The Big Anxiety

Taking Care of Mental Health in Times of Crisis

Jill Bennett

• Publisher: Bloomsbury Academic
• Year: 2022
• Print ISBN:
  9781350297791
• Edition: 1
• eBook ISBN:
  9781350297760
• Topic: Psychology
• Subtopic: Social Philosophy
• Index: Psychology

This book takes a creative approach in examining one of the biggest crises of our time: that of mental suffering, distress and anxiety. By bringing together essays and dialogues from thinkers and artists across a range of disciplines, it re-imagines approaches to crisis, support, and care. Amid growing recognition that mental health is not only the province of psychiatry and the health sector, but a concern for the whole community, the book opens up critical new ways of thinking about our internal lives and the forces that affect them.

The book significantly advances the way we think about cultural responses to mental health and the understanding of the struggles of inner life. Featuring both theoretical and practical examples of the value of using imagination in response to trauma, anxiety, and depression, The Big Anxiety shows how creativity is not a luxury, but a means of survival.

Part I

Suicide, felt experience and what works

Chapter 2

Why do art therapies work?

Siri Hustvedt with Jill Bennett

Siri Hustvedt’s writing offers insight into a number of philosophical concerns underpinning the conceptualization of the therapeutic benefits of arts and the means by which these are achieved. In this piece, she elaborates on her work on mechanisms, the limits of cognitive-behavioural models of mental health and the meaning of suicidality.

Jill: Interest in the psychosocial benefits of creative writing, and of arts engagement more generally, has led researchers to look for ‘mechanisms’ that may lead to positive change.

What is the problem with mechanistic thinking?

Siri: The word ‘mechanism’ is ubiquitous in biology and psychology. Its continual appearance in neuroscience papers sent me back to its origins in seventeenth-century philosophy – Descartes, Hobbes, Newton and others. In the early modern period, nature became a great machine of inert matter that functioned according to causal laws that could be described mathematically. Every natural machine (including the human body) was reducible to its component parts, and a close analysis of each part would bring an understanding of the whole. Criticism of mechanistic thought has been part of science ever since. Among the notable voices are Margaret Cavendish (1623–73), Gottfried Leibniz (1646–1716), Giambattista Vico (1668–1744), eighteenth-century defenders of vitalism (Montpellier group), Goethe (1749–1832), Alfred North Whitehead (1861–1937) and the twentieth-century biologists C. H. Waddington, J. B. S. Haldane and Barbara McClintock. Some contemporary criticisms of mechanism turn on emergence theories. What if the whole is more than its parts? What if some processes emerge from other processes and once they have emerged go on to exercise further influence on those processes? Complexity theory challenges mechanistic models by asserting that complex adaptive systems emerge through self-organization, are nonlinear, and thrive at the edge of chaos (Mazzochi 2008).

In psychology, calling on ‘mechanisms’ may simply reveal a desire for the precision and cultural value of the ‘hard’ sciences. Neither biology nor psychology has laws, only regularities, a fact that has compromised attempts to give either discipline the certainties of chemistry and physics. Stephen Jay Gould called this longing in biology ‘physics envy’. Although Gould’s wit turns on Freud’s penis envy, he does not mention that Freud, who hoped to root psychology in biophysics, had physics envy too. He imported mechanism into psychology, most famously Abwehrmechanismus – defence mechanism.

In the Encyclopedia of Personality and Individual Differences, Ulrich Koch and Kelso Cratsley (2020) write: ‘In the most inclusive sense psychological mechanisms offer causal explanation of mental states and behavior, often with reference to underlying systems, activities, or entities. . . . However, the concept has been deployed in dramatically different ways with very different meanings depending on the school or particular tradition of psychology.’

Mechanistic models have been successful at isolating and identifying biological processes, which explains their endurance. Francis Crick’s central dogma in genetics (often reduced to DNA to RNA to protein) is an example of a triumphant mechanistic model. A number of contemporary scientists, however, believe the model’s linear neatness belies the complexity of the molecular processes involved (Woese 2004; Koonin 2012; Camacho 2019). A scientific model’s success suggests only that something has been uncovered by using it, not that it is an accurate depiction of what is actually happening in nature. Mechanistic models explain how the larger machine works through the movements and interactions of its parts, but biological processes do not always follow a clear sequence and may be stochastic (randomly determined).

In psychology studies of art therapies, the use of the word ‘mechanism’ gives a ‘scientific’ gloss to the research, but the term is rarely defined, and its use may actually impede developing interdisciplinary approaches that might uncover why art has therapeutic value.

Jill: Applications of the mechanistic model in the arts and health field are often striking for their failure to account for the specificities of an aesthetic process or practice. You make this case in ‘The writing self and the psychiatric patient’ (Hustvedt 2016a), in which you discuss a paper (Baikie and Wilhelm 2005) that proposes four ‘mechanisms’ to explain the beneficial effects of expressive writing. Since that time, the search for causal mechanisms has gathered momentum, especially in the field of music and health. A recent UK study (Perkins, Yorke & Fancourt 2018) identifies multiple ‘clusters of mechanisms’ (the term ‘mechanism’ ascribed loosely to effects or benefits identified by the respondents) but offers little precision. While it validates ‘participation in singing’ as a generic activity, there is no consideration of the salience of the content, form or aesthetic qualities of what is created or performed.

My concern is that such an approach instrumentalizes arts participation without elaboration of the means by which a creative process may support growth or ‘repair’. You refer to a writer in one of your classes feeling ‘alive’ after a writing exercise. In Chapter 8 of this volume we discuss a film project that a participant describes as having ‘given me back my reality’ (she had been subjected to ongoing abuse in a child welfare institution, the reality of which had been denied by perpetrators and institutional authorities). The experience for her was one of ‘being believed’. While this outcome relies upon a well-supported, extended engagement, it is the effect of creating a film that encapsulated (the feeling of) what happened, crafted to achieve stated communicative goals (‘to explain what happened to us to our children’; to take control of the story and how it is told; to ensure that this never happens again; to hold social services accountable).

The process, it seems to me, entailed finding a form to achieve not only these goals but the fusion of felt and narrated experience (of ‘the narrating I and the experiencing Me’, as you put it (Hustvedt 2016b: 375)) in a manner that is not possible through the other, sometimes available, channels of legal testimony or media reporting. We might also observe that the processing of emotion or distress in a creative collaboration is clearly not an individual reaction, precipitated by a discrete mechanism. It is the outcome of a relational process in which expression is enabled, elaborated, received and ‘held’ within a containing space (in which one may come to experience ‘being believed’). Distress is thereby potentially co-regulated in a collaborative process, which sets itself the task of creating a scaffold for narrating experience. The process of fashioning an expressive form and giving shape to a narrative (in this case through collaborative storytelling, performing, recording, scripting, text/film editing and so forth) itself enabled a titration process, through which the recounting of trauma and felt experience could be modulated and directed to an extent that is not possible when one gives testimony in formal contexts.

The evaluation of the reparative dimension of such a creative process might, then, trace the transformation of felt experience into expressive form throughout a particular work’s coming into being. But this implies a phenomenological aesthetics rather than a mechanistic model. By what methods or with what approaches do you think we can advance insight into a creative process and its psychosocial outcomes with sufficient subtlety and precision?

Siri: The qualitative study you cite on postnatal depression (Perkins, Yorke & Fancourt 2018) compared two groups of women and their babies, both under supervision; one sang together, the other played together. They concluded the singing group did better. After ‘an inductive thematic analysis of participants’ transcripts’, the authors identify four ‘overarching themes’ which then mysteriously become ‘mechanisms’: psycho-emotional, activity, social and environmental (Perkins, Yorke & Fancourt 2018). The following comment falls under psycho-emotional: ‘Everything is for the baby. You go to a class and it’s always for the baby. . . . This [singing] is good for the baby but at the same time it’s something for us as well’ (Perkins, Yorke & Fancourt 2018). Is this a causal mechanism? Doesn’t this woman also address a social bias in her environment: new mothers are often regarded as props for their children’s development (in ways fathers are not) and expected to fulfil a fantasy of maternal sacrifice and self-abnegation? Falling short of this ideal risks moral condemnation not only from others but also from the self that has internalized the fantasy, which then contributes to depression. Isn’t the psycho-emotional also social and environmental?

The reputed emotional benefits of choral singing have produced a host of papers on the subject, including those that have measured cortisol, a stress hormone, and oxytocin, a hormone linked to labour, nursing and social bonding in the participants (Schladt et al. 2017). However, there is no one-to-one correspondence between the subjective experience of ‘feeling anxious’ and cortisol concentrations (O’Brien, Tronick & Moore 2013; Linz, Singer & Egbert 2018; Vlenterie et al. 2021) or between ‘feeling good’ and oxytocin (Guzman et al. 2013; Olivera-Pasilio & Dabrowska 2020). Reduction from first-person reports to biological ‘mechanisms’ is at best riddled.

I do not think investigating connections between subjective reports and biological processes is futile. The interdisciplinary field of psychoneuroimmunology links social-psychic factors such as ‘lack of social support’ to nervous, endocrine and immune functions to demonstrate how stress can result in chronic inflammation and increased vulnerability to disease. Understanding the effectiveness of art therapies requires investigative tools from several disciplines.

The problems you identify are ones of omission:

(1) Lack of attention to the salience of artistic content;

(2) Ignoring the particular (as opposed to the generic) form of the art in question;

(3) Forgetting dynamic processes that occur during a project, a temporal movement that can be represented as a narrative;

(4) Failure to adequately treat the intersubjective or relational (as opposed to purely subjective) qualities of collaborative, therapeutic art-making.

A general suspicion that subjective qualities (lived experience, Husserl’s Erlebnis) pollute scientific objectivity has led to the avoidance of personal and interpersonal meaning. In neurology, for example, anosognosia – the failure to recognize illness or deficit – has been widely studied. A neurological patient may refuse to acknowledge that his arm is paralysed and may even attribute it to someone else; and yet, a patient’s particular explanation for the immobile limb – it’s my pet rock, it’s the arm of my dead brother and so on – has been largely ignored in the field with significant exceptions (Sacks 1985; Solms & Kaplan-Solms 2000; Feinberg 2001). When a physician ignores a patient’s story, he treats her as a biomedical object, a collection of mechanisms, rather than an embodied subject with a history.

Every story represents time and creates meaning by linking events in a causal chain. Time – invisible, intangible, mysterious – is often conceived spatially. In contemporary Western cultures, the timeline moves from left to right according to the conventions of reading (in Arabic, the direction is reversed). The past is also understood as behind a body not in front of it. Because every story is dialogical, part of intersubjective linguistic reality, told to and for another (even when the teller and the listener are incorporated in the same person) it is inherently social. When an ‘I’ addresses a ‘you’, the alienation in the symbols of language allows the speakers to leave the present and move into the past or i...

Table of contents

• Cover
• Half-Title
• Series
• Title
• Contents
• List of figures
• List of contributors
• Acknowledgements
• Introduction
• PART I Suicide, felt experience and what works
• PART II Culture and experience
• PART III Dialogue and embodied encounters
• PART IV Designing for experience
• PART V Resistance, racism and decolonization
• PART VI Reparative action
• PART VII Thinking in action with creative resources after trauma
• PART VIII Soundwork/earwork
• PART IX Lived experience, activism and survival
• Index
• Copyright