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Contextualising Distress I: Background and Power-mapping

Written by Steven Coles on . Posted in Clinical Psychology Bite-Size

Contextualising Distress I: Background and Power-mapping

Issue 20 – January 2010

Author: Steven Coles (steven.coles@nottshc.nhs.uk)

Key points

  • There is evidence for all forms of distress being shaped by a person’s social world and life experiences
  • The limited attention to the context of people’s distress has led to power being concealed
  • Rather than understanding power as residing within a person, power can be seen as acting between and through people.

 Implications for practice

  • The positive and negative powers shaping an individual’s wellbeing can be mapped, which may highlight practical areas for change.
  • Change requires significant levels of energy and support, and there are likely to be factors and forces restricting alterations in a person’s world.
  • A group will have more power than someone acting alone. Such groups can be an important source of social support, give people a greater voice and provide practical coping strategies. 
There are multiple lines of evidence highlighting the role of a person’s life experiences and social – material world in shaping all forms of distress 1,2. However, Boyle (2008)3 highlights that Psychiatry and Psychology often avoid the importance of a person’s social world in understanding unusual experiences and distress. Instead both have focussed on the individual as the source of difficulties. The following outlines the first in a series of practical suggestions for contextualising distress. The suggestions in the series are not rigid frameworks, but flexible ways of making sense of distress and highlighting the concrete realities of life.

Background: The Operation of Power

The limited attention to the context of distress has also concealed acts of power3. In particular obscuring acts where powerful groups harm and cause to distress to less powerful people3 (e.g. those implementing social policies that harm those with least; men sexually abusing women; employers exploiting employees; parents harming children and so forth). Power can be defined as the ability of a social group or individual to influence others in accordance with their interests4. Furthermore, Foucault (1980)5 notes that power should be conceived as an action rather than being seen as located within the individual. Smail (2005)4 notes two level of power: distal and proximal. The main flow of power can be seen as flowing from distal sources (e.g. economics, politics, culture etc), which are then felt through more proximal influences (family, work, education, relationships etc). An individual will have their own ability to act (agency) and can attempt to utilise resources in their environment, however a person’s ability to act will be limited given the greater flow of power from distal and proximal sources.

Power- mapping: Proximal Sources of Power

Staff and people within services will be severely limited in influencing distal power such as economics – even clearly identifying these distal sources can be difficult. However, it is more feasible to map out sources of power closer to an individual (proximal sources). Hagan and Smail (1997a, b) 6,7 have devised power-mapping which is a flexible tool that looks outward to the positive and negative influence in a person’s world. It can be used to map proximal resources either in an individual’s current situation or childhood.7 The map covers four main domains: Home and Family Life (parents, relations, spouse/partner, children, love life); Social Life (friends, leisure, associations); Material Resources (education, work, money, health, housing, physical environment); Personal Resources (confidence, understanding of past, intelligence). Personal resources are seen as developed and shaped through a person’s life experiences (on top of what a person was born with). Society will also attach differing values and treat individuals differently (positively or negatively) due to aspects of their bodies, such as an individual’s gender, ethnicity, age, physical attractiveness etc. The power-map can be used to make sense of a person’s distress and relate it to the negative and positive powers in their life (either past or present). Parts of a person’s life may be complicated and contain both constructive and unhelpful aspects, for example a partner might provide practical and financial support, but also be critical and emotionally damaging. An individual may have a number of positive potential resources, but be blocked from accessing them. For example having money, but being restricted from using it due to the influence of a family member. Despite such complexity, mapping the resources in a person’s life can help to clarify their situation and identify areas for potential change: regions to be developed, potential resources to be utilised and perhaps negative aspects to be minimised. However, changing these areas can be difficult and require significant levels of energy and support. Furthermore, there will be forces and actions keeping aspects of someone’s life in place, e.g. an abusive partner might be the only person someone has in their life, or the partner is likely to have an interest in keeping the individual in the situation, or abuse is all the person has known and expects from life. However, looking outwards for change is more likely to identify realistic goals than looking inward.

Supporting Groups

A single individual is limited in their ability to act on the world. People coming together as a group with a shared interest are more likely to have influence and act against powers imposed upon them. Staff can have a role in facilitating groups of likeminded individuals to form groups (see Keenan, 20098 on Mind Medication Groups), however, there are risks, such as staff dominating the perspective of the group or entangling groups in bureaucracy. The Hearing Voices Network is a successful example of how people coming together can act more powerfully than alone. The network provides a challenge to dominant biomedical knowledge, offers social support, can lend meaning to a person’s experiences, and suggest concrete strategies for coping with voices. The flow of power is central to the experience of distress. Whilst at times services might be limited in their ability to alter this flow, mapping aspects of power can help people to clarify and understand their predicament. Furthermore, it is more likely to highlight realistic areas for change than an inward focus.

REFERENCES

  1. Bentall, R. P. & Fernyhough, C. (2008). Social predictors of psychotic experiences: Specificity and psychological mechanisms. Schizophrenia Bulletin, 34, 1012 – 1020.
  2. Friedli, L. (2009). Mental health resilience and inequalities. Denmark: WHO
  3. Boyle, M. (2008). Can we bear to live with-out the medical model? Paper presented at De-Medicalising Misery II conference on 16th December 2008 at University College London.
  4. Smail, D. (2005). Power, Interest and Psychology: Elements of a social materialist understanding of distress. Ross-0n-Wye: PCCS Books
  5. Foucault, M. (1980). Power / Knowledge: Selected interviews and other writings 1972 -1977 (C. Gordon Editor). New York: Pantheon Books.
  6. Hagan, T. & Smail, D. (1997a). Power-mapping – I: Background and basic methodology. Journal of Community and Applied Social Psychology, 7, 257 – 267.
  7. Hagan, T. & Smail, D. (1997b). Power-mapping – II: Practical application – the example of child sexual abuse. Journal of Community and Applied Social Psychology, 7, 269 – 284.
  8. Keenan, S. (2009). Medication groups. Clinical Psychology Bite-Size, 15 (June 2009)
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