Many years ago, when I was beginning my research into men’s experiences of depression, I met a psychologist who worked in an adult ward. They were very keen to tell me about the assessment ‘methods’ they were using and of which they were clearly very proud. Today, I want to write about ‘the method’.
And so, I went to the office where I was shown a box. It was about a metre long, half a metre wide and about 10-15 cm. tall. It had no top and was full of sand. It was placed on a table next to what looked like a tallish book case. Except instead of books, the shelves were full of toys, most likely taken from children’s shops. They were mostly human figures; some small, about 5-7 cm, much like toy soldiers, others were larger, about 20 cm. They were representations of adults and children, males and females. Some, a minority, were animals, mostly pets.
My first reaction when I saw this was one of bewilderment, but I didn’t have time to think, as the psychologist was telling me about their theoretical framework which was served so well, as people were representing their relationships by placing the figures next to each other. As the clinician was telling me about it enthusiastically, they demonstrated the point by placing a few figures in the sand.
I was listening (with scepticism, I must admit) and then it struck me! I was looking at a sandpit and the psychologist was asking people to play in the sand. And the moment I realised it, I started thinking things that cannot be repeated in a polite academic blog. Let me just say that they can be rendered by something like “If you ever asked me to play in the sand, I would shove that sandpit….”. I tried not to listen to the proud words about how this wonder of a tool helped diagnose, assess and whatever else. For instead of a psychological instrument, I was looking at an instrument of infantilisation and humiliation. I was thinking about myself being asked to play in sand and not being able to refuse. You know, in a psychiatric hospital a refusal can make you an uncooperative patient and you really don’t want that!
So, on the one hand, we have a clinical psychologist very clearly proud of what they were doing. It was a presentation of genuine professional pride. Moreover, I do believe the enthusiasm with which the psychologist was telling me about the ‘instrument’ was sincere and it suggested their genuine wish to help the patients. On the other hand, it was me staring at a sandpit, completely bewildered and quite angry with what I was looking at and listening to. The psychologist and I were looking at very different things. Today, I wish I had asked the clinician about it, but at the time I just wanted the conversation to end, hoping that what I was thinking didn’t show. In any case, the difference between our perceptions needed an explanation.
The explanation is not particularly difficult and can be rendered by the word ‘context’ and the psychologist’s inability to see psychological practices as partaking of the ‘real world’ and being contextualised by it. It was just staggering. It’s as if when you cross the threshold of the psychologist’s office, the social world in which we live disappears and new rules apply. All of a sudden, a sandpit stops being a sandpit and becomes an ‘assessment tool’ and all who behold it must see it in such a way. Moreover, the new world, invoked to existence by the clinician’s fiat, is clear and obvious to all those within it. Obviously, I am no longer Darek Galasinski, I become a patient whose face concerns (Goffman) disappear and you can ask me to play in the bloody sand!
There is plenty of literature which points that psychology and psychiatry ignore social contexts in which they operate, I have written about it as well, both in my academic writing and here on this blog. Indeed, in my last post, I suggested that clinicians should also start thinking about themselves as ‘persons’, not only clinicians, doctors, psychologists. You know, human beings. This blog just shows another aspect of acontextual psychology. Except this time, removing psychology from the ‘real world’ got me very angry and although I can only speculate, I suggest that my reaction is unlikely to be unique.
But I want to finish with just one more example which I often quote trying to exemplify what I mean. The Beck Depression Inventory has an item asking about the respondent’s sex life. The item goes like this:
- I have not noticed any recent change in my interest in sex
- I am less interested in sex than I used to be.
- I am much less interested in sex now.
- I have lost interest in sex completely.
and whenever I see this item, I always despair and it’s not even because the strange and ambivalent here word ‘interest’. You see, I think what’s missing here is one crucial question:
Sex with whom?
For pity’s sake, there is no such thing as one homogeneous all-purpose sex! And when I say this, students or trainees burst out laughing, as if it were something extraordinary that one does not just have ‘sex’, but one tends (I use the verb very deliberately) to have sex with another person. It’s as if sex with (here put the name of the object of your sexual fantasies) or the same person you have faithfully had (boring) sex were one and the same thing. And it doesn’t take a degree in psychology to think that it’s not. No, you might still dream about sex with (here put the name of the object of your sexual fantasies) and be fed up with and uninterested in the boring sex you’ve had for the last however many days, weeks, months, years, decades (I’d imagine timescales change over the years). Just like the sandpit, the BDI asks questions, as if we didn’t live in a real world.
I wish I had a snappy way of ending this post. I don’t. So, let me just say that Twitter will still be full of references to ‘language’, rather than to people using it in order to communicate with others, while ‘clinicians’ will still be assuring us about their ‘patient-centred’ approach. Sandpit rules.