Discussions of power
Discussions of power are notably absent from mainstream psychological and psychiatric
accounts of emotional distress and troubled and troubling behavior. Yet there is abundant evidence not only that people’s life circumstances play a major role in the development and maintenance of a wide range of behavior and experience labeled as symptoms
of mental disorders, or otherwise of social concern, but also that these circumstances
are patterned by the operation of power. For example, children are typically relatively
powerless and some of the most striking evidence linking social context to later emotional and behavioral difficulties, relates to childhood adversity. The US ACE (adverse
childhood experiences) project – a collaboration between the Center for Disease Control
and the Kaiser Permanente clinic in California – has studied the impact of childhood
adversities over many years. Reporting an ACE in any of 10 categories conveyed a 2 to
5-fold increased risk of attempted suicide; compared to those reporting no adverse
experiences, those who reported seven or more, were at a 31-fold increased risk of a
suicide attempt (Dube et al., 2001). Those reporting four or more ACES had a 4 to 12-
fold increased risk for depressed mood in the previous year, illicit drug use and injecting street drugs, alcohol misuse and suicide attempts (Felitti et al., 1998). Similarly,
Anda et al. (2007) reported that experiencing five or more ACEs was associated with a
10-fold increase in the likelihood of being prescribed neuroleptic medication and a 17-
fold increase in the likelihood of being prescribed ‘mood stabilising’ drugs. These and
many other studies have provided a robust body of evidence about the impact on physical, psychological and behavioral outcomes
