Hello Dearest Students,
For the last five weeks I have tried to expose you to material that is out of the mainstream, to provide you with a perspective that may be different from the conventional MI content. I have refrained from traditional "teaching" because I believe in facilitating learning rather than telling you what you need to know. Sometimes if instructors participate in online discussions, this creates a hawthorne effect, which may bias commentary from students in a particular way. This is why I have not responded to your posts.
I want you to know that I am deeply moved by your posts and replies. From my perspective, many of you have explored ideas that may not have occurred to you before. That, in an of itself, makes my job worthwhile.
I am so impressed by the student realization that the Pro-psychiatry v. Pro-recovery is a false dichotomy. That it is. Psychiatry in its best form, provides psychoeducation, TRUE informed consent, and person-centered, individualized planning. Herein lies the conundrum. At this point in time, there are between 30-100 neurotransmitters in the central nervous system, I have read a specific number of 54. Researchers have linked some of these neurotransmitters to symptoms (e.g., dopamine, serotonin), but do not yet understand how these actually work. If you are familiar with the mathematic concepts of permutations and combinations, when you have 54 potential variables, and you target two of them, there are many many combinations possible. Add to this individual differences in brain chemistry, and frankly, anything is possible. This is why, in my opinion, that medications are a "crap shoot" in terms of efficacy for managing symptoms. This is also why I think practitioners should be honest about what we "know" about these medications and their effects on the brain, both good and bad. Then, and only then, is there truly informed consent.
So, I am FOR psychiatry that offers real help to people, and is honest about what we REALLY know about medications and the brain. If you look closely at any antipsychotic medication pharmaceutical handout, or Physician's Desk Reference (PDR), it may surprise you to find that the description states "actual method of action unknown."
Medications CAN help people, and medications can bring lots of bad effects as well. At least the DSM5 finally acknowledged "discontinuation syndrome," so when people go off meds, or switch from one to another, people know that the brain zaps and other weird symptoms are part of the withdrawal process. Prior to DSM5 many consumers were told that antidepressants were not addictive. Now we know better. I believe people should be able to choose whatever level of treatment they feel is best. However, without being told the real potential outcomes of the treatment, there is NO informed consent. For example, someone was told that ECT is like putting a 9 -volt battery up to your head. This, to me, is not informed consent. Many docs are quite cavalier about the treatments they prescribe, and this needs to change.
Community support, employment and/or meaningful activity, housing, and the presence of at least one person who loves unconditionally -- these are the ingredients to recovery. Good health care and pro-recovery psychiatry should also be part of the supports in the community. I truly believe that if we are honest about what we know and don't know about mental illness and its treatment, and present ourselves with an authentic willingness to help, we can help people alleviate their pain and live their best, self-defined lives.
Our responsibility as educators and practitioners is to reflect regularly on what we think we know, and what we actually know about mental illness. The best teachers to support this reflection are people who have mental illness...This I know.
I have so enjoyed reading your responses, and I thank you for your work. You give me hope!
~ Dr.B.
My top take away is that recovery seems to be very much in contrast to the main stream psychiatry that we see today, so I’m left with a lot of questions. Most of my clients with significant mental health challenges attend monthly medication management meetings. They have fifteen-minute consultations with their psychiatrist to assess whether their medications need to be adjusted or changed. I wonder what other conversations occur? Do these clients receive psychoeducation or alternative treatment options? I do know that very few of my clients attend regular counseling and they certainly do not seem to be aware of the potential benefit of this type of treatment. The students of HCE 619 have learned about the positive impact the human relationship has on recovery, so why does it seem that psychiatrists are unaware of this treatment option or at best speak of it so little? Are non-pharmaceutical treatment options taught in our medical schools? It’s frustrating to see how supporting people with significant mental health challenges seems to be so slanted towards medication management that is only cloaked in the guise of recovery.
ReplyDeleteFifteen minute medication consultations are based on monetary constraints and are insurance and agency driven. It is odd to think much could be accomplished in a 15 minute check in. Yet medications are such a big part of treatment for people and have such significant side effects, it is shocking such key decisions would be determined in such a short time. In an ideal world, people may be seen for the period of time needed. One time that may only be 15 minutes, but another time they may need longer. It seems unlikely these changes would occur in our current system. It is certainly not likely psych-education occurs or alternative treatments would be discussed in such a short time frame.
DeleteGeoffrey, thank you for your post and sharing your experiences. Until this class and yours and other students' statements I had not realized how heavily medication is relied on. I knew that medication has been used in psychiatric treatment, but I always assumed that counseling was always paired with such medication. It is definitely disconcerting to find that this is not the case, and it teaches me that part of our role as we go into the field is to advocate for counseling as a requirement in treatment if medication is being considered and utilized.
DeleteThere were many important concepts included in this class. The top take away for me is the importance of viewing mental illness from the perspective of the person who is diagnosed. Recovery is not only possible but very much attainable for people. The idea that they are diagnosed and then have to live the rest of their lives medicated and in and out of hospitalizations is not supported by the concept of recovery.
ReplyDeleteMedications may play a role as one tool for people who choose to use it. Informed consent which includes a full disclosure of risks and benefits is not only important but a right. Other tools a person may use in the process of recovery may include counseling, inclusion in the community, work, psycho-education, support, yoga, and many other options. It is imperative that people have a voice in their treatment.
It is essential that society as a whole moves toward better understanding of stigma related to people with mental illness diagnoses. Social, economic and community issues impact recovery. This impact can be positive or negative. Inclusion in the community, work, and experiences of social standing within the community support recovery.
Providers of mental health treatment can play an important role in recovery. If the providers support recovery and support concepts around community inclusion people with mental health diagnoses are able to gain skills, support, and information to make informed choices around their treatment.
Toni, our write up reminds me of the articles about the Soteria Project and the rise in peer advocates. We have such an opportunity to help connect people to recovery and to advocate politically at the local and higher levels for inclusive communities and whole person healthcare.
DeleteIf we listen to people and what they want as well as what they believe will work for them, we are able to support recovery. People often flourish when given an opportunity to do so. Every interaction we have with each other is a chance to promote inclusion in the community and recovery.
DeleteToni and Liz, I whole-heartedly agree with your statements regarding the importance of listening to our clients and advocating for their rights to choose their treatment paths as contributing members of their communities. I agree that when given the chance, most will rise to the occasion to flourish in their communities. I do wonder though how we might approach this when mental health issues result in criminal behavior. What is our role as mental health workers in terms advocating for our clients while also recognizing some of the more extreme challenges that may arise?
DeleteMy takeaway from this course is the need for patient focused treatment. Giving a patient options and requiring informed consent is vital in the recovery process. There is a need in our healthcare system for a change of separation of mind and body, when we need to treat a person as a whole and stop treating symptoms of the real issues but the underlining problems. This takes time that is not given many clinicians because of the focus on increasing patients and decreasing doctor patients interactions. The recovery movement helps put mental health back into patients hands and focusing instead on garnering life skills and community involvement that can extend beyond the doctors office. The future looks brighter, and it is a hope of mine that with courses like this the clinicians of the future hold these principles in mind and fight for their patients.
ReplyDeleteMichelle, I appreciate your advocacy for patient focused treatment. It is imperative for each of us to know a multiplicity of resources from legal rights, to medication effects, to housing and benefits which can seem overwhelming but if we serve as a team and work together, our clients win.
DeleteThe Recovery Movement has been fueled with Hope in the darkest and bleakest of moments. We are all entering various fields within the professions of the helping field and the most important thing we can do is create an environment where hope can be allowed to grow. When we meet with a client, he or she is bringing a suitcase of past experiences of which many of these experiences are disappointments wrapped in pain or numbness. We each have the opportunity to sit with a person and really hear the story that unfolds and be part of the future. I want to be part of the recovery story that allowed people with severe and persistent mental illness to become advocates and peer mentors. When we meet with a client, we have the opportunity to listen for hope and feed it.
ReplyDeleteSitting with people and hearing their story certainly promotes hope. We do have an opportunity in our interactions with people in work, in the community, and often within our families to provide support. Opportunities for growth that include chances for success and failure allow people to experience all aspects of life.
DeleteMy top take away of the course could be viewed as a simplistic one. “To figure out how best to help, the most useful thing a helper can do to start is to ask the person what kind of assistance he or she thinks would be useful in dealing with his or her current situation.” (Davidson, Rakfeldt, & Strauss, 2010, p. 97) I think appreciating people for who they are and taking the time to understand their individual needs – and what form of help they think is most effective in their life circumstance – as the people we serve should be able to focus on what they feel will help them improve their situation. If someone wants to talk about employment, develop a resume, search for jobs, or explore education opportunities this could be how they use their time seeking services. If they need or want to focus on housing, employment, transportation, medical or mental health care then providers could put their case management skills to use to help them achieve their goals. The individuals we serve need unconditional positive regard and counseling support while using the time they have with us to address the needs they feel are most important to them.
ReplyDeleteHello Dustin, it may be simplistic but it is also extremely respectful to assume that your client know what is best for his or her recovery.
DeleteThe idea of recovery is not new, but I think it has been drowned out by the loud voices advocating for the medical model. I think one of my takeaways from this course is that it is ok to speak out about the recovery approach that puts the individual back in control of his or her life. I would like to help empower the people I work with to believe in themselves and their hopes and dreams. It is not always easy to speak your heart in a professional setting where you may be seen as over-invested. But I think, for me, one of the most important things is remembering to always value each person"s experience and validate it even if it may be completely different than what I know.
ReplyDeleteSandra, I would agree that a significant concept of this course is that we as counselors must empower our clients to take back control of their treatment path to recovery, even if it means giving up the more medical model. Of course, when working with clients we may find many that are not used to having such control. They may shy away from this empowerment at first and feel discomfort as they navigate their choices. It will be important for us to continue to provide education, support, and safety as our clients begin to feel more and more comfortable as they take control of their choices and treatment paths.
DeleteMy top take away is that the missing link for true recovery is the lack of relationship and connectedness of those with mental illness. This in conjunction with medication therapies would contribute greatly to true recovery. A lot of materials were presented on the history of how mentally ill people have received “treatment”. True recovery was never the goal, but the managed care approach ruled the day. The few instances I learned about that proved to be the most beneficial, like Moral Treatment, the Tuke’s method, Dorethea Dix, all included respectful, purposeful, patient-led connectedness to a community. Civil Rights pioneers, such as Judith Chamberlin, fought hard for this community inclusion. Now, with Dr. Fisher and Loren Mosher, there is evidence to prove what we instinctively should know, people are made to be in community with one another. Isolation and separation from this community, as seen in the asylums, with abuse of the vulnerable, over medicated patients results in a less than whole person and is the baby of the rehabilitation view of recovery, not the empowerment view of recovery.
ReplyDeleteRecovery truly occurs for people in the context of relationships and connection. Engagement in and with the community promotes recovery and supports people with mental health diagnoses. Dr. Deegan's story shows how important hope is for recovery.
ReplyDeleteMy top takeaway is simple and although it is biblical in nature, it is a thought process which leads to humane treatment to people with or without a physical or behavioral health condition; treat others as you would want to be treated. Throughout the dark history concerning people with mental illness symptoms, it seems like the purpose of those treatments was not recovery but to take away people's rights as citizens because they were different. In many cases, people had normal symptoms as a result of physical conditions or difficult life events. In other cases, providing hope, love and inclusion within the community would have been appropriate "treatment". Treating one another with respect, kindness, healthy choices, and a family/community support system may be the right way to go, as opposed to cookie-cutter medication regiment, institutionalization, and isolation from family etc.
ReplyDeleteSuzanne, I appreciate your comment regarding the simplicity and value in treating others with kindness and respect. It seems like such a simple request - to simply treat others with kindness and respect them enough to allow them to make decisions for themselves and their treatment while also being active members of their communities. And yet, as we saw through our videos, readings, and class conversations this was not always done throughout the history of mental health treatment. Indeed people's rights were taken away, but the additional dangerous element that we must remember about this history is that people did not necessarily intend to take away these rights. Rather people with good intentions allowed for this to happen in the name of attempting to do what they thought would help the patients. This fact makes it even more important that we steadfastly advocate for and support the human rights of our clients and allow them choice in their treatment. My only worry with this as we are about to enter the field of mental health is that it may be more easily said than done. For example, when a client is under extreme duress and behaving violently and screaming to go home, will we honor that or will we be tempted to use medication or suppresive methods to simply calm the client temporarily? I worry that while we stand for our client's human rights in theory, in particularly challenging moments we may be tempted to forget these very important beliefs. We will need to find significant strength to maintain these values through the more difficult and stressful moments.
DeleteThe most profound concepts from this course for me were those articulated by the psychiatrist Peter Breggin. In his video titled How to Help Deeply Disturbed Persons—Fourth in the" Simple Truths" Series, Breggin stated that modern psychiatry functions with an etiology that says “I’ll diagnose you and drug you and send you home, and maybe a social worker will talk to you- maybe- along the way.” Breggin points out that it is a person’s social fabric and connections that are directly implicated in the process by which a person can become extremely disturbed. He says that “the process is one of no longer trusting people.” His solution? Healing can begin when a consumer builds a trusting relationship with someone, and in the healing of “broken social threads of the family” if possible.
ReplyDeleteSocial connections are paramount in the recovery movement. Love, connection, belonging, community- all these forces are part and parcel of a person’s recovery. Breggin, despite his many years in psychiatry, stands in direct opposition to the monolithic institution of psychiatry in his further claim that drugs do not tend to assist in recovery, and that diagnoses are not beneficial. This too is an important feature of the recovery movement- drugs are not for everyone, and if they are, they should decide that for themselves, perhaps when they have been informed of all other conceptualizations of illness and treatment.
I think this really stands out to me- the idea that deeply disturbed individuals need first and foremost to establish a meaningful relationship and healed social connections, because it provides a simple solution for what seems to be a very complex and difficult problem- see Occam’s Razor. This simple truth is so painfully and utterly obvious, yet missed by nearly the entire field of modern psychiatry.
I believe that this conceptualization is helping me to really hone in on my identity as a professional in this field. I have always felt at odds with the use of pharmaceutical drugs and diagnostic labels. Now, I have a developing awareness of the more enlightened ways of thinking of recovery from mental illness, and will work to educate and empower others to this end. Drugs are not the only solution, and their effectiveness and manner of prescription is dubious. Rather, it is the simple solution of love and relationship that seems to reappear over and over. It is motivating to listen to a wise and well-regarded clinician speak out in favor of that feature of recovery.
Module 1 - What is Recovery
ReplyDeleteAlthough there are many concepts that stood out to me from Module 1, Dr. Daniel Fisher’s Interview in the video clip entitled “Building Hope in Culture of Recovery” proved especially significant to me because it altered both my thoughts and actions. I am currently a school counselor, and I like to think of myself as a counselor who is entirely student and client focused. Additionally I support my students’ and clients’ rights to choose their learning and treatment paths. It wasn’t until I listened to Dr. Fisher’s interview that I realized that although I possess these believes, my thoughts and actions do not necessarily demonstrate this. When Dr. Fisher shared that he had been diagnosed with schizophrenia and had been able to reach a level of recovery that enabled him to pursue and attain his doctoral degree in psychiatry, I was blown away. My incredulity made me realize that I had never heard of anyone recovering from schizophrenia to such a degree that they were not only able to live a happy life, but they were also able to excel in a highly challenging career field. It made me realize that my experiences had led me to unintentionally develop a belief that schizophrenia is a highly debilitating disorder that prevents people from leading normal lives. More importantly Dr. Fisher’s personal story, along with Patricia Deegan’s story and the recovery definitions shared in the other content from module 1, helped me to realize that true recovery does not merely mean a semblance of managing symptoms of mental illness and living a relatively satisfying life; no, true recovery, means overcoming mental illness to the degree that one can live a life of hope, purpose, stability, and happiness as a thriving, contributing member of their community while being fully in control of their lives and treatment path. This revelation was helpful to me in that it enabled me to reshape my thinking and the actions that I will take as a counselor. Prior to hearing Dr. Fisher’s story I might have easily fallen into a fixed mindset regarding the destination of those who struggle with severe mental illness. His story revealed to me that there is no limit to what one can do, regardless of mental health affliction, when they are provided the right support and hope from caring counselors, community and family members. This hope and support empowers these individuals to overcome their illnesses and become whomever they wish to be. Empowerment as a treatment tool and the believe that true recovery is possible indeed are both significant foundational elements of the recovery movement, and they are ones that I will hold dear as I work with future clients.
(D. Fisher, personal communication, 2008)