Theory matters. How we think about "mental illness" and particularly, what causes it, greatly influences what choices are made available for people with mental illness. The fact that I phrased the last sentence this way indicates that people with mental illness "should be provided" with choices, by "normal people." Later we will discuss whether you can provide someone with rights and choices, or if they already HAVE THEM.
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| Spinning Chair Exhibit Glore Psychiatric Museum St.Joseph, Missouri |
What are the prevailing etiological theories in psychiatry today? What do these theories lead us to DO to (and with) people with mental illness?
Answer these questions, and respond in detail to at least 2 of your classmates' answers.
Based on this week’s readings and video clips it seems that psychiatry today views mental illness as no longer an incurable disease that at best can merely be managed, but instead a condition that one can recover from. Until fairly recently people with mental health conditions were sent to hospitals to get well. This often resulted in long periods medication experimentation, isolation, hopelessness and a loss of self. Since the de-institutionalization movement there has been progress towards the recovery. This movement looks to empower people with mental health disabilities, making them the prime person responsible in their own recovery. People with mental health disabilities should no longer be held back by their helpers until they are considered well. Instead, people with mental health disabilities are realizing that they can experience considerable psychiatric challenges and still actively make progress towards their hopes, dreams and aspirations. The process of recovery becomes recovery itself. It was nice to read the Fisher article about work in recovery. As a Vocational Rehabilitation Counselor it is not uncommon that I work with clients with mental health disabilities who are worried that they are no ready to take steps towards their goal of becoming employed. Sometimes these clients are receiving these same reservations from their case managers and counselors. Fisher (2013) stated “it is necessary to recognize that people recover from mental illness and that work helps in that process.” This made me think of the new action oriented “Progressive Employment” approach that the state of Maine is implementing. It seems like a perfect approach in that “everyone is ready for something.” So clients who have reservations about going to work can engage in an employment activity as simple as a tour of a company or an informational interview with no commitment from the job seeker or the business. I think this employment approach will be especially effective with those with mental health disabilities.
ReplyDeleteI agree with the movement of empowering people with mental health disabilities through real life experiences. Treating patients in specialized healing environments is important when needed to help introduce concepts, but true healing and growth comes from real life experiences. Giving some support in the real world and letting patients/clients be more independent and achieve goals is fundamental in establishing real world skills and confidence. Even in my job I am there to teach skills and then take a step back and give my students opportunities to succeed and fail and both are great learning experiences that are equally valuable in the process of self-efficacy.
DeleteHello Geoff. You succinctly put it "the process of recovery becomes recovery." The life story of Dr Fisher illustrates your point perfectly. An action oriented approach is much more likely to produce hope for a person with mental illness than stagnantly waiting for stabilization before living life.
DeleteDr. Fisher's discussion around giving hope instead of leaving people with hopelessness which may lead to suicide supports your idea, Geoff, that people who have been diagnosed with mental illness related diagnoses can live their lives now without having to wait to become "well enough." Dr. Patricia Deegan also presented a message of hope and accomplishing dreams.
DeleteI think the action oriented approach of "Progressive Employment" is a great step for our VR consumers, and I think it addresses the SAMSHA guiding principle of "many pathways" to recovery. Through our studies as rehabilitation counselors we have learned about and had to commit to the principle of a "non-linear path to rehab" which seemed counter to how VR services were oftentimes provided. Consumers had to basically appear to have already been "recovered" before a VR counselor felt they were ready to seek employment. For those who did not appear this way, I think it created a sense of hopelessness for a lot of individuals who wanted to work but the "expert" said they could not. Progressive employment helps bring down that barrier for folks by meeting them where they are moving forward with them in a non-linear fashion.
DeleteI agree that treating people as human beings with the focus on wellness, hope, and perception that they are heroes overcoming a great issue in their life, is the optimal way to support recovery. I like how you say the process of recovery is recovery itself. Bringing down barriers to a life that embraces individuality also opens doors to recovery, employment and a way of life best for our client.
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ReplyDeleteWhat are the prevailing etiological theories in psychiatry today?
ReplyDeleteDepression, ADHD, and Schizophrenia are seen as mostly biological issues. Whether they be caused genetically, foods/chemicals, or physical ailments these issues are with the brain and that makes it a biological problem. To fix biological problems there is a consensus that you need to treat it like any other physical disease.
What do these theories lead us to DO to (and with) people with mental illness?
This theory has made medication the foremost prescription in treatment, and has left other therapy avenues as secondary in many cases. It has created a dependency on medication, and left less hope of living a life without it. If medication does not work or doesn’t give the desired effect there is a hopelessness that nothing will help or work. If medication is needed then the idea of ever really being cured or being mentally healthy is an idea that is difficult to reach with the patient and society. An example influenced by readings and videos are that you have Schizophrenia and take medication for it,despite the treatment working you there is a label for life. Our society has negative opinions on mental illness and recovery when the illnesses require medication. Yet, if someone has a physical illness and take medication societal perception of recovery is completely different and hopeful. Watching the videos this week I have hope with so many informed advocates that societal perception of mental illness will change in the coming years.
Medication does still seem like the go-to treatment method for individuals with mental health disabilities in this country anyway. The hope is that medication is only part of the treatment modality. I recall from this week’s readings that Assertive Community Treatment(ACT) programs have emphasized medication management and have historically lacked a recovery oriented emphasis. When I worked briefly as an ACT case manager I remember the emphasis was on avoiding hospitalizations. In that regard I think we did a decent job, but never don’t recall much of a push for recovery.
DeleteAs our current mental health system focuses more on trauma informed treatment, I see a shift in some of our thinking around mental illness and mental health. What was once believed to be related entirely to biological traits seems now to be viewed with more complex etiology. A combination of factors, including environmental, hereditary, abuse/trauma, poverty, etc are now seen as factors that lead toward mental illness and substance abuse. A complex approach that may include medications, counseling, case management, work supports, and community supports, may benefit people who have been diagnosed with mental illnesses. As our readings and videos point out, hope is an important factor for these supports to be effective and useful to the individual.
DeleteHi Michelle,
DeleteThank you for your post and for bringing up the issue of medication. I think you are absolutely right that currently we give medication for such issues as depression, ADHD, and schizophrenia. As we were completing this week's modules, I kept wondering about schizophrenia in relation to medication. When I think of depression and ADHD, I feel very comfortable imagining scenarios where a person is able to come to terms with these issues to a point where they no longer need medication. I have difficulty, however, imagining a scenario where a person with schizophrenia is able to eventually live without medication. It made me wonder about recovery goals and if going without medication should or could be a goal. And I wondered too, how many of my questions on the subject stemmed from my own biases or lack of understanding of these afflictions. I still do not have an answer for this but I look forward to discussing and learning more from this class.
Dr. Patricia Deegan and Dr. Fisher both discuss their own recovery process related to their mental health diagnoses. Both describe the importance of hope. As we move to a more recovery based belief around mental health, shifts are apparent. It is important for the individual who has been diagnosed to play an active and central role in the treatment team. Rather than "doing treatment to" the person, the person needs to have an opportunity to receive informed consent and make their own decisions around effective treatment. It is important that people be able to live their lives with hopes, dreams, goals, and the right to fail. When we see mental illness as something from which people can recover, our language changes. Individuals are no longer locked into a prescribed path for their lives. They have options, choices, and possibilities.
ReplyDeleteMedications continue to be viewed as central to mental health management. It is important to take into account the life experiences of the individual with mental health diagnoses. There are many side effects to medications, many of them are unpleasant and sometimes even unhealthy. Supporting an individual to find a path that works for them promotes client choice and voice. Prescribing treatments and medications as something that is done to the person sometimes without their full understanding or involvement does not promote choice, hope, or recovery.
Toni, I like how you brought attention to the concept of how language plays a key role in the recovery movement. You said that people with mental health disabilities can have lives that are no longer prescribed for them. The same people who once remained in the fog to avoid the cruel world around them see that they can control their own lives and if they so desire work towards making change to the system that once held them captive. Words like hopes, dreams, possibilities, and risks helps thinking to change allowing people to experience more wholly what it means to be human.
DeleteI think the discussion around choices and options is so critical. Helping ensure that people understand what they are taking, what the side effects are and what alternatives might be is key. We know there is a place for medications in treatment, but I find it so concerning when I hear people discuss their medications without a lot of knowledge of what they do. I hope more providers are moving towards the collaborative approach that values client input around what is working and what is not.
DeleteGeoff- Yes! People with mental health diagnoses have the ability to experience life including work, relationships, making choices-good and bad, and experiencing successes and failures. Sandy,when people understand their diagnoses and their medications and have the ability to speak about what is important to them, their treatment becomes based on what they want and need. Instead of having treatment done to someone, the person becomes responsible for their own treatment and recovery.
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ReplyDeleteI was slow to post because I think there are many views of mental health, mental illness, and what recovery looks like depending on the model of prescribed recovery and the person's placement in the community. The medical model still functions on a continuum of care that now includes a more holistic view but tends to "do what is best for the patient." Community based programs appear to be more focused on living with and in recovery. Peer advocacy and changes in the view of mental health are changing the perception of having a mental illness and the view of recovery.
I agree that community-based and other non-profit type agencies appear to be more focused on helping people "live in" recovery. Indeed, some of the things P. Deegan and Fisher were talking about, in terms of having social support and loving, meaningful relationships, cannot be readily accomplished in visits to a psychiatrist or even a counselor. Those environments provide a much needed social network and a source of integration and meaning that are part and parcel to recovery.
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ReplyDeleteModern psychiatry is greatly influenced by the deterministic world-view of human development, where people are solely a product of biology and environment. However, this view tends to lend itself to an etiological theory in which those with mental illness are powerless, or perhaps "sentenced", for lack of a better word, to these forces beyond their control. The object is largely for providers to medicate, and treatment of the trauma of the past is secondary to sedating those with psychiatric illness. That said, access to counseling services and therapeutic alliances with other professionals is unprecedented at this time. There are many avenues for treatment, however the medical model still heavily influences the treatment of these individuals out the gate.
ReplyDeleteThe Empowerment model is a more holistic approach, and those with mental illness are viewed as agents in their own recovery, not just passive recipients of medication and services. I think that this model is of tremendous value, and I look forward to the day that the various institutions and funding agencies "catch up" in terms of what they are willing to provide and what their focus is on.
Hello Shea, Empowerment is the foundation of hope and the seeds to recovery. I believe that this is the pathway to recovery for all illnesses and for the basis of being successful in life. We have read many articles and seen the side effects of medication. Some medication is very helpful but it appears to be mandated even when it is not helpful. Hope on the other hand is always therapeutic but it is not mandated and it is not always prescribed. We can all learn a little lesson in advocacy with the motto, "Do nothing for us, without us."
DeleteWhen I think about people having a voice in their own treatment and recovery, I often think about medications and side effects. Many medications have side effects which range from unpleasant to debilitating. Some medications result on further, sometimes serious, illnesses. Medication doses are often raised and then raised some more when they are not effective. Listening to the person being prescribed the medications and providing accurate and detailed information about medications allows people to make real informed decisions about their care. Not only do they feel empowered, they are more likely to stick with the choices that they make. There are a lot of options out there at this point for treatment. Providing education and information around various options allows people to make treatment and recovery choices that honor their beliefs, values, and interests.
DeleteI like the motto, "do nothing for us, without us." I have also heard, "nothing about us without us." I think of the various times I have seen or known of the "real" meeting that happens with providers where decisions are made, and then the "client" is brought in and the decision is presented. If the person balks or questions, they are viewed as uncooperative or resistant.
Hi Shea,
DeleteThank you so much for your post regarding empowerment in psychiatry. I appreciate your use of the word "sentenced" in relation to the diagnosis of a mental illness. Although "choice" and "empowerment" in one's ability to manage their own treatment and recovery may seem like such a common sense element to us, this does not diminish the reality that this is an essential part of the process. I see this in so many elements in life from the career/job setting, to motivation in the academic setting, to even happiness in one's living arrangements. When a person's right to choose and have power over themselves and what happens to them...when this is taken away, all hope is lost.
Never before has this rang so true for me; I am in California at the moment visiting my grandpa who has been placed on hospice care. All of his family is in MT (with the exception of me in Maine) and he has not had any contact with anyone in the family for 8 months. I had to track down an aunt I had never met just to find out where he was staying so I could go visit him. As I sat with him today, I found out that he really should not be on hospice care, rather he has been sent to this specific, not very nice place, because of his financial situation and some complicated family dynamics. With tears in his eyes, he asked me if I could help him "say goodbye" or at least help him escape so that he could just "walk off." Both of us were heartbroken at the lack of power we felt. It hurt him to even have to ask for help, and it hurt me to not be able to give him the power and control he should have over his own life. What I had originally pIanned to be a simple visit to see my grandpa, now has turned into a complicated, but worthwhile, endeavor to help my grandpa regain a higher quality of life. I can see that if we are able to move him to a more vibrant retirement center in which he actually wants to live where he can have a little more say in how the remainder of his life will look, he will do much better health-wise and be much happier.
I think that etiological theories in psychiatry continue to evolve. As others have mentioned, it does appear there is still a strong base in the medical model which tends to put the person with the diagnosis in the position of recipient of services from those considered experts. I think about what I see in my work as a Voc. Rehab. Counselor and many individuals do rely quite a bit on medications and guidance from providers. I see fewer people feel empowered to take charge of their mental health services which is understandable because it seems that hasn't been the norm. I am hopeful that the movement towards recovery can spread further to encourage hope. It was fascinating to hear both Dr. Deegan and Dr. Fisher talk about the importance of hope in the recovery process. Too often I think that hope is not discussed and emphasized enough for individuals with significant mental illness.
ReplyDeleteI think unfortunately there is a history of trying to encourage individuals with significant mental illness to lower the expectations of what they may be able to achieve. Dr. Fisher touched on this when he discussed concerns about giving people "false hope" but I thought it was so poignant when he said he'd rather people have "false hope" than "false hopelessness."
Hi Sandy,
DeleteI had similar feelings to Dr. Deegan and Dr. Fisher. I thought it was powerful when Dr. Deegan discussed the difference between her providers having "knowledge" versus "wisdom". The medical model focused on providers being the expert and having all the knowledge which led to grim prognoses, thus false hopelessness. Individual's such as Dr. Deegan and Dr. Fisher have been able to break down some of the prevalent myths, and have emphasized the need for providers to embrace wisdom.
The movement in the field of recovery outlined by the Dr. Deegan and Dr. Fisher videos demonstrate the progress – though at times may seem limited – of society and the field of mental health services to evolve beyond the medical model of disability. When I realized (after listening) Dr. Deegan’s speech was delivered in 1995 I was impressed with her foresight and wisdom that reminded me just how significant the field of psychology and psychiatry has progressed once individuals in recovery could begin to contribute to and shape the field. SAMSHA’s working definition of recovery is: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential”. The medical model narrowly focused on the first part, but thought improving health and wellness could only be done through a pre-prescribed treatment model with little hope for the future. Testimonies from recovering individuals finally began to show us that deviating from the medical model to empower individuals to live self-directed lives and strive to reach their full potential is essential to the recovery process. At Vocational Rehabilitation we have an old adage that “the VR process is something we do with the person, and not to the person,” and I think this highlights the difference of theoretical approach. Individuals with psychiatric disabilities seeking treatment services need us to work with them through the recovery process (using SAMSHA’s 10 guiding principles of recovery) to instill hope and empower them on their own path towards recovery.
ReplyDeleteDustin
DeleteThe saying you mention from your Vocational Rehabilitation work reminds me of the Hippocratic oath that is taken by those in the medical field, i.e. doctors, part of which states "First, do no harm". The sayings are similar in the intent to engender self-awareness on the part of the practitioner in how they approach treatment, recognizing the "other-ness" of the other is valuable in and of itself.
I believe that, although we have made great medical advances and advances in recovery-oriented care, that there is an unfortunate and embedded influence of capitalism that has corrupted and convoluted the treatment that those needing physical and mental health care receive. Many doctors are compelled to prescribe medications, but cannot offer sound nutritional advice to address the root cause of physical diseases. Similarly, psychiatrists are well-equipped to deliver diagnoses, but end up often being unable or willing to be a champion of empowerment of what the individual may need in recovery, despite being at the top of a hierarchy of services. Unfortunately, as I have discovered, and despite the great promise held in the empowerment model, there is money to be made from those who are sick, and there is a large system in place that ultimately distorts the message of "first, do no harm", both intentionally and as a casualty of large systems and capitalism.
Perhaps if the medical model were to embrace your VR saying, as it does in some progressive facilities like those of John Hopkins and wherever they offer complementary medicine, we would see a better picture of mental and physical health start to emerge in this nation.
Dustin - I like how you brought up the medical model as that is the objective measure of a disability, especially in the disability insurance world. We are so focused on test results and examination findings to understand what someone can and cannot do, that we forget the human being behind the disability application or on the telephone. In this week's readings, I appreciated the focus on wellness, empowerment, and identifying choices for clients, which I feel are significant areas for potential recovery from a mental illness. Coupled with appropriate psychotherapy and possibly medical management, many people with mental illness have the ability to recover.
DeleteThere are various theories and counseling skills utilized today for people with mental illnesses by psychiatric professionals. The counselor’s beliefs, culture and environment will influence which one(s) are used and to what extent. The reading and videos this week revealed several areas to be aware of including principles, recovery, rehabilitation, and what seems to be of upmost importance, knowing people with mental illness are human beings. Don’t treat them like an object, outcome, or service. They have feelings, a life, and a heart.
ReplyDeleteThe impression I walked away with regarding how to help people with mental illnesses has all to do with wellness, empowerment, providing choices, acceptance, respect, and perception; not about specific theories and objective treatment plans. Some theories lead psychiatric professionals to treat a part of and not the whole person. They apply knowledge learned in graduate school and likely not seek wisdom which allows them to move beyond just knowing their client on paper. Giving a client hope and having a relationship with them is what enables recovery and uncovers unique awesomeness. Theories may lead us to not fully help a client as a human being.
This is Suzanne Posey by the way. I need to make my profile public. Sorry!!
DeleteHi Suzanne,
DeleteI am looking forward to conversing with you through another class. I felt empowered after listening to Dr. Deegan and Dr. Fisher. It was great to see two professional people who had overcome the stigma the diagnosis of Schizophrenia and moved forward to help peers and other professionals. This week's reading was a perfect pairing for the videos as it toured us through the history from chains to community based recovery. I want to remember to always see around the corners and remember to hear, see, and believe in my clients. I have always revered Dorothea Dix but I did not realize that more options existed when a person was in a sick environment. I am now more open to the idea of assisting the person with recovery while positively changing his/her environment. This makes much more sense for empowerment.
I was impacted by the idea that the relationship between providers and people plays a significant role in treatment and recovery for people who have mental health diagnoses. When Dr. Deegan speaks about her decision to become a doctor, she indicated that she did not initially tell others. She knew they would not support her. Dr. Fisher talks about loss of hope and the impact that has on people. His response to the idea of false hope was powerful. Providers can become so concerned about giving false hope that they steal hope from people, leaving instead a sense of hopelessness.
DeleteHi Suzanne,
ReplyDeleteYes, it's so important to think of the person with the mental health diagnosis as a person first! When I heard Dr. Deegan describe how early on in her diagnosis she would sit, smoke, sleep, etc., it made me wonder just how many others lived or are living that same experience with no hope or anyone to encourage it. How heartbreaking it is to think that so many individuals have not been able to realize their hopes and dreams when perhaps it was possible.
Hi Everyone,
ReplyDeleteI apologize for the late post. I have been traveling and did not have access to a hotspot for internet (all set now though and I will be more on top of our communications going forward - thank you for your understanding). In terms of the etiological theories in psychiatry today, I would say that we are still largely figuring this out. Depending on the theorist, you may get very different answers. Some believe strongly that psychological issues and disorders are caused largely by one's surroundings and that by manipulating one's environment, one can improve a person's mental and emotional health. Others believe strongly that many psychological disorders are caused by chemical imbalances in the hormones and brain, and therefore must be treated by hormonal and chemical adjustments within the body. Others argue that psychological and behavioral disorders can be attributed to one's genetic or biological makeup. And still others would say that such issues can be caused by any combination of a variety of these factors. Although we may not have completely determined specific causes for the many different types of psychological and behavioral disorders, it is imperative that we remember that beyond merely naming a diagnosis, we as health professionals must provide hope to those struggling with such issues. We must remind them that although they may be struggling now, we will provide them the support they need to overcome mental illness and live the happiest, healthiest lives possible. As we have seen in the past, when we equate a person with their disorder (i.e. use such identifiers as "schizophrenic" as opposed to recognizing them as a person overcoming schizophrenia), we risk planting a seed of despair and imply that all they are and all they will be is a disability. Rather, when we recognize them as a person separate from their illness, we remind them that illness can be overcome; one can and does recover from illness and that is what we, as mental health professionals, are here to help them do.
-Jackie Hayes