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A dance of destitution - psychology's clash over coercion

Job centres are becoming gladiatorial arenas where unemployed people and professionals slug it out, whilst the ethical battle rages.

Image: University of Delaware

This week new evidence emerged of how psychologists involved in Guantanamo interrogations not only helped design and implement the torture of detainees, but made torture into ‘human experimentation’ on unconsenting subjects.

I tend to think that half-drowning a man for useless information might have troubled Hippocrates when he was sketching out his oath.

Members of the American Psychological Association have quaintly insisted that the psychologists were there to keep it “safe, legal, ethical, and effective".

Over here in the UK, the guardians of our professional ethics aren’t quite at this stage.

But there is mounting criticism of, and ethical debate around, the growing role of psychologists – and coercion - in our social security system.

The government appears to be positioning ‘therapy’ at the centre of the benefit sanctions regime. They are placing therapists in 350 job centres around the country. Already people are told they will lose their benefits if they refuse therapy. The government appears to have confirmed that people do have the right to refuse - for now. But you have to be pretty confident to assert your rights down at the job centre these days, though advice is out there

Psychologists have started to ask themselves and their colleagues – is it ethical to force or manipulate people to receive a medical treatment against their will? Is it ethical for therapists to append themselves so overtly to the caustic apparatus of workfare? And how could effective therapy take place where people are coerced into treatment?

But this is missing the point.

What these critiques implicitly seem to take for granted is the idea that this mobilisation of psychologists is about mental health, about helping people.

But we’re a long way past that point now. This is coercion by destitution.

How have we got here?

Under New Labour , we had the “work as therapy” phase. The policies of the Department of Work and Pensions and the Department of Health became saturated with the idea that work was therapeutic for people with mental health problems and that the priority should be to help people achieve the therapeutic benefits of employment.

That work itself had for many years become more precarious, poorly paid and inflexible was neither here nor there.

Then, from 2007, the solution to the growing proportion of mental health claimants on the incapacity benefit rolls was the Increasing Access to Psychological Therapy (IAPT) programme, a £170m per year attempt to radically increase provision of therapy around the country.

This programme had two success measures - effectiveness in helping people to recover, and effectiveness in helping them gain (or remain in) employment.

Recovery was at this point still the key driver - but getting a job had insinuated its way into the pantheon of measures of clinical success.

And now we have the embedding of therapists in job centres. Who now believes the conceit that state funded mental health treatment is designed to help treat people with mental health problems?

The idea of helping people to recover is being replaced with a bleak regime. Therapists speak the language of Carl Rogers and Aaron Beck through lips firmly controlled by Iain Duncan Smith, and are enrolled into the by now notorious sanctions programme.

There is nothing medical and nothing therapeutic about this policy, not in its ideology or implementation. And this is why debates about medical effectiveness and medical ethics are wide of the mark.

The voices that advocated for mental health recovery have faded away, drowned out by those hell-bent on sacrificing human complexity, suffering and nuance on the altar of public spending cuts.

In this brave new world of mental health, Iain Duncan Smith can attempt to block the publication of "death statistics" that reveal how many people have died within six weeks of their benefits being stopped.

The base logic is very simple. There are friends of deficit reduction and enemies of deficit reduction. Enemies of deficit reduction need to be ruthlessly eliminated. Neoliberalism's blind watchmaker has generated denials and rationalisations by which almost any acts of savagery can be justified. Because if it reduces the deficit then it’s worth the pain.

Job centres are being turned into ghettos of deficit annihilation, with job centre staff, mental health practitioners and mental health service users corralled within them. Mental health practitioners cost the state, job centre staff cost the state, people not working cost the state and people receiving medical treatment cost the state. This policy initiative simply puts them in one space and compels them to eat each other up.

It takes the 'work as therapy' discourse and the IAPT programme to their natural conclusions . Let the fight begin.

And so the well-articulated and wholly reasonable criticisms of efficacy and ethics that have been doing the rounds on social media are ultimately, fatally flawed because they assume that ethics and efficacy matter. And they don’t. At all.

The neoliberal lens simply doesn't recognise the particular conundrums of ethics and efficacy. It recognises drains on public funding and it seeks to eliminate them. The government, the Department of Work and Pensions, the British Psychological Society, much of the mainstream media and too many of the rest of us seem quite content with this collective misunderstanding of what it means to be a human being in the world today. Tough love, therapy, coercion by destitution, sanctions, state support. Call them whatever you will. In this particular battle there are only two sides. You cost taxpayers money or you save it.

About the author

Dr Carl Walker leads a European Community Psychology Association Task Force on Austerity and Mental health and is a member of the National Health Action Party.

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