The Streets Are Watching

While my position of editor at Spare Change is a hat I wear with considerable pride, it is not the only decoration that habitually adorns my oft-reeling head. In fact, my primary professional role is that of a graduate student in clinical psychology, a field with which I am in frequent contention. Since initiating studies in the doctoral program in which I now matriculate, I have repeatedly questioned the function of clinical psychology in society, the integrity of its practices, and what it means for my own moral dissonance to be an agent of its systems.
    The more I learn about the practice of psychology on both meta and micro levels, the more uneasy I feel. Broadly, I am concerned with the role of the field in the maintenance of a certain status quo in society, particularly that of hierarchal class stratification. Pragmatically, this means that psychologists too often work to maintain the separation between themselves and those whom they purport to help, by generating top-down solutions to problems. While mental health professionals clearly have a measure of expertise through education and experience, it is wrong for psychologists to position themselves as objective ‘fixers’ of problems. Instead, I believe we can do better work as listeners, coaches, and coordinators who would empower people to create bottom-up change within their own lives, as well as within their communities.
    On a more micro or practical level, I am disturbed by the disconnect between the ethical ideals of beneficence and ‘do no harm’ that are espoused by professionals and the street level perspectives frequently expressed by those who know the mental health system as patients. The cover story of this issue (see Morley, page 4) relates to an aspect of psychology’s own ‘schizophrenia.’ While mental health policy and practice will often present through rhetorical flourishes about working in the patient’s or client’s best interests, when you ask the patient or client about her or his experience, resulting stories will often narrate impressions of the psychologist’s or the system’s interests getting served first. If this is the case, who and what are mental health professionals really working for?
    How does all of this psychobabble relate to the world here at Spare Change? Beyond the shallowness of the common stereotype that the majority of people on the street are homeless because of mental illness, it is true that psychological stress and the socioeconomic realities of poverty, unemployment, incarceration, physical disability, minority population membership and homelessness are deeply intertwined. However, one major reason for this interconnection is systemic rather than individual—many people must receive psychological diagnoses just to be entitled to services, such as subsidies for food or housing. For people who cannot afford to pay a private shrink, a therapist must list a diagnosis in order to receive compensation from insurance providers. In still other cases, stress or trauma that accompanies circumstances that deviate from the mainstream (such as homelessness) is pathologized because norms for psychological well-being were determined by the middle-class.
    Homelessness continues to grow in contemporary America, with accompanying increases in usage of mental healthcare services. Psychology has historically remained largely removed from the search for solutions to social issues such as homelessness. Yet if a recent column by American Psychological Association (APA) president Dr. James H. Bray entitled “Psychology’s contribution to ending homelessness” (October 2009 Monitor on Psychology) is any indication, perhaps the sense of responsibility within the field is shifting.
    While I commend Dr. Bray’s recognition of psychology’s obligation to work to eradicate homelessness, I doubt that his statement acknowledges any need to abandon a predominantly top-down model for intervention. While “Enlisting the resources of experienced clinicians and researchers; training graduate students to recognize and respond to the mental health needs of homeless persons; and collaborating with other professionals, agencies, and community stakeholders…” are good suggestions, Bray does not once mention how mental health professionals can improve their services to the homeless based on the perspectives of those who actually are homeless.
    In order to truly effect positive social change, psychology practitioners must coordinate with other professionals in policymaking, healthcare, and community organization as well as members of the community themselves to craft initiatives from the bottom-up. Such work would let all people define for themselves what is the meaning of well-being, a redistribution of power that would represent a true paradigm shift in the field of psychology.