Sunday, September 8, 2013

Mad Science 2: Adjustment vs. Political-Humanist-Liberation Psychology

“Critical theory…sets out from a single intuition about the world – that the predominant values, institutions, representational schemata, and so forth of the prevailing social order are a distortion of the real, unjustly constituted in such a way as to prevent the world from becoming something other than it ‘is’; that is, from becoming what it ought to be…. [T]he critical theorist sets out…from a prior standpoint of normative sociological critique and existential refusal…. Confronted with a totality rooted in unfreedom, the critical theorist seeks to generate forms of knowledge and practice that are themselves ‘real’ – which is to say, adequate to the task of comprehending, and changing, the totality of existing social fact. The goal of critical praxis, therefore, is to liberate humanity and nature too from the brutalizing logics of power that prevent us from realizing our capacities and essence as free, creative beings.” – John Sanbonmatsu, Critical Theory and Animal Liberation, KL 157

“[M]ental disorders or problems pertain not only to the individual but also to the individual’s relationships with others. But if this is the case, then mental health should also be understood as a problem of social relationships – between people and between groups – which will provoke crises, depending on the case, within an individual or a family, inside an institution, or in a whole society.

It is important to emphasize that we are not trying to simplify a problem as complex as mental health by denying its personal roots or, in trying to avoid individual reductionism, replacing it with social reductionism…. But we want to emphasize how enlightening it is to change the lens and see mental health or illness not from the inside out but from the outside in; not as the result of an individual’s internal functioning but as the manifestation, in a person or group, of the humanizing or alienating character of a framework of historical relationships… From this perspective,…it may be that a psychological disorder is an abnormal reaction to a normal situation, but it may also happen to be a normal reaction to an abnormal situation.” - Ignacio Martín-Baró, Writings for a Liberation Psychology, pp. 110-111*
In this post, I continue to discuss the book Mad Science, but the post isn’t so much about the book specifically as using a critical evaluation of the authors’ proposals for an alternative psychiatric vision to illuminate the contrast between “adjustment” psychiatry/psychology and what I’ve come to call the Political-Humanist-Liberation or PHL approach to mental health (I admit, I like that it sounds like “full,” suggesting its comprehensiveness).1 Important PHL proponents have included Erich Fromm and Ignacio Martín-Baró, the liberation psychologist and priest murdered by a US-trained death squad in El Salvador in 1989. But its spirit isn’t found only in explicitly PHL writings, but in the work of people in the other social sciences, in history, in philosophy, and in literature.


So, as I talked about in my previous post, Mad Science is a worthwhile addition to the growing literature on psychiatry. It doesn’t break much new ground (aside, perhaps, from the extended discussion of the history and “evidence-based” evaluation of Assertive Community Treatment), but it contributes to the literature a focus on the specifically scientific failings and effects of biopsychiatry.

In my view, that’s sufficient for any individual book or article. I don’t believe that any of the authors of these critical works are obliged to provide either solutions to the problems they describe or alternative understandings of or approaches to “madness.” We don’t ask this of everyone debunking every form of pseudoscience, even when these relate to relieving suffering, and biopsychiatry is currently so powerful and harmful that revealing its failings and damaging effects is itself a valuable and needed service. Further, the obligatory attempts to provide alternative answers or proposed solutions frequently lead to a lot of tacked-on, half-baked ideas about how to “fix” things, often in lists in concluding chapters, that are at best naïve and at worst counterproductive and can detract from the power of the preceding critical analysis (see, e.g., Goldacre’s Bad Pharma and Harriet Washington’s Deadly Monopolies).

This doesn’t mean that we as a society don’t have to develop alternative understandings and approaches to “madness,” though. We do, and urgently, so I understand the impulse to include them in otherwise primarily critical books. The reign of biopsychiatry is coming to an end – it’s inevitable. As I’ve discussed, there are religious and other superstitious alternatives lining up to take its place. There are self-help charlatans eager to profit from people’s alienation. There are those with a rightwing political agenda all too pleased to attribute psychological distress and disruptive behavior to personal moral failings and weakness and to retain the coercive and eugenics aspects of biopsychiatry while abandoning any therapeutic impulse.

Talking about alternatives is also important to debunking itself. Debunking can happen and needs to happen even in those cases in which real solutions to real problems aren’t, or aren’t yet, available. We can and should, for example, work to debunk claims about the effectiveness of various alternative treatments in curing aggressive cancers even when there are no known effective cures. (This isn’t to say that a focus on cures alone is best; in many cases, contributing environmental causes should also be a focus.) It’s fine and good to debunk false and harmful explanations and treatments even when valid and useful ones aren’t known or available; and we can indicate the directions from which useful answers and responses are most likely to come, providing a general framework for investigation and action.

But it’s frequent that debunkers of biopsychiatry run into a wall of accusations that they’re necessarily denying the reality of psychic distress itself or claiming that distressed people are at fault for their suffering.2 The frequency of these accusations and their success at diverting people’s attention from the invalidity and harms of biopsychiatry is largely the result of the successful marketing of biopsychiatry and psychiatric drugs. Part of their marketing message has been that alternative – nonmedical or nonbiological - understandings of psychic distress are inherently moralizing or stigmatizing and that the only way to validate suffering as real and to remove its stigma is to treat it as a disease or disorder. These claims – like the core claims of biopsychiatry itself - are demonstrably false, and even if the debunkers were suggesting what they’re accused of suggesting, their failure to provide correct or adequate alternative understandings wouldn’t strengthen the case for biopsychiatry, either as a scientific field or as a political institution, in the slightest. But they make debunking biopsychiatry more difficult.

The success of these accusations is also to some extent the fault of the critics of biopsychiatry themselves. This isn’t to say that these critics are denying the reality of psychological distress and suffering. In my reading of this literature, I can think of vanishingly few if any cases of that sort of denial. Given how many of these critics are practicing psychiatrists or psychologists or victims of psychiatry themselves, it would be surprising if such denial were a prominent feature of the debunking literature. No, the weakness lies in their proposed alternative explanations and approaches, in the responses to the implicit or explicit questions, “Well, what do you think causes this suffering or these experiences or behaviors? What do you think is the best way to address them?”

The basic problem I’ve found with this critical genre is both scientific and political: it lacks an overarching social scientific and social justice vision and commitment. This can lead to a hodgepodge of proposed alternatives and to the acceptance of various bogus and irrational arguments, insufficient and in some cases potentially quite harmful. This is an issue at Mad in America.3 Worse, it can lead to responses that reflect and perpetuate an oppressive status quo.

Unfortunately, this is the case with the alternative vision put forward in Mad Science. First, the authors depoliticize and dehistoricize psychological suffering, abstracting it from real-world social structures and processes. Their “alternative vision of madness”4
recurs throughout history. It accepts of course the mental and behavioral consequences of well-defined diseases such as pellagra, neurosyphilis, Alzheimer’s dementia, or alcohol poisoning resulting in delirium tremens. It portrays madness not as a medical issue (disease/illness) or a phenomenon of nature as much as a human locus for a wide variety of existential struggles and deviant human actions. That conception requires a willingness to see the vast majority of mad persons, those whose behavior has not been scientifically linked to pathological processes, as poorly, sometimes very poorly, prepared actors (or sometimes evil actors) in a complex world, who try their best to deal with problems in living, sometimes very grave ones. (KL 7543)
Their model of madness and psychological distress describes these in terms of perennial, transhistorical “existential struggles,” conceiving of “traumas, fears, dilemmas, conflicts, and misbehaviors” as “inevitable parts of the human comedy” (KL 7974). They recognize that “human travail and anguish have many sources – poverty, bad parenting, troubled childhoods, and the common stresses of life” (KL 4867), but delink these from concrete social structures and historical processes.

In fact, Kirk et al. appear to endorse a sort of Social Darwinist notion that “existence is a struggle” in which the stronger succeed or just cope better than others. In this sense, the forms of distress and behavior that are deemed problematic are seen, in very capitalist terms, as evidence of poor individual coping:
In the old normal, one recognized that existence is a struggle, an effort to be engaged with the world. Everyone’s life had its ups and downs; people had strengths and weaknesses; and all experienced times of loss, disorientation and restoration, failure and resilience. Some dealt better than others with these challenges. This was viewed as part of the textured variation and diversity of human life. (KL 7974)
As this quotation suggests, just as they depoliticize social problems by reducing them to a vague existential condition, they abstract away from the social situatedness of individual experiences by suggesting that all humans face similar challenges.

Further, they seem largely to fail to recognize the definitions of psychological problems themselves as socially determined or used to label and control those who challenge the system. In discussing the various definitions of “mental illness,” for example, they leave unchallenged the common diagnostic criterion of (non-)“functioning” and how this coincides with capitalism's demands for work and submission to the logic of the system.5 They use terms like “deviant” and “misbehaviors” uncritically, appearing to accept our culture’s (and by extension any other culture’s) definitions of those terms while draining deviancy and rebellion and their labeling of political content.

The authors seem oddly eager to reassure the reader that their alternative vision “does not dismiss…personal responsibility” (KL 8013).6 For instance, they suggest at a few points that the public has been an enthusiastic partner in the selling of biopsychiatry and its drugs. People have wanted to believe in this model, they argue, not just because “the medical explanation of human travails provides comfort, solace, and hope,” but because “[i]t suggests that personal distress, inadequacy, and failure are really due to internal neurological defects that once fixed will eradicate these failings, much as antibiotics cure bacterial infections. It promises that people will not be held responsible for their failings” (KL 7948).

In other words, according to the authors a key reason people have embraced biopsychiatry is that it allows them to reframe their “personal…inadequacy and failure” as sickness and therefore not their fault or responsibility. The language of poor coping, of “failings” and “failure,” is used repeatedly, with the authors I believe at one point characterizing people experiencing psychological distress as having “failed at the game of life” (a remark I can’t find now – damn you, Windows 8 Kindle app!).

The conservatism of this vision is also evident in the role they envision for mental health professionals. Kirk et al. recognize, importantly, the destructive consequences of the fact that poor people often have to agree to a diagnosis of a mental disorder and to psychiatric drugs in order to have access to needed aid and services. In this context, it seems for a moment that they’re going to connect large-scale structural problems to people’s experiences and their psychological problems:
The problem is this: people who need assistance are labeled as mentally ill in order to receive income supports, health care, and social services. Why do so many people need assistance? The economy is stalled or spiraling down, fewer unskilled [sic] jobs are available and unemployment has increased, inflation-adjusted wages for the average middle-class family have not increased in two generations, record numbers of families have lost their homes, and services from nonprofits and local and state governments have been sharply cut in the Great Recession. Millions of adults and children, normally living in relatively precarious circumstances, are now under enormous social stress. This stress does not result from the increasing incidence of brain defects, but from economic and policy defects. (KL 7921)
This passage appears to reflect an understanding of the social sources of psychological troubles, as described, for example, in The Body Economic. Immediately, though, economic and policy problems are pushed aside as the authors respond from within their narrow vision. What’s needed to help these millions of struggling and suffering people, they argue, aren’t better policies but the “compassionate assistance” (KL 8013) of mental health professionals: “These people need opportunities and assistance, and social workers and mental health clinicians would like to help them with some of their problems so that they might seize opportunities or bear discomfort more constructively until circumstances improve” (KL 7921).

So what were previously recognized as economic and political issues are to a large extent reframed in terms of personal shortcomings. “Their” problem is that they have to learn to “bear discomfort more constructively” [!] and to be ready to avail themselves of the great opportunities that exist or will arise. Their problems are no longer pictured as the outcome of “enormous social stress” but as individual deficiencies and poor coping skills they can individually, with the aid of professionals, overcome. The problem isn’t with the system, but with individuals.

The role of mental health workers in this and other adjustment approaches is to help people deal with their nonspecific “problems in living” within the system. Mental health professionals should offer a compassionate ear and be the teachers of “life skills.” The authors, with a background in social work, see this as a positive and hopeful vision: “[P]eople can overcome adversity and improve their circumstances. This view accepts human pain and struggle as inevitable but within the abilities of people, perhaps with assistance, to overcome” (KL 4867). Mad or distressed people might need some help in learning to cope and compete in the game of life, but ultimately they're expected to pull themselves up by their own psychological bootstraps.

This vision – which instead of treating people’s psychological struggles and disturbances as meaningful responses to social conditions dismisses them as a lack of resilience in the face of the unavoidable difficulties of living – takes a similar approach to thinking about the sources of change in psychiatry. The authors devote considerable attention to leading figures within psychiatry like Allen Frances who’ve broken ranks, criticized some aspects of the model, or acknowledged problems in psychiatry. It’s often very effective to point out that even those socialized within and who’ve benefit from the system can be among the most effective forces for change. But they take a generally elitist view of historical change. They appear to expect – and want – change to follow the enlightenment of a rich and powerful man who makes it his mission to tell the truth about the model. (They actually suggest this as a hopeful scenario.) With their focus on elite insider-defectors and billionaire saviors, the authors largely ignore the critical voices of the psych rights movement and how their activism has been driving much of the work of critical psychiatry. These activists’ understanding of the personal and political meaning of their experiences is of little interest and appears to play no role in the formation of the authors’ vision.7

The authors of Mad Science claim that part of the allure of biopsychiatry has been that it sees psychological troubles as symptoms involuntary physical ailments and “not – as in former times – as signs of immorality, failure, or personal weakness” (KL 4867). But all they have to offer when push comes to shove is a rehash of those archaic notions, a model presenting distress and disturbing behaviors as reflecting immorality, failure, and personal weakness – the inability to cope with the stresses and demands of “normal events in the struggles of living.” In terms of understanding the causes and nature of psychological distress, this approach actually shares many of the weakest aspects of biopsychiatry.

Given a choice between these two sad, narrow alternatives – brain disease or personal inadequacy – it’s easy to see why many people might lean toward the former. But the fundamental problem with this vision isn’t that it’s an unappealing alternative to a pseudoscientific biopsychiatry, but that it’s wrong. It’s also ideological - of little utility outside of maintaining an oppressive status quo. In fact, while the authors of Mad Science present their vision as the classically humanistic, it’s really a selection of some of the worst elements of conservative-libertarian ideology. Theirs is a form of adjustment psychiatry, in a different universe from the political, humanist, liberation psychiatry-psychology of Erich Fromm or Ignacio Martín-Baró.

It’s interesting that the authors consider theirs a “broader” vision, more informed by philosophy, history, and the social sciences. Their
alternative view is that the array of misbehaviors, mistaken and disturbing feelings experienced by those now labeled with brain disorders are better viewed as normal human experiences in all their varieties, as described by scholars in sociology, psychology, anthropology, history, philosophy, and other disciplines that study the human condition, than by neuroscience. (KL 8000)
But as the phrase “normal human experiences in all their varieties” suggests, theirs isn’t a model that considers or seeks to understand the differences amongst the varieties, their causes or effects, but one that dissolves them all in the featureless category of “the human condition.” Their abstract and ahistorical vision is completely unlike historical and sociological understandings, which focus on the specific nature of systems, cultures, and social experiences and their positive and negative effects on the human psychological experience.

An inability or refusal to appreciate that societies can be psychologically pathogenic8 in general, with extremely damaging effects for oppressed people, leads the advocates of this model to locate the sources of psychological problems in individuals and to see the ideal of mental health as the successful adjustment of individuals to the system. As Fromm argued, the refusal to look critically at society leaves the proponents of adjustment psychiatry with two options: either a total cultural relativism in which mental health means successful adjustment to one’s position in whatever society one happens to live, or the patriotic assumption that, even if other societies have been and are currently unhealthy, the psychiatrist’s own society is the best of all possible worlds for all of its members. In practice, adjustment psychiatry’s advocates, including the authors of Mad Science, aren’t enthusiastic about making explicit the assumptions that underlie their model; but this silence on the subject with its implicit presumption of societal health serves the status quo and the interests of the powerful.

PHL models, in contrast, make no such assumptions, as described in the quotations that open this post. Rather than starting from the belief that a given society is conducive to mental health, the advocates of liberationist psychology begin with a focus on human needs and potentials. Societies are critically analyzed in terms of how they impede or facilitate the realization of these needs and potentials. In the words of Martín-Baró, “[O]ur subjective aspirations, both as groups and as individuals, must be oriented toward the satisfaction of our true needs…” (Writings, p. 121).

In PHL psychiatry, societies are criticized for their structures of oppression, which work against human (and nonhuman) fulfillment and create psychological problems. This essentially reverses the adjustment equation – instead of beginning with existing society and viewing mental health in terms of successful adaptation to it, PHL models begin with human well-being and judge societies on how well they contribute to or block its fulfillment. (My point isn’t that every one of us is entirely correct about what constitutes well-being or the best means of realizing human thriving, but that these are the normative and scientific point of departure for any real PHL psychology.)

Liberationists recognize that societies can and do have features (capitalist consumerism, for example) that work against general psychological well being and development. They seek to analyze how societies characterized by inequality, oppression, superstition, exploitation, violence, and trauma, with their associated racism, sexism, imperialism, homophobia, transphobia, ableism, militarism, and speciesism, can be pathological or pathogenic. Martín-Baró describes El Salvador’s repressive system in the 1980s, for example, as “the ‘normal abnormality’ that dehumanizes the weak and the powerful, the oppressor and the oppressed, soldier and victim, dominator and dominated alike” (Writings, p. 135). All of these structures have a negative impact on everyone in the society, including, importantly, those who appear to benefit from the system and who vigorously defend it.9

But they also appreciate that in societies characterized by inequality, oppression, and exploitation, people’s experiences and struggles are systemically, institutionally shaped. These visions are informed by feminist, antiracist, and anticolonialist work describing these structures and their effects.10 They can draw from a huge amount of research on the psychological effects of childhood abuse, of torture, of war, of sexual assault, of social and political marginalization, of prejudice and discrimination, of economic insecurity, of unemployment, of poverty, of indebtedness, of chronic illness, of harassment, of government violence,... And they recognize that these are structural problems that affect everyone negatively but affect people differently based on their social location. So, while the Mad Science authors argue that “there is no convincing scientific evidence concerning what causes people to feel or act in ways that are uncomfortable to themselves or bothersome to others” (KL 4304), PHL psychologists can point to very strong evidence of social sources of psychological distress.

Appreciating the social causes of psychological troubles naturally moves the focus away from individual-level explanations, both those locating these problems in biology and those pointing to personal character or inadequacies, and toward a psychosocial understanding. From this viewpoint, psychological suffering and madness are seen as symptoms not of individual but of societal malfunctions. C. Wright Mills’ classic statement about the sociological imagination applies here:
When, in a city of 100,000, only one is unemployed, that is his personal trouble, and for its relief we properly look to the character of the individual, his skills and his immediate opportunities. But when in a nation of 50 million employees, 15 million people are unemployed, that is an issue, and we may not hope to find its solution within the range of opportunities open to any one individual. The very structure of opportunities has collapsed. Both the correct statement of the problem and the range of possible solutions require us to consider the economic and political institutions of the society, and not merely the personal situation and character of a scatter of individuals.” (“The Promise,” in The Sociological Imagination)
These experiences and actions aren’t seen as evidence of personal weakness but as responses to, and possibly rebellion against, bad forms of human social organization.

Of course, in keeping with this expanded sociological understanding, PHL psychology also questions the definitions of deviance or misbehavior put forth by the powerful – their very conception of what constitutes a psychological problem. The history of psychiatry and psychology, and of politics more generally, is replete with the pathologization and marginalization of experiences and actions that challenged the social order. Rejecting sanctioned gender roles, being gay or transsexual or leftwing – these have all been labeled deviant, pathological, problematic experiences and actions. As noted above, in a capitalistic system, a “failure” or refusal to “function” – to work and to consume in the prescribed fashion – is viewed as a criterion for diagnosis. (Our current system, in which psychiatry functions as an ally of pharmaceutical corporations, adds new and terrible facets. The incentive to sell drugs encourages the creation of ever more alleged psychological problems. And as someone commented here a while back, political power and economic profit join hands.)

Furthermore, in connection with recognizing the political character of what’s defined as deviant and pathological, a PHL psychology is attuned to what’s defined as healthy and well-adjusted.

At the extreme end of the spectrum, in fascist and Stalinist systems, behaviors that we (mostly) now recognize as depraved were considered mentally healthy and normal. In my society, many elements of rape culture, militarism, consumerism and environmental destruction, and the killing of some other animals for sport or for food are normal, and certainly not seen as psychological abnormalities warranting therapeutic intervention.11

Clearly this is a sociological perspective, drawing on the wealth of findings by feminist and other scholars who’ve studied the psychological effects of living in conditions of inequality, oppression, fear, insecurity, violence, and trauma. But that doesn’t mean PHL psychology’s proponents cease to be interested in helping individual people. Many of the great PHL psychiatrists and psychologists have worked in clinical practice, andor written books containing advice and suggestions for troubled people. But this work isn’t individualizing. It doesn’t view or treat human psychological problems as wholly rooted in the individual psyche. The goal of PHL psychology is to help people recognize the sources of their troubles, including in the society they live in, and to thrive psychologically.

Adjustment psychology begins from the implicit premise that, well, even if society isn’t perfect, fighting for social change is outside the professional purview of the mental health worker. PHL psychology begins with a different understanding: since no individual can thrive while adapting to or trying futilely to transcend a systematically oppressive and unequal society, since oppressive social orders are psychologically harmful to everyone in them, including the oppressors, its project is inherently, unavoidably about changing the system – about fighting for and working together to create a society that will not only cease to systematically cause psychological harm but will foster psychological well being and true fulfillment.12 As Martín-Baró writes,
If the foundation for a people’s mental health lies in the existence of humanizing relationships, of collective ties within which and through which the personal humanity of each individual is acknowledged and in which no one’s reality is denied, then the building of a new society, or at least a better and more just society, is not only an economic and political problem; it is also essentially a mental health problem. (Writings, p. 120)
As Martín-Baró explains in the quotation at the beginning of this post, this doesn’t mean that individual troubles can all easily or directly be related back, much less reduced, to large-scale structural causes. The “brutalizing logics of power” show their effects in troubled minds, but the relationship between oppressive systems and psychological experiences and troubles is of course highly complex.

This vision, which puts psychology and psychiatry in the service of efforts to end oppression, recommends a very different professional role for the psychologist or psychiatrist. For one thing, those working in this approach look critically at the role of psychiatrists, psychologists, social workers, and researchers themselves in ideologically supporting and enforcing systems of oppression. They pay attention to the history of psychiatric theory and diagnosis – to how the cultural definitions of madness and of mental health have tracked and continue to track the interests of power and been used to control and discredit rebellion or messages of discontent.

In this context, they (self-)critically analyze whether the depoliticized model of “curing” itself serves the perpetuation of an unjust status quo. As Martín-Baró suggests in reference to addressing the trauma suffered by child victims of the civil war in El Salvador, psychologists should think about
what [they] accomplish while they are at work, particularly in situations like civil war. The curative work of the psychologist is necessary, but if psychology’s work is limited to curing, it can become simply a palliative that contributes to prolonging a situation which generates and multiplies the very ills it strives to remedy. Hence, we cannot limit ourselves to the question of what treatment is most effective for children who have suffered the traumas inherent in war; we cannot limit ourselves to discussing post-traumatic stress. Our analysis has to extend itself to the roots of those traumas, and therefore to the war itself as a social psychopathogenic situation. (Writings, p. 122)13
Equally important, PHL is attuned to the history and continuation of abusive practices. It rejects paternalistic, authoritarian, and coercive relations in psychiatric and psychological work just as in the broader society, recognizing that these aren’t conducive to the psychic health and growth of any party. Their ideal relationship with struggling and troubled people is one of respect and compassion, with prospects for mutual learning and growth, one which doesn’t fetishize any particular method. It’s one in which psychologists and psychiatrists listen to people in distress and take their experiences and the meanings they give them seriously rather than focusing on trying to “fix” people.

This is far from the easiest route. It’s not like people can be diagnosed with Capitalism Syndrome or Acute Patriarchy Disorder and given a pill or a few therapy sessions. There are financial and practical barriers to working in this way. But it’s the only form of mental health work that responds to the real problems in society, that offers these fields the possibility of contributing to genuine mental health – an ambitious vision of mental health that understands it not just as the absence of suffering but as true human fulfillment and thriving.

So, to summarize the differences between adjustment (of both the biopsychiatric and Mad Science varieties) and political-humanist-liberation visions:14

• Adjustment approaches begin by accepting the(ir) social order generally as natural and good, either explicitly or implicitly. They understand mental health as the successful adjustment to this social order. PHL approaches begin with real human needs, and understand mental health as the positive fulfillment of these needs. They compare, criticize, and challenge societies based on whether and how they promote or impede the realization of genuine human (and other animal) needs.

• Adjustment approaches individualize mental health: they understand mental health as an individual matter, particularly seeing psychological “disorders” as resulting from individual flaws or malfunctions. Psychological troubles are individual troubles. PHL approaches come from an explicitly political psychosocial perspective: they seek to understand mental health in terms of relationships amongst individuals and groups and sociohistorical structures and processes.

• Adjustment approaches abstract from individual and local contexts and experiences, ignoring systematic patterns of oppression and the resulting experiential differences for people in different categories and positions. PHL approaches focus on these structures and examine the resulting differences in experience.

• Adjustment approaches accept the dominant categories of abnormality and maladjustment and their negative valuation (as well as those of normality and well-adjusted behavior and their positive valuation). PHL approaches attribute no inherent value to these categories, and are alert to the role of this practice of categorizing experiences and behaviors in the perpetuation of oppressive social orders.

• Adjustment approaches ignore or deny that psychological-psychiatric theory and practice are political. PHL approaches recognize and confront this reality.

• Adjustment approaches envision the role of the mental health workers in individual terms: helping troubled or nonfunctioning individuals adjust, cope, and function by the standards of their society. PHL approaches view the role of mental health workers as working toward the realization of human thriving, which entails recognizing oppression and working for nonoppressive and liberating social relations.

• Adjustment approaches accept authoritarian and paternalistic relations in mental health work. PHL approaches view mental health work in terms of broader structures of oppression, inequality, and exploitation. They look to understand the ways their institutional or individual practices serve oppressive social relations, and work toward developing practices that help to ease suffering while contributing to a better society; this involves relationships of respect and mutual learning with people in distress.

*These two quotations are from Critical Theory and Animal Liberation

And Writings for a Liberation Psychology

All subsequent quotations from Marín-Baró are from the same edition.

1 While I recognize the institutional differences that exist today between psychiatry and other mental health fields, and among the nonpsychiatric fields themselves, I’m going to use “psychiatry,” “psychology,” “mental health work,” and the like interchangeably here. There’s no reason not to in this context: the proponents of both models can be found across fields.

2 I add “necessarily” to recognize that some debunkers are making these or similar suggestions, though most that I’ve seen aren’t. This is similar to the situation faced by atheist activists and others attempting to debunk the claims of powerful people and organizations. The attempt is made to make the discussion about the sort of people the debunkers allegedly are – heartless, callous, self-promoting, utopian,… - rather than about the strength of their arguments or the claims they’re debunking. It can be a very effective tactic.

3 I’ve seen wooish perspectives and claims of several varieties from the contributors to Mad in America. I understand and even accept the approach they’ve taken: they clearly want the site to be a welcoming space for a variety of perspectives, where diverse understandings can be aired, considered, respectfully debated, and sometimes rejected. I’m actually OK with that, and so far I think the desire to provide a space for the marginalized voices – especially for the victims of psychiatry – has been fruitful. (Even the Vatican conference I was concerned about received an honest and critical evaluation from some of the participants.) However, there need to be more perspectives that are knowledgeable about and engaged with the PHL tradition with its scientific and political commitments.

4 Throughout, the authors present theirs as “the” alternative, as though others haven’t existed.

5 They almost take note of it at one point, in a discussion of Assertive Community Treatment in which they describe how people might have their refusal to work at some no doubt boring and repetitive job coded as “apathy” rather than an assertion of their will. But then they don’t investigate or remark further on how central paid labor is to the psychiatric vision of mental health and how pushing people to work is considered a part of psychiatric treatment.

6 This emphasis leads me to wonder who their expected audience is. Their vision appears to show the influence of the libertarian Thomas Szasz, and it seems they expect the reader to share those libertarian biases.

7 It is to their credit and important that the authors do address psychiatric coercion. Unfortunately, they ignore the voices of the psych/human rights movement on this subject.

8 I’m of course using the term metaphorically.

9 This is an important point to which I’ll return in my next post on the subject.

10 It shows how successful psychiatric propaganda-marketing has been that so many people are familiar with and often refer to this literature but then don’t use it in their thinking through of psychiatric assumptions and claims.

11 This position doesn’t assume that all behavior labeled problematic is wrongly so or that all behavior viewed as consistent with mental health is wrongly so. Nor does it, as I’ve pointed out in the past, reflexively celebrate what’s considered deviant or problematic in the prevailing social view. The point is that PHL psychology doesn’t uncritically accept a society’s dominant definitions of healthy/normal vs. deviant/problematic. It appreciates that in societies characterized by various axes of oppression, the categories of psychology, like those in any other realm of culture, will tend to justify and perpetuate the system and the status quo. As discussed above, the normative starting point for PHL is real needs for well being, freedom, and fulfillment rather than the needs of the system people happen to be born into. In this view, socially defined categories of normal and abnormal don’t have any necessary normative meaning – an experience or action that’s normal, statistically or culturally, in any given society doesn’t have any claim to being psychologically positive on that basis.

12 While a PHL approach rejects the medical model of psychiatry as scientifically unfounded and harmful, it has much in common with social medicine.

13 It’s interesting that by this time – the mid-1980s – the concept of “post-traumatic stress” itself had already become so fully depoliticized that Martín-Baró could use it in his contrast of a narrowly curative approach to trauma with his own conception of “psychosocial trauma.”

14 The contrast is somewhat overstated, to be sure, but I think it captures the essential differences.

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