Submission to The Social Lens: A Social Work Action Blog by Natalie Femia, Just Healing, Sydney, Australia.
The field of mental health has been my passion since I was an adolescent. It is what drew me down the typical route of studying psychology before realising that it wasn’t the right fit for me and therefore pivoting to social work. That’s the short version of a very long journey that led me to social work, but what I was looking for was a path to change the situations and injustices I had experienced so that other people wouldn’t have to experience them, rather than changing people to adjust to the oppressive conditions of their lives. The very first lecture I attended solidified for me that social work was what I had been seeking. It was energising and reignited my passion for a radical critical perspective of human distress that had not been validated anywhere else. Sadly though, I have come to realise that this perspective is not that common in the field or even within the profession.
In my reading, I’ve come across the argument that social work has aligned itself with psychiatry from its very origins, and many argue that this is still the case today (Brady, Sawyer & Perkins, 2019; Cohen, 2016; Gomory, Wong, Cohen & Lacasse, 2011). I have witnessed support for this position during my three years working in this area. It seems that this alignment is an attempt at gaining legitimacy amongst other professions (Brady et al., 2019; Cohen, 2016), not for the purpose of better supporting the people seeking our support (I will use the term ‘clients’ from now for ease), but from what I have observed and others argue, for the purpose of gaining power through the professionalisation project (Brady et al., 2019).
If I can wander down a correlated path for a moment, the long push for registration in Australia by the Australian Association of Social Workers (AASW) has always felt to me like the epitome of this. I recently opened an email from the AASW describing the benefits of seeking registration. They wrote of wanting to build the “professional identity” of social workers, that the professional identity of social workers is lower than that of other health professionals, and that we will have “greater clout” when “dealing with Governments and the public service.” And I get it, I really do. The more outspoken I am, the more I endure tactics of silencing from others who claim I’m not qualified to speak about whatever it is I am advocating for. I can empathise with social workers who feel that gaining registration would mean gaining respect from other professions and the general population, but I don’t agree that that outcome would materialise. Do other professions and people in Australia even know that we are not registered, or what that means? Is that really the reason we are not respected or have ‘clout’ or are not seen to be qualified to have opinions? In my experience it’s not our profession that is not respected, it’s what we stand for, what we advocate for, and I’m not sure how that will change just because we become registered. The thing that is starkly absent from these discussions espousing the benefits of registration is what exactly that would mean for our clients and how they will benefit. It makes it difficult to interpret the desire for registration as something other than a power grab.
Another aspect of the chase for legitimacy can be observed in the way the AASW is trying to pass through changes to its structure that would mean moving towards a model where ‘specialties’ within social work are separated, in what seems like another aim of its professionalisation project. There have already been silo effects of specialisation with distinctions made between mental health social workers, family violence specialists, child protection specialists, and disability social workers. What happens when a client meets us from the intersection of all of those experiences? How can one be an ‘expert’ in mental health, for example, without having equal discernment of domestic and family violence or disability or child protection, and vice versa? I thought our strength as social workers was that we worked with the nuance and complexity of all of these intersections all at once.
In reflecting on ‘professionalism’ and the professionalisation project, I have been thinking about how these are rooted in white supremacy and classism. The idea of professionalism was scattered throughout my studies, in reports that we needed to complete on field placements, for example. Professionalism seemed to be more important to field educators and future teams I was a part of than our social work values and ethics. Is our time management, demeanour and etiquette more important than the positions we take on social injustice? Apparently so. Do our clients really care about those things? In my experience, no.
Why don’t we talk about how the general push to keep the peace within multidisciplinary teams almost always means compliance or complicity with decisions and practices that come at the cost of our clients, because in general, even politely and meekly objecting to something oppressive is met with disdain. This is why when I meet other social workers I am not concerned with how ‘professional’ they are, if they turn up to meetings on time, if they have the appropriate etiquette, or if they share their opinion with the correct amount of assertiveness, etc.; I want to know what their values are, what their ethics are, what positions they take on acts of oppression, and how they will maintain those and sustain themselves.
Overall I can’t stop thinking about this whole push for registration and the professionalisation project within the context of Audre Lorde’s piece, “The Master’s Tools Will Never Dismantle the Master’s House” (Lorde, 1984). If I can circle back to the social work role within the realm of mental health, it makes sense to me to think about the alignment with psychiatry through this lens of the master’s tools, with the master’s house being the psychiatric hegemony and its brothers and sisters – white supremacy, capitalism and patriarchy. We already know that the biomedical model narrows meaning, closes off alternative possibilities, and obscures social and political drivers of distress. Another effect that makes this important for us to talk about is the fact that it is clear – and has been clear to others who have argued this same point – that the biomedical model of mental health and the psychiatric hegemony create a distance between ‘professional’ and ‘client’ that is oppressive (Medicating Normal, 2022). This results in an increased (and invisibilised) power differential, othering of the client, a lack of empathy for clients and their experiences, and a denial of the legitimacy of theirs and others’ lived experience expertise. This separateness contributes to and perpetuates the oppression caused by the psychiatric hegemony.
There is power in us forming an alliance with clients and psychiatric survivors. However, it has been argued that the survivor and peer movements have also faced the issue of being co-opted by the biomedical model (Hall, 2007). In other discussions about survivors as therapists or social workers (Hall, 2021), it is argued that lived experience on its own is not the answer given this potential for co-optation, but that values and ethics like social justice and anti-oppression, and a social perspective of mental distress are all additionally important in mental health workers in relationship with lived experience expertise. Social work is naturally in a powerful position to fill this need, given our knowledge-base, ethical commitment to social justice, and the likelihood that our workforce contains a high percentage of social workers with some sort of lived experience.
In my teaching I have witnessed social work students feeling challenged and confronted by a critique of the psychiatric hegemony, because the lure of the biomedical model is strong and has provided validation and legitimacy for their experiences (Lafrance & McKenzie-Mohr, 2013), and requires conscious unlearning. But I have witnessed many more students express liberation in making public those power structures that contributed to their experiences of oppression and distress. Getting social work to the position of a liberatory alliance with psychiatric survivors, mental health peers, and anyone with lived experience of mental distress, begins with a radical education in critical mental health theory. I would love to see the emphasis shift from registration and professionalism to what Michael White (1993, pp. 121-132) described as solidarity:
And what of solidarity? I am thinking of a solidarity that is constructed by therapists who refuse to draw a sharp distinction between their lives and the lives of others, who refuse to marginalise those persons who seek help; by therapists who are prepared to constantly confront the fact that if faced with circumstances such that provide the context of the troubles of others, they just might not be doing nearly as well themselves.
If there is a fear that this solidarity would cause ‘vicarious trauma,’ ‘compassion fatigue’ or ‘burnout,’ I haven’t seen any evidence of this happening. I have only seen the opposite – distancing and complicity – contribute to the ‘spiritual pain’ (Reynolds, 2011) of social workers. In my own journey post-graduation I have found the strongest support and solidarity to sustain myself through punitive and oppressive workplaces in my fellow social work peers committed to this same fight, but even more so in alternative mental health spaces outside of social work where communities are building to challenge the biomedical dominance in their (our) own experiences of distress and reclamation of madness. In this journey I find more resonance in Lorde’s (1984) writing that can be applied to madness under the psychiatric hegemony:
Those of us who stand outside the circle of this society’s definition of acceptable women; those of us who have been forged in the crucibles of difference…know that survival is not an academic skill. It is learning how to stand alone, unpopular and sometimes reviled, and how to make common cause with those others identified as outside the structures in order to define and seek a world in which we can all flourish. It is learning how to take our differences and make them strengths. (p. 112)
My own survival in both my lived experience and this work has not been an academic skill but a combination of the radical education I have since learned is rare and a privilege in this field; of standing alone, unpopular and sometimes reviled in this work; and of making common cause with those others identified as outside the structures. I have been learning to shed the stigma from within our profession toward lived experience in reclaiming my own, and in doing so am finding an expansion of meaning, possibility and agency in these alternative spaces and communities where there is indeed a sense of hope for the possibility of a world in which we can all flourish. If anyone needs to know what professionalism means to me now, I say solidarity. Solidarity liberates us all, and provides the only power worth seeking.
References:
Brady, S., Sawyer, J.M. & Perkins, N.H. (2019). Debunking the myth of the ‘radical profession’: analysing and overcoming our professional history to create new pathways and opportunities for social work. Critical and Radical Social Work, 7(3), 315-332.
Cohen, B.M. (2016). Psychiatric hegemony: A Marxist theory of mental illness. Springer.
Gomory, T., Wong, S.E., Cohen, D. & Lacasse, J.R. (2011). Clinical social work and the biomedical industrial complex. J. Soc. & Soc. Welfare, 38, 135.
Hall, W. (Host). (2007, April 11). Peter Stastny: Dissident Psychiatrist [Audio podcast episode]. In Madness Radio. https://open.spotify.com/episode/2wPTEJUJwaXZUBuEgoBKVx
Hall, W. (Host). (2021, November 6). Survivors as Therapists: Jacks McNamara [Audio podcast episode]. In Madness Radio. https://open.spotify.com/episode/2zsAOMiZdy4W2Rdzu1GCoR
Lafrance, M.N. & McKenzie-Mohr, S. (2013). The DSM and its lure of legitimacy. Feminism & Psychology, 23(1), 119-140.
Lorde, A. (1984). The Master’s Tools Will Never Dismantle the Master’s House. Sister Outsider: Essays and Speeches (pp. 110-114). Berkeley, CA: Crossing Press.
Medicating Normal. (2022, January 22). Professor John Read: Antidpressants & Withdrawal Research. [Video]. Youtube. https://www.youtube.com/watch?v=bNv59S-gc4U
Reynolds, V. (2011). Resisting burnout with justice-doing. International Journal of Narrative Therapy & Community Work, (4), 27-45.
White, M. (1993). Histories of the present. In S. Gilligan (Ed.), Therapeutic Conversations (pp. 121-132). New York: W.W. Norton.
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