“Knowing Together” vs. “Knowing Apart”: The Importance of Extending Our Network

Carina Håkansson, PhD
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In the middle of a rainy Swedish summer, I am reading articles and blogs connected to the subject which is defined as “mental health,” and so I find myself feeling a bit “tired.” What is very obvious, when reading and pondering about mental health issues, is the psycho-individual perspective. For many years I have been aware of the increasing individual and psychological perspective in the Western world; still it makes me unhappy to notice this limited and to some extent narrowing focus described in articles, blogs, and also at conferences taking place all over the world.

Many researchers, practitioners and people with “lived experience” describe phenomena related to individuals, and most often related to psycho-individual ideas and “solutions.” In traditional psychiatry this perspective is very dominant, and Robert Whitaker describes in his books the increasing number of psychiatric diagnoses relating to individual symptoms and behavior, and the enormous increase of psychiatric drugs. He points out that an epidemic has taken place in the last decades.

The sad—and to some extent more concerning—thing, though, is that a kind of epidemic is occurring in the field of psychotherapy and psychology, with its increasing use of disparate approaches, methods, manual-based formulas and  different theoretical schools, each having their own understanding and different treatments. Psychotherapy has come to mean everything and at the same time nothing.

The increase of psychological ideas, assumptions, theories and approaches based on an individual perspective is spread not just in therapeutic contexts, but also within social services, schools, and among people in common. Far too often social, political and economic perspectives are left out, as for example the harm caused by poverty, war, and injustice in society—as illustrated by huge differences between standards regarding schools, hospitals and housing.

Instead of focusing on these issues, no matter which “category” we belong to, we tend to examine and describe from an individual perspective. More organizations connected to people with lived experience are created and finally getting a place on the official stage. This is altogether great; people who have not been heard before are taking, and to some extent being given, space for their important experiences to be acknowledged and heard.

BUT, my fear is that if those of us, no matter if we are defined as professional helpers, clients or their families,  miss the point, and instead of together trying to create a world built on equality, and justice we separate from each other by focusing on “our own idea”. For many years many of us have noticed the “fight” between different therapeutic approaches and how this fight rather has created a split than a strong movement.

For example, systemic family therapy was created as a reaction to the individual perspective some 50 years ago. Unfortunately nowadays in systemic practice and research you may often find people being described in terms of individual diagnoses. Individual-based methods and manuals are used no matter which theoretic understanding is presented.

It is high time for those of us working as professional “helpers” to find a way to not focus so much on our own specific approaches, theories and ideas, but instead focus on finding agreement on larger concerns. As much as each of us are influenced by our own history and context, we are also part of a large social and political context. These social and political issues have to be more acknowledged, and to be more taken into consideration.

The Family Care Foundation began with a vision to create a place that would be good for people, whether they be clients, their families, professional helpers or family homes. In other words; our vision wasn’t to create a method of treatment or produce a new theory. It was about something else; something that had to do with the conditions of people’s lives, our dreams, hopes and chances of creating meaning in our lives. It was about something that would give people the courage to live, and to promote the living part of ourselves. Our vision was built on the idea that we all contribute in different ways and that these contributions form a whole where each part is vital. Solidarity and each and everyone´s participation were essential from the very beginning.

Our practice has developed from people’s joint efforts, feelings, thoughts and deeds. There have been both moments and longer periods of deep anguish and uncertainty concerning the shared work, and our ability to survive as an organization. We’ve been questioned — and questioned ourselves — about what we’re doing. Is it really possible that so-called ordinary people can do what both psychiatry and social service “have failed at”? We’ve come to understand over the years how doubt and periods of self-examination are important. We’ve found a way to use this doubt and anxiety in practice, to listen to it and see it as an opportunity to comprehend something vital, something that creates meaning.

Still, today, the idea that we could create a living organization which consists of very different people coming from wildly diverse backgrounds is an amazing experience, which has affected my whole life. Influenced by a strong embodied feeling, we made the important decision when we started in 1987 that we would never do something we couldn’t stand for. No matter what happened we wouldn’t do it. We would rather shut down our operations. What brought us to this decision? The answer has to be that it felt so right, that intuitively we knew it was crucial. One of the most important decisions was to abolish psychiatric diagnosis and to support people to get off pharmaceutical drugs. It would not have been possible without being part of an international movement, taking part with other people´s experiences, courage and knowledge.

Either relational or social, political, and economical issues are not to be solved individually. It takes a lot of people to make changes – as is shown in history and also today. It takes a village to raise our children, just as it takes a connected and committed movement to make change happen.

I have a dream of a movement less focused on psycho-individual aspects and more focused on a wider perspective. In practice, it means we need to try to stop fighting about different psychological and theoretical approaches and methods and instead try to extend our understanding and network. It is important to find allies outside our “comfort zone.” We will have to extend our network and invite people who have  experiences other than “mental health” issues.  People who know something else about being human, and human beings, and human life conditions.  People who, in their daily lives, as well as in their political and social actions, know the importance of taking a stance, of cooperating, and of being connected in life and with other people.

While we as individuals may not become known, the chance to make real change, if we can come together in this way, will certainly increase.

* * * * *

Interview with Carina Håkansson

27 COMMENTS

    • Carina: I just posted on an another article today which ties in a bit with what you were saying.I felt like when I was hospitalized in 1989 that I was being singled out in a group dynamic that was not functioning completely well-a loosely based communal living arrangement where in we were left-wing political activists of various hues. I think that I now understand that I was too indirect in voicing my criticisms and acting out in a
      disconcerting manner. After having read Whitaker’s recent book and having participated for several years on MIA, I see where the drugging was the most expedient
      and cost effective measure to address my behavior. The books detailing of PR strategies and prescribing protocals, mirrors much of what I experienced with the choice
      Of medication given to me.’I would only add, that it seemed to me in the late 1980s and early 1990s that many film and television productions also contained a pro-medication message. I think that a lot of the concern here on MIA is to find less obtrusive measures to reintegrate people that don’t stigmatize and cause long term health problems.

    • Transgenerational trauma is trauma that is transferred from the first generation of trauma survivors to the second and further generations of offspring of the survivors via complex post-traumatic stress disorder mechanisms….” https://en.wikipedia.org/wiki/Transgenerational_trauma

      Perhaps much of the time when psychiatrists claim a person’s “mental illness” is clearly hereditary (i.e., passed down through DNA/genes), the “mental illness” has actually been passed down from parental PTSD due to transgenerational trauma?

      (The above would also imply that that the person’s “mental illness” is far more environmental/emotional than biological.)

  1. My own psychiatric treatment was extremely unsucessful; I was diagnosed worse at the end than at the start, and I was a very real threat to myself while I consumed strong drugs. My family were very supportive but I don’t know if family therapy would have ‘worked’.
    I notice I recovered the same way as a lot of people manage to recover – through ‘meditation and philisophy’. There’s a tendency to think one way works, but there are probably lots of common routes.

  2. This article is very good and thoughtful; yet we will never achieve success until we not only abolish psychiatric drugs, but also therapy and its children, CBT, DBT, ACT,psych0-social rehabilitation, vocational rehabilitation, sheltered workshops, supportive employment and other demeaning and demoralizing “things such as this.” What has happened at least in America is that which was created to assist an “intellectually disadvantaged” population; such as the “Special Olympics” was such created as now been extended to include those who are falsely considered “mentally ill” their symptoms usually exacerbated and created by drugging, therapy including therapies such as CBT and DBT. I have yet to forget how and why they would subject “high-functioning” ‘highly intelligent” college graduates or “could-be” college graduates to such utter nonsense as to demoralize and demean them by involvement in “places” that treat them as “if they were blubbering idiots.” I guess they needed a reason to “pump up their drugs and make them further into zombies.” Thank you.

  3. My belief is that we are all interconnected…I agree with you that we need to form connections and build bridges…this is our best hope. If we can be a part of things without trying to control or own the process or outcome, we can build on each others’ strengths…not easy…but so powerful…

    Cindy

  4. You write and speak thoughtfully, Carina Håkansson. I wonder, however, if you might share some thoughts on other dimensions of the frequent conflicts between psychiatric professionals and those who speak from experiential knowledge. Unless one happens to be independently wealthy, a care giver such as yourself must be paid, usually by some third party other than the client, and very often by medical insurance organizations that have no first-hand knowledge of what you do or who the client is as an individual. How does a third party develop confidence that what you are doing actually helps and works to a good end for people in distress? “Just trust me” seems a rather naive position to take in these things.

    A related issue pertains to the “how” or “process” of what you do. Care givers who are paid for their services are generally trained and licensed in some way. How does society or academia decide what their training should be? Or would you instead propose to abolish academic preparation of healers, as some at Mad in America seem to feel is needed.

    And finally, I would ask a question that has angered quite a number of people at Mad In America, in my commentaries on other articles. What are your thoughts on how society and professionals “get from A to B” — from the present prevalent conditions of largely drug-based practice or confinement of people who have experiences considered by family or the rest of us to be bizarre, to a more open system in which each patient is assessed and regarded as an individual within a matrix of supports? What needs to change in popular perception and public law to reduce the abusive excesses so often complained of at Mad in America?

    I write as a non-professional in the healing arts, who is never the less engaged as a website moderator and author in support to thousands of people who have chronic neurological pain. I have written at MIA and elsewhere in opposition to what I regard as the mythology of psychosomatic or “somatoform” medicine.

    Sincerely,
    Richard A “Red” Lawhern, Ph.D.

  5. Hi Carina,

    Congratulations on what you are doing in your network. To me, it sounds vastly better than what happens here in the USA. I have a couple of observations about your interview that might seem superficial or even silly at first, but I think that they may actually be very important for you and your clients.

    The first observation is that the clients in all of your photos look quite unhappy to me. Nobody is smiling. They look slumped and passive. You don’t say anything about “depression,” but I would guess that many of your clients would be described as “depressed,” at least in the non-professional sense of the word.

    Here is the second observation:

    At 4:58 into the video, you introduce your idea that you should no longer diagnose your clients and should no longer use psychiatric terms.

    You say that this is one of the best things you’ve done in your professional life.

    THEN… at exactly 5:55 into the video, you say these magical words:

    “It really made a change.”

    THEN… You SNAP YOUR FINGERS and you SMILE.

    I think that at 5:55 into the video, you are accessing something very important within yourself that is not available to many of your clients. I actually think that this is the core problem happening in at least many depressed people. If you are interested, see

    http://egg.bu.edu/~youssef/SNAP_CLUB/

    http://egg.bu.edu/~youssef/SNAP_CLUB/20150330164151576.pdf

    I also think that the idea of not using psychiatric terms is wonderful and, as you say, honest. I hang out at web sites where many people are very deeply identified with their diagnoses and even introduce themselves with a string of DSM categories and corresponding string of drugs. People, who, I am afraid, are in deep trouble.

    – Saul

  6. Hi Carina,

    Thank you for yet another engaged account of your ‘living organization’s’ shared practices, the openness to question the issues of social injustice not as ‘borderlands’ but as negations, oppression, exclusion, societal harms within wider groups of people. Even though it seems still be individuals harmed by the effects of structural oppression and negation who become guests in the families in the ‘living organization’.

    This may be due to the historical splitting between the treatment of ‘harmed individuals’ and – eventually (or not) – political measures to ameliorate social conditions, be it for economically, racially, trans-generationally marginalized sub-groups.

    A historical exception to this splitting between ‘therapy’ and ‘social politics’ sprang to my mind reading your above reflections and questions:
    The de-institutionalization of psychiatry in some regions in Northern Italy that became known and represented by the workings/writings of Franca and Franco Basaglia. The social processess unfolding in many steps in the development of ‘democratic psychiatry’ were/or became part of regional social politics.

    The diverse social groups engaged developed something else than a ‘mental health community’ in parallel to the regional communities, but reproductive processes in which different social actors and societal agents took part – exemplified by social cooperatives and the political will to create legal frameworks for these.

    It always stikes me that this – regionally restricted – societal inter-group relations and co-operative work changes had been brought about more by political action and a tradition of communist regional political powers than a usual narrower focus on the socialization of therapeutic relations and community allows to recognize.

    When I reflect on what different groups – therapeutic, communitarian, political – developed over many years – with Trieste as a kind of ‘centre’ of hope social and political action – I was and am being inspired and challenged to ‘understand’ these fundamental changes within the historical ‘context’ of the political struggles in Northern Italy. These social and political struggles are described in accounts of the history of worker co-operatives as related to the popularity and necessity of communist party groups in/from their long fight to resist fascism and its capitalists powerful agents in (northern) Italy.

    May be, I take a leap of faith here – but that may seem foolish, the overwhelming destructive powers of neo-liberalist unbridled turbo-capitalism in ever more corporocratic states, have re-produced historical moments in ever more regions where the oppressed, exploited, harmed, negated, abused majorities and radical leftiest, marxist or commune-ist political groups may rejoin in shared struggles for real societal and economic change.

    May be more of us are being forced to experience AND recognize that dispossessed, harmed, exploited groups (not just some particularly mad or breaking individuals), social solidarity bottom up and rightheous claims and fights for re-approprietion of ‘the commons’ and ‘co-operative economies’ are part of the same societal/intergroup dialectical struggles and transformations.

    Thus the splitting of ‘therapy’ and ‘political action’ can be revealed as an illusion that serves the re-production of capitalist service industries. In order to form alliances with ‘mass actors’ of real socio-historical change, one/the we’s/groups interested may indeed be inspired by history, from northern Italy plus many other regions.

    Over the last years I have come to no longer expect – and this is a reflective and a political standpoint – any meaningful societal change from re-groupings between/within corporocracy’s social/health/educational services or other industries. (Recycling, modernisation and expansion of global capitalism.)

    In order to build preconfigurative alternatives, imo (!), multiple groups of change agents need to come from righteously enraged and desperately hopeful groups of the marginalized people PLUS real allies who have decided to chose a commune-ist standpoint and join the struggle – as well as the ‘underground’ celebrations and parties.

    Squatting is a good thing to do, says David Harvey in a recent discussion: We should squat many more things and places. That is the nature of the radical and reflective standpoint I wish to highlight in times of upshooting corporocratic fascism.

    A long essay-ish comment grounded in long term work and praxis: seems I keep going to hit bottom. We are many down here – our realities don’t appear on tele or in tabloids. But we are many here…

    With warm wishes and radical honesty in solidarity,
    Ute

    • “Thus the splitting of ‘therapy’ and ‘political action’ can be revealed as an illusion that serves the re-production of capitalist service industries.”

      Activism is the best cure for depression. Justice is the best cure for trauma.

      We do need to get away from the neoliberal disaster we’re living right now and not only because of the impact on our psyche – we are about to destroy our planet. There’s a great writer who connects all these issues of oppression in an insightful way – I recommend Naomi Klein’s books, especially “Shock doctrine” and “This changes everything”.