A little while after my Ossington Circle interview with author Paul Moloney, I was sent (by Paul) the Midlands Psychology Group Manifesto for a Social-Materialist Psychology of Distress. It's an unadorned, long, well-written text that is full of important insights. I appreciate it as someone who is trying to understand "the system" and how it impacts people, and how we could help one another first to survive in the unequal and often violent society we live in, and how we could try to make change. I am going to go through the manifesto a bit here.
The manifesto is arguing against "most psychology", which it describes as "individual and idealist". By contrast, the manifesto is "social materialist". To the manifesto, "individuals exist, but their experiences are thoroughly social, at the very same time as they are singular and personal. And cognitions occur, but their relation to the material world is neither determinate nor arbitrary."
An important consequence of the social materialist approach is that it argues "distress arises from the outside inwards", it is "not the consequence of inner flaws or weaknesses". While "all mainstream approaches to ‘therapy’ locate the origin of psychological difficulty within the individual, usually as some kind of idiosyncracy of past experience." The explanation of why some individuals succumb to distress while others can withstand it is, in the social materialist school of thought, quite simple. It is due to the "embodied advantages someone has acquired over time from the social/material environment". Understanding distress, like understanding survival, is done best by looking from the outside in - at what happened to the individual in society. Hence, trauma, inequality, and other social realities are causes of distress.
The manifesto attacks psychiatric diagnosis as a "quaint notion that distress can be neatly partitioned into robust categories", which "reflects the mistaken belief that it is caused by organic diseases or impairments." Understand distress as social and material, and the categories fall apart, as in diagnostic failure:
"This may be why psychiatric diagnosis is notoriously both unreliable and invalid. Evidence of unreliability is provided by the lives of service recipients, who frequently receive different diagnoses during their contact with services. Further evidence comes from studies showing that, even in reliability trials where normal variation is artificially constrained (by video presentations, special training and broad categories) psychiatrists frequently disagree about the ‘correct’ diagnosis (e.g. Bentall, 2003, 2009; Pilgrim & Rogers, 2010; van Os et al., 1999). Evidence that diagnosis is invalid comes from studies of comorbidity which show that patients who meet the criteria for one diagnosis most likely meet the criteria for at least one other (e.g. Boyle, 2002; Brady & Kendall, 1992; Dunner, 1998; Maier & Falkai, 1999; Sartorious, Ustun, Lecrubier, & Wittchen, 1996; Timimi, 2011). Other evidence comes from studies of symptom profiles which show (for example) that the symptoms of people given a diagnosis of bipolar disorder do not cluster separately from those of people given a diagnosis of schizophrenia (Bentall, 2003). Because psychiatric diagnosis is neither reliable nor valid, all of its claimed benefits – in respect of aetiology, treatment, prognosis, service planning, inter-professional communication, reassurance to service users and their families – are compromised."
Individual and idealistic psychology leads not only to diagnostic, but to treatment failures, because by aiming at relief through "insight" it fails to recognize that "much of our experience, including emotional arousal, is not necessarily available to conscious introspection". Social materialist psychology offers a more "multiple, complex, and open-ended" view of the causes and the possible treatments of distress.
The bad news is that social-materialist psychology does not provide any easy cures - neither, though, does mainstream psychology. The manifesto is very direct about this: "Distress cannot be cured by medication or therapy." The notion of a "cure" is harmful - "the majority of psychoactive drugs cause mental and physical harm, especially with long-term use," and "whilst the talking therapies appear more benign, too often they are just a more insidious form of control, fostering the illusion that misery is an internal failure or breakdown, awaiting correction from an expert."
On the other hand, both medication and therapy can help. Medication "can usefully anaesthetize the distressed to their woes, yielding brief bubbles of respite or clarity. During these short, chemically induced holidays from their misery, those with the resources may initiate life changes that alleviate their problems and establish positive future trajectories," while therapy "provides comfort (you are not alone with your woes), clarification (there are sound reasons why you feel the way you do) and support (I will help you deal with your predicament)," which, "in an atomised, fragmented, time-poor society, where solidarity and collectivity are derided, time limited, and relationships consistently infected with a toxic instrumentalism, these are valuable, compassionate functions."
In social-materialist psychology, success in treatment is predicted by compassion, understanding, and resources - not technique. If the therapist is compassionate and understanding, and the patient has resources to act on the new insights, the chances of success are high. Technique, on the other hand, doesn't matter. Discarding the idea that specific techniques matter might be difficult, but it would be helpful:
"In a thoroughly commodified society it is perhaps understandable that some practitioners will want to have branded, marketable products, just as in a professionalised culture some will want to identify themselves as bearers of highly specialised knowledge and skills. Like everyone else, therapists must earn a living, so it is only to be expected that interest should influence how they present themselves and their work. Nevertheless, doing so distracts attention from the actual causes of distress by bolstering the belief that it is a mysterious state amenable only to professional help; it disables friends and family, who may feel that they could not possibly understand; and it negates the contribution of community, solidarity and trust. The presentation of therapy as specialised technique cheapens and oversells psychology itself; leads to resources being wasted comparing the marginal differences between this brand and that; and deflects effort and attention from the very real opportunities for psychological research and insight that are supplied by the highly privileged situation of the therapeutic encounter."
The manifesto, like Paul Moloney's book, provides a compassionate and nuanced take on psychology and therapy. If you want to help others, take a look at it.