Is distress a Psychology or social justice issue?

Someone on Twitter posts a photograph of a person standing beside their wheelchair underwater, portraying the power of water. Another user comments, 'Resilience'. This illustrates a trend that psychology is currently in danger of emulating: whereby insight and outsight merge and become insight alone. Where regardless of the context, the individual has to thrive. If they do, it's because they are resilient. And mental health disorders replace the broad social, economic, and material determinants of health and wellbeing.

This new book Outsight: Psychology, politics and social justice argues that as psychologists we have managed to remove the individual from their community and context, and that it's time we undid that. The authors themselves are a collective rather than individual, belonging to the Midlands Psychology Group - a small team of psychologists who meet regularly to brainstorm ideas on the role of psychology in the context of our times. The book pays tribute to this and even includes a set of guidelines for anyone who wants to create a similar group. While it goes through some successful examples of community-building by psychologists and offers a manifesto for a social materialist approach to distress, this book is preoccupied chiefly with raising some hard questions about our current compulsively psychological approach to distress.

According to the group, distress is a normal reaction to our disordered circumstances. If we fail to see this, it's because our culture distracts us from identifying and talking about broader, non-psychological factors such as income, education, unemployment, working life conditions, food insecurity, housing, and access to affordable health services of decent quality.

The authors suggest that psychologists, counsellors, therapists, and coaches should acknowledge this and help reduce self-blame. There isn't anything that needs fixing other than our obsession with fixing individuals. Just because we may have privileged access to our feelings and perceive them as raw and intense doesn't mean that what shapes them is exclusively internal, they suggest.

The external, more distal power dynamics may exercise an even more significant influence while we're busy with introspection. In these neoliberal times of various gaps between wealth, genders, ethnicities, 'included and excluded'; the erosion of communities; the public sphere giving way to privatisation; and ecological and environmental challenges, the authors argue that the role of psychologists and therapists needs to be broader, more dialogic and compassionate, more political, and more radical. They say it needs to focus more on urgent areas such as policy changes, building and working with communities, addressing the needs of the 'oppressed majorities' and questioning ideology.

Outsight places emphasis on the need to allow people to write their own stories of their distress, come together to find more comfort and social support but also to develop connections that enable them to make better use of the power and resources individuals possess to effect change (in their circumstances, rather than themselves). 

Does distress even belong to psychologists, given its ideological, political, economic, cultural, and sociological roots, the reader might wonder? Might we psychologise what is anything but psychological (internal to the individual)? Is our approach to distress influenced more by current ideology and maintaining existing disciplinary segregations and less by the actual evidence? 

The points raised in Outsight echo those raised by other recent publications, such as a review which found that depression is most likely not caused by a chemical imbalance (Moncrieff et al., 2022); the concerns around how the standard classification of mental health disorders has been compiled (Davies, 2013, 2022); and some evidence that psychologists themselves may be unfamiliar with alternatives to diagnostic labels despite many of them seeing the application of 'medical labels to psychosocial problems' as an issue (Rasking et al., 2022).

As part of a recent campaign initiated by the British Psychological Society, psychologists argue that to tackle inequalities, the Equalities Act should protect social class (Rickett et al., 2022). This argument is important, given that the UK has seen increasing inequalities in the last decade (Marmot et al., 2020; Tompson et al., 2022).

Reviewed by Dr Raluca Matei, an applied health psychologist who teaches at the Universities of Chichester and Bath, and Roz Williams, coach and Professional Doctorate candidate at Birkbeck, University of London. 

• Outsight: Psychology, Politics and Social Justice by The Midlands Psychology Group is published by PCCS Books