Isaac Prilleltensky
and Ora Prilleltensky
Full citation: Prilleltensky,
Correspondence should be sent to
Isaac Prilleltensky, Department of Human and
Organizational Development,
There is great commonality in the
critique of counseling psychology put forth by Vera and Speight (2003) and by several
critical psychologists. Critical psychology is an approach that challenges the
discipline to question its allegiance to the societal status quo and to
construct ways to promote mental health in conjunction with social justice (Fox
& Prilleltensky, 1997; Nelson & Prilleltensky, in press; Pare & Larner,
in press; Prilleltensky & Nelson, 2002; Sloan,
2000). Vera and Speight (2003) synthesize the shortcomings of an approach that
pays lip service to cultural diversity and social justice but falls short of
articulating emancipatory ways of living our lives
and doing our jobs. They enumerate the barriers to acting, and not just
thinking, justly. They point out that multicultural competencies must go beyond
the recognition of oppression: a culturally competent practitioner ought to
enact alternatives that not only identify, but strive to eliminate oppression.
Psychologists’ levels of awareness of
how the profession upholds the status quo differs across fields and exposure to
critical perspectives. Vera and Speight perform an invaluable service by
crystallizing the dilemmas for those who may be unfamiliar with psychology’s
support for an unjust state of affairs (Prilleltensky,
1994). We welcome their contribution, as they adroitly summarize the unwitting
alliance between counseling psychology and the societal status quo. In this brief
article we take seriously their call for aligning our practice as psychologists
with the principles of social justice. We believe that progress can be made by
(a) stressing the synergy of diverse values, (b) stressing the synergy between
wellness and liberation, and (c) learning from existing critiques within
psychology and other fields. In a separate paper (Prilleltensky
& Prilleltensky, in preparation) we also address
the need for (d) promoting role reconciliation between the counselor as healer
and the counselor as social change agent, and (e) adopting psycho-political
validity as a new measure for the evaluation of our social justice agenda. Due
to space considerations the last two recommendations will be discussed in
another paper. We discuss the recommendations in the context of the lives of
people with disabilities, a group that is often left out of the discourse on
multiculturalism and diversity.
Synergy of Diverse Values
No single value is comprehensive
enough to address the entire range of human needs. Therefore, we judge values
such as social justice, caring and compassion, and cultural diversity on their
synergistic qualities, and not on their isolated merits (James & Prilleltensky, 2002; Prilleltensky,
2001). Vera and Speight (2003) correctly point out that multicultural
competence without social justice is insufficient. We conceptualize human needs
and values into three separate spheres of wellness and liberation: personal,
relational, and collective. Personal needs such as a sense of mastery and
control are promoted by values such as empowerment and self-determination.
Relational needs such as support and affective bonds are upheld by values such
as caring and compassion and respect for diversity. Finally, collective needs
for economic security, shelter, and structural safety nets are met by values
such as social justice, equality, and emancipation (Prilleltensky,
2001; Prilleltensky & Nelson, 2002). If we
concentrate solely on relational values such as cultural diversity and
democratic participation we run the risk of neglecting both personal and
collective needs. The historical focus of psychology on self determination and
health meant that little or no attention was paid to democratic participation,
cultural diversity, sense of community or social justice (Fox & Prilleltensky, 1997). Vera and Speight are justifiably
alarmed that if we concentrate on celebrating diversity without attending to
power inequality and social injustice we will undermine wellness and
liberation, for they cannot exist but in the synergy created by the composite
of values.
Historically,
there is a propensity to concentrate on single values. Such proclivity is
largely determined by dominant political and cultural ideologies. During
conservative times personal values of self-determination tend to be extolled,
while principles of equality and justice come to the fore during progressive
eras (Levine & Levine, 1992). It is our job to diagnose the mood of the
times and realize what values we’re missing from the equation. There is little
doubt that psychology has absorbed the zeitgeist of the last three decades and
concentrated on individual remedies for social maladies (Fox & Prilleltensky, 1997; Prilleltensky,
1994). As a result, we have neglected social justice and support for
marginalized communities at our peril.
The current risk in terms of our
values is to extol respect for diversity above all, for cultural diversity
cannot exist in the absence of social justice. This is a point that requires
more theoretical elaboration in light of the point made Vera and Speight
regarding multicultural competence without social justice. Values are
co-dependent and inter-dependent. Extreme reliance on a single value undermines
the existence of that very value, for it cannot thrive in the absence of
others. We must be forever vigilant about what values are being privileged and
what values are being ignored. There cannot be justice in the absence of
compassion and there cannot be compassion in the absence of justice. Striking a
balance among values for personal, relational, and collective wellness and
liberation is our most pressing task as psychologists and citizens.
The values of self-determination and
social justice in particular, have been severely undermined for many people
with disabilities. So long as the problems they encounter in their daily living
is attributed to the impairment itself, efforts to
enhance wellness is conceptualized and enacted at the individual level. Those
who require assistance with daily living often have to fight for control over
what services they will receive, their mode of delivery, and who will assist
them with the most intimate self-care tasks. The inability to carry out
physical tasks unassisted is often taken as deficiency in the ability to make
important decisions about one’s life.
Unfair distribution of power has
implications not only for how independence is defined (in primarily physical
terms), but how it is actually enacted in various medical and rehabilitation
settings. Much of the work carried out by counselors, occupational and physical
therapists is focused on patients' ability to independently carry out
activities of daily living, or to come to terms with their inability to do so.
Whereas most people would prefer to be as independent as they can in self-care,
it is critical that this value would not be regarded as necessary for
autonomous adult functioning. The value of independence must be seen in the
context of what is feasible and desirable by the person with a disability and
by his or her immediate circle. I, Ora, am reminded
of a patient I worked with who had to negotiate with one of his treating
therapists that it is pointless for him to attend a breakfast group. A stroke
had left this man with significant physical impairments, while his cognitive
functioning remained relatively intact. It was very clear to him that he would
not be attending to his own breakfast at home given the time and energy that
this required of him. Given the emphasis placed on physical rehabilitation,
convincing his therapist of this was no easy task. Making such decisions on
behalf of others is what truly robs people of dignity and control over their
lives.
Synergy of Wellness and Liberation
The helping professions have
traditionally concerned themselves with wellness, health, and well-being.
Influenced by the hegemonic medical model, psychology, psychiatry, and
counseling conceptualized problems in living in intra-psychic terms. Mental
health, wellness, and most recently positive psychology became choice
metaphors. They all conjure images of people enjoying life, worry-free and
healthy. This is a most worthy goal, which we fully support. But as with any
single value, wellness cannot stand on its own. Unless wellness is supported by
justice, fairness and equality, it is bound to fall. Wellness cannot thrive in
conditions of inequality and injustice (Kim, Millen, Irwin, & Gersham, 2000; Marmot, 1999). The impact of poverty,
marginalization, exclusion, exploitation and injustice is just as deleterious
on the body as it is on the soul (Prilleltensky,
Wellness is a positive state of
affairs, brought about by the simultaneous satisfaction of personal, relational
and collective needs (Prilleltensky, Nelson, & Peirson, 2001). To meet these needs we have to attend to
power dynamics operating at micro, meso, and macro
levels of analysis (Nelson & Prilleltensky, in
press). Empowerment does not take place only at the personal level. Relational
and collective empowerment support personal empowerment and vice versa (Kiefer,
1984; Lord & Hutchison, 1993). Power equalization must take place at all
these levels.
Liberation needs wellness as much as
wellness needs liberation from oppressive forces. Liberation, like freedom, has
two aims: Liberation from and liberation to. Whereas the former strives to
eliminate oppression and abuse at the personal, relational, and collective
levels, the latter seeks to pursue wellness for self and others.
People with disabilities have long
struggled to attain wellness and liberation at the same time. They have claimed
that disability is not a personal tragedy that requires medical solutions, but
a social issue that requires social intervention. They have decried the medical
model of disability that regarded the problem as residing solely within the
disabled individual. The focus on bodily abnormality meant that
medically-driven solutions were called for. Treatment was designed, implemented
and evaluated by a host of professionals, with the disabled individual having
little input regarding the process. What could not be cured had to be
rehabilitated, and what could not be rehabilitated had to be accepted.
Psychological theories focused on the need to adjust to one's misfortune and
make the best out of a tragic and limited life. Those who did not despair
despite their disability were often perceived as being in a state of denial
(Oliver, 1996; Olkin, 1999).
People with disabilities have argued
that it is society, rather than the impairment itself, which is the source of
their disablement: "In our view, it is society which disables physically
impaired people. Disability is something which is imposed on top of our
impairments by the way we are unnecessarily isolated and excluded from full
participation in society. Disabled people are therefore an oppressed group in
society," declared the
Proponents of this alternative social
model of disability have demonstrated the multiple ways in which people with
disabilities are socially and economically disadvantaged. Being historically
excluded from mainstream schooling, many did not attain the necessary skills in
order to further their education and make them competitive within the job
market. Some encounter discriminatory attitudes and a lack of willingness to
make simple accommodations within the work place. Those who require assistive
devices and/or attendant care often come against paternalistic policies
designed to retain professional control over resources. Physical barriers have
also been a source of exclusion, as public spaces were historically designed
with able-bodied people in mind. A shortage of affordable accessible housing
and inaccessible public transportation further marginalize people with
disabilities (Barton, 1998; Morris, 1993; Olkin,
1999; Oliver, 1996).
In a study on women with physical
disabilities and motherhood most participants reported that they did not
envision that they would lead a similar life to nondisabled
peers (Prilleltensky, O. in press, a, b, c). One
participant who spent most of her childhood in an institution described the
difficulty in imagining an adult life beyond that setting: "You didn't see
kids there leaving, or getting married, or having kids...they just left and you
never heard from them again..." At the time of the participants' birth
some four decades ago, most of their parents were encouraged to
institutionalize them (although few did), were told to expect little in the way
of progress and growth, and were generally painted a grim picture of life with
a disability. Not surprisingly, few parents expected that their children would
lead typical adult lives and some ignored or actively discouraged daughters'
emergent sexuality. The structural barriers prevented the very imagination of
life outside oppressive institutions.
The political action and struggle of
disabled people around the world has resulted in significant progress. No
longer willing to put up with inadequate resources and professional control,
people with disabilities have collectively fought for economic, legislative,
and social gains. In the
The legislation of the American with
Disabilities Act in 1990 has ensured that many of the aforementioned gains are
not contingent upon people's goodwill, but are enforceable by law. For example,
it is illegal to discriminate against a worker based on disability status, to
hold a civic gathering at an inaccessible venue, or to fail to accommodate the
needs of a disabled patient at a health clinic.
Although there is still a long way to
go, there is little doubt that these practical gains in legislation, economic
resources, and social participation, do go a long way toward the enhancement of
wellness. Furthermore, the new focus on disabling societal barriers and
systematic powerlessness has done much to improve the self-esteem and wellbeing
of people with disabilities (Crow, 1996; Morris, 1993; Oliver, 1990;
Shakespeare, 1998; White, in press).
Synergy Across
Critiques
Counseling psychology cannot afford
to ignore critiques in other fields of psychology, nor can psychology afford to
ignore critiques from outside the discipline. The field of critical psychology
has been struggling with how to promote a social justice agenda in ways that
parallel, but have not been mentioned by Vera and Speight (Fox & Prilleltensky, 1997; Prilleltensky
& Nelson, 2002; Sloan, 2000). Prilleltensky and
Nelson (2002), for instance, proposed means of promoting a social justice
agenda in psychology. They made specific recommendations for working critically
in school, health, counseling, clinical, work and community settings. Community
psychology has also been highly influential in fostering social change,
prevention, cultural diversity and empowerment for the last four decades
(Nelson & Prilleltensky, in press; Prilleltensky, 2001). Disciplinary boundaries sometimes
prevent fruitful explorations of similar agendas.
Insularity is a definite risk. We
need to apply the call for diversity to our own professional practice. There
are diverse fields within psychology concerned with social justice and social
change. Looking around can help us find wheels that are well oiled, we don’t
need to reinvent them.
The second point is not less
pressing. Psychology cannot afford to ignore critiques of the helping
professions and of the societal status quo mounted by people with disabilities
(Oliver, 1990), by consumer/survivors of the psychiatric system (Nelson, Lord,
& Ochocka, 2001), by gay, lesbians, transgender
and bisexual people (Kitzinger, 1997), and by other
disciplines (Fox & Prilleltensky, 1997). As
psychologists, our ability to see beyond our own psychological glasses is
limited. Just as we need to expand our definitions of wellness to incorporate
other cultural perspectives, we need to listen to critiques of the helping
professions raised by non-psychologists.
But the problem of insularity goes
beyond critique: it affects action as well. We should heed Audre
Lorde’s dictum: “the master’s tools will never
dismantle the master’s house.” People with disabilities did not achieve the
rights they did because of professionals. Often, it is in spite of
professionals that people with disabilities and other marginalized groups make
progress towards wellness and liberation (Oliver, 1990). If we are to make
progress towards social justice, we need to create alliances with the people we
wish to help (Nelson, Prilleltensky, & MacGillivary, 2001). Much can be learned from social
movements and consumers’ movements in their efforts to declassify homosexuality
as an abnormality, to obtain access to pubic buildings and transportation, or
to overcome the stigma of mental illness (Nelson & Prilleltensky,
in press). These actions, we claim, will not materialize until counselors
reconcile their role of healers with their role of change agents and until they
enact psychopolitical validity in their research and
interventions (Prilleltensky, I, in press a, b; Prilleltensky & Prilleltensky,
in preparation).
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