Taking a Position Within Powerful Systems

Abstract

Psychiatric diagnosis remains the dominant model for conceptualising mental health difficulties and psychological distress. Psychiatric discourses rooted in the biomedical and biopsychosocial models are structurally embedded within service design throughout the UK and determine service provision, access to help and support, research grants, and overwhelmingly shape policy and legislation. Within this socio-political context, clinical and community psychologists continue to develop alternative conceptual frameworks and practices to counter individualising and arguably pathologising constructs of disorder and mental illness. As practitioners become increasingly outwardly looking and focus efforts on changing the underlying socio-materialist conditions that shape psychological distress, the need to recalibrate clinical psychology to address inequality, discrimination and social injustice as a matter of course is irrevocable. For many psychologists working in organisations designed on the basis of diagnostic discourses, the question as to how one positions themselves in-line with pre-existing psychiatric practices is crucial. Does one integrate approaches or question and challenge these psychiatric practices more overtly? Alternatively, could clinical and community psychology achieve a more ethical and conceptually coherent practice through activism to protest against the dominance of psychiatric diagnosis? This chapter explores how clinical psychologists position themselves in contexts where psychiatric diagnosis is the prevailing mode of practice, and it then goes on to explore what lessons clinical psychology can learn from community psychology when it comes to questions of psychological distress and psychiatric disorder.