Relatedness and relationships in mental health:
Funded by the Independent Social Research Foundation
During 2015-16, this ISRF funded network brought together scholars from a range of disciplinary perspectives (psychology, philosophy, psychiatry, sociology) to reclaim and foreground relationships as a central concern for mental health and wellbeing. This work will culminate in an event, to be attended by researchers, practitioners, service-users, and carers, which will consider what exactly is, and what ethically and clinically ought to be, the role of relationships in mental healthcare. We are interested in exploring the research, clinical and personal implications of our findings to date.
Through collaborative workshops, we explored a number of questions by drawing on qualitative empirical data, clinical experience and theoretical perspectives. Our workshops loosely followed three themes:
- Relationships with family and peers can seemingly create, maintain, and ameliorate mental distress. It is unclear which relational factors are implicated in which processes. How can a relationship be both good and bad for mental health?
- Periods of distress and hospitalisation disrupt relational networks, and service-users with enduring difficulties are known to have smaller social networks, yet, with the greater inclusion of informal carers, the burden of care increasingly falls on non-professionals. Is a real ‘distributed recovery’ possible in the current context?
- In mental healthcare, open-ended ‘care’ may involve dependency, yet socio-politically extended periods of ‘dependence’ can be positioned as ‘malingering’ by a discourse of ‘austerity’ that attributes blame to the margins. Independence and self-support are prized. Differing needs in mental health mean flexible notions of care and in/dependency are needed – how can care exist where dependency is disallowed?
The therapeutic relationship is the intervention in mental health – yet the current UK system is individualistic. We were interested to understand more about how current agendas including ‘social recovery’, ‘relational security’, and the inclusion of informal carers sit alongside the practical, ethical and conceptual role of relationships.
A feeling of connection is fundamental for a flourishing life. Humans need to belong; we need frequent, positively valenced interactions with others, and at least one strong, stable and reciprocal relationship characterised by care and concern (Baumeister & Leary, 1995). If deprived of either of these, individuals are more likely to be unhappy, lonely, and stressed, and risk increased physical and mental health problems and suicide (Baumeister & Leary, 1995). Yet in the context of mental health, relationships are dually implicated in both “the creation and amelioration of mental health problems” (Pilgrim, Rogers & Bentall, 2009, p.235).
However, contemporary capitalist constructions of the self, as individualist and independent, and biomedical models that construct mental illness as the result of biological processes in discreet organisms, fail to take connectedness into account. This ‘internalism’ (Broome & Bortolotti, 2010), neglects the relational context of distress and wellbeing, and has resulted in a narrow, diagnostically-led focus on the individual in mental health services and polices (Pilgrim et al., 2009).
In the context of mental health, connectedness is both crucial and complex. For some people, intersubjectivity itself is perceived as dangerous, such that relationships threaten to engulf or annihilate the self (Lysaker, Johannesen, & Lysaker, 2005). Psychosocial development can be disrupted by the onset of disorders, curtailing experience of close relationships outside of the family (e.g. Macdonald, Sauer, Howie & Albiston, 2005). Relationships can be perceived as ‘risky’ and frightening (Dorahy et al., 2013; Redmond, Larkin & Harrop, 2010), and stigmatisation and isolation is commonplace (Pilgrim et al., 2009). Interpersonal difficulties are exacerbated by the increased likelihood of trauma, abuse and adversity in early life (Mackrell & Lavender, 2004). Consequently, people with long-term mental health problems often rely heavily on family (e.g. Randolph, 1998), with whom they may have complex relationships.
The therapeutic relationship is known to be significant for recovery, and positive connections are part of successful long-term therapy (Haskayne & Larkin, 2013). Belonging, safety, openness, participation and empowerment are the quintessential components of a therapeutic environment (Haigh 2013; Pearce & Pickard, 2012). Unfortunately, acute wards for those in most distress are perceived as frightening and non-therapeutic, with impersonal care (Fenton, Larkin, Boden et al., 2014). Low staff morale, high staff turnover, and the ‘revolving door’ phenomenon undermine the provision of consistent and empathic relationships (Haigh, 2002). The socio-political climate and the “independence imperative” (Taylor, 2013, p248) mean service-users have fewer opportunities to form secure attachments. We feel the significance of relatedness and relationships for mental illness and health needs revisiting.