Agonia: Mental Health Advocates

On Mental Health Consumers Showing Anger
About Prejudice against Mental Illness:
The Lines and Fine-Lines
Between Aggression, Assertion, and the Survival-Instinct

In "A Working Definition of Empowerment," by Judi Chamberlin, Psychiatric Rehabilitation Journal 20(4):43-46, I read that "[l]earning about and expressing anger" is an important facet of defined empowerment [for mental health consumers]. I wish to explore this topic, from the rather-predictable standpoint of what social science has to say on this topic-- and then to embellish this with report of my own observations and experiences on this matter.

In general, the folks who study these things usually make a distinction between such anger/hostility as is expressed aggressively versus assertively. "Aggressive thinking focuses too much on pleasing oneself at the expense of others. Aggressive thinking often ignores the impact of one's behavior on others. It is an "I win, you lose" position. Aggressive behavior includes many forms of domination and direct manipulation. Aggression usually aims at getting control of situations or getting ones goals met no matter what the consequences are to others" [see "Assertion Training: Be More Competent and Confident With Anyone!," by Tom G. Stevens , at this link.] On the other hand, assertion means "Asserting yourself means asking for what you want and need. Assertion is not aggression; it is not a process of demanding, taking, bullying, cajoling, whining, complaining or stepping on others. Self-assertion is about asking for what you want, directly and from a position of strength, without demanding or begging" [see "Assertiveness Training," by Mark Sichel, at this link. ] It is commonly said that the process of becoming assertive may require training, such that "[t]he basic idea behind assertiveness training is to practice assertive actions until they can be repeated even under stress" [see "Assertiveness," giving an overview of this training at this link. ]

Generally speaking, I would say, most people subject to mental illness have problems in expressing anger: they will do so either aggressively or passively (I tend to fit into the latter category.) This problem area generally comes with a hylebiopsychsocial loading-- conditioning and biology therefore do play a role in this set of difficulties [see "Aggression," in Wikipedia at this link ]. On the other hand, this problematic is not unique to the cohort of mental health consumers: frequently "normal people" [albeit with some bad habits] engage in aggressive behavior-- the type acted passively perhaps being more common [as more-socially-acceptable] than the physical type of aggression. Assertion implies elective behavior: in hopeless conflict-- where the outcome is certain to be BIG-TIME LOSS, it can be reality based "not to play." Most conditions of this type are not-so-lossy, however, and the skill of assertiveness really implies some discernment-- the ability to detect situations-- generally social-- when "constructive engagement" is a possibility.

As humans-- professionals are not immune from anger-resolution problems: one very frequently encounters passive-aggression in the mental health profession-- the aggressive-aggressive type only surfaces now and again-- and sometimes have surprising power to survive in the system despite the usual discomforts that collleagues and virtually all others feel toward them. Sometimes the mechanism behind this is displacement-- "kicking at folks" figuratively when frustration is met. In other conditions, it becomes quite apparent-- especially when one wits that "the problem is not what I say, it's that I said it."

In psychosocial work-- by which I denote psychiatry, psychology, social work, nursing, and (pastoral and other) counseling-- it is apparent that the passive form of aggression is quite acceptable, practice, particularly if a clinical reason for humiliating behavior can be explained/imagined. In particular-- while it is necessary and when done correctly is valid-- diagnosis can and is played as a "game" with sadistic intent. Accordingly, the person on the receiving end of diagnosis-- and this applies to clinician-colleagues as well as "patients"-- may not infrequently be the real, though subtle victims of aggressive intent on the part of the "diagnosticians." While there are protections developing for MH pros against this raw use of diagnostics as a "weapon" [ see for example the section on "Impaired Professionals" in the NASW Code of Ethics ] -- frequently a successful weapon-- for being one's cruel self and getting away with it-- this is certainly not the case with clients/patients/consumers and aggressive behavior-- as fancifully or really defined-- will routinely net a "bad diagnosis." The sequelae to this gamespersonship in mental health is of quite wide distribution-- such that a consumer with a "legitimate beef" with the clinic/clinician(s) will still run a certain definable risk of being defined as "a personality disorder" [like antisocial, schizotypal, passive aggressive] when in fact the real "owner" of this diagnosis may be the person writing this up in "the chart."

This is the upshot for the mental health consumer: one has to be extremely careful in expressing anger to mental health professionals: they will quite frequently "play with this," by psychopatholgizing what may indeed be even quite assertive, needs-based pronouncements from the client; this in turn becomes-- an INVALID to this extent-- stain on the consumer's record; one may even assume that there are clinicians "looking-for/ferreting-out" as much aggression from an assertion as possible: IN THIS THE 'DONKEY'S GLUTEUS MAXIMUS' SYNDROME WILL BE IN EVIDENCE-- BUT IT WILL HURT THE CONSUMER-- IS DEVILISHLY HARD TO OUTLIVE-- AND EVEN A VERY PLAIN-SPOKEN ASSERTER CAN FIND HERSELF/HIMSELF IN A "PICKLE" OVER SUCH SHENANIGANS.

From the "inside" and the "outside" of the mental health profession, from much lived experience, I can vouch for the verity of what I contend here. While submissiveness to this form of psychological sadism is definitely counter-indicated for the consumer-- one still should carefully weigh all contingencies as a person with mental illness when taking up issues with the MH pros-- one certainly runs here a risk of unethical and invalid diagnostics-- as well as punitive measures-- including involuntary hospitalization when outside the institutions-- and seclusion/involuntary-medication/shock-treatments/psychosurgery-- depending on how the clinician(s) see you and how cruel and how dishonest they are.

So: CAVEAT!!! Beware! Pick-and-choose your conflicts with mental health clinicians with savvy-- and by all means be assertive, non-aggressive as possible. This will not be 100% insurance from keeping you from involuntaries-- but it may help.

--Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44

Telephone: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com

posted by Louisville Hermitage @ 10:55 PM