The Remedy of Mutuality in the Place of Power Imbalance

Photo by Andrew Moca on Unsplash

We tend to gravitate toward authority, the experts who tell us what to know, but sometimes the voice we’re taught to trust disguises a power imbalance. In global mental-health, it has been the same for decades, institutions in the global north set an agenda, design interventions and deliver to the global south, but whose knowledge really counts? Who has the authority to shape what counts as evidence? In order to challenge the power dynamics, the remedy may lie in mutuality; reciprocal exchange, interdependency, mutual learning.

In Bemme’s paper, the usual narrative is challenged. Under current circumstances, where a body of people are responsible for developing mental-health interventions to areas of the world that are not theirs, there is a display of ‘epistemic power’, the power over what is deemed valid knowledge, which, essentially, without knowing how knowledge is produced, even with the intention of helping, will only reproduce more tools of dominance.

This is where the benefits lie in mutuality, as it offers a counterbalance to the misalignment of practices. Bemme and colleagues suggested mutuality as the remedy, experimenting with ‘mutual learning process’. They committed to an open ended, slower iterative instead of the immediate ‘roll-out now’, they prioritised trust and responsiveness to the needs of their collaborators and realised that process and outcome are not mutually exclusive. There was focus on rebuilding relational architecture.

So what emerged when the process changed?

• The model – from a deficit model (‘what’s wrong with you?’) to a strength or asset based view of community mental health

• The inclusion of local and experiential knowledge in scaling intervention and designing research

• Direct funding given to community organisations, not just universities in the global north

• A challenge of core concepts (trauma, resilience) through the lenses of those with lived experience in the global south

  
  

And what this suggests:

Mental health is not a one size fits all, solutions are not ‘exportable’ between different types of lives, people’s lived experience can offer a wealth of knowledge. Mental health is entwined with social and political context, lived experience is a form of expertise, and many communities are already using healing practices that do not align with western diagnostic manuals.

But the reality is that despite the positive outcomes, full mutuality is aspirational under current institutional arrangements. Even this project was not without its constraints; as with most interventions, it too was initiated in the global north, suggesting power asymmetry from the beginning. Meetings were conducted in English, a language not mutually shared, there were digital connectivity issues due to instability of resources and despite the desire for full inclusivity, who joined was established through existing networks; the study remained elusive. What this highlighted is that it is less about making tweaks to become equal and more about dismantling the existing frameworks, realising the damage of power imbalance, or real change (and mutuality) cannot happen.

For those working in leadership, coaching and organisational change, it is worth considering mutuality as a technique to improve both relationships and outcomes. Expertise may be loaded with assumptions that have not been questioned, yet continue to be used and followed because someone has deemed it ‘correct knowledge’. Could there be alternative ways of thinking? Instead of deciding the strategy for someone, could they play a role in shaping it instead, for it to be executed together? Mutuality may offer the difference between empty application of a method or practice and the result that evokes transformative shifts. Begin with the relationship before structure, lead with questions before answers, optimise practice for meaning before efficiency. Once the expectation shifts, insight can be developed together, decisions can be co-shaped. Unfortunately, most businesses are not currently wired this way, and maybe that’s the reason so many organisations struggle with genuine transformation.

Mutuality is not easy. It is not a ‘feel good’ exercise, but a confrontation, acknowledging the need for new structures, new metrics of success, retuning what’s currently believed. The challenge faced in implementing mutuality, as seen through the eyes of a depth psychologist, is that it threatens control. Global mental health, and leadership everywhere, suffers from the collective shadow. The need to feel competent and indispensable is compromised if others are allowed to collaborate, relinquishing knowledge to those not ‘qualified’ through technicality. The shadow, the part that we refuse to see, demonstrates an unconscious desire to be dominant; and the conscious labels this ‘helping’. Without confronting the shadow, mutuality will only be a performance and not a reality; it requires death of the ego, unravelling the need to be the one in the know. Once these barriers break, collaboration can become a real pathway to meaningful change, relinquishing the unconscious need to be right — the first real act of mutuality.

For Bemme's full study, published in Social Psychiatry and Psychiatric Epidemiology, 2023, find the link here: Mutuality as a method: advancing a social paradigm for global mental health through mutual learning | Social Psychiatry and Psychiatric Epidemiology

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