Art, psychotherapy and psychosis : the nature and the politics of art therapy.

Combining Art, Psychotherapy and Social and Political Awareness: This study is a form of star gazing in that it locates the art therapy profession within the firmament of psychological methods aimed at liberating people with serious mental disorders. It considers the nature and the politics of art psychotherapeutic practice with clients with a history of psychosis. My thesis can be summarised in the following way. There is international evidence to suggest that there is a relationship between poverty, social deprivation and psychosis and that mental disturbance is not divorced from the societal context. Similarly, the art therapy profession’s development reflects societal trends. During the second part of the twentieth century, the emergence of social and political awareness in art therapy occurred in relation to the treatment philosophies of social psychiatry and during the optimistic, economically prosperous decades of the 1960s and 1970s. This contributed to the development of large sections of the profession’s practice being with people with serious mental disorders in the public sector. The proportion of work by art therapists with the seriously mentally disordered during the 1980s and the 1990s was maintained. However, the profession together with others working in public sector mental health, looked inwards during this harsh political and economic time in Britain and the focus of attention turned to the development of psychotherapeutic rigour at the expense of other aspects of its practice. Despite the historical estrangement between public psychiatry and private psychotherapy, art therapists have found that an understanding of psychotherapeutic theory is important to the development of their practice. It is particularly important for work in the public sector with people with a history of psychosis, but psychotherapy alone is not sufficient. It is also necessary to theorise what making art might mean to the people involved in psychotherapeutic relationships. Nevertheless, it is not sufficient to view what happens in art therapy solely in the light of this art making and the cultural issues provoked by it, because the development of theory and practice also depends upon an awareness of the social political context and the ramifications this has for practitioners and clients. Repeatedly throughout the history of relations between psychiatry and psychoanalysis there has been a failure to mention the different locations of their practice. Psychiatry takes place in public sector institutions and psychoanalysis is mainly practised with fee-paying clients in the private sector. Confusions of practice are a consequence of the widespread failure to notice the difference. Adaptations of the therapeutic frame are necessary for work within the public sector. People working in public sector institutions wishing to apply the tenets of psychoanalytic theory regularly fail to translate the knowledge gleaned from it into forms of practice that are appropriate to the public sector. This is compounded by the fact the very few actual psychoanalysts involve themselves in the public sector, and by the estrangement between the psychoanalytic community and that of psychiatry. An additional influence is the tendency in both communities to be alienated from the political sphere. Art psychotherapeutic relationships with people with serious mental disorders and the conditions of the public sector indicate that there is a searing need for a synthesis of art, psychotherapy and political awareness. In the present political climate this is underlined by the ideological push for evidence of effectiveness and by the continuing estrangement between psychiatry and psychotherapy. Using the history of art therapy practice and contemporary ideas about work with people with serious mental disorders, I show that a synthesis of the three elements is possible and necessary. This synthesis could make a potent improvement to the ability of art therapists to claim the distinctiveness and effectiveness of their contribution.