The Wandering Mind – Andrea Fella Audio Dharma ; Insight Meditation Center ; Andrea Fella
This from Mike’s blog, New Directions:
Peer Operated Recovery Treatment and Support (PORTS)
A Mental Health Recovery Model
Developed by Michael Hlebechuk
PORTS is a mental health self-directed care model that combines mental health brokerage services with a peer counseling/advocacy education program and a couple of evidence based practices that actually work. There are no outcome studies to demonstrate the efficacy of PORTS. It has never been implemented. I drafted it up in response to a question for a job interview. I firmly believe, however, that if implemented this model would help people along the road to recovery in ways we haven’t seen yet through a formal program. The 2 page draft that outlines PORTS is located at:
Here is an excerpt from the first page of the pdf linked above:
Recovery has become a major buzzword in the mental health community. Mental health systems are
beginning to focus seriously on assisting people with psychiatric disability to recover and move on
with their lives.i Scientific research has yielded practices that have an evidence base to support their
effectiveness in helping people recover from mental illness. People with psychiatric histories have
provided valuable input into system design, pointing to new treatment methods and principles that
foster their gaining productive roles in the community and having meaning restored to their lives.
SAMHSA’s Center for Mental Health Services has investigated treatment modalities that put
control into the hands of people receiving treatment. Self-directed care, person centered planning,
and consumer operated services along with evidence based practices have become the cornerstones
to achieving the promise of transforming mental health care in America in ways that promote the
dignity, respect, and recovery of the individual. The paragraphs that follow offer an example of how
various recovery-oriented treatment approaches can operate in concert to promote people moving
on with their lives.
The Peer Operated Recovery Treatment and Support (PORTS) Project lies at the core of the
proposed treatment delivery system. PORTS is a consumer-operated service program (COSP) that
provides treatment coordination and resource brokerage services. Individual customers who have
agreed to engage in a recovery plan that includes the goal of obtaining paid or voluntary
employment are referred to PORTS by the behavioral health organization. Customers are linked
with a Peer Advocate Mentor (PAM) and a Recovery Specialist. The PAM is supervised by the
PAM Project, a third party COSP. The PAM will work with the customer to develop recovery
strategies and ensure that services are provided in a dignified and respectful manner. The Recovery
Specialist is a PORTS employee who will coordinate the customer’s mental health and resource
Customers will receive a PORTS orientation within a week of being referred. During orientation
customers will hear recovery stories from individuals with similar diagnoses who have taken firm
steps to move on with their lives. They will gain hope in learning that people can and do recover
from mental illness. Customers will also learn about PORTS’ mission, self-directed care, selfdetermination
and recovery principles during this first week.
All PORTS services are delivered through a person centered planning process. Through this process
the customer develops a person centered plan with the assistance of a PORTS Recovery Specialist,
the PAM, and any individuals the customer invites to be members of the circle of support. Circles of
support are generally composed of the family members, friends, and professionals the customer
believes are most supportive. The resulting person centered plan is more than a treatment plan. It is
a life-plan; complete with the individual’s dreams and goals and steps to make them a reality. These
steps are detailed in Action Plans.
Each PORTS customer will be allotted an individual resource budget of $2,000 for the first year of
service. Through this budget customers may purchase services and supports within the community
or from a participating mental health provider to carry out an Action Plan. Take, for example, an
Action Plan with the stated goal of obtaining employment. A step toward this goal may be the
purchase of a set of clothes to wear at job interviews. The Action Plan would detail the budgeted
amount for each of these purchases. Core mental health services such as symptom monitoring,
medication management, addictions counseling, acute care and crisis services are provided by the
behavioral healthcare organization per the person centered plan and are not purchased through the
individual resource budget. Fifty percent of the funds that remain in the individual resource budget
after an annual cycle of service are carried over into next year’s budget. An additional $500 is
added to the second and subsequent year’s budgets. All brokered community services and supports
purchased through individual resource budgets must be approved by the Recovery Specialist. All
purchases over $100 must be approved by a representative of the behavioral health organization.
So, PORTS seems to be an approach to implementing person directed, brokerage style services and supports in mental health. Sounds good!
To: Members of the Oregon Consumer/Survivor Council and Interested
From: Michael Hlebechuk, Chair
Re: Meeting announcement
The next meeting of the Oregon Consumer/Survivor Council will be held
in meeting room HSB-352
located on the 3rd floor of the Human Services
Building (DHS main office), .
Minutes of the previous meeting: csc-minutes-081308
Why has the font on my blog gotten so tiny??
From MindFreedom News:
Our soldiers deserve better than a bag of pills
With suicide rates higher than they’ve ever been, the stress of combat and long deployments, the US Military should be doing everything it can to address the mental health needs of its soldiers.
Instead, soldiers in crisis are currently being offered little more than pills.
They deserve better.
They deserve alternatives to the one-size-fits-all, pharmaceutical approach to mental health.
On October 5, 2008 MindFreedom International will delivered signatures to the campaign headquarters of both Barack Obama and John McCain.
From Beyond Meds, a recovery oriented blog found here. For the whole post, go to the source.
When I was at my acupuncturists the other day I basically collapsed on the table after pounding on her office door when I couldn’t tolerate sitting in the office. I REALLY needed to lay down. I can sit in recliner type chairs but an upright chair I can last in only so long and I had reached my limit at the health food store where I had lunch before I went to accupuncture.
I learned that it was the acupuncture that made my endometriosis pain almost non-existent. It is, after all, the reason I went to the acupuncturist in the first place but I didn’t expect such rapid results. Almost totally pain free after two treatments. She told me that pain is usually the easiest symptom to treat and the rest of my hormonal issues and my basic poor health would probably take much longer to deal with.
Her diagnosis of my situation in the Chinese way of interpreting things is that my liver is in serious shape. Since Chinese medicine deals with the whole being I’m really being treated for everything my body is suffering from even though I presented saying I needed help balancing my hormones.
In any case, I collapsed on her table after being out for an hour—I was sick of staying in bed and so my husband took me to lunch. But that hour was really too much and as I collapsed on her table I burst into tears.
It ended up being like a therapy session. I told her I was dealing with so much anger. And rage. My circumstances so damn frustrating. Doctor after doctor mishandling me. Making me sicker. My rage is targeted mostly at my sister who doesn’t give a shit that I’m sick and at my last doctor who seems to have no interest in admitting any fault and is therefore just as bad as any drug pushing doctor. It’s also targeted at people in the recovery movement who think that their road to recovery is the only road to recovery and they seem to dare to think that if I only followed their way I would be well by now. One thing I’ve learned on this journey is that there are as many roads to recovery as there are people. My recovery stories page on this blog gives a glimpse of this—-all different methods of recovery…I borrow from many of their journeys, but ultimately I trust my gut. And so should anyone else struggling to recover…There is nothing tried and true for every person who has been labeled. No one thing. Perhaps the only necessary ingredient is believing that one can get better and all of these people have that and I do too, in spades.
In any case I have rage. It’s probably primal rage and it’s just glomming on to whoever is an attractive target right now.
How do I clear it out? How do I forgive my sister and my doctor? How do I embrace the giant egos of some of my recovered friends when they seem to condescend on my journey? (please don’t everyone assume I’m thinking of YOU…it’s just a couple of people really)
One thing is clear. I have no mental illness, but I’m very very physically sick. The drugs made me sick. The withdrawal made me sick. My prescribing psychiatrist who is watching me go through this process agrees. My husband who knows me intimately agrees. No mental illness…nope, just sickness caused by drugs and drug withdrawal.
Mad Liberation by Moonlight
The full moon is on October 14th this time. This would make the radio show happen on Friday night, 10/17/08. I have to clear this with Dan but so far, that’s the plan.
Friday! On KBOO Radio 90.7 FM
1- 2 a.m. Late Friday night
(yes, I know that it is technically Saturday morning- relax, it’s just a radio show)
October 17th, 2008
This show is dedicated to Everyone
*who has ever been given a psychiatric label, *who experiences mental health challenges and of course to *anybody who has the misfortune (or good fortune) of being awake at that hour.
You can participate!
Call in at (503) 231-8187
We also hope to have some live in-studio musical
performance by CS/X performers on this show.
(Set your alarm if you aren’t usually up at that time)
Friday nights from 1 am to 2 am usually following the full-moon, will be a segment on KBOO radio (90.7 on your fm dial, to the left of NPR), also streamed on the internet on their website, http://www.kboo.fm/index.php will be time for Mad Lib by Moonlight. The program is part of the usual Friday night show, The Outside World.
Excerpt From: The Rape of the Mind
Source material- go to
The Psychology of Thought Control, Menticide, and Brainwashing
Joost A. M. Meerloo, M.D
NOTE: This work has been long out of print, last known publication date 1956, the World Publishing Company. Of course, the technology has advanced and the techniques have been refined, but the principles remain the same.
from the Forward:
“And fear not them which kill the body, but are not able to kill the soul.” -Matthew 10:28
This book attempts to depict the strange transformation of the free human mind into an automatically responding machine a transformation which can be bought about by some of the cultural undercurrents in our present day society as well as by deliberate experiments in the service of a political ideology.
The rape of the mind and stealthy mental coercion are among the oldest crimes of mankind. They probably began back in pre historic days wheh man first discovered that he could exploit human qualities of empathy and understanding in order to exert power over his fellow men. The word “rape” is derived from the Latin word _rapere_, to snatch, but also is related to the words to rave and raven. It means to overwhelm and to enrapture, to invade, to usurp, to pillage and to steal.
The modern words “brainwashing,” “thought control,” and “menticide” serve to provide a clearer conception of the actual methods by which man’s integrity can be violated. When a concept is given its right name, it can be more easily recognized and it is with this recognition that the opportunity for systematic correction begins.
In this book the reader will find a discussion of some of the imminent dangers which threaten free cultural interplay. It emphasizes the tremendous cultural implication of the subject of enforced mental intrusion. Not only the artificial techniques of coercion are important but even more the unobtrusive intrusion into our feeling and thinking. The danger of destruction of the spirit may be compared to the threat of total physical destruction through atomic warfare. Indeed, the two are related and intertwined…..
from the first chapter:
The first part of this book is devoted to various techniques used to make man a meek conformist. In addition to actual political occurrences, attention is called to some ideas born in the laboratory and to the drug techniques that facilitate brainwashing. The last chapter deals with the subtle psychological mechanisms of mental submission.
CHAPTER ONE — YOU TOO WOULD CONFESS
A fantastic thing is happening in our world. Today a man is no longer punished only for the crimes he has in fact committed. Now he may be compelled to confess to crimes that have been conjured up by his judges, who use his confession for political purposes. It is not enough for us to damn as evil those who sit in judgment. We must understand what impels the false admission of guilt; we must take another look at the human mind in all its frailty and vulnerability.
The Enforced Confession
During the Korean War, an officer of the United States Marine Corps, Colonel Frank H. Schwable, was taken prisoner by the Chinese Communists. After months of intense psychological pressure and physical degradation, he signed a well documented “confession” that the United States was carrying on bacteriological warfare against the enemy. The confession named names, cited missions, described meetings and strategy conferences. This was a tremendously valuable propaganda tool for the totalitarians. They cabled the news all over the world: “The United States of America is fighting the peace loving people of China by dropping bombs loaded with disease spreading bacteria, in violation of international law.”
After his repatriation, Colonel Schwable issued a sworn statement repudiating his confession, and describing his long months of imprisonment. Later, he was brought before a military court of inquiry. He testified in his own defense before that court: “I was never convinced in my own mind that we in the First Marine Air Wing had used bug warfare. I knew we hadn’t, but the rest of it was real to me the conferences, the planes, and how they would go about their missions.”
“The words were mine,” the Colonel continued, “but the thoughts were theirs. That is the hardest thing I have to explain: how a man can sit down and write something he knows is false, and yet, to sense it, to feel it, to make it seem real.”
This is the way Dr. Charles W. Mayo, a leading American physician and government representative, explained brainwashig in an official statement before the United Nations: “…the tortures used…although they include many brutal physical injuries, are not like the medieval torture of the rack and the thumb screw. They are subtler, more prolonged, and intended to be more terrible in their effect. They are calculated to disintegrate the mind of an intelligent victim, to distort his sense of values, to a point where he will not simply cry out ‘I did it!’ but will become a seemingly willing accomplice to the complete disintegration of his integrity and the production of an elaborate fiction.”
The Schwable case is but one example of a defenseless prisoner being compelled to tell a big lie. If we are to survive as free men, we must face up to this problem of politically inspired mental coercion, with all its ramifications.
It is more than twenty years [in 1956] since psychologists first began to suspect that the human mind can easily fall prey to dictatorial powers. In 1933, the German Reichstag building was burned to the ground. The Nazis arrested a Dutchman, Marinus Van der Lubbe, and accused him of the crime. Van der Lubbe was known by Dutch psychiatrists to be mentally unstable. He had been a patient in a mental institution in Holland. And his weakness and lack of mental balance became apparent to the world when he appeared before the court. Wherever news of the trial reached, men wondered: “Can that foolish little fellow be a heroic revolutionary, a man who is willing to sacrifice his life to an ideal?”
During the court sessions Van der Lubbe was evasive, dull, and apathetic. Yet the reports of the Dutch psychiatrists described him as a gay, alert, unstable character, a man whose moods changed rapidly, who liked to vagabond around, and who had all kinds of fantasies about changing the world.
On the forty second day of the trial, Van der Lubbe’s behavior changed dramatically. His apathy disappeared. It became apparent that he had been quite aware of everything that had gone on during the previous sessions. He criticized the slow course of the procedure. He demanded punishment either by imprisonment or death. He spoke about his “inner voices.” He insisted that he had his moods in check. Then he fell back into apathy. We now recognize these symptoms as a combination of behavior forms which we can call a confession syndrome. In 1933 this type of behavior was unknown to psychiatrists. Unfortunately, it is very familiar today and is frequently met in cases of extreme mental coercion.
Van der Lubbe was subsequently convicted and executed. When the trial was over, the world began to realize that he had merely been a scapegoat. The Nazis themselves had burned down the Reichstag building and had staged the crime and the trial so that they could take over Germany. Still later we realized that Van der Lubbe was the victim of a diabolically clever misuse of medical knowledge and psychologic technique, through which he had been transformed into a useful, passive, meek automaton, who replied merely yes or no to his interrogators during most of the court sessions. In a few moments he threatened to jump out of his enforced role. Even at that time there were rumors that the man had been drugged into submission, though we never became sure of that.
[NOTE: The psychiatric report about the case of Van der Lubbe is published by Bonhoeffer and Zutt. Though they were unfamiliar with the “menticide syndrome,” and not briefed by their political fuehrers, they give a good description about the pathologic, apathetic behavior, and his tremendous change of moods. They deny the use of drugs.]
This is powerful reading- I encourage you to take a closer look. The book has ramifications that are very timely both in terms of geo-politics and psychiatric politics.
From my favorite mental health blogger, Ron Unger-
(his blog, Recovery from Schizofrenia-http://recoveryfromschizophrenia.org/blog/)
Posted by Ron Unger on October 5th, 2008
Here in Lane County Oregon, USA, a group known as the Consumer Council, working closely with MindFreedom, has been pushing to put in place official guidelines which would hopefully change the behavior of mental health professionals. Two of the important things we are asking them to do is to quit misleading and disempowering people into believing that genetic and biological explanations of “mental illness” are fact, and to let people know they may eventually be able to live successfully without medication and that help is available to them in making that transition.
So far we have gotten the local mental health system to move forward with some vague and poorly explained guidelines, though even these have gotten the professionals stirred up as they find themselves being asked to take into account consumer concerns. What follows is a copy of an email about the concerns of the “treatment team” of the county mental health department, followed by my rebuttal. I thought it might be of interest to those of you who are pushing for change in your own mental health system.
I have changed the name of the mental health worker who wrote this email, as I didn’t ask her permission to post it here.
Sent: Tuesday, September 30, 2008 9:04 AM
To: LEVINE Al; *LC H&HS 2411 MLK Mental Health
Subject: RE: attached position on consummer empowerment
Sorry for the late reply. I hope this is timely enough for consideration.
Some concerns were expressed at Wednesday Treatment Team about this, both by the LMPs and by the clinicians.
Of particular concern was the paragraph on the second page requiring that “clients be correctly informed about what is known about their mental health condition and providers do not misinform clients with explanations that are disempowering (genetics, chemical imbalance).”
The problem highlighted with this wording is the assumption that information about biological factors that contribute to mental health issues is disempowering. There was a feeling voiced that this particular wording stemmed from local political pressures rather being based on empirical information.
There was also concern stated about the phrase in the third paragraph that stated that “current treatment, including medications, may be necessary for a limited time.” (Italics mine.)
Clearly, it would be misleading for anyone to tell a client that medications may be necessary only for a limited time. For many clients, that is not the case.
Finally, There was a question of what “alternative treatment” means, and an objection to the phrase “dependence on psychiatric medications.”
There is way too much in this document that seems to make specific directives without clear definition of what that entails.
Personally, I believe LCMH needs to make a position statement on consumer empowerment. I just have my doubts that policy and practice (Expressed in the Heading “Consumer Empowerment Guidelines”) should be guided by what appears to be local political pressure rather than by a broader “Memorandum of Understanding” (or some such) of what client empowerment consists of, and which LCMH takes the time and effort to draft on its own, taking into consideration an array of current policy and practice, as well as local consumer input.
If the Consumer Council wishes to make a definitive statement such as the one above, they have every right to do so and, I believe, should be encouraged to do so. However, I do not think it serves anyone well for LCMH to adopt a hybridized version that may bind practitioners to wording that could have unintended consequences down the line.
I think much better wording could be used to express a commitment to increased consumer participation in treatment and a strengths-based recovery model. My concern is that the statement as is stands is focused less on real client empowerment than on limitations placed on what providers may and may not say. I do believe that any clinical guidelines coming from LCMH need to recognize the fact that medication is certainly not the only answer in treating any mental health condition. I just don’t think this is the way to express that reality.
I refer you to the very excellent SAMHSA statement (thanks, Gina!) that answers the question: “What is Recovery?” It has a much more encompassing–and philosophically acceptable–statement on consumer empowerment.
[then what follows is my response:]
It was very interesting to read the concerns that came out of the Wednesday treatment team meeting. I understand that many of the guidelines didn’t make much sense to you, that they seemed to unnecessarily limit how providers talk about things and they seemed to you to just be based on politics, and not on any reasoned and evidence based efforts to improve mental health care. I think the fact that you got this impression points out a definite weakness in the guidelines, and that has to do with the fact that they included inadequate explanation of the reasons for their existence.
The guidelines you saw did not come directly from the Consumer Council, though they did start as a result of recommendations for guidelines that were made there. I don’t know who put all the words together as you saw them (and they have been changed more since) but it now seems clear they don’t sufficiently explain why guidelines are necessary, and the basis for them. I think that rather than weakening them till they say less and less (which seems to be happening as they go through more committees and reviews) they need to be revised to clearly explain why they are vitally necessary to protect consumers against harm imposed by the mental health system. Let me attempt to explain here.
If a woman has a physical injury which a doctor has reason to know will leave her permanently unable to walk, and the doctor informs her that she will have to depend on a wheelchair to get around for the rest of her life, the doctor is being perfectly reasonable in telling her that. It may be depressing and initially demoralizing news to her, but it helps her face reality and prepare to get on with her life.
Now let’s consider an example where a woman has a physical injury which is more ambiguous. In the history of medical observation, most people with this sort of injury have not been able to walk again, but a sizable minority have been able to walk again. Let’s consider that in this example the doctor also tells the patient that she will have to depend on a wheelchair to get around for the rest of her life. Do you see the problem with that? If the woman believes her doctor, she will not take an interest in therapy that might get her walking and spending time outside of her wheelchair, and she may well end up permanently disabled, not because of her injury, but because of misinformation from her doctor. This would properly be classified as medical system imposed disability.
In the example above, perhaps the doctor was worried about nurturing hopes that might turn out false, or perhaps the doctor was worried that if she attempted to get out of the wheelchair and walk she would further injure herself and the doctor wanted to prevent any risk of this happening. It doesn’t really matter what the motivation of the doctor was: the patient has the right to hear that there is a possibility of recovery, and the right to pursue a course of rehabilitation therapy even if there is some risk of further injury in the course of the therapy. The doctor violated her informed consent by failing to give her critically important facts about possible treatment alternatives.
I used an example from physical medicine, but the same principles can be applied to a mental health problem. Brenda’s message stated that “There was also concern stated about the phrase in the third paragraph that stated that “current treatment, including medications, may be necessary for a limited time.” (Italics mine.) Clearly, it would be misleading for anyone to tell a client that medications may be necessary only for a limited time. For many clients, that is not the case.” Following the reasoning in Brenda’s message, the doctor in the physical injury example might have stated that he could not tell his patient that she might walk again and not have to depend on a wheelchair, because clearly for many of his patients with such injuries, they were not able to do that! I hope it is obvious to all of you that the doctor’s logic would be flawed. When we say a person “may” recover and walk again, or recover and no longer need medications, that is very different from saying the person “will” recover in that way. All we need to say that a person “may” recover is examples of some people with the given condition who do recover.
(One might also ask how many of this doctor’s patients weren’t able to walk again just because they had been misled by the doctor into not trying to recover. Predictions of failure can make failure more likely, which is why it is critical not to exaggerate the likelihood of failure, or especially critical not to make it appear inevitable.)
Some of you may feel that the above example does not apply, because you are sure that some of your clients definitely have no chance of getting off medications and doing well. I would challenge you though, to find empirical evidence that shows that mental health professionals are able to reliably predict who has no chance of making such a recovery. Harding did a long term study in Vermont of the people with the worst prognosis in psychiatry, people with a diagnosis of schizophrenia who had been hospitalized for years in the so-called “back wards.” She found that decades later, a third or more of these people were off medications, showing no symptoms of schizophrenia, and living lives that involved work and relationships. Similar studies elsewhere also show many recovering (though percentages vary: a similar study in Maine showed a lower rate of recovery, probably because Maine did not offer the same assistance in rehabilitation offered in Vermont.) It seems to me that when we do not objectively know who will recover and who will not, we should just say we don’t know, and let people know they have a chance.
Some of you may claim that you know certain people cannot ever live successfully off medication, because they have already tried a number of times and failed. But the fact that a person had even multiple relapses after quitting medications is still not proof that medications will always be necessary: it is also possible to find stories of people with such multiple relapses who eventually got off the medications successfully and then had decades or the rest of their lives living successfully without any medications. So again, where we don’t have the ability to make a reliable prediction, we would do better to back off, and admit that either outcome is possible, including the possibility that the need for medication may still be for just a limited time, even though there have already been multiple relapses. (Of course, if competent help is provided to a person attempting to get off, which includes not just medical oversight in withdrawing slowly but also development of a relapse prevention plan and assistance in shifting to alternative coping, then it is much more likely that a future attempt to get off the medication will succeed, or at least not end in disaster.)
The mental health system has traditionally been afraid to tell people they might eventually not need medications, because they worry this will make clients quit medications while they are in fact still necessary for that person. But when clients are told that they will need medications for the rest of their lives, or even subtly led to believe they will always need medications just by never discussing with them the possibility that they will recover to a point where they won’t need medications, then the effect is to misinform them in a way that is disempowering (which violates the principle of informed consent). We don’t have a right to do that, and it isn’t adequate mental health treatment. It is much more honest, and it works well, to simply discuss openly the danger of quitting medications abruptly while they are still perhaps needed, and to introduce instead the option of gradually reducing medications while shifting to other forms of coping, always knowing one can resume more medications if it is decided that is necessary. This allows facing the uncertainty squarely, in an honest and transparent manner, with the consumer having a choice about how much risk to take, without the professional attempting to make that choice for the consumer.
Another problem with telling people they will always need to stay on medications, when we really don’t know for sure this is true, has to do with the risks of the medications. If we tell 100 people that they will always have to stay on medications, when in reality 10 of those people could have gotten off successfully if they knew this was possible, then we are responsible for keeping those ten people on highly risky medications for no reason whatsoever. If some of these people die early because of the effects of the medications, then we are responsible for their deaths. We might argue that, if we told all 100 people that they might be able to get off medications then lots of people might try getting off them who can’t handle it and that would cause more trouble overall than would be caused by keeping some people on medications unnecessarily, etc. But my point is, we don’t have any ethical right to make these kinds of decisions for people, or to make the 10 who could get off suffer or even die unnecessarily because it is more convenient for us to not disclose the possibility that some can get off medications successfully.
Another issue: there is also a danger of mental health system imposed disability when people are convinced of explanations of their problem which have a greater sense of permanence and which are less likely to be controllable by the person. That is, when people are convinced that they are mentally ill because of their genes, or because there is some kind of problem in their brain which is strictly biological and has nothing to do with how they are choosing to react to things, such as a “chemical imbalance,” they naturally feel less able to do anything about recovery, other than perhaps depend on taking pills for the rest of one’s life (with usually only partial success at most.) If I have a brain tumor, I’m not going to believe I can get rid of the problems it causes by changing my thoughts and behavior. I think this should be obvious enough to not require research backing, but in fact, for schizophrenia at least, there is research that shows that genetic and strictly biological explanations are disempowering and increase stigma. One article that summarizes this research is attached. [Well it’s not attached in this post, but if you post a comment and request a copy I can email it to you at the address you registered with.]
I have a friend who was in the mental health system for years, where he received both many medications including neuroleptics, as well as electroshock. He described to me how he recovered by reconsidering all his ways of thinking and processing information, in a process that took years. He is now a college professor with national recognition for his work, and of course has not taken any medication for many years. He could not have done this had he believed that he would be inevitably mentally ill due to his genes or some strictly biological process in his brain. Fortunately, he was able to reject the misinformation he got from the mental health system, but I don’t think recovery should have to depend on consumers figuring out how to reject our misinformation: they shouldn’t be misinformed to start out with.
The truth is, we don’t know that any consumer we see has even a genetic predisposition toward a mental illness, much less a genetic “cause” because there are no genetic tests. (You may believe that the evidence that genetic differences contribute to mental illness is strong – some others differ with this – but one thing that definitely doesn’t exist is evidence to show that everyone with a particular mental illness has a genetic difference. For example, there is evidence that genetic differences create a predisposition to PTSD, but for any given person with PTSD, we cannot say that there is a particular genetic difference. There could be many other reasons why that particular person has a mental health problem.) We also don’t know that any consumer we see has any specific brain difference that is causing the illness: there is no brain test for mental illness specifically because there are no brain differences that reliably always show up in people with a given diagnosis and never in people without the diagnosis (nor are there any brain differences that even come close to meeting this criteria.) This means that genetic and biological explanations are simply unproven theories. (They are also rather dubious theories if one attempts to take them as a complete explanation, because no one has ever explained how a mental illness caused by genes or a biologically based brain difference could go away over time in the cases of people who get off medication and go on to live highly successful lives.)
What is essential to maximizing chances for recovery is that consumers be given explanations that suggest a role for the consumer in his or her own recovery. (These explanations do not need to be presented as fact, but just as theories or possibilities that offer hope.) For example, consumers can be told that their mental problem may result from a reaction to life events, reactions which over time they could learn to shift. This conveys the belief that complete recovery is possible and that the consumer has a role in it, which are beliefs that are cited by those who do recover as being essential in their journey.
Just a couple more issues: I was curious about the objection to the phrase “dependence on psychiatric medications.” Was this a purely political objection, or was it based on some kind of reasoning or evidence? It seems to me that from every objective criteria, this is an appropriate use of the term “dependence.” Dependence on something is not necessarily a bad thing: for example if I had an irreparable spinal cord injury, I would happily depend on a wheelchair, and I wouldn’t object to anyone calling it a “dependence.” Clearly, when a person cannot successfully get through a week or a month without taking a bunch of psychiatric medications, they are depending on them. The use of the word “dependence” might also bring up associations with dependence on other substances that have withdrawal effects, but even then this associations cannot be successfully argued to be misleading, because all classes of psychiatric medications have been shown to have withdrawal effects, or “discontinuation syndromes” or whatever you want to call them, at least in many people.
I agree that it would be helpful for the guidelines to go into more detail about what alternatives are and which ones might be accessed through LaneCare services. I think one of the best ways that LaneCare services can actually help is in having a therapist and/or case manager or peer support person guiding people in accessing things that are already available in the community for free, but which are ordinarily not accessed by people caught up in mental health problems. This includes everything from social groups, spirituality, family support, nature, building social support networks, free educational opportunities, exercise options, dietary and substance consumption changes, and other lifestyle changes. Of course, for a consumer to even see these as relevant, they often need to see the possibility of a broader understanding of mental health problems than that which they have often learned in the mental health system.
To sum all this up: I understand very much that the proposed guidelines would just seem an encumbrance on the everyday practice of mental health workers, if the justification for them is not well known. However, I hope I have made the case that there is a very strong justification for these guidelines, in that they contain suggestions which are necessary to avoid mental health system caused disability and even unnecessary death, to fully comply with the principle of informed consent, and to create the strongest possible assistance in recovery. It’s fine to have nice definitions of recovery, such as that found in the ten principles on the SAMHSA site, but it’s also important to have guidelines to insure that mental health workers don’t unnecessarily make such recovery less likely or impossible. I hope what I’ve written here makes apparent the reasons for these guidelines, and I hope in the future we will be able to include a better explanation for the guidelines within the guidelines themselves.
In many respects, these guidelines are a companion piece to the trauma guidelines, which also attempt to make mental health providers more aware of, and avoid, the possibility of mental health system imposed harm. I think we all have a lot to gain from such guidelines. They may temporarily make our work a little more difficult as we learn new things, but what we gain is increased competence in doing what we really care about, which is helping people. That’s a goal we can all agree on.
(for more talks like this, go here.)
recorded at the
Insight Retreat Center
Insight Meditation Center began in 1986 as a small group meditating together once a week. Today, hundreds of people participate in events at the center throughout the week. Talks are shared with a world-wide audience through the online Audio Dharma program.
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A POEM TO A TAOIST HERMIT
My office has grown cold today;
And I suddenly think of my mountain friend
Gathering firewood down in the valley
Or boiling white stones for potatoes in his hut….
I wish I might take him a cup of wine
To cheer him through the evening storm;
But in fallen leaves that have heaped the bare slopes,
How should I ever find his footprints!
Bye for now!