for Health and Justice
of Health Psychology
2003, 8, 219-221
by Isaac Prilleltensky and Ora Prilleltensky
This version may differ from the published version.
In 1979 and 1980, in a direct-action effort to prevent the spread of
nuclear power, the Coalition for Direct Action at Seabrook attempted to
occupy New Hampshire's nuclear plant construction site. During both occupation
attempts I watched state troopers teargas, Mace, and beat some of my comrades.
It was quickly apparent how little I knew about first aid and how important
such front-line skills could be. At about the same time, I felt just as
useless when one of my young sons got a nasty cut on his knee. Realizing
that the political analysis leading me to Seabrook and the child-rearing
philosophy directing my parenting were meager preparation when blood flowed,
I enrolled in a course to become an emergency
medical technician. Theory had its place, but practicality counted
for something, too.
When the course ended, I worked for an ambulance company. The daily excitement,
combined with the satisfaction of doing something directly useful for
a change, kept me pretty charged up. But before long something troubled
me: Almost every medical emergency my ambulance charged towards resulted
from something preventable: heart attacks brought on by poor diet
and lack of exercise; other health conditions escalating to dangerous
levels because lack of health insurance made routine medical care impossible;
automobile crashes made more likely or more deadly by alcohol, speeding,
road construction, confusing signs, or faulty automobile design; workplace
injuries stemming from clumsy machine components or profit-motivated management
practices; and much, much more.
I still knew that having an ambulance always ready to pick up victims
is crucial. But I couldn't help but think: shouldn't some effort also
go to change the circumstances that spawn what no longer seemed either
accidental or inevitable? I soon quit my job and returned to graduate
school, to contemplate the links between psychology, radical politics,
and social change. My first aid skills rusted away.
I recalled this personal back-and-forth tug while reading Isaac Prilleltensky
and Ora Prilleltensky's article "Towards
a Critical Health Psychology Practice." As a friend of both authors
and collaborator of the first, I was not surprised to find myself nodding
at their conclusions and prescriptions. They clearly lay out both the
rationale for, and the path of, a more critical health psychology, in
keeping with critical psychology's broader effort to revamp mainstream
psychology. Most important, Prilleltensky and Prilleltensky clarify that
critical health psychology should seek not just to become an adjunct to
health psychology but to transform health psychology. At whatever level
a health psychologist works -- the individual, the community, or the larger
society -- critical psychology's guiding concerns are relevant.
Working health psychologists may wonder what all this has to do with
their day-to-day job demands, but the authors point to one example in
particular that should have some resonance: the traditional enshrinement
of physical independence as the preeminent goal. This manifestation of
prototypically Western assumptions contaminates much of psychology as
well as other fields, inhibiting solutions based not on rugged individualism
but on mutual aid and interdependence. Those who take seriously the
Prilleltenskys' call to reconsider the value of independence at all costs
will be forced to assess not just individual capabilities and limitations
but those of the larger community as well.
Still, on the front lines, I imagine health psychologists would appreciate
a longer account of specifics they can use on their day jobs. I'm reminded
of clinical psychology students in a seminar I once observed whose reaction
to a presentation by a community psychologist was one of disdain: "That's
all well and good," one said, "but we didn't come here to get
a Ph.D. in social change." For the effort by Prilleltensky and Prilleltensky
to have as deep an impact as it should, future work by them and others
must point the way in more detail to how working health psychologists
can redress societal causes of distress without neglecting the immediate
needs of their clients. Otherwise, too many may too quickly conclude that
the only solution is to splinter the field, with some addressing practical
needs while others work more broadly at the margins.
The authors make another crucial point I'd like to emphasize further.
Addressing the "need to connect corporate agendas with personal
suffering," they say this: "As critical health psychologists
we have to ask ourselves whether we want to support the status quo by
treating its victims, or whether we want to join with them to challenge
noxious consumerism." In Table 2, they suggest critical psychologists
engage in "Critique and boycotts of media and corporations making
profits at expense of population health" and that they "Promote
social cohesion and egalitarian social policies." These important
efforts would advance the cause of health as well as the cause of justice.
In my view, psychologists must become even more forthcoming in spelling
out the direction in which society must move. Especially in an age of
rampaging corporate globalization, the Good Society that Isaac Prilleltensky
elsewhere has spoken of so eloquently must aim directly at eliminating
our corporate-run society.
It's common to hear psychologists -- and not even just critical psychologists
-- acknowledge that modern society is far from healthy. Many mainstream
therapists know that the stresses and inequalities and injustices of everyday
life limit the degree to which they can help their clients. If things
were different -- if we lived in a more egalitarian, less profit-oriented,
more humane society -- it would likely be easier to work through whatever
kinks inevitably remain. Yet the task of creating such a society is so
daunting -- and the dismissal as utopian of those who engage in such thinking
so sneering -- that it's usually easier to dull our awareness of our society's
toxicity or simply refrain from bringing up the subject.
Critical health psychologists should say this straight-out: Modern
society is not healthy for ordinary human beings. We need to scrap it,
and start over.
Yes, we may be stuck with what we've got for some time to come. In the
short run, we may only be able to change little bits and pieces. But,
as Isaac Prilleltensky and Ora Prilleltensky do here, we are obligated
to state the obvious: Societal institutions reinforce power differentials
that help some at the expense of most. The corporate
form of economic power, the traditions of law
and state that inhibit true democracy, the
commingling of psychological individualism with capitalist dogma and social
Darwinism -- all these and more we must identify, critique, and root out.
We know what circumstances frustrate people's needs and sicken them in
body and mind, and we have a pretty good idea what alternative arrangements
would reduce the number of future victims. It's time we spoke up and said
what we know.