Intersectionality and Intersectional Analysis in the Arts Therapies: How Does It Enhance Our Thinking about Social Justice?

艺术治疗中的交叉性和交叉分析：它如何促进我们对社会正义的思考？

Susan Hogan

Derby University, UK

Abstract

The usefulness of intersectional analysis is explored. Its implications for enhancing arts therapies practice are set out and analyzed in detail. In particular, intersectional analysis is discussed in relation to gender issues. A case study is then offered to illustrate the practical application of the concept. An argument is made for the introduction of further critical theory to be taught in our curriculums to enhance critical pedagogy.

Keywords: social justice, utility of intersectional analysis, intersectional analysis and gender, intersectional analysis and motherhood

摘要

本文探讨了交叉分析的效用。文中详细地阐述和分析了交叉分析对促进艺术治疗实践的意义。特别讨论了交叉分析与性别议题的关联。随后提供了一个案例研究来说明这一概念的实际应用。文章提出了一个观点, 在我们的课程中引入更深入的批判性理论来加强批判性教学。

关键词： 社会正义、交叉分析的效用、交叉分析与性别、交叉分析与母亲身份

What is Intersectional Analysis Today? How Does an Understanding of Intersectionality Change our Understanding of Selfhood?

Intersectional analysis has become a means of analyzing data and social structures and conceptualizing personal identity (Christoffersen, 2017, p. 1):

Intersectionality recognises that people’s identities and social positions are shaped by multiple factors. Among others, a person’s age, disability, ethnicity, gender, gender identity, religion and belief, sexual orientation and socioeconomic background contribute towards their unique experiences and perspectives.

Ussher (2019, p. xx, my italics) spells out that an intersectional approach helps in

…acknowledging the interaction and mutually constitutive nature of gender, sexual identity, age, cultural identity, and other categories of difference in individual lives and social practices, and the association of these arrangements with health and wellbeing. This intersectional framework recognises that individuals are characterised simultaneously by multiple and interconnected social categories, and that these categories are properties of the individual in terms of their identity, as well as characteristics of social structures.

A Ph.D. student of mine responded to this discussion by using the analogy of all the different ingredients that make up a cake, but that is not quite right, because the constitutive elements are not static. Smith (1983) foresaw this conceptual problem:

Our identities are created by our cultural context, intersecting with many other elements. However, to say there may be different elements, such as ethnicity, which intersect with one’s body is potentially problematic, as such a formulation might imply a separation of elements; it is more helpful to see intersectional elements as unified aspects of selfhood, which are more or less operational depending on context. Scholars have highlighted simultaneous and multiple forms of oppression. (my italics)

As Smith emphasizes, context is crucial in indicating different aspects being to the fore, but emphasizes that these are unified aspects of identity. Brah also emphasizes the dynamic, non-static, quality of different constituent elements at play and warns that “structures of class, racism, gender and sexuality” cannot be treated as separate elements “because the oppression of each is described in the other—is constituted by and is constitutive of the other” (1996, p. 12).

Here we have an attempt to show the simultaneous, concurrent, constitutive nature of intersectionality. It is linguistically tricky ground. As Carbado (2013, p. 816) has noted,

there are discursive limitations to our ability to capture the complex and reiterative processes of social categorization. The very articulation of the idea that race and gender are co-constitutive, for example, discursively fragments those categories—into race and gender—to make that point. The strictures of language require us to invoke race, gender, sexual orientation, and other categories one discursive moment at a time.

In Smith, as with Brah, we see a description that emphasizes the interplay of mutually constituent elements. Furthermore, different contexts, as Smith posits, may be viewed as bringing out different potentialities, and in those interactions we change and are changed, often imperceptibly, moment by moment. Fine (2010) puts it as: “The active self is a dynamic chameleon from moment to moment in response to its social environment” (p. 7). Ethnographers have articulated a sense of a self in process. Moreover, we should not assume an essential sameness of human subjectivity across cultures, or even within subject positions. Rather than a fixed self that is determined by our biology coupled with early formative childhood experiences (as some psychologists and others would have it) a more fluid approach to identity is adopted. We are formed and reformed, made and making simultaneously through our interactions with others. This is an epistemological shift away from the early theoretical formulations that dominated the arts therapies (or at least a useful check on them). The “self” is a work in progress, not something fixed.

Hogan applied this approach to art therapy in an edited volume (1997) that explored intersectional aspects of identity in relation to constructions of madness and also in relation to the person of the art therapist. For example, Campbell and Gaga’s (1997) essay explored being black and an art therapist and aspects of internalized racism; other contributors thought about facets of identity such as sexual orientation in relation to practice. Feminist Approaches to Art Therapy included an exploration of key concepts and contributions, especially with respect to the usefulness of a focus on gender representation, power and identity and its importance for mental health. This work falls into an area that Facer and Enright (2016, p. 84) have called “cognitive justice,” which concerns new forms of theory emerging from and reflecting previously marginalized views and perspectives. They note that such perspectives are often explicitly political, and question the dominance of hegemonic forms of knowledge and produce reflective epistemological critiques of disciplinary norms. Feminist Approaches to Art Therapy helped to create a paradigm shift toward more social approaches to the arts therapies, even though the term “intersectionality” was not well known in the 1990s.

Why Intersectional Analysis?

We are edging toward further discussion of why this is a useful concept for arts therapists in their practice. Hogan (2019, 2020a) suggested that it is a useful theoretical construction for arts therapists to think about. In Gender and Difference in the Arts Therapies: Inscribed on the Body, Hogan (2019) argued the case that it allows for more expansive thinking on topics such as gender identity. As Fine (2010, p. 3) put it, to speak of a male or female sex is reductive, as it compresses an enormous variety of different cultural ideals into one entity,

Every person is unique, multifaceted, sometimes even contradictory individual, and with an astonishing range of personality traits within each sex, and across contexts, social class, age, experience, educational level, sexuality and ethnicity, it would be pointless and meaningless to attempt to pigeonhole such rich complexity and variability into two crude stereotypes….

In Arts Therapies and Gender Issues. International Perspectives in Research (2020) the advantage of thinking intersectionally is highlighted as useful in helping to challenge overarching social constructions, those which set conceptual discursive limits. Hogan (2019, p. 3) suggested that this concept could also start to enable us to question classificatory and treatment practices that have an effect on our health and wellbeing. In other words, these elements are crucial not only in how we are seen and classified and diagnosed, but also how we may be treated, or not treated within mainstream services. If intersectionality is going to be useful to us, it must be as a conceptual tool that allows us to see human beings as more fluid then previously, rather than solidifying into a new orthodoxy. The essay attempts to make a case for thinking about the complexities of human beings and why it is helpful to think beyond dominant social constructions and the binary of masculinity and femininity:

Gendered subjects (us) are constituted through social relations. One might then go a step further and challenge the notion of us as having a fixed steady identity, though we seemingly have this—a “core” sense of self, but close analysis reveals that actually we are all distinctive in different situations; we all have different repertoires of being. Context makes us different people. If I am engaging with my dog, I am likely to feel very different things compared to when I am engaging with my vice-chancellor, or a best friend. Different contexts bring out different potentialities and in so doing we are changed, often imperceptibly, moment by moment.

Fine’s analogy of the chameleon mentioned above is a good one insofar as the chameleon “blends in” to its environment without too much conscious thought, or so we suppose. However, humans enact or perform “gender” identity more or less self-consciously within certain discursive and conceptual limits, as Butler has argued (1993), but Butler concedes that repetition of enactments can lead to a sense of immanence. Bourdieu talks about our habitual ways of being in the world as “habitus.” It is our embodied experience, described by Bourdieu as second nature. Ingold (2000, p. 162) describes habitus “as how people acquire the specific dispositions and sensibilities that lead them to orientate themselves in relation to their environment and to attend to its features in the particular ways that they do.” Indeed, even genetic theories should be viewed as potentially very reductive when deterministically applied to ideas about identity.

Gendered identities of masculinity and femininity cannot be reduced to any “logic” of genetic influence. The significance of genes and groups of genes, indeed, is codetermined by interactions within the human organism as well as by interactions that people have with the social and material environment in which they live (Shilling, 2016, p. 36).

Intersectional Analysis: New Money for Old Rope?

Regulatory frameworks have been called dispositive apparatus, defined by Foucault as: “a thoroughly heterogeneous ensemble consisting of discourses, institutions, architectural forms, regulatory decisions, laws, administrative measures, scientific statements, philosophical, moral and philanthropic propositions—in short, the said as much as the unsaid. Such are the elements of the apparatus. The apparatus itself is the system of relations that can be established between these elements” (1977, p. 194, my italics). Or another way of conceptualizing this might be to think of a web of intersecting meaning-making elements, including discourses, institutions, and so forth. We can immediately see that a form of intersectional analysis has been evident within cultural studies for some time and would fit May’s definition of Intersectionality, “as a sustained and on-going practice, a way of perceiving and establishing and engaging with the world that runs against the grain of established (and oppressive) imaginaries” (May, 2015, p. viii). The themes that intersectional analysis explores of “subjectivity, knowledge, power, and social systems” (May, 2015, p. 1) clearly concur with concerns of critical cultural theory, which, in my view, should form a more dominant part of the training curriculum of arts therapists; otherwise, arts therapists may unwittingly oppress those that they work with. May notes that intersectional analysis aims “to unsettle oppressive logics, to plumb gaps or silences for suppressed meanings and implications” (pp. vii–viii), which is something critical cultural theory and feminist critical cultural theory clearly seeks to do (and see Foucault above, “the said as much as the unsaid”). It is a mode of thinking which is helpful to trainees and practitioners. May suggests that what makes intersectional analysis distinctive is its “razor-sharp focus on eradicating inequality,” but again, many feminists would concur, even if not using the particular term (p. viii). I am not intending to set up an opposition here, just noting that intersectional analysis may perhaps be viewed as a particular form of cultural analysis, but one, which does, it must be acknowledged, have a lot of overlaps with feminist critical theory.

Ferree (2018) suggests that intersectional analysis marked a departure from earlier social theory that saw class as particularly structurally significant in relation to other aspects such as ethnicity or gender, which were seen as of secondary importance (as epiphenomenon). Therefore, it marked a shift in thinking in acknowledging these as equally significant and as viewing these aspects as reverberating together (see Brah’s remarks above). Warner and Shields (2013, p. 803) observe that the term has been used variously to discuss “multiple marginalized identities” or, in contrast, as a “general theory of identity” and that it constitutes “a framework, a theory, and an approach to social justice.” Crenshaw herself, revisiting the topic some years after her original essay (1991), which coined the term, identified three distinctive ways in which the term is being mobilized: as a “framework or investigations of intersectional dynamics”; secondly as a “paradigm” (and theoretical debates about the scope and content of this) and thirdly as a set of “political interventions employing an intersectional lens” (Cho, Crenshaw, & McCall, 2013, p. 785). Therefore, May’s assertion that intersectional analysis does have a particular “focus on analysing and contesting systematic inequality” (May, 2015, p. 1) is perhaps an oversimplification, though we can acknowledge this lens of enquiry and practice as an important aspect. Furthermore, as Carbado (2013) astutely reminds us, “intersectionality does not necessarily and inherently privilege any social category” (p. 812).

Cho et al. (2013, p. 787) suggest the overarching benefit of intersectionality as its exposure of “how single-axis thinking undermines legal thinking, disciplinary knowledge production, and struggles for social justice.” They also acknowledge the complexities involved (p. 787):

…the utility and limitations of its various metaphors, including the road intersection, the matrix, and the interlocked vision of oppression; the additive and autonomous versus interactive and mutually constituting nature of the race/gender/class/sexuality/nation nexus; the eponymous “et cetera” problem—that is, the number of categories and kinds of subjects (e.g., privileged or subordinate?) stipulated or implied by an intersectional approach; and the static and fixed versus the dynamic and contextual orientation of intersectional research.

Cho et al. (2013, p. 807) also assert that operations of power, a central theme within critical cultural studies in general, needs to come to the fore as a focus,

Closer attention to the manifold ways in which the operations of power at the local level are constituted through the regional, the international, and the global is critical if intersectionality studies is to fulfil its radical potential.

To conclude, there is a case to be made for a greater degree of critical cultural theory to be taught in our training curriculums (and intersectional analysis as a useful approach or “lens” within this). This essay will now attempt to demonstrate precisely how the concept of intersectionality is very useful for art therapy with a tangible case study. Pregnancy and childbirth is a good illustrative example, as multiple macro-conceptual ideas: power-dynamics, practices, social expectations and ideals, intersect with the micro—the body with its own unpredictable effects and autonomous processes, simultaneously subject to regulation and social restraint in a destabilizing cocktail.

Case Study: Intersectional Analysis as Useful in Helping to Understand Pregnancy, Birth, and New Motherhood

Art-based groups are a valuable resource for women to make sense of, and come to, terms with their birthing experiences, as they potentially build self-awareness and self-confidence through the sharing of experience in the process of making art. Reflecting on and interrogating their experiences allows women to develop enhanced self-acceptance and self-compassion. Although verbal support groups might work well for many women, some women do not know why they feel so distressed following birth, so they cannot talk about it. Inchoate emotions can be captured in art in ways that are fundamentally different to that of a language-based approach. As art therapy practitioners are aware, the image can reveal in ways surprising to the maker of the image.

I have been working with new mothers for over twenty years; the transformational quality of making art is noted by them, as well as an increased sense of volition: their capacity to make a creative act happen and to take risks in the process is liberating, exciting, and life-enhancing. Making time and space for personal reflection in a moment of transition has also noted as significant and enriching (Hogan, 2020b, c). After being disempowered, new mothers have reported participation in such groups as life changing.

Pregnancy and childbirth impacts ideas of selfhood; it is existentially challenging and conceptualized differently in different cultures, from a maternal-fetal unity to an oppositional individualistic stance, which can posit the pregnant women’s behaviors as a danger to her yet “unborn baby,” or indeed the women may become viewed as of lesser value than her “cargo.” In some cultures, in which rates of infant mortality are very high, delayed attachment is still a norm and babies might not be named until they are some months old.

Pregnancy itself places extraordinary stress and change on our body and subjects it to increased and unprecedented social jurisdiction (Hogan, 2003, 2008). The social proscriptions to which women are subject during pregnancy vary. Indeed, There is a lack of consensus and women report receiving high amounts of contradictory advice from health professionals as well as from their families and communities.

Childbirth is a very complex terrain. In my essay, The Tyranny of Expectations of Post-Natal Delight: Gendering Happiness (2016), I note the social pressure women are under to reproduce and draw together a number of themes, including the importance of the liminal and contested nature of childbirth (see also Hogan 2008). I debunk the idea that maternal competence comes naturally and further theorize the destabilizing nature of the event and critique some of the ways that post-natal depression is discussed (for example, that women have “predisposing factors” being like little seeds implanted within the individual awaiting activation!).

I expand further upon childbirth itself as a professionally contested domain, as this has consequences for women’s experience. Women become caught between different models of doing birth: caught within the power dynamics between professions, hospital protocols and temporal pressures caused by underfunding. The political and ideological nature of birth is also touched upon, as many potentially contradictory cultural ideals are involved and evoked. I also examine iatrogenic illness. Practices which can be counterproductive and illness-inducing form part of professional repertoires of behavior; such practices with potential iatrogenic outcomes have been, and continue to be, embedded in hospital regimes. They are insidious, widespread, and put forward as “normal” and reasonable. They are hard for women to resist. The most blatant example of a widespread illness-inducing practice is the tendency of hospitals to put women into beds (where they can be more easily “monitored”), when mobility often helps with managing pain and hastens childbirth. Women may experience people they do not know doing things to their body without informed consent. Women may intuitively feel ill at ease with the practices they encounter in hospital environments (such as “routine” induction) but feel unable to challenge them (McCourt, 2009) or may only manage to marshal small acts of resistance (Martin, 2001).

Although motherhood is heterogeneous, Toril Moi (1999, p. 81) suggests, “there can be no ‘identity’ divorced from the world the subject is experiencing.” Hence, to discuss women’s experience of childbirth purely as an individual pathological response, as post-natal depression for example, is to reify a complex set of experiences to which women are subject in a deterministic, reductive, and oppressive manner. Drawing on field theory, in my essay I ask the reader to think about the field as highly contested and to think further about what this might mean for women’s experience. I suggest that breaking off any one aspect of women’s birth experience is unsatisfactory and that it is the combination of a myriad of factors, which renders childbirth and new motherhood as uniquely disorientating and potentially distressing. My essay concludes that pregnant women and new mothers are caught in a web of intersecting and conflicting discourses, practices, and expectancies that render the experience unstable. It is not women per se who are “unstable,” it is the very terrain, or field, itself, but it is hard for individuals to “see” this. Intersectionality has profound implications for how post-natal distress can be understood. It helps us to view these conflicting forces at work and assists in giving us an alternative conceptual framework to work with—one which does not characterize individual mothers as unstable or inadequate and having failed in women’s ultimate destiny—motherhood. Instead, the emphasis is moved from an individual’s “problem” to a culturally produced phenomenon, which has destabilizing features.

This unique blend of physical capitulation and for many, unprecedented bodily interference and pain, coupled with the weight of societal and familial expectation about mothering, the interruption of and disarticulation from ones former life, and the experience of active discrimination combine to create a truly disorientating and dislocating event for many women, some of whom cannot articulate their feelings—they are supposed to be rapturously enjoying their newborn, and indeed, might well also be enjoying their newborn despite this tumult (Hogan, 2016, p. 3).

To close, I have suggested that the contested nature of childbirth and new motherhood, coupled with a myriad of conflicting ideals inherent in discourses and images that surround us, combined with medically disempowering and iatrogenic practices and discrimination, as well as the visceral nature of the event itself, converge to make for a destabilizing and toxic mix which is unhelpful to women’s mental health. I suggest it is profoundly important not to classify this as an individual’s problem, as women’s experiences are more helpfully understood as culturally produced through the intersection of a complex range of cultural ideas and conflicting ideals and cultural expectations. For intersex persons, or those transitioning who become pregnant, or wish to become pregnant, there are yet extra complexities (Linnell & Zappa, 2020). In conclusion, arts therapists and other health practitioners working with new mothers can better help women, who may be feeling bewildered, with an awareness of the myriad of intersecting issues that impact women’s mental health, or otherwise risk further compounding women’s oppression during pregnancy, birth, and in new parenthood.

Discussion and Conclusion

Using a case study, that of new mothers, this essay has made an illustrative case for why intersectional analysis can be useful, in helping, as May (2015, p. vii) put it, “to unsettle oppressive logics.” Ultimately, we are constituted and constituting simultaneously through our interactions with others, with all elements at play, whether or not intersectional theory can quite capture this complexity, or not, remains to be seen (Carbado, 2013). The reason we must endeavor to unsettle these oppressive logics is because, otherwise, we are part of the discursive apparatus, which causes people to become distressed and dis-eased and which fails to see the field of oppression that caused the “mental illness” in the first place. In which case, we are handmaidens of the status quo and neoliberalism (albeit with a heartfelt desire to mitigate distress). Certainly, a call for intersectionality to be part of the US curriculum has already been made (Talwar, 2010), and it has, arguably, been implicit in the work of a number of writers for several decades, although US and European perspectives differ. This essay has hopefully served to make a case for the benefit of introducing more critical cultural theory into our training curriculums internationally. It should be acknowledged that critical thinking and reflexivity is already part of the culture of training in the UK, but can be further deepened.

Here in the UK, our regulatory body is the Health and Care Professions Council (HCPC). In our HCPC Standards of Proficiency (SOP 8.5), “arts therapists should be aware of the characteristics and consequences of verbal and non-verbal communication and how this can be affected by factors such as age, culture, ethnicity, gender, socio-economic status and spiritual or religious beliefs,” which seems to me like a strong nod toward intersectional analytical thinking and reflexivity. This requirement is part of the generic document, which applies to art, drama and music therapists in Britain. In the subject-specific section, art therapists are also exhorted to think about overarching frames of reference and the links between different disciplinary ideas, giving, I would suggest, a clear mandate for the introduction of yet more critical cultural theory (SOP 13.17). This latter point on overarching frames of reference concords with what Crenshaw has written (Cho et al., 2013).

By focussing on structures of power that constitute subjects in particular socio-political formations, we locate intersectional dynamics in social space and time. This does not mean, however, that subjects are simply structural positions. It does mean that debates in intersectional studies will circulate less around categories and identities and more around how those categories and identities (and their specific content) are contingent on the particular dynamics under study.

Influenced by the USA, British universities are currently “decolonizing” our curriculums. I think, if this is done well, it will entail providing more context and critical analysis of historical ideas and past paradigms, with a focus on operations of power: in particular, what Crenshaw herself calls for, a more vigorous focus on “the manifold ways in which the operations of power at the local level are constituted through the regional, the international, and the global” (2013, p. 807).

Every decade has its own zeitgeist and none of us are exempt from conceptual limitations (Hogan, 2001). Critical cultural analysis (including intersectional analysis) can help us acknowledge and think about this for the benefit of the people we work with, to better conceptualize issues at play and avoid reductive interpretation (Hogan, 2015), oppression (Hogan, 2016), or psychic abuse (Hogan, 1997). I would like to see open-minded, intelligent critical analysis to the fore as we go forward as a set of professions.

About the Author

Dr Susan Hogan Ph.D., D.Litt. is Professor of Arts & Health at the University of Derby and Professorial Fellow of the Institute of Mental Health, Nottingham University. Email: s.hogan@derby.ac.uk.