Should therapy be political? Influence of social factors on mental health may make a case for such an approach

When acclaimed British psychoanalyst and social critic Susie Orbach was asked at an event if the therapy she does is somehow also her politics, she answered, “I hope it’s not my politics but I hope it expresses my politics." Susie is known worldwide for her work on the intersection of feminism and psychotherapy. In her BBC show In Therapy, she addresses the sociopolitical issues that come forth during her work with clients. She does so by staging live extemporised sessions with the help of theater artists.

Susie’s response represents a necessary dilemma that challenges the traditional methods of therapy and makes the therapist break boundaries of ideologies and opinions concerning the underrated role of society and the “system” in inducing mental health issues. As more people embrace the notion of 'personal is political', therapy too has reached an ideological juncture which calls for a revolutionary transformation.

Expressing politics through therapy ultimately means having a political opinion in the first place, before eventually recognising that the issues of the client who comes for therapy also have socio-political roots. Finally, it requires the therapist to take an approach that intersects with human rights and mental health, delivering an inclusive, non-judgmental mode of help.

Recent findings have linked global issues such as climate change with poor mental health. Similarly, drastic shifts in governments have been a major precipitator of distress in the public. Moreover, collective scrutiny of any mental health issue, such as the suicides of Indian farmers or students, or gender-based violence, will bring to light factors that trace back to faulty public policies and a very systemised ignorance of discrimination and inequality. Therefore, any individual realising that their trauma has something to do with the society around them is a challenge for therapists, but at the same time, such knowledge opens up new avenues for therapy to work.

 Should therapy be political? Influence of social factors on mental health may make a case for such an approach

In a society where fascism, inequality, inaccessibility of resources and abuse of power have a serious involvement in people’s lives, it is sheer betrayal to make healing a matter of personal responsibility. Illustration by Satwick Gade

A recent study published in the Journal of Clinical Psychology analysed the impact of therapy that involved political discussions between the therapist and the patient, including self-disclosure of opinions with regards to what is happening around the world. Results reported a nurturing therapeutic relationship and asserted that therapists’ political views have a lasting impact on their work with clients. But such findings cannot only assume positive outcomes.

To invite political discourses into therapy is to enter sensitive territories associated with a diverse set of belief systems. The question remains: Is it possible to cultivate such an understanding among mental health professionals, that too in a country where several different individual ideologies exist, moulded by one’s caste, gender, religion and/or sexual orientation? Moreover, even if it is good for therapy to be influenced by political conversations, does it help people in the long run, serving the sole reasons they sought therapy for?

“It helps, if you know what you (therapist) are doing,” says Kartiki Keshkamat, a clinical psychologist with a private practice based out of Pune. “It’s hard to imagine effective therapy without addressing people’s sociocultural factors, and what is sociocultural is eventually political. Talking about politics doesn’t mean “influencing” clients or implanting any new ideas in them. It means recognising the true factors that have perpetrated mental health issues and then working with the clients to understand that relationship.”

Ahla Matra, a Bengaluru-based psychotherapist, works at The Alternative Story, a center which takes a psychosocial approach to providing mental healthcare services. Reflecting on taking a political approach to mental health issues, Ahla says, “Initially, therapeutic techniques worked on the assumption that the cause of distress is within the individual. Politically-informed therapy takes into account that an individual’s mental health is not affected just by their biological or psychological factors. If we avoid talking about poverty, casteism, sexism, homophobia, transphobia and other forms of systemic discrimination, we are placing the responsibility solely on the individual.”

Psychotherapy was historically meant to be apolitical in nature. Under the dominant biomedical umbrella of mental health, it was considered righteous to not delve into environmental factors that impact people. The cognitive-behavioural approach to therapy soon became ideal which, largely speaking, saw people as harbourers of their own issues who are unable to look at a problem differently, unable to rationalise their trauma or alter their ways of thinking.

Such therapies rapidly became the “gold-standard” for mental health treatment. They are brief, easy, directive and only need the person to change their thoughts and perspectives. But an overlooked reason behind this popularity was that it prevented people from broadening their outlook about their “illnesses”. It barricaded further inquiry into the sources of mental health issues and who or what is maintaining them. Psychological distress that is driven (and scientifically linked to) by forces like capitalism and injustice became an issue of self-control, self-worth, self-esteem and competency.

Radical feminists like Carol Hanisch have fiercely criticised such methods. In her infamous paper, The Personal Is Political, Carol writes, “Therapy assumes that someone is sick and that there is a cure, e.g., a personal solution. I am greatly offended that I or any other woman is thought to need therapy in the first place. Women are messed over, not messed up! We need to change the objective conditions, not adjust to them."

Pondering over this, Kartiki adds, “This is not to promote or demote any one kind of therapy, but the therapist should know when to use one or the other. Imagine a client coming to me with a history of sexual trauma. I know I need a political approach and not a dominantly cognitive one which would ask me to simply ‘change’ her thoughts about what happened. Unless I address the social factors that perpetuate her distress, which is the patriarchal culture and its many forces, I won’t be doing a fair job. This is what being ‘political’ means.”

People have a tendency to internalise their issues and make them ‘their own’, but such tendencies are bred by dominant discourses. Take the example of the painful guilt of not earning enough that drives someone into depression, or an addict who is always blamed for making the “wrong choice”. In her paper Society of Choice, Slovenian philosopher Renata Salecl posits that the post-industrialist era has forced us humans to create an ideal image of everything that must be achieved in order to be happy, and when it is not, evidently, the person has no one to blame but themselves, eventually becoming anxious. Similarly, journalist Johann Hari explains how we have always looked at addiction as a personal choice instead of looking at it as a problem of society precipitated by the lack of access to basic resources one needs to survive and flourish. Such ideas are also indicative of a much needed change in treating such conditions.

Ahla puts forward an efficient example of how professionals also need to change the way they look at distress. She adds, “Anger as an emotion is often pathologised in the context of therapy. Individuals may be labeled as “hysterical” or “unreasonable” for expressing anger. A person belonging to a marginalised community might face violence or other forms of oppression on a daily basis by virtue of their identity. Anger is a valid emotion here, as one may feel helpless against the systemic oppression. Any socio-politically informed therapy would empower the client to perceive the anger as a natural response to oppression and, to an extent, even use it as a healthy tool for transformation. We may do so by helping the individual gain a comprehensive understanding of oppression and how it affects them. This requires a safe, empowering space where the individual can examine the impact of their social location on their mental health.”

In a society where fascism, inequality, inaccessibility of resources and abuse of power have a serious involvement in people’s lives, it is sheer betrayal to make healing a matter of personal responsibility. Bringing politics into the therapy room can help both the therapist and the client look at these factors as a part of psychological distress. This not only liberates the person of self-blame, but also provides them with a sense of solidarity, which is a long-term goal in the path to recovery.

Updated Date: Jul 11, 2019 10:37:59 IST