Analysing the Social Context of Individual Distress: Celebrating the Pioneering Work of David Smail

David Smail: Clinical Psychologist, Sociologist, Philosopher, and Political Critic

David Smail, clinical psychologist, who has died aged 76

As Karnac Books republish four key works by the pioneering clinical psychologist, his son Alastair reflects on his achievement.

When my father died just over a year ago, the family was unsure what to do with his books. He had said he would like them published on the internet for free; either that or left alone. We did not have the capacity to post them on the internet, although David had put many articles and an internet publication on his website: The reaction to his death, as for example in The Guardian obituary persuaded us that we needed to do something.

Rod Tweedy from Karnac had himself approached David before his death on a project Rod was pursuing on his own behalf. It seemed sensible, then, to approach Karnac. Price was all important to us; the books had to be less than £10 each for the purposes of accessibility. Kindly, Karnac agreed to this. Indeed we are delighted with the design of the books, incorporating as they do the excellent artwork of Hassni Malik.

The wisdom of republication has also been reinforced by the decision of the British Psychological Society and the Midland Psychological Group to hold a memorial conference on David’s work on 12 and 13 November 2015 in Birmingham.

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‘Power, Interest and Psychology: Developing David Smail’s Ideas’, a special BPS/DCP conference in November

I volunteered to write the summaries for the back of the books and Karnac’s website. I wanted the opportunity to re-read my father’s work in a concentrated way. I am a lawyer but I did not feel it an inappropriate violation of professional boundaries to do so not least because David’s work was always aimed at the interested lay person or sufferer of distress as much as mental health professionals. I have identified at least the following themes in David’s work in the hope that those who are not familiar with his work might be interested in becoming so.

The first point is that his observations are founded on experience. He was for 30 years or so a clinical psychologist in the NHS meeting for the most part citizens of Nottinghamshire who were suffering from distress and anxiety. The theorising came after actual experience.

His fundamental position is that mental distress is usually an understandable result of the environment in which the sufferer finds him or herself. It is not something internally wrong with the individual. For the most part distress and anxiety represent an entirely rational response to the sufferer’s situation.

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“Frequently the environmental forces are distal to the sphere of influence of the individual although experienced proximally.”

Frequently the environmental forces are distal to the sphere of influence of the individual although experienced proximally. That which makes you redundant for example, is out of your control. You will, however, experience proximally the anxiety and depression associated with it. As the root problem is frequently distal, it is usually inappropriate to consider that the problem can be ‘cured’.  Schools of psychology which claim otherwise are intellectually, and probably otherwise, dishonest.

The fact that distal influences are significant highlights the importance of the nature of society and politics. We need to take care of ourselves at those levels if we are to minimise many of the factors that might result in unhappiness. David was a practitioner throughout the Thatcher era, when society was dismantled in favour of the ‘loadsamoney’ false idyll and had to deal with patients the victim of that period. These themes are as relevant now as ever. As I write the Labour Party debates internally its response to this government’s gradual dismantling of the public sector under the guise of austerity.


David Smail (1938 – 2014)

In addition to highlighting the socio-political impact on mental health, David acquired important philosophical insights into the nature of human behaviour from his 30 years experience as a practitioner. At least two stand out for me. First, truth is a subjective phenomenon. Something is only true if an individual recognises it as such.  Society may have objective conceptions of normality, but they do not necessarily coincide with an individual’s subjective understanding or experience.

Secondly, the development of character depends on years of experience within one’s own range of power.  Accordingly, it is very difficult in terms of dealing with anxiety and depression simply to change by an exercise of will. People find it very difficult to change. That is a limiting factor to therapy’s ability to be effective.

As to therapy itself: that involves 3 main elements – provision of comfort, clarification, and encouragement in the use of available powers and resources. The best hope is to negotiate with the patient a change in position in relation to a stressor that is within their available powers and resources.  The exercise is a limited one and does not provide a ‘cure’.

Alastair Smail


Karnac Books are republishing four key works by David Smail: Illusion and Reality: The Meaning of Anxiety, How to Survive Without Psychotherapy, Taking Care: An Alternative to Therapy, The Origins of Unhappiness: A New Understanding of Personal Distress

36947  36950  36948  36949


Reviews and Endorsements

‘David Smail richly deserves his place amongst the great psychological, philosophical and political writers of the modern age. His critical analysis of the way we are harmed by our experiences in a world that is systematically structured to do so demands our urgent attention. Based on decades of experience as a clinical psychologist, his writing liberates us from fake doctrine, illuminates what is best in humanity, and gives us the courage to embrace our fears, inadequacies and fallibility..’
— Elie Godsi, Consultant Clinical Psychologist, therapist, and author of Violence and Society: Making Sense of Madness and Badness

‘David Smail’s analyses, commitments and elegant prose comprise classic works in the tradition of independent scholarship. He translated the traditional assumptions of psychotherapy into the structural and situational determinants of human problems. He was a psychologist who argued against psychology and came to see the barriers to social progress institutionalized within society itself. A man of the left, he made the left less doctrinaire and more relevant. He is greatly missed.’
— William M. Epstein, author of Empowerment as Ceremony and Psychotherapy as Religion

‘David Smail showed that if we want to ease our unhappiness then there is no other way but to change the world in which we live, beginning with the illusions perpetrated by the psychology industry. David’s work forms a rich intellectual legacy and a testament to a man who spoke up for the most oppressed and marginalised. It will also provide a beacon for anyone who wishes to understand what is wrong with our society and to struggle towards making it a better one.’
— The Midlands Psychology Group

‘David Smail was a constructive critic. With finely tuned precision, he cut deeply into what is wrong with psychotherapy and, with wisdom, he pointed to another way to deal with the feelings of despair, anxiety, and depression we experience in contemporary life. He was a genuine psychologist who applied the craft skillfully. Reading what he has written is, for want of a better term, “therapeutic.” His books always leave me thoughtful and hopeful, comforted by the sense that here was a man who actually understood something of life and had a grasp of what happiness really means.’
— Dr Tana Dineen, author of Manufacturing Victims: What the Psychology Industry is Doing to People

‘David Smail keenly recognised how many of us think and feel, and showed how attempts to reduce distress are so often limited by targeting the wrong thing: that is, the people in pain, not the more distal causes that underpin the suffering. All of David’s books beautifully but tragically describe the paradox that those offering therapy often find themselves in: wanting to help but often making things worse by mis-perceiving the meaning of distress. His work deserves to be read anew by all those in the helping professions who are prepared to question their own work, to think seriously about the meaning of the current tsunami of personal unhappiness, and to learn from this wise and perceptive author.’
— Susan Llewelyn, Professor of Clinical Psychology, Harris Manchester College, Oxford University

‘David developed clinical psychological ideas that offered a radical and humane approach to understanding and helping people in difficulty. He broadened the scope of the practice of clinical psychology from assessment to reflective therapeutic interventions, and then on to community psychology and locating preventative work and the facilitation of collective activity in communities of interest. His introduction of community psychology roles to mainstream clinical psychology services was innovative and ahead of its time.


“He analysed people’s proximal powers in the context of distal forces.”

David argued that a rigorous understanding of individuals necessarily incorporates an appreciation of their access to power. He analysed people’s proximal powers in the context of distal forces. He described a reflexive approach that means that there are questions that are always pertinent to psychological interventions: What resources are available to this person/family/community? What material, social and economic power is accessible to them? What possibilities for change are afforded by their situations and environments? In whose interests is this intervention? Thus we are always challenged to consider whether services are truly in the interests of the people they purport to help.

David showed us the importance of the quality of relationships, of being humane and modest, and, most importantly, to go beyond individualistic and voluntaristic concepts for understanding and working with people who are distressed. Apart from the thoughtful and practical ways of working that he inspired, he also generated invaluable and creative networks of support and encouragement between people who are committed to the ethical concern that “our common humanity enjoins us to mitigate suffering in others as in ourselves”. I shall continue to appreciate David’s wisdom and integrity and to remember him very fondly.’
— Jan Bostock, Psychological Services Professional Lead, Planned Care, Northumberland Tyne and Wear NHS Foundation Trust.

‘David believed that if we are to ease distress we must abandon our faith in therapy and take better care of each other. Psychotherapy might offer comfort, clarification and encouragement, but for many, perhaps most, it does not offer a cure. This can only be found through changes in our social arrangements – an essentially political task. It is no small tribute to David’s life and work that his arguments seem truer than ever today.’
—  and , The Guardian

“David proposed that if we want to understand why we are unhappy then, rather than insight, we must cultivate ‘outsight’ into the world around us.”

One thought on “Analysing the Social Context of Individual Distress: Celebrating the Pioneering Work of David Smail

  1. Pingback: The Enigma of Childhood: How our earliest relationships profoundly shape all our later ones, by Ronnie Solan |

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