Recovery, Trauma, and Empowerment (#1072)
Wednesday, July 25, 2007
Pat Risser (firstname.lastname@example.org) and
Scott Snedecor (Scott.Snedecor@state.or.us)
This consumer-oriented workshop will present the history of the Consumer/Survivor movement and its roots in other civil rights movements. There will be discussion about the two different aspects of the movement, self-help and advocacy, and how these aspects converge into a system that is recovery-focused. Additional topics will include the impact of trauma on the lives of people in the mental health and substance abuse system. More specifically, ways in which the system can help in healing past traumas as well as ways in which it can re-traumatize the individual and stifle the healing process will be explored. Discussion will focus on how helping others can facilitate the healing process for oneself, and suggest ways for people to get involved in the trauma-sensitive, self-help, peer support movement.
Recovery is cited, within Transforming Mental Health Care in America, Federal Action Agenda: First Steps, as the "single most important goal" for the mental health service delivery system.
To clearly define recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA) within the U.S. Department of Health and Human Services (DHHS) and the Interagency Committee on Disability Research in partnership with six other Federal agencies convened the National Consensus Conference on Mental Health Recovery and Mental Health Systems Transformation on December 16-17, 2004.
Over 110 expert panelists participated, including mental health consumers, family members, providers, advocates, researchers, academicians, managed care representatives, accreditation organization representatives, State and local public officials, and others. A series of technical papers and reports were commissioned that examined topics such as recovery across the lifespan, definitions of recovery, recovery in cultural contexts, the intersection of mental health and addictions recovery, and the application of recovery at individual, family, community, provider, organizational, and systems levels. The following consensus statement was derived from expert panelist deliberations on the findings.
Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningfu l life in a community of his or her choice while striving to achieve his or her full potential.
The 10 Fundamental Components of Recovery
˙ Individualized and Person-Centered
˙ Peer Support
* "C" = Consumer or Client; "S" = Survivor; "X" = Ex-Patient or Ex Inmate
The modern C/S/X movement began over 25 years ago.
The first documented group was the Insane Liberation Front (named by Tom Wittick) in 1970. The ILF was co-founded by Howie the Harp, community organizer Dorothy Weiner and labor activist Tom Wittick. Though the group only lasted for six or seven months before it folded, many other groups were to follow.
They took turns meeting in the living rooms of different people and identified the two major branches of the Patients' Rights Movement as "Advocacy" and "Peer Support" or "Self-Help."
Definition of Self-Help
Webster's Dictionary defines self-help as "the act or an instance of providing for or helping oneself without dependence on others" (Webster's, 1974). In more general terms, it is the process whereby individuals who share a common condition or interest assist themselves rather than relying on the assistance of others.
Self-help has gained such acceptance that the former Surgeon General of the United States, Dr. C. Everett Koop, observed that, "...the benefits of mutual aid are experienced by millions of people who turn to others with a similar problem to attempt to deal with their isolation, powerlessness, alienation..."
"Mental health consumer/survivor self-help" is the process by which mental health consumers/survivors provide assistance to one another based, to a large extent, on the principles of the self-help philosophy.
Benefits of General Self-Help
Characteristics and Values of General Self-Help
Self-help programs have been instituted in a number of different fields including substance abuse treatment, educationhousing, corrections, and physical and mental disabilities.
Unique Features of Consumer/Survivor Self-Help
Although they share these features in common with other self-help groups, mental health consumer/survivor organizations place an extraordinary value on peer support, hope, and recovery.
Consumer/Survivor Self-Help Classifications
There is a diversity of philosophies in the consumer/survivor self-help movement regarding the professional mental health system with three main categories.
Regard system as oppressive
Will work with system despite being critical
Believe system is source of positive help
Relationships with professionals
Refuse to work with the system
May include professionals within organization but maintain c/s/x leadership
Professionals involved on at least an equal level
See the movement as a struggle for liberation
System needs improvement but benefits some as does self-help
Self-help is an adjunct to the system, not an alternative
There is a great
mix of beliefs within consumer/survivor self-help groups that cross the
boundaries between categories; neither groups nor individual group members fit
neatly into "little boxes". Since a major goal of the
consumer/survivor movement is to reduce the use of "labels" by
fostering the recognition that diversity should be respected, classification
schemes are only one approach to understanding self-help groups and should be
Types of Services Offered
˙ Drop-In Centers
˙ Housing Programs
˙ Support Groups
˙ Homeless Services
˙ Case Management
˙ Crisis Response
˙ Benefits Acquisition
˙ Employment Assistance
˙ "Hi-Tech" Computer Network
˙ Anti-Stigma Services
˙ Information and Referral
˙ Information Dissemination
˙ Technical Assistance and Training
˙ Independent Living Skills and Supports
˙ Higher Education Assistance
˙ Commercial Enterprises
˙ Managed Care
Consumer/survivor-operated services are successful in increasing the overall quality of life, independence, employment, social supports, and education of consumer/ survivors.
Overall Recommendations fro m CMHS
"Efforts to develop consumer/survivor-operated services should include adequate technical assistance, more public education, strategic planning, funding, and cooperation with a need to increase people of color participation."
Incorporation with Managed Care
The (Olmstead Decision) Right to live in the Community and People with Psychiatric Disabilities
In 1999, by a clear majority, the United States Supreme Court held in Olmstead v. L.C., 527 U.S. 581, that under the Americans with Disabilities Act (ADA), undue institutionalization qualifies as discrimination by reason of disability and that a person with a mental disability is "qualified" for community living when the state's treatment professionals have determined that community placement is appropriate, the transfer from institutional care to a less restrictive setting is not opposed by the individual, and the placement can be reasonably accommodated, taking into account the resources available to the state and the needs of others with mental disabilities.
Olmstead says that people with disabilities have a legal right to choose to live in the community, with the supports and assistance they need, instead of being forced into institutions.
In order for community services to be in alignment with Olmstead they must promote the values of community integration, choice, independence, self-determination, dignity, respect and personal responsibility.
All people with disabilities, including people with psychiatric disabilities, are presumed to have decision-making capacity. Capacity is presumed about all decisions, including whether or not to accept or reject physical or mental health care. A judicial finding is required to negate this presumption. Persons with mental disabilities who choose to have their family members or significant others involved in plans and decisions should be encouraged to receive this support. But family members cannot negate the option of community living when that option is chosen by the individual with the agreement of treating professionals. One way of facilitating family involvement is through advance directives.
C/S/X Movement History
First mental hospital in the United States, Pennsylvania University Hospital, where a basement was reserved for people identified as mentally ill
According to psychiatric legend, French psychologist Phillip Pinel strikes the chains from mental patients held in the Bastille in France. Philip Pinel (1745-1826), the leading French psychiatrist of his day, was the first to say that the "mentally deranged" were diseased rather than sinful or immoral. In 1793, he removed the chains and restraints from the inmates at the Bicetre asylum, and later from those at Salpetriere. Along with the English reformer William Turk, he originated the method of "moral management," using gentle treatment and patience rather than physical abuse and chains on hospital patients.
Dorothea Dix beg ins her work on behalf of people with disabilities incarcerated in jails and poorhouses. A Boston schoolteacher, Dorothea Dix (1802-1887), made humane care a public and a political concern in the United States. In 1841 Dix visited a local prison to teach Sunday school and was shocked at the conditions for the inmates. She subsequently became very interested in prison conditions and later expanded her crusade to include the poor and mentally ill people all over the country. She spoke to many state legislatures about the horrible sights (people were being housed in county jails, private homes and the basements of public buildings) she had witnessed at the prisons and called for reform. Dix fought for new laws and greater government funding to improve the treatment of people with mental disorders from 1841 until 1881, and personally helped establish 32 state hospitals that were to offer moral treatment.
Founding of the American Psychiatric Association (APA). At a meeting in 1844 in Philadelphia, 13 superintendents and organizers of insane asylums and hospitals formed the Association of Medical Superintendents of American Institutions for the Insane (AMSAII), which later became the American Psychiatric Association in 1921.
Alleged Lunatics' Friend Society organized by former mental patients in England
Samuel Gridley Howe told the Massachusetts legislature, "There are at least a thousand persons of this class who not only contribute nothing to the common stock, but who are ravenous consumers, who are idle and often mischievous, and who are dead weight upon the prosperity of the state."
Henry Knight cut the ribbon on the first institution for Undesirables in Connecticut stating, "Being consumers and not producers, they are a great pecuniary burden in the state."
Mrs. Elizabeth Packard published the first of several books and pamphlets in which she detailed her forced commitment by her husband in the Jacksonville (Illinois) insane Asylum. She also founded the Anti-Insane Asylum Society, which apparently never became a viable organization. Similarly, in Massachusetts at about the same time, Elizabeth Stone, also committed by her husband, tried to rally public opinion to the cause of stopping the unjust incarceration of the "insane."
Wilhelm Wundt established the first formal psychological laboratory at the University of Leipzig in Germany where he introduced a scientific approach to psychology and performed many experiments to measure peoples' reaction time. This event is considered the birth of psychology.
Sir Francis Galton in England coins the term eugenics to describe his pseudo-science of "improving the stock" of humanity The eugenics movement, taken up by Americans, leads to passage in the United States of laws to prevent people with various disabilities from moving to this country, marrying, or having children. In many instances, it leads to the institutionalization and forced sterilization of disabled people, including children.
American Psychological Association (APA) founded.
Sigmund Freud presented his concepts of psychoanalysis in a publication entitled "The Interpretation of Dreams."
Clifford Beers (1876-1943) publishes 'A Mind That Found Itself,' an autobiographical expose of c onditions inside state and private mental institutions. He started the Clifford Beers Clinic in New Haven in 1913. It was the first outpatient mental health clinic in the United States. Beers was one of the biggest supporters of the Eugenics movement in America, which also flourished in Germany during the early part of the Twentieth Century. Since the postwar period, both the public and the scientific community has generally associated eugenics with Nazi abuses, which included enforced racial hygiene, human experimentation, and the extermination of undesired population groups. Developments in genetic, genomic, and reproductive technologies at the end of the 20th century however, have raised many new questions and concerns about what exactly constitutes the meaning of eugenics and what its ethical and moral status is in the modern era.
The National Committee for Mental Hygiene is founded by Clifford Beers in New York City. This was the forerunner of the National Mental Health Association in 1950 (NMHA).
The U.S. Supreme Court, in Buck v. Bell, rules that the forced sterilization of people with disabilities is not a violation of their constitutional rights. The decision removes the last restraints for eugenicists; advocating that people with disabilities be prohibited from having children. By the 1970s, some 60,000 disabled people are sterilized without consent.
Bill W. and Dr. Bob found the self-help society known as Alcoholics Anonymous on June 10, 1935.
The National Mental Health Foundation is founded by conscientious objectors who served as attendants at state mental institutions during World War II. It works to expose the abusive conditions at these facilities and becomes an early impetus in the push for deinstitutionalization.
First they came for the Communists, and I didn't speak up, because I wasn't a Communist.
Then they came for the sick, the so-called incurables, and I didn't speak up, because I wasn't mentally ill.
Then they came for the Jews, and I didn't speak up, because I wasn't a Jew.
Then they came for me, and by that time there was no one left to speak up for me.
Modern translation of poem by Martin Niemoeller, 1946
We Are Not Alone (WANA), a mental patients' self-help group, is organized at the Rockland State Hospital in New York City. Their goal was to help others make the difficult transition from hospital to community. Their efforts led to the establishment of Fountain House, a psychosocial rehabilitation service for people leaving state mental institutions. Members of Fountain House supported one another by creating a community among people struggling with serious mental illness. This initiative laid the groundwork for the "clubhouse" model, which promotes the importance of meaningful work in people's lives, and which would serve as a model for psychiatric rehabilitation programs developed in the 1960s and 1970s.
The combined specialty of 'neuropsychiatr y' was divided into 'neurology,' dealing with organic or physical diseases of the brain, and 'psychiatry' dealing with emotional and behavioral problems
The American Psychiatric Association's Diagnostic and Statistical Manual (DSM) has 112 mental disorders in its initial, 1952 edition.
Resident patients in state and county hospitals in the U.S. peaks at around 550,000.
Congress passes the Social Security Amendments of 1956, which creates a Social Security Disability Insurance (SSDI) program for disabled workers aged 50 to 64.
President Kennedy, in an address to Congress, calls for a reduction, "over a number of years and by hundreds of thousands, (in the number) of persons confined" to residential institutions, and he asks that methods be found "to retain in and return to the community the mentally ill and mentally retarded, and there to restore and revitalize their lives through better health programs and strengthened educational and rehabilitation services." Though not labeled such at the time, this is a call for deinstitutionalization and increased community services.
Congress passes the Mental Retardation Facilities and Community Health Centers Construction Act, authorizing federal grants for the construction of public and private nonprofit community mental health centers.
The American Psychiatric Association's Diagnostic and Statistical Manual has grown to 168 mental disorders in the DSM-II from the 112 mental disorders in its initial, 1952 edition.
Insane Liberation Front (ILF) is organized by Howie the Harp, Dorothy Weiner a union organizer and Tom Wittick a political activist/organizer in Portland, Oregon. It is the first known ex-patient group that was dedicated to liberation from psychiatry.
The U.S. District Court for the Middle District of Alabama hands down its first decision in Wyatt v. Stickney, ruling that people in residential state schools and institutions have a constitutional right "to receive such individual treatment as (would) give them a realistic opportunity to be cured or to improve his or her mental condition." Disabled people can no longer simply be locked away in "custodial institutions" without treatment or education. This decision is a crucial victory in the struggle for deinstitutionalization.
The first Conference on Human Rights and Psychiatric Oppression is held at the University of Detroit (held annually until 1985).
ADAMHA (Alcohol, Drug Abuse, and Mental Health Administration) established.
The U.S. Supreme Court, in O'Connor v. Donaldson, rules that people cannot be institutionalized against their will in a psychiatric hospital unless they are determined to be a threat to themselves or to others. Also, Rogers v. Macht (Rogers v. Okin or Rogers v. Commissioner of Mental Health) filed and finally adjudicated in 1982 establishing a limited right to refuse treatment (psychiatric drugs) in Massachusetts.
First informed consent ECT lawsuit
NIMH (National Institute of Mental Health) initiates a unique but modestly funded demonstration program, the Community Support Program (CSP) to stimulate and assist states and localities in improving opportunities and services in the community for people with a serious mental illness.
On Our Own: Patient Controlled Alternatives to the Mental Health System is published. Written by Judi Chamberlin, it becomes a standard text of the psychiatric survivor movement.
The National Alliance for the Mentally Ill (NAMI) is founded in Madison, Wisconsin, by parents of persons with mental illness.
Congress passes the Civil Rights of Institutionalized Persons Act (CRIPA), authorizing the U.S. Justice Department to file civil suits on behalf of residents of institutions whose rights are being violated.
The American Psychiatric Association's Diagnostic and Statistical Manual has grown to 224 mental disorders in the DSM-III from the 112 mental disorders in its initial, 1952 edition.
P.L. 97-35 Omnibus Budget Reconciliation Act created Mental Health Block Grant
November, Berkeley bans electroshock (Court reverses), Ted Chabasinski organized this.
The National Association of Psychiatric Survivors (NAPS) is organized (originally under the name The National Alliance of Mental Patients (NAMP))
Committee for Truth in Psychiatry (CTIP) organized by shock survivors Marilyn Rice and Linda Andre
First Annual 'Alternatives' Conference in Baltimore in June
The National Mental Health Consumers' Association (NMHCA) founded.
The first group of psychiatric survivor/consumers trained to work for the mental health system as professionals were trained in Denver, Colorado as Consumer Case Manager Aides (CCMA's).
Public Law 99-660 (The Healthcare Quality Improvement Act of 1986), and continuing through Public Law 101-639 (1990), Public Law 102-321 (1992), and Public Law 106-310 (2000), where the federal government mandated mental health planning as a condition for receipt of federal mental health block grant funds and mandated participation by stakeholder groups, including people living with mental illness and their families, in the planning process. P.L. 99-660 also mandated, "the provision of case management services to each chronically mentally ill individual in the states who receives substantial amounts of public funds or services,"
The Protection and Advocacy for Mentally Ill Individuals (PAIMI) Act (P.L. 99-319) is passed, setting up protection and advocacy agencies for people who are in-patients or residents of mental health facilities.
First lawsuit against a shock machine manufacturer
The American Psychiatric Association's Diagnostic and Statistical Manual has grown to 253 mental disorders in the DSM-III-R from the 112 mental disorders in its initial, 1952 edition.
Resident patients in state and county hospitals in the U.S. drops below 100,000
New York State OMH appoints first Office of Consumer Affairs (Darby Penney)
Altered States of the Arts founded at Alternatives 90 in Pittsburgh by Gayle Bluebird, Howie the Harp, Dianne Cote and Sally Clay.
Support Coalition International (SCI) founded in May
The Americans with Disabilities Act (ADA) is signed by President George Bush on 26 July
"Alternatives '91" conference in Berkeley draws over 2,000 participants for the largest consumer/survivor conference ever. Howie the Harp calls this the largest voluntary gathering of mental patients in the known galaxy.
Substance Abuse and Mental Health Services Administration (SAMHSA) was established by Congress under the ADAMHA (Alcohol, Drug Abuse, and Mental Health Administration) Reorganization Act, Public Law 102-321 on October 1, 1992. SAMHSA includes CMHS (Center for Mental Health Services).
National Assoc. of Consumer/Survivor Mental Health Administrators (NAC/SMHA)
MADNESS email list first messages sent
The American Psychiatric Association's Diagnostic and Statistical Manual has grown to 374 mental disorders in the DSM-IV from the 112 mental disorders in its initial, 1952 edition.
In April, the first class of the Consumer Service Provider Training graduates in Contra Costa County, California. This is the first training for Community Support Workers where the curriculum, class design and training were all implemented and taught by other consumer/survivors with a recovery orientation.
First time shock machine manufacturer pays money to a survivor
The Mental Health Parity Act of 1996 passed, barring insurance companies and large self-insured employers from placing annual or lifetime dollar limits on mental health coverage.
Supreme Court rules in Olmstead v. L.C., 527 U.S. 581, that under the Americans with Disabilities Act (ADA), undue institutionalization qualifies as discrimination by reason of disability including people with a mental disability.
The National Council on Disability (NCD) publishes, "From Privileges to Rights: People Labeled with Psychiatric Disabilities Speak for Themselves."
SOCSI (Subcommittee on Consumer/Survivor Issues) is created as a federally supported body to advise the CMHS (Center for Mental Health Services) National Advisory Council on consumer/survivor perspectives and issues.
NARPA (National Association for Rights Protection and Advocacy) holds twentieth Annual Rights Conference in Niagara Falls
"...quality of life depends on a job, a decent place to live, and a date on Saturday night." Charles G. Curie, M.A., A.C.S.W., SAMHSA Administrator
National Consensus Statement on Mental Health Recovery
Violence and mental illness and stigma
Mad. Crazy. Insane. Demented. Deranged. Loony. Psycho. Dangerous. These are all words used by the public to describe people who are labeled as having a mental illness.
Unfortunately, the public believes those labeled as mentally ill are dangerous and need to be watched carefully. According to the National Institute of Mental Health, a recent survey conducted in California found that 83 percent surveyed believed those labeled as mentally ill are dangerous. In reality, though, less than 2 percent of those labeled as mentally ill people are dangerous, according to the institute -- a figure no higher than the incidence of violence in the general population.
Even more disheartening is the institute's finding that society holds ex-convicts in higher regard than people who've had a history of being labeled with mental illness.
Patients of no other set of medical issues are kept under such scrutiny by the public. Cancer patients who refuse chemotherapy are not taken to the hospital by the police and forced to get treatment. People are not locked up for not participating in treatment (refusing to use an inhaler or lighting up a cigarette) or failure to comply (eating a fast food hamburger while on a diet).
Laws that seek to curtail the rights of people labeled as mentally ill – the right to be left alone, the right to refuse treatment – are damaging to the dignity of those labeled as mentally ill. These laws only deepen the stigma and serve to drive the some people into hiding when they could be getting help.
People labeled as mentally ill face more obstacles in society than any other segment of the population. In many cases the stigma is far more disabling than the illness itself. They find it difficult to find jobs and make friends. To further frustrate matters, those close to people labeled mentally ill are not likely to offer as much support as they would if the person had cancer or even AIDS instead.
How far has society come since the first mental hospital opened in Williamsburg, Va., in 1773? While the hospital was the first to cater specifically to the mentally ill, it was nothing more than a prison, with patients shackled and abused. Committal was virtually a life sentence.
Today the mentally ill aren't treated much better. A 1980 study found that a substantial number of mental health care professionals harbored resentment toward their patients. When a student in an upper-level psychology course recently mentioned she was an intern at Bangor Mental Health Institute, the student in front of her joked, "You wouldn't happen to be going there for treatment, would you?"
Yet nobody would joke about heart disease.
In its brochure "The Stigma of Mental Illness," the NIMH says: "Historical physical abuse or neglect have been replaced by a less visible but no less damaging psychic cruelty. ... W e no longer send (people labeled mentally ill) to a far-away asylum. Instead, we isolate them socially, a much more artful though equally debilitating form of ostracism."
The APA (American Psychiatric Association) has repeatedly stated that they are unable to predict dangerousness with any degree of certainty.
Similar "ism's" are:
Discrimination can be blatant but more often consists of:
1. Not powerful individually
2. hundreds, even thousands daily
3. cumulative effect over years
* Dr. Chester Pierce, an African-American psychiatrist and author writing about racism in the book, "The Black 70's", termed the multiple small insults and indignities directed at people "micro-aggressions."
Effects of Mentalism
People internalize the negative attitudes
People feel ashamed
People blame themselves for their difficulties
People feel worthless
People feel hopeless about their future
People lose confidence about their abilities
People feel they must hide their histories
People fear losing their job, their friends, their credibility
People become demoralize d
People direct their anger and helplessness back upon themselves creating a worsening spiral downward
Us vs. Them
This black-and-white style of thinking is referred to in psychodynamic literature as "splitting."
˙ Behaviors of the power-down group are framed in pathological terms.
˙ The same behaviors are excused or even valued in members of the power-up group.
A quiet client who causes no community disturbance is deemed "improved" no matter how miserable or incapacitated "they" may feel as a result of the "treatment."
"They" may be miserable but that's not the point.
"Their" misery doesn't matter. The only thing that matters is any inconvenience "they" may cause "us."
Labeling, diagnosis and other practices tend to decontextualize people.
Typically, when treatments are ineffective or unacceptable, the recipient is blamed. He or she is:
and, has therefore failed the provider rather than the other way around.
Mentalism and Language
There is NO such thing as a "side-effect."
There are only "effects" from taking drugs. Some effects are desired and others are undesirable.
Calling an adverse effect a "side-effect" obscures and minimizes the resultant pain, suffering and misery that can be caused by psychoactive drugs. This discounts our experiences and perceptions and thus denies our reality.
"Decompensating" is an us-them term
The demotion from "us" to "them" is a loss of one's designation as a person.
A person with a diagnosis can become:
"a schizophrenic" or
"a bipolar" or
CMI, SMI, SPMI, ADHD, etc.
Mentalism and Prognosis
Mentalist pessimistic prognostication leads clinicians to guide people into the "6 F's" of employment:
FOOD like fast food McDonalds or bakery
FILTH is janitorial or cleaning service
FLOWERS is gardening or landscaping
FILING is low-level secretarial type work
FASHION is low-level thrift store work
FOLDING is low-level piece rate work like stuffing envelopes
The six "F's" are the sort of low level, dead end jobs that are generally thought of as "meaningful" employment for the "mentally ill."
˙ Clinicians tend to gloss over problematic "side-effects" described by their clients without fully considering the impact upon people's lives.
˙ "Side-effects" are "dumbed down" so that people do not get an accurate view of the risks involved.
˙ Even in cases where some form of "informed" consent is sought, often no distinction is made between dangerous side effects and uncomfortable ones.
˙ TD Tardive Dyskinesia is a neurological condition caused by antipsychotic medications. It is characterized by the gradual onset of involuntary muscle movements that may include grimacing, rapid blinking and squinting, tongue protrusion, movements of the arms and legs, and twisting and writhing motions of the trunk. When TD is detected early, it is often completely reversible. If it is not detected early, TD is often progressive and permanent, so that even if the medication is stopped, the person may continue to have odd movements that s/he cannot control. When these movements are severe, they can interfere with sight, eating, speech, walking, and other basic activities. The movements are extremely stigmatizing, and can have serious health consequences. For example, when TD causes involuntary movements of the muscles of the throat, liquids may leak into the windpipe when people swallow, causing repeated bouts of pneumonia. While the person is taking the antipsychotic medication, the movements of TD are often masked. They also may not be apparent until the person is distracted or excited.
For all these reasons, the American Psychiatric Association recommended in 1980 that psychiatrists reduce the dose of antipsychotics on a regular basis and examine people taking these medications for TD annually using a standardized assessment such as the AIMS (Abnormal Involuntary Movement Scale) or the DISCUS (Dyskinesia Identification System Condensed User Scale). However, generally, individuals taking neuroleptics are encouraged to stay on a maintenance dose of medications. Regular dose reductions are rare, as clinicians fear the person will "decompensate." Rarely is an AIMS or DISCUS performed or documented. Generally the discussion of TD is limited to the warning of possible "muscle tics" given in the informed consent. The net result is that year after year, thousands of people receive antipsychotic medications without ever being thoroughly evaluated for a potentially disabling medication side effect.
One can only conclude that mentalism is operating here as elsewhere, causing psychiatrists to feel that unidentified TD is somehow an acceptable risk for people having psychiatric disabilities. The comparison with medical maltreatment based upon racism, such as the Tuskegee experiment in which African-American men were allowed to be exposed to the risks associated with untreated syphilis, is inescapable.
Myth of Compliance
Nowhere in medicine are physicians more preoccupied with enforcing "compliance" than psychiatry. Most non-psychiatric physicians have come to accept that compliance itself is a myth.
˙ Humans don't comply with anything (Studies of "compliance" with everything from diabetic diets to anti-hypertensive agents show that humans don't comply with anything. At least one third of people in these studies fail to follow their doctors' instructions and many studies have shown rates of "non-compliance" of over 50%.)
˙ Best results are obtained when people are well-informed and in control of their treatment
˙ Incarceration is used to contain the person who will not comply, though, because the incarceration occurs in a hospital, it is deemed to be "treatment"
˙ Imagine jailing a diabetic for having dessert or incarcerating a person having chronic bronchitis for lighting up a cigarette or forgetting his/her inhaler
Mentalism and the Environment
˙ The separation of the facilities (i.e., restrooms) for "staff" and "clients" mirrors the conditions in the Southeastern U.S. prior to the civil rights movement.
˙ Client "public" restrooms often have a lower standard of maintenance and privacy.
˙ There are even places where the stalls in the "client" restroom have no doors. This was justified as a "safety measure."
(Consumers Advocating Recovery through Empowerment)
NAMI C.A.R.E. is a support group for people facing the challenges of recovering from severe and persistent biologically-based mental illnesses. It is a place where people dealing with depression, bipolar disorder, schizophrenia, anxiety disorder and other disorders have found a supportive place.
There are no biochemical markers, no biological tests, no hard evidence at all, to "prove" the existence of "mental illness." Proof = demonstrate a reliable association between a clearly specified pattern of observables and other reliably measurable event(s) which operate as antecedents. (This is same level of proof used for TB, cancer, diabetes, etc.)
Truth about "Mental Illness"
You, as an adult, have a right to put anything you wish in your body, but at least have the facts first, and don't have any illusion that you're curing a disease.
Alcohol, tobacco, and street drugs might make you feel good, but they are nothing more than nonspecific mood alterers and frequently have dangerous effects which make you feel bad. And when you want to get off them, for that or other reasons, you'll likely find them addictive. If you read the relevant literature, you'll find that the neuroleptics, SSRIs , etc., have the same assets and liabilities.
The standard for a true disease advanced by Mary Boyle in Schizophrenia: A Scientific Delusion? : "...the requirement is to demonstrate a reliable association between a clearly specified pattern of observables and other reliably measurable event(s) which operate as antecedents." This fits TB, cancer, diabetes, etc., but doesn't fit any DSM "disorder" played around with by psychiatrists.
Mentalism and Trauma
Mentalism can cause further difficulties for those who have a past history of trauma.
Mental Health's Trauma tizing (and Retraumatizing) Effects
˙ Incarcerates citizens who have committed crimes against neither persons nor property through the involuntary commitment process.
˙ Imposes diagnostic labels on people; labels that are often pejorative, stigmatize and defame.
˙ Induces proven neurological damage by force and coercion with powerful psychotropic drugs.
˙ Stimulates violence and suicide with drugs promoted as able to control these activities.
˙ Destroys brain cells and memories with an increasing use of electroshock (also known as electro-convulsive therapy).
˙ Employs restraint and solitary confinement in preference to patience and understanding.
˙ Humiliates individuals already damaged by traumatizing assaults to their self-esteem.
˙ Teaches learned helplessness through the constant threat of the use of involuntary commitment, force and coercion.
˙ Lacks sensitivity to issues of trauma including being unaware or unwilling to address potential "triggers." (Hospitals/offices may have personnel, equipment, smells, procedures, pictures, etc. that might be vivid reminders of past abuse suffered by patients.)
˙ Mental health professionals often just don't listen. They KNOW what's best for the person so they discount the person as being the best expert on their own life so they tune out or don't hear what the person is really saying.
In the United States, a child is reported abused or neglected every 10 seconds. (6 every minute = 360 every hour or 7.2 in each state = 8,640 every day or 172.8 in each state = 60,480 every week or 1,209.6 in each state = 3,153,600 every year or 63,072 in each state)
Up to 30% of girls and up to 20% of boys are sexually abused before they reach adulthood.
Approximately 1.5 million adult women and 835 thousand men are raped and physically assaulted by an intimate partner each year.
Roughly 4 – 6% of our elderly are abused, primarily by family members.
70% of women who are homeless were abused as children. Nearly 90% of women who are both homeless and have been diagnosed as having a mental illness experienced abuse both as children and adults.
80% of incarcerated women have been victims of physical and sexual abuse. The majority of murderers and sexual offenders, who tend to be male, have a history of childhood abuse, neglect, maltreatment and trauma.
The majority of both men and women in substance abuse programs report childhood abuse or neglect. Each year, more than a half-million women injured by their intimate partners require medical treatment.
Each year, 2,000 (40 in each state; almost one a week) children die from maltreatment: 90% are under the age of five.
43% of psychiatric inpatients reported physical and/or sexual assault history (Carmen, 1984)
42% of female inpatients of state hospital reported incest (Craine, 1988).
52% of consumers in an urban psychiatric emergency department reported incest
40-50% of male consumers were sexually abused in childhood.
Actual numbers are uncertain due to differences in how data were collected (chart review vs. interview)
Does not include post-traumatic effects associated with poverty, exposure to violence, homelessness, trauma within the mental health system, other life experiences (military), etc.
There is great negligence in obtaining trauma histories from people receiving mental health services even though available studies indicate that a huge number of people, between 70% - 90%, in the public mental health system are affected.
We need to learn to ask,
"What happened to you?"
instead of diagnosing problems (What's WRONG with you?) based upon people's thoughts, moods, feelings and emotions.
Thoughts, moods, feelings and emotions are NOT an illness, disease or disorder!!
We need to learn to listen to people's stories.
Selective inattention to a past history of abuse often causes clinicians to fail to diagnose the root cause of psychiatric disability.
It is important to understand that, due to the power differential between staff and recipients, many psychiatric interventions trigger or retraumatize the survivor.
Triggers and retraumatization can occur in both the physical and interpersonal environments.
Examples include spread-eagle restraint of a rape victim or disbelieving the history given by a survivor of incest.
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Because powerlessness is a core element of trauma, any treatment that does not support choice and self-determination will tend to trigger individ uals having a history of abuse.
People may re-experience the helplessness, hopelessness, pain, despair, and rage that accompanied the trauma.
They also may experience intense self-loathing, shame, hopelessness, or guilt.
Mentalist thought tends to label these negative effects of treatment in pejorative terms that blame the survivor: "He's just acting out," "She's manipulating," "He's attention-seeking."
These labels are often communicated through the attitudes and language of staff, and become re-traumatizing in themselves.
Mentalism, like racism or sexism, is abuse.
Overcoming Mentalism (1)
What is the desired product?
Tenure in the community
Quality of life
Increased agency funding
Generating Billable Medicaid Units of Service
The system's biological approach reduces human distress to a brain disease, and recovery to taking a pill. The focus on drugs obscures issues such as housing and income support, vocational training, rehabilitation, and empowerment, all of which play a role in recovery.