“From private symptom to public action”
Social action therapy is a little-known psychological model, which uses activism as a means of treating mental distress. Libcom’s pamphlet Class Struggle and Mental Health championed the view that capitalism and state oppression cause psychological suffering. This is true, but it the flipside of this is that resisting capital and state power can potentially lead to better mental health. This is the premise on which social action therapy is based; that any political action which relies on mutual support, consciousness and solidarity is essentially therapeutic for the activist. For the oppressed, political and economic oppression is not just a matter of theories and statistics but is a deeply personal experience. In line with this, social action therapy is at once a method of direct action and a form of treatment; it is a way to fight oppression on both a personal level and a political one.
In terms of methods, the libertarian and anarchist movements and the service user/patient liberation movements both arrived at similar conclusions. Both schools of thought reject representation, so-called professionalism, charity and help ‘from above’ in favour of direct democracy and self-management. Indeed, a popular slogan for the disability rights movement in the 1980’s was ‘piss on pity’, a middle finger to the care system and a move to politicize needs and demand rights instead of charity. It’s a sentiment that many activists can doubtless relate to. Social action therapy reflects this; a central feature of the model is the individual’s transition from being a ‘patient’ in professionally-led services (i.e. in treatment which comes ‘from above’, with the backing of the state) to being an activist in a user-led campaign, fighting from the bottom up.
The implications of social action therapy could have been world-changing, not just for the psychiatric patient/survivor movement but for anyone whose experience of injustice and discrimination has pushed them into psychiatric services. The idea was first outlined by a radical feminist psychologist called Sue Holland in her 1992 article ‘From Social Abuse to Social Action’. However, Holland’s writing never got mainstream attention, and today social action therapy is almost unheard of among conventional psychologists. It’s easy to see why the powers-that-be wanted Holland’s work ignored; professionals tend to hoard their skills, and a theory that puts service users in control would put therapists out of a job. Holland herself wrote “Whilst other psychologists advance their careers by writing about radical psychology, I find that actually doing it leaves little time to meet editor’s deadlines.” Apparently, the caring professions are not kind to their dissenters.
Holland’s initial therapy project was with a group of women from a low-income estate in London. Many of the women were struggling with money, housing and childcare, and had experienced racism and sexism, including domestic abuse. All of them were being treated by mainstream psychiatric services, and all were taking medication for a range of mental illnesses when Holland first started working with them.
Stage 1) Patient on Pills. “Women often feel so bad about themselves that they can’t face their everyday life. They go to the doctor complaining of ‘nerves’ and get pills to calm us down or cheer us up. We then see ourselves as having a ‘medical’ problem […] we see ourselves as a ‘psychiatric case’, waiting to be cured.”
The neoliberal psychiatric model atomizes patients with individualistic diagnoses and treatments, and denies the social and political causes of suffering. The rationale is that poor mental health originates from individual flaws, essentially blaming the patients themselves for their own oppression, blinding class consciousness and internalizing their legitimate anger as guilt in the process. The ‘patient on pills’ is someone who is stuck in this self-blame trap.
Any kind of stigma or exclusion leads to feelings of guilt and shame, especially in capitalist societies that claim meritocracy and sneer at the victims of their system. Anyone who has ever had to count pennies until payday knows how frankly embarrassing poverty can be sometimes, and how much other people can judge you and make assumptions about you. When Holland talks about ‘feeling bad about ourselves’, this is what she means. ‘Feeling bad’, feeling guilty and blaming yourself for what’s happened to you are incredibly damaging to a person’s mental health. But this is political as well as emotional; when powerless people have these feelings it stifles the potential for solidarity and makes them easier to control. A psychiatric system that turns angry workers into ‘patients on pills’ is collusive in this exercise in power.
Stage 2) Person-to-person psychotherapy “talking to a woman therapist […]reveals our buried feelings, such as anger and guilt.”
The aim of the one-to-one therapy in stage 2 is to counter the self-blame and despondency felt in stage one, to help clients see past personal guilt and to begin to accept themselves as ‘wronged’ by the system rather than somehow ‘wrong’ within it. Holland states that this one-to-one therapy focussed on a few issues that were identified in partnership with the client, and this point is important. In my own experience of counselling, I’ve seen therapists tell clients what their own issues are. A client will say something like “I’m depressed because I’m in arrears on my rent, and my husband has left me”, and the therapist will decide which of these two issues to talk about. This is almost always a pretext for an exercise of power, often with a statist agenda, since if the therapist avoids talking about the client’s rent arrears or their housing and instead focuses on the personal/relationship issues, then they will distract the client’s attention away from the social and political issues that may be affecting them. Naturally the therapist’s judgment is influenced by their own bourgeois values; the social and political are ignored in favour of the narrow and personal, and the client carries on looking inward rather than outward to try and improve their life. Holland’s therapy is different to this, because it lets the client not the therapist decide which issues are important and which issues aren’t.
Holland also specifies that her women clients should work with a woman therapist, and this is important. The end goal of this model is solidarity, and clients across the spectrum of the working class, minorities and other oppressed groups should ideally work with a therapist from within their own community. Women clients would not learn how to stand up to male patriarchs if they had to rely on a man to do it for them. The best therapists draw on personal experience as well as state-backed training; ideally, working class former patients should learn the skills to support each other.
A client should be allowed to “explore the meaning of her symptoms, which frequently mask grief, oppression, rage and loss”. In her report, Holland noticed that “towards the end of this one-to-one work, the woman is expressing a greater social interest in the world around her”. This is not surprising.. They stop accepting the world for what it is, and begin to think about how that world can be changed. This is where Social Action Therapy becomes distinct from other types of therapy; ending self-blame is the first step not just towards better mental health but also towards direct action.
Stage 3) Talking in groups. “Now, freed from our personal ghosts, we can get together in groups and discover that we share a common history of abuse, misuse and exploitation […] as women, as working class women, as Black women… Now we can see, and say together what we really want.”
Holland said that going from one-to-one counselling to talking in groups led to a ‘sistering’ experience between the women. Meeting other women in similar circumstances allowed them to realize that their symptoms (and the hardships that caused them) were not unique to them, but actually something that they had in common with each other. They also realized that they shared strengths as well as problems, and because of this mutual support, the women began to realize that, together, they could stand up and change their circumstances rather than shutting up and accepting them. Through mutual support, class consciousness was developed.
The purpose of the group is to provide mutual therapeutic talking. It is in this stage that the therapist begins to take a back seat, and the individuals involved slowly begin to counsel each other rather than relying on help from above, and the whole project goes from being professionally driven and representative to being self-organized and user-led. Psychiatric power is challenged, and mutual aid has replaced formal treatment.
Stage 4) Taking Action “Having changed ourselves from patient to person, from depression to self-awareness, we can now use our collective voice to demand change.”
In step three, the women realized that their problems were bigger than just themselves. In step 4, they realized that if they work together they have the strength to tackle them. Holland said this started when the women told her they wanted to break away from state care and start their own neighbourhood advocacy and counselling service, using the skills they’d learned in their group.
Holland wrote that the women were initially stopped from realizing their dream by the powers-that-be in the local NHS, who presumably considered the prospect of having too many happy women doing meaningful work to be some sort of affront. The women struck back, illegally occupying the flat that they had been practicing out of and demanding the recognition of their skills and the right to work. After a long struggle, they won, and the Woman’s Action for Mental Health (WAMH) group was formed.
Social Action Therapy works independently from the State and the Psychiatric system and is founded on the principles of mutual support and direct action; this makes it the perfect starting point for anyone interested in a Libertarian alternative to coercive psychiatry. Service users can do it for themselves, and activist groups, with or without professional allies, can use this model to achieve genuine separation from the old system of drugs and locked wards. For patient liberation groups in particular, this model is particularly important; they can move beyond campaigning for better services and begin to provide the services themselves.
But the struggle for better mental health doesn’t exist in a vacuum. It is a luxury to be able to separate the personal from the political; for most of us, they are one and the same; our oppression affects our mental health, and in turn our mental health affects our ability to fight back. The powerful have always benefitted from the self-doubt, hopelessness and guilt felt by the powerless. For anyone who has ever been stamped on, the fight for freedom is an internal battle as well as an external one. Social Action Therapy is relevant not just to the service user/survivor movement and the struggle against psychiatry, but to every struggle for social justice.
In social action therapy, solidarity and struggle become an end as well as a means. It’s easy to see why no-one wants to talk about Holland’s idea; it has the potential to change the world.
For anyone who wants to know more, Sue Holland’s original article is called ‘From Social Abuse to Social Action: A Neighbourhood Psychotherapy and Social Action Therapy for Women’. It was published in a book called ‘Gender Issues In Clinical Psychology’, edited by Jane M Ussher and Paula Nicolson, published by Routledge in 1992
“Do we help to sedate, or to activate?”
Written by Apsych. Please distribute freely.