Expanding Critical Psychology's Challenge
for Health and Justice

Dennis Fox

Journal of Health Psychology
2003, 8, 219-221

Invited commentary on article 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.