THE MISSING ARGUMENT

            Many psychiatric survivors complain that the psychologist, psychiarist, or social worker they see is distant, cold, and condescending .  This “professional distance” has its origins in the universities that train these professionals and the text books that they study.  The “missing argument” was discussed at length with social work professor and consumer/survivor advocate, Nere St. Amand, of the Univeristy of Ottawa.

Interviewer :   “ To what extent are universities and higher education responsible in forming and training people to become distant, condescending professionals?”

Nere:  “I guess one of the problems is that people who have psychiatric problems are not part of the                               training.  You have the expertise in terms of living experience and we have expertise in terms of the books and there is not necessarily any link between the two.  Univerities train by the books.  What people have is personl life stories.  We try to fit one into the other. So I think that it is a big problem.”

Interviewer:  “How are training programs or curriculums for social work or other professionals prepared?”

Nere: “Well they are prepared by professionals and by academic people, respecting certain criteria -             the number of credits or field placements – it's all bureaucracy.  They are not prepared by people who  have experienced the problems generally.  Sometimes yes, but in most of the cases no. So they are prepared in isolation.”

Interviewer:  “So who writes the text books?”

Nere: “  Textbooks are written by so called experts who do research, and then they publish their research. “

Interviewer:  “Do these people have clinical experience?”

Nere: “They might have clinical experience or personal experience, but generally to write a text it's people that do research and not people who have hands on experience.  All of us write case work

or group work or community work for courses and curriculums. Sometimes we have our own ideas, but not necessarily experience in these fields.”

Interviewer:  “Could there be a better approach?”

Nere: “Well definitely there could be many ways where people would be involved.  People who have had some  direct experience with the problem could be involved.  That would be one thing. There could be something that is less formal or less 'fixed in cement'. .. There could be dialogue between people who have experience, people who do research, and people who teach for example.  But we don't see that very much, because we are stuck in an ivory tower doing what we think is good and then when we are confronted with reality we see that it doesn't jive together.”

Interviewer: “Would it help to do a survey of mental health consumers main disappointments with therapy as we know it today?”

Nere: “Well sometimes there are surveys that are done ... If it's a professional he will do the survey in a way that will fill in his or her questions.  If it's someone who has questions about psychiatry that does the survey this person will question psychiatry, but generally it (psychiatry) is not questioned.”

Interviewer:  “Are therapists trained to use a one size-fits-all approach to therapy or are they trained to use different modalities with different kinds of problems?  For instance Reality Therapy is a popular modality these days, but it may not be appropriate for certain clients who are already acting responsibly.”

Nere: “Some people will like Reality Therapy and will use it everywhere and some like short term therapy and they will use it everywhere.  Some other people are experts in aversion theapy or hypnosis.

We are very, very limited people.  We are limited by our training, our experience, and by our own character.”

Interviewer: “Do you think that not much is known about the brain right now, even in university training programs?”

Nere: “Definitely the brain is a mystery.  I mean we have done a little study of how the brain works, but it has been done only at the intellectual level, not at the other levels of the brain like spirituality, or relationship with the soul.  Not one textbook will talk about that.  That's part of the brain; it's part of the being.  Who will talk to you about your basic values about life?  We are so limited with the knowledge that we have.”

Interviewer: “ How often do you think that therapists (psychiatrists included) lie to their patients about the medications side effects or shock therapy?  Do they teach deception of the patient in their university training?”

Nere: “If my convictions are for shock therapy I will use shock therapy and I will see the benefits of shock therapy and I will convince others about the benefits and I will refer to some studies that have been done outlining the postive effects of shock therapy.  But I personally believe that it is a crude, cruel way of treatment (if that is still a word) to help people.  Psychiatrists don't have much to treat people they have only a few options and one of these options is shock ...  That's what we do all the time is impose our treatments our ways of seeing things.”

Interviewer: “  A psychologist told me once that if we told the patients the side effects of the medication the patients would refuse to take them.  Is this attitude part of the university training?

Nere: “They are trained to minimize the side effects and sometimes they don't even know because there

are so many pills on the market.  I find pharmacists are better informed about the side effects than psychiatrists or doctors. Pharmacists are more impartial. If you go to a pharmacist will go into his book and take the time to tell you.  But the psychiatrist will not many times will do that.  He just wants to put you back 'in business' and he wants you out of his office. He wants his fees.  That's the  way it's done.

'As long as I have my fees go home and I hope you won't complain too much.  And if you do complain well come back next time and we'll revise your medication'.  They (psychiatrists) play God  or they play different games with the people.”

Interviewer:  “Often therapists in the mental health profession who counsel and run psychiatric hospitals treat their mental health clients as if they are “bad children”.  Do you think that this attitude is fostered in schools that teach psychologists, psychiatrists, and social workers?

Nere: “Yes, people are considered as 'problems' they are not considered as people.  That's the general rule of therapy of these schools – medicine is the same.  The therapies coming from the Eastern world

will say the opposite.  They will say, 'You are a resource;  you are a person and you are going to heal yourself.'   Therapies coming from the West will say that ' you are a problem or a multiproblem and I am going to treat you'.  It's kind of the opposite.”

Interviewer: “Do you think that academic institutions teaching potential counselors really understand the personal pain, poverty, and social dislocation that mental illness causes?”

Nere: “They are too distant.  They are very distant from poverty.”

Interviewer: “I read in a book that mental illness is more painful than cancer.  Do you agree? ”

Nere: “Oh, yes,  I think that there is much more pain in mental illnesses.  Cancer at least is defined.

It depends how you look at it, but there are possibilites of treatment, but mental illness you're thrown around by everyone in every direction and there's not that many people to help you.  There's not that many institutions, professionals, or even general people to help you, because we are not very compassionate.”

Interviewer: “This lack of compassion .... is it taught in the universities?”

Nere: “Yes, definitely, they encourage distance.”

Interviewer: “Why?”

Nere: “Well, for example they will not recommend touching someone, or to hug someone, or to be close, or be friends.  You are not supposed to bring your problems home, so that you will not be affected by the problems that you deal with.  If you don't feel good and I hug you ...  it can end up a love affair or a sexual affair and it's abuse.  That's how it's presented ...  Because of that possibility we are taught to be distant, and not to mix with, or get involved with,  not to get too close ..  to keep our distance.”

Interviewer: “What do you see the future bringing in the development of psychiatric professionals? Do you think that pressure from mental health consumer/survivors is going to impact the face of psychiatry, pschology, and social work to make it a kinder, gentler profession, more sensitive to the needs of those who suffer from mental illness?”

Nere: “The professions are definitely changing. They've been changing for a little while, since 1970 mental institutions for example they have had to change drastically.  They have had to open their doors; or they have had to close their doors totally... A lot of people are now interested in alternative ways of therapy.  That is putting pressure on professionals. It's a good pressure. There are some survivor groups that are there watching what is going on and that are getting involved.  They do ask professionals questions, which is great.  We should have more of that.  If the people who have problems continue to ask questions I think there's possibilities.  Things won't change unless it comes from the roots – from the people ... Abuse will continue – abuse by systems, abuse by professionals, because it's kind of a game.  If you're without power, or if think you have no power then (they'll) abuse you.  If you appeal your situation, or report it, or make it public, then the professionals will feel a bit threatened and will change.”

Conclusion

     It is evident that the “missing argument” is the hidden agenda that is taught in universities where mental health professionals train.  This agenda teaches that there is a hierarachy of power in which the patient is subservient to the professional.  Survivors are seen as problems, not people, and because of the fear of sexual assault charges or burnout the professionals are taught to distance themselves from the people whom they are trying to help.   The mental health client is not supposed to have knowledge, ask questions, or talk too much otherwise their medication will be “reviewed” or they will be slapped with another diagnosis.   The text books that the universities use are written primarily by academic researchers not necessarily individuals who have clinical experience and currently there is no imput from actual consumer/survivors in developing the curriculums or course texts.  It is time that we who have experienced problems like depression, mania, anxiety, psychosis, etc. insist on having imput into the university courses that train mental health professionals.  Instead of the professional's view that we are the problem, we should look at ourselves as a resource.

  

WHAT IS MISSING IN THE SYSTEM?

      Recently, I was hospitalized and since have been pondering what is missing in the formal mental health care system.  I was in a personal crisis when I decided to see if the hospitals have changed in the last 18 years since I was incarcerated the last time.  Indeed, I was willing to go in open-minded and see for myself.   My husband and I waited for hours in a grubby little room at outpatients and noted that a man with chest pains was immediately rushed in for treatment. The first lesson was that a mental health crisis is put on the back burner compared to other diseases.  After seeing the psychiatrist, I was processed and put in the belly of the beast.  My personal belongings were rummaged through and all my pills were confiscated.  I was feeling violated, but still entertained the possibility of getting help.

      The thing that came next was a shot in the butt.  This, I was told, was supposed to help make the withdrawal from antidepressants smooth and painless.  For the next 72 hours I was supposed to sleep.  It didn’t quite happen like that though.  I lay on a lumpy bed and was given so many doses of Zyprexa that my restless leg syndrome made me pace the halls in physical torment.  I found myself treated like a bad child and subjected to silly, inconsistent, and petty rules.  Although I am nearly 50 years old and have survived fires, floods and everything in between I was not allowed down in the hospital lobby to get a Tim Horton’s coffee.  This was supposed to be behavior modification, but what was the objective?  To make me a trained seal that flapped my flippers on command?  There was an absence of being treated with dignity and no respect for my surviving a life of so much pain.  Instead of the harbor of safety that I sought, the hospital was a police state complete with video cameras to watch my every move.

      My expectations of being hospitalized were that I would receive counseling, occupational therapy, and group therapy.  On my own initiative I went once to group therapy and to crafts, but did not receive any form of counseling. ( It was explained to me that I was too upset to get counseling).  The group therapy revealed a half dozen consumers who all said that they had no hope left.  It was obvious that the system was not meeting their needs, but leading them to despair.  In my opinion some common sense, compassion, and caring would have made the difference.  I have attended many consumer groups in different parts of the country and felt compassion, concern, comfort, and inner healing, however, the hospital seemed to have no soul.  The routine seemed to reduce individuals to mere cogs in a wheel.  I was not  treated like a person with dignity, but a thing to be pushed around.  Essentially, all the experience did was make me angry and outraged.  In the end I have concluded that the hospital system is no more enlightened than it was 18 years ago and a place to be avoided like the Plague.

      An American National Research Project for the Development of Recovery Facilitating System Performance Indicators sponsored by nine different states  comments that: “We must fully acknowledge that the formal system often hinders recovery through the bureaucratic program guidelines, limited access to services and supports, abusive practices, poor quality services, negative messages, lack of ‘best practice’ program elements, and a narrow focus on a bio-psychiatric orientation that can actually serve to discount the person’s humanity and ignore other practical, psychological, social, and spiritual human needs.  At the core of such hindering forces is the operationalization of society’s response to mental illness, that of shame and hopelessness and the need to assert social control over the unknown and uncomfortable.” 

     This same National Research Project which I found on the internet ( www.namiscc.org/ Recovery/2002MentalHealthRecovery.htm) points out that recovery for consumers/survivors points to many universal components, some of which the system could help provide if it had the will.  Those who have material resources such as a livable income, safe housing, healthcare, transportation, and a telephone do better than those who live in poverty, and a lack of basic resources.   Attitudes of fear, shame, lack of personal responsibility, self loathing, and invalidation impede recovery, whereas recovery chances are boosted if the system encourages self-reliance, personal resourcefulness, self-advocacy, choices in treatment and a holistic view of health.

      Some personal traits that should be encouraged by mental health professions and are vital to recovery are attitudes of purpose, faith, expectancy, and finding meaning in one’s illness.  Also, persons who got well had goals, options, spirituality, and role models.  The belief in recovery itself is also very important in wellness, whereas the formal mental health system focuses on illness.  Also, consumers/survivors do better when

they don’t have to relate to detached professions or a different professional every time they seek help. Consumers/survivors do better when they can relate to someone who cares about them.  This is where peer counseling and consumer groups can help as well.

     The National Research Project says that the mental health system needs to have a new paradigm based on the following:

1.      mental health services should be recovery enhancing respecting the patient’s life experience and expertise.

2.      People should be empowered by gaining control over their lives and involved in the consumer movement

3.      Holistic treatment in which a person is seen as more than a disease should be implemented

4.      there should be an emphasis on hope, positive mental health, and wellness

       instead of just biochemical imbalances and medication

     While the hospital and formal mental health care system provide the expertise on medication, it is largely up to the individual patient to work on getting well.  Social connectedness, and feeling part of a community are key components in recovery and left to the individual to work on.  Finding role models is important as well.    In the United States there are safe houses where a person in crisis can talk to peer counselors.  I would like to see the day when that happens in Canada.   It would be ideal to build a center where the mentally ill could get both medical advice and also be able to talk to other consumers/survivors who could give us hope and encouragement.