[MUSIC PLAYING]
So first, congratulations on the
publication of your book, Phil.
And thank you for
taking the time
to speak a little
bit with me about it.
I do have a few
questions to ask you.
So shall we get started?
Yeah, that would be great.
Your book makes a strong
argument that mental illness
as a social justice issue.
Can you explain that a bit?
Yes.
I'm happy to do that.
And I think it's probably
helpful to look at two parts,
one is causes of
mental illness and then
the other is treatment.
And so if you think about--
as we know from our
public discourse today,
we live in a society
of incredible inequity,
where the top 10% has a
third of the nation's income,
and the lowest 10% has just
2% of the nation's income.
In these times which have--
you know, it's really been
about the last 30 years
that we've seen income
inequality soar like this.
We've also seen a rise of
mental illness, 10 to 20 times
more depression, and 10%
of Americans struggle
with anxiety.
We've seen what you might
call kind of a public despair
in our times.
And we know-- we'll
get into this further--
but we know that that
economic stress contributes
to mental illness
and mental suffering.
And so in times of
downturn, people
are more likely to be
distressed and be mentally ill.
And then when the
economy gets better,
people tend to get
a little better.
But then when there's
more economic stress
and they lose their jobs,
they get mentally ill again,
or they have a relapse
or a recurrence.
So there's a close link
between our social world
our economic world and
our mental well-being.
And then when it
comes to treatment,
if you look at
treatment, you can
see that different
people in our society
are accorded different kinds of
treatment for mental illness.
So the wealthier,
the owning class,
tend to have psychotherapy
and medication,
whereas though the working
class, if they get treatment
at all, tend to get just
medicine of a stronger type.
So there's a sense
in which they aren't
getting the most complete
treatment for mental illness.
And so if you look at how
it's a social justice issue,
I would say it's both
in the causes that
stem from economic suffering and
then in the kinds of treatment
that are available once
mental distress is in place.
One of your sources in the
book, Judy Chamberlain,
coined the phrase
mentalism to refer
to prejudices against those
who are either experiencing
mental distress or who
have been diagnosed
with a mental illness.
What are the symptoms?
I hear mentalism.
I think sexism, racism.
What are the symptoms
of mentalism?
Yeah.
Well, there's a kind of
play in the question too.
The symptoms of
mentalism are symptoms
that are affecting all
of us as a society,
not just the person who is
struggling with mental illness.
So the mentalism,
like racism or sexism,
is both a set of
practices that are
discriminatory
against people who
have mental distress and also a
set of unconscious stereotypes
or attitudes that just
arise somewhat naturally it
seems like when you
encounter someone who speaks
a little differently, or
talks a little differently,
maybe speaking to themselves
or something that.
Mentalism is manifested
when people in communities
are just rounded up by
the police for doing--
for being out of the
ordinary and put in prison.
So a lot of people
face mentalism
as they're incarcerated
for their mental illness.
And it also-- just like other
oppressions, racism or sexism,
mentalism can kind of go inward.
So people can have
an internalized sense
of oppression.
Once they've become a
psychiatric patient,
they may trust themselves
less or may feel shame
about their psychiatric
history, or they
may sense that they're kind
of a bad person at some level,
not trustworthy.
And that's the
internalized effects
of mentalism in the
individual that I
think we can approach through
our care and counseling
methods.
Can one social class really
influence or contribute
to his or her mental health?
And flipside, is mental
illness interpreted differently
depending upon
one's social class?
Well, that's a really
great two-part question.
Let's start with
the second part.
One's mental illness
is definitely
interpreted
differently depending
on one's social class.
So people who are poor are
more likely to be given
diagnoses of mental illness.
And more severe forms
of mental illness
are diagnosed among the poor.
This first question about
whether one's social class can
contribute to one's
mental illness,
this is kind of a chicken or
egg question in the field.
On the one hand, some
people have said, well,
maybe poverty--
maybe mental illness
contributes to poverty.
On the other hand, people have
said maybe poverty actually
contributes to mental illness.
The evidence is really
weighted toward the latter.
So there's a really strong
relationship between--
when there's economic
stress in a society,
more people have mental
distress and suffer
psychiatric symptoms.
That's becoming more and
more well-established in
big, big studies, big analysis.
And you can see it
in things like people
are more likely to be anxious
or depressed if they don't own
their own home, or car, or
if they don't get income
from investments.
Social class is a tricky word.
It doesn't just mean your
income or your education.
It means what you have
to do for a living.
So someone could own a company
but have very low income,
and they'd be in a
different social class.
And then people who only rely
on their bodies or their labor
for work are in a different
kind of social class as well.
And I think one
other thing we have
to consider when we talk about
social class is disability.
So people who are
disabled are also--
and or outside of the economy--
are also in relationship to
the other social classes.
So it's really clear that
social class does directly
impact one's mental health.
And it's actually through
dealing with social class
that we could treat
mental suffering
in a more rich and
complex way that
could lead to real solutions.
You seem to find a strong link
between the suffering that's
associated with mental
illness or distress
and the phenomenon
of neoliberalism.
Can you describe
that link for us?
Neoliberalism is-- which began
in the mid-'70s, early-'80s--
is an economic philosophy
of the free market, that
says the free market if
unregulated leads to benefits
for all as it grows.
And that's the
economic philosophy.
There's also a kind of culture
of neoliberalism in our times
with a real emphasis on personal
responsibility and initiative.
So people we hear all the
time in a neoliberal era
about the entrepreneur.
It's really lifted up
as kind of the hero.
Neoliberalism seems to presume
that everybody in the society
kind of has equal access or
equal footing to begin with.
And at the same time, we've seen
this huge rise in inequality
economically in an
era of neoliberalism.
At the same time,
the media bombards us
with images of the
super rich that
seem to kind of
naturalize their wealth
and then blaming the poor
for using the social safety
net at the same time.
But I think neoliberalism
is really a feeling
that you should be able to pull
yourself up by your bootstraps
when there's really not enough
resources to go around for you,
and you're struggling
at a very basic level.
One person with a
psychiatric history
who'd been injured
at work was trying
to get workman's compensation.
And he described
himself as a liability.
He was using the words of the
marketplace or of neoliberalism
to describe his own self.
Though in an age
of neoliberalism,
mental suffering is another
site for self-blame.
I can't achieve.
I can't be industrious enough.
I can't be an
entrepreneur of myself.
You observe in the book, Phil,
that modern American psychiatry
tends to disregard a
patient's social circumstances
and prefers to
interpret or diagnose
a person based upon what you
call a biomedical framework.
First, what does
that phrase mean?
And what are the inherent
dangers to such an approach?
Well, I'll answer your
question somewhat indirectly
by sharing this backed
statistic from the World Health
Organization.
In the societies
that have the largest
gaps between the
rich and the poor,
there are much lower rates of
recovery from schizophrenia.
And in societies where
that gap the smaller,
there are much higher
rates of schizophrenia.
The biomedical framework
just can't completely
account for those kinds
of social macro factors.
It tends to see illness as
existing within the brain
or genes of an individual.
And it tends to
see pharmaceuticals
as a key that fit directly
into that illness,
to unlocking it, or
treating it directly.
But one thing we know is that
the social world is much more
inextricably connected
with mental illness
and mental suffering.
I would say the
biomedical framework
is preferable to
approaches in the past that
blamed particular parents
for the mental illness
of their children or
approaches, for example,
that rely on ideas of demons
or that kind of thing.
But the biomedical framework,
by stressing the individuals
so completely,
misses the context
of their social and political
situation, which as we've seen
is essential to both the
causes and the course
of mental illness over time.
You use the phrase psy even
in the subtitle of your book.
And as I read it, it had an
ominous kind of a tone to it.
I thought immediately
of Eisenhower's warning
about the military
industrial complex.
And I'm just wondering,
what is the side complex?
And why must, as
your subtitle says,
it's discourses be resisted?
I agree.
It does have an ominous tone.
And I'm a part of
the psy-complex,
right, with my training
and credentials.
The psy loosely refers
to those working
in psychology, psychiatry,
counseling, mental health
counseling.
And it does refer back
to this early time
in the history of
psychology when
they were doing a
lot of measurements
on people to see if
they were fit for war--
kind of the birth of early
psychology in this country.
But today, for my
purposes in the book,
I'm using the
psy-complex as a way
to describe how our
systems kind of use
a subtle form of social control
with our psychiatric diagnoses
and our labels in our practice.
And so the psy-complex,
you kind of see it
when someone comes into
a counseling center
and two counselors are
talking about that person.
And they talk about that
person as their diagnosis
or that borderline
and her family.
You see that kind of
file speak sometimes
when the person's
identity kind of becomes
wrapped up in the label.
And that happens as well when
people make case conferences
about clients
without them knowing
and talk about
their problems just
in terms of psy-complex
notions rather than in terms
of their whole social world.
There was a group
that was meeting--
there was a group of
patients who were meeting
at a psychiatric hospital.
And this is to turn
to your question
of how they can be resisted.
And those patients as they
were meeting in a group
preferred everyday language to
describe their difficulties.
And they preferred to talk
about their coping strategies
rather than just focusing
on the symptoms alone.
And they were living in the
discourse of the psy-complex
but resisting it at the
same time in that fashion.
People work in the
psy-complex in a lot
of ways in social
service, giving welfare,
in those kinds of
settings, when they
have to make complex decisions
about people and their lives.
The psy-complex is a way
to talk about the kind
of social control that's exerted
even when psychology doesn't
realize it's doing so.
How are psychiatric
patients marginalized?
Well, there's a lot of ways
that psychiatric patients
are marginalized.
The question is a large one.
I'd start by saying there
are people with serious--
diagnosed with serious
mental disorders
or have an 80% or 90%
higher unemployment rate
than the regular population.
So there's a form of kind of
marginalization in that fact.
I think there's
a marginalization
as well if we just rely on just
exclusively psychiatric models
to understand their experience
and we don't address
social factors such
as economic stress,
then we miss a significant
part of their story
or what they're experiencing.
Psychiatric patients are
marginalized in some sense
because their struggles
are invisible.
Some people have a hidden
psychiatric history
that they don't talk about.
Other people it's pretty
clear that they're different,
but they're marginalized
because maybe they live at home
and they lack
access to resources,
or they don't have a place to
talk about their own experience
of mental distress besides
the clinic or the counseling
center, which are so
influenced by symptom models.
People often describe
their own experiences
of psychiatric
distress in ways that
are different from
experts or professionals.
And they want their
voice to be heard.
So for example, one
patient said you'll never
understand my mental
illness, unless you
understand racism in a society.
Is the psychiatric
establishment the psy-complex,
I guess, misusing its power?
Well, that that's
a complex question.
I'll just start by
saying that I think
some of the best critiques of
the psychiatric establishment
are from within the
psychiatric establishment.
So there's this tradition
of social psychiatry
that looks at the
society and sees how
sick the society is in a sense.
And there's also
people who are drawing
attention to social factors
within psychiatry itself.
In all of our fields, there's
a given power differential.
I think that's heightened in
psychiatry because of the fact
that so many psychiatrists
are in the wealthier class
while so many of
their patients are
in the working class or
even contingent classes.
So that power
differential is heightened
by the economic
difference there.
I think we also have to
talk about the influence
of psycho-pharmaceutical
companies.
They really shape
the research agenda
of the psychiatric field.
And they're actively
marketing within the field.
So it's hard to get literature
that strikes you as objective,
because so much
of it is supported
by the pharmaceutical industry.
That's one way in which
there's a misuse of power
in psychiatry, because
it's being funded
by the very people who are
creating the products which
are being sold.
So there's a problem
with objectivity there.
I would say there's
psychiatrists and counselors
who can do their job well
even in those fields.
But I think it requires
really kind of critiquing
the given ways of operating.
The injustice that you
describe in the book
is sort of maddeningly
multi-dimensional.
As I was reading it, I saw a
medical, political, economic,
and ethical concerns
just to name a few.
Considering its complexity, is
this an intractable problem?
First, let me address
the question by saying,
I think the complexity
is an important part
of solving the problem.
So I have especially
focused on economic factors
and social class in this
book, because I believe--
and research is
starting to show--
that by addressing
the conditions
of the entire society, we can
create a healthier society,
mentally healthy society.
So I don't think the
problems are intractable.
I think they have to be seen
in their complexity in order
for us to address them at any
more than an individual level
putting a band-aid on a problem.
I would say you can see--
just beginning to talk
about social classes
is huge first step and talking
about it in ways that confront
the conditions of capitalism.
We don't have to be afraid
of critiquing capitalism
in our society.
And one of the patients
who I quote in the book
said he's looking for a drug to
cure the world of capitalism.
That's his hope.
We've seen-- here's some
hopeful information.
We've seen that raising the
minimum wage by about $3
an hour in a large
city contributed
to the well-being, the
psychological well-being,
of the whole city in
some measurable ways.
So there's really the
macro solutions could maybe
do the most good in
addressing the problem.
But I think we have
to see the problem
as involving these macro factors
such as economic distress.
You spend a fair amount of
time examining the experiences
of those who have
survived the psy-complex
and are now reclaiming some
authority over their lives.
What role can they play
in changing the system?
And in a related question
then, how important
is community action?
Well, I'll begin by
saying that, it's
people who've been
through the mental health
system who have the central
role in changing it I think.
And in a sense,
experts like myself,
should maybe play
a background role
and provide something like
a forum for the concerns
or maybe access to
institutional resources,
but not set the agenda
for such concerns.
That would be within
the community itself
that decided certain
things were important.
I think community
action is essential.
And it really depends--
the different kinds
of actions can
be undertaken in
different spaces
depending on what
the concerns are.
For example, one
gentleman that I knew
was going around and
going to mental hospitals
where there were mass graves
with just numbers on them
and finding out the names and
putting plaques on those graves
as a way of
memorializing the dead.
And that was a form of social
justice for this individual
and I think has profound
theological overtones.
I think the kind of
activism we might
want to support the
most or communal action,
as you call it, would be in
addressing the core conditions
in our society between the
haves and the have-nots
and really
deconstructing the idea
that those are natural somehow.
I think that would
be one of the ways I
would want to focus my
resources and communal actions
in this area.
Are pastoral ministers and
counselors in some respect
first responders?
And if so, what
training can prepare
them to deal justly and
effectively with those who are
experiencing mental distress?
Well, that's a great question.
Pastoral counselors, ministers,
they are direct responders.
Persons with mental
suffering, mental illness,
are much more likely
to see a minister
than they are a psychiatrist.
A quarter, about a
quarter of people,
will come to the minister first.
Maybe 16% will see a
psychiatrist first.
I think pastors and counselors
have somewhat different roles.
But what links them is
you're able to see what's
happening in the broad society
even why you see what's
happening in individual life.
And I think that provides
a resource for them.
So rather than
seeing somebody who
comes to them with
mental distress
is just being a
person with symptoms,
you kind of can
externalize it and say,
isn't that the kind of story
that's happening to all of us?
I mean, you're close enough to
this kind of economic suffering
in the culture that
we live in that you
can tell stories about
poverty in your community that
make it sound as if it's a
shared experience that we're
all undergoing.
That linking of the social
world to the individual world
is so important in this.
I think counselors can
play a specific role
in addressing the shame
that so often accompanies
talking about social class.
If you understand how the
changes of neoliberalism
have come about in the
last couple of decades,
it's not any one individual's
fault for feeling distress
in times like these.
You can help people
resist shame when
they have to do things
like pay with food stamps
at the checkout counter,
the kind of shame that
come from being in a society
where being poor is--
being working class
is marginalized.
Counselors can help by actively
talking about social class.
They can ask
questions like, if you
can take a snapshot of your day
and show it to a rich person,
what would you tell them?
You can ask questions
about working like,
have you ever done
something to help
another worker that your
manager wouldn't approve of
or something like that?
You can kind of ask questions
that bring out the conditions
of working in our time, because
people want you to actively
address their social class.
They want it to be addressed
in counseling in order for that
to be an authentic
relationship that
really speaks to their needs
in their current situation.
Are you optimistic about finding
a just and lasting solution?
I am optimistic about
finding a just solution.
And whether-- I think one of--
as I said already, I think one
of the most important things
is that we begin to talk
about economic suffering
and social class.
That's a conversation
that's begun
in our international
sphere, but I
think it needs to affect
these disciplines too,
like pastoral care
and counseling.
We need to talk
really specifically
about what's happening
in people's lives.
I think that raising
consciousness
both about the
effects of what it's
like to be diagnosed with
mental illness and then
the effects of what it's
like to struggle with things
like unemployment, debt,
foreclosure, those things that
affected us during
the Great Recession
and continue to affect us today.
When we draw our attention to
these really concrete factors,
I think we realize we can
change them in some ways.
Your community might have
a different set of concerns
than mine, but I
really encourage
counselors and ministers to
get involved in social action
at a macro level.
Maybe it's construction
workers in your community
who are suffering a lot
of injuries or wage theft.
If you could get involved
in an organization like jobs
with justice on the side
and then see clients,
I think it addresses
something like burnout that
comes from so many
people suffering,
and you feel like you're just
putting a band-Aid on it.
But if you can figure out what's
happening in your community
and make some
small changes, I've
really seen a difference in both
the mental health of counselors
and then the conditions
in a given community
when we can do these macro
interventions as well.
At the same time,
there's one quote
that I include in
the book that says,
"we're ministers
and not messiahs."
We're prophets of a
future not our own.
And there's a kind of
comfort in knowing that we
can't do everything as well.
So I would I would add that
as a caveat to my answer.
What is your target
audience for the book?
And what do you
hope to accomplish
through its publication?
Well, really the target
audience is educated clergy,
counselors, mental
health counselors,
people who understand
a little bit
about the psychological field.
And then the goal of the
book is to really shift
the conversation
from simply symptom
reduction from mental
illness to prevention
at a broad scale, so societal
prevention for mental illness
through economic justice.
If we can begin to think
about how we could change
the conditions of our society
to create a more mentally
healthy society, that's
really some concrete steps
towards that end or really
the goal of the book.
Finally, as a
scholar, what value
do you place on research
libraries like those
that we have here at BC?
I think a research library
and a team research librarian
is really an
incredible experience.
It's like having someone who
is in your corner working
for you in a complex field.
They can understand the
questions you're asking
and help you with resources.
You can also just
step into those stacks
in O'Neill or Labyrinthian, and
you can experience a kind of--
you might have a
research question,
but when you walk
into the stacks
you experience your
world kind of opening up
and you say, oh, I
hadn't thought about this
or here's a particular
issue just by walking
to a particular area.
You know it's been really
helpful for me from my work.
And then I just add, something
about Boston's whole system
of getting books to you quickly
from all these other libraries
that are nearby, interlibrary
loan, but also the Boston
College system of connecting
to other libraries in the area,
it has been really incredibly
helpful for my work.
I've been able to build very
quickly the kinds of questions
and see the themes and
research agenda for this work.
So it's been tremendous,
all the resources
here in terms of libraries.
