Today’s post is in response to the comment left by Lex Douvasa of the MHCD Research and Evaluation Team about my most recent post. In short, that essay talked about my (experientially if not actually) transcendent adventures as a mental health patient, about how my spiritual views have evolved since the resolution of my psychosis, and how spirituality and meditation help with mental health issues. Lex brings the Recovery Model into the conversation.
(Once again, I have modified my essay since it was first posted including some elaboration, clarification, and additional links. I may eventually post a permanent statement to the effect that minor changes can be expected for the first 24 hours, in case anyone cares. Or maybe I will try to be more patient, and polish my work before I send it into cyberspace. Either way, if I ever make changes that alter the basic opinions I express, I will announce them explicity. This update and message were posted c. 10 pm PDT, Tues July 21, 2009)
Dear Lex,
As I explore the internet communities interested in mental health, I am surprised at the intensity of the discord. The various factions differ so widely in their viewpoints, that it is hard to see how any consensus could ever develop, at least not in the near term. That makes me wonder if I am being smart in diving into this controversy, especially since my attitudes are not yet fully formed, and I dislike extreme views and dogma. Then I think: maybe that will be my role, to comment without developing a strong allegiance to any side.
Even from that position, however, it is easy to embrace the Recovery paradigm in mental health. I have spent years in substance abuse recovery using the 12-step model. So I know that the approach can be effective. Anything that encourages people to be find deep sources of strength, to never stop pursuing improvement, and which provides hope of a better life, must be considered a good thing. The spiritual dimension of the 12-steps can also be beneficial, though obviously it does not appeal to all. It appears that in the mental health context the spiritual aspect is not emphasized to the same extent as in, for instance, Alcoholics Anonymous. That is good, since people who run out the door won’t be helped. I am glad there are people working to bring this way of seeking peace into the realm of mental wellness. Of course, even though the Recovery paradigm seems like it should be fairly harmless, and has a vast potential, it is not immune to criticism. The Wikipedia discussion helped me see some points of contention that were new to me. Although probably written from a pro-Recovery viewpoint, it still gives a balanced perspective. Most of the criticisms seem to revolve around fear that abandoning the traditional structure might leave people stranded or feeling bad about themselves. It almost comes across as paternalism, like people with mental conditions can’t tolerate being told they have some ability to help themselves. Despite the few voices of dissent, my impression is that the Recovery approach is headed toward the center stream. It already looks pretty well accepted as a valuable option in the arsenal of approaches to psychiatric ‘distress’ (here you could insert ‘illness’, ‘condition’, ‘abnormality’, ‘giftedness’, ‘diagnoses’, or whatever your preferred term is for the kind of entity the mental health system addresses). I applaud you for working to advance and document its effectiveness. Do you agree that it is gaining wide support? Or are you facing more resistance than I understand?
Since you inquired, my own treatment began as a rigidly traditional approach (I am using my hospitalization as my starting point here, though my first interactions with the ‘system’ started in childhood and adolescence). My psychiatrist (between 2000 and 2006) treated me with a powerful mix of medications that left my mind fuzzy, like a permanent hangover. In that state, it became easy to buy into her assessment that I should give up hope of ever again being productive. Since before then I had been an aggressive high achiever, this prognosis hit me very hard, and no doubt prolonged my severe depression. Eventually, I made the intelligent decision (despite my chemically impaired cognition) to switch to a different system of care. In that setting (Kaiser Permanente), they did not follow a Recovery Model explicitly, but did promote a sense of optimism and hope for improvement. The Kaiser methodology embraces mind-body philosophy, which is where I found out how important exercise can be. As for brain derived neurotrophic factor (BDNF) I listened to a good podcast on Dr. Ginger Campbell’s ‘The Brain Science Podcast‘ not long ago about exercise, the brain, and BDNF. The Kaiser staff also introduced me to DBT (Dialectical Behavior Therapy), which you mention. I participated in part of the DBT series, and benefitted from it, though the protocol struck me as unnecessarily complicated. Despite that reservation, DBT’s underpinnings of savoring bodily experience, not running away from feelings, and remaining in the present moment all make a big difference for me, when I abide by them. In short, I believe that by turning to Kaiser for my mental health care I entered a pretty enlightened system; I am grateful that it encouraged me to seek progress, rather than accept a static place of disability. (As a disclosure, I was a Kaiser physician before my neck degeneration ended my surgical career. I now have no connection–financial or otherwise–with Kaiser, except as a patient.)
In my opinion, a lot of mental illness results from feelings that spiritual traditions have historically tried to alleviate: hopelessness, futility, meaninglessness, loneliness, guilt, resentment, etc. That does not mean everyone with mental illness should be religious, or even do anything that harkens to a (possibly nonexistent) spiritual realm. But it is probably a good idea to encourage people to explore what they value in life, why they think it matters whether they treat people well or poorly, what helps give them a sense of purpose or meaning, and what they think makes a good person. That will give them some benchmarks for measuring their progress, milestones separate from society’s focus on material success and social popularity. It might also help them look more realistically at their failings, and recognize that they have the same human frailties as the remaining 6,760,820,999 people on the planet. If they take it a step further, and develop a sense of divine presence, or connection with a transcendent realm, then so much the better (and although I personally object to religions that are judgmental and fundamentalist, each person needs to choose their best path to wellness).
As I have emphasized in this nascent blog several times already, there is no one prescription that will work for everyone. Nevertheless, the Recovery Model in mental health, if it works anything like AA has in the addiction community, should have broad appeal and effectiveness. The mutual support, spirit of ongoing action, and belief in even seemingly hopeless cases can all be adapted from the addiction world to the benefit of those of us with psychiatric issues. Adding in encouragement for growth in the direction of finding meaning and purpose in life, or even exploring feelings of transcendent spirituality, would also be helpful to many people.
Thank you for bringing this paradigm to the forefront of my attention. I have read a little about it before, but it helped me to explore the topic further. Whether or not anyone reads all the way through this (typically for me) overlong post, the exercise helped me expand my understanding of available approaches to psychiatric conflicts.
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Lex Douvasa at http://mental-health-recovery.blogspot.com/
Hey Will!
Thanks so much for your thorough response! I enjoy reading your posts, they are quite articulate! For starters, I am so sorry to hear about the arthritis in your neck halting your career; my family has several oral surgeons and I know something like that would be hugely damaging to them. May I ask what you have chosen to fill your time with since? I can imagine someone from a medical background with personal experience with mental disorders would make an amazing psychologist/psychiatrist, but I’m not sure what the psychiatry part would mean in terms of school (since you already have a medical degree), but I’d love to hear what you are up to.
Thank you for directing me to the Wikipedia arguments, as it has provided some great arguments to comment on. For example, it is a very valid concern that a new recovery approach will alter, but not necessarily add to, the burden of the healthcare provider. In my experience, it seems that the more a facility leans into recovery practices, the more they encourage the development of peer counseling and peer mentorship, which would in fact detract from the burden placed solely upon the healthcare provider. In regards to recovery involving a cure, that is a battle that has been broiling it seems. The problem is with the term recovery, which implies a return to a state of normalcy or the absence of an ailment; I perhaps would have chosen a different name to champion but most practitioners recognize that some mental ailments there will never be a full relief from, and just aim at living a fulfilling life despite (rather than without) minimum symptom interference. When the argument is used to say that recovery happens to very few people, I believe the one pursuing the argument is typically thinking of recovery in the sense of no symptom interference; so yes, many people will continue to have symptoms for elongated periods or even for their entire lives, but they do so while leading successful careers and holding onto fulfilling, meaningful relationships.
Well I won’t address all of the arguments here, maybe in a post on my blog but I do not want to litter your wall with my ramblings! But once again I thank you for directing me towards that! It does however seem that evidence-based practices and recovery are starting to align in the development of psychometrics, which the NIH is now providing tons of grant money for.
I believe it is gaining fair support, but there is still some serious discontent. It seems that consumers seem to support it more than some practitioners, many of who argue it is a fad that is out for making more money. There also seem to be different cultural implications to recovery based upon the country one is looking at. For instance, in America mental illnesses are often followed by alienation from one’s former social group, so recovery is focused upon building up one’s social network, their employment status, and their housing. Peer mentorship tends to play more of a “here is how to survive” type of role. In the U.K. however, mental illnesses seem to be less stigmatized so recovery takes on more of a communal aspect with peer mentors and counselors taking on almost the role of a psychologist or therapist here in the United States. Contrarily in New Zealand, the indigenous Maori ethnic members suffer from abnormally high rates of mental illnesses, so the government has conveyed that it is a moral imperative to support the mentally ill in recovery in an attempt to make amends for early imperialism (a sort of mental-health affirmative action plan).
I’m glad to hear Kaiser seemed to get things going in the right direction! It regrettably seems to be the case that hospitals still focus on warehousing and stabilization rather than treatment, but kudos to you for stepping in and seeking a more appropriate treatment plan elsewhere!
I agree with you entirely. Non-denominational meditation for the purpose of self-reflection seems invaluable; while often times this turns into some sort of religious belief, I tend to think developing faith in one’s self is just as important as any religious affiliations; and this meditation seems to allow consumers (and everyone in general) to come to terms with themselves and the realization of what their short comings are, and just as importantly what their strengths are. Sometimes it is hard to swallow the fact that when something went wrong it was truly out of our hands, but I think meditation brings one’s locus of control back towards the individual. Any sort of improvements cannot truly happen until someone 1) knows where they are at, and 2) can take responsibility for their own actions and let the rest go. It is similar to a metaphor I once heard: you can have a map and compass in the rain forest, but they won’t get you anywhere unless you know where you are on the map. Meditation lets you know where you are on the map.
Wew my apologies on the long reply! I fear I suffer from long posts as well! But again thank you for your vary articulate opinion and input! And definitely for directing me towards the criticisms of recovery!
All my best,
Lex
Mental Health Recovery Blog
Posted at July 22, 2009 on 8:17am.
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Will at http://willspirit.com
Thank you, Lex. I appreciate the long reply, and you (and all) are welcome to put as much text here as you want. I would love to see conversations like this develop on my blog. Your understanding of the Recovery movement obviously far surpasses mine, and I hope that those who read my post from yesterday will also attend to your statement. I feel like my own post reads like that of an arm chair philosopher, rather than someone who is actually informed. But again, I’m starting to see that as my role, so I’ll do my best to just accept that my knowledge is limited, even if my opinions are not.
As for how I’ve filled my time since the big collapse of my career (and much else that mattered to me): at first I just withered up into a psychic ball, kind of like a sow bug when a child plays with it. After that initial retreat, I tried graduate school in informatics, but unfortunately the program turned out to not offer what they advertised (a key professor quit), and a close friend committed suicide. That led to a relapse of sorts. I taught high school biology briefly. I did a stint as a public speaker for the Childhood Lead Poisoning Prevention program of California. After that, I started volunteering in mental health settings, as well as working really hard with CBT, DBT, mindfulness, etc. Most recently, I attempted to get accepted to mental health training programs, including some psychiatry residencies. I got universally rejected. I was warned in advance, and received hints from those who interviewed me, that I was being too open about the extent of my psychiatric history. As much as lip service is given to the idea of consumers becoming providers (‘prosumers’), training programs seem hesitant to accept someone with histories of psychosis and suicidal depression. I only blame them a little, and I still have the option of applying again (maybe to programs where I haven’t already laid everything out). In this era, training directors must fear that a ‘sick’ student might perpetrate some horrendous crime, and they’d be responsible for accepting someone who clearly has problems. I made a deliberate decision to be really up-front, even though I knew it might not fly. But I did not really want to go if there was a need to hide the fact that I had the same conditions as those I hoped to help. Besides, right now I am enjoying my writing projects. Although it would be nice if there were a way to make a living from them.
Yesterday your comment’s links did not connect, so I wasn’t able to find your blog or provide a connection to it. Today I was able to navigate there. Right now I have to get going, but I look forward to reading your posts. I’ll also add you to my blogroll, for whatever that’s worth.
Thanks again for finding me and providing such insightful and well-informed commentary.
Posted at July 22, 2009 on 8:49am.