassured that we are still free (but perhaps we don't have to make lots of decisions right now), and feeling that we are understood and that our response is a perfectly explicable way of responding to this situation (which involves somebody taking the time to understand what it means to us).

The vital role of compassion (from others and towards oneself) has been emphasised by many recently, and is part of the reason, perhaps, why various forms of mindfulness-based therapies are suddenly so popular (as they often encourage practices of self-care and compassion). Compassionate treatment of self and others is, perhaps, an opposite to the judging-comparing-monitoring mode which is so culturally encouraged at present. Rather than fearing that we are lacking, pretending that we aren't, and trying to prove that we are better than others, we accept that everyone is imperfect, are open about our struggles, and move away from a competitive way of relating with others.

Vitally, an alternative compassionate, or self-caring, form of working with distress does not present this as something that is necessary just for people who are struggling (reinforcing that 'us and them'). Rather it is seen as something everybody needs to engage in to counter those omnipresent self-monitoring messages (which affect us all) and to address the struggles and distress which we all experience.


Find Out More

  • Many of the ideas in these posts are explored, in more detail, in the textbook and module for D240.

  • A very accessible book that covers may of these areas is Richard Bentall's Doctoring the Mind.

Permalink 9 comments (latest comment by Meg-John Barker, Wednesday, 19 Oct 2011, 10:42)
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