Generative Narratives and the Counterculture Psychiatrists

 

 

I just came from a conference in Phoenix, AZ called Innovations in Public Service Psychiatry put on by the American Association of Community Psychiatry and an organization called Recovery Innovations. It was really interesting stepping into this unfamiliar scene and I made some new unexpected friends.

Here’s the story:

Brad Lewis, my cool psychiatrist friend who teaches at NYU, invited me to present with him on Narrative Psychiatry and the Story of the Icarus Project.

For outsiders like me who are really critical of mainstream psychiatry, the first thing to understand is that “community psychiatry” is a counterculture within the larger culture of biomedical psychiatry. When I say “counterculture” I don’t mean these people had flowers in their hair or face piercings. They were wearing suits and the conference was in a hotel with carpets that smelled like terrible chemicals. But compared to the psychiatrists that are touting the biopsych line, these people are radicals, and I am heartened to realized that they exist and are out there attempting to shift the dominant paradigm.

Community Psychiatry has its origins in John Kennedy’s administration and the 1963 signing of the Community Mental Health Centers Construction Act which established more than 750 community mental health centers throughout the United States. While it was the mainstream back in the day, that was before the rise of biopsychiatry and big pharma in the 1980s. Like so many other liberal and progressive causes from the 60s and 70s, Community Psychiatry has been beaten down dramatically by the forces of neoliberalism and big business. The ones who are attracted to community psychiatry aren’t doing it for the money, it’s because they actually care and want to make a difference in people’s lives.

Flash forward to 2012 and the main narrative that Community Psychiatry is attempting to use to take back power in the psychiatric arena is the language of “Recovery”. To a radical like me that is much more interested in large scale social and political transformation, the language of “recovery” misses the mark that my Icarus friends and I are shooting for, but within the dominant language of “brain disease” and “lifelong mental illness”, the narrative of “recovery” has an important role to play and opens up so much space for dialog and hope.

Amidst the presentations and workshops I heard language like “mental health in not simply a function of biology, genetics, or personal choice – it is also a function of the social conditions in which people are born, grow, live, work, and age”; “well being must be measured as mental, physical, spiritual, and social”; “medicine should be about health, not disease, prevention, not repair.”; “collaborative medication management”; “shared decision making – the value of relationship in informing choice”; “culturally appropriate and trauma-informed care”; “understanding the link between coercive, directive practices and inadvertent re-traumatization”; “understanding the psychiatrist’s role in coaching life skills and meaningful activities.”; and “recovery is remembering who you are and using your strengths to become all that you were meant to be”. There is a whole little world out there of folks who are using the language of “Peer Specialists” and “Recovery” and doctors who see their former patients as experts and teachers and having important wisdom to share. All psychiatrists in the US should be having these conversations! As the Foundation For Excellence in Mental Health Care says, “Expect Recovery…The New mainstream.”

I think what impressed and surprised me the most about the conference was that it was full of people who actually like and feel comfortable around “mad” people, can relate to our kind because they’re around us all the time, and don’t just see us as people to drug into normality. When I talked about the Harm Reduction Guide to Coming Off Psych Drugs and how critical it is that psychiatrists understand that one day their patients will have to come off of them, many people in the audience clapped! (see video.)
Borrowing from Brad Lewis’ language in his new book Narrative Psychiatry (watch his awesome 8 minute video to get the sound bite version) – there’s an important distinction between “pathological narratives” and “generative narratives.” No matter how many psych drugs we take or don’t take, the fact is that we think in stories. Biopsychiatry, like Recovery, is a story, and one of them is pathological and one of them is generative.

And we desperately need to shift the story.

So in conclusion, there are deeply ingrained power dynamics in the discipline of psychiatry, and although the “peers” get to be a part of the dialog, at the AACP they’re not running the show by any means. By definition, reform moments take the steam of revolutions: the history of the Non-Profit Industrial Complex is all about giving jobs to the discontents and channeling radical energy into institution to keep capitalism going. Within the Icarus Project, we’ve been talking about this idea of “dangerous gifts” for years now, and I’m coming to realize that the “gift” is not only about sensitivity, it’s also about a kind of yearning. People like us know the world can be better, we feel it inside of ourselves more than the normal ones. I definitely met some psychiatrists last weekend who understand that dynamic. According to Dr. Michael Schwartz, (my favorite new nutty psychiatrist friend from Brooklyn who works at the state hospital in Austin, TX), recovery is about realizing that we need to “re-cover” each other, to cover for one another in a harsh world. Dr. Schwartz also has a great theory about madness and human evolution and the need for the “crazy” people to keep the species going.

I hope to stay in touch with my new friends and contacts and that in the coming years there is more cross-pollination between the worlds of the Icarus Project and Community Psychiatry.
Mad Love to all the mad lovers,
Sascha