How to Survive Without Psychotherapy

Author(s) : David Smail

How to Survive Without Psychotherapy

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This book is directly aimed at sufferers of mental distress. The book’s aim is to remove from sufferers the burden of 'fault' for their pain and to demystify some of the practices that surround the 'treatment' of mental illness.

It is not exactly a self-help book because it is a false claim of any 'treatment' of mental illness that 'cure' can be brought about by exercise of will. Much of what causes mental distress is lack of power and resource, outside the control of the sufferer. Surviving without psychotherapy involves the appreciation of several things. First, the limited nature of therapeutic assistance – whilst clarification and support may help the sufferer understand his/her predicament and encourage the use of what resources the sufferer has, therapy cannot change the distal root causes of distress. Second, that only socio-political solutions can address some of the most powerful causes of distress, e.g., redundancy, housing and poverty. In sounding a cautionary note about psychoanalysis, Smail observes that mental distress is far more about money than sex.

David Smail analyses the claims of 'treatments' of mental distress. He explains why willpower alone cannot remove symptoms. There is discussion about resources open to an individual in positioning themselves against stressors to minimise the effect of the same. That said, feelings of stress and anxiety are regularly an entirely rational response to the sufferer’s predicament.

Reviews and Endorsements

‘David Smail’s analyses, commitments and elegant prose comprise classic works in the tradition of independent scholarship. He translated the traditional assumptions of psychotherapy into the structural and situational determinants of human problems. He was a psychologist who argued against psychology and came to see the barriers to social progress institutionalized within society itself. A man of the left, he made the left less doctrinaire and more relevant. He is greatly missed.’
— William M. Epstein, author of Empowerment as Ceremony and Psychotherapy as Religion

‘David Smail showed that if we want to ease our unhappiness then there is no other way but to change the world in which we live, beginning with the illusions perpetrated by the psychology industry. David’s work forms a rich intellectual legacy and a testament to a man who spoke up for the most oppressed and marginalised. It will also provide a beacon for anyone who wishes to understand what is wrong with our society and to struggle towards making it a better one.’
— The Midlands Psychology Group

‘David Smail was a constructive critic. With finely tuned precision, he cut deeply into what is wrong with psychotherapy and, with wisdom, he pointed to another way to deal with the feelings of despair, anxiety, and depression we experience in contemporary life. He was a genuine psychologist who applied the craft skillfully. Reading what he has written is, for want of a better term, "therapeutic." His books always leave me thoughtful and hopeful, comforted by the sense that here was a man who actually understood something of life and had a grasp of what happiness really means.’
— Dr Tana Dineen, author of Manufacturing Victims: What the Psychology Industry is Doing to People

‘David developed clinical psychological ideas that offered a radical and humane approach to understanding and helping people in difficulty. He broadened the scope of the practice of clinical psychology from assessment to reflective therapeutic interventions, and then on to community psychology and locating preventative work and the facilitation of collective activity in communities of interest. His introduction of community psychology roles to mainstream clinical psychology services was innovative and ahead of its time. He endorsed community psychology, and was vigorously pioneering, while also sceptical about aspirations for psychology securing significant social change.

David argued that a rigorous understanding of individuals necessarily incorporates an appreciation of their access to power. He analysed people's proximal powers in the context of distal forces. He described a reflexive approach that means that there are questions that are always pertinent to psychological interventions: What resources are available to this person/family/community? What material, social and economic power is accessible to them? What possibilities for change are afforded by their situations and environments? In whose interests is this intervention? Thus we are always challenged to consider whether services are truly in the interests of the people they purport to help.

David showed us the importance of the quality of relationships, of being humane and modest, and, most importantly, to go beyond individualistic and voluntaristic concepts for understanding and working with people who are distressed. Apart from the thoughtful and practical ways of working that he inspired, he also generated invaluable and creative networks of support and encouragement between people who are committed to the ethical concern that "our common humanity enjoins us to mitigate suffering in others as in ourselves". I shall continue to appreciate David's wisdom and integrity and to remember him very fondly.’
— Jan Bostock, Psychological Services Professional Lead, Planned Care, Northumberland Tyne and Wear NHS Foundation Trust.

About the Author(s)

David Smail was a consultant clinical psychologist in the NHS and Special Professor in Clinical Psychology at the University of Nottingham.

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