Liberation and Mental Health

When I taught English as a Second Language to nursing assistants and housekeepers in a Boston hospital, one thing that stood out to me was how tired they were when they arrived in class. All of them had been up before dawn. They had been on their feet doing physically and emotionally taxing work for low pay. They had been bossed around, told not to speak their native language, and been at the receiving end of racial epithets and anti-immigrant slurs coming from patients. Many were proud to report how they conducted themselves in a professional and compassionate manner despite these epithets.

Harder to manage were the supervisors who treated them badly, who unfairly denied them vacation, who yelled at them and demeaned them in front of co-workers. Those episodes left them shaking with anger, sometimes in tears, totally distraught. I wasn’t their therapist, but as every teacher knows, big feelings can get in the way of learning, so it felt like part of my responsibility to help them process those feelings. In any case, I knew I couldn’t ask them to park that part of themselves and open their books to start studying common phrases used on the job (which is what management wanted us to do in these classes so that workers could better follow instructions).

One thing I could do, though, was teach English skills in a way that also provided them with information and perspective about their situation. In class, we read stories about workers dealing with similar issues. They could see that they were not alone, that they weren’t being targeted by supervisors because of some personal failing. We read about workers who took action – who found ways to stand up to their bosses as individuals and as part of a group. Most powerful of all, we talked about the union that they were all members of. We had union stewards come in and speak. We role-played meeting with management alone vs. having a union steward at your side. We read parts of the contract and learned English by learning their rights.

“Thank God for the union,” I used to think to myself. As imperfect as it is, it provides structural support for fighting the boss and for staying human. Without it, the worker is literally on his or her own. When they arrived in my class feeling alone and despairing and wrung out, I could point to an entity that contradicted that narrative. It wasn’t a cure, but it made a huge difference.

What would a therapist do if one of these workers presented herself for services? If the stress and the anger got to be too much for her, and she ended up hospitalized or seeking outpatient mental health care, what would the therapist see? And how would the therapist’s training cause her to respond? Probably, the therapist would see the client as having “problems” – depression, anger management issues, stress, etc. The therapist would provide strategies for the client to manage these problems. The therapist might refer the client to a psychiatrist for medication. The goal would probably be for the client to control her symptoms enough so that she could go back to work.

If she had a normal English teacher and a normal therapist, she might have memorized the common phrases used on the job along with some positive self-talk and perhaps some medication so that she could take her place in the economy as a good low-paid worker.

It’s enough to make you think that capitalism needs the “helping” professionals (like educators and social workers) in order to patch people up, equip them for proper functioning, and inure them to oppressive conditions so that we can all keep doing our part to keep the whole nightmare of a system going.

Educators like me have Paulo Freire and a rich history of popular education that he helped spawn. We can draw off numerous thinkers and models to empower our students rather than see them as empty vessels operating at a deficit and needing to be filled with learning. We can “co-investigate” their conditions with them, and in a process of reflection and action, they will learn not just literacy skills but they will also learn how to be subjects of their own lives – how to affect the conditions they experience, not just fit into those conditions.

What about therapists and social workers – the people who are often tasked with saving people’s lives only to send them right back out into the same conditions that got them into a crisis in the first place? What resources do they have to discover a more liberatory model of “help” – a model that sees people not just as individual manifestations of mental disorders that need to be cured? Where do social workers look when they want to support clients to see that their rage, stress, anxiety, etc. are not personal failings but can in significant ways be traced to the system they live in, and that the system is not a fait accompli; it is something they – the client and the social worker – can affect?

Social workers and therapists need look no more! A new book edited by Dawn Belkin Martinez and Ann Fleck-Henderson, “Social Justice in Clinical Practice: A liberation health framework for social work,” provides an excellent overview of what it means to put a liberatory model of mental health care into practice. Ten case studies featuring a wide range of clients – from all over the race, class, and gender spectrum – suffering from a range of problems – including “major mental health” issues, addiction, and domestic abuse – tell the story of how a practitioner can engage a client in a radically different way.

Drawing from Ignacio Martín-Baró, the “father” of the liberation psychology, the liberation health practioners in these case studies aim to transform not just the individual but the society that contributed to the harm of the individual. They also transform themselves by learning from their clients, reflecting on their practice, and investigating how their own worldview or class-race-gender roles affect their relationship with their client.

Consider the story of Kevin, a white working-class man of Irish descent who was raised in a culture that valued individualism and strong, aggressive male behavior. He started drinking at an early age and came to associate sobriety with vulnerability because it was when he was sober that he was “consciously aware of feeling scared and hurt.” Having received such strong cultural messages that it was not okay to feel fear or pain, he pushed them away by using drugs and alcohol. When he started seeing Liana Buccieri, his social worker and the author of his case study, he had been sober for 8 months, but he was also “stuck,” still showing explosive anger and other behaviors that were getting in the way of him doing what he wanted to do.

Buccieri guided him through a process of analyzing the personal, cultural, and institutional factors that contributed to his addiction. She asked him, “Who benefits from you thinking it’s not okay to be vulnerable or it’s not okay to ask for help? Who benefits from you blaming yourself?” As they deconstructed the messages he had grown up with and his understanding of “the way things are,” he gained new perspective. For example, he realized that if we had a culture of community responsibility rather than individual responsibility for people’s well-being, then “things would really have to change [and] no one in charge wants that.”

Kevin began to “link his individual symptoms and behaviors more and more to systemic issues; he began to think about the ways that capitalism, classism, racism, and sexism all impacted his struggles and experience in life.”

At this point in the story, if we were in my English class, we would have the union to turn to. “Here is a way you can join with others to take action, to file a grievance, to fight for a better contract, to be given and receive solidarity,” I might say.

But what does Kevin have? Here in the U.S., in contexts outside of the labor movement, are there structures or organizations or entities he can turn to to experience solidarity, to experience himself as an agent of meaningful change?

In Kevin’s story, the author alludes to the possibility of him joining with others to get a policy changed at the shelter he lives in. This is a major shift. Instead of just exploding in anger about the policy and possibly getting himself kicked out, he sees that others are upset about the policy too and that together they could have “strength in numbers.” The author also alludes to the Occupy movement, which was at its height when she and Kevin were working together. Among its many accomplishments, the Occupy movement can claim these ripple-effect victories as well: liberation health practioners had something to point to when they wanted to show that it’s possible for regular people to do more than get mad about the way things are but to also fight back against the people “in charge.”

Melvin’s story provides another case study. A young man whose mother emigrated from El Salvador when he was a child has now finally been able to join her at the age of 15 after a dangerous border-crossing. At first, they are overjoyed to be reunited but problems ensue. Melvin becomes depressed and suicidal as he struggles to fit into his new environment and as he comes to grips with what it means to be undocumented. Like all liberation health practioners, his social worker, Estela Pérez Bustillo, worked with Melvin to deconstruct his story and understand all the contributing factors. In addition to mainstream interventions with her client, Pérez Bustillo also let Melvin know about the immigrant rights movement, which he was motivated to learn about. Joining groups that were pressuring the U.S. government for immigration reform, Melvin developed “a sense of inclusion and solidarity.” Activism also “gave him hope that with pressure from grassroots movements,” U.S. policy could change to be more favorable to immigrants.

Each case study in this book is a gold mine of information and analysis about how social workers and therapists could take a radical stance alongside their clients. Most practioners are not trained to co-investigate with their clients the ways that mental health is connected to the health of the systems that run our daily lives – such as work, home life, economic practices, immigration, gender norms, etc. These are powerful forces that operate on all of us in powerful ways that we sometimes don’t even notice until we explode in anger (like Kevin) or become suicidal (like Melvin) or suffer in all the other ways that people suffer as they attempt to survive the onslaught of these pressures.

A significant contribution that this book makes is it actually walks you through what it looks like to use a liberatory approach to mental health care. Whatever setting you work in (even a hospital!), there are case studies here that will model how to integrate these approaches into your counseling.

What if you’re not a social worker? Well, this book is still a must read. If you are a human being weathering the persistent and ongoing storms of racism, classism, sexism, and all the other isms (and all of us are doing exactly that every day), you may find yourself reaching out for help someday. (Or you may have a child or a friend or a colleague who just can’t take it anymore.) What kind of “services” will you get? Did you know that it’s possible to have liberation be part of the conversation, that it’s not your job to mold yourself to a contorted and dysfunctional system? With the stories in this book in mind, you will be a better equipped to marshal effective resources should you find yourself mentally or emotionally stuck.

Finally, are you involved in social justice work? Take heart. The fight can seem long and hard. But keep in mind that your work has many dimensions. In addition to winning reforms that bring real improvement to people’s lives, such as raising the minimum wage or preventing an eviction, you’re also providing a forum where people get to be whole – where people get to experience themselves as agents of change in their lives and in the life of their community. You’re providing a “home” for Kevin and Melvin and all of us, really, where we get to experience solidarity – which, in addition to changing the world, has all sorts of mental health benefits.

Leave a comment