Emma Tseris, Associate Professor, Social Work, University of Sydney, Australia
Introduction
Social work practice in mental health is complex and contested. A major component of the mental health social work role is the completion of psychosocial assessments, which enable social workers to contribute a person-in-environment perspective on multidisciplinary health teams. However, it is very important that social workers also participate in a broader exploration of power, and socio-political analysis of mental health discourses and practices. This includes understanding the limitations and harms of explaining mental distress through the language of psychiatric diagnosis, and critiquing an over-reliance on psychopharmacological treatments (Manchester, 2015). In addition, an intersectional feminist perspective is valuable in making sense of women’s often adverse experiences of the mental health system, and in moving beyond notions of individual ‘symptoms’, or pathology. An intersectional feminist approach can generate many possibilities for social workers to bring gender-awareness to their practice, in order to respond more holistically, ethically, and effectively to women’s experiences of distress.
Resisting the biomedical approach
Due to the dominance of a biomedical paradigm, mental health is often positioned as a neutral and universal concept, rather than one that is deeply embedded in social, political, and cultural assumptions. However, social workers can play an important role in critiquing the dominant biomedical paradigm in mental health, which is constrained by its highly individualistic perspective on mental health, an illness-based and medication-focused approach to understanding distress, and an emphasis on the personal responsibility of individuals to attain mental wellbeing (Topor et al., 2022). Social workers can provide a much more expansive understanding of mental health that explores the connections between violence, social inequalities and distress (Karban, 2017). Increasingly, social work is also engaging in critiques of coercive mental health treatment and human rights violations in mental health systems (Maylea, 2017). There is a pressing need for the social work profession to challenge risk-averse mental health practices and explore alternative approaches to involuntary mental health treatment.
Historically, the psychiatric system has been deeply entwined with patriarchal oppressions, with psychiatric diagnoses assigned to women experiencing gendered violence and/or refusing to conform to gendered expectations around mothering and marriage (Moore, 2021). Diagnoses such as ‘hysteria’ were inherently linked with ‘women’s nature’ (Zavirsek, 2000). In the present-day, the mental health system’s narrow focus on the assessment and containment of distress, and the surveillance of other behaviours deemed ‘abnormal’, leads to women’s experiences of gendered violence being routinely ignored or minimized within mental health systems. Consequently, it is essential that social workers remain attuned to the gendered dimensions of mental health treatment. While people of all genders can experience harm when receiving mental health professional interventions, a feminist analysis draws attention to the heightened oppressions that women can experience when interacting with mental health systems. The centrality of diagnostic language within mental health systems often precludes an analysis of the gendered and socio-political contexts of distress. As a result, women’s experiences of violence and other gendered oppressions are often concealed within psychiatric assessment processes that focus on and primarily ask questions relating to ‘symptoms’. In this way, mental health services frequently participate in the silencing of women’s voices within patriarchal societies.
Social workers can disrupt the oppressive impact of mental health services on women’s lives. Feminist perspectives on mental health are valuable, as they enable social workers to question the notion that the most appropriate response to women’s distress is a psychiatric diagnosis and a medication-first response. Instead, women’s distress is conceptualized as arising within socio-political environments, including patriarchal social contexts wherein women experience gendered violence, injustices, and inequalities. Through adopting a socio-political lens, it becomes clear that a range of social inequalities, including violence, poverty, and discrimination, are deeply connected to women’s experiences of mental distress, and that women often experience further oppressions as a result of their engagement with mental health services, especially within coercive and involuntary interventions (Tseris et al., 2022). It is essential for social workers to make these connections, in order to understand the limitations of medicalized and individual-focused responses to distress. Social workers also need to critique highly gendered psychiatric categories that are assigned to women (for example, Borderline Personality Disorder), which are used to label and pathologize femininity, women’s emotions, and women’s resistance to violence. This involves moving away from the idea that women are simply ‘unwell’, and towards exploring the potential meanings and social contexts of distress, in collaboration with people who have received psychiatric diagnoses.
Intersectional feminist analyses of mental health
Intersectional feminism is crucial in extending a gendered analysis of mental health, to explore the colonial and racialized logics of the mental health system, which are very harmful to First Nations women and women of colour. For example, a biomedical perspective erases the impact of historical trauma, and ignores collectivist approaches to social and emotional wellbeing (Dudgeon & Walker, 2015). Further, it is necessary to interrogate the politics of diagnosis, whereby women, queer and gender non-conforming people, First Nations and racialized people, and people experiencing poverty, are disproportionately assigned psychiatric diagnoses.
In addition to a socio-political analysis, it is crucial that social workers are dedicated to working in solidarity with people who have first-hand experiences of the mental health system—to ensure that the subjugated voices of people who have direct interactions with psychiatric services are central to informing social work practice, advocacy, and activism (Liegghio, 2020). This creates opportunities to challenge the significant power imbalances between professional and lived experience knowledge; to resist diagnostic language as the only approach to discussing mental distress and differences; to challenge the limitations of medicalized responses; and to critique coercive practices. From here, there are many generative possibilities available to social workers to explore a much broader array of responses to emotional despair and crisis arising in contexts of gendered violence and inequality, for example, housing, advocacy, education, income security, as well as crisis and longer-term resources in contexts of gendered violence and abuse. Indeed, beyond formal mental health systems, there are myriad opportunities for social workers to engage in community building, policy work, research, systemic advocacy, and social change to alleviate or even prevent the social drivers of distress, including gendered violence, gender-related poverty, and gendered harassment and discrimination across a range of contexts and institutions. In addition, social workers should explore the highly gendered (and sometimes contradictory) expectations placed on women across diverse contexts, including expectations regarding mothering and caring, sexuality, physical appearance, and emotional expression. In sum, it is highly relevant in social work practice to make consistent connections between individual experiences of distress and the socio-political contexts of women’s lives.
References
Dudgeon, P., & Walker, R. (2015). Decolonising Australian psychology: Discourses, strategies, and practice. Journal of Social and Political Psychology, 3(1), 276-297.
Karban, K. (2017). Developing a health inequalities approach for mental health social work. British Journal of Social Work, 47(3), 885-992.
Liegghio, M. (2020). Allyship and solidarity, not therapy, in child and youth mental health: Lessons from a participatory action research project with psychiatrized youth. Global Studies of Childhood, 10(1), 78-89.
Manchester, R. (2015). Towards critical mental health social work: Learning from critical psychiatry and psychiatry survivors. Critical and Radical Social Work, 3(1), 149-154.
Maylea, C. H. (2017). A rejection of involuntary treatment in mental health social work. Ethics and Social Welfare, 11(4), 336-352.
Moore, K. (2021). The woman they could not silence. Scribe Publications.
Topor, A., Boe, T. D., & Larsen, I. B. (2022). The lost social context of recovery psychiatrization of a social process. Frontiers in sociology, 7, 832201.
Tseris, E. J., Bright Hart, E., & Franks, S. (2022). “My voice was discounted the whole way through”: A gendered analysis of women’s experiences of involuntary mental health treatment. Affilia, 37(4), 645-663.
Zaviršek, D. (2000). A Historical Overview of Women’s Hysteria in Slovenia, The European Journal of Women’s Studies, 7, 2, 169-189.
