medico practice

Guidelines for psychosocial work

An example from the medico-practice: Gays and Lesbians activists of Zimbabwe (GALZ) fight together for their rights. Photo: GALZ 

What should therapy, psychosocial aid and emancipatory psychosocial work look like? How can we make room for attentive relationships that are based on mutual aid and help individuals and groups to refuse the commodification and pathologicization of their illness? How to create alternative forms of living and working? How to redefine the old psychoanalytical combination of therapy and cultural criticism? How can we mobilize the subversive power of psychosocial practice to shake up circumstances from within?

For over 30 years medico has cooperated closely with project partners all over the world that are fighting the psychosocial consequences of authority and power in the tradition of Frantz Fanon, Martin Baró, Steve Biko, Edward Said and Gayatri Spivak. Although our discussions were initially about the effects of dictatorship and repression, as well as the hope and contradictions of liberation movements, there has been a growing focus on the consequences of social and structural violence along with struggles for dignity and self-empowerment. As well as arranging material support, medico has been able to establish cross-continental relationships, communications systems and discussions about politically active psychosocial work, based on an empathetic understanding of other people’s subjective viewpoints.

This includes allowing oneself to be truly touched by the reality of the other person’s life, who, as so-called “globalisation losers” in Haiti, Mali or Bangladesh, or as migrants, have to endure continuous, never-ending terror, “a landscape of suffering”, to quote the South African psychologist Johanna Kistner.

It also includes a recognition that even in conditions like these, people are not passive victims who await the intervention of external experts, but explore a wide variety of ways – some creative, some desperate, some furious – to change their living conditions, come to terms with their experiences and become political subjects.

At the heart of medico’s endeavours is the desire to make contact with local actors and helpers, establish relationships with them, express empathy, dignity, trust, respect and solidarity, and channel indignation into joint courses for action.

Thus psychosocial work involves:

Intervening in the debate

Through publications, open debates, events and campaigns medico expresses its opposition to society’s indifference to the social causes of mental illness; to pathologicization and to the business interests behind psychotropic drugs; and to the commodification of treatment, which now only recognizes standardized modules and privatized provision. We support public psychosocial care that is committed to the common good rather than being subordinated to making a profit.

Developing a self-reflective psychosocial attitude

Even in the most difficult circumstances - for example, following the earthquake in Haiti – our aim is to forge project partnerships based on dignity and self-help that are developed and implemented directly by their beneficiaries. There must be equal two-way communication and relations with our project partners; this is just as important to us as providing practical aid. We always seek in our actions to acknowledge our own limitations, ensuring that the survivors preserve their dignity and that medico doesn’t step in and become paternalistic in a way that would merely confirm their past experiences of helplessness. Our approach is to reject narcissistic helper fantasies, to recognize the creativity and competence of others, and to trust in their development potential.

Working according to the context rather than by standardizing

The subjective experiences and cultural and social narratives of mental illness are as many-layered and singular as individuals and the societies they live in. Creative support of the kind Nashet organizes in Lebanon, innovative methods such as those tested by the Antonio Valdivieso Centre in Nicaragua, and active resistance such as that practised by Khulumani in South Africa and M3 in Mexico can only develop in a specific context; these activities can inspire others, but they cannot be replicated as a form of “best practice”. This is not about methods being better or worse than each other, but a distrust of standardization itself, which seeks to control things that are alive and subjective.

Creating sheltered spaces

An important step in psychosocial practice is to support the creation of sheltered spaces – if only for a short time – in which people can experience the trust, empathy and solidarity they need to comprehend their personal situation and reflect on it. This can take the form of group meetings and counselling – therapy too – but it can also involve joint theatre and cultural projects, e.g. Freedom Theatre with young people in Palestine, or the work of the human rights organization AHRDO in Afghanistan, which makes the unspeakable visible.

Empowerment and networking

When one looks beyond individual suffering and takes account of its social context, and when connections and relationships are forged between people who have experienced similar things, it creates opportunities for people to shake themselves free of the privatization of social experiences of violence and establish links. This can happen in the context of a psychosocial approach for the common good involving communities scarred by conflict in South Africa (Sinani) or potential female victims of honour killings in Kurdistan (Khanzad) or a LGBT self-help group in Zimbabwe (GALF).

Recognition and gaining the right to have rights

An important element of psychosocial work is showing solidarity with the struggle for emotional, social and legal recognition (Honneth). When victims of personal and structural violence deprivatize their suffering and call for accountability, prosecution and compensation, they make themselves visible as subjects who demand the right to have rights.

Justice is happiness

No one can be happy for long in an extremely unequal world. Kate Pickett and Richard Wilkinson’s remarkable study showed that more people suffer from mental illness in societies with a high degree of inequality. Our conception of psychosocial work includes campaigning for a fairer world with more equal distribution of property and for a normative definition of a good life that leaves none by the wayside, and recapturing one’s individual desire to show solidarity.


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