There is an interesting parallel to SH's work in the much larger
programmes led by ELizabeth Lira (ILAS, Chile) and others in Latin America
who have worked with torture victims AND their families and social
networks AND intervened in society, most notably to combat the culture of
forgetting and impunity.  While we do desperately need more examples,
models, practices, praxis,  that start  from the social and societal - I
don't htink their kind of inspiring work would have been possible without
starting from individual experience, and while not letting up on the
social causes and the need to de-individualise the experience of trauma,
they have treated the individual too.  In this they combine both
ameliorative and transformational approaches.  We have written a bit about
this and provide references at
http://www.compsy.org.uk/PSLarticle3final.pdf  (JCASP (2005) 15, (1),
63-78.)
I suppose what I'm saying is that we need to think dialectically about
these issues - it isn't simply a matter of being in favour of 'solidarity
based' approaches and rejecting those rooted in therapy - it is a question
of both 'horses for courses' and of nesting approaches within others -
having a more systems based notion of the linkages, interdependencies,
contradictions and synergies.
Mark



> Hi Annie,
> A few of us have been thinking recently about "solidarity based sense
> making" as a form of social justice intervention as praxis and in terms of
> finding new non medical ways to think about 'stress' but I see the promise
> of this approach as getting away from clinical and therapeutic ways of
> thinking and acting. Inspiring though SH's work was I don't think we needs
> to go back to social action psychotherapy to engage in "solidarity based
> sense making"
> David
>
> ________________________________
>
> From: The UK Community Psychology Discussion List
> [mailto:[log in to unmask]] On Behalf Of Annie Mitchell
> Sent: 21 October 2007 14:20
> To: [log in to unmask]
> Subject: Re: Mental Health Policy
>
>
>
> Re Richard's point about solidarity based sense making, does anyone have
> any up to date knowledge of/ references to the work of Sue Holland ( from
> social abuse to social action)?
>
>
>
> Annie
>
>
>
>
>
>
>
> Annie Mitchell
>
>
>
> Clinical Director,
>
> Doctorate in Clinical Psychology,
>
> School of Applied Psychosocial Studies,
>
> Faculty of Health and Social Work,
>
> University of Plymouth,
>
> Peninsula Allied Health Collaboration,
>
> Derriford Road,
>
> Plymouth,
>
> Devon
>
> PL6 8BH
>
>
>
>
>
> Phone  Programme Administrators:
> Jane Murch, Emma Hellingsworth
>
> 01752 233786
>
>
>
> Please note I  work 3 days per week:
>
> usually Monday, Tuesday & either Wednesday or Thursday.
>
> -----Original Message-----
> From: The UK Community Psychology Discussion List
> [mailto:[log in to unmask]] On Behalf Of richard pemberton
> Sent: 21 October 2007 13:20
> To: [log in to unmask]
> Subject: Re: Mental Health Policy
>
>
>
> I think this letter is very good. But continuing to plow my 'positive'
> theme. Just suggesting that takling income inequality is the best primary
> prevention measure begs all sorts of interesting questions. Its an
> ecomonic remedy for the human condition? What are we saying are the other
> effective ways? Layard and Johnson are surely just mirroring all sorts of
> interesting cultural norms and the sucess of psychology and psychiatry in
> giving a language and licence for new frameworks for understanding despair
> madness and fear. Whats obviously missing is the social context for all
> this. Just to reverse the polarity and say its all social and economic is
> equally strange and limiting? .
>
> The way I am manging this in my job is to ask what needs to be in place
> for this Layardism not to bounce? Hence step zero. How do we increase
> opportunities for solidarity based sense making? How do we set this in a
> reasoned public health agenda where the levles of 'social recession' in a
> particular locality are known and well understood. Layard himself really
> is trying to get into this. If people have been given a meaningful choice,
> I am pretty relaxed if people want help with their 'bad thinking'.
> Sometimes I need help with my own. When I was a therapist I surprised by
> how helpful people found it to learn to stand outside themselves. People
> who were very low benfited much more than I would have expected from for
> example keeping a diary. I dont think I was contributing to their
> oppression. What I think is important is the connectedness between
> individual and social spaces and experiences good and bad
>
> This involves changing the way we think about them and live within them.
>
> I wonder if people have read the royal college of psychiatry document
> recovery a common purpose. This invites a complete rethinking of practice
> and education. Its much more first person than third person and seems to
> me to be explicitly social model based.  One report doesnt represent a
> summer. Its dead interesting though that something as social as this is
> coming out of psychiatry.
>
> After I gave my talk on recovery wellbeing and positive psychology last
> week.  I was approached by a member of the audience to say that they were
> about to set up a local community psychology network! Something definately
> seems to be in water.
>
>
>
> Richard
>
>
> On 10/21/07, julie bird <[log in to unmask]> wrote:
>
> Mark (and all)
>
> ..... 349 words... cut and paste.. but it might not be the cut and paste
> job that you would have done...
>
> (i'm getting caught up in wondering whether how we have signed suggests,
> however subtly, that you are either a 'service user'/survivor, OR an
> academic etc etc...  am i going off on one here, or does anyone else think
> this is what could be read?does it matter? would be nice to know what
> others think).  is it pedantic again? i'm not sure..
>
> Changing politicians' minds about changing our minds?
> We write in response to the Health Secretary's recent announcement that
> £170m is to be made available by 2010 to increase the availability of low
> intensity, high volume, psychological interventions. At present Cognitive
> Behaviour Therapy (CBT) is the preferred approach.   While we welcome the
> belated recognition of widespread emotional distress in our community, and
> applaud the government's willingness to spend public money on it, we have
> a number of serious reservations about the approach adopted.
>
> CBT, and all like treatments, individualise social problems, draw
> attention away from the more important social, economic and material
> causes of distress and propose individual cognitive dysfunction as both
> the cause of people's problems and as the most appropriate site for
> intervention.   Using a medicalised metaphor of 'illness' to describe
> human misery distracts attention away from the noxious effects on persons
> of structural poverty, unemployment, job insecurity, violence, abuse,
> racism, sexism, inequality and consumerism (among others) which are the
> root causes of human distress.
> Briefly, the scale of socially caused distress is so vast, and growing so
> rapidly, that it is impossible to 'treat it better', let alone 'cure' it,
> as Mr Johnson and Lord Layard have suggested, by training more therapists.
> It is, simply, not feasible to treat all of those in distress, one at a
> time, with any therapeutic technique.
>
> The approach announced is, we argue, not only conceptually misguided, but
> also likely to be socially and economically wasteful of scarce resources.
> Even assuming therapeutic success, when 'treated' many or most distressed
> people will return to the same psychologically toxic environments that
> produce distress and will be subjected to the same causes of distress all
> over again. CBT and associated approaches are thus comprehensively
> problematic. Primary prevention of distress at a society-wide level - not
> the 'cure' of individuals - is the only way to substantially reduce
> socially, economically and materially caused misery.
> Contemporary research shows that reducing income inequality in our society
> would be just one of the most effective ways to reduce psychological
> distress and physical ill health - not just for the disadvantaged - but
> across society in general.
>
> ________________________________
>
> Date: Fri, 19 Oct 2007 21:23:57 +0100
> From: [log in to unmask]
> Subject: Fwd: Mental Health Policy
> To: [log in to unmask]
>
>
>
> All
> Looks like I have a busy weekend.......
> M
>
> PS My affiliation and grandiose title not self-serving, all the papers
> seem to insist on a daytime phone number and address ;)
>
> ---------- Forwarded message ----------
> From: [log in to unmask] < [log in to unmask]
> <mailto:[log in to unmask]> >
> Date: 19 Oct 2007 11:42
> Subject: Re: Mental Health Policy
> To: Mark Rapley < [log in to unmask] <mailto:[log in to unmask]> >
>
>
> Dear Mark
> Thanks. It's an interesting subject, but I'm afraid far too long at its
> current length; the letters we publish are a maximum of 350 words. If you
> would like to cut it and resubmit I'd be happy to look at it again.
> Jane
>
>
>
> "Mark Rapley" <[log in to unmask]> 19/10/2007 11:29
>
> To
>
> "[log in to unmask]" < [log in to unmask]
> <mailto:[log in to unmask]> >
>
> cc
>
>
>
> Subject
>
> Re: Mental Health Policy
>
>
>
>
>
>
>
>
>
>
> Dear Jane
> As requested.
> Best wishes,
> Mark
>
>                                                 19th October 2007
>
>
>
>
> Dear Editor,
>
> Changing politicians' minds about changing our minds?
>
> We write in response to the Health Secretary's recent announcement that
> £170m is to be made available by 2010 to increase the availability of low
> intensity, high volume, psychological interventions. At present Cognitive
> Behaviour Therapy (CBT) is the preferred approach, to be delivered at
> primary care level to adults of working age, by people who have some basic
> training.
>
> While we welcome the belated recognition of widespread emotional distress
> in our community, and applaud the government's willingness to spend public
> money on it, we have a number of serious reservations about the approach
> adopted. Briefly, the scale of socially caused distress is so vast, and
> growing so rapidly, that it is impossible to 'treat it better', let alone
> 'cure' it, as Mr Johnson and Lord Layard have suggested, by training more
> therapists. It is, simply, not feasible to treat all of those in distress,
> one at a time, with any therapeutic technique.
>
> Even if we could train enough practitioners, there is good reason to
> believe that one-to-one talking treatments administered by professionals
> are mostly only marginally effective. While it is certainly the case that
> a wealth of evidence exists to suggest that professionally-delivered
> therapy, in the hands of some practitioners, for some people, may be of
> some benefit, effect sizes tend to be small. However, and the widely cited
> NICE Guidelines overlook this, the research base is also clear that not
> only may lay people be as effective as professionals in delivering help
> through talking and listening, but also that all talking therapies are
> effectively equivalent, and equivalently limited, especially for those in
> the most difficult living circumstances.  This is so even when delivery is
> organised through the stepped care model that runs from use of self help
> guides to full therapeutic interventions.
>
> That is to say, not only is the effectiveness of CBT and kindred
> interventions - in any hands - widely exaggerated, but they are impossible
> to apply in many 'real world' situations and with many people. Indeed the
> widely reported 'cure' rates in the studies relied on by the government
> and its advisers are, actually, quite likely an artefact of the highly
> controlled nature of the randomised controlled trials (RCTs) which purport
> to demonstrate their effectiveness. As with all such clinical trials, RCTs
> by their very design can not, and do not, reflect the 'real world' where
> treatment is actually applied. As such, framing policy via reliance on
> their artificially-inflated success rates is either scientifically naive
> or politically expedient, or both.
>
> Moreover CBT, and all like treatments, individualise social problems, draw
> attention away from the more important social, economic and material
> causes of distress and propose individual cognitive dysfunction as both
> the cause of people's problems and as the most appropriate site for
> intervention. We note that a compelling account of the factors which have
> produced the present, and remarkably recent, 'epidemic' of individual
> cognitive dysfunction seems to be absent from the analyses that government
> has offered to date. We also note that the relentless focus on the
> individual, and their supposed cognitive deficits, illicitly employs a
> medicalised metaphor of 'illness' to describe human misery and thus
> distracts attention away from the noxious effects on persons of structural
> poverty, unemployment, job insecurity, violence, abuse, racism, sexism,
> inequality and consumerism (among others) which are the root causes of
> human distress. It is, surely, bad enough to be depressed because of
> difficult living circumstances or to be anxious because you are subjected
> to regular domestic violence, without currently popular theory suggesting
> your depression or anxiety are caused by your own irrational thinking.
> Blaming the victim like this simply proffers therapeutic ritual as a cure
> for societal oppression, whilst at the same time placing responsibility
> for distress and its' resolution onto the individual.
>
> The approach announced is, we argue, not only conceptually misguided, but
> also likely to be socially and economically wasteful of scarce resources.
> Even assuming therapeutic success, when 'treated' many or most distressed
> people will return to the same psychologically toxic environments that
> produce distress and will be subjected to the same causes of distress all
> over again. If they do not go back into immediately toxic contexts, there
> will still be a flood of newly damaged people as a result of the
> persistence of the social causes of distress ignored under present mental
> health policy settings. CBT and associated approaches are thus
> comprehensively problematic. Primary prevention of distress at a
> society-wide level - not the 'cure' of individuals - is the only way to
> substantially reduce socially, economically and materially caused misery.
>
> To be effective, primary prevention necessitates social not cognitive
> change. Contemporary research shows that reducing income inequality in our
> society would be just one of the most effective ways to reduce
> psychological distress and physical ill health - not just for the
> disadvantaged - but across society in general.
>
> Signatories
>
>
> Julia Bird, Jan Bostock, Mark Burton, Julie Chase, Deborah Chinn, Paul
> Cotterill, John Cromby, Dawn Darlaston-Jones, Bob Diamond, Paul Duckett,
> Suzanne Elliott , Michael Göpfert, Dave Harper, Carl Harris, Carolyn
> Kagan, Valeska Matziol, Steve Melluish, Annie Mitchell, Paul Moloney,
> Moira O'Connor, Penny Priest, Mark Rapley, David Smail, Janine
> Soffe-Caswell and Carl Walker on behalf of the UK Community Psychology
> Network, a group which includes academics, campaigners, mental health
> service users and survivors, health and social services managers, clinical
> psychologists, students and volunteer workers.
>
> Mark Rapley, PhD,
> Professor of Clinical Psychology,
> Programme Director - Doctoral Degree in Clinical Psychology,
> School of Psychology,
> University of East London,
> London, E15 4LZ,
> U.K.
>
> Tel:   +44 (0)208 223 6392 (Direct)
> Tel:   +44 (0)208 223 4567 (Messages)
> Tel:   +44 (0)7951 908409  (Mobile)
>
>
> On 19/10/2007, [log in to unmask]
> <mailto:[log in to unmask]> <[log in to unmask] > wrote:
>
> Please could you resend this letter as an email; we are unable to accept
> attachments.
> Jane Campbell
> Letters
>
> "Mark Rapley" < [log in to unmask] <mailto:[log in to unmask]>  >
>
> 19/10/2007 10:40
>
>
>
> To
>
> [log in to unmask] <mailto:[log in to unmask]>
>
> cc
>
>
>
> Subject
>
> Mental Health Policy
>
>
>
>
>
>
>
>
>
>
>
> Dear Editor,
> I attach a letter for publication from the UK Community Psychology
> Network.
> With best wishes,
> Yours sincerely,
> Mark Rapley
>
> http://www.independent.co.uk/
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