September Meeting

Our recent Hedge School meeting had eight attendees discussing the first part of a four part documentary series, Adam Curtus' The Century of The Self. The Happiness Machine gave an account of how Freud’s theories were used by his nephew, Edward Bernays, in the development of the public relations industry.  watch here -Basically we are human beings with uncontrollable desires, knowledge of these desires can be used to make us act in ways that we might not otherwise choose to.

The group discussed a number of ideas coming from the documentary. The first point of note from our discussion was that we felt conflicted about Bernays, on the one hand he manipulated and profited from the exploitation of Freud's theories while on the other hand he had introduced the world to Freud's work's by getting them published in the United States. We were struck by how, during the 20th century, capitalism became inextricably linked with democracy. Capitalism seeks to control the masses while democracy is supposed to be a system of equals. 

Despite none of us being overly fond of Bernays, we did wonder if we were blindly blaming him for things which were much greater than he could have controlled. We talked about how we, the group, might be buying in to the idea that we need to be happy, and that we even know how to achieve that. Perhaps by overthrowing the capitalist system for a socialist one we would just be replacing one abusive system for another? By appealing to our sense of what we lack we are turned into consumers. As a group we wished for nothing more than to 'fix' society by creating some sort of socialist utopian state. If only we could manipulate the public to convince them to vote for the 'left'..... perhaps we should use propaganda/ PR?

We then spent some time discussing politics, Obama, ideology and selling out in order to stay in power. In the end we are human beings, alive, with the sole purpose of replicating our genes. We are not, although we may think this, happiness machines.    

Next meeting, Wednesday 8th October at 6pm, upstairs in the Friend in Hand!

August Meeting – “Work and ‘the crafting of individual identities’ from a critical standpoint”

This month, we discussed a theoretical paper by David Fryer and Rose Stambe.  Drawing on the work of Michel Foucault, the paper examined the contribution of psy-power-knowledge to the construction of the ‘unemployed’ subject, and the production of neoliberal unemployed subjectivity.   

We discussed our government’s invention of cultural tropes; ‘the age of entitlement’ and ‘dependency culture’.  We noted that proposed changes to welfare policies reflect an increasing readiness to locate the problem of unemployment in the unemployed individual, and not in broader society, which effectively functions to obscure the social, political and economic aspects of unemployment and to alleviate the neoliberal regime of responsibility.  We asked what is required of the unemployed individual?  They must celebrate their New Start by self-improving, up-skilling, and reporting their work search efforts to our surveillancing government.  The unemployed individual may choose to, or even be required to, engage with agents of the psy-industry to assist them to achieve their goals. 

We considered how the psy-industry articulates with neoliberalist ideology.  The psy-industry promotes happiness (e.g Seligman), the absence of mental illness, the right to freedom, and fulfillment of an individual’s emotional, intellectual and spiritual potential.  The dominant theme of two psy-products­­­, ‘positive psychology’ and CBT, is the idea that it is necessary to change the way one sees the world, as ‘mental-ill-health’ is the product of faulty or irrational ideas about the world, the self, and/or others.  Accordingly, these psy-products neglect the impact of the structural inequalities on wellbeing and employment status.  Thus, we can see how these tenets resonate with neoliberalism’s promotion of competition, freedom from others, self-fulfilment and consumerism.   So, the psy-industry supports the maximization of productivity in a neoliberal regime by treating and fashioning a healthy and motivated workforce.  Accordingly, the psy-industry contributes to the rejection of poverty and inequality as explanatory frameworks for unemployment and unhappiness. 

We reflected on the compromised social status of the unemployed person, and in our efforts to bring to mind other subjectivities, we realised the extent to which the hegemonic discourse of neoliberalism has foreclosed other ways of being.  We acknowledged the difficulty (and near impossibility) of envisaging a different kind of society, with a multitude of subjectivities for both ‘employed’ and ‘unemployed’ individuals and collectives.  We discussed the notion that psychology is political, sociological and philosophical.

            Naturally, the issue was then considered for its expression in the mutually-constructed interpersonal space of psychotherapy.  As the psy-industry is a knowledge producing entity, and indeed constructs subjectivities, how do we move beyond the taken-for-granted assumptions that we as practitioners bring to the therapeutic space?  While noting the discouraging nature of this reality, the use of Foucault’s conceptualization of power and resistance offers a way out.  By deconstructing reality, we undermine the familiarity of the present, and may be somewhat comforted (and activated!) by Foucault’s theory that hegemony is always subject to contestation..

July Meeting- Critique of formulation

It was great to see all those who attended the Hedge School yesterday evening. A group of about 10 of us were discussing Craig Newnes’ article on psychological formulation. I think the first thing that people seemed to bring up was how confronted they felt by what the article claimed. The critique of formulation was so damming that it seemed to shake the foundations of our professional identity.  We talked about the fact that the critique was of the professional discourse of formulation and how we as clinicians felt that we practiced differently to that. Although there was an acknowledgement that service pressures and expectations limited our ability to always do this. 

For most of us, formulation was what we needed to do more of in an effort to move away from diagnostic language and simplistic understandings of people’s distress. We thought that research supported the idea that people attending therapy wanted to be asked about their history and previous experiences. It seemed that most of us valued this part of our practice and saw it as giving a lot of meaning to what we do. In fact, we talked about creating meaning and how this was viewed as the vehicle for change in therapy- making sense of one’s situation allowed for change. It was also acknowledged that different ‘meanings’ or formulations could be created and that this did not necessarily mean that one was more right. We also discussed the status of psychological formulation in legal and forensic settings, where a psychologists' formulation may inform legal outcomes (for instance may identify aggravating and mitigating factors). The subjectivity of formulation in this context is particularly problematic given it is requires determinations be made about distal and proximal causes of behaviour (as opposed to ongoing / dynamic / meaning making formulations utilised in therapy).

We also questioned the need for a complex formulation encompassing everything from birth to present day from a public health perspective, i.e. was spending limited resources on formulation value for money?  It was also thought that formulations that were tentative to begin with and continued to develop over the course of therapy may hold more value than a single static formulation offered after a brief assessment. Also, we wondered if different therapeutic approaches practiced by clinical psychologist all took the same approach to formulation. What about psychodynamic and systemic approaches? Did we have ‘evidence’ to support this and if we thought that we did/didn’t, what counted as evidence? Apparently not everybody is a CBT therapist??!!

We discussed how at the start of clinical training inexperienced trainees could often write quite insightful formulations but that they usually lacked the integration of psychological theory, this seemed to come over the course of training. We wondered if we were, in fact, still formulating intuitively (as we did at the beginning of our training) with what we saw to be the contributing factors and then backing that up with psychological theory post hoc so that it maintains our expert position? We also, appreciated the authors critique of the language used in formulation, particularly the professionals substitution of the word ‘want’ for ‘need’. This seemed to highlight for many of us that although we might want to formulate collaboratively, the professional discourse, which we must all become fluent in speaking, will still get in the way of this.

Finally, a question was asked of the group ‘would you still practice psychological formulation if it was illegal’?. The consensus was that people would. The main idea was that people are intuitively curious and when they are faced with a situation that they do not understand they will usually attempt to formulate (with some sort of psychological theory) it so that they can create a meaning for themselves. Perhaps clinical psychologists have just found a way to claim it as their own expertise as a way of furthering the profession, but the group seemed to feel that in reality everybody had the ability to practice it. However, it was generally felt that strict psychological formulation defined as something that psychologists only could provide did not necessarily offer much in addition to this more inherent formulating, and therefore could be dropped with no loss.

As usual there were many more questions than answers generated! Thank you again to everybody for coming along and to Craig Newnes for supplying the article! 

-Next meeting Wednesday 13th of August.

We had a cosy group last meeting, and had a good discussion about empathy and gender. We talked about a paper by Andrea Lobb, about the asymmetrical attribution of empathy to men and women. There was a good mix of agreement and disagreement with Lobb's arguments(s). The group generally liked her idea of the androgynisation of empathy, but some thought that this has in many respects been attained, or is at least much closer to being attained than she was presupposing. Although we acknowledged that Lobb took care to make clear that she didn't intend to argue 'against empathy', some thought she may have ended up doing so nonetheless, and may have been a little too keen to discard the idea of empathy as a feminine virtue to be celebrated.
We found the way in which the paper discussed empathy in relation to power quite interesting. In particular, we spoke about the idea that those who are marginalised may develop greater empathic ability, and some reasons for this.  We were also interested in power and gender as it may relate to different professions that work side-by-side, such as medical doctors and nurses, and psychiatrists and psychologists. We wondered what role gender may play in power dynamics between psychiatrists (a profession which is perhaps still somewhat male dominated) and psychologists.
We also spoke about empathy and gender on a more individual level, and our own experiences of choosing a profession both in which empathy is key, and which is female dominated. We discussed whether gender had influenced, or been a barrier, to our choices. We also talked about how some of the challenges men in psychology may face compare and contrast with the challenges faced by women in male dominated professions (for instance engineering).

 It was great having a chat about this topic, especially as a few people mentioned they'd not really encountered feminist perspectives on issues in psychology before.
See you all next time.

We had a good meeting this week. We discussed the Johnstone chapter and people seemed to be in agreement about the difficulties we face when we feel that we have no other option but to use psychiatric diagnoses, even if just as an administrative tool. We questioned it's role in legitimising psychiatry, as a metric for funding, as a scientific tool to base treatment and prognosis on, and it's impact on the individual and the system around them when a diagnosis is given by an 'expert'.

We seemed to all be in agreement that psychiatric diagnoses are flawed at their best and abusive at their worst. However, we came up against the same quandary, so what do we do now? Although we can think critically, how to we act critically? 

The Johnstone chapter suggested psychological formulation as an alternative. However, the group spoke more about the need for a political voice and how clinical psychology was not well represented in that way. We felt that our representative bodies were more concerned with cosying up with psychiatry than questioning it. As with always, we are left with more questions than answers. But, I think, it's better to know what you don't know than to think you know it all.....

Finally, if people would like to suggest topics for future discussions then please email me, aidanjakelly[at]gmail.com.

What is diagnosis and why do we use it?

Diagnosis and the scientific ideology of reductionism go hand-in-hand. Reductionism is the belief that everything can be explained by the sum of its parts, i.e. that it can be reduced to one type of knowledge. So for psychiatry this means “that aspects of meaningful human behaviour can be fully explained in terms of ‘non-meaningful’ entities such as genes, neurotransmitters and ultimately atoms and molecules” (Bracken & Thomas, 2009, p 14). Diagnosis is a reductionist practice, where a label or diagnosis is said to represent an illness with a biological aetiology.  

Johnstone (2008), in explaining the purpose of diagnosis, writes first about how it functions in general medicine. She states that it is used as an essential first step to determine the appropriate treatment and then goes on to detail a list of other preferred, but not essential, criterion that are often also fulfilled. These include; that it gives information to patients and families who want to know what condition they are suffering from, gives details of prognosis, allows professionals to communicate in shorthand, provides a basis for research, informs aetiology, and signposts patients and their families towards appropriate services and resources. 

How suited then, is diagnosis to the field of psychiatry where medical causes, such as ‘biochemical abnormalities’ and ‘genetic vulnerabilities’, are still only working theories, rather than established facts (Bentall, 2009; Johnstone, 2008)? Psychiatry, as with natural sciences such as chemistry, biology and physics, relies upon the ability to use valid and reliable categories or units as a way of testing hypotheses and developing theories. In medicine the ability to define and classify different illnesses allows for hypotheses about prognosis, aetiology, and treatments that can then be tested (Johnstone, 2008). In summation, the medical model and psychiatry needs classification of its units of study, to act as objective truths, so that it can then engage in scientific thinking, but does our understanding of distress need, or benefit from, it’s classification?

 Next Meeting

So the next meeting of the Sydney Hedge School is next week, 6pm on Wednesday 9th of April, upstairs in The Friend in Hand pub on Cowper Street Glebe. 

We are going to be discussing the use of psychiatric diagnosis. This is a massive area and we won't be properly able to do it justice. However, we will try and start thinking about it. To do that we will use two texts, a short 1 page article by Peter Kinderman that addresses the use of language such as 'disorder', and the second, a 12 page book chapter by Lucy Johnstone, that nicely critiques the arguments and interests that support the use of psychiatric diagnosis. In particular, Lucy Johnstone's chapter is rich with ideas while also being clear and readable enough to provoke thought and discussion. So if you haven't already and would like to come along to the next meeting, drop me an email on aidanjakelly[at]gmail.com, and I'll send out the articles to you.

Look forward to seeing you all next week!

Inaugural meeting

It was great to see everybody that made it to the inaugural meeting of the Sydney Hedge School last Wednesday evening. By my count 17 people came altogether! For those of you who didn't quite make it, the next meeting will be on Wednesday the 9th of April (same time and place). Write it in your diary now! I will post more information on the topic and paper to be discussed closer to the time.

At the meeting we discussed what it meant to critique psychology and then talked about some of the areas that we might be interested in critiquing.

What people seemed to value the most was the opportunity to talk in smaller groups. That way everybody got a chance to contribute and engage in conversation. 

As a brief summary of the discussions that took place a few people have written about how they experienced their group conversations. I have copied these below.

James wrote: 

"Our discussion broadly focused on the way in which political factors influence which research methodologies and therapy approaches are deemed acceptable in psychology.    

Ø  In attempting to emphasise it's scientific credentials, psychology has rigidly adopted certain quantitative methodologies  (e.g. RCTs) whilst often marginalised qualitative methods and other experimental designs (e.g. single-subject experimental designs).        

Ø  Problems of applying statistical averages of groups (derived from quantitative research) to individuals. For instance, identifying that on average therapy X is associated with a slightly better outcome on a particular symptom scale than other similar therapies, can lead to the fallacious assumption that therapy X would be the best therapy for an individual patient (or should be the "default" approach).

Ø  Pressure we experience to apply and advocate "evidence based treatments" in order to distinguish our training from that of other allied professionals (including registered psychologists) who also do therapy. At times we may do "token" CBT to feel as if we have used out "clinical skill set", even though it may not feel like the right approach for a particular patient.
 

Ø   Limitations of current DSM nosology in informing treatment approaches. We discussed often finding psychodynamic diagnosis more helpful in formulating and guiding treatment.
 

Ø  We discussed the "art" of therapy, the way in which scientific psychology and clinical training fails to explore this. How do we develop this component of clinical practice?"

Adele wrote:

"Our discussion went round in a circle many times, which I think reflects the basic tension we are all grappling with between valuing the scientist-practioner model and knowledge gained from RCTs (and other group-based research) to the limitations of this and need to focus on the art of therapy with individual patients.

We felt that the idea of 'informed ignorance' mentioned in the article was important.  We felt that it was important to bear in mind the idea of science as the best model we have right now.  It is a scaffold - not the absolute truth which is applicable in the same way to every patient.  For example, in group-based trials, there may be some people who did not find a particular treatment (e.g. CBT) helpful, even though overall, on average, people reported improvements.  We thought about how this might impact on our view of individual patients who do not respond to an evidence-based treatment and disliked the term 'treatment resistant' - which seems to imply some kind of failing on the patient's part.  It was felt that holding an awareness of the limitations of the scientific approach in mind meant that we might listen out for the expertise brought into the room by our patients as experts of their own lives and experience.  At the same time, we felt that having some idea about whether a treatment works overall is a very necessary thing - otherwise we could be doing something that is not at all therapeutic.

The idea of sincerity both in research and treatment also came up.  We wondered whether the professional façade which we feel ourselves adopting at times is helpful - for example, are there times when self-disclosure or giving advice (both things we are trained not to do) are actually more helpful to patients than for example, using Socratic questioning? 

These are some of my recollections of our discussion - perhaps if one of the other group members had written it you may have received a very different answer!  But I hope that helps just to keep at least some kind of record of the issues that came up."

I wrote:

My recollection of my group discussion is that we started talking about the pressures to adhere to certain discourses when working within mental health services. We spoke about the hierarchical structures within such services, where psychiatry and medicine were privileged and how this could leave some professionals from a range of disciplines feeling as though they must adopt that language and way of working. 

This lead on to the issue of diagnosis and if, how, and when it was to be used. Again, the group spoke about the way that they felt they must use psychiatric diagnoses even at times when they did not feel it was therapeutically helpful. The way diagnosis is used as a financial metric, with which to distribute resources, was also seen as problematic and meant that some people played the 'diagnosis game', assigning whatever would attract services irrespective of whether the person met criteria or not. 

Next we talked a bit about research- the conflict between wanting to produce something that was seen as scientific (such as quantitative data) and often preferred by academic institutions, as opposed to something more meaningful (perhaps with qualitative data).  

Lastly we spoke about the difficulty we had in speaking two different 'languages' when working in mental health services. One where we speak with management and write reports from a conservative and narrow frame, and the other where we explore context, meaning, and the experiences of the people with whom we work. 

I am sure that I've left some bits of the conversation out and of course presented the parts I have included with my own biased interpretation. 

Critical approaches

What does critical mean anyway?

On this blog and at our meetings we will often talk about being critical or using critical approaches. Whether it’s in relation to psychology, psychiatry or another related field, we will be using the word in much the same way. But there may be some of you who are unsure what it really means and whether it’s something you want to get involved with.

So, in an effort things a bit clearer I thought it would be useful to offer a brief explanation.

To do so I have read the introductory chapter from Kagan, C., Burton, M., Duckett, P., Lawthom, R., & Siddiquee, A. (2011). Critical Community Psychology (1st ed.).

The word ‘critical’ is often used in common language to express opposition to or disapproval of a topic. A person who is a critic opposes and takes an ‘anti’ stance against all topics. As Kagan and colleagues write there is no method to this, just an individual voice saying whatever they like. This is largely destructive and not very productive.

Rather, the ‘critical’ we want to engage with is similar to the word critique and comes from the school of thought called critical theory. This group of scholars would critique a social phenomenon by applying a more general theory of human society, as it’s frame of reference. The purpose of this is to understand the phenomenon in terms of the contradictions that are inherent in society. For example you might apply a feminist theory of patriarchal practices to a local labour relations issue. By applying this broad, more general theory, you will understand the phenomenon differently to how you would otherwise have if you read it simply at face value. This may add to your level of overall understanding of that phenomenon and the critique will reveal the assumptions behind the phenomenon that would otherwise remain as unspoken rationalised truths. Some of these may be contradictory and not in the interests in a certain group in society and so social change may take place.

Critical approaches to psychology (and psychiatry) could therefore critique the cornerstones of the discipline such as the scientist-practitioner model, evidence based practice, psychiatric diagnosis, talking therapy, psychiatric medications etc. Really the list is endless. By critiquing these areas we do not necessarily oppose them, although we reserve the right to, but rather we hope to reveal the parts of the phenomenon that are excluded from or minimised by the dominant narrative.

If you are interested in watching critique in action then check out this Slavoj Zizek clip http://www.youtube.com/watch?v=mxrqzNpuf94 -the first 3 or 4 min in particular are great.