From Ideology to Good Sense Psychology
East Midlands Critical and Community Psychology Group (EMCCP)1
In this paper, we consider what, in our view, marginalises a ‘good sense psychology’ and maintains the
dominant ideology within the mental health field of individuals with deficits. We also explore how psychology
could start to apply in practice some of the concepts discussed in the Midlands Psychology Group’s Manifesto.
We are a group of psychologists working in the East Midlands with an interest in critical and community
psychology perspectives. We welcome the Midlands Psychology Group’s (MPG) manifesto, which pulls open
the curtains of psychology’s darkened therapy room and the blinds of psychiatry’s artificially lit clinic, so to let
in the vast complexity of the world and how it impinges upon us. We also support the non-reductionist nature
of their viewpoint, which incorporates the human body without leading to simplistic biological causal
explanations. The manifesto incorporates ideas from sociology without neglecting the importance of the
person and their experience at the centre. In essence the manifesto would appear to make ‘good sense’: a
combination of ethics and intellect which in turn guides social action (Gramsci, 1971). This raises questions as
to why this good sense is not more common in psychology and psychiatry, as well as pointing to how a good
sense psychology could be implemented in practice. We are aware of the limitations of our commentary being
grounded in an Anglo-centric perspective.
Why is the manifesto not common sense?
At the core of the MPG manifesto is the idea that the world and our life experiences shapes us and our distress.
Within mental health practice this fundamental idea is obscured. It is concealed to such an extent that services
often view individuals as disordered, reduced to biological and cognitive mechanisms and disconnected from
their life experiences. Critics of this perspective are portrayed as radicals and the term ‘anti-psychiatrist’ is
often used as a general term to dismiss anyone questioning the status quo (Double, 2002). Why and how is this
feat of mystification achieved? There are many possible answers, but we will focus on two areas: in whose
interest is it to marginalise ‘good sense’, and what forms of discourse are used to maintain the status quo.
Before discussing how social context is marginalised by professionals, it is important to consider the wider
economic and cultural context. For several decades we have experienced an unrestrained form of capitalism
and a neoliberal ideology (Harvery, 2005). This ideology conceptualises people as self-managing and selfcontained entities, disconnected from the world around, and valued as consumers or as elements in a process
of production (Bauman, 2008). In such a system, society serves the economy (Tawney, 1920), and the
promotion of competition and market forces are seen as key principles. These principles are pursued
1
Written by following representatives of EMCCP (alphabetically) Steven Coles, Gemma Dexter, Suzanne Elliott, Miranda
Glossop and Mel Wiseman-Lee
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irrespective of the social, material and emotional impact that they have upon the population. Those suffering
the most in this system need to be managed or ‘repaired’ to increase productivity, or contained so as to
prevent wider disruption. This management might occur through the criminal justice system, alterations in the
welfare system, but also through mental health practice. Whilst the latter could be seen as an offer of comfort
and care to the disenfranchised, mental health services have clear social control functions (Vassilev & Pilgrim,
2007). Cushman (1995) notes how psychological practices are created to address the results of problematic
aspects of culture and society which have given rise to distress. Due to the fact that these therapeutic
practices arise out of the same problematic culture, they often reflect and reinforce the original problems, such
as using language and ideas that locate the problems in individuals and concealing the social and contextual
nature of distress.
Mental health professionals are a key interest group maintaining the marginalisation of a social-material
understanding of distress, though there are many others (Pilgrim, 2007), including the pharmaceutical industry
(Busfield, 2013). Boyle (2011) describes how the professional insecurity of psychiatry and clinical psychology
leads these groups to avoid and manage social context, as it is a threat to professional interests. The American
Psychiatric Association president’s recent article (Lieberman, 2013) demonstrates this sense of threat, stating
he was ‘alarmed at the harsh criticism of the field of psychiatry’. Lieberman’s article shows how the discourse
of physical medicine and science act as powerful sources of rhetoric serving mental health professionals’
interests. Psychiatry has struggled to gain full legitimacy for its use of medical rhetoric due to repeated criticism
of its foundations (Pilgrim & Rogers, 2009; Rosenberg, 2006). As a result, psychiatry occupies a position of
relative weakness to, and receives limited respect from, other branches of medicine. In the face of critique,
psychiatry has turned evermore to biological sciences in an attempt to improve its scientific credibility.
Lieberman (2013) attempts to bolster the status of psychiatry using the language of science: ‘the scientific
foundation of psychiatric medicine has grown by leaps and bounds’, and by strengthening the link between
psychiatry and the rest of medicine by describing criticism of a medical view of distress as ‘no different than
being “against” cardiology or orthopedics or gynecology’. Psychiatry strives, through the language and practice
of science, to claim its place at medicine’s esteemed high table, while at the same time putting behind it past
criticism and a chequered history. Unfortunately, for people in distress, this technical and individualising
language focuses our minds on the individual as deficient and conceals their life history and context necessary
to make sense of their distress.
As MPG point out, psychologists do not always resist such reductionist discourse. Cognitive- Behavioural
approaches utilise the language of science to justify their pre-eminence, despite the shaky evidence such claims
rest upon (e.g. Epstein, 2006). Whilst biological psychiatry often attempts to avoid context completely, Boyle
(2011) describes how psychology often engages in subtler forms of avoidance or ‘safety behaviours’.
Psychology acknowledges the outside world, including issues of power; however by a sleight of hand it also
manages to individualise the problem so that the negative effects of the powerful on the powerless become
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reduced to internal schema, cognitive distortions and personality traits. These individuals can then be acted
upon, whilst leaving problematic social structures, cultural practices and material inequality in place.
Psychological practitioners’ current claim to a technical skill base to ‘fix’ individuals draws attention away from
how the powerful harm the powerless. Whilst there are exceptions, as a profession clinical psychology has
generally eschewed opportunities to highlight the importance of the social material world as it is not in its
interests to do so; instead heavily supporting access to individual psychotherapies. We believe a technical and
scientific discourse focussed on individuals accrues prestige, financial gain and avoids the risk of challenging
powerful groups whose cooperation is necessary for such gains. Can the profession practice in an ethical and
context focussed manner, which questions the dominant hierarchy?
Practicing ‘good sense’ psychology
The ‘Psy industries’ have devoted considerable energy to public ‘psycho-education’ to promote the idea that
distress is an illness like any other (Read, Haslam, Sayce & Davies, 2006). Whilst this has undoubtedly shaped
how we understand ourselves, a lay understanding of distress still remains closer to the kind of good sense
psychology evident in the MPG manifesto than the dominant ideology promoted by mental health
professionals (Read et al., 2006). A ‘good sense’ psychology can only prevail if enough groups see it as in their
interests to adopt this worldview; however, currently even those with least are often led to believe their
interests and freedoms are served by the status quo and construe themselves as autonomous self-regulating
individuals (Gramsci, 1971). This requires us to continually question dominant individualistic professional ideas
and open up space for alternatives. We believe that applied psychologists have a legitimate role in challenging
this harmful ideology of individualism, and in promoting alternative and more ethical ideas within systems and
dominant hierarchies. Psychologists should align themselves with marginalised groups and communities.
Feminist psychologists have long argued that this requires us to simultaneously work politically and individually
(Ussher, 1991).
Many of us are restricted by systems set up around the individualised notions of human distress. As NHS
applied psychologists, we are often employed to provide assessment and interventions based on ‘identified’
individuals. We are engaged in daily conversations regarding disorders, internal ‘mental states’, appropriate
behaviour and reality. We meet in private, maintain strict confidentiality, hold professionals’ meetings and
make decisions based on what we ‘know’ about a person from professionally interpreted information. These
are technologies of power; yet when we are offered opportunities to challenge prevailing ideas, do we take
them? The dynamics of power, described above, make it difficult for critique of the status-quo to be heard and
understood in legitimate and powerful spaces. However it is essential we apply and embed good sense in our
practice. One antidote to this apparent impotence is for acts of ‘dissensus’ to take place, that is, acts of
speaking out of turn in ‘legitimate’ and ‘plausible’ spaces (Ranciere, 2004). Applied psychologists, moved to
question the status quo, have opportunities to uncover and make visible the social conditions impacting on
people.
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Making political and social oppression visible
As applied psychologists we are privileged to be creators of truths and have access to powerful and legitimate
spaces: clinical records, assessment reports, research papers, training rooms, team meetings, service
commissioning meetings as well as social and mass media. We can bring in our knowledge of the impact of
social context, inequality and oppression to all these spaces and document these legitimately in ways that are
not so easily ignored. We can, in these spaces, question taken for granted ideas and make clear the role of
social material context in formulations and intervention strategies. We can publicly share this knowledge
through interaction with writing, drama, journalism and social networks to counteract the invisibility of social
context in discussions of human distress. The media attention garnered by the DCP (2013) critique of
psychiatric diagnosis is a good example of this.
Addressing issues of power and knowledge
Demystification, transparency and access to information are key to reducing the potential for disempowering
practices with people who consult with us. Simple acts, such as clear communication and sharing
correspondence, are a minimum in aspiring to reduce power imbalances in therapy (Newson, 2000). Systemic
Models, Narrative Therapy and Community perspectives remind us to question taken for granted ideas, though
we are aware social constructionist ideas can neglect the material perspective advocated by the MPG (Kelly &
Moloney, 2006). Critically reflecting upon power in our relationships with the people who consult with us
allows us to challenge 'them and us' ways of relating (Proctor, 2002). Using tools such as power mapping
(Hagan & Smail, 1997) allows us to position ourselves alongside people in acknowledging the influences on our
wellbeing, challenging self-blaming ideas, and seeing more clearly where the problems reside.
Making explicit the contested nature of knowledge
As applied psychologists we need to acknowledge that our theories and practises are one of many possible
ways of understanding the world, and are influenced by professional interests and context. This modesty is
crucial in addressing power imbalances and seeking to promote subjugated ideas (see Burnham, 1986). We can
seek to understand and use people’s own language, highlighting dominant narratives, such as how the
biomedical model shapes our understanding of reality, and examine and encourage alternatives (White &
Epston, 1990). Debates are one format for revealing the diversity of perspectives in mental health, which
moves conversations away from isolated private therapeutic encounters into the public realm where they are
open to democratic scrutiny (Keenan & Coles, 2012).
Addressing isolation and subjugation
Practices of connection, such as bringing people together and witnessing or sharing experiences, is essential to
the project of realising good sense psychology. This is what brings the EMCCP network together: it sustains and
nurtures marginalised ideas and practice within our profession. Working alongside groups of service users and
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survivors, such as the Leicester Living with Medication Group, the Nottingham Mind Medication Group (see
Coles, Keenan & Diamond, 2013) and the Psychology in the Real World groups (Holmes, 2010) can also help
turn up the volume on ideas which are too often stifled. We also guide people who consult with us away from
institutions that individualise and pathologise their experiences, and towards organisations like The Hearing
Voices Network, Soteria Network and other projects promoting social approaches to mental health.
Final Comments
Attempting to implement a good sense psychology has required questioning aspects of what we had previously
been taught about 'being a good psychologist'. We support psychologists working to bring about a more
humane and social- material understanding of distress. However, we also acknowledge that psychology needs
to show modesty in what it knows and reflect on the limits of how far it acts, so that it does not dominate the
public realm. The issues raised by the manifesto belong not just to psychology - they are of concern to all
citizens.
Affiliations
Steven Coles, Clinical Psychologist, Nottinghamshire Healthcare NHS Trust; Gemma Dexter, Clinical
Psychologist, Derby Hospitals NHS Foundation Trust; Suzanne Elliott, Clinical Psychologist Leicestershire
Partnership NHS Trust; Miranda Glossop, Clinical Psychologist, Leicestershire Partnership NHS Trust; Mel
Wiseman-Lee, Clinical Psychologist, Northamptonshire Healthcare NHS Foundation Trust and Lecturer at the
University of East London
Contact:
suzanne.elliott@leicspart.nhs.uk
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