Social Perspectives on Mental Distress – finding the meaning in distress situations

Duration: 8.55 mins

Speakers: 

Interviewer, Colin Burbridge 

Dr Jerry Tew, Institute of Applied Social Studies, University of Birmingham   

Another thing that interests me is how does your perspective give meaning to people’s distress experiences, such as hearing voices? 

A social perspective seeks to make the connection between what people actually experience and the life experiences that they have gone through, whether they’re past life experiences or what they’re going through now. However, people’s lives are quite complex and it may not be immediately obvious how a particular distress experience, like hearing voices, may relate to either past or present life events.  What makes it even more complicated is that I think there are different ways of looking at things that are equally valid and we’ve got to take seriously.  Service users have been very effective I think over recent years of actually getting professionals to re-evaluate the way that we’ve looked at things and something like self-harming or hearing particular voices may be for people their best way of dealing with and surviving in a very difficult situation and it’s something to be understood and respected. 

Yes. 

At the same time, it can be the scream for help, it can be the ‘this is unliveable, somebody’s got to do something about it’. So that’s one of the contradictions I think we’ve got to grapple with in terms of finding meaning, that the same act, the same voice, can have different sorts of meaning. It can be both ‘this is how I survive’ and ‘please, could I have another way of surviving rather than this!’ 

Yes, yeah. 

And we’ve got to come in on both of those levels. If we look more specifically at the experience of hearing voices, people actually hear voices in all sorts of different ways but it’s quite common for people to hear some voices that are actually anything from the childhood imaginary friend onwards. They are maybe people experiencing spirit guides or somebody that is making good – a voice that gives good advice or calms you down, or whatever. So some voices seem to have quite a positive survival type value.  Some voices may be making silly remarks, jokes, that sort of thing and they distract and that may also be about surviving. They may also be a real nuisance when you’re trying to do things in everyday life and somebody’s telling you a joke, just when you don’t want to hear it.   And then there’s the third sort of voices which can be hurtful, can put you down, can be abusing, all that sort of thing and they can make life not just difficult but virtually, it’s just too much to deal with and looking at those profile of voices, probably particularly the last of those sorts of voices but potentially all of the voices may be giving clues about what are the life experiences that this distress relates to if voices are being really lewd and sexualising? Then is this referring back to an experience of sexual abuse or something that was very uncomfortable at the very least, sexually. If you’ve got a hectoring voice saying ‘you’re living a worthless life’ and all that sort of thing, was there a real person who spent a lot of time telling you how useless you were and so on? And that’s just a tape that’s carrying on playing through your head.  For some people I think this is very hard to make the connection between voices and real life. For others, once they start doing it, wow, it’s just so much, things start to make sense and the distress experience becomes meaningful rather than ‘how can I get on with my real life and ignore that bit’ to ‘well those voices are actually telling me something that’s quite important about my life and I need to respond to them’. 

In relation to assessing, what do you think people may need in terms of treatment, therapy or support? 

The sort of situation that we’ve been talking about, what we hope is that by teasing out a bit what is the distress saying, then that may be useful in setting the agenda for therapy or counselling. Somebody’s going to be a lot clearer ‘now these are the life issues that I’ve not dealt with very well and I need to have better strategies for dealing with them’. 

Yes. 

It may also be very useful in setting the agenda in terms of ‘what are my particular vulnerabilities or trigger points? What are the social situations that I find particularly difficult to handle and therefore where I may need, at least in the short term, support either from professional helpers or from carers or other people in my network. I’m going to need someone to go along with me to do this’. So it’s not a therapy agenda, it’s about making the real world a bit easier to deal with, identifying which bits of the real world are the hard bits that people are going to need support with. 

In relation to providing self-understanding for service users, how do you feel that that applies? 

Well I think that’s very much where I’m starting from, that I don’t think social perspectives work in terms of me getting it all right in my head and mapping somebody’s life out and making all these connections. That’s really neither here nor there. What makes a difference is if the person who’s going through the experiences makes connections that are valid for them, and then that helps to set an agenda for me to work with them. 

Yes. 

So I think their self-understanding is the core of this and that’s something that others can work around. It’s not for me to say ‘you’ve got to have the right sort of insight, which is the way that I see it’, because that’s no use to anybody. 

Yes. And how can this apply in relation to understanding for people who are carers? 

I think it’s the same answer I’ve just given really in terms of carers can feel really bewildered as to how they can help and they may find that the things that they think they’re doing to help, actually seem to be making things worse, but it’s not at all obvious why that’s happening.  If carers can have some understanding of these are the connections between this person I care about and their distress and their life, sometimes these may be very painful things but for a lot of people, dealing with the fog, dealing with the unknown, is just the worst. If it is ‘oh, we are dealing with, I never knew when we got married I knew nothing about this but I now know that my partner was abused as a child’ – difficult stuff to deal with.  But at least you can be there for that person while they’re beginning to deal with those things, rather than dealing with what’s seen to be completely unconnected behaviours, moods and so on that are just so hard to live with because they don’t seem to have a meaning. Once they start to have a meaning, it may be painful but you can do something with it. 

It's giving a name to the unknown isn’t it? 

Mm. 

So that you can, as you’ve said, you can work with it and you can deal with it.        

END OF RECORDING