medicine by devaluing its strengths derived from its alliance with the worlds of language and metaphor, and instead “pretend to be a concrete diagnostic-curative discipline that models itself on medicine” (p. 229).


The ‘medical gaze’ In recent years, we have seen how those


in the psychological professions, including family therapists, have increasingly adopted the medical model (and its highly descriptive language of specifi c observable detail) as the best means to improve access to psychological therapies (Nel, 2009). One of the most striking features of adopting this “medical gaze” (Nell, 1992, p. 229) is how, during a time of severe economic crisis and social inequality, it seduced us to fall silent on the role of the state in all of this, and instead to focus on situating the problem inside the individual (Nel, 2010). We became complicit with the view that the distress at being excluded from meaningful economic activity and the day-to-day struggle for survival can, and should, be described in medical language, the language of individual ‘disorder’ and ‘pathology’. It is here that we are often required to individualise social problems, to pathologise those who struggle with inequities. Why have psychologists and family therapists been so keen to enter into these clinical roles, to accept posts in university departments and the government, and to lend their weight so unquestioningly to adopting the language of medicine? Why are we so drawn to “the precision of diagnostics, the exact focus of its interventions, its adoring patients and its magical cures” (Nell, 1992, p.229)? Whatever the answers, Nell had a stark warning: For the loquacious disciplines, the medical


gaze is barren, and psychology’s pathetic fate is that its seduction by the clinic is followed by its own impotence. Psychologists deluded by the medical gaze are made impotent by the company they must keep… (p.230).


What can we do? The medical gaze does not seek to


understand the universality of human experience (Nell, 1992) in its social context. Instead, it focuses on investigating the specifi c and the concrete. According to Foucault (1973), this investigation is mainly a silent encounter where the doctor examines a body in silence “free of the burdens of language” (p. xv). But what if we accept


12


the burdens of language? What language could we use that might burden us with its imperfections, but help us to get closer to the challenges that people face through discrimination and injustice? For a start, instead of using a form of medical language to expertly locate people in one specifi c diagnosis or another, we could use a more psychosocial language to “help people locate themselves within the complex network of forces that operate on us all: social forces… but also those [in] the network of crisscrossing relationships in which we are embedded” (Frosh, 2013, p.22). I would go further. This kind of language


can also help us to locate ourselves fi rmly in the complex social contexts of people’s lives. Of course, it is in this dialogical territory that we are confronted both by “the richness of language” (Nell, 1992, p. 229) and “the intrinsic insuffi ciency of language” (Frosh, 1997, p. 98). Perhaps it is here that we can “openly acknowledge [a] dependence on language and metaphor” (Nell, 1992, p. 230) and begin to grapple with fi nding ways to use language to talk to those who are less privileged than us and who are struggling against injustice for a better life. For example, as Combs (2018) suggests, it is here that we will be able to get a more grounded sense of the contextual, relational nature of people’s life problems and where we can begin to understand, for example, the distressing eff ects of racism and poverty. It is here that we can conceptualise people’s diffi culties as “struggles for dignity and survival in the face of injustice” (Combs, 2018, p. 13), rather than as individualised notions of ‘depression’ or ‘anxiety’.


What am I doing? In writing this article, I’ve tried to talk


openly about some of my sites of privilege and oppression (Heron, 2005). At times this process raised feelings of guilt about how in the past I have been – and at times continue to be – implicated in systems of oppression. I try to resist avoiding these feelings of guilt. Instead, I am challenging myself to get more comfortable at being uncomfortable in confronting my own privilege in my personal and professional lives. I acknowledge my lack of knowledge and, as Combs (2018) suggests, try to seek out marginalised voices and perspectives and learn from them. For example, now I am learning how the British history of slavery and obstacles continues to reproduce inequalities in education and employment amongst black people in Britain today (Akala, 2018). And how things like class and extreme poverty can shape people’s lives (Louis, 2017; McGarvey, 2017). As a trainer, I try to resist using medical


or essentialist language in conversations with students when talking about clients who fi nd themselves in some predicament or another. I try to encourage them to take relational risks (Mason, 2005) and talk with their clients, supervisors, trainers and peers about oppressive and racist practices. I urge them to pay careful attention to the language they employ to describe their clients and to document people’s acts of resistance and responses in the face of prejudice and oppression as indicators of their wellness and strength (Richardson Kinewesquao, 2015). After all, it is through these acts that all of us strive to maintain our dignity, connection, relationships,


Context 164, August 2019


Privilege and struggle: A personal journey towards anti-oppressive and anti-racist practice


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