Anyone reading these blogs on Mad in America knows that there is reason to be mad about the past and present state of mental healthcare. This is not new, but has received new life, support, and importance with the findings reported in Robert Whitaker’s book “Anatomy of an Epidemic”.
However, it is quite unclear how much progress has been made in improving things. Dropping out of formal mental health treatment – or avoiding it completely – is one option, but how does that help someone who wants to use that option? Protest at the upcoming APA meeting is planned, but such protests have occurred on and off for years without much significant or lasting effect.
No, I would suggest that our next challenge may be how we can all work together for mutual benefit, even those who seem to be far apart in their opinions. Time is of the essence here, especially if you have concern, as I do, about the new DSM (Diagnostic Manual) that is due out from the American Psychiatric Association in about a year. Don’t believe the claim that the members of the Task Force and Work Groups are now less influenced by the pharmaceutical industry. Although more may not be getting paid by these companies as they previously were until DSM 5 comes out, their perspective is likely to be the same as it always was, and we don’t know how they may be rewarded afterwards. There are precious few, if any, master clinicians or constructive critics of psychiatry that have been involved. If not delayed or changed, this DSM will have major effects on hundreds of thousands of clinicians, millions of citizens, and scores of patients, as the number of diagnoses are set to expand, diagnoses which still usually do not have any direct correlation to organic changes in the brain.
I would tentatively suggest that those of us who want to work together, to join under a new moniker, something like The United States of Our Minds. This moniker implies that no matter our position in life, our history of mental healthcare or caring, or what we are mad about, that we have more in common and that our minds can join for solutions. Such an alliance must also include much more than the “survivors”, the public, patients, psychiatrists, and therapists. It must include representatives of all groups who have a powerful influence on our mental health: politicians, administrators, clergy, researchers, alternative caregivers, and the like.
To accomplish such a goal, we might incorporate processes that have worked outside of mental healthcare, but can easily be applied. Here are some.
– The I-Thou Relationship
This is the kind of relationship recommended in the last century by the philosopher Martin Buber. It stresses respect and dignity of the other. It stresses authenticity. It stresses openness. And it stresses the potential holiness of each interaction, which now would include on-line, whether one believes in a God or not.
– The Truth & Reconciliation Process
At the end of apartheid in South Africa, most observers were expecting a “bloodbath” as power shifted from the Afrikaners to the native South Africans. Instead, the politician and activist Nelson Mandela, newly released from a long prison sentence, developed the Truth & Reconciliation Commission under the leadership of the Archbishop Desmond Tutu. Afrikaners who admitted their wrongdoings under duress, who did not go beyond their orders, and who asked for forgiveness, usually received a light sentence. This showed how cultural conflict can be lessened and shifts in power accommodated. In our areas of concern, we need to apply the I-Thou relationship to cultural competence, especially for those cultural groups like Native Americans and young Black American males, who too often end up in jail or prison. Power needs to be shared more with the people want services.
– Human Rights
Human rights are usually applied only to the most severe violations, such as politically motivated rape or torture. In mental healthcare nowadays, it is most obvious in enforced, for-profit residential treatment for adolescents. However, the Universal Declaration of Human Rights from 1948 was much more basic and can easily apply to all aspects of mental healthcare, from abuse to providing basic services. The President and CEO of Planned Parenthood of Wisconsin stated this principle most clearly recently: “At Planned Parenthood, we treat health care as a basic right, dispensed freely and without judgment regardless of race, gender, sexual orientation, class or age”. Let’s work to make sure this applies to mental healthcare also. For myself, I’m going to present on human rights at the upcoming American Psychiatric Association meeting.
Certainly, other names and other principles may be better than the ones I’ve put forth. But, as the old saying goes: united we stand, divided we fall.