Communists in the Clinic

Ian Parker reports on the progress of the Red Clinic and the role of communism for its workers and supporters

We all know well the toll that capitalism takes on our lives, and the physical and mental strain that exploitation and oppression involves. Distress intensifies in times of austerity, with isolation of people from each other giving new actual and virtual twists on alienation at work, and for those excluded from the workplace. Capitalism is bad for your mental health.

Whether or not everything would be hunky-dory when we have overthrown capitalism is a moot point, and anyway we cannot wait, so what should communists involved in the field of mental health do now, and how should they think about their role and aims? One answer has just been given by Dorotea Pospihalj of the Red Clinic, an avowedly internationalist collective of therapists committed to providing accessible treatment who define themselves as communist.

Free associations

This recent thought-through answer in the online paper For a Communist Clinic is conceptualised using specific theoretical resources; it is psychoanalytic, which not all radical mental health practice is nor should be, and Dorotea’s paper is aligned with the work of the old Maoist philosopher Alain Badiou. For Badiou, the ‘communist hypothesis’ is about an always open possibility that we enact through a range of events that will include the domains of politics, of course, and science, art and love, the last of which frames much clinical work whether it is psychoanalytic or not.

This does not mean that communists in the clinic attempt to indoctrinate, nor even subtly suggest that their patients become communists, but there are aspects of the ‘free association’ that is possible in the clinic that chimes with the kind of ‘free association’ that we struggle for in the field of political economy. As Dorotea Pospihalj points out, there are psychoanalysts of the right as well as of the left, and she draws on her own experiences of political activism in Slovenia – she is based in Ljubljana – to show how some bizarre political choices can be made by therapists who think they are ‘radical’.

There is a sometimes jokey recent webcast with Dorotea, who stood as a candidate for the ecosocialist Left party in recent elections in Slovenia, available on the Psy-Fi Psychology and Theory show, and another Psy-Fi episode is about similar initiatives in Brazil with Christian Dunker and myself; we can see here how important an internationalist perspective and organisation is to the Red Clinic, and to anything that pretends to be ‘communist’ in clinical work. We not only learn from each other’s quite different experiences as we talk and act in solidarity with each other, but we are able to break out of the national peculiarities and limits of our own national traditions. We need to break out of those limits in our therapeutic work and in our conceptualisation of what it is we are doing.

The politics of truth

What underscores communism in the clinic in conditions of capitalism – and who can say whether this kind of clinic will actually be necessary under communism – is a politics of truth combined with theoretical reflection. This argument, again drawing on the work of Alain Badiou, is something that is actually familiar to revolutionaries outside the clinic; we bring our analytic understanding of the nature of capitalism to bear on our politics and we know that we must speak the truth to power. We are beset by lies in this society, and our political activity is grounded in truth; speaking truth to others and speaking truth to ourselves about what we are doing.

The Red Clinic is one of the sites for taking this work forward, but not the only site. Meetings about the Red Clinic have grappled with the role of particular models of therapy and our relation with treatment that is already available on the National Health Service. The NHS is a valuable resource, and anticipates in its form – free medical support at point of treatment for all – what we would hope for under communism. It is not for nothing that rabid right-wingers hate the NHS and want to privatise it, destroy it.

While we fight to defend the NHS we also mobilise to extend what is good about those services, increase participation of service users and make the treatment something that is empowering rather than demobilising, something that embeds support in social networks instead of increasing the isolation of people who are simply doled out antidepressants because that is cheaper and quicker. Here we need to link with other radical initiatives like the Free Psychotherapy Network and the recently formed campaign for universal access to counselling and psychotherapy.

Local and global

These initiatives need to be local as well as international. In Manchester, for example, the CHARM network that was set up to challenge attempts to concentrate mental health care in a large hospital in north Manchester has also been extending its links with activists and users of services to address questions of racism. The Red Clinic has been devoting energies to the struggle against racism and apartheid, with its practitioners supporting a group of clinicians in Palestine, and hosted an online discussion of work on ‘Mental Health in Palestine: Resisting Settler Colonial Partition’.

Communism is an opening to another world beyond capitalism, something that needs to be built now, and we know well from radical mental health initiatives around the world, whether that is in England and Wales or work in indigenous communities in Amazonia, that working class self-activity needs to be intimately linked with struggles against racism and sexism and other forms of oppression. The work in Brazil reflects on the process of listening as the core of progressive work, not immediately obviously communist, nor necessarily psychoanalytic, but congruent with what it is to be a communist in political activity.

For a communist clinic

There is a long history of radical therapy that has known, in its heart, that the capitalist system must be overthrown before the crisis in mental health services can really be resolved. The reflections on communism in the clinic pick up the threads of those debates. Meantime, we need to defend what services we have and build better ones, the kind of services that are democratic and open, and that facilitate the kind of free association that enables people to fight for communism.

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Red Clinic: Strikes Manchester

Ian Parker reports on debates in the context of political struggle over what radical therapy might look like

One of the teach-outs on 31 March hosted by UCU during the ‘four fights‘ strike over casualisation, diversity, equality and pensions in Manchester, after an anti-casualisation picket at the university, was on ‘Red Clinic’. This was a collective discussion in solidarity with, and as part of the strike, asking how we could build a Red Clinic that was oriented to developing truly accessible and sustainable provision of psychotherapy for the working-class and the oppressed in the broadest senses of the terms, attentive to the interrelations between axes of oppression, and transcending national borders.

This initiative, we said at the outset in the publicity, would be informed by Marxist, anti-racist, queer feminist and radical disability theories. It should be explicitly internationalist. We began with an outline of where we were up to so far and gave examples of the kind of work we had in mind.

Mental Health

The Red Clinic initiative is in its early days. It began in London following a Mental Health Workers Inquiry to explore clinical approaches that foreground anti-capitalism and anti-imperialism. We are dealing here with at least two issues. One is the nature of global capitalism which, intersecting with vicious racism and sexism, is driving spiralling rates of distress; mental health suffering is a political matter. The other is access to mental health support, with privatisation of services replicating the isolation that people feel; mental health provision is a political matter.

So, there was a decision by a small group of radical therapists, lawyers and activists to set up something that would badge itself as run by communists. This term ‘communist’ is deliberately chosen to point to the need for collectively run services that increase peoples capacity to themselves engage in conscious activity together with others to change the world. Solidarity in the practice of therapy, in its form as well as its content, is crucial here. Perhaps it would be possible for those committed to this project to bring in therapists to work face-to-face and online.

We began to advertise for therapists, thinking to employ therapists who would take on a high fee-paying client in order to subsidise work with a low or no-fee paying client. We started to think about how to manage this, and then we took a step back. It seemed too much of a stretch with the small group we had working with us to do all of this. Now Red Clinic is taking another step forward, but on two tracks of work. One is to engage in political dialogue with practitioners, and to set up a political education programme to discuss how to connect therapy with radical theory and practice. The other track of work is to build bases for the Red Clinic, and work out how to offer practical clinical support to those in distress, including to working with trades unions, grassroots organisations and social movements.

Dilemmas

So, we need to be clear that this is a project that is riddled with problems, with issues that we believe can only be worked through in collective discussion and in practice. These problems cannot be solved in the abstract by good theory, so we begin this process now by setting out some of the dilemmas we face.

First, what do we mean by ‘therapy’? Is it to be underpinned by radical psychoanalytic ideas about the unconscious and the way that past relationships are replicated and worked through in the clinic, or does it also include ‘client-centred’ humanist approaches that focus on personal growth, and cognitive-behavioural approaches that offer short-term alternative ways of reframing problems, and group analytic approaches that are already collective? We think it includes all of these things, and more, and that means that practitioners with different understandings of the ways that societal distress gets inside people will be working together in the Red Clinic. So, how do we handle those disagreements?

Second, what do we mean by radical politics? We say we are communist, and we hope it is clear that this means that we work in the spirit of the most open and materialist ‘intersectional’ understanding of how exploitation and oppression works. But, does that mean that a good therapist is necessarily a communist of this kind, and should say so, and what are the consequences of that for the expectations that those seeking help will have of the therapists they meet in the Red Clinic. How does that political commitment express itself, if not in turning the therapy itself into a form of political education, which, to be clear, we think it should not. So, how do we avoid turning therapy into propaganda?

Third, must people be radical or turned into radicals? There is a question here about what commitment we expect from those who access the service, if they are not paying, which they should not and which they do not even now in rapidly-shrinking NHS services. We need to ask how therapy can operate as a space for people to speak in confidence without being judged, can operate if there is an implicit expectation that they are, in some way, ‘radical’. How could they be engaged in a radical political project called ‘red clinic’ alongside and as an intimate part of the project to understand their distress and change the way they engage in the world. So, how do we release service users from the demand to be good radicals?

Fourth, what do we mean by ‘collective’. The signifier ‘communist’ is not enough, given the history of the way the term has been used and abused, to guide us, and there are institutional obstacles to this. The therapy as a private enclosed space is necessarily in some way outside the collective sphere, and it is a refuge and space to speak, to speak without the usual consequences of speaking to a family member, or an ‘expert’ or, indeed, a comrade. Advice is absent and so is commitment of the usual kind in everyday life. The collective work of the institution of any clinic is suspended in the actual clinic room. So, how do we square our social project with personal change?

Challenges

If these were not problems enough, there are more. The very small numbers involved and the conditions in which we work mean that online therapy will likely be the main option, but that is a form of work that has an alienating isolating effect that runs counter to the ethos of the Red Clinic. What it is to be ‘collective’ in these conditions changes radically. That also means that ‘internationalism’ threatens to be reduced into tokenism as we link with radical therapists in different parts of the world and work out what we can offer each other practically in terms of support.

There are in post-pandemic global capitalism, a host of issues that compound those that have beset red or radical therapy initiatives in the past. We know we are reinventing some of those past initiatives in new conditions, and we need help to do that, which is why a meeting in a context of a strike seemed a good place to begin again. We are asking whether we can do this, how, and whether different questions and answers can be developed if we are to have any success in the project.

Laya Hooshyari gave a vivid account of her work in South Tehran with ‘subaltern’ women, those who face oppression that is very different from the usual middle-class clients in psychotherapy. The group took on the name ‘Women with Red Lips’ after a participant in the group there who confronted the cancer she lived with, putting on red lipstick as a sign of her defiance. Laya described how different this work was from the usual therapeutic fake ‘empowerment’ of clients. She also insisted on the significance of the workers’ own presence in meetings and discussions about the formation of the Red Clinic.

Sohrab Resvani talked about his work in a co-operative clinic, run by an assembly of ‘shuras’, self-governing workers and consumers councils in Iran that was focused on ‘social self-understanding’ or, what could also be translated as ‘socialist self-understanding’. He raised a key question for the Red Clinic about its ‘internationalism’; whether we are concerned with simply transferring resources from privileged wealthy sites we work in to other places we are in solidarity with, or whether we are willing to support some form of ‘convoy’ that would physically practically take aid to, say, Mariupol or Gaza. Moreover, he argued that critical psychology needs not only to make a critique of the therapeutic and educational content of psychology, but also the ‘organizational form’ of clinics. It will be self-defeating, he said, if we build a Red Clinic as, for example, a private company or a charity.

Artemis Christinaki, who has worked with asylum seekers in the transit camps in Greece could not attend due to Covid, but a point that she wanted to make was relayed to the meeting, that there is a difference between most versions of psychotherapy and some versions of psychoanalysis that have political consequences. Much psychotherapy aims to soothe people and enable them to happily adapt again to existing conditions, while some psychoanalysts do not at all pretend to make people happy. Instead, the task of analysis is to face up to the unbearable contradictions that we live with, and enable us to actively confront them. In a project such as the Red Clinic a task would not only be to confront them individually but equally build a collective of understanding and action within it.

The opening talks were provocative, and participants at the meeting picked up on these points and took the issues in a number of different directions. A therapist working with the IAPT (government funded ‘Increasing Access to Psychological Therapies’) services asked whether we are ‘experts’ handing down knowledge, and what our target clients are; is it, for example, that we treat radicals, those disappointed by the failure of Jeremy Corbyn, for example, or is this really to be for everyone.

A senior clinical psychologist who had been managing services in Manchester spoke, in similar terms, about the danger of a gap between some of the academic debates about how to provide therapy, and the actual lived oppression of those who are receiving treatment in the NHS. She pointed out that the NHS is the largest single employer in the UK, and that we need to engage not only in the development of something that may effectively function as another tiny ‘private’ service, but also in the context of existing NHS provision.

A number of participants raised the question of the link between education and clinical provision, and asked how the Red Clinic could function as a cooperative, how transparent it could be in its functioning. For example, a recently qualified counselling psychologist asked what the implications are of using money from wealthy clients to subsidise or provide no-cost treatment for those who could not afford to pay. What would be the consequences, for example, on the perception of treatment of those who are paying, knowing that they are subsidising others.

An impossible collective process

Lydia MacKinnnon from the Red Clinic, who had come over to the meeting from Paris, responded to many of the questions, but acknowledged that these were questions that we need to work through. The questions had implications not only for how the Red Clinic might develop as a service, but also for the political education process it wanted to set up. This meeting was part of that process, a collective process. Also mentioned by another participant was the work of the ‘Clinique Contributive’ in Paris, and researchers involved in this work are interested in linking with the Red Clinic.

The Red Clinic, someone commented, was impossible but to say that something is impossible is no reason to say that it should not be attempted. Such a project is necessary. There was commitment by some of those now engaged in therapy, and by some present who have experience in managing services to help with the project. Ten people signed up to stay in contact with the Red Clinic, and others emailed to say they wanted to be kept in the loop. Red Clinic is on Facebook. To keep up to date with the development of the Red Clinic, email Ian Parker at discourseunit@gmail.com

You can read and comment on this article where it was originally published here

This is also part of the FIIMG project to put psychopolitics on the agenda for liberation movements