Abstract
In his accessible and engaging book, Travel and Movement in Clinical Psychology: The World Outside the Clinic, Miraj Desai challenges clinical psychologists to move outside the narrow confines of the traditional therapeutic frame and travel beyond the safety of the consulting room. The book is a bold call to clinical psychologists to inhabit the external world and engage actively with toxic social, political, and economic forces that contribute to dis-ease. Readers of the book are confronted with three implicit questions, none of which have clear answers: (a) what exactly would it look like to practice clinical psychology in the way Desai envisages, (b) can clinical psychology maintain a unique identity if its theory and praxis evolve into a more socially conscious, politically informed discipline that resembles community psychology, and (c) how can clinical psychologists transcend professional boundaries to achieve a “postdisciplinary praxis” that is beyond conventional interdisciplinary collaboration? Desai’s book invites clinical psychology to become more aware of its obligation to address social justice, but it also reminds us that more movement is needed if the practice of clinical psychology is going to meet this obligation.
Empirical evidence supports Desai’s assertion that psychiatric illness is inextricably linked to poverty, oppression, and marginalization (Burns, 2015; Lund et al., 2010; Priebe et al., 2016). But Desai goes further than asserting that sociopolitical forces shape psychological health. By invoking the examples of activists such as Mahatma Gandhi and Martin Luther King, Desai argues that the active and concrete pursuit of social and economic justice should be integral to clinical psychology. But what exactly does this imply for everyday practice? It is clearly not enough for clinical psychologists to understand in exquisite detail the intra-psychic world of their patients and articulate this understanding in jargon which is incomprehensible to those outside the discipline. More is needed from clinical psychology. But precisely where and how are clinical psychologists supposed to act to ameliorate the distress of their patients if the origins of psychological suffering are, at least in part, social and political? Is it enough to use well-placed, clearly formulated interpretations and questions to make patients conscious of how their subjective distress is a function of the sociopolitical world they inhabit? Are clinical psychologists supposed to transform patients into activists who are empowered to recognize and confront the social forces that impede psychological wellbeing? Or are clinical psychologists expected to do something even more concrete, more direct, and more immediate by actively engaging in the construction of a new (presumably less toxic) political and economic order? Imagining a reformed practice of clinical psychology, Desai uses Mahatma Gandhi and Martin Luther King as prototypes of “worldly clinicians.” These examples might be read to imply that traditional psychotherapy focused on the internal world of the patient has no place, and that the “world” created in the relationship between therapist and client cannot be the site of political transformation and individual liberation without an active engagement with the physical world outside the clinic. But is this true?
Desai’s call to see the individual in context is compelling, but it is not new. A number of scholars, including Erich Fromm (1994), Rollo May (1996), Frantz Fanon (Hook, 2004), Laurence Kirmayer (2007), Amartya Sen (1999), and Stephen Frosh (2010), have called on mental health professionals to see beyond the intrapsychic world of their patients and to understand the sociopolitical, cultural, and economic contexts of psychological distress. Nonetheless, Desai’s book reminds us that symptoms of mental illness are always socially situated and that psychological distress resides not within individuals but in the spaces between people—spaces created by economic and political systems. For a long time, community psychologists have known this and have actively worked outside the clinic to promote mental health and liberate individuals (Nelson & Prilleltensky, 2010). If the practice of clinical psychology becomes completely aligned with community psychology, what will make it uniquely clinical? Is Desai calling for the dissolution of boundaries between clinical and community psychology? Or is Desai calling for clinical psychology to subsume community psychology and thus maintain the hegemony of clinical psychology at the apex of psychological practice?
It is patently clear that clinical psychology risks becoming irrelevant if it focuses narrowly on patients’ intrapsychic worlds and confines itself to individual internal cognitive or neurobiological processes. Desai’s book reminds us that a psychology that insulates itself from the outside world and allows clinicians to dis-locate patients from their context, is unethical and dangerous. Any theory that isolates the individual from their sociocultural or political context is woefully incomplete and lopsided. The practice of clinical psychology will move towards greater integrity and potency if it explicitly entails processes that reunite individuals with their social worlds and reconnects patients to their personal agency to participate in the (re)construction of these worlds. Opposing isolation, insularity, and myopia are active ingredients in the practice of clinical psychology. Desai’s book reminds us that travel and movement (as both experience and metaphor) are potent antidotes to the isolation, insularity, and nearsightedness of traditional clinical psychology. The “new” clinical psychology that Desai envisages is one that requires union and integrity. Such a union necessitates dissolving boundaries between professions and disciplines, to enable a “postdisciplinary praxis” that is beyond conventional transdisciplinary collaboration. The work of promoting mental health is larger than any one discipline. Desai seems to be calling on clinical psychology to travel beyond professional boundaries—to transgress borders—in order to collaborate with other professions and learn from other disciplines about promoting social justice and well-being. The dissolution of professional boundaries will require clinical psychologists to give up any monopoly they imagine they have on understanding or treating mental illness. Clinical psychologists need to work not only with other mental health professionals but with lawyers, economists, engineers, political scientists, and environmentalists.
Throughout his book, Desai uses the terms “travel” and “movement” to denote both experience and metaphor. He portrays this sense of movement as he seamlessly shifts between widely divergent ideas; moving from phenomenology to Zen Buddhism, and from Karen Horney to Mahatma Gandhi. The imagery of travel invites the reader to move from the personal to the political, from the individual to the contextual, and from the inside to the outside. This image of movement carries with it a sense of liberation, as Desai imagines how clinical psychology might become less insular, a-contextual, Euro-centric, and grounded in presuppositions (i.e., assumptions that are taken to be truths within psychological theory and clinical praxis, but that are not necessarily supported with evidence). Desai suggests that by becoming more open and dynamic, the practice of clinical psychology might move towards greater integrity, potency, and relevance. For Desai, movement implies action in the world. He uses graphic examples to illustrate how racial oppression is enacted through restrictions of movement, segregation, and confinement to particular spaces. These are apt and powerful examples that foreground issues of race, and the need for clinical psychology to engage with racial oppression. What is, however, remarkable is how in a book on movement and travel, issues of physical impairment are not given any attention. By failing to discuss how the movement of atypical bodies is restricted, Desai continues the long-standing bias in clinical psychology against a more conscious consideration of the body, the oppression of persons whose bodies do not conform, and how ableism works to restrict movement. Everything that Desai writes about persons “embodied with colour” can (and should) be extended to a discussion of disability in clinical psychology. Desai’s book points clinical psychology in the direction of social justice, but it also highlights just how far the discipline still has to go to make social justice work central to its everyday practice.
