A Stranger in a Strange Land (Pt. 2): What Happened to You?

Andrew L. Yoder, MSW
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What Happened to You?

I believe that it is my responsibility as a practicing social worker to listen to the voices of persons with lived experiences and accept this truth:  individuals are the best experts on themselves.  People don’t forfeit that personal wisdom when they have distressing experiences in their lives.  It is impossible to understand anything meaningful about an individual’s needs or situation by looking only at broad generalizations.  It is the person-in-context that matters most.  Understanding a person in their context happens only one way:  through patient, active listening to that person and the loving invitation to share their personal story.

Through the act of deep listening to personal stories of distress and healing, I have become convinced that even the most well-meaning mental health professionals are persistently asking the wrong questions.  We are operating within a system that prizes the stability, conformity, and sedation of persons with experiences too unusual or too “disruptive” to social norms.  It is a system that asks the question, “What is wrong with you?” and it is a system that defines “fixing” the problem as managing symptoms so that people aren’t a bother (financially, logistically, and socially) to other people.

The disease model promotes a backward notion that the experience of extreme emotional states begins from a biological root independent of social context, and then causes social and relational turmoil in a person’s life.  I have no problem believing that there is a biological component to human lived experiences of extreme distress.  That seems to be basic common sense.  It’s not magic; obviously biological things are happening when we feel or experience anything.

But while there is little supporting evidence for the disease model hypothesis, there is ample supporting evidence for a social/trauma perspective which suggest that tough stuff happens to us in our life and sometimes our mind and body struggles to cope.   The tougher the stuff, the more extreme the compensation / coping efforts of the mind and body.  Really tough stuff can sometimes set a person down a road to a very isolated place full of internal confusion and complicated and distressing thoughts and feelings.   These coping may alter biological activity so that our brain does “look” or act different when engaged in these high-intensity trauma coping endeavors.  But I believe that such biological changes are most frequently effects of unresolved traumatic lived experiences, not the causes of the “symptoms” themselves.

The question we should be asking is, “What happened to you?”  Our primary task as a humble servant of fellow human beings should be to become a meaningful partner in a healing, restorative journey as defined by the individual seeking support.   Our aim should be at providing love and encouragement and love to a person undertaking a meaning-making journey.  We must not be afraid of intense lived experiences and we must humbly offer the possibility of compassionate partnership as individuals work to reconcile these experiences with their deepest selves.  Doing this requires accepting all the ways in which unresolved trauma impact lives, and creates tension and distress.  I believe that the appropriate attitude of a social worker toward such experiences is one of tenderness and patience.

Selective, Evidence-Informed Prescribing

Psychiatric medications can, in some instances, be a helpful tool to provide relief from acute distress.  When they are prescribed selectively for a limited duration, they may be one part of a larger healing process.  When the minimal benefits are not overstated and the substantial risks are not minimized, medications may be understood by the individual as useful in temporarily alleviating acute distress.  When prescribing choices are made in collaboration with the individual and when the individual is free to choose the approach that feels right for them (including the legitimate choice to take no medications,) then the relationship between individual and prescriber can be fruitful.

As a social worker, I believe it is my ethical obligation to question prescribing practices that ignore scientific evidence or justify prescribing decisions based on flawed “common wisdom.”  Research has consistently told the same story for years:  while psychiatric medications can sometimes be helpful when used briefly and selectively, they are consistently more harmful than helpful over the long term in the majority of cases.  I believe it is the duty of every mental health worker, whatever their area of expertise, to be fully and accurately informed about the risks and benefits of medications.  I believe we have an obligation to protect the people we serve from reckless, thoughtless, or dogmatic prescribing practices.

While working within the public mental health system, I have experienced a tremendous amount of pushback by asking for evidence-supported rationale for prescribing decisions that impact the people I work with.   That’s because more often than not mental health “professionals” cannot logically or rationally justify their decisions with a sound and articulate rationale that is consistent with available evidence.   Many if not most prescribing and mental health “treatment” decisions are made based on illicit appeals to authority, “common wisdom,” unexamined biases and emotional reactions, or blanket statements repeated over and over again without any factual base.

I don’t accept that certain “professionals” are above the requirement to justify their decision making and demonstrate clear and accurate rationale for the choices they make.  Every human being is capable of being informed about the evidence (or lack of evidence) available concerning the uses and efficacy of psychiatric medications.  And every person making prescribing choices has an obligation to clearly explain their decision making and demonstrate that those decisions are consistent with evidence.  And any person has the right to ask for such justification from a prescriber or any other “professional.”

Thankfully, I have been blessed to occasionally work with wonderful prescribers.  I have sat in the room with a person I was serving and their prescriber and witnessed genuine open collaboration, responsiveness to the needs and wishes of the individual, cautious prescribing choices, selective-use approaches, and general willingness to listen to the individual.  But tragically, my experience is that this is presently the extreme exception rather than the rule.  This must change, and I believe it is my responsibility as a social worker to be an advocate for these changes.

The “Therapeutic” Stance

The way I see it, the only real difference between me and any person that I might work with is that I get paid to try and be a good person.  Lots of other people simply do that for free.  What I mean by that is, while its true I have a certain amount of specialized education and training and sometimes that background helps me think about the human condition or social problems in interesting ways, doing my job “well” really comes down to this:

How much love and empathy I can convey to another person

How much patience and flexibility I can offer to another person

How much respect for another person’s humanity and autonomy I can demonstrate

How much hope I can offer and how much faith I can place in another person, and

How willing I am to defend another person from systemic abuses, even when those abuses may come from colleagues or “superiors.”

None of the things I just mentioned require an advanced degree in anything.   And yet I believe these things represent the heart of the “therapeutic stance” for counseling or “therapy.”  By contrast, the antithesis of the therapeutic stance can be described like this:

Belief that I get to define the problem and prescribe the solution for another human being

Belief that it is helpful or appropriate use coercive tactics to force another person to accept my plans for them

Allowing a sense of personal resentment, frustration or even protective fear to dominate my emotions when another person does not do what I have planned for them

Getting caught up in an emotion-based power struggle in which I seek to “beat” another person, “punish” behavior I deem to be bad,  or “win” a power game

Insistence on actions or behaviors from another person that I would never expect from myself.

When I model the therapeutic stance in this way, it seems so obvious.  In fact, you could basically label it as the “Don’t Be a Jerk” model of therapeutic interaction.  And yet, my experience has shown me that this is not the dominate model persons with lived experiences encounter in many cases.  If a person is largely independent, with modest or robust means, and with problems society tends to deem more common or acceptable (some depressed mood, conflicts at work or in relationships, mild grief and loss, etc.) then I think it’s more likely for a person to connect with counselors and professional supports who truly approach their work from the “Don’t Be a Jerk” model.

But the entire landscape changes when it comes to persons labeled by the system with “Severe, Persistent Mental Illness.”  Within this system domain, a philosophy of humane partnership seems largely absent.  What feels to me like the opposite of an appropriate therapeutic stance frequently practiced and sometimes openly defended when working with those other people.  This must change, and as a social worker I believe it is my obligation to be an advocate for such changes.

 

The Good News

I chose the field of social work because I feel a personal sense of responsibility to try and serve my human and brothers and sisters with a spirit of love.  That may sound silly or evoke a little cynicism, but it is true for me.  These were the values of my father, who died in my arms at the age of 63 after a nearly lifelong battle with depression.  They are the values that helped bring me back from the brink of my own lived experiences of extreme distress.  I never expected to work directly within the public mental health system, and some days I question what I am doing within a system that is so deeply, deeply flawed.

And yet, I have recently had the opportunity to begin work with an agency that has given me some renewed hope.  The agency I now work for receives payment from the public mental health system, but its roots are in a small community of less than ten thousand persons.  It began as a small group of volunteers over twenty years ago, and has held fast to a mission of community based service and its commitment to uphold human dignity and mutual respect in its interactions with people.  A person who walks in the front door of the agency and asks for help, is not “Case Number 823491A.”  It’s Bob, from down the street, whose having a rough time today and could use a little human support.

That’s not to say things are perfect.  I don’t think any agency that intersects with the public mental health system can fully escape the influence of its dogmas or the demands it places on agencies who receive its funds.  Attitudes in the agency toward persons the system labels “severely and persistently mentally ill” still reflect a symptom maintenance belief that those people are sick and cannot be expected to do much more than just cope and avoid hospitalization.  Those people must take medications, they must be taken without end, and a person should never be supported in stopping them, because that’s too dangerous to them and too costly to the system.

These unpleasant and (I believe) incorrect assumptions still exist.  But I also find that within the agency –   from my immediate colleagues to agency director – people are having the conversation.  I can say to my supervisor, “I don’t believe mental illness is a literal thing and here’s why” and that will turn into an open and positive discussion.  I can go to at least one of the prescribers who works for our agency and say, “I really have questions about these medications,” and have a genuine dialog about it without her feeling threated or me feeling insulted.

Things are not perfect.  But people are talking.   And ultimately, since the social worker’s role is defined as not only direct support of other human beings but also as the duty to challenge institutional injustices and confront social and professional prejudice, a big part of my job is to keep people talking.

***

Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

47 COMMENTS

  1. Iron Maiden- Stranger in a Strange Land (Official Music Video)

    http://www.youtube.com/watch?v=tS1C9miU1wg

    What happened to me ? I fell for the mental illness scam, you know depression anxiety serotonin gaba …

    Condition x = treatment y …

    They don’t even know how those pills work.

    Truth About Antidepressants & Chemical Imbalance, Psychology http://www.youtube.com/watch?v=KIjOZq_AUeE

    Those fraudsters with there clinical words sound so convincing even I fell for it, I see right though it now. The ‘mental illness’ scam is the biggest scam ever to infest this planet.

  2. Hi Andrew. I don’t think you can do it. Really, I just don’t . I am a former social worker; I have relinquished my license to a (almost police) state that wanted to demand I prove I was not impaired once I came out with my diagnoses. But, if you can continue to make a difference from within the system, please keep telling us how. Because I am at a loss.

  3. Hi Andrew, In your pair of articles you offer up a comprehensive account of your take on the predicaments that face a consumer in general. This is a great help for how it allows fitting in to another framework the various aspects of one’s own experiences and stepping back again in order to see what it all adds up to.

    I’m glad that you bring in this kind of breadth and say what it means to you to advocate and in many types of stiuations.

  4. Andrew, I am so glad you’re working in the field. Please keep doing what you’re doing.

    I am subjected to a lot of anger by my co-survivors when I say that an outright ban on involuntary treatment is both unattainable and likely undesirable. I support the use of drugs in psychiatric emergencies. When I was writhing around on the floor while screaming that my hands and feet were on fire, antipsychotic injections without my consent were both humane and ethical.

    What am I concerned with, like you are, is the lifelong chronic disease model. I see these folks in my doctor’s waiting room all the time. They have been trained to be disabled, to have no hope, to have no self-esteem. Just collecting welfare and shuffling in for their drug injections.

    I wish the psychiatric reform movement could focus their goals a little. I’m not interested in devoting my life to a goal that can’t be attained and abolishing psychiatry is just that. What I would like to see is genuine reform.

    • I am with you. My question is: how do we go about achieving the genuine reform that you mention? What are some achievable goals that we can rally support around and actually accomplish? Like Ted C., I believe that if we don’t do something soon it will be too late to do anything. I think it’s tremendously dangerous for us when talk of a national register of the “mentally ill” is being talked about in Washington.

      How do we go about getting people who work in the system to adopt the practical and sensible things that Andrew states here very clearly? I feel like we’re just spinning our wheels in the movement at this point in time.

      • Agree Stephen that we are running out of time and spinning our wheels.

        And I don’t if folks have seen the latest news but Virginia State Senator Creigh Deeds was stabbed by his son and is in critical condition. The kid than shot himself to death. I greatly fear he will turn out to have alleged suspected mental illness which will make things worse since this is a politician’s kid.

        • I saw this in this morning’s news. More fuel to the fire. I suspect that if the boy does turn out to have been on “meds” it will probably be one of the SSRI’s that are known to induce all kinds of bizarre suicidal and homicidal behavior in people. Of course they will probably hush all of this up and just emphasize that he was “terribly mentally ill!”

      • Stephen, I think the answer might be in “baby steps.” Here are some achievable goals that I would like to see in my lifetime:

        1. Consent to be defined in mental health laws as informed and uncoerced.

        2. Make sure that the test for “competence” is not merely compliance.

        3. Raise the legal standard for outpatient commitment up to that required for hospitalization.

        4. Include the mentally ill as an identifiable group under hate speech laws.

        5. Amend our Representation Agreement Act to include mental health decisions.

        6. Make coercion (e.g. threatening to make voluntary patients involuntary, threatening to take away housing or other social benefits) illegal (this is, of course, related to my point above about the meaning of consent).

        7. Establish safeguards to protect children against unwarranted psychiatric drugging.

        8. Make a legal advocate available for anyone diagnosed with a serious mental illness.

        These are just a few reasonable and attainable goals that I prefer to work on.

    • I am always so appreciative of people willing to tackle the reality of this grey life, without many points of clear black or clear white.

      One of the most important values for me personally is that I try my best to be committed to accuracy. Not “truth,” because the philosophers will tell you that truth is hard to quantify. But accuracy is not. Accuracy really comes down to: (1) being honest about what you don’t know (2) being honest about the limits of what you do know and (3) accepting the reality that things are complicated.

      So, I’ve had a client who heard voices ordering him to set himself on fire. He expressed to me and others that he did not want to set himself on fire. And yet, he had been in the emergency room on more than on occasion. The last time he was in the emergency room he was civilly committed for 180 days. Why? Because he set his hands on fire, and burned the flesh on his hands and fingers all the way down to the bone in certain areas. He suffered major infection, and required both heavy skin grafting and some plastic sugery. Doctors said that it was nothing short of a miracle that he did not destroy all nerves and permanently lose the use of both his hands. This was a 22 year old kid, who nearly lost the use of his hands for the rest of his life.

      The commitment said that he was presently a danger to himself such that it wasn’t safe for him to be independent in the community. And you know what, I think I agree. I don’t say that lightly. But nothing about this kids command voices ordering him to set himself on fire had changed. While the kid did not want to be hospitalized (which I can understand) he also was pretty clear that he didn’t want to be setting himself on fire either. That wasn’t a choice he was freely making for himself.

      I worked with another person who shot his neighbor to death because this person thought he was receiving orders from the government, and that his neighbor was a child abuser who he was ordered to kill in order to protect children. Premeditated murder. He murdered him, then drug the body out of the house and hid it in a boat in the backyard. It was only after the CIA didn’t pick up the body that he thought something was wrong. When the police questioned him, he told them everything because, again – he thought he was doing what he was supposed to be doing.

      He was found not guilty by reason of mental defect (yeah nasty term I get that) and ordered into psychiatric care. He was put on anti-psychotics, and he cleared cognitively. Yes, I know how that sounds, but this is how he described his own experience to me. He started on haldol and said that it was after this medication support that his thoughts began to clear. He was lucky to work with some psychiatrists who treated these meds as selective use and supported downward titration. When I worked with him six years after the crime he was not on haldol anymore. He also had no more voices or thoughts that he describes in his own words as “delusions.” But the meds were a big part of his early stabilization – that’s what he says about his own experience. Now his major struggles are with extreme guilt and shame for what he did.

      So what do with do with the really complicated situations where the answers aren’t perhaps always as simple as “you never want to hospitalize someone” or “medications are never the answer” or “involuntary services are never appropriate.”

      • Andrew, in general, I find that almost all statements that include the words “never” or “always” turn out to be fundamentally flawed. The examples you gave are very apt in describing situations where the “all involuntary treatment is torture” mantra really doesn’t apply. I was kicked out of the Facebook group called Repeal Mental Health Laws for exhibiting the same kind of rationality that you do here.

    • Francesca,

      We agree on many things, but certainly not on this one. The whole concept of civil commitment is a travesty. There should be only one way to deprive people of their liberty: the commission of a crime. Everything else should be off limits. Retrospective validation of abuse is not a good argument for me. If we are going to take “potential retrospective validation” as a rationale to implement non criminal paternalistic policies, then we should also,

      – Deprive obese people of their freedom and put them in a “fat camp” to force them to lose weight. I bet that many of these will be happy to have been put in such a setting.

      – Quarantine HIV positive people, especially in areas highly impacted by the epidemic such as gay districts in large cities. I am sure that many gay men would approve a policies that would take out of circulation those who would test positive in hypothetical mandatory monthly tests.

      – Force all those with an addiction problem -be that problem with alcohol, drugs or whatever- on a disintoxication program. Surely many will be retrospectively thankful.

      Government sponsored paternalistic policies, of which involuntary commitment is just an example, have caused untold suffering throughout human history. There is already a tool to deal with people who misbehave: the criminal justice system. In a democratic society, that should be the only way that government should be allowed to use to institute behavioral control. The notion of a psychiatrist, or a group of psychiatrists, who is (are) accountable to none other than himself(themselves) having legally binding power to decide who deserves to have his/her freedom taken away is preposterous and I will fiercely oppose it for as long as I am alive. In this particular matter, I am an absolutist, and I do not accept any compromise whatsoever.

      Paternalism denies the freedom of the individual to make his/her own choices. It puts collectivism and statistical analysis above individual freedom.

      • As usual, you make excellent points, cannotsay2013, but tell me what you would do in the situation I was in: writhing around on the floor, screaming that my hands and feet were on fire, rejecting medication. Seriously, should involuntary treatment in this instance really be characterized as a “travesty” or a “human rights violation.”

        There are lots of problems we can fix. We can raise the standard for civil commitment. We can also raise the standard for outpatient commitment. We can amend the Representation Agreement Act to allow for mental health advance directives. We can provide a legal advocate to every person diagnosed with a serious mental illness. We can force psychiatrists to provide support for tapering meds.

        But the biggest thing we can do is work towards cohesion in the psychiatric reform movement. I disagree with the motives of the Repeal Mental Health Laws Facebook group. Okay, fine. Instead of lambasting me and censoring me and shrieking at me, why don’t we see what we have in common. We both agree that involuntary treatment needs to be way reduced. So let’s work on that together. Then, if we attain that goal, we can split off and you can continue to work towards full abolition.

        Seriously, attempting to remove it altogether won’t succeed and will have various negative consequences for all of us in the system. Also, it will turn off people like me who do have something to offer.

        Lastly, even if this were to succeed (which it won’t), no Court would enforce it because it would be a fundamentally unjust law.

      • cannotsay2013,

        My heart is with you. And I consider myself to be a seeker on this subject, not a “knower.”

        So I have the same question as Francesca Allan, help me understand what you feel would be the most compassionate, just response in the situations (real ones I experienced) I described above. This is the question that has kept me up nights, as someone who stands opposed to forced treatment as a principle, but has had direct personal experience with situations that have given me pause. What do you think?

        I hope its obvious that I wrote my article as an expression of the beliefs I’ve come to hold – and those include a rejection of coercion as a rule. But does that mean there is never, ever a situation that challenges the general principle, where the more compassionate act might be some short term actions without a person’s immediate consent? Before you say know, help me understand what your response would be to someone whose voice hearing experience has caused him to set himself on fire when left on his own (on his own, by the way, being with few social supports.)

        These are the kinds of discussions I need to have, because they’re the questions I don’t have good answers to.

        • Andrew (and Francesca),

          Before I elaborate further, I have to make the point that the only reason I am engaged in the psychiatric survivor movement is my absolutist position against involuntary treatment/commitment. I am convinced that all the bad things that psychiatry has done through its history are rooted in its status as a legally form of coercion. This is the reason I am here and the reason I am interested in “psychiatric survivor talk”. If psychiatry didn’t have this status, I wouldn’t care less that some psychiatrist thinks that I am OCD any more than I care whether some astrologist thinks that I am Leo or Cancer and whether my natal chart predisposes me to become X or Y. Psychiatry has not destroyed my life because some psychiatrist thinks that I am OCD, it has destroyed my life because that OCD thing was forced into me through an involuntary commitment/forced drugging process.

          Now, back to your question. Society already determines which people are fully responsible adults and which people are not. It’s called the “age of consent”, which in most Western cases it’s 18 (in some countries, it was 21 some time ago and in the US, depending on the state, it is 18 for some things but 21 for others -like drinking). Not every 18 year old (or 21 year old) is equally mature or equally responsible however one defines “mature” or “responsible”, yet as a society we have decided that such is the case. People who commit crimes as adults, ie, aged beyond the age of consent, are not spared of their punishment just because they were “not mature enough” or “responsible enough”. Even a low IQ cannot spare anybody from punishment.

          Now, things are not that simple in some cases, like people born with learning disabilities but even for those people, it is not an easy thing to take way their rights: http://articles.washingtonpost.com/2013-08-02/local/41002259_1_morris-and-talbert-jim-talbert-jenny-hatch .

          If society decides that there has to be a process to take away from people their “personhood” status for whatever reason, temporarily or permanently, then there should be an open public debate about that, the provision should pass through congress, it should be validated by the constitutional court of the land (in the US case the SCOTUS), and then judges should administer that process. The backlash that is likely to follow such a proposal would make it fail, at least in the US.

          Come to the world of psychiatry. With existing law, a psychiatrist has a blanket prerogative to take away that “personhood” status from you using shaky justifications such as a “DSM diagnosis” (I hope that I don’t need to convince anybody here that the DSM is a work of fiction). Judges, for the most part, behave with this type of requests as the FISA court behaves with NSA requests: rubber stampers.

          So in short, unless society decides through the democratic process that personhood can be taken away through the courts, anybody doing something irresponsible should be treated exactly the same way regardless of whether that person has been given a DSM label by some psychiatrist. I do not accept the retrospective validation argument, even if I were to be the only person on Earth who was civilly committed and didn’t like it. The very notion of individual rights is that no matter what the rest of the world thinks about themselves giving up those rights, I still have the right to exercise it. I do not accept the idea that a psychiatrist should decide that I do not deserve to be free even though I have committed no crimes whatsoever. Period, end of the story.

          • Even if psychiatry didn’t have the force of law behind it, it would still be toxic. Teaching people to voluntarily accept the notion that they’re biologically and chronically defective is a vile practice.

            But voting on the issue of involuntary treatment wouldn’t further your position. In the emergency psychiatric situation I have described, you would simply never find a majority of people willing to leave me on the floor screaming in pain.

            And, as I’ve already stated, even if you did find such a majority, doctors would not honour that law (in situations like the one I have described) and no court would find them liable. Once that door is open, then psychiatrists would be free to utterly disregard the meagre rights that we have, e.g. to Review Panels up here. This is not a road we want to go down.

            There is a huge distinction between emergency intervention and ongoing treatment. Outpatient commitment (or assisted community treatment as we euphemistically call it up here) is insidious and needs to be reviewed. That’s where we should focus our attention.

          • Francesca,

            I don’t think psychiatry can be reformed anymore than I think that astrology can be be reformed. In the history of civilization, the establishment clause of the US constitution was a breakthrough. It’s the idea that people should be free to believe whatever they want to believe but that government has no right to impose any of those beliefs onto anybody. That’s how I see the struggle against psychiatry. The day the threat of coercive psychiatry disappears from my life is the day I will stop considering myself a member of the survivor movement. In the context of psychiatry I only care about the abolition of coercive psychiatry.

          • I just want to thank you both for the discussion. I’ve wanted to reply back multiple times but have been to busy to do so until now. I probably can’t go back now and revisit all the conversation points along the way, so I’ll just speak in summary instead.

            First, I agree that the system we have at present is broken beyond the hope of repair. That is a belief, but its my belief and I feel it strongly. I have similar political views, which I won’t get in to.

            So personally, I can’t put much energy behind advocating for kinder, gentler involuntary treatment laws IF those reforms are just going to be tacked onto a system so fundamentally flawed and self-serving that they will have little meaning or little protection for real people.

            I have more energy for advocating for more revolutionary change. So my comments above and my comments to follow both come from a more “philosophical” level.

            I agree very strongly with Francesca that I am generally very skeptical of absolute statements. Most times I have chosen to use word like “always” or “never” in statements I have made in the past, I’ve been embarrassed by that choice and humbled by others who have reminded me of the contextual, case by case circumstances in which my absolute statement just doesn’t hold water. So I try to incorporate that uncertainty into my thinking, with varying degrees of success.

            I think we can clarify some values that we hold, some guiding principles that reflect the kinds of things we most “want to be able” with how we live our lives. But that’s the best I can do. I’m not ready to say that there is no scenario in the entire whole of 7 billion people in which some selective and well-regulated involuntary treatment is not the most humane choice. I just don’t have the knowledge base to make such a claim. All I can say is that I hold dear to the principle that coercion is a dangerous and frequently damaging mechanism that I want to avoid whenever I can if at all possible. Right now, coercion is to the go-to first choice in the public mental health system, particularly for persons the system labels as “chronically mentally ill.” That is wrong on all moral levels, for me.

            If I was faced with a situation where a person announced his or her intention to murder a neighbor, based on some unusual beliefs that seemed not to be accurate (ex: belief that he or she was receiving brain-messages from the CIA giving orders to kill other people), and if that person did not want to voluntarily accept support services and expressed his or her intention to walk out the door and head home to commit the act of murder….

            ….then I would probably support an involuntary hold on that person. Why? Because despite whatever flaws there are in the system, I also believe I have a duty to protect the life of the neighbor, another human being whose life and safety are equally important.

            Now that’s just my thinking as of this evening. If you disagree, I am really hoping to listening. Tell me why you think that would be wrong, and tell me what you think would be the better choice for me to make instead, when faced with that situation.

            (A situation I really have been faced with, while working as a crisis mental health worker in the hospital emergency room.)

          • Since I have written some many “on the other hand” posts in this thread, because these are the difficult issues I struggle to reconcile for myself, I wanted to take a moment to restate my general objection to involuntary treatment. I want to acknowledge that I have seen mechanisms like involuntary civil commitment be abused more often that I have seen them make even a small amount of rational sense.

            Let me give you an example (I’m changing several details to protect anonymity): A male who had been assaulted by police officers in his history (a fact not in dispute, their are records of the incident, and the disciplinary actions taken against the police officers involved) was confronted by police again years later. He was quite triggered, he panicked, and the police were being needlessly aggressive and escalating the situation. When the police decided to try and physically subdue the man, who was not being violent, only yelling at the police a lot, he panicked even further and bit one of the police officers.

            That man ended up civilly committed for six months, and mandated to a locked, inpatient psych ward. He did not react well to being imprisoned like that, and was “acting out,” which resulted in more medications, more coercion, and discussions about how he might need to be continually “recommitted” so that he would stay in the system.

            An absolute, total travesty. Here is a man who was basically thrown in a psych hospital as punishment for the crime of protecting himself against aggressive cops, after he had already been brutalized by police once in his life. As punishment, he was locked up, forced on drugs and every time he did the natural thing, to resist that injustice, he only illicted more coercion in response.

            That should make anyone furious. It makes me furious! In fact it was a big, big factor in my walking off the job. Our psychiatric facility was supposed to have the mission of providing compassionate and individualized care to persons in the most severe of distresses – the 1 percent – where every other less invasive, less restrictive option had been tried and failed. It was supposed to be a support facility for persons who were literally in imminent danger of hurting another human being or themselves. And it was supposed to be about using the absolute least amount of force possible for the absolute least amount of time possible. The program even had policies and “value statements” about medications which said that it was the individual’s right to refuse medications, and to be involved in all decisions about medications, and to have full information to make decisions, etc.

            But I quit because, that’s not what really happened. What really happened is two thirds or more of the people in that facility had absolutely no business being there. They were in NO way an imminent danger to anyone. Most of them ended up court committed because they pissed off one too many ER doctors, or the wrong psychiatrist, or the police, and were determined to be “inconvenient” to the system, and thus sentenced to “warehousing” – sticking inconvenient people away somewhere against their will where they can be chemically sedated and ignored.

            It is horrific. Please know that I know this. The system is absolutely broken and inhumane. That doesn’t mean I don’t wrestle with philosophical questions about what my ethical responsibilities are when I do encounter a person who is actually an honest to god danger to someone else in the community who wants to walk out the door and go back into the community. That’s a real question I face. And I don’t have a good answer.

          • Last comment, and side note:

            The site administrator is helping me with a screw up in which I have accumulated more than one site log in over the years. I logged in with the wrong (old) account above (alyoder) so I apologize for the confusion, the icon (which I don’t find to be very appropriate to the context here) and the added messiness in this thread. I’ve communicated with site admins and they are helping me fix my mess! Please be patient. 🙂

          • “I’m not ready to say that there is no scenario in the entire whole of 7 billion people in which some selective and well-regulated involuntary treatment is not the most humane choice. ”

            Actually, I am 100 % willing to make the statement each and every single one of those 7 billion people deserves the right to refuse forced drugging and refuse incarceration if they have committed no crimes. There are areas in life in which absolutism is warranted, and this is one of them, otherwise one is being an absolutist of the worst kind, the absolutism of believing that every single evil of the world can be justified in “particular circumstances”.

            The protection against government forced “fat camps” if absolute, no exceptions allowed. The protection against the quarantine of gay males who live in urban areas with high risk of HIV infection is also absolute, despite the fact that the US government alone spends 18 billion dollars on HIV programs each year and ~ 15000 people die every year of preventable HIV infection, most of them gay males.

            When it comes to the person you mention, if those threats were credible (ie, the threatening person had the means and the will to carry out the threat), there is already a criminal statute called “criminal threats” or “terrorist threats” on every US state and at the federal level to take care of the situation.

            Let’s not forget that the so called “insanity defense”, and its derivatives, are the other side of the coin of “coercive psychiatry”. The side I have suffered is “we coerce psychiatry onto you for your own good”. The other side is “use psychiatry to get away from the commission of a crime”. Sorry, I happily trade not having access to “insanity defenses” if involuntary commitment/forced drugging statutes are repealed.

      • “There is already a tool to deal with people who misbehave: the criminal justice system. In a democratic society, that should be the only way that government should be allowed to use to institute behavioral control.”

        *LOL*

        I had this JOKE of a “trial” in a “court room” where I watched the “prosecutor” PRETEND LIKE SHE WAS ON TELEVISION.

        If that woman behaved the way she did in MY courtroom, I would throw her out and take her TV away.

        http://youtu.be/Z5NC-x1_S1U

  5. Having been a client in the system, then hired to staff at voc rehab, then wrongfully terminated because I called them on their acts of discrimination against people with disabilities, I learned ADA law. The most useful clause to me was “reasonable accommodation for reasonable request,” which is what I applied to win my legal mediation.

    I discovered that the system, throughout, is a legal house of cards, in chronic violation of ADA law. I was lucky, eventually, to find an attorney who worked with me, but I had to be persistent in my search for legal support. Most of the mental health advocate attorneys from whom I requested support were really advocates for the system and the established norms of stigma and discrimination, enabling it down the line, as their funding also comes from the same source.

    However, I found a publicly-funded employment attorney, outside the mental health and advocacy system, and because she was outside the mental health system, per se, she was not inherently biased against people with psychiatric histories. She met me eye to eye, respectfully, and did right by me. That was a novel, and very welcome, experience at that time.

    Another conclusion I drew, from my personal experience and observation, was that the system sucks peoples’ energy, like a nest of vampires. I find it psychically so messy, that it was impossible to bring in light. The management staff for which I worked *needed* clients to be in the dark, to feel their own power (and become drunk with it). It was a truly horrible and traumatic experience, and eye opening, as far as observing the underbelly of our society. I’d never seen such corporate and personal vampirism, all under the guise of being contracted to support those in need.

    I admire and respect your courage and determination to change the system from within. I tried and was sacrificed in my attempt. Now, I contract independently with different groups within the public health system, to help expand and shift awareness around energy and health, from a non-diagnostic perspective. I do a lot of my work pro bono, so money doesn’t become some dangling carrot issue. They’ll use *any* vulnerability to control, so I keep my boundaries very clear, which are now, finally, respected.

    Good to know there are brave and determined folks from within, kicking up the dust for change. Best wishes in your quest to make these positive shifts.

    • “The management staff for which I worked “needed” clients to be in the dark, to feel their own power (and become drunk with it).”

      Exactly! It’s totally in the interest of the mental illness system to keep people helpless and dependent. It’s truly disgusting and it doesn’t happen just where you were employed. I see this carried out every day at the state hospital where I work. The goal is to keep people helpless for all of the talk that we do about “recovery.” The power and control is too much for the staff to give up. This is what our movement is really working against as far as I’m concerned. People running the system are not going to give up their power over people. I don’t know how you go about combating this without a major uprising and revolt.

      • I so understand your frustration, Stephen. I’m no longer in that space, but I can still feel it from vivid memory. The lawsuit thing was a necessary part of my path out of there, for whatever reason, but I wouldn’t recommend it. The legal system is just as toxic as the mental health system, in much the same way. That required healing, in and of itself.

        For me–and this is what my work and presentations are about–it was ALL about finding that internal freedom, ‘THE healing journey,’ as many would call it, which is hard work in an oppressive environment. But it’s where we can break through the illusions and fear induced by all of this corruption, find our own voice and sense of self, and create what we need to move on from these heinous and debilitating paradoxes. Complex, creative, and forward moving.

        This was my path, at least. I found that pushing against such stuckness was really draining to me, after a while. In my environment, any appearance at progress and expansion would pop back into place like a rubber band quickly, the system was so tightly closed, and it would sting as such, in the process. All in all, I learned to create from a whole new perspective. That was the gift from the healing I did. I’m always happy to share anything with anyone that is interested.

        • Reading your response reminded me of what happend to me this morning. I was asked to come and speak to the Recovery group on one of the Forensic units at the state hospital where I work. At one point I was emphasizing that the people in the group are their own experts on their own lives and that they know what they need that will put them on the road to recovery. I could see expressions change on some faces and then, all of a sudden, the moderator who invited me to speak interrupted and asked if anyone wanted to share their goals for recovery with me! It was apparent that such talk was not well received on her part! I guess that she doesn’t really want any kind of “empowering” talk to go on. Just another example of keeping people helpless and powerless.

          I’d be interested in hearing what you have to share about all of this.

          • Your example says it all. This happened to me many times, as I continued to truth-speak my way out of this mess. At every turn, no matter how reasonable and focused I was about individual empowerment as the way out of this needless suffering–offering my example of speaking publically, making a film, and creating a healing practice based on energy and natural healing—I’d be abruptly cut off and the focus redirected, just as you describe. Often, when I made statements of certainty around mental health and related issues, someone from staff would express the typical indoctrination missive—“well, no one really knows, it’s a confusing issue,” as if to purposely sabotage the pursuit of clarity. Conversations would never move forward because of this innate resistance. After all, it’s bad for business. But more than that, on an immediate level, I feel it really threatens staffers, et al, to go against the grain in any way. Egos flair easily in this world, projecting fear and defensiveness, in lieu of moving forward the cause of societal and individual well-being. Plus, the box is ‘safe,’ although I’d argue that this is one of the illusions. Safety is not found in one’s comfort zone (illusion); it’s found with one’s own innate individual sense of safety. That’s an internal mechanism, a belief, it’s not external. This clash with mixed messages and resistance went on for me for a few years, at every turn running into this smoke & mirrors duplicity.

            How I ended up navigating this chronic and frustrating dynamic was to apply all that I had learned from the healing communities that did help me, far and away from the mental health communities to which I had once turned, which wound up only leading to all this we’re talking about, pure resistance. This is where my own personal paradigm completely shifted, in every way. I had already been studying Law of Attraction, energy and vibration, and personal ownership, via a variety of healing and spiritual studies. I also knew that my experience with the system was an exact duplicate of my family dynamic and issues. (I come from a very academic family, invalidating of emotions, to the point of shaming, which is a sure fire way to throw a person way off their intuition and inner guidance, causing them utter internal chaos—which we, as a society, are calling ‘mental illness’).

            A big part of the spiritual work I do is to own whatever experience I have as a result of my own beliefs, which cause an internal vibration from which we create our reality. This is what I learned about, thoroughly. Where we focus our thoughts will determine what we create next. It’s a pure cause and effect relationship. So whenever I’d have these incidents occur, which was plenty of times, I’d go home and do my energy work. Hard to explain this in a post, as it is kind of a different language than what we’re used to, which is why I offer workshops and classes, to learn, apply and practice shifting our own energy. This is self-healing, which breaks the bonds of dependence on ANYTHING, other than our own trust in our process. With practice, one can really learn to master one’s life with great ease. Anyone has the capacity to learn and practice this, if they desire to. There is no discrimination in the energy world.

            There are a variety of techniques by which to do this self-healing work, depending on what is the most resonant process for each individual. The beauty of it is that it is how to heal in present time, using triggers (such as being sabotaged) as guides, and this inevitably heals related trauma and confusion from past time dynamics. This is the new healing I discovered. I’ve been invited to speak to a group of public health nurses in a couple of weeks, and I’m going to present this to them. They’re asking for assistance with burnout from overwhelm and frustration, which I find this work addresses with great ease and clarity.

            One challenge, here, is that everyone has to walk their own path, and get to this point for themselves. We can only do our own healing work, following our own paths, and not the paths of others, and shine as an example for others. So if you take these experiences as your own path of learning and guidance, then others will intuitively feel these shifts, and you will influence others. This is the rippling effect of healing, and of energy. It’s how I practice my work.

            If any of this speaks to you and you want to know more specifics, please feel free to contact me. My contact info is on my website, which pretty much tells the whole story of how I evolved out of the system, and out of my past time issues. http://www.embodycalm.com

        • I work in Admissions so I see people when they first come into the state hospital where I work. Most people are vibrant, full of life, often disagreeable, and talkative. They often don’t want to comply with signing papers etc. But the point is that they’re alive and moving, even though they may not want to do what staff want them to do and they say things that staff don’t approve of or like.

          Then, I look out through my office window that looks into the courtyard used by two of the units I watch these same people that were alive and vibrant in Admissions become obese, numb, vacant, and shuffling along looking at the ground. And this is called “good treatment.” And when I speak about this I get blank stares from staff before they turn away without commenting in any way at all. What is wrong with this picture and why is it okay to do this to people???????

  6. Nicely done, Andrew! I want to reinforce your message of hope for change. You (and many others) are succeeding in “keeping people talking”. I encounter many MH professionals who are in full accord w/ your views.
    It wasn’t that long ago that gay marriage was feared and opposed by most of the public – and now it seems supported by most.

  7. “You (and many others) are succeeding in “keeping people talking”.”

    That’s part of my torture.

    Non-stop communication = talking / telling / explaining / soul puking / expressing / dumping / crying / screaming.

    A form of purgatory if it isn’t Hell itself.

    Torture is the method used to produce the information.

    • It’s always helpful to me to explain this shift, so I appreciate your asking. It’s a constantly evolving perspective in the ‘light-worker’ energy healing community.

      Some of my teachers were Buddhists, I also studied with Kabbalists. The healing meditation I do is Chakra-based. In Anatomy of the Spirit (1996) Carolyn Myss describes the Chakras and our energy system as a synthesis of all spiritual paths. Law of Attraction is at the core of it all. LOA is not a spiritual path, but a guide to healing and manifesting, as per the vibrational laws of the universe. Like attracts like, always.

      “As human beings, our greatness lies not so much in being able to remake the world – that is the myth of the atomic age – as in being able to remake ourselves.” Mahatma Ghandi

      When we remake ourselves, allowing ourselves to shift with the natural flow of change, in the habit of releasing attachment to what has gone before, including yesterday, we actually create a new world for ourselves, reflecting our internal positive and grounding shifts—one by one. Allowing our perceptions to shift is what allows the world to change.

      • Thanks. It all makes good sense to me. Twenty years ago probably not but now I’m a little older and hopefully understand things a little better! Wouldn’t it be great if we were allowed to share these kinds of things with the so-called “patients” who wanted to learn in places like state hospitals? What an alternative this could be to the mantra of “take your meds and do the program!”

  9. Following a screening of my film last year via the local dept of health, I did a workshop with about 40 clients from the system attending. Some were very grounded and focused, other were more challenged in this regard, but it was an all-inclusive discussion, very lively. It lasted 5 hours, while we applied all of this stuff. They got it, and were very intrigued by this different perspective, and wanted to learn more. In their evaluations, they said they wanted me to come back. That was being arranged, but then guess what happened? That process was stopped dead in its tracks by the ‘peer management.’ Suddenly, the grant had some stipulation in it that would only allow certain types of training from specific agencies. Uh-huh.

    I also have a client, with whom I’m working privately, who has just tapered from 18 years of psych meds. This work is supporting her transition beautifully. In previous years, I’ve supported a lot of people coming off medication. Med withdrawal takes tons of energy, and this helps rebuild. A few have sought my work and support specifically to avoid starting meds, which they’d been advised to take, but prefer not to go down that road.

    I also like to work with staff that has direct contact with clients.

    When we’re focused on peoples’ energy, there’s no difference in people we call ‘clients’ or ‘patients,’ and those who are not. None at all. The distinctions we make are illusory. As far as my work is concerned, everyone is addressed equally.

    Not sure what you’re referring to when you say, “Twenty years ago probably but now I’m a little older and hopefully understand things a little better.”

    • The twenty year ago remark just refers to the fact that I know so much more now than I did back then. I’ve met some really good people who’ve taught me so much about the things such as you’re talking about. I used to be a hospital chaplain who lived constricted in one way of seeing things and then one day I “awakened” and learned that there’s a much bigger world out there than I ever realized. I ran across Alan Watt’s presentations on Youtube and they opened the world up for me.

      I’m glad that you’re out there doing what you do so that at least some people get a chance to do and see things differently. Thanks for sharing.

      • Ah, got it, thanks for clarifying. I’ve not listened to Watts, although I know of his work, and yeah, it’s part of what I talk about. For me it started with Deepak Chopra back in the ’80’s–bringing to light for me the connection between our emotions and our physical state of being; then Carolyn Myss, who drew an even bigger and more subtle picture; and now I’m a big fan of Esther Hicks, whom I think does a wonderful job talking about our physical vs. non-physical selves, and our shift into vibrational reality over physical reality. She addresses what we call ‘mental illness’ in such a neutral and accessible way, as well as all the illusions of society. No such thing as ‘psychosis’ in these teachings. She really crossed me over into what I now understand about the nature of personal reality, and our creative processes.

        In any event, thanks for the dialogue. It’s been helpful and enlightening to me. I very much appreciate the hard work you are doing, as well.

  10. Alyoder, I agree with you that we need a serious overhaul of the mental health system. So let’s work on that. Let’s not waste our energy, time, money and other resources on the unattainable.

    In your example of the crazy neighbour, I too would call the authorities even though no crime had been committed. Once the neighbour was hospitalized, however, I would not advocate forced treatment in that scenario. The imminent harm aspect would disappear once he/she was hospitalized and imminent harm is pretty much the only justification (that my tired brain can think of at the moment anyway) for forced treatment.

    It’s not the emergency psych intervention that troubles me. It’s the “you’re diseased, you need to take these drugs for life, if you don’t take them, we’ll make you take them” scenario that I most object to. Whether the psychiatric industry chooses to admit it or not, the fact is that people often make spectacular recoveries from mental illness and they deserve the chance to go drug-free.

    A lot of people who swallow the Kool Aid essentially give up their lives. They have been trained to be disabled, to have no hope, to give up on their growth potential. It breaks my heart seeing them in my doctor’s waiting room.

    • Francesca, I added a post in the conversation chain above, but again – I apologize I’ve accidentially got multiple emails/accounts at MIA and I’m working with site admins to fix that and get the old one discontinued.

      With that out the way, I very much agree with you on all points I think. But just to clarify terms, you said you don’t object to the emergency psych intervention but only to the forced treatment that follows.

      When I use the language of forced treatment, I was including the act of holding someone in the hospital or admitting them into an acute psych ward as forced treatment. And I was saying there seem to be a few extreme situations in which that becomes the least harmful, least inhumane option.

      But I’m also curious, if you could see the place for emergency psych intervention, but not forced treatment (and again, i don’t feel like I have any core disagreement here) what should be done for, and in partnership with, persons who have been admitted into the hospital on an emergency basis because they were a danger to someone?

      I sense that we basically agree in our objection to the idea that you just shoot them full of drugs they don’t want with the idea that they should then be on these drugs forever because they have a permanent “illness.”

      What about a selective use model, in which certain medications were seen as a last resort, and used as minimally as possible for the least amount of time possible, and only in the most rare of extreme situations, with the sole goal of stabilization from the most acute phase of a very severe crisis that has put a person at severe risk? A model that included the expectation that immediately after acute stabilization, a titration OFF any medication administered would be considered the “standard of care” for most cases?

      My disposition at present (open to change) is that I am not anti-medication as a blanket absolute. What I object to, is the “drugs first, frequently and forever” model of practice in the West. I think psychiatric medications, possibly even “antipsychotic” medications, have a limited place in a selective use model. What do you think?

      • “Francesca, I added a post in the conversation chain above, but again – I apologize I’ve accidentially got multiple emails/accounts at MIA and I’m working with site admins to fix that and get the old one discontinued.”

        No problem. I’m just embarrassed that I didn’t figure out that Andrew L. Yoder and Alyoder were the same person!

        “When I use the language of forced treatment, I was including the act of holding someone in the hospital or admitting them into an acute psych ward as forced treatment. And I was saying there seem to be a few extreme situations in which that becomes the least harmful, least inhumane option.”

        Yes, I have been inconsistent in terminology but I do make a distinction between hospitalization and drugging. I do believe, as you do, that there are some situations (like the one I was in) where forced treatment is the right thing to do. This point of view makes some abolitionists nuts, to the point that they can’t even argue coherently.

        “But I’m also curious, if you could see the place for emergency psych intervention, but not forced treatment (and again, i don’t feel like I have any core disagreement here) what should be done for, and in partnership with, persons who have been admitted into the hospital on an emergency basis because they were a danger to someone?”

        I guess it totally depends on how they’re presenting and I really don’t have a “one size fits all” answer. I certainly wouldn’t advocate releasing them while they were still in such a state though. And, indeed, perhaps drugs would end up being necessary but I would prefer them to be the last resort after trying everything else. My medical records show that once I was pretty wacked out and they put me in isolation for a while they did some paperwork or drank some coffee or something. Two hours later, I was completely rational and they were amazed that this happened without drugs. Not advocating isolation here, just pointing out that sometimes a little time out can help enormously.

        “I sense that we basically agree in our objection to the idea that you just shoot them full of drugs they don’t want with the idea that they should then be on these drugs forever because they have a permanent “illness.” ”

        Yeah, this is terrible policy for a few reasons including that it’s soul-destroying, fundamentally misguided and too costly for the taxpayer. I have no doubt that in some cases psychological disorders originate in brain malfunction but when it’s assumed that this is always the case, we’ve got real trouble.

        “What about a selective use model, in which certain medications were seen as a last resort, and used as minimally as possible for the least amount of time possible, and only in the most rare of extreme situations, with the sole goal of stabilization from the most acute phase of a very severe crisis that has put a person at severe risk? A model that included the expectation that immediately after acute stabilization, a titration OFF any medication administered would be considered the “standard of care” for most cases?”

        I think this is what the alternative European programs are all about. Sounds wonderful. Don’t know their position on forced treatment but even were it included it would still be a wonderful model.

        I have to take Lamotrogine as I developed epilepsy in response, my neurologist and I believe, to ECT. Now that it’s been a year post-seizure, my neurologist and I are going to try tapering that down and see how I do. My psychiatrist was aghast at this, absolutely dumbfounded that a doctor would want to reduce meds once a patient has stabilized.

        “My disposition at present (open to change) is that I am not anti-medication as a blanket absolute. What I object to, is the “drugs first, frequently and forever” model of practice in the West. I think psychiatric medications, possibly even “antipsychotic” medications, have a limited place in a selective use model. What do you think?”

        Me too. My question is how much of a shitstorm do you have to put up with for stating your well-thought and rational views?

  11. Alyoder, I’m sure working within the system was ghastly and I totally respect your decision to leave. All the same, it’s a shame that you were unable to stay and provide some kindness and respect to the patients. Occasionally, I would come across a really awesome psych nurse and that made an enormous difference to me.

    • I’m still working in the public mental health system. Only know I work with a group that have historically either been chronically hospitalized or placed in secure pysch facilities or group homes. Instead, in our program, they have their own houses and appartments indepedent and free in the community, and we meet them in their homes or in the community to offer support. That support can range from individual counseling and therapy right down to transportation to medical appointments down to rides to the grocery store.

      These service are selected by the individual, not by us. Occasionally there have been times where the program has started to take more control and wanted to dictate services to an individual, but we’ve had open frank conversations about that within our team, where it was safe for that trend to be openly challenged. We made corrections and moved back in the right direction.

      There is an expectation that they work with a psychiatric prescribe and then take medications prescribed to them, and regrettable, this expectation comes from the automatic assumption that persons who have had a long history of hospitalizations must be “sick” and must need to be on medications permanently. As you know I have serious, serious objections to this assumption. But I have been supported by my team in advocating for and with individuals concerning their desires around medications, including their desire not to take medications if that is what they wish. I’ve even gone to prescriber appointments with a person to help them advocate for their wishes.

      Sadly, I can’t say the outcomes have always been perfect. Interactions with prescribers have been, let’s just say “mixed.” And there are some within our agency who still believe in a “those other people” type mentality toward persons the system has labeled “mentally ill.”

      The program I currently work in is getting a lot of things right. And some of the things I think it gets wrong are the subject of active, open, discussions (and sometimes debates!) I would like to be a part of those discussions. So for now, this feels like a good place to be.

  12. I appreciate these critiques and agree wholeheartedly with the need for collaboration. This is lacking strategies that are specific, and I am seeing enormous opportunity for change in Oregon. Peer programs are starting to flourish. And we *must* get nature, wellness, and play into our agencies. These articles (including this comment!) can be detrimental to mental health because they have clinical and oppositional contexts. Let’s start your goals of collaboration by creating settings with love, community, health, and joy…

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