That Old Familiar Madness

by Katherine Tapley-Milton

I can feel that old familiar madness

That creeps up most stealthily upon me

And fills my soul with interminable sadness

It’s like crawling over acres of broken glass

And is too terrible for you to see --

What this monster does to this lass

I’m torn and bleeding and scarred within

And the hours are long as time does pass.

I’d like to make an exit, but that would be a sin.

Yet, I remain confused why I have to live in agony

I pray to have this burden off of my back

Because I’m starting to get panicky

As I am being tortured on a medieval rack

With the Grand Executioner turning the screws

God, please deliver me from the Inquisition

I certainly need to hear some good news

It is my sanity that is in question

Please help me Lord, my soul is one big bruise.

Self-Help for Your Anxiety

Make a Worry Date with Yourself

     One technique to conquer worry and anxiety is to make a “worry date” with yourself for ten minutes  in the morning and another ten minutes in the evening.  During the worry session the purpose is to talk into a tape recorder, use a coach, or  talk to yourself and go over your anxieties.  If you run out of worries repeat them over and over again until the ten minutes is up.  Make yourself get as upset as you can and don't introduce any positive thoughts in your worry date.  Try this for at least ten days and you will start to notice that you are getting bored with your worries and they don't get you worked up like they used to.  If you start worrying through the day, remember that you have a worry date where you can focus on your worries.  You are not allowed to worry outside of the prescribed worry times.  This technique looks like it would backfire, but it actually helps anxiety.  One professor in a small town started a club called, “Worry Wednesdays”.  People in the community were supposed to write down all of their anxieties and mail them in by Wednesday.  He didn't look at people's letters, but felt his idea helped keep people from worrying. Writing down all your anxieties on paper and throwing them into the fireplace might achieve the same goal.  It feels satisfying to see your worries go up in smoke.

Journaling to Relieve Anxiety

     One self-help method that therapist recommend is journaling.  It is a very cheap, accessible way of venting your feelings, solving problems, and work though unresolved issues.  You should journal at least twenty minutes a day in a private place.  Don't forget to write the positive experiences along with the negative experiences.  Write about your hopes and dreams, your ambitions, your fears, and worries. Today, a lot of people take journaling into cyberspace and blog on the Internet. If you take this route, you have to ask yourself, “Do I want the whole world to know about my problems?”  For the best result, you should keep your journal private.  Who would want to publish their diary on the Internet?

Your therapist may be interest in reading your journal to know what you are thinking and feeling, but don't show it to anyone else.

The Benefits of Hobbies on  Mental Health

     Hobbies or leisure activities are often viewed by society as unproductive time because our culture emphasizes work so much. This is a throwback to the Protestant Work Ethic.  Therefore we often have guilt when we are pursuing leisure time pursuits.  Researchers have found that hobbies provide benefits not only for the individual, but society as a whole as well.   Beth Driver of the Academy of Leisure Sciences states that ,“The benefits of leisure are increased physical and mental health, economic development, family bonding, and environmental awareness.”  In fact, some of our favorite activities like playing sports, reading a book, or just sitting in a hammock are beneficial leisure activities.  For psychiatric survivors, hobbies reduce the stress that daily life puts on us and provides relaxation, a diversion from our illness, and improves our quality of life.    

     Persons with anxiety should take up a hobby, because it takes the emphasis off of their problems.     Hobbies or leisure activities are often viewed by society as unproductive time because our culture emphasizes work so much. This is a throwback to the Protestant Work Ethic.  Therefore we often have guilt when we are pursuing leisure time pursuits.  Researchers have found that hobbies provide benefits not only for the individual, but society as a whole as well.   Beth Driver of the Academy of Leisure Sciences states that ,“The benefits of leisure are increased physical and mental health, economic development, family bonding, and environmental awareness.”  In fact, some of our favorite activities like playing sports, reading a book, or just sitting in a hammock are beneficial leisure activities.  For anxiety sufferers, hobbies reduce the stress that daily life puts on us and provides relaxation, a diversion from our illness, and improves our quality of life.

Choose from the below hobbies or add one of your own .  Circle the ones that you would be interested in.

Oil painting

Acrylics

Beadwork

tye-dying

Candle and Soap making

Velvet Art

Crocheting

Cross stitch

rescuing animals

Doll House minatures

Drawing

Jewelry Making

scrap booking

Knitting

Abstract art

Painting animal portraits

Quilting

Scrap booking

Sewing

Gardening

Stamp Collecting

Refinishing antiques

Woodworking

Carving

Computer Games

Board Games

Puzzles

Bowling

Pool

Bird Watching

Genealogy

Salt water aquariums

Reading

Writing

Beachcombing

Amateur and Ham Radio

Pottery

Hiking

Ceramics

Collecting rocks, gems, minerals

Cooking

Body Building

Sports

Crossword Puzzles

Dragon Boating

Model trains

Writing

Teaching a skill

Flower Arranging

Bronze Sculpture

Volunteering at a food bank

Chill out with some leisure activities so that you manage your anxiety more effectively. 

You will be helping your own mental health and that of others.

DARE TO IMAGINE;FROM LUNATICS TO CITIZENS

From Asylum to Hospital

     While researching and writing chapter two of the book, “Dare to Imagine: From Lunatics to Citizens”, Nere St- Amand (social worker)  and Eugene Leblanc (Editor) were very fortunate to find two diaries of abused inmates of the lunatic asylum in Saint John, New Brunswick. The first letters were Stephen Innis’s ,who was incarcerated in 1869, and the second one was Mary a lady who was institutionalized in 1883.  Mr. Innis  apparently had a big family row over his sisters upcoming marriage, the police were called,  and he was dumped into the asylum.   His letters to his boss depict a violent environment where he received abuse  from both inmates and staff.  Innis predicted that his stay would be a long one and so he committed suicide.  Mary’s diary was a gem to researchers trying to find out what asylum life at the end of the 19th century was like.  Originally, Mary wasn’t eating or sleeping well and her five sons had her committed to the asylum.  She talks about the abuse of other patients by the staff, the cold, the hunger, the brutality, and the despair.

From 1903- 1980‘s

     In the beginning of the twentieth century the word “asylum” was changed to “hospital”. 
Superintendent Hetherington describes 1903 as a time of great “scientific enlightenment” and
“intense humanity” and Chapter Three of “Dare to Imagine” analyzes this time period to see if these optimistic words come true or if they are just fantasies.  In 1904 Dr. James Anglin  became superintendent of the Provincial hospital and he had the fence torn down and the chains removed from the patients. However, the hospital's capacity originally was 80 patients and at the time 1,500 patients were in it.  In fact so many patients  were admitted at one time that the type of their illnesses and the circumstance of their committal were not even registered. 

     In 1916 a teenage Wendy Tupper was admitted to the Provincial Hospital allegedly because she was afraid of men.  After 60 years of psychiatric care Miss Tupper still had her original complaint and she was playing with dolls and waiting for her mother to come back to her.

“A newcomer to the hospital encounters sighs, sounds, and smells which he has never encountered before.  Everywhere he goes doors must be locked and unlocked.  Everywhere patients have a drugged look. And idleness reigns.” Camp 1976:15  By 1920 conditions at the hospital were considered to be 20 years behind the times, the building was in ruins, and the 35 staff members were inadequately trained.  Patients were placed in restraints, and the dreaded crib beds were still being used.  Twenty years later the same kind of criticisms were levied at the hospital.  By 1929 the Provincial Hospital expanded.  There were to more wards, a store, and another kitchen.  In 81 years the hospital grew 13 times.

     From 1931-56 Superintendent Dr. E. C. Menzies was at the helm of the Provincial Hospital.  His main innovation was to allow the patients to go to the bathroom at night, by keeping the bathroom door open.  Prior to that the patients were chained to their beds at night and had the doors to their bedroom locked.  That left them no choice but to relieve themselves in their beds. Dr. E.C. Menzies boasted that the Provincial Hospital had treated 11,796 and 4,708 were thought to be completely cured.

     By 1936, insulin shock was practised at the Provincial Hospital.  This was the practice of

overdosing patients with insulin to make them go into convulsions.  Insulin shock was a crude form a shock therapy.  During World War II there was a lack of doctors and trained personnel,

since many had gone to war.  There was an influx of patients who were shell shocked and suffering post traumatic stress syndrome from fighting in the war.  By 1942 electroshock was introduced and used on the patients under the supervision of Dr. Fisher. The great writer, Earnest Hemingway, had shock therapy in 1961 and a few days later committed suicide.  Dr. Cerletti invented shock therapy in 1938, calling it “annihilation”.  He got the idea for this kind of treatment or mistreatment by watching pigs being killed in a slaughterhouse.  The pigs were electrocuted before having their throats slit.  Even today in Southeastern New Brunswick15-20% of helpless psychiatric patients are either tricked or forced to have shock therapy which is barbaric. Shock therapy causes permanent memory loss and brain damage and in many cases destroys the person.

     By 1945 three former staff members of the Provincial Hospital wrote to Montreal paper, The Standard” and made complaints about the hospital.  This lead a retired reporter from “Time” magazine to pose as a staff member.  His article, “Eight Days in a Mental Hospital” soon became public.  An excerpt said, “I noticed that eight patients wore hobbles around their ankles which mad it very easy to push them off balance should they become violent.  Four were strapped to benches and were released to be transferred to bed, where they were  strapped down by wrists and ankles to the bed itself.  I was shown dungeons underground where unruly patients were formerly confined.”  When this article came out there was panic among the administration and the politicians in whose riding these atrocities were committed.

     Starting in 1956 people in the United States, England, and Italy started challenging the

way that psychiatric hospitals were handling their patients and by 1968 “A Report of the Study Committee on Mental Health Services' aimed at reforming psychiatric care by treating patients in the community instead of institutionalizing them.  Self-help and consumer-driven groups were encouraged.

COMING TO NEW BRUNSWICK: COMMUNITY TREATMENT ORDERS?

          Community Treatment Orders or CTO’s have been instituted in Saskatchewan, Manitoba, British Columbia, and Ontario and there is a movement afoot to bring them to New Brunswick.  Internationally, CTO’s are law in 41 states of the U.S., in Austrailia, New Zealand, and the United Kingdom.  The goal of CTO’s are to provide seriously ill mental health consumers with a less restrictive treatment than being detained in a hospital or held in the legal system.  The patient is treated in their home

and is followed by a mental health professionals.

THE CRITERIA

    The criteria for patients being put on CTO’s is the following:

1.      a prior history of hospitalization

2.      a CTO plan is in place

3.      the patient has seen a doctor within the last 72 hours of a CTO

4.      the patient’s ability to comply

5.      consultation with the patient or the patient’s decision maker

6.      consent to have a CTO

BENEFITS AND WARNINGS

     An interesting article on “Community Treatment Orders: International Comparisons” by John Dawson at Otago University in New Zealand comments that there are, “… significant therapeutic benefits for the patients; greater compliance with outpatient treatment, especially medication; and reduced rates of hospital admissions.”  However, the same study points out that, “CommTO’s are strongly linked to the use of depot (or inject able) medication, which is disliked by many patients, and patients commonly complain that their treatment is dominated by the use of medication, with little access to other therapies.  CommTO’s tend to be issued for the maximum period permitted by law and discharge is likely to occur shortly before an independent review hearing would be held.  When the patient’s treatment is proceeding satisfactorily, clinicians seem to have a strong preference for maintaining the status quo, so discharge from the order may not be easy for patients to obtain.”

     In Canada, most CTO’s are issued for six months at a time.  Theoretically, they can be rescinded by one of three conditions: 1. by the doctor at the request of the patient or her decision maker 2. non-compliance of the patient or 3. the withdrawal of consent of the patient or the patient’s decision maker.

     Although there are benefits to CTO’s, John Dawson warns that, “Clinicians should avoid assuming that all patients on CommTO’s must be administered medication by injection.  CommTO’s should not be over-used for patients with affective (mood) disorders, for whom their efficacy is uncertain, and whose capacity to consent may swiftly return after their initial treatment.  Nor should CommTO’s be over-used when there is extreme pressure on hospital beds.”  CTO’s have been found most effective in those patients who have psychotic disorders.

     CTO’s may provide a good alternative to jail or psychiatric hospitals in New Brunswick.  However, the cautions put forth by New Zealand’s experience should be kept in mind.

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.

   

    

IS REALITY THERAPY IN REALITY?

     William Glasser who wrote the book, Reality Therapy, became a psychologist in 1947 and a psychiatrist in 1957 in the days when Freud was in fashion and mental illness was explained by unconscious conflicts.   Today, mental illness is considered to be a biochemical imbalance in the brain.  In an address at “The Evolution of Psychotherapy Conference”on Sunday May, 2000 Glasser commented, " ... Regardless of the cause, psychological or chemical, the belief that mental illness is real and those suffering from it have little or no control over their symptoms has yet to be seriously challenged."  He throws down the gauntlet by contending that there is no such thing as mental illness, that there are just unhappy people who have made the wrong choices.

     Glasser asserts, "I contend that when we are unable to figure out how to satisfy one or more of our five basic needs built into our genetic structure that are the source of all human motivation, we sometimes choose to behave in ways that are currently labeled mental illness.  These needs, explained in detail in Choice Theory, are: survival, love and belonging, power, freedom and fun.  What is common to these ineffective and unsatisfying choices, no matter what they may be, is unhappiness: there is no happiness in the DSM-IV... the choice to be unhappy is not mental illness."

     In his address at Anaheim, California, Glasser bolsters his opinion by citing Thomas Szaz and Peter Breggin as psychiatric experts who he has a high regard for.  Glasser cites Breggan as one of the world's leading experts on brain drugs. According to the former, "Many of them (brain drugs) actually harm the brain and render it unable to function normally.  For example, the drug makes it harder for many patients to figure out how to satisfy their needs as well as they would be able to do without the drug.  By applying Reality Therapy, Glasser claims to have helped seriously symptomatic patients to function normally without the use of drugs.

     The reason we are exploring Reality Therapy is that many of the mentally ill will meet a reality therapist during the course of their treatment.  I think that Reality Therapy has become popular as a "fix it yourself" therapy that fits into a mental health care system that has suffered cut backs and patient overloads.  Also, after a brief training period the reality therapist comes back sounding sagacious and authoritative.  Gone is empathy because if the patient is miserable he or she is promptly told to make different choices or judgmentally blamed for being the one responsible.  It's just another case of blame the victim.  When in a deep depression I certainly resented being told that I was miserable because it was all my fault.  I felt angry and assaulted.  I also will not thow my medication into the river, because it has helped me lead a more normal life.

      Many mental health consumers are sick and poor and this grossly limits the choices they can make.  Being unable to work, they cannot choose their income, and often are stuck in substandard housing.  Often they have lost out on a good social life and are struggling with unbearable pain. To the rich and healthy the number of nice choices increases.  Maybe reality therapy works best for the well to do who can move where they want to, have a great career, enjoy lots of friendships and feel vibrant health.

     Another thing about Reality Therapy that I don't buy is that it advocates a "create your own reality" kind of thing.  Life does nasty things to people and sometimes one is caught between the devil and the deep blue sea.  What if all my choices involve me in equal misery?  Am I then supposed to rejoice because I have made a different choice? Am I supposed to delude myself into feeling happy if I am broke, sick, and lonely?

      In my opinion William Glasser is going against science when he says that mental illness does not exist.  Scientists are finding that low serotonin causes certain kinds of depression and illnesses like schizophrenia have been linked to too much dopamine in the brain.  What makes Glasser think that the brain cannot get sick?  Every other part of the body is subject to illness. Genetic markers are being found for manic depression and many other mental disorders.

    On the positive side of Reality Therapy some people do need to make better choices in their life and have gotten into problems of their own making.  Probably, we all need to make better choices.  However, there is no call to insult a schizophrenic or manic depressive by telling them that all their misery is their own fault.