Being With Those In Serious Distress: Empathy, Compassion, Dignity, and Relationship

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I was contacted on one occasion to conduct an assessment and consult with a family in regards to their son who was in his early twenties who had been involuntarily committed by his father to a state mental hospital. As I entered the facility, wondered how any in this place could not feel worthless, depressed, and mad. I entered to meet John. He appeared somewhat lethargic because of the cocktail of psychiatric drugs he was being given, but he greeted me warmly and with a smile. John began to immediately speak and told me how he was an African American infant who when he was around two years old was turned white. (John was quite pale in complexion). He then proceeded to tell me about the mind control he felt he was experiencing, that his freedom was taken away, he could no longer think for himself. I asked him who he felt was controlling his mind. His answer did not surprise me- it was his father. I later asked the mother if John’s father was a racist and if John had been abused. The answer was yes to both; the father had been linked to racist organizations. The abuse began around the age of 2. It was clear that John had a powerful message, though surrounded in metaphor. To the person only wanting to categorize behavior and ignore experience, would they have known what John was seeking to communicate?

I encountered a young man, around 12 years old, who was hearing voices. Prior “treatment” included: prescribing psychotropic drugs to suppress the voices or telling him to ignore the experience. During my consultations with him, I sought to journey with him, to build a connection where he would feel safe to share his experience. The young man heard two voices, one male and one female. And as he began to relate his past experiences and the recent loss of a relative, it became obvious that these voices filled a need in his life. His issues with grief had never been processed and information had been concealed from him; family dynamics are often shrouded in secrecy. He had been very close to this relative. Therefore, it was obvious that he needed to hear from this relative in some way, to know that things were okay. And that is exactly what the young man told me, that this was the voice of that relative. The other voice represented his mother.

I was pleased that I was able to journey with this person and come to a breakthrough and discovery but was saddened that no one had thought of doing this before. So often, when health professionals encounter those who hear voices, it becomes so terrifying that they do not want to delve into it. Shutting down the experience is the best alternative for them. But, by doing this, we may be making a grave mistake. Often, experiences like these convey great meaning, as in the case of this young man.

In another case, a woman came to me with the thought that she was Mary Magdalene. Many in the mental health system would dismiss this thought, labeling it delusional and recommending that she be placed on an antipsychotic drug immediately. My approach: I wanted to know why this person felt she was Mary Magdalene. What is it like to be Mary Magdalene? Why the need to be Mary Magdalene? Over time, I learned that this woman had used illicit drugs and supported her use through prostitution. Later, she had a religious revival, and felt guilt about her past. Over time, she came to realize why she felt the need to connect with the story of Mary Magdalene; and over time she came to a greater awareness of her experiences and ultimately of herself.

A 16-year-old young man came to see me at the clinic. He was in immense suicidal despair. He explained that his father had been frequently absent from his life, making promises, and then leaving. His father always disappointed him. The father was now being released from jail, and the young man was conflicted as to whether he should once again embark on that path of building a relationship knowing the past precedent. The young man said that his father was a failure and by default, he also was a failure. He had earlier been psychiatrically hospitalized and this only made him feel more worthless and disempowered. The young man told me he went to see many therapists before but he never could be genuine with them or open to expressing his feelings. He said that he felt some spoke condescendingly to him and did not truly care about his experiences. I could understand his sentiment as under the medical model, treatment is about ‘doing’ things to a person, even by force or coercion, to somehow correct an unseen chemical defect in the brain. But to me, treatment is about how we treat others. Treatment is based on interaction, on values, on dignity and compassion. I discussed with the young man his strengths, the absurdity of life at times, the courage he has shown in the face of adversity. He told me that no previous therapist had been so encouraging while also causing him to think and reflect. He entered with gloom; he left with a smile, and with a sense of hope.Another of my clients, related to me about his prior time at a residential treatment center.  He said that many of the staff would call him and the other children by obscene names, that he often felt bullied, degraded, and “like I never was a human being”. The father of this young man told me that “you have done more for him in a few weeks than many did in years.” This was a kind compliment, and I was pleased that I was able to make a contribution to this boy’s life; but beyond that, I began to think what exactly was different in my approach with this young man that has allowed a connection to blossom forth to help him progress in a short period that was contrary to what he had received in years of prior ‘treatments’. I found the answer to this in what I sought to create, and I believe this is the key to any genuine emotional healing relationship. I radically tore down the barriers that would separate us.  I tore down the hierarchy. I did not bully him or seek to use my position to force or coerce. From the beginning, I informed him that he was in a safe place to be his actual self, a place where he could feel comfortable to express whatever he chose without judgment or hostility. It came to be that whenever crises arose, he would often seek me out.

Many treatment programs today are based on staff being in positions of power over the person and seeking to modify the way the person thinks and feels by a system of manipulations. Those who conform to this are said to be ‘improved’ and are discharged. But I have never seen any real progress come from such ‘treatment’. This is because it was never based on genuineness, it was never authentic.  We know that residential treatment facilities are costly and we know that the ‘success’ rates for such programs are very low.

I believe that one role of the therapist that is basically forgotten today is to be an activist. If we truly want to see people happy and free from mental anguish, then we must take a role in championing the basic rights and dignity of all human beings. This activist role has been lost because the current medical-pharmaceutical model in the mental health system would tell us that everything is a chemical problem in the brain of the person. If this is the case, then there is no immediate need to change our environment, or the way our society operates. But it is oppression that truly is at the root of distress for many, and we must address it.

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Dan Edmunds, EdD
Dr. Dan L. Edmunds is an existential psychoanalyst and psychotherapist in Northeastern Pennsylvania. His work has focused on drug free, relational approaches for those undergoing extreme states of mind as well as autism and developmental differences. Dr. Edmunds is the founder of the Center for Humane Psychiatry, an emancipatory movement for human rights in the mental health system. Dr. Edmunds has advocated for psycho-social approaches for those in distress that are affordable and accessible. Dr. Edmunds developed a therapeutic community project and is involved with autism acceptance and the autistic rights movement. Dr. Edmunds is the author of BEING AUTISTIC: AN APPROACH TOWARDS UNDERSTANDING AND ACCEPTANCE; THEY SAY MY CHILD HAS ADHD: DEBUNKING THE BIO-PSYCHIATRIC PARADIGM; THE MEETING OF TWO PERSONS; and MYSTICAL METAPHORS. Dr. Edmunds is a frequent speaker on critical psychology issues.

5 COMMENTS

  1. Oh, this piece makes me feel sad and angry.

    I don’t do what the author does for a living, and usually not to such depth or with such elegant understanding (though sometimes, perhaps I do?). I do it for my friends and the people I meet at my local mental health day centre where I am a member.

    I offer compassionate understanding, not everyday. I’m a gardener and often a lazy boy! But a few times a week in cafes and in my living room and sometimes in the day centre. Guess what? people calm down, and their mood improves and sometimes they move on and become ever so slightly more confident.

    In the long term I have seen someone I decided to befriend and support get out of the doldrums he had been in for seven long years of using a variety of services. While I can’t say all the changes that came about in his life were due to me I can say that almost every time I spent time with him his mood improved and every two weeks his approach to his mental distress improved too. Mainly I sat there, listened and tried to understand his experiences, the way he thought about things and what he had been through. I didn’t try to give him answers to his problems, although I did suggest some ideas for him to try out if he wanted. Two years from when we first met he is studying for a degree and has started his own business. When I met him he was throwing his TV out of his window in frustration and going shopping at 1am to avoid people.

    But the day centre staff, the housing support workers, the social workers and all the other kind of staff we have these days offer shallow life coaching, referral to drug prescribing psychiatrists and referral to other agencies who are as incompetent and as shallow as they are. And that makes me angry.

    I talk to the staff of trauma and how a large proportion of the members of the day centre will have experienced child sexual abuse, family violence and twisted family relationships. The staff panic, say they will refer anyone who, “Discloses,” onto other services (there are non, or not many and what other services exist are often crass and insensitive) and anyway these kind of things are too difficult for staff and peer supporters to deal with and it is not in there service contract to deal with sort of thing. Well that is what the staff say. Yet members talk of them all the time to me and presumably to each other.

    The staff talk of, “Recovery.” I think they mean playing dominoes with members, and talking over what they might want to do with their lives and their time and maybe providing a little encouragement. Not a bad thing to do but I don’t think it likely to succeed very much unless the traumas people have experienced are at the very least acknowledged with some degree of human compassion.

    So it is sad to read of someone who as standard sees it as their job to offer compassionate understanding to the mentally distressed (no doubt added to by the wisdom gained from good training and years of experience) while the people I know are offered, or sometimes forced to receive, patronising activities, shallow conversations and dangerous medication.

    And sometimes I am angry that those who are paid to look after my friends do it so badly.

    • I so agree with what you and John Hogget are saying: you are both doing a wonderful job. I am trying to do the same for my son.The fact that I did have a breakdown myself at the age of 17, is helping me to understand what he is going through. Heart and tender care are certainly missing in the mental health services.

  2. It’s noteworthy that whatever good the author may have done (which is unknown since he only offers self-praising anecdotes, which are subject confirmation bias and other cognitive errors) was despite the practices and training of the therapy industry rather than because of it. I strongly agree with his vote for activism and addressing the societal/cultural issues and oppression that is at the root of distress for many. The therapy industry, however, is not well-positioned or well-trained to do this important work since it requires a problem-solving approach that is the opposite of the individual-pathologizing one it uses now.

    PS – I looked at some of the author’s other articles, as well, and he seems very focused on saying that he does not seek to be in a position of power over the children he works with. “The [man] doth protest too much, methinks.”

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