A common response that I hear from practitioners, is that they cannot engage in therapy with some clients, because their issues stem from problems in the family, school or the wider community, and are still present. I can understand this, and can see how some traditional therapeutic approaches such as CBT may struggle when presented with an overly systemic issue.
However, what I have increasingly become aware of, is that it is hard to find situations where a mental health difficulty and a societal issue are not linked.
Anthropologist Tanya Marie Luhrmann adopts a similar view in her work with Schizophrenia and finds it “hard not to draw the conclusion that there is something deeply social at work“, and advocates for an approach that tackles cultural issues as well as the biological. She also goes as far to say that hallucinatory voices themselves are shaped by local culture.
In response to the government’s austerity policies over recent years, psychologists against austerity have highlighted 5 psychological pathways they term ‘austerity ailments’, specifically highlighting the consequences of austerity on mental health: i) Humiliation and shame ii) Fear and mistrust iii) Instability and insecurity iv) Isolation and loneliness and v) Feeling trapped and powerless. The report clarifies how these social stresses can impact on mental health. Within my work with asylum seekers and refugees the above ailments are particularly pertinent.
Working with people from different cultures has given me a unique perspective on mental health, and it is futile if cultural or systemic issues are ignored. Anna Leach picked up on the importance of taking into account culture and how neglecting to do so can result in offense and psychological damage. Similarly, in a BBC podcast Dr Pat Bracken suggests that the first place we need to start, when dealing with mental health problems of people from different cultures, is from their community and what they say are their needs and wants. Pat says that we should not impose our Western definitions and concepts of mental health onto others.
My view is that we need to adopt the same approach with all clients regardless of background. If we don’t truly listen, and don’t approach from a non-judgmental position then we can only impose our own views and diagnosis, and there is the likelihood that we begin to control rather than liberate.
Is there a place then for an attitude in mental health services, which says that a client is ‘untreatable’, because of unmet needs in their environment or society? Perhaps within particular types of therapy yes, but what this does highlight is the need for a different approach.
There are ways that mental health services can work with people who due to social/systemic issues may not fit neatly into prescribed therapies: We can firstly listen to our clients, to understand their needs and wants, rather than looking to define and diagnose in the first instance. We can then work alongside social and community organizations to advocate for our clients and support community interventions to address these wants. We can also be active in politics and active in trying to facilitate positive change at the political level. I admire the The Psychologists Against Austerity campaign which is one such approach. Finally, we need to remain critical of own approach, and continually question our intentions.