The first part of this two-part blogpost series looked at what neoliberalism is and how this ideology manifests in healthcare and social policy, particularly within the psy arena, concluding with a consideration of cognitive behavioural therapy (CBT) through a political lens.
This second and concluding part casts an eye on positive psychology and a particular variant of biopsychosocial model as phenomena inextricably entwined with neoliberal thinking.
Positive psychology
Although a separate theoretical tradition to the cognitive-behavioural paradigm, the positive psychology movement shares some assumptions with CBT and is also highly consistent with neoliberalism. Positive psychology emerged largely through the ideas of Martin Seligman, a former president of the American Psychological Association. The approach sought to move the focus from psychopathology (what is ‘wrong’ with the person – psychology’s traditional purview), an emphasis on ‘positive’ emotions and human flourishing. Positive psychology is informed by humanistic and cognitive psychology; notably, drawing on cognitive assumptions, it assumes that thoughts can be ‘controlled’ to some degree in order to manage emotions.
Positive psychology also celebrates certain ‘virtues’ or ‘character strengths’, including persistence (which could be understood as hard work and motivation), self-regulation or self-control, and responsibility: the relevance of these ‘strengths’ to neoliberal governmentality is clear. Perhaps unsurprisingly, it has long since been pointed out by critically minded researchers that positive psychology invokes neoliberal narratives pertaining to welfare reform policy within the UK, US and beyond. Particularly pertinent is the suggestion, from within seminal positive psychology literature, that this approach contributes to “making normal people [sic] stronger and more productive”.
Positive psychology assumptions are to be found in all crevices of the collective social imagination; most notably, the self-help industry is rooted in positive psychology. Such assumptions can also be discerned in the UK government’s recent announcement and in the ethos of IAPT itself, arising from an economic model tied to neoliberal retrenchment. Whilst historically CBT has been the bedrock of IAPT, hybrid modalities such as acceptance and commitment therapy (ACT) – which is partly informed by positive psychology - are becoming more established. Further, the Lightning Process - which in the private sector has been applied to almost every health condition conceivable, and has more recently been touted by (bio)psychosocial proponents in the field of MUS as a potential ‘treatment’ for young people with ME/CFS - is informed by positive psychology alongside other approaches. (The suggestion that the Lightning Process might help people with ME/CFS is thoroughly critiqued here).
The biopsychosocial model
The ascendancy of the biopsychosocial model itself (at least, a particular variant thereof) can also be understood through a lens of neoliberalism. Given the increasing numbers of people affected with long Covid, and the possibility that long Covid will be strategically positioned as ‘subjective’, largely ‘medically unexplained’ and thus putatively undeserving for political purposes (see here, here, here), the political application of this model should be of interest to everyone.
As critical scholars and disabled activists have long since pointed out, whilst the model is typically associated with the work of Engel who sought a more contextualised approach to healthcare, it has (at least in name) been appropriated by a network of power structures comprising state officials, academics and actors within the disability insurance industry to serve a neoliberal project of retrenchment across healthcare and welfare arenas. These agendas, notably as they pertain specifically to ME/CFS, so called ‘medically unexplained symptoms’ and more recently the implications for long Covid, have now been written about at length, including within peer-reviewed literature (see here, here, here, here, here, here, here, and here for examples).
Without rehearsing these arguments, it is noteworthy that dominant (bio)psychosocial theorising – a politicised variant of biopsychosocial model if you will - bears little resemblance to Engel’s ideas. Whilst Engel is cited in seminal (bio)psychosocial papers that lay the foundation for welfare reform, this may reflect an attempt to legitimate what is effectively disability denialist propaganda as opposed to a genuine affinity with Engel’s ideas.
In another twist to this biopsychosocial tale, Professor in Health Psychology Marie Santiago-Delefosse has suggested that the attribution of the biopsychosocial model to Engel may be an accident of history, a case of ‘right time, right place’ (at least, for Engel). Santiago-Delefosse recounts how, whilst other academics had in fact sketched out biopsychosocial approaches prior to Engel, Joseph Matarazzo – former president of the American Psychological Association – drew upon the model to advance his agenda of creating a niche for behavioural psychology within medicine, a niche that became mainstream health psychology. Matarazzo’s version of health psychology was quantitative, individualist, cognitive-behavioural and couched in neoliberal thinking, bearing a far closer resemblance to dominant (bio)psychosocial theorising than Engel’s work. In an interesting parallel to the ascendancy of psychosocial discourse in the realm of ‘medically unexplained symptoms’, Santiago-Delefosse notes that the appeal of Matarazzo’s approach was partly tied to the contemporaneous economic climate and the impetus to reduce public health spending. This suggests that a particular variant of biopsychosocial model has both arisen from, and been applied to justify, neoliberal ideology.
Bleak prospects for disabled people?
As previously intimated, given the possibility of further austerity in many countries owing to the pandemic and related management, neoliberal ideology - here demonstrated to be entwined with the psy disciplines and with the formation and regulation of citizens according to ableist norms - seems unlikely to abate. Since these dynamics disproportionately harm disabled people, it might be assumed that the future is bleak for our communities.
Yet, it does not have to be this way. Dominant social groups and all those in positions of influence can choose to challenge taken-for-granted truth claims about recovery being tied to moral character. The government - and all those involved in shaping health and social policy, including many researchers - can choose to engage with disabled people, to work toward a fair social security and healthcare system and to address structural barriers to meaningful employment for those who are able. Surely now, with the emergence of long Covid, there could be no better time to do so.