WMD on WMHD 2018


 

Plenty to like in the WHO statement  for World Mental Health Day 10th  October 2018 , calling for the  need to focus on mental health of young persons; with an emphasis on recognising the stressful world not of their making but in which, likewise, not of their own choosing they find themselves having to make sense of, and make a life in;  and on prevention and the need to  focus on supporting them in building resilience and skills to survive in that difficult world  in order to be able to make a life worth living in it.

Not much at all to like about how the mental illness-industrial-complex that we have builded-here, upon the foundational myth- the powerful single-story: that if a person struggles, then there is something wrong with them, and therefore we need to diagnose them, drug them up and dump them.

That this degradation narrative is now tagged onto the master file of one-in-four – over 2 billion – of us shows how utterly stark raving bonkers it is…

The conspiracy of institutions ravenous for more money to deliver more of the same message includes all those services, charities and NGOs that bring out their brightest and best weapons of mass deception on days like these, and who have have built their cash-grabbing/ “fundraising” strategy upon categorizing people as defective, diagnosable and thus we need them to fix us with their fixes; and then have the gall to admonishing those struggle when they choose [as is their right] to not make themselves even more vulnerable by seeking their brandedversion of  “help”.

Even, especially, a day later is a good day to reflect upon our own role – knowing and unknowing participation in how weaponizing diagnosis is a such a powerful tool of oppression, and maybe make some choices and some changes so we can suck less.

It is no coincidence that WHO’s call comes only a couple of days after the UN climate conference announced we have 12 years to turn around our abuse of the environment- even if you do think that’s nonsense, realise that young people can’t afford you to. The two are not unconnected- because everything IS connected – and young people can see how little regard you have for their future…

The act of diagnosing and naming a person as a mental illness is the basis of discrimination, a foundation of oppression, and a violation of personhood.

And – if you are one of those keen to do so – before you even mention the word, diagnosis is the root, trunk, branch and DNA of what you want to talk of as “stigma” because calling this spade a spade is yet still, too difficult a step for you to take. Time to call it by its true name.

At the centre of every “case” of “mental illness” is a human being, struggling, and in pain. and, likely not just the one person but, too, many of those connected with them.

Diagnosis and separating people is not only not the answer it is the very opposite of any kind of answer that will make a path out of the mess we’ve created.  Meanwhile, though connecting is not all we need do – there are too many – but it is a big part and one we can all play our role in, and one we can start any time.

“All that stuff about symptoms and diagnoses – it is interesting, it’s just not that useful.”

Our institutions and corporations have been successful in turning “mental health day” into “selling mental illness day”, it is what they do, and they are good at it.

We have made mental health all about diagnoses and drugs.
It is time we made it about people.

 

 WHO –  World Health Organisation Statement 10 Oct 2018

World Mental Health Day 2018

10 October

YOUNG PEOPLE AND MENTAL HEALTH IN A CHANGING WORLD

Adolescence and the early years of adulthood are a time of life when many changes occur, for example changing schools, leaving home, and starting university or a new job. For many, these are exciting times. They can also be times of stress and apprehension however. In some cases, if not recognized and managed, these feelings can lead to mental illness. The expanding use of online technologies, while undoubtedly bringing many benefits, can also bring additional pressures, as connectivity to virtual networks at any time of the day and night grows. Many adolescents are also living in areas affected by humanitarian emergencies such as conflicts, natural disasters and epidemics. Young people living in situations such as these are particularly vulnerable to mental distress and illness.

Photo:WHO /Sergey Volkov

Half of all mental illness begins by the age of 14

Half of all mental illness begins by the age of 14, but most cases go undetected and untreated. In terms of the burden of the disease among adolescents, depression is the third leading cause. Suicide is the second leading cause of death among 15-29-year-olds. Harmful use of alcohol and illicit drugs among adolescents is a major issue in many countries and can lead to risky behaviours such as unsafe sex or dangerous driving. Eating disorders are also of concern.

Growing recognition of the importance of building mental resilience

Fortunately, there is a growing recognition of the importance of helping young people build mental resilience, from the earliest ages, in order to cope with the challenges of today’s world. Evidence is growing that promoting and protecting adolescent health brings benefits not just to adolescents’ health, both in the short- and the long-term, but also to economies and society, with healthy young adults able to make greater contributions to the workforce, their families and communities and society as a whole.

Prevention begins with better understanding

Much can be done to help build mental resilience from an early age to help prevent mental distress and illness among adolescents and young adults, and to manage and recover from mental illness. Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings and of course training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded.

Investment by governments and the involvement of the social, health and education sectors in comprehensive, integrated, evidence-based programmes for the mental health of young people is essential. This investment should be linked to programmes to raise awareness among adolescents and young adults of ways to look after their mental health and to help peers, parents and teachers know how to support their friends, children and students. This is the focus for this year’s World Mental Health Day.

World Mental Health Day 2018

10 October

YOUNG PEOPLE AND MENTAL HEALTH IN A CHANGING WORLD

Adolescence and the early years of adulthood are a time of life when many changes occur, for example changing schools, leaving home, and starting university or a new job. For many, these are exciting times. They can also be times of stress and apprehension however. In some cases, if not recognized and managed, these feelings can lead to mental illness. The expanding use of online technologies, while undoubtedly bringing many benefits, can also bring additional pressures, as connectivity to virtual networks at any time of the day and night grows. Many adolescents are also living in areas affected by humanitarian emergencies such as conflicts, natural disasters and epidemics. Young people living in situations such as these are particularly vulnerable to mental distress and illness.

World Mental Health Day 2018: “Young people and mental health in a changing world”.

Photo:WHO /Sergey Volkov

Half of all mental illness begins by the age of 14

Half of all mental illness begins by the age of 14, but most cases go undetected and untreated. In terms of the burden of the disease among adolescents, depression is the third leading cause. Suicide is the second leading cause of death among 15-29-year-olds. Harmful use of alcohol and illicit drugs among adolescents is a major issue in many countries and can lead to risky behaviours such as unsafe sex or dangerous driving. Eating disorders are also of concern.

Growing recognition of the importance of building mental resilience

Fortunately, there is a growing recognition of the importance of helping young people build mental resilience, from the earliest ages, in order to cope with the challenges of today’s world. Evidence is growing that promoting and protecting adolescent health brings benefits not just to adolescents’ health, both in the short- and the long-term, but also to economies and society, with healthy young adults able to make greater contributions to the workforce, their families and communities and society as a whole.

Prevention begins with better understanding

Much can be done to help build mental resilience from an early age to help prevent mental distress and illness among adolescents and young adults, and to manage and recover from mental illness. Prevention begins with being aware of and understanding the early warning signs and symptoms of mental illness. Parents and teachers can help build life skills of children and adolescents to help them cope with everyday challenges at home and at school. Psychosocial support can be provided in schools and other community settings and of course training for health workers to enable them to detect and manage mental health disorders can be put in place, improved or expanded.

Investment by governments and the involvement of the social, health and education sectors in comprehensive, integrated, evidence-based programmes for the mental health of young people is essential. This investment should be linked to programmes to raise awareness among adolescents and young adults of ways to look after their mental health and to help peers, parents and teachers know how to support their friends, children and students. This is the focus for this year’s World Mental Health Day.

Advertisements
Posted in Ideas | Leave a comment

Ceremony – Joy Division / New Order


This is why events unnerve me

Notice whom for wheels are turning

Heaven knows, it’s got to be this time

 

 

 

This is why events unnerve me
They find it all, a different story
Notice whom for wheels are turning
Turn again and turn towards this time
All she asks is the strength to hold me
Then again the same old story
World will travel, oh so quickly
Travel first and lean towards this time

Oh, I’ll break them down, no mercy shown

Watching her, these things she said
The times she cried
Too frail to wake this time

Oh I’ll break them down, no mercy shown
Heaven knows, it’s got to be this time
Avenues all lined with trees
Picture me and then you start watching
Watching forever
Forever
Watching love grow, forever
Letting me know, forever

Songwriters: Bernard Sumner / Ian Kevin Curtis / Peter Hook / Stephen Paul David Morris

Ceremony lyrics © Universal Music Publishing Group

Posted in Uncategorized | Leave a comment

Staircase of Oppression in “Mental Health”


Two-and-some years ago I stumbled across a video online, a TEDx talk I  found very useful, in which the presenter shared a diagram, a conceptual model of how oppression is constructed, in steps, as an escalation, first from categorizing persons, through stereotyping, discrimination and on to full weight of structural, systemic oppression.

When I went back later the video had been taken down but was available elsewhere but set to “private viewing only” and I could no longer view it. Then a year-and-some ago I went searching for it again, and couldn’t find it again, but I did find a useful paper written in Norway that took a similar model, or the same one,  and applied it to clinical practice.

Presented, as the title suggests, and intended that clinicians might use it in their own practice, a “tool for reflection” it draws attention to  how in clinical practice there can be a tendency to slide down the staircase, and also suggests some ways to counter that tendency and rather than work in ways that limit the person, and  instead in ways  that intentionally support the person in claiming or reclaiming their power.


Diagnosis as a foundation of oppression

In mental health services, the entirety of practice is built upon the central practice of diagnosis – of categorizing the person. Whilst we might convince ourselves with stories of how this is a benign act,  the effect is one of dehumanization, an act of violence against the personhood of an individual and without which, any subsequent steps have nothing upon which to build.

Diagnosis means to set apart from in order to know, or come to know. In mental health services – and many social services built upon or at least based heavily upon on psychiatric and other diagnoses- we habitually and systemically set people apart once we have diagnosed – objectified – them.

Intentional or not, the categorization and objectification of person-as-diagnosis gives the lie to “patient centred care”. What we have far too often is not, as is [pro]claimed, “patient-centred-care'” but “diagnosis-centered-oppression”, and falls a good deal short of being worthy of being called “care”.

“Clinicians cannot avoid categorizing the patient’s pattern of symptoms and signs in order to reach diagnosis and treatment.

“On the other hand, to counteract the automatic categorizing and objectifying of the patient as a person it is of paramount importance to recognize him/her as a fellow human being, and thus in staying human ourselves.

“In objectifying the person diversity is blurred, and cultural stigmatizing attitudes towards marginalized groups are abundant and easy to take up.”

The paper by Janecke Theisen is shared below.

I wanted first to share my own interpretation of the diagram that forms the basis in the paper. I enjoyed brief correspondence with Janecke we’d had similar experience trying to get to eth source, she certainly got furthest, identfying it as having been developed by WILD (The Women’s Institute for Leadership Development, located in Boston, USA). I tried all the people I know who might know more but got nowhere – so If you’re reading this and you do know it’s origin or authors then I’d be happy to learn and give credit and add links…

This is version below is for what its worth my own interpretation. Essentially, my contribution is to flip the staircase 180 degrees on the horizontal axis: instead of escalating steps, what is expressed is the effect of that escalation upon those being oppressed – literally, being pressing down upon, and the constricting, or stripping away,  of the the space in which we can be human, in which we can be.

Intuitively, I wanted to express something  of a felt-sense of how we feel when we experience oppression – being crushed; and how each subsequent step crushes the soul, confines the human spirit, reduces the space in which a person can be a person, can be; and eventually reducing that to which Franz Fanon termed the “zone of nonbeing”, where our very beingness is denied us.  We are denied right to personhood even denied being-ness.

The words we use to describe others say far more about us than they can ever say about them.

 

 

ORGINAL ARTICLE

From oppression towards empowerment in clinical practice – offering doctors a model for reflection

JANECKE THESEN

Section for General Practice, Department of Public Health and Primary Health Care, University of Bergen, Norway

Abstract

Objectives: This article aims to present an Oppression Model describing how and explaining why doctors sometimes take up the role of oppressor in clinical practice, and to furthermore create change by proposing alternatives. The model is intended to increase awareness of power issues in medical practitioners, thus creating an urge for empowering practices.

Design: The Oppression Model is constructed by theoretical reasoning, inspired by empirical findings of doctor-as-oppressor from a Norwegian research project with users of psychiatric services. The model is composed of the chosen theoretical elements, assembled as a staircase model. The model is intended to give descriptions and explanations and foster change relevant to oppressive processes in clinical practice, and is mainly relevant when meeting patients from vulnerable or stigmatized groups. An Empowerment Track is conceptualized in a similar way by theoretical reasoning.

Results: The Oppression Model describes a staircase built on a foundation of objectifying, proceeding by steps of stereotypes, prejudice, and discrimination up to the final step of institutionalized oppression. An Empowerment Track is proposed, built on a foundation of acknowledgement, proceeding by steps of diversity, positive regard, and solidarity towards empowerment. It represents, however, only one of several possible ways of proceeding in developing empowering practices. Conclusion: Keeping the Oppression Model in mind during patient encounters may help the busy clinician to counteract oppressive attitudes and actions.

Key Words: Communication, consultation, empowerment, family medicine, general practice, oppression, physician-patient relations, psychiatric services, stigma, theoretical model

Measuring the coping power of poor people against what I thought I could have managed myself, with the same history, in the same circumstances, they never failed to amaze me. (Julian Tudor Hart)

Background

Regarding myself as a patient-centred general practitioner, I believed that the majority of my patients appreciated my consultation behaviour. However, while doing a study of the experience of users of psychiatric services (in this article called ‘‘the Experience Study’’); I learnt some hard lessons that never left my professional mind. The users described dehumanizing experiences of being reclassified as the stigmatized ‘‘other’’ [1]. They presented convincing and harsh experiences of oppression, lack of love, and lack of a life of one’s own – mainly in their encounter with people in their local community, but also in the health and social services. My findings suggested that the dominating person in a human encounter sometimes stigmatizes and harasses the other, and that doctors are no exception.

Why did doctors like me take up the role of oppressor in medical encounters? Was it mainly due to personal shortcomings, or was the reason more structural? How could the oppressive process be described? If I accepted that I sometimes acted as an oppressor of my patients, how could I change? And why had these power issues been predominantly invisible to me in the past? In order to enable myself and other medical practitioners to counteract oppressive behaviour I decided to visualize such processes in a model. Just as an unpleasant snapshot of oneself as disgustingly overweight can make people go on a diet, the snapshot offered by the model was intended to reveal a picture of reality in order to foster change. Most intimidations are unintended – even unrecognized – by the oppressor. By acknowledging that oppressive practices are taking place in medical practice it should be possible to develop strategies for counteracting dehumanizing oppressive behaviour, and to stimulate patient empowerment in the clinical context.

Aims

The aims of this article are to present an Oppression Model describing how and explaining why doctors take up the role of oppressor in clinical practice, and furthermore to create change by offering alternatives. The model is intended to increase awareness of power issues in medical practitioners, thus creating an urge to develop change.

Material and methods

The model is inspired by empirical findings from the Experience Study where users of psychiatric services in six Norwegian rural communities were participants and informants [1]. The Experience Study describes stigmatization and oppression of psychiatric patients but it does not explain how and why people, including doctors who have chosen a helping profession, take up the role of oppressor. The model is a result of exploring academic literature looking for theories that could possibly account for this phenomenon, while constantly weaving back and forth between data from the Experience Study, my professional knowledge as a general practitioner, and my personal knowledge from being in positions both as oppressor and sometimes even as oppressed. From this process some theories have been rejected, and some have been accepted as providing answers to my research questions and adequate explanations of the phenomena observed. The Oppression Model is composed of the chosen theoretical elements from this process of theoretical reasoning, assembled as a staircase model.

The choice of a staircase metaphor was inspired by a model developed by WILD (The Women’s Institute for Leadership Development, located in Boston, USA). My use of the staircase emphasizes the foundation of the staircase, and how all steps rest heavily on the process of objectifying as a point of departure. The Oppression Model is designed to be simple enough to be kept in mind by the busy medical practitioner – like a snapshot that will remind him/her of important power issues while in clinical action.

Theoretical perspectives

Oppression as the opposite of empowerment

My conceptual point of departure is psychologist Prilleltensky’s definition of oppression, both as a state and as a process. ‘‘Oppression, as the antithesis of reciprocal empowerment, curtails self-determination, perpetuates social injustice, and suppresses the voice of vulnerable individuals’’ [2].

Prilleltensky emphasizes the coexistence of political and psychological oppression. Political oppression is understood as what is actually done to people by others in a one-up position. Psychological oppression is about the oppressed person’s ‘‘internalised view of self as negative and as not deserving more resources or increased participation in societal affairs’’ [2], also known as self-stigma. This coexistence explains why patients will not always agree to being in an oppressive situation if they are asked, making them even more vulnerable to medical power.

Power issues in medicine

Encountering patients, doctors have a great deal of power and are usually in a one-up position. This is not good or bad in itself, but the crucial question is how this power is used. Speaking from the medical culture, Engel and Emmanuel challenged the strong voice of biomedicine and called for a stronger impact of the patient’s voice [3–4]. From the context of general practice, Levenstein et al., Waitzkin, Candib, Fugelli, Malterud, and Hollnagel have explored power issues in medicine [5–10]. But these authors are rare exceptions. Other terms related to power issues are also rare in medical discourse: social stratification, social exclusion, discrimination, stigmatization, racism, sexism, cultural differences, multiculturalism, disempowerment, and other variations on the term power.

There is, however, an extensive literature describing and analysing consequences of oppression in medicine from the outside, mainly in the social sciences. Feminist critiques, critical psychology, consumer and disability movements, gay/lesbian/ bisexual theorists, anti-racist movements, and organizations for HIV-infected individuals have criticized medicine as an instrument of more general oppressive practices in society.

Figure 1. The Oppression Model. For legend, see text.

Empowerment in medical discourse

The term empowerment is becoming increasingly popular in the medical discourse. However, empowerment for the purpose of lifestyle modification and health promotion appears to be more related to patient education in achieving goals medical people have set for patients, than of reversing the processes and products of oppressive practices in society [11]. The kind of oppression described in the Experience Study [1] calls for a more radical interpretation of the empowerment concept, concerning fundamental issues of human rights more than influencing disease by modifying lifestyle. I therefore return to Prilleltensky’s definition – empowerment as the opposite of oppression – as an adequate conceptual frame of reference for the model I want to propose.

Objectifying – a foundation for oppression

Philosopher Skjervheim [12] has written extensively on the phenomenon of objectifying. He describes how a person can make another person an object of study instead of meeting him/her as a fellow individual, sharing the human condition. Skjervheim distinguishes subject–subject – or the intersubjective relationship, from subject-object relations – or the relationship that predominates in natural sciences. He offers an example: Two people talk, and A states: ‘‘The cost of living will increase even more.’’ B then has two choices: He can either engage in the issue and discuss the statement with A in a subject-subject relation, together discussing a third issue. Or B can ignore the issue, refrain from engaging in the discussion, and rather focus on the fact that A declares this, as in a subject-object relation. If we change the example to a conversation where A states that his actions are controlled by external forces by way of radiation, the chances of B relating to A in a subject-object relation instead of in a subject-subject relation will usually increase.

The foundation of the Oppression Model is formed by Skjervheim’s important distinction

between meeting the other as a subject, a fellow individual, as opposed to meeting him/her as an object to be studied, a thing representing a category, something to be reasoned about but not a person to be engaged with.

The Oppression Model

The Oppression Model is summarized in Figure 1. The model describes a staircase built on a foundation of objectifying, illustrating the danger of being swept up to the final step of oppression once the process of objectifying begins. The staircase steps illustrate how stereotypes can lead to prejudice (negative, or stigmatized stereotypes), which leads to discrimination (unjust allocation of resources, voice, and democratic participation on the basis of group membership – such as disability, gender, class), which leads to systemic or institutionalized oppression (discriminating practices built into the very structure of society). Below, each of the steps of the Oppression Model will be elaborated further.

The process starts by the objectifying process of categorizing the person. Clinicians cannot avoid categorizing the patient’s pattern of symptoms and signs in order to reach diagnosis and treatment. On the other hand, to counteract the automatic categorizing and objectifying of the patient as a person it is of paramount importance to recognize him/her as a fellow human being, and thus in staying human ourselves. In objectifying the person diversity is blurred, and cultural stigmatizing attitudes towards marginalized groups are abundant and easy to take up.

The notion of objectifying that proceeds towards oppression embodies the whole person, not only his/her symptoms and signs. Staying within the Oppression Model, I can see Mrs Smith only as the problematic and ever-returning somatizing neurotic patient without any real pain, or Mr Simpson only as the promiscuous gay guy who deserves his HIV infection.

Patients from stigmatized groups are especially at risk of becoming ‘‘the other’’ when seeing the doctor. Goffman describes a stigma as ‘‘an attribute that is deeply discrediting, but … a language of relationships, not attributes, is really needed’’ [13]. This is because a stigma is ‘‘a special kind of relationship between attribute and stereotype’’. In this way, Goffman points to the role and responsibility of the one stigmatizing the other. Or, he points to my attitudes towards women with medically unexplained disorders represented by Mrs Smith, or towards gay men represented by Mr Simpson.

The consequences of the next steps of stereotyping and prejudice are harassment and intimidation. Social psychologist A ̊s described what happens in encounters between people from a dominating and an oppressed group before any actual power is required [14]. A ̊ s, who studied gendered interaction in national politics, describes the harassment of women by men in ‘‘the five master suppression techniques’’: making someone invisible, ridiculing, withholding information, blaming and shaming, and no way to win (damned if you do, and damned if you don’t). Familiar examples from general practice consultations could be: Assuming that Ms Thompson, the middle-aged woman in front of me, is heterosexual, making it invisible that the death of her friend Jane actually equals being widowed after 20 years of a committed relationship. Ridiculing Mrs Smith’s fear of a brain tumour that kept her awake for the last five nights. Withholding the fact that the psychiatric medication I want Mr Stevens to take is likely to cause impotence or diabetes. And so on.

Philosopher Young describes the consequences of the last steps of discrimination and oppression as ‘‘the five faces of oppression’’. These are: exploitation, marginalization, powerlessness, cultural imperial- ism, and violence [16]. In this position of institutio- nalized oppression the consequences for patients are exclusion, unjust distribution of resources, limited democratic participation, limited self-determination, and limited voice and choice.

The story of Bill from the Experience Study serves as an illustration of powerlessness: Bill did not want the work that a well-intended psychiatric nurse had found for him. This was hard to understand until he told us that he had to get up very early, spend more than two hours daily on the bus to get to work and back, and had to pay more for the bus tickets than he earned for a full day’s work.

Above, I have presented the foundation and steps of the Oppression Model. The staircase as metaphor illustrates the progressive temporal and structural relationship between objectifying stereotypes and institutional oppression – from private images of ‘‘the other’’ towards structural and institutionalized oppression requiring power. The steps are presented as distinct entities for didactic purposes, but in real life the processes can take place simultaneously. An important shift occurs between the steps of prejudice and discrimination: some sort of institutional power is required in order to discriminate and oppress but not to prejudice and stereotype. Prejudice and stereotypes are private constructs that can give themselves away in the doctor’s body language and clinical decisions in consultations with low-hierarchy patients. But some sort of societal power is needed to legitimize the skewed distribution of resources and unjust practices that hits vulnerable and oppressed groups.

Alternatives to oppression

This article is neither about how patients can change their role as oppressed, nor about how authorities can change doctors’ behaviours towards non-oppres- sive actions. It is about how doctors, on seeing their own role as oppressors, can choose to become allies of empowerment processes in patients instead. Theorizing is not enough; alternative modes of behaviour in clinical practice need to be tried out and to be validated in carefully designed research projects. Participatory action research designs will probably be best suited for this task.

The Oppression Model is a disturbing and negative description of how some doctors can function some of the time. It is important not to leave doctors who recognize this snapshot in a state of dismay and passivity. I therefore propose a possible alternative strategy in the form of an Empowerment Track. I consistently probed for the relevant opposites of the foundation and different steps of the Oppression Model as a guiding star in proposing an Empowerment Track.

What are the counterparts of objectifying, stereo- typing, and discriminating that can be applied by the practitioner to counteract oppression? Taken lit- erally, this could be a dangerous way of proceeding, suggesting that there are only two opposing roads, and that dichotomy is what is needed. On the contrary, I want to remind the reader that empow- erment is a highly context-dependent concept and thus many different ways can be right ways of contributing in empowerment processes.

A proposed Empowerment Track

The Empowerment Track (Figure 2) the step of acknowledgement, understood as a fundamental respect for the experiences of ‘‘the starts by other’’ in a subject–subject relation. Then follow the steps of recognizing diversity and a stance of positive regard. The consequences of this are for the doctor to focus on resources and identify strengths. Finally come the steps of solidarity and empowerment, asserting that the patient in front of us, as a fellow human being, should have the same resources and rights as we have ourselves. Below, each of these possible steps will be elaborated further.

Figure 2. An Empowermment Track. For legend, see text.

The Empowerment Track is founded not on objectifying but on acknowledgement as described by psychologist Schibbye. She explicated acknowledge- ment as being heard and seen as the person one is, as being understood, as being met with respect, and as being recognized in ways that acknowledge uniquely personal experiences [17]. Although the patient needs the doctor to sort out her/his symptoms, the cool objectifying, medical gaze is not sufficient to acknowledge her/him as a person. She/he needs to meet a healer too, another human being, someone to trust, someone to engage with.

It can be argued that the opposite of objectifying should be subjectifying, not acknowledgement. However, as a foundation for an Empowerment Track it is not enough to recognize the other as someone different from yourself: she/he needs to be recognized as someone uniquely human and as worthy of respect as yourself.

On the Empowerment Track, I might see Mrs Smith’s despair at not being able to fulfil her role as a teacher and mother in ways I can relate to and work with, and Mr Simpson as the guy struggling to cope with medication side effects, a committed relationship to John, and being a loving and present father to his sons from his first heterosexual marriage.

The next steps of the Empowerment Track, founded on the attitude of acknowledgement, emphasize the patient’s resources. On these steps, diversity replaces stereotypes, and positive regard is attributed to the patient and her/his qualities, instead of prejudice and stigma. At these steps, the doctor opens up to the positive expectation, a strong belief that the patient has strengths and solutions

to contribute. Antonovsky’s concept of salutogenesis captures people’s own contributions to staying well in spite of being exposed to pathogenetic agents [18]. Hollnagel & Malterud elaborated the salutogenesis concept with a patient-centred model, drawing attention to patients’ self-assessed health resources [10]. For example, signalling in various ways to Ms Thompson that I do not assume heterosexuality could create space for her to talk about the loss of the love of her life. Listening carefully around Mrs Smith’s fear of a brain tumour could reveal good as well as not-so-good reasons for her fear, and teach me about her coping strategies when in panic. And so on.

The final steps of the Empowerment Track are solidarity and empowerment, as opposed to discrimi- nation and oppression. In this context, solidarity means to convey to the patient that she/he deserves and should receive the same resources and rights that we have. It captures the meaning of Prilleltensky’s concept ‘‘reciprocal empowerment’’ [2], where solidarity in practice can be listed as the actions and power to give to self and others equal ability to define identity, equal and sufficient resources, and an equal voice in society.

Discussion

Limitations and weaknesses of the model

Although the Oppression Model has been developed for a specific purpose and context – the clinical consultation – the underlying foundations are not original and have been articulated by other authors. An example is philosopher Honneth, who describes similar processes in his book ‘‘The struggle for recognition’’ [19].

Models can be dangerous. They can lock the mind and blind people to the unexpected, to what is different, to new developments, to what does not follow the rule of the model. Another danger in using the Oppression Model is the misunderstanding that objectifying, categorizing, diagnosing etc. neces- sarily are bad practices that are to be avoided. An example illustrates this point: failing to diagnose anaemia, depression, or hypothyroidism in a for- merly dismissed woman misdiagnosed as having chronic fatigue is just as detrimental to patient health as stereotyping and stigmatizing patients with conditions like chronic fatigue, liver cirrhosis, fibromyalgia, or HIV infection.

The Oppression Model is most relevant when meeting low-status patients from vulnerable and marginalized groups who regularly experience oppression, of which psychiatric patients serve as an example.

Finally, even when we take acknowledgement as a starting point and keep our minds set on positive expectations, there still are patients who are very hard to like, and some who even want illegal or immoral services from us. In my experience, they are very few. How to behave in such situations is beyond the scope of this article.

Consequences of accepting the Oppression Model as a valid description

When being accused of oppressive professional behaviour most doctors would probably reject the claims and say that some (other) doctors may behave badly, or that the patients are difficult or have misunderstood.

I have presented the Oppression Model to facilitate awareness of the forces at play by high- lighting the double-edged sword of objectifying and categorizing: on one hand an invaluable tool in diagnosis, on the other hand the point of departure for stigmatizing behaviour. The Oppression Model presents clinicians with the unpleasant fact of how, in some medical meetings, the doctor can act and be perceived as an oppressor. Acknowledging this, the clinician can choose to accept the state of affairs with various justifications. Or, he can choose to take up the professional challenge of trying out various Empowerment Tracks. Clinicians might choose the empowerment tracks the more closely the patient resembles themselves or people they admire. The Oppression Track predominates when patients belong to stigmatized groups low in medical and societal hierarchies. Hunter reminds us that moral knowing is not separable from clinical judgment

By being aware of these mechanisms, we as clinicians have more freedom to choose who we want to be in medical encounters, and thus stay human ourselves [21,22].

References

[1] Thesen J. Being a psychiatric patient in the community: Reclassified as the stigmatized ‘‘other’’. Scand J Public Health 2001;29:248–55.

[2] Prilleltensky I, Gonick L. Polities change, oppression remains: On the psychology and politics of oppression. Political Psychology 1996;17:127–48.

[3] Engel GL. The need for a new medical model: A challenge for biomedicine. Science 1977;196:129–36.

[4] Emanuel EJ, Emanuel LL. Four models of the physician– patient relationship. Jama 1992;267:2221–6.

[5] Levenstein JH, McCracken EC, McWhinney IR, Stewart MA, Brown JB. The patient-centred clinical method, 1: A model for the doctor–patient interaction in family medicine. Fam Pract 1986;3:24–30.

[6] Waitzkin H. The politics of medical encounters: How patients and doctors deal with social problems. New Haven, CT: Yale University Press, 1991.

[7] Candib LM. Medicine and the family. New York: Basic Books, 1995.

[8] Fugelli P. James Mackenzie Lecture. Trust – in general practice. Br J Gen Pract 2001;51:575–9.

[9] Malterud K. Symptoms as a source of medical knowledge: Understanding medically unexplained disorders in women. Fam Med 2000;32:603–11.

[10] Hollnagel H, Malterud K. Shifting attention from objective risk factors to patients’ self-assessed health resources: A clinical model for general practice. Fam Pract 1995;12: 423–9.

[11] Anon . World Health Organisation [Home page on the Internet]. Ottawa Charter for Health Promotion [cited 28 August 2004] [available at: http://www.who.int/hpr/NPH/ docs/ottawa_charter_hp.pdf].

[12] Skjervheim H. Objectivism and the study of man. Oslo: Universitetsforlaget, 1959.

[13] Goffman E. Stigma: Notes on the management of spoiled identity. Harmondsworth: Penguin, 1968.

[14] A ̊ s B. Kvinner i alle land … Ha ̊ndbok i frigjøring [Women in all countries … Manual in liberation]. Oslo: Aschehoug, 1981. 42–73 (in Norwegian).

[15] A ̊s B. The five master suppression techniques. A theory about the language of power. Video, english subtitles. Va ̈ xjo ̈ : Municipality of Va ̈ xjo ̈ Equal Opportunities Committee, 1997.

[16] Young IM. Justice and the politics of difference. Princeton, NJ: Princeton University Press, 1990.

[17] Schibbye ALL. The role of ‘‘recognition’’ in the resolution of a specific interpersonal dilemma. J Phenomenological Psychol 1993;24:175–89.

[18] Antonovsky A. Unraveling the mystery of health: How people manage stress and stay well. San Francisco: Jossey- Bass, 1987.

[19] Honneth A. The struggle for recognition: The moral grammar of social conflicts. Cambridge: Polity Press, 1995. [20] Hunter K-M. Narrative, literature, and the clinical exercise of practical reason. J Medicine and Philosophy 1996;21

[21] Marinker M. Medicine and humanity. London: King’s Fund, 2001.

[22] Deegan PE. Spirit breaking: When the helping professions hurt. Humanistic Psychologist 2000;28:194–209.

 

Related:

Original article in full
From Oppression to Empowerment in clinical practice- offering doctors a model for reflection – Janecke Thesen

Staircase of Oppression- Angela Sun at TEDxKids@BC:
https://amara.org/en/videos/afc84yj8j4za/url/808682/

The Experience Study
https://recoverynet.ca/2017/02/21/experiences-of-being-a-psychiatric-patient-in-the-community-reclassified-as-other/

Posted in Ideas | Leave a comment

Recovery as a Self-Directed Process of Healing and Transformation By: Patricia E. Deegan Ph.D.


The word “recovery” has now stuck onto every sentence uttered in mental health services just so we’ll know just how “recovery oriented” everything and everyone has now become.

“Recovery oriented” is now an established branding but just what does that mean?
And what do they mean by “recovery”? 

In this article Pat Deegan shares at some length, her journey of how she started to struggle,  how things started to take a strange turn for her, then how others – adults – took charge and decided that she was ill and that they needed to take control of and set limits on her life.

At centre is three diagrams used to signal three stages: before diagnosis, after diagnosis, and recovery. But, this is a very different idea of recovery – a process of learning, growing, of trial-and-error, and transformation.

She tells how she remembers clearly a key moment when she was being told by a babbling doctor how she was now an illness. In instinctively rejecting this imposition of identity she found a resolve and an idea for a different story for her life than the one the doctor was prescribing for her, one of  finding her power, learning to take charge of her own life, and fixing mental health services so people would not need experience what she had.
She also tells of how even with that resolve and energy and with the powerful sense of change she now felt inside, it would take some time for others to be able to notice – there would be many more months of  “coke-and-smoke syndrome” before she would one day  took up her grandmother’s  invitation that she made daily with great patience and joined her shopping.

That first step led in time to more small steps, exploring, finding what works for her, developing strategies for living and especially for living with vulnerabilities that she could learn to recognise were part of her, part of her life.

As she did she noticed in time how some of the experiences that would hitherto have given rise to her having great difficulty no longer would. She had grown, learned, was growing, learning. Becoming confident in deciding for herself what she needed, and how to turn her dream into reality,  all part of becoming a full person. As she says this is quiet different from the story that services prefer we fall in with so they can tell themselves the story that they are doing a good job.

Recovery is intensely personal. and it is bloody difficult.
Nobody can give it to you and nobody can tell you what yours is.
For Pat and many others it’s about self-directed,  interdependent full person able to make own life our way transformation far from going back to make like a lamppost, but about embarking on a journey into the unknown and becoming who we can be.

The article rounds off with some suggestions of how workers and services can play their role in supporting people as they make their self-directed journey of transformation.

No amount of rebranding and slogans and swag can bring about the kind of real systems change that so many can see we need in mental health services.
KH

Recovery as a Self-Directed Process of Healing And Transformation

-Pat Deegan

[Abridged ver.

“Recovery is often defined conservatively as returning to a stable baseline or former level of functioning. However many people, including myself, have experienced recovery as a transformative process in which the old self is gradually let go of and a new sense of self-emerges. In this paper, I will share my personal experience of recovery as a self-directed process of healing and transformation and offer some suggestions as to how professionals can support the recovery process.

One: Pat Before being diagnosed 

First of three stages in which Pat Deegan uses the imagery of a flower with petals to tells her story of how the way she was perceived by others, and how she saw herself in three stages:  before, then after diagnosis and then in her recovery-transformation. A journey of  promise then of finding herself struggling, others taking control and deeming her “ill”, ceding identity to an illness,  being given a prophesy of doom, than rejecting that prophesy and within that finding energy and resolve to begin finding her way to becoming –  through spirited fight, growth, transformation and emerging as a full person- as Pat. 

“The illustration below symbolizes how I experienced myself and how others perceived me, before I was diagnosed with schizophrenia.

“The most immediate impression of this symbolic flower is its integrity and wholeness. This represents the fact that before being diagnosed with mental illness there was a basic congruity between how I understood myself and how others perceived me.

“I was the oldest child in a large working-class Irish Catholic family. My friends, my social role as a worker and student, my spirituality, values and beliefs, culture, family and socio-economic class all converged to form the unique individual I was at seventeen years old.

“It was precisely because my future was unknown that I could project my hopes, dreams and aspirations into it. That is, hope arises in relation to an open, ambiguous and uncertain future.

“The image of me as a whole, unique and promising young person began to crumble during the winter of my seventeenth year. Even now I can vividly recall some aspects of the emotional distress I began to experience.

“For instance, during basketball practice it became harder and harder to catch a ball. My depth perception and coordination seemed strangely impaired and I found myself being hit in the head with passes rather than catching the ball. Objects around me also began to look very different. Countertops, chairs and tables had a threatening, ominous physiognomy. Everything was thrown into a sharp, angular and frightening geometry. The sense that things had utilitarian value escaped me. For instance, a table was no longer something to rest objects upon. Instead a table became a series of right angles pointing at me in a threatening way.

“A similar shift in my perception and understanding occurred when people spoke to me. Language became hard to understand. Gradually I could not understand what people were saying at all.

“Instead of focusing on words, I focused on the mechanical ways that mouths moved and the way that screwdrivers had taken the place of proper teeth. It became difficult to believe that people were really who they said they were.

“What I remember most was the extraordinary fear that kept me awake for days and the terrible conviction I was being killed and needed to defend myself.

“The adults around me eventually decided that I had “gone crazy,” and I soon found myself being escorted up a hospital elevator by two men in white uniforms. Once in the mental hospital, I was diagnosed with schizophrenia.

Two: Pat After Diagnosis

2. As viewed by those around me once I had been diagnosed

 

 

 

“Whereas before being diagnosed I was seen as a whole person, after being diagnosed it was as if professionals put on a pair of distorted glasses through which they viewed me as fundamentally ill and broken.

it was as if professionals put on a pair of distorted glasses through which they viewed me as fundamentally ill and broken.

“The jagged lines represent the distorted lens through which I was viewed. It seemed that everything I did was interpreted through the lens of psychopathology.

It seemed that everything I did was interpreted through the lens of psychopathology.

“For instance, when growing up my grandmother used to say I had ants-in-my-pants. Now, in a mental hospital, I was agitated.

“I never cried very much while growing up, but after diagnosis I was told I had flat affect.

“I was always quiet, shy, and introverted. Now I was guarded, suspicious and had autistic features.

“And in a classic double-bind, if I protested these pathologized interpretations of myself then that was further proof because I lacked insight!

“Notice also in the first illustration there was congruity between how I viewed myself and how others viewed me but after being diagnosed there was a lack of congruity. That is, although I was severely distressed, I still felt that deep down I was myself – Pat.

“However, the professionals and later my family and friends, seemed to forget about Pat and were now more interested in “the schizophrenic”.

“This is symbolized by the substitution of a diagnosis for my name in the center circle.

 “What mattered most to psychiatrists, social workers, nurses, psychologists and occupational therapists was that I was “a schizophrenic”. My identity had been reduced to an illness in the eyes of those who worked with me.

My identity had been reduced to an illness in the eyes of those who worked with me.

“It was only a matter of time before I began to internalize this stigmatized and dehumanized view of myself.

Dehumanization is an act violence

When we diagnose, we objectify and dehumanize : we set a person apart from us, apart from humanity. We deny and remove their persnhood, reduce them to “it”. This is an act of violence. 

“Dehumanization is an act of violence, and treating people as if they were illnesses is dehumanizing. Everyone loses when this happens.

Dehumanization is an act of violence, and treating people as if they were illnesses is dehumanizing. Everyone loses when this happens.

“People, especially people who are feeling very vulnerable, internalize what professionals tell them. People learn to say what professionals say; “I am a schizophrenic, a bi-polar, a borderline, etc.”.

“Yet instead of weeping at such a capitulation of personhood, most professionals applaud these rote utterances as “insight”. Of course the great danger of reducing a person to an illness is that there is no one left to do the work of recovery.

“Notice that the empty petal is missing from Illustration 2. This symbolizes the fact that because of my diagnosis professionals lost hope that I could have a meaningful future.

“I recall the day this happened for me: I asked my psychiatrist what my diagnosis was. He looked at me from behind his desk and said,

“Miss Deegan, you have a disease called schizophrenia. Schizophrenia is a disease like diabetes. Just like diabetics have to take medications for the rest of their lives, you will have to take medications for the rest of your life. If you go into this halfway house, I think you will be able to cope.”

“Coping is definitely not what a teenager wants to do on a Friday night!   I was not at all inspired by the thought of a life spent coping. I remember feeling like I had been hit by a truck upon hearing his words.

Coping is definitely not what a teenager wants to do on a Friday night!

A Turning Point: Survivor’s mission

On how the energy she felt from her survival instinct – her rejection of the doom prophesy generated the determination to follow the dream of who she could become, and the role and place she could make in the world.

“I remember feeling like I had been hit by a truck upon hearing his words.

“As the psychiatrist continued to babble on, I felt a surge of anger rising up within me. Although I knew better than to get too angry in a psychiatrist’s office, I found the words forming silently inside me:
“You are wrong. I’m not a schizophrenic. You are wrong!”

“Today I understand that this psychiatrist did not give me a diagnosis. He gave me a prognosis of doom.

Today I understand that this psychiatrist did not give me a diagnosis. He gave me a prognosis of doom.

“Essentially this psychiatrist was telling me that by virtue of the diagnosis of schizophrenia, my future was fait accompli. He was telling me the best I could hope for was to cope and remain on medications for the rest of my life.

“He was saying my life did not open upon a future that was ambiguous and unknown. He was saying my future was sealed and the book of my life had already been written nearly 100 years earlier by Emil Kraepelin (1912), the psychiatrist who wrote a pessimistic account of schizophrenia that influences psychiatrists even to this day. According to Kraepelin my life, like the life of all schizophrenics, would be a chronic deteriorating course ending in dementia (Kruger 2000).

“With the wisdom of hindsight, I understand why this moment in the psychiatrist’s office was a major turning point in my recovery process.

“When I rejected the prognosis of doom I simultaneously affirmed my worth and dignity. Through my angry indignation, I was affirming that “I am more than that, more than a schizophrenic.”

“Importantly, it was my anger that announced the resurrection of my dignity after it had been so battered down during hospitalizations. My angry indignation was a sign I was alive and well and resilient and intent on fighting for a life that had meaning and hope.

“What some would have seen as denial and a lack of insight into my illness, I experienced as a turning point in my recovery process. Rejecting the hopeless prognosis through angry indignation happened almost like a reflex.

“And just as quickly as I turned away from the prophecy of doom, I found myself asking – so now what? In other words, I turned away from a hopeless path but also, at the same time, had to turn toward something.

“What I remember was that when I left the psychiatrist’s office, I stood in the hallway and had an image in my mind’s eye of a big heavy key chain – the type carried by the most important and powerful professionals who have the keys to all the hospital doors. I found myself thinking, “I’ll become Dr. Deegan and I’ll make the mental health system work the right way so no one else ever gets hurt in it again.” And this plan became what I have come to call my survivor’s mission.

“Yes, it was a grand dream that would have to be molded and modified with time and maturity. But it was my dream nonetheless and it became the project around which I organized my recovery. I did not tell anyone about my dream. In hindsight, this was very wise.

“I wish I could say that having found a survivor’s mission I resolutely marched forward in my recovery. But recovery does not strike like a bolt of lightening wherein one is suddenly and miraculously cured.

recovery does not strike like a bolt of lightening wherein one is suddenly and miraculously cured.

Powerful change within, as yet no visible change on the outside

Though Pat was herself now able to sense a great shift within and begin to see the possibility of a different future than the one she was being offered, it was yet to translate to changes others might notice in her behaviour.

“The truth is, when I returned home after that transformative experience, I proceeded to sit and chain smoke in the same chair I had been sitting and smoking in for months. In other words, although everything had changed within me, nothing had changed on the outside yet.

“Here is what people would have seen me doing at that time in my life:

“I turn my gaze back over the years. I can see her yellow, nicotine-stained fingers. I can see her shuffled, stiff, drugged walk. Her eyes do not dance. The dancer has collapsed and her eyes are dark and they stare endlessly into nowhere…
She forces herself out of bed at 8 o’clock in the morning.
In a drugged haze she sits in a chair, the same chair every day.
She is smoking cigarettes.
Cigarette after cigarette.
Cigarettes mark the passing of time.
Cigarettes are proof that time is passing and that fact, at least, is a relief.
From 9 a.m. to noon she sits and smokes and stares.
Then she has lunch.
At 1 p.m. she goes back to 10 bed to sleep until 3 p.m.
At that time she returns to the chair and sits and smokes and stares.
Then she has dinner.
She returns to the chair at 6 p.m.
Finally, it is 8 o’clock in the evening, the long-awaited hour, the time to go back to bed and to collapse into a drugged and dreamless sleep.
The same scenario unfolds the next day,
and then the next,
and then the next,
until the months pass by
in numbing succession
marked only by the next cigarette
and then the next…”

(Deegan 1993,)

“For for many months, I would live in what I came to call the coke and smoke syndrome.

For many months I would live in what I came to call the coke and smoke syndrome.

First step

Then she describes how she came to take her first “proactive”  and how it was her grand mother’s patient support and suggestion that enabled her to come to take it…

“The first truly proactive step I took in my recovery process occurred at the prompting of my grandmother.

“Each day she would come into the living room as I smoked cigarettes.

“She would ask me if I would like to go food shopping with her and each day I would say “No”.

“She asked only once a day and that made it feel like a real invitation rather than nagging.

“For reasons I cannot account for, one day, after months of sitting and smoking, I said “Yes” to her invitation. I now understand that “yes” and the subsequent trip to the market where I would only push the cart, was the first active step I took in my recovery.

Other small steps followed such as making an effort to talk to a friend who had come to visit or going for a short walk.

Bigger Steps

“Eventually it was suggested I take a course in English Composition at the local community college and I agreed. Going to college presented me with a whole new set of challenges such as managing anxiety, distressing voices and suspicions during class time as well as finding ways to concentrate in order to do homework.

At the time there were no organized self-help and mutual support groups for ex-patients so I was very much on my own in terms of developing coping strategies.

Learning to find  “what works for me” 

“Through a process of trial and error, I discovered self-care strategies that worked for me.

“For instance, I learned at a young age that street drugs, alcohol and even some over-the counter drugs such as certain types of cold medications were not good for me. I avoided these and am certain this helped my recovery.

“Relationships – especially learning to balance time alone and time with people – have always been an important self-care strategy for me. In the beginning, my relationships were quite limited and lopsided in the sense that people tended to care more for me than I did for them. Over time I learned to become more intimate with people and to develop more mutually reciprocal relationships.

“Routines were important to me, especially in the early years of my recovery. Sometimes when everything was falling apart inside of me, it was good to be able to rely on routines that would give form and structure to the chaos I was experiencing.

“Having a sense of purpose, a reason to get up in the morning and a goal to organize my recovery around were important. Studying a wide range of subjects, especially world religions, philosophy and archetypal psychology were helpful in my efforts to make sense of the experiences I was having.

“My spirituality offered me a way of finding meaning in my suffering and that in turn helped me through feelings of anguished futility, self-pity and the inevitable “why me” questions that come with difficult passages.

Tolerant environments have always been helpful in my recovery. I discovered this quite accidentally when I moved from a single rented room, into an apartment I shared with a group of ex-hippies. In that environment, my roommates were quite open to all sorts of unusual experiences and their world-view included experiences like auras, astral travel, etc. In such a tolerant atmosphere my psychotic experiences were not viewed as terribly deviant and nobody overreacted.

In such a tolerant atmosphere my psychotic experiences were not viewed as terribly deviant and nobody overreacted.

Instead, people were non-intrusive, generally kind and supportive, and they gave me the room I needed to experience my madness. In this tolerant environment I learned that although psychosis does not come with directional signs and maps, it does have a certain terrain and topography. I found that if one returns to the psychotic landscape over time, one can come to know it, to learn not to fear it, and to master ways to navigate through it.

I found that if one returns to the psychotic landscape over time, one can come to know it, to learn not to fear it, and to master ways to navigate through it.

“Learning to tolerate discomfort, anxiety and symptoms meant developing a new relationship to time. I can remember trying to make it through a one hour class and sometimes watching the clock, repeating to myself, “I can make it just one more minute.” Each success built my sense of self-efficacy and confidence in my skills to endure and persevere.

I learned to tell myself “tomorrow will come”. This phrase took on great significance for me in my recovery. Tomorrow will come meant that if today was too painful, it too would pass.

I did not find psychiatric drugs to be particularly helpful except for their capacity to help me sleep during very stressful times. I found the emotional numbing, sexual dysfunction, and overall sluggishness caused by the drugs to be more disabling at times than psychotic symptoms. The key for me was learning to use medications in conjunction with self-help strategies and overall self-care practices. The more skilled I became in using self-help, the less I relied on medications.

The key for me was learning to use medications in conjunction with self-help strategies and overall self-care practices.

The more skilled I became in using self-help, the less I relied on medications.

Later: working through a history of having been abused
This work needed to come later because as she explains she needed to be able to feel grounded and confident in her abilities to work through what would come up, and be able to be ok.

“Later in my recovery, I became willing to do psychotherapy in order to work through a history of child abuse.

This was long and difficult work and I am glad I embarked on it after I had established myself in a meaningful career and had a strong network of friends. I needed to be firmly planted in the present as an adult, in order to look back at the trauma in my childhood. In the course of doing the trauma work. I sought out the help of an occupational therapist who specialized in sensory defensiveness in adults. She helped me learn a myriad of coping strategies including use of a sand blanket, joint compression, tactile brushing, and the use of a sensory diet to help me modulate sensory input and affective arousal. These strategies have proved tremendously helpful and are a part of my everyday recovery “toolkit”.

Reflecting on and sharing some personal self-help strategies

Shares some of the strategies she developed and that she found work for her.

“I developed many self-help strategies that made it possible to cope with a myriad of symptoms. For instance, I learned to use headphones and earplugs to stop the distressing voices I heard. I learned to avoid certain types of situations and subjects that would lead me into the vortex of delusional thinking.

“Physical exercise, especially daily walks in the woods, remain an important self-help strategy for me.

“Overall physical health, a good diet, a willingness to pace myself and to get sleep were all important strategies that I learned and refined over time. For me, recovery meant learning to overcome the shame and stigma I had internalized. Like many people in the early stages of recovery, I saw becoming normal as a goal.

For me, recovery meant learning to overcome the shame and stigma I had internalized. Like many people in the early stages of recovery, I saw becoming normal as a goal.

“I remember going through a phase where I measured my wellness by how little medication I took and how few mental patients I was associated with. In fact, there was a time when I refused to be around people with psychiatric histories. I thought the further I could get away from them, the further I could distance myself from my own history. For many years I settled for simply “passing” as a normal person.

Pressure to remain in the closet

Pressure – from within, to stay away from others who were struggling in similar ways,  to stay quiet, and how that lead to having to deal with everything alone; and the pressure from without, from others. 

“The pressure to remain in the closet about my psychiatric history did not come just from me. There was a good deal of social pressure to keep my psychiatric history a secret. For instance as a student in graduate school there was the unspoken rule that if you had a psychiatric history there was no way professors would allow you to become a clinical psychologist.

“I hid my psychiatric history and that meant reliving many traumatic memories with no support. For instance, I remember doing my first internship in a state hospital and on the first day having a panic attack when the heavy metal door slammed shut behind me. I can remember freezing in a type of flashback when I witnessed a person being dragged into restraints. Only a few years ago that had been me! Living in the closet meant I had to work through this part of my professional development alone. I found living in the closet was the same as living a lie. I grew tired of being ashamed.

Living in the closet meant I had to work through this part of my professional development alone. 

I found living in the closet was the same as living a lie. 

I grew tired of being ashamed.

Three: A whole person

3. recovery: I am a person, not an illness

“By the time I had finished my doctorate I began to meet psychiatric survivors and activists who had recovered. Meeting these friends was an epiphany for me. They taught me it was not my problem the world insisted I be either a clinical psychologist or a mental patient.

“It was not my problem people insisted I wear one hat or the other in order to make them comfortable.I was a whole person.
I was a person with a psychiatric history who was also a clinical psychologist.
If the world did not have a category for that, then that was the world’s problem, not mine.
I did not have to live in the closet so others would feel comfortable.
And importantly,
I was not alone.
There were others like me and if we supported one another, we could lead our lives with pride.

“Notice that one new petal has been added to the flower, vulnerabilities. I do not feel I have a residual mental illness that is in remission and that may get activated at some later time.

Living with vulnerabilities

“However, like most people, I live with certain vulnerabilities. I still use my self-care strategies on a daily basis in order to stay well.

“I am a person, not an illness. I can use what I have learned through my recovery to continue to lead a whole and vibrant life.

I am a person, not an illness.

“Recovery has been a process of healing and transformation for me. I am not the same person I was before I went crazy. My madness has been a kind of fire through which I have walked and through which I have been changed.

Recovery has been a process of healing and transformation for me.

I am not the same person I was before I went crazy.

My madness has been a kind of fire through which I have walked and through which I have been changed.

The powerful dominant narrative of ‘Recovery as Restitution’

There were times in the early years when all I wanted was to go back to who I had been. I wanted to go back to high school and pursue that dream of becoming an athletic coach. I wanted to go back and “feel like myself again”. This wish to return to the former self is understandable and is called a restitution narrative by Frank (1995).

“The restitution narrative is a story that some people tell about their recovery. Its basic storyline is: “Yesterday I was healthy, today I am sick, but tomorrow I will be healthy again.” The phrases “good as new” and “I feel like myself again” capture the essence of the restitution narrative. Frank notes that restitution narratives are most often told by people were recently ill and least often by those with long-term conditions.

“The restitution narrative does not tell the story of the struggling self, but rather is a testament to the expertise of professionals and their technologies that have “fixed” the problem.
This type of narrative is the preferred narrative of the medical professions, as well as the powerful interest groups/industries behind medicine.

“The restitution narrative permeates our culture in a myriad of ways. TV advertisements, infomercials, brochures 19 in doctors’ offices, and drug advertisements in magazines, newspapers and professional journals all tell of the restorative wonders of medications.

“For instance, in a mainstream psychiatric journal a 1996 advertisement for an anti-depressant drug shows a little girl with a big smile, racing her energetic mom up the stairs in their home. In bright crayon colors, a note from the child reads: “I got my mommy back”. Then comes the name of the drug with the middle letter in bright crayon color. The restitution storyline is clear: Depression came, the medicine worked and then this mom was restored to her family as good as new.

“Through the power of such images and advertising, the restitution narrative has become a cultural expectation of how all illness should end happily ever after.

Through the power of such images and advertising, the restitution narrative has become a cultural expectation of how all illness should end happily ever after.

…does not hold true for many

‘For those of us who have struggled for years, the restitution storyline does not hold true.

For those of us who have struggled for years, the restitution storyline does not hold true.

“For us, recovery is not about going back to who we were. It is a process of becoming new. It is a process of discovering our limits but it is also a process of discovering how these limits open upon new possibilities. Transformation rather than restoration becomes our path.

Transformation narratives emphasize the agency of the self in the healing process as opposed to crediting professionals with curative powers.

The task of professionals and services

“In this light, the task of mental health professionals becomes one of supporting people and helping them build skills and a sense of agency. Helping people learn to become self-directing as opposed to compliant, is a goal of the recovery process.

Helping people learn to become self-directing as opposed to compliant, is a goal of the recovery process.

“Because recovery is a unique journey for each individual, there is no cookbook approach. Mental health professionals must explore the special gifts and resources of each individual and help them mobilize these resources in the service of recovery. Begin with asking people what they already do to cope with various distressing symptoms.

Begin with asking people what they already do to cope with various distressing symptoms.

People are more than their diagnoses. People diagnosed with mental illness are resilient and are more than passive victims of disease processes.

People are more than their diagnoses. People diagnosed with mental illness are resilient and are more than passive victims of disease processes.

“Professionals who learn to collaborate with the active, resilient, adaptive self of the client will find themselves collaborating in new and rewarding ways with people who may have been viewed as hopeless by others who reify diagnoses and related prophecies of doom. There is hope for recovery.

There is hope for recovery.

“We can no longer justify the pessimism and prophecies of doom that surrounds diagnoses like schizophrenia. We now have seven long-term studies that ground our hope for recovery in empirical findings…
Each of the seven long-term studies has large cohorts of between 140 – 502 research participants diagnosed with major mental illnesses. The length of study during which the research participants were studied ranged from 22 years – 37 years.

The recovery rate in these seven long-term studies ranged from 46% to 68%. That is, half to two-thirds of people diagnosed with major mental illnesses were found to show significant or complete recovery over time.

Even in the second or third decade after being diagnosed, people still go on to significant or full recovery. We should never lose hope (Harding and Zahniser 1994). Recovery is not the privilege of a few exceptional clients.

Recovery is not the privilege of a few exceptional clients.

We can now tell people the good news that empirical data indicate most people do recover. Since there is no way to predict who will or will not recover, we should approach each person as being able to recover if given sufficient opportunity to build skills and supports.

We can now tell people the good news that empirical data indicate most people do recover.

… we should approach each person as being able to recover if given sufficient opportunity to build skills and supports.

In this way, professionals can stop the iatrogenic wounding of hopelessness and begin working with clients on that the transformative journey of recovery.

More of the full article:                Full article here
More pat Deegan articles:           click here
More Pat Deegan:                         PatDeegan.com

 

Posted in Abuse, Emancipate yourself..., Ideas, my story, psychosis, recovery perspectives | Leave a comment

Workshop#1: Accepting Voices – Thu 29th Nov 2018


Pleased to announce, in community partnership with Inner City Family Health Team, this special opportunity to participate in our highly valued “liberating” , emancipatory”,  even “universe-tilting” Workshop #1: Accepting Voices.

This workshop offers a beginning, an introduction to a non-diagnostic, non-medical,  human experience perspective understanding of the kinds of experiences – like difficult-to-hear voices- that are often categorised as “psychosis”.

A key part is making connections between pain, trauma psychosis powerlessness and disconnectedness we can experience when we find ourselves feared and discarded by society.
Continue reading

Posted in Event, Healing, hearing voices, human diversity, Ideas, making sense of "mental illlness", psychosis | Tagged , , , , | 1 Comment

blah blah blah – Armin van Buuren


All we ever hear from you is blah blah blah
So, all we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah blah blah

Blah Blah Blah  – Lyrics

Armin van Buuren

 

State of trance, how you feelin’?
If you’re ready for this let me see those hands and
Clap, clap come on
All we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah blah blah
All we ever hear from you is blah blah blah
So, all we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah blah blah
All we ever hear from you is blah blah blah blah blah blah
All we ever hear from you is blah blah blah
So, all we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah blah blah
All we ever hear from you is blah blah blah
So, all we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah
All we ever hear from you is blah blah blah
So, all we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah blah blah
All we ever hear from you is blah blah blah
So, all we ever do is go ya ya ya
And we don’t even care about what they say
‘Cause it’s ya ya ya ya
Blah blah blah blah
Songwriters: Armin van Buuren / Joshua Peter Record / Andrew James Bullimore
Blah Blah Blah lyrics © Warner/Chappell Music, Inc
Posted in Uncategorized

Hearing Voices Group Toronto | Fall 2018


Ninth year. new location!
We’re moving downtown.

  • The Where
    Inner City Family Health Team – ICFHT
    4th Floor
    69 Queen St East 
  • The When
    Dates –  see poster
    Times-  6:00pm to 7:30pm

Note:
1. Take the stairs or the the smellyvator to 4th floor.

2. ICFHT operates a clinic on Thur eves which we’re not part of.  You’ll come through reception and sign in/out – be nice eh?

More about Inner City FHT : innercityFHT.ca

  • The WTF?
    What’s a hearing Voices Group?

    A Hearing Voices Group is not a clinic,
    not treatment,
    not a service,
    not a program,
    NOT an intervention.
    It is just people who get told their experiences are “not real”  Doin it for themselves… 
  • What you don’t need
    You don’t need a referral – because we don’t take them.
     

What do we mean by Hearing Voices?


Hearing voices as experience

“Voices” is sometimes literal – we hear voices you don’t- voices you might think are “not there” to be heard just because you don’t hear them does not make them “not there”, “not real”, it just means you don’t hear them.

Sometimes it’s metaphorical, or simply does not presuppose that voices must come from human bodies – the universe has many voices.


Hearing Voices as approach

Sometimes “hearing voices” is a broad term for an approach/ outlook/ worldview that can be used to embrace a whole bunch of experiences that have been made taboo and are often dismissed  as “not real” and/or “abnormal” but which are actually so common they are better / more usefully be classified as “pretty  bloody ordinary indeed”.

  • 75% Three-in-four humans will hear a voice no one else hears at least once – often around challenging life events, like loss of a loved one
  • 50% of people in long term marriage heard, saw, otherwise sensed the presence of their deceased spouse 
  • 22% of young people
  • About 10% of all people hear voices regularly
  • Two thirds of world leaders at the 1943 Quebec Conference did 
  • Even 38% of Doctors do it…

The majority of people who hear voices never need seek help: they find the experience valuable, useful, even enjoy it, and find it helps them in their life or work – eg many, many  writers do.

Culture shapes our experiences , research shows how people living on different continents experience voices differently.

In some cultures it is those who do not hear voices , and do not talk about it who are regarded as giving cause for concern.

In fact, if you don’t hear voices sometimes then maybe you’re missing out.

As for those who do struggle… it is often because they feel disempowered and disconnected from others , isolated. 

About 80% have experience adverse experiences like abuse, neglect, bullying in their youth.

A person given a diagnosis of “psychosis” is fifteen times more likely to have been abused as a child than a person with no psychiatric diagnosis.

sh!t is f#cked

The last two alone suggest how much this Sh!t is f#cked .

…and how much we need find our compassion.

Difficult-to-hear-voices always make sense in context of the whole-life of the person who hears them- so long as we make time and allow ourselves to really listen then we can understand.

Hearing Voices is not just about “voices”…


If you sometimes hear voices, hear other things, see things, smell things, feel things, think things that others don’t and when you try to talk top them about it they get their freak on, then give us a try because we do to.

We talk about “hearing voices” because it’s descriptive of the most common of the kind of experiences that get called names like “psychosis”. I hear voices [you don’t], its that simple.

It also tends to be the one that scares more people more shitless so they want to control and treat us like crap because they do.

Why do some people struggle? people who feel disempowered by their experience of voices are often disempowered in other aspects of their life. If we work on those, the voices can change. if we work with our voices, it can get easier to change things in our life we need and want to change.

Who can come?

if you hear voices...If you want to come, come.
If you’re only coming because someone else told you to come, then try asking them 

“have you realised how much you  sound like a ‘command hallucination’?

We are totally non-medical, non-diagnostic.

We’re a full charter hearing voices group.


The voices are real

The voices arereal
– as real as real can get.

We know that you don’t make ’em up and we know it can be a pain-in-the-ass –  almost as much of a pain-in-the-ass as pain-in-the-ass humans can be a pain-in-the-ass -or arse if you prefer.teh voices are real

We also know it can be valuable and funny and sad and insightful and scary and everything else that life can be.

If you’re struggling and want to try something new
we can share some stuff that you can try – some is really simple, some bloody hard, some might work for you, some might not. Nothing works if you don’t try it.

The only way to find out what works for you is if you try it .

 

Voices change


You can, if you want to, change how you experience whatever you experience, that includes voices. 

The Hardest Thing…

the hardest thing...

The hardest thing that people who hear voices have to deal with…

Our Hearing Voices group is one place you can find we try hard to not treat each other that way.

We choose not to …
-use diagnostic or medical language
-tell you what’s wrong with you, what to call yourself,  or who you are

We choose instead …
-to listen,
-to share what works for us, how we make sense of our own experience.

we envision a society that understands

We envision and enact a society that understands voice hearing, supports the needs of individuals who hear voices and views them as full citizens.
This type of society is not only possible it is already on its way.

We believe all  human experience is meaningful and understandable – if only we make time to listen, and to figure out what it means to us.

We believe the hearing voices approach is emancipatory…

Emancipatory for people who hear voices…

If I hear voices they are “my” voices: mine because it’s…

  • me who gets to hear them
  • me who gets to choose what they mean to me  
  • me who gets to choose what I do about what they say

Emancipatory for people who support loved ones who who hear voices and emancipatory for workers and for clinicians too…

seriously-folksFree yourself from the doctrinaire nonsense that says the people you care about hear voices because they haven’t taken enough tablets,  or had enough chemicals injected into their buttcheeks, that they can’t do anything for themselves, that they can’t learn and live a life worth living, and that that your role is confined to sneaking around their back and checking up on them to make sure they take their drugs.

“Hearing Voices” is not about “mental illness”

Hearing Voices is not about “mental illness” – whatever that is.
It’s not even really about illness.

It is a global emancipatory human rights movement, in 35 countries on all continents…
but mostly it’s about being human.

Heck, Canada even has a voice hearing former Prime Minister on its money…

hvgroup-to-charter-sep2016Charter

Here’s our charter – what we’re about.

Print pdf: hvn-toronto-group-charter

 

 

 

 

Big Tom Hanks
Big Up and Big Thanks to Houselink Community Services for granting us use  of their spaces  for eight years!

Poster/Flyer
please feel free to print share our poster .
Printer friendly version here: HV Group Toronto-Poster-FALL2018

Posted in Event, hearing voices, Ideas | Tagged ,

R.E.S.P.E.C.T. | Aretha Franklin


Posted in music | Tagged

Hearing Voices Cafe Toronto – Fall 2018


Hearing Voices Cafe, Toronto

Hearing Voices Cafe is open to all – we invite you to join us in a different kind of conversation about what it means to experience being human in this world.

Many human experiences like hearing voices have, in our culture, been mystified and made taboo and yet are remarkably common. Making experiences harder to talk about makes experiences harder to live with and harder to learn how we might live with them.

This leads to more of us struggling including individuals and families supporting their loved ones.

Hearing Voices Café is rooted in the simple belief that we can come together to talk about difficult human experiences in ordinary language and in ordinary places – so we do.

Join us for a different kind of conversation about what it means to be human in this world.


When

We meet monthly – [usually] first monday of the month, 6pm to 8pm.
Note we take a rest in Aug.

See the poster for forthcoming dates. We begin our fourth year in Sep 2018.


What is a Hearing Voices Cafe?

Hearing Voices Café Toronto-Pamphlet-Jan2016For more information see this pamphlet:
Hearing Voices Café Toronto-Pamphlet-Jan2016

 


Hearing Voices Cafe on the radio

“many social movements have their origins in cafes and coffee shops…”

Here’s a brief segment from CBC Radio’s Metro Morning with Matt Galloway  aired on Tue 3rd Nov 2015.
Reporter-Editor Mary Wiens spent time talking with folks at The Hearing Voices Cafe, Toronto. Many thanks to Mary, Matt, at Metro Morning and to Sue and David at Coffee and All that Jazz.

Hearing Voices Cafes in other cities

The first HV Cafe was in Hamburg. Toronto was the second – but the first to become a regular feature in the landscape.

There are now others :

Toronto | Valladolid | Paris | Madrid | London  |]
Calgary  | Oshawa

HV cafe

Artist Dora Garcia is the cosmos-rocking creative force behind bringing people together this way. For more information check out here…  HV Cafe and more links at the foot of this post.

 

Please support us: print and share our poster 
pdf: HV Cafe poster Fall 2018

Posted in Event, Ideas

“Consensus reality” is Major Major reality reality…


‘Experiences that fall outside of “consensus reality”…’

Tis an odd thing to say, eh?

There is no such thing as “consesus reality”.
For sure, when it comes to “mental health”
there is no consensus
-anywhere.
Maybe that’s a good thing.

There is instead a great many
seeking to impose
their language,
their world view,
their ‘reality’
their will
…upon others.

Consensus does not mean:
“I think we can all agree [with me]”

Consensus requires that everyone give their consent
– that is what it means.

Consensus =    consent + consent + consent + consent + consent
…………….+ consent + consent + consent + consent + consent
…………… etc.

Consensus does not mean “majority”
-especially the kind of majority declared without an actual vote or count.

Consensus is many acts of giving consent
and consent is a conversation.

So for there to be anything like a  consensus reality
that mans about 7,500,000,000,000 people need to give you their consent
that your idea of reality is the one we’ll call “the consensus reality”.
How’s that working out for you?

When people use terms like  “consensus reality”
and especially terms like “outside consensus reality”
what they seek to do
is impose their idea or version of reality on the rest
– and especially upon those they deem “outside”
their reality.

Majority reality is, maybe more accurate term, as in:
“This is the reality I’m  in
and it’s the reality that the people I know are in
the reality people like me are in,
and so it must be  reality:
“The One Reality”
and you you should be in too.

It’s an exertion of power,
an act of dominance,
an act of violence.

It’s a bit dumb.

The majority, self appointed arbiters claim “mandate” to  then ignore and dehumanize the rest, declare them illegal, declare their reality not real.
-ain’t democracy grate?

Major Major reality
Major Major lived in his own reality too and sought,
using what very little power he had from his position and rank,
to impose his will on others.
Major major fuck up
-was his reality.

Your reality is yours,
unique to you

and as real as any other.
Go reality.

Shared reality
Now we’re talking, those parts of your own unique reality reality that are yours but that you also share with others and theirs.
Sharing is good,

Difference is good too.
The differences are not wrong
– they are where we learn from and with each other.

This clip is from the Movie Catch 22 adapted from the book Catch 22 and features Major Major midst his reality reality.

 

Humberto Maturana, biologist and Nobel Prize winning biologist puts it:

“When one person
tells another what is reality
what they are doing is

making a demand
for obedience.”

https://recoverynet.ca/2017/03/16/when-one-human-being-tells-another-what-is-real/

or, if you prefer, Homer Simpson:

“Kiss my flat, plastic butt reality!”

https://recoverynet.ca/2014/05/05/kiss-my-flat-plastic-butt-reality-homer-simpson/

-The Dave

Posted in Emancipate yourself..., Ideas | Tagged , , ,