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“Just a social construct”

“Just a social construct”

nbarker's picture

I have a lot of complicated feelings on this subject, so please, bear with me. I've been very hesitant to post this. I have been going through quite a trying time this past week. In attempting to come off one of the medications for my fibromyalgia that has been giving me deleterious side effects, it ended up triggering a huge flare-up. I even ended up in the Emergency Room on Saturday--it's been over a year since I last hit a 9 on the Pain Scale. Thus, it is only just now that I am able to even look at a screen for long enough to write this post to try and figure out some of the things that have been troubling me in our class recently. This is not meant at all as an attack on anyone, nor do I believe anyone has been intending ill. These issues are very painful for me to discuss, as they bring up a lot of my most deeply personal experiences, both with mental health and with domestic violence. I am also much more disjointed than I would like, at the same time that I am trying to put this in a way that can be heard.

After Anne's post of class notes for 11/6, in which she mentioned that she noticed that the visit from Victor and Orsola threw some of us. I was definitely one of those people. This visit, in combination with the storytelling workshop, and our prior discussions of mental health in Feminist Studies class, is what brought me to write this post.  Running throughout all of these instances is a thread of thought that I have found very troubling. In each of these, there seems to be the implication that we should regard mental illness as being "just a social construct", and an assumption that you can make situations that are inherently unequal into equal ones. Let me address them below.

I was excited for the storytelling workshop, not just because of its applications in terms of how it applied to our class, but also in terms of my growth as a writer.  But I was profoundly disappointed and more than a little disturbed when Benaifer and Monsoon mentioned that they thought that storytelling wasn't just therapeutic in nature, but that the narativ method could be used as a form of actual psychological therapy. They claimed that the act of speaking aloud the hurt can be therapeutic in and of itself.[1]  Similarly, the two people representing co-counseling said that it could in fact be used as a form of psychological therapy.

This is an incredibly psychologically dangerous idea. For people with less-severe instances of mental illness, perhaps this could indeed help as a therapeutic method. However, to hold this and other such “alternative therapies”[2] out as a method of psychological therapy means that it enables people of many different levels of mental health to believe that their problems are the fault of society. This allows them to say “it’s society’s fault that I am sick, it’s nothing wrong with who I am.” It enables saying “if society weren’t this way, I wouldn’t be this way.”[3]

This is a profoundly ableist notion. These sorts of beliefs are reinforcing our society's attitude that it is incredibly shameful to be mentally ill, mentally disabled. Thus it is much easier for one’s (VERY socially constructed) sense of shame to blame your problems on a factor “outside” yourself, rather than your mental illness being caused by an organic problem that society has told you is more “your fault”. This is just reinforcing societal an internal shame about mental illness, and preventing the healing that can provide some measure of peace. Mental illness is one of the few categories of disability that can be very hopeful: many disorders have some hope of remission (such as depression and PTSD). Holding out therapies that have little to no empirical evidence of them working prevents the mentally ill from seeking and carrying out therapies that are empirically proven to work much more than they worsen, when every action can count towards or against healing, and when inaction can worsen the situation.  We cannot afford to take on therapies where the therapists have no training in how to deal with worsening situations, even when those carrying out the therapies are ourselves. This is a reason empirical therapy exists: to save people from the most harm possible in an already stressful and harmful situation. Empirical therapies exist because the consequences of therapy can be and often are life and death. The power dynamic between therapist and patient will always be an inherently unequal one, but that doesn't mean that it is inherently “bad”. Patients can and do take comfort in the training of their therapists. 

We, as laypeople, have no way to determine the extent of another’s illness in a way that can lead to treatment. Even when we are the sufferers, such as in my case with PTSD, we rarely have the capabilities to determine the extent to which our illnesses have affected us.[4] I spent years thinking I was “fine”, and that it wasn’t out of the ordinary to have those brutal nightmares. I spent years denying the existence of my illness, years I wish I could reclaim even now. Going to alternative therapies, mostly ones proposed by my father, just impeded both my and my mother’s healing from our psychological traumae, and enabled him to keep abusing us for years. My mother and I tried to "do our parts to help", all the while he was abusing us further. 

Psychological stress and mental illness are not things that should be played with lightly. Indeed, storytelling, and rehashing the traumatic event, is strongly contraindicated in many psychological conditions. In many disorders, going over a traumatic memory may in fact gravely worsen the disease, as is the case with Post-Traumatic Stress Disorder, for example (which I have).

I won’t deny that mental illness IS exacerbated by social constructs, and in the case of Axis II (and IV) illnesses, they can be largely environmentally “caused”. However, mental illness is not a social construct in and of itself. More often than not, mental illness has a biogenetic component, what is as close to something truly objective as is possible for current humans to achieve. Mental illness is not “just a social construct”. This issue wouldn't even be on the table if mental illness wasn't mental, per se. Mental illness is just as much an illness as cancer. If mental illness had physical manifestations it wouldn't even be being questioned as to its “realness”. We wouldn't feel a need to dismiss it as being "society's fault". 

There was another related issue brought up on Tuesday: on using co-counseling as a way to deal with domestic abuse. I vastly prefer the term domestic violence, as is the standardized terminology in the survivor community of which I am a part. Confronting your abuser, especially in a context such as couple’s therapy, rarely leads to anything but more trauma to the victim, and another chance for the abuser to harm. In many cases this can lead to grievous bodily and mental harm to the victim.

Seeking out these therapies often leads to victim blaming. Many of the tenets of such therapies claim to make an “equal space” for abuser and victim to be in together. Claiming that you can even create a space of equality between abuser and victim is horrifying and utterly false, and reinforces the societal messages we victims have been fed all along; that it is the victim's fault for "being such a bitch", that we "deserve it", that "you had a part in it too", all of which are patently untrue. This enables abuse, and implicitly sends the message that their abuse is somehow excusable, even merited.There was another related issue brought up on Tuesday: on using co-counseling as a way to deal with domestic abuse. I vastly prefer the term domestic violence, as is the standardized terminology in the survivor community of which I am a part. Confronting your abuser, especially in a context such as couple’s therapy, rarely leads to anything but more trauma to the victim, and another chance for the abuser to harm. In many cases this can lead to grievous bodily and mental harm to the victim. These sorts of alternative therapies also tend to attract abusers to them like flies. Let’s again take the case study of my father: he tried many such nontraditional therapies—the ones I can recall at the moment include Non-Violent Communication, Victories of the Heart, and various appropriated traditional cultural practices in a very corrupted form.

I’m not entirely sure where I was going with this. Perhaps conclusions will come to me tomorrow, for a follow up post.  For now, I need to fight down my pain attack.

[1] This is the same sort of discussion that was used for many years to justify Freudian-derived therapies, including its modern outgrowth, psychotherapy, especially psychodynamic therapy. Freudian therapy has very little effect for the vast majority of disorders, shown in empirical studies. This lack of improvement in and of itself can be incredibly harmful in cases of severe mental illness.

[2] With the caveat that there are, in fact, many alternative therapies with empirical evidence to suggest that they DO have effectiveness over and beyond the clinically accepted methods of therapy. Take, for example, the famous case of acupuncture. I myself had a large degree of success using EMDR, once dismissed as being ineffective, in helping to treat my PTSD, along with cognitive-behavioral therapy.

[3] As a dear friend of mine (not in this 360) said to me yesterday, "My depression isn't a social construct. It's an illness. A social construct wouldn't keep me confined to my bed for days on end."

[4] I also feel I need to say at this point that I have little faith in the medical system as it is. It needs change. Alternative therapies that do have empirical evidence, e.g. massage, are very necessary in the beginnings of that change. 

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