Post on 31-Mar-2023
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Murray, M. (2012). Psychologie de la santé communautaire, des arts et de l'action sociale
[Community health psychology, arts and social action]. Bulletin de Psychologie, 65, 33-40.
Michael Murray
Keele University
U.K.
Contact:
Dr. Michael Murray, Centre for Psychological Research, Keele University, Staffordshire, UK
ST 15 8DF. Email: m.murray@keele.ac.uk
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Community health psychology
Abstract
Community health psychology is an approach within health psychology that has evolved
over the past ten years. It draws its inspiration from complementary strands within critical
psychology, social activism and public health. It is concerned with working with groups and
communities to transform their living and working conditions and to enhance the quality of
their health and social wellbeing. The aim of this article is to trace the development of this
approach and to consider the particular contribution of the arts to enhance local social
action and broader social change.
Keywords: Participatory action research; Arts; Public health
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Community health psychology
Community health psychology seeks to develop a more social and political approach within
health psychology that develops ways of enhancing health and wellbeing through various
forms of social action. This approach draws attention to the importance of the broader
societal context within which health and illness are located. It stresses the importance of
the interconnection between critique and action coupled with a reflexive stance to our own
research priorities and practices (Campbell & Murray, 2004).
This approach is part of the broader critique of health psychology which has developed over
the past 15 years (Murray, 2004). Health psychology can trace its formal establishment back
to the 1970s - a period of retrenchment in the capitalist world with the election of
conservative governments in many western nations. As such it was informed by the
individualism and the victim-blaming ideology that was pervasive at that time as
governments placed greater responsibility for ill-health on the individual. However, health
psychology had much more radical forebears as is evident in a brief review of influential
contributions in the 1960s. This was the period of sustained social and political revolt
throughout Europe, North America and the former colonial world. This political revolt was
echoed within the psychology establishment. For example, William Allbee was elected
President of the American Psychological Association in 1969 with a radical agenda
connection social action with improvements in psychological health. As he argued at that
time:
‘We must realise that the terrible suffering that exists in our society among the
disenfranchised, the poor, the havenots, can only be remedied by direct
confrontation with the establishment, by the socialisation of our care-delivery
systems, by the development of adequate tax-supported public facilities, staffed
with competent BA-level interventionists using social models which can only be
developed as creative people find out about the real problems ... The times are right
for revolution!’ (Allbee, 1969, p. 7).
Such a call energised many psychologists, especially those working in the field of mental
health, to explore new ways of practicing. They were dissatisfied with the individualist
assumptions and ‘scientist-practitioner’ model favoured by clinical psychology that sought
to emulate the power and methods of medicine. In the United States, this move led in the
1970s to the development of community psychology based on a more community-activist
approach to health intervention. This turn to the community was premised upon an
awareness of the social basis of mental health and the need to work collectively to challenge
social oppression in its myriad forms.
Conversely, the emergent health psychology focused on individual change. Matarazzo
(1980), who was very influential in defining the new discipline, argued that its aim was to
‘aggressively investigate and deal with the role of individual behaviour and lifestyle’. Rather
than developing social and collective strategies to ‘deal with’ structural inequalities health
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psychologists turned to the evolving social cognition models of individual attitude change.
The theoretical approach developed by Fishbein and Ajzen (1975) became the dominant
orientation within health psychology. This approach drew much if its inspiration from the
information-processing models that had become popular within mainstream cognitive
psychology at that time. As Fishbein and Ajzen (1975) stated in their foundational text:
‘Generally speaking, we view humans as rational animals who systematically utilize
or process the information available to them. The theoretical structure or
conceptual framework we have adopted assumes a causal chain linking beliefs,
formed on the basis of available information, to the person’s attitudes, beliefs, and
attitudes to intentions, and intentions to behaviour’ (p. vi).
Although their formulation of the relationship between attitudes and behaviour included
reference to social norms it was very much an individual change model that made limited
connection with the broader social world. The following 30 years has witnessed various
attempts by health psychologists to refine and extend this attitude model but the basic
assumptions are similar to the original formulation.
However, more recently there have been various attempts to reconnect health and
community/social psychology and to explore new forms of social activism designed to
promote health. The challenge to the social cognitive models was initially on
methodological grounds. Health psychology researchers became frustrated at the
quantitative methods of investigation and there has been increasing interest in qualitative
methods (Murray & Chamberlain, 1999). Some health psychologists have begun to reach
out to more activist forms of social inquiry – ones that are not premised upon information
processing and behaviour controlling assumptions. In particular, they have turned to
various forms of community-based participatory action research. As in community
psychology, in general, there are different orientations within this approach. The more
accommodationist orientation focuses on processes within the community, while the more
critical orientation aims to connect intra-community processes with the broader socio-
political context. A primary aim of the critical orientation is:
‘to promote analysis and action that challenges the restrictions imposed by
exploitative economic and political relationships and dominant systems of
knowledge production, often aligning themselves with broad democratic movements
to challenge the social inequalities which flourish under global capitalism’ (Campbell
& Murray, 2004: 190).
This emergent approach has deliberately attempted to connect with other developments in
critical social and health psychology and with critical developments in community
psychology (e.g. Kagan, Burton, Duckett, Lawthorn, & Siddiquee, 2011). In devising
strategies for social and community change, critical health psychologists are aware of the
need to understand and to respect the local knowledge held by communities. As
Jovchelovitch (2007) has argued, a starting point for change must be ‘a deep commitment to
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the belief that ordinary people have a contribution to make and know what they are talking
about and an acceptance of the incompleteness and limitations of one’s own knowledge’ (p.
156).
Community health psychology also places a focus on enhancing community wellbeing rather
than on managing individual sickness. Thus it can take up issues such as poor housing and
lack of resources which contribute to individual ill-health. Sometimes the links can be
explicit such as challenging particular environmental toxins that contribute to specific health
problems. An example of this is that environmental justice campaign of Sullivan, Petronella,
Brooks, Marillo, Primeau & Ward (2008). In this project Sullivan and his colleagues worked
with residents of polluted neighbourhoods highlighting the links with respiratory illness and
the need for environmental change. Other times the concern is more general and overlaps
with the more general community psychology.
Participatory action research
An important feature of much community health psychology is the active involvement of
community members in the research process. This approach is the basic tenet of
participatory action research in which the group or community are actively involved in all
aspects of the research from developing the research question, through to designing the
research methods, collecting the data and promoting various forms of social action.
Through this approach the participants become co-researchers in the process identifying the
obstacles to social change and their own role in the change process. This approach is
informed by the critical literacy developed by Paulo Freire. He characterised the traditional
approach to education as ‘an act of depositing, in which the students are the depositories
and the teacher is the depositor’ (Freire, 1970, p. 53). In the more critical approach, the
educator engages with the students in an active dialogical manner to encourage them to
consider the broader social and structural restraints on their lives and how they can begin to
challenge these restraints through collective action. He used the term conscientization to
describe this process of developing critical consciousness: ‘Problem-posing education
affirms men and women as beings in the process of becoming – as unfinished, uncompleted
beings in and with a likewise unfinished reality’ (p. 65).
Freire stressed that his work was ‘rooted in concrete situations’ working with poor peasants.
He emphasised the collaborative nature of his work and described the radical as someone
who ‘does not become the prisoner of a “circle of certainty” within which reality is also
imprisoned ... This person does not consider himself or herself the proprietor of history or of
all people, or the liberator of the oppressed; but he or she does commit himself or herself,
within history, to fight at their side’ (p. 21).
Freire’s philosophy highlighted a belief in the potential of ordinary people. In his writings
he stressed the need to actively engage in dialogue with people as part of the process of
personal and social transformation, the development of critical consciousness. It was the
opportunity to engage in active dialogue which is at the heart of change. It is through this
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process that people learn to critique the nature of their reality. As Freire stressed, “To
surmount the situation of oppression, people must first critically recognize its causes, so
that through transforming action they can create a new situation, one which makes possible
the pursuit of a fuller humanity” (p. 29).
Freire’s popular education is designed to promote this process of dialogue and critical
reflection. He notes how oppressed people have internalised feelings of worthlessness and
powerlessness. The challenge of the popular educator is to work with them to discover their
strengths and potentials through the process of reflection and action. At the centre of this
process is the quest for human freedom and authenticity. Freire argues that “[f]reedom is
acquired by conquest, not by gift. It must be pursued constantly and responsibly. Freedom
is not an ideal located outside of man; nor is it an idea which becomes myth. It is rather the
indispensable condition for the conquest for human completion” (p. 29).
These ideas have been the cornerstone of popular education for forty years. Although they
were developed at a time of brutal oppression they still have relevance today where the
challenge is to insert them into a world of consumer capitalism which offers the promise of
human fulfilment through individual lifestyle choice rather than collective struggle. It is not
an approach that is familiar to most health psychologists although there is increasing
discussion on its potential. For example, Brydon-Miller (2004) notes how it has been
enriched by other theoretical frameworks, in particular feminist theory. These new
frameworks have emphasised the need for continual reflexivity (e.g. Finlay & Gough, 2003).
From local action to broader social change
The focus on local social action has some implicit dangers if the researchers do not reflect
upon the broader socio-political context. For the past ten years or more there has been a
move to decentre the role of the state through the privatisation of health and social services
and the downloading of responsibility not only to the individual but increasingly to the
community. Thus communities that are already disadvantaged have the additional burden
of being considered responsible for their condition. This becomes the new contemporary
form of victim blaming. Previously, we argued:
“By locating the responsibility for health problems within marginalized local
communities, such analyses serve as a smokescreen for governments who seek to
reduce welfare spending [etc.]” (Campbell & Murray, 2004).
Health psychologists have an important role to play in challenging this new extended form
of victim blaming. This requires ongoing reflection on our practice as well as a commitment
to broader social change. While community action can enthuse and excite large numbers of
people we need also to consider the broader political context within which it develops and
whose interests are primarily served by its promotion. The recent growth of interest in
community activism by conservative politicians has contributed to sustained reflection
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about its basic assumptions. Internationally this debate has been fanned as versions of
participatory community action have been adopted by world development agencies as a
means of imposing globalisation and the interests of multinational corporations. Thus
rather than working to promote the interests of marginalised community members this
approach can become a means of concealing a bigger transnational agenda (Kindon, Pain &
Kesby, 2007). It can become a means not of challenging established power interests but
rather of pushing responsibility back on the poor and excluded. As Kindon et al have stated:
‘while participatory approaches seek socially and environmentally just processes and
outcomes, they none the less constitute a form of power and can reproduce the very
inequalities they seek to challenge’ (p. 2).
It is for this reason that Cooke and Kothari (2001) described participation as the ‘new
tyranny’. By this they meant that rather than challenging structural inequalities
participatory projects have often ignored the workings of the system and as such
contributed to its maintenance.
Historically, critical psychologists have emphasised the importance of reflexivity. This has
meant different things to different researchers but broadly it is the concern to reflect upon
our practice in the collection and in the interpretation of data collected. In the case of
scholar activists, issues of reflexivity become more important since it is concerned with
multiple issues from the research/action, the interpretation of data, the use of data, the
relationship with the community, etc.
The danger is to become over-involved in local projects to the neglect of awareness of the
larger socio-political context. An important part of this process is the extent of critical
engagement with the broader political agenda. There is an ongoing need for scholar-
activists to connect local action with the broader socio-political and cultural context and
within an ongoing process of critique and reflection (Murray & Poland, 2006). Thus rather
than imposing a fixed agenda the researchers work with members of groups, communities
and broader social movements to excavate and challenge the structures that disempower
them and exclude them from power.
Community health psychologists are aware of the limitations of focusing solely on singular
and localised projects. They often report that while community residents can be enthused
by local activities they are frustrated at the obstacles to broader social change. As Campbell,
Cornish, Gibbs & Scott (2010) recently noted: ‘such projects are frequently successful in
building the ‘voice’ of the poor, but less successful in building ‘receptive social
environments’’ (p. 963). They argued that there is a need to turn our attention to exploring
broader social movements that can create such ‘receptive social environments’. This is a
major challenge for community health psychologists who have as of yet given limited
attention to the processes involved in these larger social movements.
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Campbell et al define ‘voice’ as ‘the capacity of poor people both to develop critical analyses
that link their poverty to wider social inequalities and to articulate forceful demands on the
basis of these critical understandings. ‘Projects develop voice through providing
transformative social spaces for dialogue in which poor people are able to engage in critical
thinking about the social roots of what might previously have been regarded as individual
problems’ (p. 963). This is the typical work of the community activist but the challenge is to
move beyond this local development of critical thinking and action. Campbell et al illustrate
the process of building receptive social environments within which this local social action
can move to a higher level through an analysis of a number of collective health movements.
These movements were able to build this receptive social environment by a) uniting a broad
range of people behind its objectives and b) promoting a moral symbolic agenda for change.
Such a process of building a supportive social environment can occur at the local as well as
at a broader level.
Lott & Bullock (2007) have identified a range of such broader activist strategies. They begin
by stressing the need to reject individuating theories of poverty and wealth as was
emphasised by Ryan forty years ago. To this we can add opposition to the process of
collective victim-blaming whereby we can denigrate whole groups or communities. Instead
we need to consider who benefits from this process of victim-blaming and how they can be
challenged through various forms of social critique and action. Such challenges can vary in
magnitude over time and place but behind them is a common commitment to social justice
(Murray, Nelson, Poland, Maticka-Tyndale & Ferris, 2004).
Critical health psychologists today can learn from the many struggles of disenfranchised
people over the years. By working at different levels and with different social groups and
movements they can contribute more actively to the development of a more equitable and
healthier society. Through connecting critical scholarly and activist traditions they can not
only be involved in deconstructing oppressive discourses but also be engaged in different
forms of collaborative challenge and resistance to symbolic and material oppression.
Researchers and activists in community health promotion (e.g. Jacobs, 2006) have argued
that a central concept in their approach is that of empowerment. This concept has been
defined by Wallerstein (1992) as:
A multilevel construct that involves people assuming control and mastery over their
lives in the context of their social and political environment; they gain a sense of
control and purposefulness to exert political power as they participate in the
democratic life of their community for social change (p. 198).
An important part of this definition is that community health action is seen as collaborative
with the community and critical as regards broader societal institutions and structures. As
Levarack (2004) stressed:
Empowerment has an explicit purpose to bring about social and political changes,
usually through affecting public policies, decision-making authority and resource
allocation (p. 87).
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Community health psychology has the opportunity of developing an understanding of these
changes through active engagement.
Arts and social change
The arts have historically played an important role in both discouraging and facilitating
social action and change. Art can be characterised as either anaesthetic or aesthetic. By
anaesthetic is meant that art can dull the senses and diminish questioning of the social
order. Conversely art as aesthetic can be concerned with increasing awareness. It can draw
attention to issues that are often ignored. It can encourage a reassessment of the everyday.
In his review of the role of arts in health care Camic (2007) argues that “the arts can
challenge people to think differently, engage in different behavioural experiences and
experience different emotions” (p. 288).
Different forms of art can involve people emotionally. As such they can be both a source of
personal satisfaction as well as a catalyst for social action. People can be involved to
varying degrees in the arts from observers through to active participants. Artists have
sought to involve people in their work – the success of an artwork is bound up with its
success in emotionally as well as cognitively engaging the audience.
The arts can play an important role in building such a supportive social environment through
mobilising large numbers of people and articulating a moral agenda. Individual artists have
historically played an important role in drawing attention to injustice and visualising a new
agenda. As Adrienne Rich (2006), the American poet and feminist argued:
Poetry has the capacity to remind us of something we are forbidden to see. A
forgotten future: a still uncreated site whose moral architecture is founded not on
ownership and dispossession, the subjection of women, outcast and tribe, but on the
continuous redefining of freedom – that word now held under house arrest by the
rhetoric of the ‘free’ market. This on-going future, written off over and over, is still
within view.
The power of poetry to become an organiser for change was confirmed recently in the Arab
uprisings where the words of poets were enthusiastically taken up by the masses. Tamim al-
Barghouti, a Palestinian poet, argued that the use of poetry in Tunisia had “widened
people’s imagination, changed their perception, increased their self-confidence and showed
them how fragile their tyrants are”. The state realising the revolutionary power of poetry
deliberately targeted its advocates. In Bahrain a woman was sentenced to a year in prison
for reading a poem which included the lines, “We are the people who will kill humiliation
and assassinate misery. Don’t you hear their cries? Don’t you hear their screams?” (Fenton,
2011).
Central to the process of social change is the leadership provided and the articulation of a
new collective story by and with the community. The role of leadership in all forms of
social action is central. The leader can inspire, support, and challenge community members
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(Morris & Staggenborg, 2004). Stories can be an important means by which the leader can
engage the community and encourage reflection. Storytelling has often been consigned to
the sideline in discussions about social change – they are often considered a diversion from
practical issues. But stories convey the history and trajectory of a community as well as
provide a guide to future action. As Selbin (2010) argued:
‘... often we use them [stories] not just to narrate our lives [...] but to tell, to share
news, information and much more: to guide, to warn, to inspire, to make real and
possible that which may well be unreal and impossible. Stories allow us to imagine
the transformation of our lives and our world.’ (p. 3).
In his review of collective movements of change, Selbin concluded that ‘the crucial factor in
explaining how and why revolution persists is the stories of revolution, rebellion, and
resistance we tell’ (p. 3). Within the community one of the roles of the critical educator is to
work with the community to reflect on and critique their experiences and begin to develop a
change strategy which takes the form of a story of potential – what can be done. Selbin
stressed ‘the importance of the articulation of compelling narratives and stories in any
meaningful effort at change’ (p. 194).
Political movements can be galvanised around vivid stories of potential change. Consider
the case of the civil rights movement in the United States which was epitomised in Martin
Luther King’s ‘I have a dream’ speech which only lasted 14 minutes but continues to
reverberate. Similarly powerful folk songs such as Woody Guthrie’s ‘This land is your land’
can enthuse millions. The lyrics can be drawn upon by politicians. For example, Barak
Obama used the phrase ‘It’s been a long time coming but tonight change has come to
America’ on the day of his election victory, drawing from Sam Cooke’s civil rights anthem ‘A
change is gonna come’. In Britain there is a long tradition of political songs (Lynskey, 2011).
An example is Billy Bragg’s ‘Between the wars’ which invigorated supporters of the miners’
strike with his call: ‘I’ll give my consent to any government/that does not deny a man a living
wage’.
Certain community narratives can also play a reactionary role by excluding people from
involvement in activities such that it becomes the role of the community activist to
challenges such narratives and to develop alternatives. This is not an easy task since
communities have shaped their identities around such narratives and they are often
reinforced through songs and images. The gradual assertion of new narratives can often be
subverted by older tales of reaction. The scholar-activist is aware of this clash of narratives
and how they can inhibit the process of change. It is through a combination of forms of local
action, alternative narratives and trusted leadership that communities can begin to explore
new ways of working and living.
An example is the work we did in promoting awareness of the occupational health hazards
within the deep-sea fishing industry (Murray & Tilley, 2006). Traditional approaches
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focused on promoting safety awareness among individual fish harvesters. Such an approach
mirrored the victim-blaming approach condemned by Ryan 40 years ago. Our approach was
to engage whole communities in this process and to highlight a wider agenda for safety
action. This involved a variety of community arts activities including plays, concerts and
exhibitions. An important part of this project was the songs that we developed with local
residents. In one community we worked with a folk singer who drew upon interviews
conducted with fish harvesters and developed a series of songs about fishing and safety.
When played at local concerts and on the radio, these songs had a powerful echo in fishing
communities and contributed to developing a receptive social environment. However,
despite substantial local and national interest, for various logistical and funding reasons, it
was not possible to further extend this project. This illustrated the tensions often
experienced by scholar activists between the success of local social action and longer-term
social change.
Another example is the CALL-ME project which was established to explore the character of
social isolation among older residents of a disadvantaged urban neighbourhood and to
investigate the potential of collaboratively developing community social activities (Murray &
Crummett, 2010). One such activity was a community arts project. This is defined as the
use of multiple forms of creative arts activities in a community setting. It requires the active
involvement of local people in its development and an awareness of the broader socio-
political context within which the action is located (Webster & Buglass, 1997). At the outset,
the researchers invited a group of older residents to reflect upon their neighbourhood and
to consider a plan of action to promote social interaction. When the idea of a community
arts project was introduced some of the local residents were ambivalent but agreed to
participate not least because it was something to do.
Over a period of two years a group of older residents met on a weekly basis to experiment
with a range of art forms including painting, pottery and glass engraving. They met for two
hours each week and were led by a local community arts worker. During this period they
completed a number of arts projects. At the completion of each project the participants
organised a community exhibition of their work. They invited not only local residents but
also city officials and local politicians. In this way, the project moved from an opportunity
for social interaction to one that challenged dominant negative social representations of the
community held by outsiders and began to become a form of social action.
It was through a process of dialogue and local action that members of the community began
to question their circumstances, to articulate their needs and begin to develop the
community arts projects. The results of these projects were a source of great community
pride which promoted substantial wider discussion. However, as previously emphasised, the
success of such local action needs to be considered with reference to the support or
otherwise of the immediate social environment, its history and culture, the character of the
leadership offered, and the broader political climate within which the action is located.
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A recent evidence review by the UK Mental Health Foundation (2011) on the impact of
participatory arts on the health and wellbeing of older people concluded that while the
research to date indicates that such activities can be very beneficial to the participants there
is a need for further research. One challenge is the relative limited research expertise of
community artists. Health psychologists can play a very important role in assisting in the
development and evaluation of such interventions.
While arts can ask questions it is the linking with political action that it can lead to social
change. Within the community arts movement there has been continuing debate about the
limitations of local arts activities. As Duncombe (2007) argues:
Cultural resistance, unless translated into political action can become ‘imaginary’
solutions to real world problems and create ‘magical’ communities in the place of
real ones’ (p. 498).
However, there is also the danger of over-pessimism leading to lack of any action. In the
darkest night there is always room for hope and that is something we can learn from
history. As Duncombe concluded:
For all the problems with cultural resistance, there is still potential. For in cultural
resistance lies the possibility of imagining and creating something different. People
who have little access to political power or material wealth can express through
culture their criticisms of their current situation and conjure up a vision of something
different’ (p. 498).
The grass is singing
Much of traditional health psychology is imbued with what Martin-Baro (1984) has
described as ‘scientistic mimicry’ with the aim to develop universal laws which can describe
the relationship between variables. Conversely community health psychology is concerned
with not how things are but what they can become. Its focus is not on describing but rather
on transforming the social world and enhancing community health and wellbeing. The form
of its research practice is collaborative and change oriented. Recently, the Australian
linguistic scholar Anna Wierzbicka (2011) reflected on character of psychology and what it
can learn from the humanities. She defined the humanities as the study of human
experience and more specifically ‘what can happen to people and what people can do;
possible ways of thinking, ways of feeling, and ways of speaking; possible motives and
possible values’ (p. 38).
This definition places an emphasis on potential rather than fixity, on diversity rather than
uniformity. In doing so it opens up multiple ways of seeing the world but also ways of
creating a new and hopefully better world. As Wierzbicka argues:
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‘The humanities’ seeks also to provide opportunities for people to think about how
someone can live, and whether it is good or not good for people to do things of
some kinds. This is not something open to empirical verification’ (p. 40).
This quest for personal and social transformation lies at the root of community health
psychology.
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