Over-stressing Stress: American Psychological Association Report Omits Oppression

14
6597

This month the American Psychological Association (APA) released its report, “Stress in America 2023: A Nation Recovering From Collective Trauma.” This was a follow-up to a similar report in 2020. The report was based on a nationwide survey of 3000 Americans 18 years or older by the Harris Poll. The results of the report were alarming and concerning. It found a significant impact on well-being due to the post-traumatic effects of the COVID-19 pandemic and growing numbers of people impacted.

For example, for those ages 35 to 44, there was an increase in chronic health conditions from 48% in 2019 to 58% in 2023. The same age group reported an increase in mental illness from 31% to 45%, although the highest rate of 50% was reported in the age group of 18 to 34. Nearly a quarter of adults rated their stress between 8 and 10 on a scale where 10 means a great deal of stress, up from 19% in 2019 before the pandemic.

A hand erases a chalk drawing of the world surrounded by stick figuresOf particular note is what respondents indicated were the most significant causes of stress. Stress was due to increased financial strain on their household, money as cause of fights in their family, and feeling consumed by worries regarding money. Though the focus of the report was on COVID-19, the role of stress was extended to other factors. Global conflict, racism and racial injustice, inflation, and climate-related disasters were also noted as playing a role.

As suggested by the title of the report, the sole explanation for the range of adverse consequences on well-being was trauma-related stress. This is made explicitly clear in the repeated references to the long-term impact of stress on various physiological systems of the body and associated emotional and psychological effects, the negative consequences of lacking or ineffective coping skills, and the need for individuals to better understand stress and develop sound stress management skills.

A closer examination, however, reveals that the report commits a serious error in failing to accurately understand the more significant factors responsible for the high levels of stress reported by the respondents and its deleterious impact on their physical and mental wellbeing. By employing this framework, the APA  perpetuates mainstream psychology’s harmful denial of the political uses of its theory and practice and veils the far more potent role played by neoliberal ideology in causing the substantial suffering reported in the survey.

In a previous blog, I made the argument that oppression originating in unjust social structures and practices is the single greatest factor contributing to human suffering. However, once again in this report its destructive impact is neglected and actively obscured by psychology in the service of neoliberal ideology that advocates extreme self-interest, competition, over-consumption, and greed.

The widespread destructive nature of neoliberalism on human welfare has been observed by numerous others. A recent example is the work of the medical anthropologist, James Davies, who details how medicalization, the ever-expanding use of pharmaceuticals, and a consumerist philosophy based in modern capitalism has depoliticized our mental distress while driving higher levels of suffering. Neoliberalism has led to a growing disparity in wealth and income, expanding and crippling levels of debt, low wages, an undermining of social programs, and insecure employment.

Given this, it is no surprise that issues of financial strain and anxiety and conflict regarding money were the most significant stressors reported. Despite this, the fundamental role played by neoliberal policies in inflicting damage on respondents receives absolutely no mention. Instead, APA’s chief executive officer, Arthur C. Evans Jr., Ph.D., states, “To move toward post-traumatic growth, we must first identify and understand the psychological wounds that remain.”

The report thus continues to perpetuate the highly individualistic bias of neoliberalism that essentially blames individuals for their affliction, while also making them responsible for resolving their problems. The explicit use of the language of “mental illness” aligns its analysis with a biomedical model.

This same individualistic, illness-based bias is evidenced in an article, “Stress in America 2021,” which described the how physical health was harmed by individuals’ inability to cope in healthy ways with the stress of the pandemic. Examples included undesired weight gain, increased alcohol use, and poor sleep. The so-called solutions proposed were identifying and changing unhealthy habits. Similarly, the 2023 report blamed respondents by noting individual factors that interfered with effective coping, such as reluctance to talk about stress with others, overestimating one’s level of well-being, and downplaying the impact of stress.

An utter neglect of how the physical and mental health problems were not the result of personal failure, but predictable and justifiable responses to unhealthy material and social environments is also exposed in the 2020 report. This can be found in the host of examples of advice for coping with stress. Some examples illustrate this. For “How to support students”: Create a space for students to talk about the things that are bothering them, even if those things are not related to school or schoolwork. For “How to support Gen Z”: Create traditions for Gen Z that celebrate milestones in new ways. They can be the generation that reinvents society by creating new celebrations and traditions that are meaningful.  For “How People of Color can build resilience”: It’s to be expected that people feel stressed, angry, outraged, frustrated or a host of other feelings because of systemic problems. Acknowledge those feelings and do what you can to take care of yourself as you continue to cope and manage in today’s reality.

These trite and tone-deaf recommendations are akin to those noted by Davies in his discussion of programs designed to silence worker discontent or decrease unemployment. Emphasis is placed on personal motivation, change, and responsibility. He states that they are a form of  phony empowerment “…found in the trite aphorisms of the self-help industry where popular psychologists as ascribe to us almost magical abilities to alter circumstances despite the harsh realities constraining us.”

Extensive research has been done on the role of social determinants of health or the conditions in which individuals are born, grow, live, work and age on a wide range of indicators of well-being. These determinants include physical environment, access to food, education, employment, and health care. The risk posed by social determinants is not equitably distributed throughout society, but vary significantly across different populations. These inequalities are aligned with disparities in political, economic, and social power, created and maintained by the prevalent neoliberal ideology. Societies with high levels of inequality experience over twice the amount of mental distress as those with lower levels of inequality.

A consistent finding of this research is that stress plays a mediating role in producing the adverse consequences of higher rates of morbidity and mortality. The experience of inequality, such as feelings of shame, anger, and inferiority, and the imbalance between demand and control for those occupying lower status in society, all demonstrate that mental distress is determined by psychosocial factors. Stress is a link in this process whereby inequality gets under the skin or embodied, but not the ultimate determinant.

By attributing causality to stress, the APA is not only practicing bad science, but also engaging in mystification. Mainstream psychology and psychiatry both are complicit in using their power to negate the experience of individuals regarding the causes for their suffering. This is accomplished by creating plausible misinterpretations about why certain things happen to them that veil the impact of oppression and legitimize and protect the status quo.

A range of strategies are used, many of which are evidenced in attributing suffering to stress. These include portraying suffering as due to impersonal and natural causes that are not subject to moral condemnation; focusing attention on individual responsibility to address the problem; and peddling market-based solutions that foster consumption of products and services of the healthcare industry. Further, this secures the consent of the oppressed  which stifles both awareness of their exploitation and abuse and subsequently resistance to unjust practices.

This critique of concepts such as trauma, stress, and resilience as reinforcing neoliberalism has been observed by others. It has been found to be especially detrimental to historically colonized, exploited, and marginalized communities. Alternative models and approaches have been proposed that take into account the need to move beyond the dominant and narrow focus of individualism in order to take into account the role of historical and social-political factors that impose and uphold systems of oppression and inequality.

An article in American Psychologist in 2023 by McLean, Fish, Rogers, and Syed proposes an Indigenist Ecological Systems Model. This model is proposed in order to go beyond simply looking at larger structural contexts, such as legal and educational, by including the systems of power that shape those contexts. The model promotes narratives of resistance that respect the capacity of individuals to resist, transform, and thrive in the face of adversity will also engaging collective resistance communities.

Another example is the Psychology of Radical Healing advanced by Adames and his colleagues. Like the previous model, it opposes locating problems in individuals and not in systems of oppression and social determinants of health. It integrates liberation psychology, ethnopolitical psychology, black psychology, and intersectionality. Psychologists work mutually with individuals to cultivate critical consciousness regarding the impact of oppression on them, cultivate both self and cultural knowledge, encourage radical hope envisioned in possibilities, and working individually and collectively toward achieving strength and mounting resistance.

Approaches such as these are essential to demystifying the true causes of suffering inflicted by a death-affirming neoliberal ideology. The interdependence of compassion with a commitment to justice is essential to truly serving the growing number of individuals suffering at its hands.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

***

Mad in America has made some changes to the commenting process. You no longer need to login or create an account on our site to comment. The only information needed is your name, email and comment text. Comments made with an account prior to this change will remain visible on the site.

14 COMMENTS

    • Thank you for your positive feedback. As a parent of a disabled young adult, I agree and understand. A great deal of stress is created by adverse social and economic factors that make it difficult to provide care and services to those with disabilities as well as the discrimination and stigma which society places on those with disabilities as well as their families. I wish you well.

      Report comment

  1. Excellent read and I think this may also relate in some aspects to this discussing anxiety vs. stress from a family and emergency department physician:

    – Anxiety vs. stress: The right definition will lead to better mental-health care –

    ““It seems like every new patient includes anxiety in their personal medical history,” says a co-author of this article on patients in his family practice. But when commenting on their symptoms, he notes patients generally make statements of social stress: bullying by their bosses; the difficulty of their home lives; or in one memorable case demanding, “What are you going to do about my loneliness?” Other physicians have noted a similar phenomenon, with patients lamenting that “every hobby has to be a side-hustle,” “nobody just plays anymore,” and “people have fewer friends than ever before.”

    These are not symptoms of psychiatric morbidity (anxiety disorders) but rather social stressors and using medications to resolve them is likely poor care.” …
    https://healthydebate.ca/2023/11/topic/anxiety-vs-stress-right-definition/

    Report comment

    • Thanks for your positive comments. Often those who are experiencing anxiety and stress will also experience physical symptoms associated with both. As a result, they will go to their physicians for help. Because of the dominant biomedical model, the social factors such as the ones you note go unaddressed–even when persons raise them. Instead, again as you observe, a biological treatment is used that fails to resolve the problem. In the current adverse climate created by neoliberalism in which so many people are exploited, over-worked, discriminated against, and outright oppressed, it is imperative that all health care worker broaden their scope and accept their responsibility for first validating the impact of social sources of suffering and second finding ways to oppose injustice.

      Report comment

  2. Thank you for this. I am currently doing my Master’s in Social Work and already beginning to feel like we are just putting a band aid on wounds which are not even being acknowledged aka the systemic oppression you highlight here. I do still think that working with individuals to help them with trauma is important and valuable, however agree that the systems which cause much of the trauma are still in place and because the oppression is more subtle, the individuals are still “blamed” and this causes ongoing internalizing which perpetuates and compounds existing trauma. I would love to read more of your articles and see what propositions you have regarding change in society as, until this point in history, most political change simply uses the people as pawns, gets them riled up with promises of a new life and freedom, then very little changes once the new system has gained power.

    Report comment

    • Thank you for your positive comments. I am glad to hear that the position I take resonates with your own experience and values. We definitely need more people working with those who are suffering who are attuned to the sometimes profound impact that systemic oppression has on their well-being. I agree that working with individuals is still valuable and believe that such individual work can integrate a social justice focus in which those who are afflicted are able to developed awareness of how the internalizing of oppression contributes to their problems. I would recommend my book, Embracing Disillusionment: Achieving Liberation through the Demystification of Suffering, as additional reading as it provides a discussion of how we can work with clients in ways that promote their personal growth as well as engage them in discovering ways of identifying and opposing oppression. The work of other authors who have similar ideas is also referenced there. Best wishes in your studies and continued work.

      Report comment

  3. Frank and Liz, Frank thanks for the article. Liz asa retired MSW with a history of psych survivorship after my over twenty years in the field. I have learned there is so so so much history not discussed in grad school and so many vital frameworks missed on various levels.
    And the profession has changed after I left with a hoarse of others because of paperwork, bilking, biopsychiatry , and the lure of private practice. We all tried private practice and not a well throughout or good idea considering the just of the article because inn a small room one can only talk abd the interventions as a change agent just cannot be possible if one is even aware. So much need and I tried but it became like drowning in the waters of employment. I would hope for your sake and others a more change agent and proper historical ficus with the acknowledgment of the mistakes and errors hurts and harms we as a profession did mostly I think unintentionally I hope most times.
    The whole layered frameworks of all the disabilities need drop dives on individual levels abd the folks themselves and also many have had several dx in several different caragorrues . And family members too and abuse is always part of the yuck and again apologies for hurts and harms from agencies and professionals and if one is lucky sometimes family as well. The process of hearing and creating a dialogue with appropriate common sense approaches is again vital with orgs and families sbd others in any group of humans.

    Report comment

    • Mary, thank you for you positive feedback and important observations based on your own experience. I identify with how overwhelming it can be when we are confronted with the sometime immense amount of suffering, loss and trauma that those we serve have experienced. Also when we work in systems that prioritize profit over people, our task is made just that much more difficult. Unfortunately, much of the training that continues to be provided to mental health professionals is contaminated both by a biomedical bias and by neoliberal values that are contrary to human well-being. Until there is a recognition of the need for a radical change in how we understand and care for human suffering, the sad reality is that not only are we not effectively in ameliorating it, but can even contribute to it. However, if we start with ourselves and develop what Paolo Friere called critical consciousness in which we can name the oppressive structures and abuse of power, recognize that they are neither natural or inevitable, and instead embrace practices that liberate us, we will be able to join with those we serve in the same process.

      Report comment

  4. In our neoliberal societies (East/West et al) vulnerability is the de ri·gueur invitation for one or another professional to swoop in and protect the dictates of neoliberal’s insatiable exploitive systems (i.e., institutions, ideology, media and educational mystification, etc.), and do so under the guise of helping people. (Nobody, IMO, captures the breadth and depth of how this is accomplished, than does Wendy Brown). Given that much if not most vulnerability arises out of structural deficiencies (equity, inequality, etc.), the APA’s “omitting” systems of oppression from mere consideration, and thus further (institutional) critical examination, is little more than the usual cynical and virtue signal-foreclosing of ethically, morally, and knowledge centered remediation’s, by the very professionals tasked with helping vulnerable people to begin with. Now that there is one solid definition of crazy…

    Report comment

    • Kevin, Regrettably what you say is true. It is indeed a deeply ingrained bias in psychology and other “helping” to uphold neoliberalism’s toxic beliefs and values by obfuscating and denying the potent impact of injustice. It is a type of insanity far more pernicious than the presumed forms of insanity they attribute to its victims.

      Report comment

  5. This highlights such an important premise – there’s always an assumption that it is the individual who is the problem and not the wider system/organisation or the circumstances surrounding the person at the center of concern. It happens all the time, all over the world it seems. I certainly witness this in my work place on a daily basis.
    Thankyou for reminding us. I just wish that it would get a wider reach.

    Report comment

    • Cathy, Thank you for your recognizing the importance of extending our understanding of the cause of suffering beyond the individual. I am not surprised that you witness this in your work, but am pleased that you recognize this problem. This awareness is the foundation from which you can help individuals become more aware of the adverse impacts of structural factors and use this to first avoid blaming themselves and second opposing those injustices.

      Report comment

  6. Blaming suppressive behaviors (psychopathy) on “neoliberal ideology” is going to get us absolutely nowhere.

    No one knows or cares what a “neoliberal” is, particularly in the context of mental health.

    If you think neoliberalism has some impact on social justice, then let’s attack the source of neoliberalism. But I bet it traces back to psychopathy.

    The thing I like about targeting psychopathy is that this is a researched subject and a validated real human condition. It gives us a known starting point. From there we can advance into ponerology or criminology or law and maybe find a way to better restrain psychopaths so they do less harm. That’s the direction I would take if you really want to deal with “oppressive structures.” A psychopath can make ANY structure oppressive!

    Report comment

  7. To My Dear Mentor,
    As I prepare for another talk on what it means to be a socially responsible psychologist, I, as always, search for your latest words/position. You bring so much lightness to the dark. I am forever grateful and will be once again citing your work.
    Warmly,
    Erin W

    Report comment

LEAVE A REPLY