the team room with a mug of soup for her lunch (on the move) and her work mobile rings: “Oh no, it’s another call. I have to take this …sorry”. She returns five minutes later just as the other members of the team gather. It’s all a breathless rush. The first family is due in ten minutes and no one can locate the file. “Who saw them last?” I am told that the therapist is on sick leave so, “We need a stand-in”, says one of the young, keen psychologists. I am the visiting consultant supervisor and already I’m feeling the pressure to create some structure, so we can get started. Eventually, we begin to prepare for the session and it goes well enough despite insufficient pre-session discussion. By now, the nurse’s soup is cold, and after the session she rushes off to answer another call. “We’ve been going through a reorganisation of staff as our neighbouring CAMHS is not functioning, so many people have left or are off sick”, apologises the young, keen psychologist. In this scenario, there is little or no space to consider the implications on staff morale, stress levels and the quality of service being provided. It is “heads down” practice.


The forces that push us from behind our backs


Systemic practice must consider the


impact on the practitioner of working under such compressed, stressed, and ultimately depressing working conditions. Erich Fromm (1981), the psychoanalyst and social philosopher, argues that to be able to take a critical look at ourselves as social beings, we need to attend to the forces that push us from behind our backs. Our awareness of such forces is the first step in altering our circumstances for the better. These distal forces (Smail, 2006) are the less immediate, more distant, powerful influences that we cannot define so readily, but which nonetheless heavily influence the ways we live, and the constraints we must operate within. Dealing with cuts in services, and pressure to do more with less, are expressions of an ideology that has failed to grasp the glaringly obvious fact that, without appropriate resources and time to consider the complex nature of mental health practices, our clients and patients are not likely to improve. If this cycle continues, the system will implode and some would say this is already happening. Too many skilled practitioners give up or


4


decide to enter the private sector. As a consequence, creativity and the practice wisdom of the workforce in the state- funded services is depleted or staffed by private companies whose workforce is often poorly equipped or insufficiently trained.


Big questions to consider The following is an excerpt from a


speech in support of the NHS made by Michael Sheen on St David’s day 2015, arguing passionately for a relationally focused society in which ...all are equal in worth and value and


where that value is not purely a monetary one. A society that is supportive, that is inclusive and compassionate – where it is acknowledged that not all can prosper; where those who are most vulnerable, most in need of help, are not seen as lazy … because they are us. The sociologist Michael Rustin echoes


this view when he proposes a relationally focused society, “...more relevant to human wellbeing than the pursuit of the chimera of ‘economic growth’ as the measure of human happiness” (2015, p. 16); and where the marketisation of care may “dull ethical sensibilities” (Sandel, 2012, p. 141). These are among the forces that push us from behind our backs.


Pushing back: co-creativity as acts of opposition


Part of our job is to be irreverent


towards the status quo when it harms us and/or our clients. “Creative delinquency” is part of the therapist’s repertoire as well as support and understanding. Fromm (1981) described disobedience as …an act of the affirmation of reason and will. It is not primarily an attitude against something but for something. For our capacity to see, to say what we see, and to refuse to say what we don’t see. To do so we do not require to be aggressive; we need to have our eyes open to be fully awake and willing to take responsibility, to open the eyes of those who are in danger of perishing because they are half asleep (p. 22). It is what we stand for that counts. Social activism against policies and


practices that dehumanise and oppress services and service users are important strategies for creative protest and opposition. However, direct action is not always possible and, if we are tired, fearful


of being sacked, or worried about our short-term contract being extended, we may lose heart and settle for making the “best of a bad job”. But this should be the start of a conversation and an opening to take action wherever possible to raise the debate.


Levels of protest: “Sun destroys. The interest of what is happening in the shade” (from The Whitsun Weddings by Phillip Larkin)


It is useful to bear in mind that, as well as


organised acts of opposition and political protest, apparently inconsequential matters can also have profoundly positive repercussions. Aesthetic endeavours can become acts of resistance against oppression (see Afuape, 2011). Creativity here is considered the emergence of an aesthetic process between us that is often initially hidden from view, smouldering until it sparks into life. Thereafter the visible expression of creativity gathers momentum.


Strange Fruit: A case in point


‘Black Bodies swinging in the southern breeze Strange fruit hanging from the poplar trees‘ Abel Meeropol wrote the song


Strange Fruit fi rst as a poem. He was a schoolteacher from the Bronx, committed to American civil rights. He was horrifi ed when he fi rst saw photographs of the lynching of black men. He fi rst introduced the lyric to Billie Holiday at an integrated nightclub in New York, but she didn’t get the importance of the song until after the poem was put to music. Arrangers, producers, sound engineers and musicians were all involved in the song’s evolution. In time the public was exposed to the special quality of the song, selling one million copies by 1939. Creative expression took shape from


small beginnings – the anonymous photographer (whatever the motivation), the publisher of the photograph and Meeropol’s poem, inspired by the image. The beginnings of the creative process are impossible to defi ne precisely, but what began as a personal protest against lynching was fanned out by others involved. Creativity is not an isolated event. The boundaries of creativity are not easily defi ned, but are grown in contexts, often of opposition to prevailing power and infl uence.


Context 164, August 2019


The politics of practice and the state we are in


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