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 anytimeEmail: freethink@insightbb.com
What Happens When Mental Health Professionals Who Are Consumers
"Come Out of the Closet":
The Telling Case of Kay Redfield Jamison, Bipolar Psychologist,
And the University of Louisville (Kentucky) Libraries System It could be that Kay Redfield Jamison, Ph.D. psychologist, is the most-prolific mental health professional who-- as a person with bipolar disorder-- is a consumer as well of mental health services. Her books are "serious" and usually quite academic, and all relate to the topic of her experience with mental illness, both personally and professionally.
According to the comprehensive Web-source "Bookfinder.com," Jamison has out nine (9) published works; these nine include her beautifully-written
An Unquiet Mind (1995) and its translation into Spanish, as well as
Manic-Depressive Illness (1990)-- at the time and unto now THE authoritative statement on bipolarity as a biopsychosocial condition.
But let me explain the "treatment" this signal writer-- a MH professional who admits to being bipolar-- gets from a major American academic library system-- the University of Louisville system-- which includes a panoply of University libraries-- including those for arts and sciences and medical (including psychiatric) books. According to the search I did this night,
"Jamison, Kay Redfield," in this system renders but an announcement "Your search results in no hits!" This finding almost certainly means that these several libraries contain NO books by Jamison. According to the Table D-- on
cumulative binomial probabilities-- a cognate for the "sign test"-- in
Nonparametric Statistics for the Behavioral Sciences, 2nd Edition, by Sidney Siegel and N. John Castellan, Jr., 1988-- this 0:9 skew reaches a confidence-level of P < .002-- "would occur by expectation-of-chance only once in 500 totally-random trials." Phrased in a Bayesian way, using calculations that are more-in-vogue now, this skew has an
odds ratio (OR) stands at .0229 with 95% confidence-intervals between .0038-.1378.
Both of these sets of figures are what is called
"statistically significant." But like the sign test, these data only
show that some condition here is non-random. A kind of
post-hoc analysis is possible, however, in an effort to explain-away why this non-randomness should occur. I shall do so by way of "thought experiment" (which is a valid technique used in such disciplines as physics and astro-science) in order to derive an exhaustive list of putative hypotheses for this differential. More or less in the spirit of the "principle of charity" used in logic, I shall derive such a list with the emphasis on the most defensible exclusion-strategies for the library system here and those wh0 influence the selection of its books.
- The University of Louisville libraries system esteems Jamison not to be a significant academic writer. This thesis might be used only tenuously, for outside of this system, Jamison is well-respected both by the public and by academics; she is considered a "saint" to mental health consumers.
- Jamison's work is TOO OLD, DATED to be in the collections. Again, with a collection of hundreds of thousands of books-- if not a number in the millions-- some of which date back to the 18th and 19th centuries-- this argument does not seem persuasive, either. And besides, most of Jamison's books are of recent vintage-- less than 20 years "old."
- Accident/Other: The library systems did not KNOW about Jamison or of her important psychosocial work-- particularly on bipolar disorder. Again, as in Louisville, I have witnessed Jamison's theses being discussed in colloquia for mental health professionals, this claim does not persuade either. "Miscellaneous causal possibilities" seem too SKETCHY to limn here.
- Those who influence the selection of library books for the system-- professors who recommend books and the professional librarians who purchase them for the system-- DO NOT ESTEEM THE WORK OF JAMISON PRECISELY BECAUSE SHE IS ESTEEMED TO BE MENTALLY ILL-- AND THUS DISCREDITABLE EVEN IF SHE WOULD PRESENT THESES OF THE PROFOUNDEST VALIDITY.
Of these theses, it is hard to avoid the conclusion that the latter is fairly persuasive, if not THE reason for the non-presence of Jamison's books in the system. If
prejudice is not the entire reason for this "zero," it would still be difficult to explain this extremity to the other causes above besides
the disparagement that is afforded so-called "impaired professionals" in mental health and in academia generally. Speaking from my own experiences as a former mental health social worker, I have good reason to think from my "heuristic" that this form of prejudice toward MH pros who have experienced mental decompensation as a live factor in how mental healthers stigmatize the psychiatrically ill, and then too especially the mental health professionals who have had these conditions. I always got good "job-ratings" for my performance as a psychiatric social worker; I never ever told patients in that capacity that I had mental illness-- and my jobs did not
essentially consist of psychotherapy but of supportive psychiatric services and social-history taking; but when I told fellow MH workers that I was bipolar-- BAD THINGS WOULD HAPPEN-- bosses would ask for my immediate resignation for the reason that "I talk too much"-- there was much obvious gossip and "diagnosing" of a negative sort-- when I was "pulling" a solid 40 hours of work per week under stressful (forensic psychiatric) conditions-- had two forms of professional certifications (ACSW and CSW-- and was well on my way to LCSW)-- and had two peer-reviewed professional publications-- TO BE TOLD "YOU WERE TALKING WITH XYZ COLLEAGUE ABOUT YOUR DIAGNOSIS-- YOU NEED TO GO TO THE HOSPITAL"; two psychologists insisted on administering a psy test on me on such a "diagnostic question" and after passing the test-- and he exactly told me so-- he reversed himself with the madding crowd and said that "things indeed were going on in my head" because I told some colleague that I had been in a psychiatric hospital for decompensation; in group therapy class at the Kent School of Social Work, I was given an hour's worth of the "hot seat" (all MH pros know what the hot-seat means-- a total-gang up on a member for a time) because another classmate was sure that I had "some deep dark secret that the group should know" and later when I helped this guy get a job where I worked upon telling him about my psychiatry experiences, he did his utmost to get me run-off/fired. And I could and may someday go on... but in what I say I do think I have experiences which would corroborate stigmatization against mental health professionals like myself and Kay Redfield Jamison-- the focus of this discussion.
HERE IS THE RUB: 1. while it is sometimes painful-- "one gets CLOMPED" -- for "coming out of the closet" as a mental health consumer ; 2. it is also true that "There are many ways to fight [mental-illness- ] stigma. The simplest way is to "come out of the closet" and present "positive visibility" in the community and the media" [see
"How to Use the Media to Fight Stigmas and Discrimination," by Susan Rogers, National Mental Health Consumers' Self-Help Clearinghouse ] it is also true that mental health empowerment in part consists of "Assertiveness-- being able to clearly state one's wishes and to stand up for oneself-- [which] helps an individual to get what he or she wants" [see
"A Working Definition of Empowerment," by Judi Chamberlin, Psychiatric Rehabilitation Journal 20(4):43-46, Spring, 1997 at this link ]; 3. as mental health professionals who are consumers, we need to abet the process of this assertiveness, because "We mental health professionals have unwittingly reinforced ... devaluation of consumers... Individuals with mental health problems and our families also have contributed to stigma and discrimination by being silent about our illnesses, by promoting coercive approaches (in the case of some families), and by not effectively organizing politically to alter public attitudes and policies" [see
"All We Are Saying Is Give People with Mental Illness a Chance," by Paolo del Vecchio, M.S.W., Psychiatric Services 57(5):646, May 2006 ] .
Therefore the mental health professional who is a consumer is in a special cohort-- and we need by all accounts to show leadership when blatant and subtle discrimination occurs. This with exactitude would seem to be our existential calling. Thus now I hold up the cause of Kay Redfield Jamison and the non-presence of her important books in the libraries of the University of Louisville. In the same way, historically, black people had long experienced the dearth of materials in mainline sources for the content of black thinkers/intellectuals/writers. An important thinker like Jamison for mental health NEEDS at every count to be shown here:
SHAME SHAME SHAME ON THE UNIVERSITY OF LOUISVILLE AND ALL ASSOCIATED WITH ITS LIBRARIES FOR PERPETUATING THIS INJUSTICE!!! --
Vernon Lynn Stephens, M.S.S.W.
D.S.M. IV-TR # 296.44Telephone: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com
