More on Mental-Health-Consumer-Assertiveness:
Comment on Such a Program's Inauguration in Lakeland, Florida
The Ledger-- a publication from Lakeland, Florida-- near Tampa-- recently reports that assertiveness-training will be provided for consumers at a local mental health system. This training will address the passivity and "learned helplessness" which people with mental illness not infrequently exhibit, for example in the reported tendency of 'regulars' at a drop-in center there to ask-permission to use the restroom. To this intervention effort I would like to address this entry.
This web-log-- I reiterate-- and all writing perpetuated under this aegis-- endeavors to "say the truth, the whole truth, and nothing but the truth, so help me Truth." Therefore I shall endeavor to describe this worthy effort for all mental health consumers not only from OUR side, but from as many other "sides" as my admittedly limited experiential perspective will permit.
First-things-first: I think it the best-of-ideas that there is now a flesh-and-blood movement afoot in brick-and-mortar mental health places to get the notion of consumer-self-assertion "off the ground." It is absolutely true that numerous consumers exhibit "learned helplessness," and there are times when essentially for strategic reasons I have shown such tendencies. Self-assertion-- as an aspect of self-determination-- is long-overdue for mental health consumers as a cohort/group.
Second-things-second: I do think it expedient, however, to note that our "learned helplessness" is typically a learned-response when it appears, an add-on from numerous inputs to the biological fact of schizophrenia, bipolar-disorder, and the schizo-affective spectrum betwixt the two. The Ledger seems to specify the care-giving system as having "paternalistic tendencies" that teach this 'helplessness'. I would respond-- having been "on the giving-end and receiving-end of the mental health profession"-- that only part of the mental health system abets lack-of-assertion, and part does not; and there are a number of inputs to this condition which are completely apart from the mental health system. In society in general, for example, stigmatization of mental illness is quite pervasive, reinforced by historic cultic beliefs in "demon possession," and by booster-shots subliminally of this cultic belief with numerous "mad-slasher" stories in film, and the news. We only need to hear a minimum number of times about the misdeeds of the deranged should-be-consumer who killed 32 innocent people at Virginia Tech last year, OR of the current (good publicity!) escapades of Britney Spears to reconfirm all these prejudices; and it is a simple fact that we get nearly as many such subliminal messages like this as we get of the black-faces presented on TV as perpetrators of some crime.
In fine, I do not think any amount of assertiveness-training for consumers will make this prejudicial attitude "go away" in society. Should we become the-most-assertive individuals in our communities, there will still be immense social ideation-- largely fictive-- to put down "those uppity mental patients." To those of sufficient age, such phrasing will have a decidedly familiar ring to it: exactly such talk was employed by those who were prejudiced against black people prior to the full-development of the Black Civil Rights Movement. And it is instructive to look at the social forces behind this movement to see the points I am about to make. The Fellowship of Reconciliation early on as well as the NAACP trained activists in self-determination and non-violent resistance to the evils of racial discrimination; Rosa Parks was heroic, but her effect came atop the concerted work and planning of numerous concerned others [see the Wikipedia article on Ms. Parks, here, to corroborate this assertion.] Martin Luther King, Jr., was a giant of a man, but again his emergence came with the concerted and shrewd political coordination of numerous others (some of whom had more-or-less beige skin-pigmentation.) [Again, see the Wikipedia article on Dr. King for corroboration to these contentions.] In all of these matters, it took self-assertion-- YES!-- but also self-assertion coupled with much politically-astute homework.
This is the gist of my point: no amount of self-assertion will bring about all the changes we desire without teamwork-- and to (as Frederick Douglass said) to 'agitate, agitate, agitate' on all levels to see that justice-be-done. Some portion of this activity will HAVE to be political and structural in nature. In this way, mental health consumers will have to learn the requisites of how-to-form-alliances and to develop interest-bases.
Of course mental health consumers need to be involved at base-one in this game; but one must in coalition building take on 'friends' as well. The much-touted family-of-consumer connection needs to be tendered as possible-- in my estimation this cannot be overdone: real families of real "patient-patients" in psychiatry have told me that they would prefer-- for all their trouble-- that she/he the consumer "was dead." Lock-them-up is not infrequently the response families have toward consumers; occasionally the mainline mental health groups like NAMI have speakers who espouse exactly these views. Yet this type of organization should not be discarded, but cultivated-- when possible-- in a constructive way. For numerous consumers-- including me-- family amounts to "a remote afterthought" whose concern for me is more biased on the whole than the most-prejudiced provider I have ever met. Other connections will thus be necessary to stabilize alliance, and relevant political action.
For me, concerned others, few-in-number, priceless-in-value, are the mainstay of my recovery. By these I denote my friends. Yet it is true that the typical inner-city consumer (where I live here in Louisville) may not have many friends. These, I say, need to be cultivated, always with some view that all relationship has a political/structural dimension-- in that the use of power and influence is exhibited down to the level of the social dyad.
Social-organizations beside the family and friendship are a matter of some ambivalence on a value scale of effectiveness. There are numerous churches which SAY "we love the mentally-ill much: we heal them," which is an attitude that cuts-both-ways in that the 'healing' given is rooted in a spirituality of exorcism, as I have indicated; of course this mind-set is not evidence-based, but more to my disconcertment the condescension implied by these religious groups betrays deep-set negative attitudes, an estimation that these-afflicted-souls-need-our-salvation as the final note. I would say-- consistent with the teaching of Jesus-- that should a professedly religious body refuse "you as you in existential-good-faith ARE"-- then by all means "depart out of that house or city, shake off the dust of your feet" [Matthew 10:14, KJV.] But by all means, have your exit known, and your reasons-- non-acceptance due to prejudice-- for your withdrawal. Other voluntary groups, clubs, associations, fellowships, fraternities/sororities may actually be somewhat less-prejudiced than many churches, but like the Black Civil Rights Movement again, these may not be ready to "hear" an agenda that deals with the woes of disenfranchised mental health consumers. In so many ways these topics may be considered 'Verboten!' The agenda at all endeavors should be to soften this 'forbidden state.' If the group is totally unwilling to serve a topic on mental health parity-- defined broadly, in a social sense of equity-- then only by modeling acceptable behavior long and hard-- even if it is difficult-- may be the only viable option. Sometimes with non-religious groups, too, the most-responsible thing a consumer can do is "dust her/his feet" of such people, exactly as with the churches.
In this process of respect for self-determination, mental health providers/professionals have only a "few rotten apples": I have found really sadistic providers about one-in-twenty-- in this discipline/profession does not matter much-- the psychiatrists have their quota of "meanies" as much as the psychologists, social workers, and nurses. In general, though, the kind of sadism practiced-- when it appears-- may be verbalized as condescension -- "I'm-only-trying-to-help-you-" sadism. In this case, though, with such people in general in fact, CORRECT BEHAVIOR may become the only effective way to deal with them. Of course, when it is an option, the service complaint can be such 'correctness' from the consumer. On the whole, then this is the seldom-seldom-necessary gambit for the egregious professional. More likely, the consumer can obtain service with the least sadism, the least cruelty, the least condescension than may be the case from social clubs, churches, families, yea even the so-called mental health advocacy groups. It is nothing but convolution of reality for such groups now to hold up providers-on-the-whole as the culprits in thwarting consumer self-initiative/determination!
"By their fruits, ye shall know them!" [Matthew 6:20.] If a person supposedly interested in me-- or such a group of folk-- talks about nothing but what a drag it is to have types like me out on the streets, not "put-away" like in the old days-- the GOOD old days-- then I would have to say such an interest however presented is POISON-- whether it be an advocacy group, a family, a social club, a church, or a professional. Coalition-building should not be attempted with such-like: they need to be shunned! But if from any walk or ilk we encounter people who REALLY DO abet my liberty, equality, fraternity-- then by all means these need to be cultivated, and in ways that speak to micro-power, and by that politics. I have actually found this interest motley in all kinds of groups-- some of which say they are interested in mental health consumers and others not. To my assessment, the providers look more like allies -- for the most-part-- and not adversaries. I wish the drumbeat I now hear too much-- toward blaming the HELPERS we have-- who figuratively and literally 'provide' -- and away from the real responsibility of those who provide-not.
Assertiveness then is an important aspect of what we consumers need to DO: it is part of our requisite responsibility. But not all the discrepancy falls because we have not assertively asked for justice: what-we-ask-for is a service unavailable to us at request or demand or price. The structural imperative thus becomes: ORGANIZE BY ANY MEANS NECESSARY! BY POLITICS CERTAINLY! WITH COALITIONS OF SADISTS, NEVER! As in the example of Rosa Parks and Martin Luther King, Jr., such existential/political responsibility and action will be the real framework from which assertion will "work."
--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44
Telephone: 1(502) 561-5419 anytime for MH issues
Email: freethink@insightbb.com anytime for MH issues
Agonia: Mental Health Advocates
Sunday, January 20, 2008
Monday, January 14, 2008
Recovery in Mental Health as "..a Combination of Rights and Obligations"
Mental health "recovery" is the by-word in this field today. It seems to mean an emphasis on empowerment, partnership-with-providers, and aggressive-community-treatment (ACT) more than aught-else. The term "recovery" seems nuanced from the standard (medical) definition of this word, which at this social locus denotes "remission-of symptoms" essentially. This in time may prove to be a merry source of confusion, conflict, yea competition between providers and consumers (as well as other stakeholders in mental health.) I have 'come down' of late into promotion of mental health recovery as a movement; however, it still would seem as though the potential dissonance between the movement's terms and the terms of the mental health discipline(s) will require clarification.
None of the salient definitions from the "recovery" movement that I have read suggest that there will be in all cases a total remission of symptoms. The talk of being a "survivor" in an asymptomatic state is on close examination brave utterance, and even these survivors will usually and forthrightly say that some mental health consumers remain symptomatic. On the other hand, there seems to be a waning of the old-line provider-types who see as IMPOSSIBLE recovery in psychiatry as meaning a nearly-asymptomatic state. This has to do with the veritable fact that outcomes for even the most-severe psychiatric diagnoses have become-- with treatment-- more-benign, more-favorable, more-optimistic. However, clarification of terms and agendas in both camps-- I regret that there are becoming "camps" and "sides" in this teamwork-- might help and abet constructive work in this area.
I prefer the term "empowerment" as an overall descriptive for this process with mental health consumers: this puts the discussion immediately into the realm of human/civil rights language, and this seems to be exactly what is meant when publications cite recovery as "...a way of living a satisfied, hopeful and contributing life even with the limitations of [mental] illness" (William Anthony, Ph.D., 1993)--"...the process in which people [with a mental illness] are able to live, work, learn, and participate in their communities" (the President's New Freedom Commission on Mental Health, July, 2003)-- "... a journey of healing and transformation for a person with mental illness disability to be able to live a meaningful life in communities of his or her choice while striving to achieve full human potential or personhood" (SAMHSA, ~ 2005, may have provenance from Dr. A. Kathryn Power, Director of SAMHSA at the time.) What is defined-in-context in other words is quality-of-life as well as self-determination more than the elimination/obviation of a clinical state per se. Here I think we "have something" on which to work.
Actually, on the issue of quality-of-life and self-determination, there will be little quarrel from providers. Indeed, this type of terminology is specified in-- say-- the Code of Ethics of the National Association of Social Workers (NASW.) And neither the psychiatrists nor the nurses nor the psychologists have any ethical qualms with this agenda of informed-consent-to-treatment-unless-dangerous-to-self/others. And, as I have indicated, the empiricism works into a moderation of the notions of outcome/prognosis for the mental disorders generally.
While there may be tiffs about "recovery" as full-remission to some in mental health, few anywhere would argue contra the person's best-obtainable quality-of-life OR self-determination. I think it better to use "empowerment" as the general term for this process, referring to the specifics of this type of quality and determination. Not only doe this have justification in terms of usage I have limned here, but for the civil/human rights aspects-- upon which I shall devote words in the next portion of this entry-- this word-choice seems optimum.
There was a time when mental patients were locked away into total-institutions-- euphemistically called asylums-- where for the mishap of schizophrenia or bipolar-disorder one would "do life"-- dwell incarcerated until death-- in conditions in many ways not distinguishable from prison. In about 1956 came chlorpromazine and lithium -- then the inexorable process of deinstitutionalization, after which mental health consumers went to eke out community existences-- not uncommonly very isolated/lonely existences-- on their fare of neuroleptic-and-shunning by almost everyone. For a time we were not "welcome"; to degrees this is still so, although not to the extent that existed in the 1960s-1970s with the ubiquitous urban mega-personal-care-homes (PCHs) which became the "new back wards." Until quite recently and until quite-quite recently in venues like Missouri, mental health consumers would not vote. Occasionally one finds reports that marriage is prohibited HERE AND NOW because one/both of the participants have a mental disorder. Because of the deranged killer at Virginia Tech-- slaying 32 people in pique after being jilted-- we may fully expect stricter-laws on the "book" about mental illness incarceration, and in practice more-highhanded-arrest-practices in mental health-- for which no apologies will now be given. Jailing of mental patients-- a crime-against-humanity decried by Dorothy Dix in the 19th century-- is NOW a common practice-- 25-35% of the population of people residing in jails are mentally-ill. As these impinge on "life, liberty and the pursuit of happiness"-- that which EVEN applies to those who would be "put-away"-- there ARE civil rights' aspects to this condition. The term EMPOWERMENT is thus with no reservation a "good" term to use for the real-need-- not the brave-utterance extraneous.
We consumers have a REAL rights' issue with which to deal. But with rights come responsibilities. Not all the responsibilities are subtended by the guidelines providers have occasionally in-print about "what the patient needs to do." These statements all tend to be one-sidedly-in-favor of the provider, are virtually like the bad-old-days' "yellow dog contract" not to join unions in the 1930s and prior in Kentucky coal-mining. We consumers DO need to be responsible to providers-- who have no bounden obligation to treat us like indulged babies, and can "fire"us as much a we "fire" them. But in a larger sense, I mean to say that the mental health consumer needs to expert philosophical/existential responsibility in her/his life-- which means a devotion to having the wherewithal to make informed choices about one's condition and treatment-- and to "take what happens"-- the risks for mistakes and not to project these to "that doctor, that nurse, that psychologist, that social-worker who MADE ME DO THIS MISTAKE."
I do not see enough informed responsibility-- of the existential/philosophical kind-- or of the assuming-responsibility-for-mistakes-type in the mental health consumer movement-- on which by now I have four decades of experience. NOTHING IS CHANGED if either we "let go" without service complaint a sadistic provider; NOTHING IS GAINED by feeling defensive about the actions of these 'uncaught' deranged commiters-of-mayhem who should be in the hospitals designed for such folk; ONLY FOLKLORE AND OPINION-OPINION-OPINION is uttered if we do not study mental health, our conditions, our cures, our legitimate outcomes/prognoses. All of these matters require people who will either exhibit a measure of responsibilities -- or who will be treated like babies and criminals. These terms exactly would seem to apply to the social contract which has been afforded to the mental health consumer: let us know both ourselves and our rights through empowerment; recovery-as-being asymptomatic is entirely another issue, not as important as this-first-desideratum.
--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44
Telephone-- about mental health: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com anytime
Mental health "recovery" is the by-word in this field today. It seems to mean an emphasis on empowerment, partnership-with-providers, and aggressive-community-treatment (ACT) more than aught-else. The term "recovery" seems nuanced from the standard (medical) definition of this word, which at this social locus denotes "remission-of symptoms" essentially. This in time may prove to be a merry source of confusion, conflict, yea competition between providers and consumers (as well as other stakeholders in mental health.) I have 'come down' of late into promotion of mental health recovery as a movement; however, it still would seem as though the potential dissonance between the movement's terms and the terms of the mental health discipline(s) will require clarification.
None of the salient definitions from the "recovery" movement that I have read suggest that there will be in all cases a total remission of symptoms. The talk of being a "survivor" in an asymptomatic state is on close examination brave utterance, and even these survivors will usually and forthrightly say that some mental health consumers remain symptomatic. On the other hand, there seems to be a waning of the old-line provider-types who see as IMPOSSIBLE recovery in psychiatry as meaning a nearly-asymptomatic state. This has to do with the veritable fact that outcomes for even the most-severe psychiatric diagnoses have become-- with treatment-- more-benign, more-favorable, more-optimistic. However, clarification of terms and agendas in both camps-- I regret that there are becoming "camps" and "sides" in this teamwork-- might help and abet constructive work in this area.
I prefer the term "empowerment" as an overall descriptive for this process with mental health consumers: this puts the discussion immediately into the realm of human/civil rights language, and this seems to be exactly what is meant when publications cite recovery as "...a way of living a satisfied, hopeful and contributing life even with the limitations of [mental] illness" (William Anthony, Ph.D., 1993)--"...the process in which people [with a mental illness] are able to live, work, learn, and participate in their communities" (the President's New Freedom Commission on Mental Health, July, 2003)-- "... a journey of healing and transformation for a person with mental illness disability to be able to live a meaningful life in communities of his or her choice while striving to achieve full human potential or personhood" (SAMHSA, ~ 2005, may have provenance from Dr. A. Kathryn Power, Director of SAMHSA at the time.) What is defined-in-context in other words is quality-of-life as well as self-determination more than the elimination/obviation of a clinical state per se. Here I think we "have something" on which to work.
Actually, on the issue of quality-of-life and self-determination, there will be little quarrel from providers. Indeed, this type of terminology is specified in-- say-- the Code of Ethics of the National Association of Social Workers (NASW.) And neither the psychiatrists nor the nurses nor the psychologists have any ethical qualms with this agenda of informed-consent-to-treatment-unless-dangerous-to-self/others. And, as I have indicated, the empiricism works into a moderation of the notions of outcome/prognosis for the mental disorders generally.
While there may be tiffs about "recovery" as full-remission to some in mental health, few anywhere would argue contra the person's best-obtainable quality-of-life OR self-determination. I think it better to use "empowerment" as the general term for this process, referring to the specifics of this type of quality and determination. Not only doe this have justification in terms of usage I have limned here, but for the civil/human rights aspects-- upon which I shall devote words in the next portion of this entry-- this word-choice seems optimum.
There was a time when mental patients were locked away into total-institutions-- euphemistically called asylums-- where for the mishap of schizophrenia or bipolar-disorder one would "do life"-- dwell incarcerated until death-- in conditions in many ways not distinguishable from prison. In about 1956 came chlorpromazine and lithium -- then the inexorable process of deinstitutionalization, after which mental health consumers went to eke out community existences-- not uncommonly very isolated/lonely existences-- on their fare of neuroleptic-and-shunning by almost everyone. For a time we were not "welcome"; to degrees this is still so, although not to the extent that existed in the 1960s-1970s with the ubiquitous urban mega-personal-care-homes (PCHs) which became the "new back wards." Until quite recently and until quite-quite recently in venues like Missouri, mental health consumers would not vote. Occasionally one finds reports that marriage is prohibited HERE AND NOW because one/both of the participants have a mental disorder. Because of the deranged killer at Virginia Tech-- slaying 32 people in pique after being jilted-- we may fully expect stricter-laws on the "book" about mental illness incarceration, and in practice more-highhanded-arrest-practices in mental health-- for which no apologies will now be given. Jailing of mental patients-- a crime-against-humanity decried by Dorothy Dix in the 19th century-- is NOW a common practice-- 25-35% of the population of people residing in jails are mentally-ill. As these impinge on "life, liberty and the pursuit of happiness"-- that which EVEN applies to those who would be "put-away"-- there ARE civil rights' aspects to this condition. The term EMPOWERMENT is thus with no reservation a "good" term to use for the real-need-- not the brave-utterance extraneous.
We consumers have a REAL rights' issue with which to deal. But with rights come responsibilities. Not all the responsibilities are subtended by the guidelines providers have occasionally in-print about "what the patient needs to do." These statements all tend to be one-sidedly-in-favor of the provider, are virtually like the bad-old-days' "yellow dog contract" not to join unions in the 1930s and prior in Kentucky coal-mining. We consumers DO need to be responsible to providers-- who have no bounden obligation to treat us like indulged babies, and can "fire"us as much a we "fire" them. But in a larger sense, I mean to say that the mental health consumer needs to expert philosophical/existential responsibility in her/his life-- which means a devotion to having the wherewithal to make informed choices about one's condition and treatment-- and to "take what happens"-- the risks for mistakes and not to project these to "that doctor, that nurse, that psychologist, that social-worker who MADE ME DO THIS MISTAKE."
I do not see enough informed responsibility-- of the existential/philosophical kind-- or of the assuming-responsibility-for-mistakes-type in the mental health consumer movement-- on which by now I have four decades of experience. NOTHING IS CHANGED if either we "let go" without service complaint a sadistic provider; NOTHING IS GAINED by feeling defensive about the actions of these 'uncaught' deranged commiters-of-mayhem who should be in the hospitals designed for such folk; ONLY FOLKLORE AND OPINION-OPINION-OPINION is uttered if we do not study mental health, our conditions, our cures, our legitimate outcomes/prognoses. All of these matters require people who will either exhibit a measure of responsibilities -- or who will be treated like babies and criminals. These terms exactly would seem to apply to the social contract which has been afforded to the mental health consumer: let us know both ourselves and our rights through empowerment; recovery-as-being asymptomatic is entirely another issue, not as important as this-first-desideratum.
--Vernon Lynn Stephens, MSSW
D.S.M. IV-TR # 296.44
Telephone-- about mental health: 1 (502) 561-5419 anytime
Email: freethink@insightbb.com anytime

