James Barnes, writing for Aeon, introduces me to his take on the new-to-me psychoanalytic framework of relational theory, which he calls the “relational-intersubjective model”.
For Descartes and for modern neo-Cartesian models alike, our experience of the world and others occurs ‘on the inside’ – in our individual minds or brains. For modern psychology, this meant that mental life could be studied and measured in isolation, lending itself to empirical and quantitative science. Prior to my training, I’d understood the limitations of this in a purely philosophical way only. I hadn’t made the link between it and the practical day-to-day reality of our failed mental health system – nor had I traced it to my own distress.
All of this came together for me only later, in the years I was in therapy and training to be a therapist. As opposed to the Cartesian view, it was the relational view – where mind and healing are understood inter-subjectively – that made proper sense of my distress. Instead of locating the problem ‘in’ the person, relational therapists see distress as arising in the relationship between the individual and the rest of the world.
This immediately made me think about the social-relational model of disability, which I discovered last year through Jane Mantzalas, Amanda L. Richdale, and Cheryl Dissanayake in a paper about autistic burnout.
The [social-relational model] bridges these perspectives [between the medical and social models], conceptualizing disability as a form of social oppression dependent on the relationship between an individual’s “impairments” and social and environmental influences. While aspects of a person’s condition may restrict their activity, disability is socially imposed.
From a relational-intersubjective perspective, psychological and emotional suffering and what ameliorates it are understood very differently. We are no longer thinking about experiences occurring in putative internal worlds, about cognitive distortions, nor imbalances or dysfunctions in the brain. Such phenomena are understood as secondary or derivative at best. From this perspective, focusing on internal processes – at the expense of interpersonal relationships and social context – has got it exactly the wrong way round. Much like how the mind itself is understood, psychological and emotional problems are not foremost ‘in here’ but ‘out there’. Even if we do in some sense ‘internalise’ our experience, it nevertheless remains fundamentally social and interpersonal throughout life.
Mantzalas, et al.:
Disability may be "structural" or "psycho-emotional" and affect an individual’s activity and psychological or emotional wellbeing. Whereas structural disablism is caused by exclusionary factors in the environment (e.g., access to employment or information, and physical access to buildings), psycho-emotional disablism is an internal form of oppression that can indirectly or directly contribute to exclusion.
Exclusion by indirect psycho-emotional disablism stems from structural reminders that individuals with disabilities are different, leading to embarrassment and preventing them from using services or facilities (e.g., accessing a building via a hidden entrance or a supermarket’s designated "quiet hour"). On the other hand, direct psycho-emotional disablism comes from an individual’s relationships with their families, friends, professionals, strangers, and themselves. Being stared at, called names, infantilized, ignored, and narratives about curing disabilities can lead to lower self-esteem and self-worth, and subsequent social withdrawal.
To be clear, I don’t believe that we can say that the foremost reasons for all impairment or disability somehow are “out there”, per Barnes, because that’s not my actual experience. It’s true that externalities can prompt or cause my disabling. It’s also true that my brain literally is wired in ways that can make life inherently problematic if not occasionally traumatic.
(That said, Barnes nails what’s always bothered me about cognitive-behavioral therapy, in that it “explains cognitive distortions, erroneous beliefs and ‘misappraisals of reality’ as the key to understanding […] distress, and its treatment involves challenging and ‘correcting’ such subjective distortions”. Sometimes, yes, my brain isn’t actually guilty of misappraisal at all and very much is not the thing in need of correction.)
Nonetheless, clearly we need more models like the relational-intersubjective and social-relational, and what’s more we need them to engage in dialogue with each other. It’s an important counter-narrative to the dominant mythos of capital which subverts our capacity to build solidarity and capacity.
Most importantly, especially when we think broadly in terms of our approach to ‘mental health’, there is a dramatic shift in what are considered the causes of emotional distress. The neo-Cartesian standpoint starts and ends with the person’s supposedly problematic subjective cognitions and perceptions about things on the neutral ‘outside’. Even in avowedly ‘biopsychosocial’ models, the role of others and the world is understood only derivatively, in terms of ‘triggers’ and ‘stressors’ of otherwise internal processes.
Because mind is understood as inherently interpersonal and social in the relational-intersubjective model, there is no need to hypothesise ‘external causes’ for what are then ‘internal problems’. Rather, social and interpersonal realities are immediately a part of a person’s emotional and psychological state. In other words, experiences of others and the world can be seen as inherently distressing, and it is these that are seen as primary in understanding most mental distress.
Counterintuitively, perhaps, understanding the ways in which we disable each other—that for any given person it’s not all just in their head and so up to them to solve on their own—actually empowers us to rid ourselves and each other of that particular disabling behavior and so focus together on the structures which disable us all.