On the Mad in America podcast this week, we explore the importance of raising awareness of psychological approaches that challenge mainstream perspectives. Joining us today are three people who are practising clinical psychologists and who have written for Mad in America.
Zenobia Morrill is a critical-liberation psychologist and psychology professor who received her doctorate from the University of Massachusetts, Boston. Her research interests include critical and liberation psychology, the psychotherapy process, and wider conceptual and ethical issues in psychology and psychiatry.
José Giovanni Luiggi-Hernández is a clinical psychologist in private practice, a qualitative researcher at the University of Pittsburgh, a writer for Mad in America and part of the recently launched Mad in Puerto Rico website. His interests include understanding the lived experiences of colonized people using phenomenological, psychoanalytic, and decolonial frameworks, LGBTQ issues and psychotherapy for physical health concerns.
Also joining us is Mad in America’s lead research news editor, Justin Karter. A graduate in both psychology and journalism, Justin’s research and writing span topics in the philosophy of psychology, critical psychology, MAD studies, cross-cultural psychology, qualitative methods, and theories of counselling and psychotherapy.
In this conversation, we discuss the possibilities opened up by adopting a critical mindset, identify some of the barriers to working in such a way, and share some key resources to help aspiring psychologists explore alternative approaches.
The transcript below has been edited for length and clarity. Listen to the audio of the interview here.
James Moore: Zenobia, Justin, Luiggi, thank you so much for joining me today. Could you each tell us about your study and career path and if anything in particular led to your critical perspective?
Zenobia Morrill: I think about this as a question around my inflection points with the field and with psychology, which often were moments of disillusionment or disenchantment. I think psychology, at least to me, seemed to promise so much resolution and hope, and that wasn’t how I experienced it. I had a turbulent childhood, and my first interfacing with the mental health field was as a patient and through psychological testing.
I kind of watched how things fell apart in my family, and we really suffered. I’ve been with loved ones through what psychology would call a psychotic break. I was forced into therapy as a kid with some helpful, but many unhelpful, experiences there.
My mother was homeless in the US for over 10 years, and this was after we had connected to the mental health system, and so this kind of visceral, upending heartbreak of what we went through really persisted.
In many ways, it might then be confusing that I went on to study psychology. But I think I still held this belief, kind of like that James Baldwin quote of “I believe in America, which is why I reserve the right to criticize her.” I think that was where I turned to imagining what psychology could have been, and specifically what psychotherapy or relationships could have been for me.
I guess it makes sense here to say that when I say I practice critical psychology, it means I’m interested in examining the field’s relationship to power, rather than obscuring that, because I believe that it is powerful. We talk at Mad in America about how psychology carries the power to define the standard of what a normal or healthy human is. But even more powerful is how psychology crafts the stories we can use to make sense of ourselves and our world. How is a so-called psychotic break explained to someone? But then, how is it understood or lived out by them? Maybe more importantly, what resources are opened up or shut down to them from that story?
These explanations come from psychological theory, from institutions, and from culturally sanctioned scientific findings. But then they take on a life of their own. They’re communicated in unique relationships. They’re used to describe specific people and situations. They have such personal implications in the life of the people they’re about.
I think that as I was learning my studies in psychology, I was given a pretty generic version of US psychology. It was that suffering comes from mental disorders and with the right tools, we could observe and measure this disease that’s at the root and then cure it with the right medication and intervention. That was the promise that this was almost a magical resolution. Maybe this is a crude recounting. I’m sure the biopsychosocial model was mentioned. But honestly, the psychosocial part was really not discussed.
When I had one of my first mental health jobs, I was working in a residential treatment center for children diagnosed with behavioral disorders. It became obvious to me very quickly that these kids were sent here because no one knew what to do with them. The magnitude of their pain was so great. But the treatment was all about behavioral control and incentivizing obedience, not addressing that pain. I’m thinking, is this just a fancy way of scapegoating those most harmed by systems that are ill-equipped to support them, or disordered social systems, even, is that really where disorder could be located?
We were trained to use physical restraints. I’m watching six-year-old girls take antipsychotics, and it’s just heartbreaking. As a student or someone learning or in training or even as a patient, you’re told to trust the process. But that trust is such a luxury when the process is so very mystified and unsound and unsupported. It really didn’t feel like justice or resolution or any kind of solution to me. It felt like so much dispossession. I just felt like institutionalization and psychology often gave these children, and so many people, myself included, a story that alienated them from society and humanity.
I went in, I guess, to study more privately, a kind of critical psychology and find mentorship in that and relationships that helped support this way of reexamining psychology’s methods, theories, and practices. But it wasn’t easy to do. I think there’s often an element of alienation in doing that. I always knew that I wanted to do therapy to some degree, because I believed specifically in the idea that relationships could be healing, that they could unlock different kinds of experiences and different stories of how we can be and how we can make sense of ourselves and our worlds, so for that reason, I stayed connected to clinical and counseling psychology, which enabled me to get my license and become a member of the APA and all these sort of powerful institutions in the US that play a role in creating what psychology is today and what these stories are.
Moore: Thank you, Zenobia. It’s fascinating to hear that people can have an experience with psychology, and some will run screaming from it, but other people think, No, there’s something here I want to change, and I can only do that from within.
José Giovanni Luiggi-Hernández: My own experience as a child and adolescent was that I was taken to psychotherapy for things that I didn’t think were problems, particularly around my sexual orientation. The treatment that I was getting was around changing who I was and seeing that as a disease, as a problem. I ended up studying psychology as an undergrad because I wanted to be the psychologist I didn’t get for other people, and particularly for LGBTQ people. I wanted to be someone who was available for a group of people who are marginalized.
As I entered the field as an undergrad, I was initially exposed to critical psychology. Even before taking psychology classes, I was thinking about how mental distress or emotional distress comes from our living conditions, our relationships, and how oppression plays a role in human suffering, and how psychology can be complicit in maintaining those social structures that keep us oppressed and suffering by having us adapt to those conditions.
I didn’t get that exposed to mainstream psychology, so I decided that I wanted to learn a little bit more about mainstream methods. I decided to do a Master’s of Public Health after that, with a concentration in thinking about mental health and sexual health. I was exposed to things that were being criticized in my undergrad, and realizing that all of it was true.
Then I decided to go to another institution for my PhD in clinical psychology that had a similar vision to my undergraduate program. But there, I learned more about things like Zenobia was saying, how relationships can be healing and how, instead of thinking about changing people or prescribing medication for people, how do we either change the way that we relate to people or change their living conditions and their material conditions so that people can live better lives.
Justin Karter: I guess my story is a little different. I didn’t even go into university thinking psychology was really a thing. I didn’t know the difference between psychology, psychiatry, counseling, and therapy—all these different terms.
I came from a pretty rural community in western New York, and 20 years ago, there wasn’t much talk about therapy. There wasn’t much mention of psychology, or much use of psychological language, unless it was something seen as really severe or stigmatized.
It’s kind of remarkable to look back and see how little psychology was part of things. Terms like “anxiety” and “depression” weren’t really in the mix where I grew up. Now I imagine that’s changed quite a bit, just thinking about how much the broader culture has shifted in the US.
So I didn’t enter university with this thought in mind at all. I had a pretty broad training across the humanities and social sciences. I was just trying to find my way, trying to figure out what I wanted to do. I came out of that with a real interest in understanding social movements, broadly speaking. I was drawn to the Occupy movement, and also to these literary movements that emerged after the world wars, where people started imagining what it means to be human in different ways. That’s sort of where I landed.
Then I got interested in journalism, so I went on to do a journalism degree, thinking I’d report on some of these emerging ideas. What I thought of as maybe a kind of new lost generation. Somewhere along the way, I ended up in a humanistic and phenomenological psychology class. I didn’t know what to expect going in. But it turned out to be a kind of psychology that took up those kinds of questions. Very different from the Psych 101 I’d taken earlier at a big research university. That course kind of reignited something for me. It gave me a path into thinking about these things more deeply.
It also gave me a different way of thinking about humans at a time when I was worried about how meaningless things could feel, or how destructive people could seem. I think I’d absorbed this idea that humans are basically just algorithms playing themselves out. A kind of biological programming colliding with cultural and personal events that shape them in predictable ways. That view made things feel pretty cynical, or at least pessimistic, about what we’re actually capable of.
But the kind of humanism that came through in this particular branch of psychology gave me some hope. It opened up a different way of thinking about things.
I went on to pursue a doctorate in counseling psychology, but not because I wanted to be a therapist. I still didn’t have much interest in that. My master’s was in community psychology, with a pretty strong critical psychology lens. I was mostly interested in studying how activist movements within the mental health world gain traction, challenge dominant narratives, and change them over time. That’s what drew me to movements like Mad in America, which I had started writing for, and to service user movements and survivor-led efforts more broadly.
Then, as I started practicing therapy, because I was in a counseling program, I found that I came to love it more than I expected. I began to believe in it as something potentially liberatory, even with all the caveats and complexities of the ways it can fall short.
Moore: Hearing the three of you, it’s really interesting that although you’ve come at this from very different perspectives, there’s a sense of dissatisfaction with the status quo or perhaps how you were treated personally or the way that the system was presented to you early on. It’s interesting to learn how you’ve used that dissatisfaction as a motivator to want to change things.
So then, if we imagine that there are younger people out there interested in psychology, what advice would you have for somebody who wanted to step outside of those well-trodden paths and wanted to explore outside of the mainstream and learn about novel or critical approaches?
Morrill: Years ago, when I was doing a podcast for Mad in America and interviewing China Mills, she said something that stuck with me. There are all these questions we tend to have about alternative ways of doing psychology. I’d asked her something about alternatives to global mental health or what kind of alternative approaches we could use. She said that alternatives have always existed.
I think it’s worth remembering that psychology, psychiatry or psychotherapy, in their current form, are not the sole authority or resource we have to understand the human experience or humanity.
There are so many stories within, outside of, and sometimes I say in-between, because they’re sort of in this liminal space around psychology, where we’re writing in novels about people, or in journalistic work. Studying the history of people and how things have changed and the stories we use to understand ourselves and how that story shifts is fascinating.
Luiggi-Hernández: Something that I’ve been thinking about for a while is how to reach youth. I think what I want to encourage people, especially youth, to do is to challenge the ways in which they consume content. I would encourage people to read a book, maybe not to get that information from TikTok, not to get that information from Instagram or Facebook or whatever it is that they’re using. Instead to sit down with the seminal texts.
I feel like now more than ever, it’s easier to read these texts because we have access to technology where we can Google different words, and we could ask people through social media about different aspects of a text that we don’t understand. I really want to dare people to read books, to look for articles around these topics, be it liberation psychology, be it decolonization psychology or be it lived experience.
My concern is often, even though there is shorter summary information out there, that won’t be enough for people to really understand the complexity of what’s critical in psychology or alternatives to mainstream.
Karter: I might just be distilling what others have said here, but it feels like your options are either to avoid or to go all the way in. If you find yourself stumbling onto a psychological concept that suddenly helps you make sense of something, some part of yourself, or a relationship, or your family, and it feels like it’s naming something you didn’t have words for, that can be really exciting.
And at that point, you have a choice. You can turn away from that concept, maybe because you sense that it’s limited, or that it’s missing large parts of your experience. You might turn instead to literature, history, sociology, or philosophy. But I think in some ways it’s already too late for that. The world we live in is so saturated with psychological language that there’s no way to avoid it completely.
So if you’re going to go in, I want to encourage people to really investigate the term. What does it actually mean? What’s the history behind it? Who first used it, and in what context? When does it seem to resonate with people, and when does it fall flat? And just as importantly, what does it mean to you? Why is that particular term helping you make something visible or tangible, something you hadn’t been able to communicate either to yourself or to others?
Once you start to see the benefit, then also ask, what part of myself is missing from this explanation? What doesn’t it quite capture? What feels like it’s been made a little too neat, when I know it’s actually messier than that? Then challenge yourself to think through the limitations, for you, for your identity, for how you’re making sense of yourself.
I think that’s probably the path. And once you start doing that, you begin to see it with all the other concepts, too. Their usefulness, yes, but also their historical contingency. Why they came to be, when they did, and what kinds of things they fail to fully grasp, especially the complexity and the messiness of human consciousness and the kinds of relational experiences we have with one another.
Moore: I was wondering what it feels like to be someone who works from a critical perspective or has a critical mindset. How does it feel to have to collude with a mainstream system that you might not agree with? For example, having to use diagnostic or billing codes. For an insurance company to pay, they have to have the “right” code, and you might not think that is right for the person you are helping. How does it feel to be working within the constraints of a system you might not be bought into?
Luiggi-Hernández: I started in private practice about a month ago, and I didn’t realize I was going to face those challenges so quickly. One of the things that has been kind of messy in that process is precisely what you said. I don’t like using diagnoses. I don’t necessarily explain suffering through these labels or diagnoses, and so whenever I have to use one, so that my patients can receive treatment, it becomes messy because I’m saying one thing when explaining to my patient how I work, and then suddenly we’re using something not coherent with what I’m saying.
I always end up having a conversation around why I’ve used the diagnostic criteria or the diagnosis, so that they can get treatment, but at the same time, that I am trying to simply work around their economic well-being so that they can get treatment covered by their health insurance, but that I don’t necessarily understand their problem as stemming from mental illness or these diagnoses.
It can become problematic in the sense that sometimes patients are also already identified with that label. Then, having that conversation can rupture the relationship with me as their therapist. But as time goes on, I have to work on rebuilding trust and understanding between me and my patient. It can have all these different consequences on our work that might not have occurred if we weren’t required to use diagnoses.
These ethical dilemmas don’t just impact therapy, but also impact me, at least personally, in terms of how I feel about the work that I’m doing. But at the same time, I know that there are not a lot of people like us in the field, and so I know a lot of people are looking for therapists like us.
Moore: I’m convinced, Luiggi, that the best psychologists are those who think to themselves, “what I do each day could be harmful to people if I don’t carefully consider how I work with someone and how I use the system for their benefit.”
Morrill: What my students might say about what drove them to pursue psychology is that they want to be for someone what they didn’t have. With every credentialing or professional stamp of approval is a little bit more power to use in the field to do it differently, if that’s what we’re interested in doing. It’s all an opportunity to form different stories, to form different kinds of relationships, hopefully ones that are more just and more collaborative.
When you develop an understanding of what’s happening and the meaning of what’s happening for a person with them, it is a fundamentally different shift from explaining to someone what is going on. Or even simply saying, “I have to enforce this thing because I’ll be liable if I don’t,” without giving someone robust informed consent about the constraints and limitations of this experience we’re having together. They should know in advance, here’s where I might act, here’s how I can resist that, and here’s where I can’t. They should be able to know the limits of psychology and the mental health field.
Karter: I would add that one of the risks of holding a critical perspective in this field, both as an academic and as a clinician, is chronic exhaustion and what that exhaustion can lead to. When you’re worn down in an academic or journalistic way, beating the drum against a narrow biomedical narrative or something like that, there’s a real risk of becoming uncritical of everything that claims to be critical. You start thinking, here’s another alternative perspective, it’s not the mainstream thing, so let me promote it or not interrogate it as closely. That kind of exhaustion can dull your discernment.
And that, I think, ultimately undermines the work. You stop believing in it as deeply. Other people can feel that. It weakens the movement in subtle ways.
Clinically, I think exhaustion draws you toward easy explanations. And maybe that’s just another way of becoming distant from people, of not letting myself be fully unsettled by them. When I’m working from a place that’s aligned with this perspective, it means I’m involved. I’m tied up in what’s happening in the session. I’m open to being moved, maybe even changed, by what’s going on, just as much as I’m asking the other person to be.
That’s a hard place to stay in consistently. There’s always the temptation to retreat into simpler explanations, to make the work about this person or this issue in a way that protects me. That makes the job a little easier, lets me sleep a little better. But that’s the risk. You get worn down without realizing it, and you start to act in ways that go against your values. And then you have to reckon with what that means.
In any kind of critical, depth-oriented, or liberatory psychotherapy, what we’re asking of people is to change in ways that might make them fit less well in the systems they came from or the systems they’ll return to. We’re asking them to be willing to be unsettled. And I think that’s also what this work consistently asks of us.
Luiggi-Hernández: I want to add something about this, too, because a lot of it is hardship, but I’ve seen some of the things that we can achieve when we work in this way. I’m thinking of some of my experiences at an internship at the Veteran Hospital here in Puerto Rico, where we were forced to use diagnostics as well. I had to do a lot of psychological reporting, and in those reports, I got a lot of information from people’s lives. So I started to add to my reports things that weren’t traditionally added.
For example, I really enjoy using the Power Threat Meaning Framework, which is an alternative to the DSM that tries to understand how people’s suffering or their behaviors are better understood through the things that happen to them, and the conditions in which they live. This framework doesn’t understand behavior or experiences as pathological or as a disease, but as something that you learn to do to survive. Adding that narrative at the end of my reports was really well received by some of my colleagues, and they really wanted to learn more about it and to engage with it more.
I realized that people are actually pretty ready for these alternatives, they’re just not aware of them. Even though being alternative or being critical of psychology and working in this way can be pretty tiring, it can also lead to a sense of hope when we see the impacts of our work.
Moore: Luiggi, you mentioned the Power Threat Meaning Framework there. Are there particular resources that people should be looking for to increase awareness, to build on what they know about psychology, to open their eyes, perhaps to global mental health, and to cross-pollinate critical ideas? Are there particular authors or particular websites like Mad in America, for example? Where can people go to expand their horizons a bit?
Luiggi-Hernández: I like to encourage people to engage with the work of Martín-Baró. I am thinking of Zenobia, who has been publishing on liberation psychology for a while. Liberation psychology has been taken up in the US and the UK, and Martín-Baró is the one who developed this idea of liberation psychology that has been taken up slowly over the decades in the West.
There’s Frantz Fanon, who’s a well-known post-colonial psychiatrist, and he wrote about people’s experiences of suffering under colonial oppression and how colonial oppression leads to psychic forms of suffering.
Karter: Of course, I have to plug Mad in America. I think we do a great job picking thoughtful interviewees and often highlight people who are doing important work in the field, which is helping to broaden what the field can be.
We all have our favorite authors, people who reached us at a time when we needed a book to cut through. For me, in this field, Erich Fromm was influential early on. But honestly, a lot of fiction shaped me too. For everyone, it’s going to be different, depending on what speaks to you. For me, it was a lot of science fiction, Ursula Le Guin and Philip K. Dick, for example.
I think for each person, there’s something about returning to your own traditions. What kind of stories have moved you, or opened something up in you, or challenged how you saw things? I’d encourage people to go back to those.
And if you’re holding a particular construct close, because we’re always being handed them by social media or the culture at large, try not applying it to yourself. Apply it instead to one of your favorite characters. Use it on your favorite movie or a book you’ve loved. See how utterly inept it is at capturing the full complexity of that person. Notice what it might help you understand, but also what it completely misses and then go back to the literature. That would be my advice.
Morrill: I guess it makes me think about schools of thought that have been born out of social strife and having to think of new ways of understanding humanity, so that we need not invent the wheel. But the problem is that those often get obscured, co-opted and sort of lost over time.
Justin mentioned Erich Fromm, so I’m thinking of the Frankfurt School, but there’s also institutional psychotherapy in France and liberation theology, which liberation psychology was born out of, as Luiggi was talking about with Martín-Baró. I think if people know certain terms to look up, they’d find out that there are different ways of understanding distress and suffering that psychology doesn’t necessarily lay claim to.
Justin’s done work with psychosocial disability advocates, and if you look up lived experiences narratives or Hearing Voices and the Hearing Voices Network Movement, you’ll find different stories that are actually conceptually challenging a biomedical model and other mainstream ideas in psychology. But that can be particularly difficult when you don’t know what to look for or where to find these organizations that are already trying to make this fundamental shift in how we understand pain and what we can do about it.
I think about the Institute for the Development of Human Arts in New York, and they have a transformative mental health curriculum. There are centers and pockets of people who are extremely dissatisfied and are also trying to find ways to do this differently. We don’t have to do it alone, and in fact, we can’t.
Moore: It’s pretty clear that the planet seems to be in a precarious place. I can only imagine, as a layperson, the amount of psychological harm being done to people living in poverty and in war-torn areas and so on. I can only see that there’s a bigger role for psychology, and particularly humanistic psychology, that meets the person where they are. Is there a message that you would give to someone who would like to become involved in healing through psychological means and helping people who are displaced or marginalised?
Karter: It’s a big question. I think the way you pose it brings a kind of silence in me because of how stark it makes the amount of suffering in the world, and how inefficient psychotherapy is as a tool for addressing that harm. I believe in psychotherapy. It matters. But it’s also intense, time-intensive work, and you could never train enough people to be skilled psychotherapists to meet the scale of harm we’re inflicting on people right now.
There’s obviously a need for it. There’s a role for it. And there’s also a need for so much else. I guess that’s what I’m wanting to say. But if you want to be part of the group of people trying to facilitate healing for those who are suffering in these ways, hopefully, we’ve provided some ways in. Some paths for folks to begin to engage with the work.
Luiggi-Hernández: I was thinking about the limits of psychotherapy as Justin was saying, but also how psychological healing really takes different forms. It doesn’t have to be the therapy itself, even though I think there are things that are best worked on in psychotherapy, but definitely not the kind of things that you mention. I have also come to terms with the limitations of psychotherapy, and I do a lot of activism myself or have worked with communities, so that they can become more resilient or more capable of sustaining themselves, or even survive in these terrible conditions.
For example, I’m currently working with immigrants in Puerto Rico. Puerto Rico is part of the US, for those who don’t know. The ICE raids are also happening here. There are psychological services for these immigrants, but some are too afraid to leave their homes to receive services. A lot of the things that the organization that I work with does is to bring food to the people to their houses because they don’t even leave their houses to get food.
Even though we’re not changing fascism, we’re at least allowing them to live another day by being there or by providing protection to this community in some ways. To become involved is a way of psychological healing. Not to be like the mainstream psych guy, but I’m thinking of mainstream psychological research that has shown that engaging in activism improves depression and anxiety. It’s helpful for a lot of people to engage in activism and to help communities. Even from a liberation psychology perspective, even if I were your therapist, I would be encouraging you as a patient to engage in your communities and to engage in some form of activism because to change the world is to heal yourself.
Morrill: Something I’m hearing across the three of us is that psychotherapy is one way, but it’s not enough, and it poses these risks, right, that it is an institution in addition to being a relationship, and that in and of itself means it can produce new forms, new symptoms, new types of alienation, and that’s very real. I think what we’re speaking about makes me think about our accountability to each other and humanity, and that’s really what we’re saying psychotherapy can be a part of, if we try to resist the risks involved and that it entails.
There’s something about that that I think is important, especially when we’re trying to resist tyranny, that there are certain psychological ethics and our belief and hope in what the field can do for people that we are trying to maintain fidelity to or uphold, to really do no harm and to consider what that means. I think that if we just try to escape the tension in that, the way that we’re kept up at night worrying about it, then we’re sort of foregoing a project that we’re kind of all in together, which is how do we grapple with this? How do we do this? How do we relate to our humanity?
I think that when we fall into that expedient way of doing it, we’re really foreclosing on parts of ourselves that we can live out and the sort of unfolding possibilities that we can experience with others, and that is the opposite of liberation.
Moore: Thank you so much, the three of you, for joining me.
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