DAVID SMAIL (1938-2014): Pioneer of the Social-materialist analysis of psychological distress
DAVID SMAIL (1938-2014) was a leading clinical psychologist and influential writer on psychological treatments and social issues. David studied philosophy and psychology at University College London and gained a PhD. His formative clinical experience was with Tom Caine at Claybury, and they co-wrote a book arguing that personal attributes of therapists were more influential than theories or techniques, and that patients’ confusion and despair could be traced, not to faulty brain chemistry, but to life experiences – a theme developed further in Psychotherapy: A Personal Approach (1978).
David was committed to the education and training of psychologists. He developed a clinical option in the psychology degree at University of Nottingham, and was awarded an Honorary Chair. From the late 1970s, David’s clinical experiences led to the development of a community-based approach and his clinical practice underpinned his thinking and writing. His books from this point moved away from the examination of therapy to exploring the interaction between the person and their world, analysing the often malign influences of the power structures in modern society.
Illusion and Reality: The Meaning of Anxiety (1984) showed how an increasingly competitive, unequal society spawns chronic insecurity. The book challenged the notion that anxiety and depression amount to a mental illness denoting that something is wrong with the individual sufferer. For the most part distress and anxiety represent an entirely rational response to the sufferer’s situation. The role of the therapist is therefore not in ‘curing’ the individual, but rather to negotiate demystification and to provide insight into the effects of the problems in the sufferer’s world, based on the sufferer and the therapist’s shared subjective understanding.
In Taking Care: An Alternative to Therapy (1987) he wrote his version of a self-help book and of how the mythology of cure reflects a society obsessed with imputations of personal ‘blame’ and ‘responsibility’, benefiting the powerful. In the work he developed the analysis of mental illness, and psychology in general, in the contexts of society, power and interest. People’s experience is embodied in the world in which they exist. Notwithstanding the claims of some, psychology cannot, in the same way that magic cannot, change the nature of that experience fundamentally. The socio-political and economic structures of the society in which we live have the greatest influence on mental health, as on many other matters. Therefore, the individuation of focus in psychology on personal relationships, happiness, and sexuality can significantly miss the point. We need to develop political and social structures that ‘take care’ of people, to enable them to have meaningful ‘public’ lives. In this way feelings of self-worth may be fostered, with individuals being less likely to yield to anxiety and distress.
These themes were further developed in The Origins of Unhappiness: A New Understanding of Personal Distress (1993), which argued that emotional and psychological distress is often brought about through the operation of social-environmental powers which have their origin at a considerable distance from those ultimately subjected to them. A person is the interaction of a body with the environment, an environment that is structured by material power. Power may be coercive, economic, or ideological, and operates at a varying distance from the person. It is always experienced proximally, but may well originate distally. The book notes that on the whole, psychology has concerned itself very little with the field of power which stretches beyond our immediate relations with each other, and this has led to serious limitations on the explanatory power of the theories it has produced.
How to Survive Without Psychotherapy (1998) was directly aimed at sufferers of mental distress. The book’s aim was to remove from sufferers the burden of ‘fault’ for their pain and to demystify some of the practices that surround the ‘treatment’ of mental illness. Whilst clarification and support may help the sufferer understand his/her predicament and encourage the use of what resources the sufferer has, therapy cannot change the distal root causes of distress. Moreover, only socio-political solutions can address some of the most powerful causes of distress, e.g., redundancy, housing and poverty. In sounding a cautionary note about psychoanalysis, Smail observes that mental distress is far more about money than sex.
In Power, Interest and Psychology (2005) he outlined a comprehensive social-materialist psychology, placing distress firmly in a material context in which our feelings, thoughts and conduct can be shaped by economic and social power. David proposed that to understand our unhappiness we must cultivate ‘outsight’ into the world around us: a perspective that encourages personal modesty, appreciation of luck and compassion, and recognition of our common humanity.
These observations were founded on experience: his insights came from talking to his patients in Nottingham while working as a NHS clinical psychologist for 30 years, and listening to their experiences of distress and anxiety. The theorising came after actual experience.
David retired from the NHS in 1998, and in 2002 founded theMidlands Psychology Group, a close-knit collection of critically minded academic and therapeutic psychologists. David did not believe that therapy alone can ease the distress in our society but that we all need to take better care of each other. Psychotherapy might offer comfort, clarification and encouragement, but distress can only be eased through changes in our social arrangements – an essentially political task.
David once wrote about how someone objecting to his viewpoint pronounced him clinically depressed, such was the bleakness experienced by this critic on reading some of David’s work. Yet, in contrast to this perspective, MPG meetings have always been heartily filled with laughter and joyful profanity, and all of us talk about how uplifted and nourished we feel from our contact with each other. Indeed, David also wrote, in possible answer to the question ‘What, then, must we do (about the current problems within and outside of our profession)?’, that at the very least we can join together with like-minded others and face these problems ‘with fortitude and good humour’. It is in a similar spirit that we wish to mark David’s passing.
The first meetings of what became the MPG were initiated by David around 2002. From the outset, those who took part shared the feeling that the workplace offered relatively few opportunities to think honestly and critically about theory and practice in psychology. This may not be everyone’s experience, of course, but in our case there seemed to be little time or space to meet for discussion and reflection upon what we were doing, and trying to do, in our work. Also, the dominance of business practices in the management of both the NHS and the universities meant that, when people did get together, conversation frequently focused upon professional survival and the need to maintain a grip upon one’s corner of the market. These are still very much our experiences of the day-to-day world of psychological treatment.
What we wanted, then, was to find space and time outside the work context where we could discuss, debate, consider and share information in a constructive and mutually supportive atmosphere. Inevitably, this meant meeting in the evening and, for some, travelling quite long distances (taking it in turns to shuttle between the east and the west midlands). Early meetings consisted of identifying common themes and concerns, and as part of this we invited outside speakers to lead a discussion centred round their work. These included Tana Dineen, David Nightingale and John Shotter.
Like David, those of us who persevered shared a discomfort with the individualism of orthodox clinical and counselling psychology, as well as with what seems to us a misplaced professional certainty about much of what we do. Attempting to articulate this discomfort more clearly, we began to share our views in writing. A very useful procedure proved to be for a group member to develop some writing around a topic of particular concern and then to circulate the result to the other members, who would each comment and suggest amendments in turn, before we then met to discuss the final document. The aim was explicitly not to critique each other’s view, but to find, clarify and develop common ground. In this way, we produced the 2006 special issue of Clinical Psychology Forum. And from this, we evolved our practice of collective writing: a positive, rewarding experience that enacts the shared value base, ethos and a solidarity which is the hallmark of our work – past, present and future.
Some may be surprised to learn that the one of the biggest obstacles we face to collective writing is the apparent disbelief of editors and publishers. It seems that many cannot conceive of our work as being so thoroughly jointly authored that it simply makes no sense to attribute it to named individuals. At the same time, we are aware that writing in this way is itself a political move that refuses, in the very moment of expressing ideas, the ideology of individualism that pervades and structures psychology. We stand in a tradition of psychologists (Curt, 1994), artists (Home, 1991) and activists (The Free Association, 2011) who all recognize that the refusal to individualise authorship simultaneously challenges ideological assumptions and asserts collective strength. Collective writing is an aspect of MPG’s work of which David was very proud, and to which he was entirely committed.
In 2006, MPG described ourselves as ‘a group of clinical, counselling and academic psychologists who believe that psychology—particularly but not only clinical psychology—has served ideologically to detach people from the world we live in, to make us individually responsible for our own misery and to discourage us from trying to change the world rather than just ‘understanding’ ourselves. What are too often seen as private predicaments are in fact best understood as arising out of the public structures of society’.
That description continues to hold today. People working in mental health services often find themselves trying to address issues of loneliness and isolation, which are common experiences for people who are scared to leave their homes, have little money and who have more often had damaging rather than rewarding social experiences. For some people, a history of abuse meets with continuing difficulties in their physical and social environments and with a lack of material resources – making it extremely hard for them to achieve the kinds of personal change that might ease their distress. It is in view of this that David wrote of supporting people to develop ‘outsight’ (as opposed to ‘insight’ into themselves) into the world around them and how peoples’ material circumstances were inextricably linked to how they were feeling.
Many who are familiar with David’s legacy will know that he identified three aspects of the work of a therapeutic psychologist which he regarded as the most important elements of the job: the provision of comfort, clarification and encouragement (see Smail, 2001). He developed these core ideas in his writings and also in many of the talks and interviews that he generously gave over the years (see, for example, his 1989 interview for a TV series on depression which is now available on YouTube:
For people feeling very alone, the provision of comfort is at the very least, one way of helping them to feel that, in their struggles with their personal problems and feelings, they have someone on their side. In an interview with Paul Maloney, David commented that:
‘Comfort comes, I think, from talking to or being with a sympathetic other person. That’s not just a question of psychotherapy; in fact psychotherapy is very limited in that way, in the degree to which you provide comfort, or solidarity I would also call it, being on the side of another person.’ (Moloney, 2004)
Yet perhaps solidarity could be added to this triad as an important idea in its own right, since it highlights the importance of collective power which might be missed from the idea of comfort. In 1998, discussing the effects of the domination of NHS business agendas on the profession, David urged us to ‘develop our organisation centrally and negotiate with centralized power’, arguing that ‘solidarity is a form of power we should make much more use of than we have in the past’.
Sixteen years on, with neoliberal political policies disguised as a financially necessary ‘austerity’ agenda, David’s suggestion is more relevant than ever. If we are to get by as people, as well as professionals, and if we want the individuals we work with to be freer of distress (and, in the worst situations, to simply survive) then we must join with like-minded others to resist the damaging imposition of a narrow business mentality that is – solely in the interests of increased profit for the powerful – both decimating public services and poisoning everyday life.
Being part of MPG became increasingly important to David in later years, as his ideas sometimes received a lukewarm reception and he was seemingly marginalised by the mainstream of the profession in the UK. In this context, he felt strongly that acting and writing collectively was one way of countering responses of cultivated professional deafness to his work. For the other MPG members, the group (and David’s work) has continually given us the comfort of having our clinical and intellectual realities acknowledged (making it less likely that we end up feeling deficient ourselves); the clarification that comes with finding more accurate explanations for the trials and tribulations we sometimes face; and the encouragement to struggle, in whatever small way, to address our concerns. In this, at least, we are no different to many of the people referred to us.
David knew that fundamental differences of opinion often prevent large groups from operating effectively: he saw this with the Psychology and Psychotherapy Association and its eventual demise. He was therefore keen, once enough common ground had been established, for the MPG to remain small. This is why, instead of inviting others to join MPG, or accepting people’s requests to join, we have consistently encouraged others to set up similar groups of their own.
Today, we are aware of other groups, including the East and West Midlands Critical and Community Psychology Groups, the North East Psychology Group, and a putative South East Psychology Group. All of these groups – and any others that might in future be formed – have considerable potential to provide comfort (meeting with like-minded people), clarification (reporting and analysing, in honest detail, experiences from clinical practice and everyday life), encouragement (helping each other to identify and use available resources to improve their situations and those of the people they work with), and solidarity (acting and writing collectively, sharing frustrations, forging alliances, and finding ways to go on). We urge people to consider taking critical ideas such as those developed by David forward in this way for themselves: you have nothing to lose, and potentially much to gain.
The Midlands Psychology Group
This is an abridged version of the tribute to David Smail that originally appeared in ClinicalPsychology Forum (February 2015) and is reprinted by kind permission of the editors and the British Psychological Society.
To find out more about Smail’s pioneering work please visit his website or click here to read the compelling article by Alastair Smail for Karnacology, Analysing the Social Context of Individual Distress.