As I read about historical "scientific" approaches to mental illness, I couldn't help but reflect on today's practices. For example, Moral Treatment began in part, as a backlash to the harsh treatments of the time. Pinel and Pussin both believed that people deserved to be treated with kindness. I see similar parallels in today's treatment approaches. On one hand, there is the medical model of diagnosis and treatment -- with the physician as expert. In many ways, like Benjamin Rush's residents who had to spin people, psychiatrists today are taught to not let their sentiments get in the way, as they know best. Forced treatment happens with regularity. Unfortunately, the "patients" are right much of the time...about the negative effects of their treatments, and are legitimately resistant. Yet, somehow, their perspectives are disregarded, as they are "irrational," deemed "noncompliant" and obviously not as smart as the expert psychiatrist. I see recovery and psychiatric survivor movements as a backlash (in part) to this medical model, repeating patterns of the past. (Opposing forces -- Mad Doctors v. Moral Treatment)
It's easy to look back and be critical of the treatments that were considered "cutting edge" at that time -- for example, drowning, spinning, drinking concoctions, bloodletting, flogging. Often people with mental illness experienced these "treatments" negatively, yet these perspectives were disregarded, and "science" prevailed over human experience. Residents were taught to not let their emotions cloud their judgment.
What are we doing today (cite a specific practice or treatment) that YOU think will be criticized harshly when seen through the lens of history, 100 or even 200 years from now? To what degree are we disregarding patient experience now, and why do you think that happens?
Reply to this post and at least 2 of your classmates' replies.
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ReplyDeleteResponse to Moral Treatment
ReplyDeleteI am away for the week with friends and families. I felt the need to read some excerpts aloud because I was becoming distressed. Rene Descartes had identified human as being capable of reason and animal as lacking reason, he went further and identified a separation of mind and body. I was not initially displeased with this definition or interpretation until the next few paragraphs justified inhumane treatment. The ability to claim that reason made a human, allowed for all that was not human to be abused. A young man responded to the teachings of Cartesian Philosophy, “Yes, we learned that in Catechism!” I was horrified that he had learned that within the past 10 years. He explained that they had learned that pets respond to pain but without reason or understanding, “Pets do not enter heaven because they lack reason.” Another person in the living room responded to the writing on Bethlem Royal Hospital, “This sounds just like the charities of today, a child is shown in deplorable conditions to encourage people to respond with compassionate contributions which often do not change the life of the showcased individual. Have we really changed?
I wonder about nursing home care and other types of institutional care. How will we be judged in a 100 years? People are woken on a schedule, cleansed, fed, and taken to recreational activities. People are having things done to their bodies all day on an external clock. This is not abuse but could an individual be cared for in a more individualized manner if places were not understaffed and adhering to cost saving measures?
We will be evaluated on our lack of presence in the lives of the individuals who we serve. We do not always listen and at times, the stress of our work is in competition with the reality of our clients lives.
HI Liz. I hope you are enjoying your week away. I also became distressed over the inhumane treatment of people listed in our readings and viewed in videos. The mental and medical health care systems that care for our most vulnerable people are often overworked and understaffed. I recently encountered a situation where a caregiver in a facility actually snuck medication into a patient's drink because the patient was refusing to take the medication. Although people seemed to realize how inappropriate that action was, less significant intrusions such as you described are overlooked. To me, it's about dignity and respect.
DeleteHi Liz and Toni,
DeleteI would suspect there is an issue with staffing and maintaining staff in these types of residential and institutional settings. Burnout must be high. When I watched the Bellevue video I thought about if I could see my self work there and I couldn't. What a drab, depressing environment to be in both as staff and patients. And I wonder how much flexibility there is in the approach to treatment there. If someone were to enter in with a new, innovative way of treating people I wonder how that would be received.
Hello Liz. I agree that in the future we will look at the way we treat our elderly in nursing home care to be outdated. I think while we move to more patient based care in different populations we still lack in treating patients of a certain age. There is a problem with bringing elderly patients into discussions about their care, and that's when staff feel like they can slip medications into food and feel like they "know best".
DeleteI had to think about this question for a while and then finally asked myself "What do I wish could be different in respect to how individuals are treated?" The first thought that comes to mind is the stigma that can be attached by society to someone who has a mental health diagnosis. I work as a Vocational Rehabilitation counselor and one of the issues that many individuals grapple with is around disclosure of disability to the employer. I've worked with many clients who fear that because their disability may not be visible that employers or co-workers will dismiss it as not real or overly exaggerated. Or that somehow this person with a disability is less reliable because of their diagnosis. I was impresssd with Pinel's philosophy around work as a means to recovery. Getting to know each person's unique strengths and matching their interests and skills is what we aim do to in VR. It is a struggle for individuals with disabilities to secure work and that's why programs like VR exist, but why should someone with a disability to have to prove themselves more than someone without? Not to mention that I often hear from people that conversations with doctors and providers are around what they cannot do, which can lead people to accessing social security benefits as a means to survive. They may have an ingrained belief that they cannot work because that is the message they hear. Many of the individuals I work with are receiving social security but some are not. And even with a limited income of perhaps $700 a month, the system is not designed as one of hope and recovery. A lot of folks feel stuck in a system that is frightening and taking a risk to explore work can be even more terrifying if you are fearful of how you may be perceived on a job. This goes back to the messages from Dr. Deegan and Dr. Fisher about the importance of hope. I am not sure I really answered this question correctly, but to summarize I hope that in 100 or 200 year we are looking at a culture that has adopted a recovery oriented mentality that is easily accessible to those with a psychiatric disability. And that a cultural shift has eliminated that fear of stigma around disclosure and what it means to have a mental health diagnosis.
ReplyDeleteSandra
DeleteI can relate to the concern in your words over how clients are treated. It is certainly true that much of what we currently have in place in terms of a "mental health care system" is very fixated on management of the effects of disease, rather than the promotion of wellbeing and recovery. It is a similar phenomenon in the field of labor and delivery; the event of a baby coming into the world is largely viewed as a crisis to be managed, a medical emergency. It is no wonder the fear and body resistance that many new mothers have in a hospital setting.
The stigma you describe as a barrier to working in meaningful, satisfying jobs, or at all, is a greater problem then I think many people realize.
I look forward to a cultural shift like the one you describe. I my mind, this shift will not come without major overall to the very fabric of society. I believe that a consumerist, capitalist society will not realize that potential, given that it does not value life and well-being so much as it does profit and product. I think we are in need of a spiritual revolution as well. That may be what is called for in order to overcome the hurdles presented by the current systems.
The question of whether to disclose a disability is complex. How much to disclose and when also need to be considered. On the one hand, seemingly invisible disabilities such as mental health diagnoses have stigma attached. When an employer does not know about a mental health diagnosis, they may get an opportunity to see the person rather than the diagnosis. At the same time, sometimes accommodations and support enable a person to successfully gain and maintain employment. It is too bad so much stigma is still attached to mental health diagnoses and disabilities in general.
DeleteHi Toni, Sandra, and Shea. You all make such great points regarding the questions of disclosure and stigma of diagnoses. I am not super familiar with vocational rehabilitation and laws regarding disclosure. I agree that it is important to find a balance so that employers can see the person as opposed to the diagnosis while also providing necessary supports and/or accommodations. Are there any laws in place that require a person to disclose issues of mental health? I understand that there are laws in place protecting a person's employment and treatment in the workplace in relation to any disabilities they may have, but I also wonder if and fear that although there are protections on paper, in reality employers are not actually providing the supports and understanding in their hiring practices and treatment of employees upon hiring. I don't have specific answers as to how this can be accomplished but I hope to see this continue to improve as issues of mental health continue to be more openly discussed in society.
DeleteHi Sandra. I agree that mental health stigma is a problem in our society and create undue hardships for individuals looking for a job. On one job application i took there were questions asking if you had a mental illness and giving you the option to disclose or not without really going over the ramifications of that. What happens if you do? What happens if you refuse? I hope that the future leaves our society more educated about mental health and we see these barriers eliminated.
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ReplyDeleteIn 100-200 years from now, I believe that the earth will look very different. I believe that wars, famine, disease and general disaster will have come to upend the paradigm we live in now.
ReplyDeleteI think that, of those communities that remain, those whose residents have progressed spiritually will view mental health much more holistically, and that the care for those suffering from mental illness will be integrated into community life. The well-being of a member of the community will be given the same consideration as the entire group's well-being. I believe that those people will look back at today's practices and be fairly unimpressed not only with how we treat people with mental illness (as abject, different, weird, needing to be medicated,etc) but also with our society in general, which does not provide for the social and emotional well-being of its population by virtue of its very essence. We have a society of consumption, commerce, and isolated nuclear families. People work tirelessly at jobs which cause them stress to no end. That our culture is the thing that is sick is evidenced by the skyrocketing rates of anxiety disorder diagnosis and depression. These future people will see that we had so, so much to learn. We are really just beginning, in my opinion.
Hi Shea. Although the second sentence in your post is a bit dark, I can see where you are coming from and what you mean by this. I see us celebrate and appreciate the beauty and way of life of more indigenous cultures in verbal ways as we look from the outside in. We recognize that many of the cultures value family and balance and treat the earth with great respect and measures of sustainability, but you're right, we do not adopt similar practices ourselves. This makes it also seem too that many of our mental health issues stem from our more self-destructive ways of life. Perhaps if we adopted a more balanced lifestyle similar to what we appreciate in more indigenous cultures, we could minimize the mental health issues that arise.
DeleteIf I could look back 100 years from now, I hope I would see that the treatment and view of mental health has shifted to a recovery model. Currently, there is still a lot of emphasis on the medical model where "doctor/therapist knows best." Currently, though there has been a shift in the number and length of stay of hospitalizations, many people continue to be hospitalized more often than needed if beneficial treatments and supports were in place within the community. The current resources are too few. People still do not have enough voice in their own treatment. Recovery and wellness are concepts that are well respected in some areas but not even considered in too many instances.
ReplyDeleteIn addition, I would hope to see a shift in how mental health is viewed. Currently, significant stigma around mental health diagnoses exists. It would be great to see accommodations and supports in place that promote wellness and inclusion in the community, workplace, in relationships, and all parts of life.
Hi Toni, Thank you for your post. I think you're right that recovery and client choice is well-respected but does not always happen as readily as one might hope. I remember not too long ago, my dad was pushed to get treatment for his issues with alcohol, and although he did so briefly and understood the need for it, he quickly found that the therapy and treatment methods did not fit him so he ended up quitting treatment altogether. Fortunately he was able to overcome his issues with alcohol and has been sober for many years but I think many others may have similar experiences and end up unable to overcome such issues on their own. This certainly highlights the importance of allowing client voice to lead treatment.
DeleteOn the other hand, sometimes those who struggle with issues of mental health may also have ways of thinking that may not be entirely factual which may lead them to seek solutions that fit their interests but are not necessarily effective when it comes to actually supporting treatment. I once had a client who stated that because he has started the year "as an a--hole (his words, not mine)" he was required to remain an "a--hole" the rest of the year due to his obsessive compulsive disorder. He genuinely believed that by maintaining a specific pattern of rudeness everyday, he would somehow attain his goals for the year, and it took a lot of work to help him see the error in his thinking. Granted this is a unique example, but one can see from this that while client choice is important, there must also be a balance in terms of helping clients to choose treatment that indeed supports their mental health goals.
End the stigma campaigns have always made me feel weird. I guess I don't really understand why. I suppose there are power in numbers to make change, which I like. I also like the idea of being a member of a group which can provide support and friendship If I had a mental illness I wouldn't want to wear an end the stigma t-shirt. I wonder why? If I had a mental illness I wouldn't necessarily want that as a defining characteristic. I hope in 100 years there are no more end the stigma campaigns.
ReplyDeleteAs I consider practices and treatment, I can't help but apply them to the educational setting because of my position as a school counselor. While working in schools I have seen too often that teachers are not equipped to handle psychologically based issues that arise for students. Too often students are sent immediately out of the classroom for disruptive behavior which oftentimes only increases such behavior and does not help resolve the true issues going on for the student. Additionally I have seen students choose online schools or no school altogether due to issues of anxiety because the school did not provide the necessary environment or supports for them to navigate these issues. Fortunately more and more schools are recognizing this and starting to hire more mental health professionals (psychologists, social workers, and school counselors) in order to address this issue. Although we are moving in the right direction, I still see students separated from the general population as part of their treatment plan. I struggle with this because I have seen that sometimes this can be helpful in terms of minimizing distractions for the student so that they can focus on treatment; on the other hand I am not sure that this provides the necessary support to enable a student to maintain their mental health upon return to general population. I have seen some continue to struggle upon reintroduction back into general population. In addition to the mental health struggles and issues that arise every time a student transitions between settings, opportunities for academic and social learning are minimized for the struggling student which puts them further behind the abilities and knowledge of their peers. Although I don't see the tendency for student removal from general population for treatment being judged necessarily super harshly, I do see this to be an area that we continue to study, critique, change, and improve upon. I see teachers receiving more training in the future so that they may better support unique mental health needs of students, and with this, I see us looking for ways to minimize student removal from class and general population so that they can navigate mental health issues in the settings in which they continue to live long-term while maximizing their opportunities for learning.
ReplyDeleteAnother area of psychological therapy that I wonder about is that of prolonged exposure therapy or cognitive processing therapy for treatment of post-traumatic stress disorder (PTSD). Logically speaking, I understand how prolonged exposure or reliving of a traumatic situation can help a person desensitize themselves to the memory of that awful experience but I can also see how reliving past trauma may simply result in increased pain and may prevent the person from healing from the experience. I also wonder too if "desensitizing" a person is the appropriate approach. We experience pain from trauma because we are human and should feel pain when experiencing something horrible. When we desensitize ourselves to trauma and normalize that experience, I wonder what other protective boundaries do we allow to be taken down and what other traumatic experiences to we end up enduring as a result of our normalization of the original trauma. Then again many studies have shown clients have been able to overcome trauma through cognitive processing therapy and prolonged exposure, and it at least requires people to face such issues in a controlled manner instead of suppressing them and having them come out on their own in uncontrolled, harmful ways. This is an area though that warrants further study and critique as well.
In 100 years I hope that we are beyond war, but that may be too much of a dream. I hope that we can incorporate better mental health services to our troops before they go to war instead of after. I think we will look back at how we prepare soldiers physically for war but not mentally and see it as inhumane. Just as soldiers run laps and do pushups there should be mandatory counseling sessions to prepare and evaluate through out training. This per-emptive solution id already being talked about and i believe it will be the future of the military mental health care.
ReplyDeleteMichelle
DeleteWhat you write about preparing soldiers physically for war, but not mentally, is very poignant. I agree that there should be strategic counseling and mental health resources available that are currently not part of the process for sending young men and women into war zones. It would appear that, for the current model being employed, having these individuals developing coping skills, greater self-awareness, and knowing themselves more deeply on an emotional level, might run counter-intuitive to the requirements of either war or the military industrial complex. There is a certain level of coercion and intimidation that is currently employed to engender homogenization, and that would be disrupted, I think, by pre-war counseling and personal work.