Beyond the therapeutic state

The therapeutic state is a pervasive set of practices and ideologies, thinking about how we should all be in the world, which have been ever present in the twentieth century. Classifications, diagnosis and the treatments have been shown to be ineffectual for many populations across the globe, but still we persist with redundant, defunct methods and techniques. Why? Because, as some would suggest, we have nothing better.

This issue is about bringing into question many of these reified, dogmatic ideologies.

These papers represent a moment in time, at an international conference organised by the Taos Institute, amongst others such as Buskerud and Vestfold University College (Norway), Taos Institute Europe, Family Institute (Wales), Helsinki Psychotherapy Institute (Finland) and Family Care Foundation (Sweden).

We have been privileged with working with the authors in this issue, who have been pushing the edges of the therapeutic state and all of its limitations and constraints.

With the costs in psychiatric and mental health systems skyrocketing and prescriptions for psychotropic drugs are written in their millions, coupled with the growth of diagnostic labelling serves to convince us that it is inside people’s minds where the their problems reside – not in the society we are part of.

The therapeutic and psychiatric language permeates our culture and society; we hear it in the workplace, in schools and institutions of higher education, in professional sports, debate programs, TV series and movies. However, since the 1950s the promise of a ‘pharmaceutical cure’ for human problems has meant reduction, perhaps even elimination, of mental illness. Nevertheless, according to the American journalist and author, Robert Whitaker, shows exactly the opposite to be the case: In Anatomy of an Epidemic, (2010) Whitaker argues that the widespread use of psychotropic drugs has led to an epidemic of people who are disabled because of mental illness. Moreover, he argues that the percentage of disability increased dramatically in all countries around the world which has promoted widespread use of psychiatric medications. He is of course not alone in this position as this issue will illustrate and illuminate.

In June 2014, a group of researchers, practitioners, service users and family members organised a conference around this theme, entitled ‘Beyond the Therapeutic State.’ It was held in Drammen, Norway at Buskerud and Vestfold University College. Over two hundred participants representing 28 different countries were present. The conference had contributors from a large number of international networks, including the Taos Institute, Centre for Mental Health and Substance Abuse at Buskerud and Vestfold University College, Family Institute Wales, Family Care Foundation Sweden, Helsinki Psychotherapy Institute and Mad in America. This brought together academics, researchers, users, family members professionals and others who have expertise from direct experience with psychiatric treatment systems. The aim was to promote the visions that go beyond current standardised psychiatric and psychotherapeutic practice and exploring new opportunities. Most alternatives to diagnosis and medication today continue to localise the problems within the individual’s mind as opposed to the community we are part of. We must look beyond this attitude, moving towards relationally oriented communities and through active participation to change the practices and policies for mental health care. So we have a growing list of diagnoses, an ever-growing army of therapeutic helping professionals, establishment of therapeutic institutions in all areas of society, a thriving market for psychotropic drugs as well as a worldwide epidemic of people who are disabled because of mental disorders. It seems timely to ask who it is that actually benefits from this growing ‘therapeutic conditioning’, and whether it is time to move beyond the therapeutic state?

In this issue, we have made an attempt to capture some of the themes from the conference. The Taos Institute and its partners from a social constructionist field of thinking and doing gathered in Drammen, Norway for a three-day event.

Drawing on the impressive global connections and affiliations of the Taos institute, we have been able to assemble these key writers, who between them provided the bedrock of the conference. We attempted to bring together colleagues who were working out of social constructionist position in their practices, and what we might call ‘beyond the therapeutic state’.

In this issue, we have six key papers on offer which provides a useful web of ideas and which together we think, captures our experiences at this important conference.

Robert Whitaker, author of the paper ‘The Triumph of American Psychiatry: How It Created the Modern Therapeutic State’ and of ‘Anatomy of an epidemic’ (2010) provides the introduction to his position as an influential speaker and activist. He spells out some stark realities of the psychiatric systems dilemmas and practices. Not only in a USA context but gives a warning of what is currently developing across the globe. He highlights the almost palpable direct consequences of the DSM on Counselling and psychotherapy practices, along with other therapeutically oriented ways of offering services to help people deal with their distress and problems of living.

Sami Timimi, author of the paper entitled ‘Children’s mental health: Time to stop using psychiatric diagnosis’ and of ‘Mis-understanding ADHD’ (2007) a psychiatrist and critical thinker about his own field, brings together the challenge of diagnosis. Thinking from within and beyond the state, he offers us a bold critique of thinking too much from inside the box, and brings the field and science of the psychiatric diagnostic process into question. In this paper, he is offering a critique of how bad evidence can lead to bad thinking and the dangers inherit in that.

John Shotter, author of the paper ‘Psychiatric diagnoses, “thought styles”, and ex post facto fact fallacies’ and of Social construction on the edge (2010) picks up the critical batten so to speak, and deconstructs for us the diagnostic, therefore the linguistic contradictions. He draws upon our use of language to again illustrate the pitfalls of not attending to relationship in an attempt to alert us how not to rely on certainty to inform how we relate, communicate and engage with and towards each other.

Sheila McNamee, author of the paper ‘Radical Presence: Alternatives to the Therapeutic State’ and co-author of Relational responsibility (1998) continues the theme of previous authors and offer us challenging and provoking ideas. She invites us to consider how we can position ourselves in relation to others and the dominant discourse which shapes and constrain us. This leads to the final two papers, and open the window to practices which challenge The Therapeutic state and its current paraphernalia’s for constraint and control.

Carina Håkansson, author of the paper ‘The extended therapy room’ and of Ordinary Life Therapy (2009), provides us with a snapshot of her practices in a Swedish context. As a key presentation at the conference, she brings to life the therapeutic work she does with families beyond the therapy room and beyond the therapeutic state. In this paper, she illustrates her practice by inviting us into her approach to working in and with relational practices.

Finally, in the paper ‘From victimhood to sisterhood – A practice based reflexive inquiry into narrative informed group work with women who have experienced sexual abuse’ Leah Salter, a conference participant offers a glimpse into the world of shaping experiences with clients, to moving in and between the various positions as researcher, therapist researcher, collaborator and researcher participant. She illuminates the shifting of these positions into being one of a group coordinating therapeutic, helpful and sustainable service without the state to aid this.

We think we have taken care in choosing these papers, and believe these best represent a moment in Drammen, a moment for all who attended and a moment which cannot be reproduced in all of its content, but is constantly being reproduced each time we meet and muse, articulate our relationship beyond the therapeutic state.

The formation of TAOS Institute Europe was held shortly after the conference. As with many of the ideas, they are relevant to our ongoing thinking and practice as counsellors and psychotherapist, practitioners, academics and researchers across a variety of countries and boundaries, whether physical or political. We hope that the ideas contained in this issue will stimulate and energise other ways of thinking about our ongoing practices and lead to new connections and a social constructionist position.

We see this issue as in invitation to think beyond the state and its therapeutics for many professions, professionals, service users, families, survivors and organisations; and many others who are looking for something different. We hope we will see you at our next conference gathering.

Billy Hardy
The Family Institute, University of South Wales, UK, TAOS Institute Europe and TAOS Associate
[email protected] Ness
Buskerud and Vestfold University College, Norway, TAOS Institute Europe and TAOS Associate
For further information on the TAOS Institute and TAOS Institute Europe visit www.taosinstitute.net