2023-06-09 10:51:45
«Psychotherapy cannot fix all problems, nor be the only support to get ahead»
Talking with… the psychiatrist Marta Carmona and the psychologist Javier Padilla, author and author of the book “Malestamos”. Interview published in No. 3 of Encuentro Magazine, year 2022.
Authors of the essay ‘Malestamos’, Marta Carmona, psychiatrist at a mental health center, member of the Silesia Collective and of the board of directors of the AEN and AMSM, and Javier Padilla, family and community doctor at a health center, also member of the Silesia Collective and deputy in the Madrid Assembly, talk about ‘malaise’ as a feeling of the times, the influence of social determinants and lifestyle on mental health, and possible responses from the collective.
In the book, you say: “Mental pathology, to be considered as such, must deviate from the norm of its time, if the phenomenon affects the entire population we are no longer talking about a pathology.” What discomforts make us perceive that we are at a more invivable point?
Martha Carmona: Both inside and outside the diagnoses, there is something happening on another axis: if I am going to be able to work or not, if I have an agency or not to develop my life project… They are transversal discomforts and have to do with the entire population.
The clinical look is useful, but there is a part that is left out. It imposes an individual, technocratic and mechanistic framework. “I need someone to come and fix something that I have broken”, when much of this suffering has to do with a failure of the socioeconomic system.
You argue that the malaise is not a dysfunction of capitalism but its logical consequence and that this has generated a ‘feeling of the times’.
javier padilla: In our time, the hegemonic feeling would be discomfort, experienced by each one as something referenced within their own biography, but that happens to other people. Three feelings intersect: that the generations of young people today will live worse than the generations of their parents; that the present is exhausted and exhausts us; and that the future is not imaginable, because it is cancelled.
“It is a cry for help of a generation”
In 2021, 4,003 people committed suicide, and there is a rebound among adolescents and young people. How does our way of socioeconomic, political organization… affect your mental health?
Martha Carmona: Suicide is complex enough to simplify and make direct associations. This brutal rise in children and adolescents is very striking, of self-harm, suicidal ideation, completed suicides… In a way, it is a cry for help from a generation. Those of us in another position have an obligation to listen and see what has happened.
During the pandemic it was the first part of society that could be renounced and with which there was no obligation to repair anything. In addition, a persecutory discourse was articulated about them, “we must keep you locked up because you are dangerous.” Nothing that within the world of mental health we have not already heard…
Does the biologist current predominate as an interpretation of mental health problems?
javier padilla: It is indisputable that those theoretical currents that move within the biologist framework tend to have access to the great speakers. But the popularization of the debate on mental health has enabled other discourses, on the climate emergency, housing, the workplace…
Martha Carmona: After decades of hegemony of the biomedical model, even its greatest exponents are having to back down and add social factors to their discourse because, at this historical moment, things are not just about dopamine.
You talk about the need to politicize the malaise, why?
javier padilla: Politicization is the opposite of the privatization of malaise, it is bringing it to the area of the collective, recognizing causes that transcend the individual. A malaise cannot be addressed with collective causes and suffering, but rather with a response that interacts with the community. Going from “what about mine” to “what about ours”.
You propose four elements as an answer: egalitarianism, social infrastructures, roots and suppression of the sexual division of labor; and the figure of the ‘universal caregiver’.
javier padilla: Anything that moves towards income egalitarianism implies a decrease in psychological suffering in society. In order for forms of collective functioning to take place, social infrastructures are needed that encourage contact and people have to be able to project themselves in that place, with roots, for some time.
«Everything that advances towards income egalitarianism supposes a decrease in psychological suffering in society»
Mental suffering is not equally distributed between men and women either, and all the measures aimed at egalitarianism in this field also help to improve it.
Martha Carmona: They are elements to dismantle the idea that on the one hand there is productive work, the important one, and then there is reproductive work, care, hidden; and generate new imaginaries.
Imagine that someone close to you, without being a direct relative, but with whom you have a close relationship, experiences suicidal ideation. Do you have a way of saying in your work that you are going to accompany that person, who is in an obvious vital crisis, without losing purchasing power? The system doesn’t understand it. But why not?
How to put psychotherapy at the service of the collective?
Martha Carmona.: Psychotherapy has to be linked to its historical moment, because the objective is to provide the person with better tools to adapt to their context. A psychotherapy detached from social determination is ethically controversial. Even though it apparently works because it blocks the symptom, months later the person may have worse symptoms. Psychotherapy has to be oriented to the collective and be a humble framework. You cannot fix all the problems, nor be the only support to get ahead.
One of the shadows of therapeutic culture is that it deactivates spaces for activism. What activists do in each era says a lot about the historical moment and social aspirations. If they’re settling for crumbs, the social moment is likely to be pretty bad.
Why are chemical, physical and emotional restraints still applied and defended as therapeutic in psychiatric hospitalizations?
Martha Carmona: Even professionals dedicated to the cause have a normalized way of working. The system leaves a lot of needs uncovered and when everything has gone wrong, in extremis, we act violently. The biomedical framework has not helped. When a situation is reached that ends in an involuntary admission, it is because, for a long time before, things have been happening that are taking the person and their environment to the limit.
Part of the design of the mental health network is intended to make these supports more community based and much more respectful of people’s rhythms, but it is underfunded.
What role can people with mental health problems play in the construction of a new model?
javier padilla: Many aspects should be linked to direct participation. The problem is that people with disabilities continue to be treated with paternalism and condescension, even when they are invited to take an active part in the design, management or evaluation of public policies. There is a long way to go.
What is the discomfort of health professionals?
Martha Carmona: Those who are in the socio-sanitary area have the feeling that they are emptying the sea “in cubes”, and that no matter how hard one tries, it does not arrive, because the demand is impossible to handle with the resources that exist. Another element that generates discomfort is the entry of vulture funds into the management of resources, and that these principles of commodification interfere more with technical criteria every day.
*** The book “We upset” It is available for loan at the library of the SALUD MENTAL ESPAÑA Confederation, by writing to documentacion@consaludmental.org.
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