In Pursuit of Justice and Wellbeing: Critical Approaches to Physical and Mental Health

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In Pursuit of Justice and Well-being Critical
Approaches to Physical and Mental Health

• Isaac Prilleltensky, PhD
• Peabody College of Vanderbilt University
• Isaac.Prilleltensky_at_Vanderbilt.Edu
• Http//people.Vanderbilt.edu/isaac.prilleltensky

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Part II Promoting Justice and Well-Being

• From Amelioration to Transformation in Physical
  and Mental Health

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Shifting the Paradigm in Helping Professions

• FROM AMELIORATION
• Treatment
• Symptoms
• In the office
• Charity
• Individualistic
• Passive victim
• Neglects Power

• TO
• TRANSFORMATION
• Prevention
• Root causes
• In natural setting
• Justice
• Communitarian
• Agents of change
• Attends to Power

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9/7/1854Removing the Handle
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Getting To The Bottom Of It.

• No mass disorder, afflicting humankind, has ever
  been eliminated, or brought under control, by
  treating the affected individual
• HIV/AIDS, poverty, child abuse, powerlessness are
  not eliminated one person at a time.

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Too Little, Too Late
CONTINUUM OF SERVICES
Wellness Promotion
Treatment
Prevention
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99
BUDGET ALLOCATION
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Poor Investment
AGE
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Prevention Saves Money
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MRFIT lesson

• Even when people do successfully change their
  high risk behaviors, new people continue to enter
  the at-risk population to take their place. Even
  when we do help high risk people to lower their
  risk, we do nothing to change the distribution of
  disease in the population becausewe have done
  nothing to influence those forces in the society
  that caused the problem in the first place.
  (Syme, 96, p. 22)

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Camden, NJ
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RELATIONSHIP BUILDING
CCOP held over 800 conversations with members and
residents about community concerns.
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CAMDEN HOUSING CAMPAIGN IMPACTS
Crime citywide was down 8.4, however this dip is
consistent with regional and national trends
Drug crime in Camden dropped 31 during the first
year of CCOPs Housing Campaign.
When examining those blocks in which two or more
vacant houses were boarded up (the major focus of
the housing campaign) drug crime dropped 56.
Conservatively, we can estimate that the effect
of the Housing Campaign was to lower drug crime
by 25.
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Community Work in ChicagoMoving from Poor
Neighborhoods

• Compared to children who moved within the city,
  children who moved to the suburbs were much more
  likely to graduate from high school (86 vs.
  33), attend college (54 vs. 21), attend 4-year
  college (27 vs. 4), be employed if not in
  school (75 vs. 41), and receive higher salaries
  and benefits.

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Quadrants of Well-being
Collective
Quadrant I
Quadrant IV
Deficits
Strength
Quadrant III
Quadrant II
Individual
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Quadrants of Well-being
Collective
Community empowerment, Recreational
opportunities
Reduction of crime and inequality Lower
pollution levels
Deficits
Strength
Reduction of aggression, Medications
Self Actualization Happiness
Individual
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Risk of Over-Reach Type I
Collective
Deficits
Strength
Self Actualization Happiness
Individual
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Risk of Over-Reach Type II
Collective
Deficits
Strength
Reduce symptoms, Take pills
Individual
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Risk of Over-Reach Type III
Collective
Community empowerment
Deficits
Strength
Individual
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Risk of Over-Reach Type IV
Collective

Lower pollution Less crime
Deficits
Strength
Individual
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Stokols says.

• The healthfulness of a situation and the
  well-being of its participants are assumed to be
  influenced by multiple facets of both the
  physical environment (e.g., geography,
  architecture, and technology) and the social
  environment (e.g., culture, economics, and
  politics). Moreover, the health status of
  individuals and groups is influenced not only by
  environmental factors but also by a variety of
  personal attributes, including genetic heritage,
  psychological dispositions, and behavioral
  patterns. Thus, efforts to promote human
  well-being should be based on an understanding of
  the dynamic interplay among diverse environmental
  and personal factors rather than on analyses that
  focus exclusively on environmental, biological,
  or behavioral factors. (Stokols, 2000, p. 27)

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Seligman says

• Seligman laments that changing these (external)
  circumstances is usually impractical and
  expensive (2002, p. 50)
• Seligman tells readers that, even if you could
  alter all of the external circumstances above, it
  would not do much for you, since together they
  probably account for no more that between 8 and
  15 percent of the variance in happiness (2002,
  p. 61).
• Really?

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How Do We Address Power Imbalance in the Helping
Professions?

• Psychopolitical validity
• Epistemic
• Transformational
• Role reconciliation between helper and change
  agent

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Psychopolitical Validity

• Psychopolitical validity derives from the
  consideration of power dynamics in psychological
  and political domains of health.
• The main objective of psychopolitical validity is
  to infuse in helping professions an awareness of
  the role of power in justice and well-being

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Psychopolitical validity

• In order to attain psychopolitical validity,
  investigations and interventions would have to
  meet certain criteria. These criteria have to do
  with the extent to which research and action
  incorporate lessons about psychological and
  political power.

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Psychopolitical Validity I Epistemic

• This type of validity is achieved by the
  systematic account of the role of power in
  political and psychological dynamics affecting
  phenomena of interest
• Such account needs to consider the role of power
  in the psychology and politics of well-being,
  oppression and liberation, at the personal,
  relational, and collective domains.

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Psychopolitical Validity I Epistemic

• Guidelines for epistemic psychopolitical validity
  are presented in Table 1.

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Guidelines for Epistemic Psychopolitical Validity
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Psychopolitical Validity II Transformational

• Transformational validity derives from the
  potential of our actions to promote personal,
  relational, and collective wellness by reducing
  power inequalities and increasing political
  action

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Guidelines for Transformational Psychopolitical
Validity
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Role Reconciliation

• To put transformational psychopolitical validity
  into action we have to be able to reconcile our
  roles as helpers with our roles as critical
  agents.

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Critical Professional Praxis
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Role reconciliation

• Our challenge is to find ways of reconciling the
  two sets of skills and aims. From the perspective
  of the professional helper, the critical
  practitioner wishes to answer three important
  questions

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Questions

• How does our special knowledge of wellness inform
  our social justice work?
• How does our ameliorative practice inform our
  transformative practice?
• How does our insider role of wellness promoter in
  the helping system inform our outsider role as
  social critic?

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Questions

• From the perspective of the social change agent,
  the critical practitioner needs to address the
  following issues
• How does our knowledge of inequality and
  injustice inform our work?
• How does our transformative practice in society
  inform our ameliorative work in the helping
  system?
• How does our outsider role as social critic
  inform or relate to our insider role?

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There Are Many Ways to Advance the Transformative
Impulse

• Creating awareness among colleagues about how
  power differentials get enacted in interactions
  with clients seeking health related advice
• Forming research and action groups in the
  workplace to explore how practices may be more
  empowering of clients

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There Are Many Ways to Advance the Transformative
Impulse

• Increasing political literacy of community
  members to empower them to scrutinize the
  practices of health and helping professionals
• Establishing practices that enable participation
  of clients, patients and community members in
  management of human services

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Community Wellness Groups

• One promising avenue for merging roles is through
  community wellness groups in mainstream
  institutions.
• The dominant model suffers from all the known
  ailments of reactivity, victim-blaming,
  person-centered and expert driven approaches.

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Community Wellness Groups

• My proposal entails overcoming the reactive,
  victim-blaming, person-centered and expert driven
  model by instituting in health and helping
  agencies community wellness groups.

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Community Wellness Groups

• These are groups where citizens afflicted by
  similar ailments can
• explore the social roots of their problems,
• activate the agency within them,
• think in terms of systemic sources and solutions
  to their problems, and
• organize to advocate for changes at the meso and
  macro levels.

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The potential benefits of this approach are
multiple

• First, clients or citizens would activate agency
  within them. They will no longer be regarded as
  victims of circumstances but as actors in change.
  
• Second, they will contribute to collective
  wellness by challenging the structures that cause
  the problems in the first place.
• Third, problems will no longer be regarded as
  individual concerns but as societal concerns.
• Fourth, health and well-being will be
  de-professionalized.
• Fifth, groups will be able to challenge the very
  structure that is supposed to help them, thus
  contributing to the accountability of mainstream
  institutions towards oppressed and marginalized
  groups.

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Rationale

• A. It is only when we institutionalize critical
  consciousness that we have a chance of making a
  difference in the long run.
• B. It is only when we take control of health and
  well-being away from professionals that we have a
  chance of empowering the population,
• C. It is only when we activate the agency part
  within clients and community members that we can
  overcome passivity in the delivery and reception
  of services, and finally
• D. It is only when community members make the
  connection between their private ills and their
  public origins that they can be angry enough to
  make a difference in the institutions that
  dominate their lives.

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• Case study 18 months
• Youth center engaged in change
• New mission statement
• Balance restore, prevent, promote
• Community action teams on justice
• Four quadrants of well-being
• Expansion of project

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In every act, in every interaction, in every
social action, we hold each other accountable to
promote   Peoples dignity, safety, hope and
growth Relationships based on caring, compassion
and respect Societies based on justice, communion
and equality   We are all better when these
values are in balance   To put these values into
action, we will   Share our power Be proactive
and not just reactive Transform the conditions
that create problems for youth Encourage youth
and families to promote a caring
community Nurture visions that make the
impossible, possible   We commit to uphold these
values with   Youth and their Families Our
Employees Our Organization Our Community   This
is a living document. We invite you to discuss
it, to critique it, to live it
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• Conformity or Change?
• Before you reply with enthusiasm to our plea for
  help, you should consider whether you are not
  merely engaged as magicians to avoid the crisis
  in the center of the ring. In considering our
  motives for offering you a role, I think you
  would do well to consider how much less expensive
  it is to hire a thousand psychologists than to
  make even a miniscule change in the social and
  economic structure (judge Bazelon, in the 60s,
  addressing a group of forensic psychologists).