Emotional Strategies and Skills for Aspiring Mental Health Workers

Mark Ragins, MD
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Recently I’ve given several “guest lectures” to college classes full of enthusiastic young people preparing to work in mental health and social services. I begin with three assertions:

  • You all want to work with people that most people avoid. These might be children or adults, people with mental illnesses, drug addiction, trauma, homelessness, incarceration or immigration issues. Each of you is “abnormal in a certain special way” and so your heart goes out to people that ‘normal’ people might reject.
  • You believe that the existing system is doing a bad job. Somehow, we’ve lost our way — become bureaucratized, started treating people like cases instead of with caring — and are just going through the motions.
  • You believe you can do a better job than we have done and not fall into the same traps that we have.

The class laughs, but also nervously agrees.

As someone who has been pursuing that same dream reasonably successfully as a psychiatrist for 30 years, I should offer whatever knowledge and mentoring I can so you don’t burn out and fail to reach your dreams.

There are three levels of helping people:

      • Intellectual/material/rational: making diagnoses, giving medications, case management, skills training, cognitive therapies, psychoeducation, etc. — requires expertise and collaboration.
      • Emotional: compassion, empathy, believing in them, giving hope, caring, not judging, emotional healing, love, etc. — requires emotional connections, personal caring, and trusting each other.
      • Spiritual: being “an angel,” God (or Christ) working through you, a “miracle” happened, “energetic healing,” praying for them, forgiveness, etc. — requires connection to selfless love and faith.

AA manages to combine all three levels in one program and environment, capable of moving ever deeper depending on people’s needs, hopes, and responses, but most other mental health and social service agencies operate predominantly on the rational level and in their best moments move to the emotional level.

In mental health, we have spent an inordinate amount of effort on the intellectual level, ranging from professional distance in our relationships, objective/observable syndromic diagnosis, behaviorally observable goals, overreliance on biological uses of medications, and measurable outcomes.

Nonetheless, since most people who come to us for help have deeper needs than that, primarily because of the pervasiveness of severe trauma, we’re going to fail most of them and be frustrated if we don’t instead operate predominantly at the emotional level and in our best moments move to the spiritual level. We need different strategies and skills to succeed on an emotional level than we use on an intellectual level (and different again on a spiritual level — but I’m focusing on the emotional level here since many people will respond to that level and you usually can’t skip over it anyway).

Here are my major recommendations for those emotional level strategies and skills:

1. Being able to connect emotionally to people who are normally rejected requires knowing why your heart got you into this work in the first place. Why are you “abnormal in a certain special way”? Keeping that flame of passion alive over the years is crucial to not burning out. I agree with Patch Adams that we burn out not by feeling too much, but by trying not to feel and distancing ourselves from our feelings until they’re forgotten, neglected, and deadened.

The program you’re working for must have a vision and a culture that aligns with your heart. It should feel like home, not like you’re the only one fighting for what’s right. Your coworkers are essential for your emotional nurturance and growth. They’re your “trench buddies.”

2. Compassion brings out our emotions and our desire to help. Compassion is very useful, driving us to a great deal of good. Unfortunately, it also can lead to compassion fatigue. Empathy is different than compassion. Empathy is a vicarious experience of the other person’s emotion, rather than a drawing out of our emotions. Empathy leads to connectedness, growth and even a shared stillness and fullness.

If we listen empathetically, we open a place in our heart for a person’s story to connect comfortably, knowing full well that it may change us, rather than listening with a focus on how we’re going to help them. When we succeed in connecting empathetically, they feel understood and cared about and trust us enough to quietly share even more. We also begin to realize that it’s not about us, it’s about them.

3. We need people to be emotionally motivated to pursue their own healing, growth and recovery rather than being dragged by us into doing what we think is good for them. Motivation is enhanced with:

  • Hope: We need to help them see a possible better future one that they believe they can achieve and that has meaning for them.
  • Client-driven approaches: People work harder on their own goals than on someone else’s goals.
  • Shared decision making: Combining their expertise in themselves with our expertise in opportunities, skills, and resources to come to better decisions than either of us would have without each other.
  • Motivational interviewing: Matching our support to the stage of change (precontemplation, contemplation, planning, action, sustaining) that they’re at.

4. Instead of running around frantically responding to crises, solving problems, and reducing suffering — all of which is wonderfully satisfying over the short run, but ultimately frustrating as the same crisis recur over and over again unless the pattern of suffering is addressed — we should focus on building protective factors (e.g. safe housing, money for necessities and emergencies, family connections, other supportive adults, positive roles and identity, and spiritual supports) so every problem doesn’t lead to a crisis. Once some practical and emotional security are established, we can focus together on learning new responses and building resilience. Almost everyone in the psychiatric hospital and jail and most homeless people have almost no protective factors.

5. Instead of focusing on what strengths we have available to use to help fix what’s wrong with them and protect them, we need to focus on what strengths they have within them (or even within their worlds) that they can discover, build upon, and ultimately be proud of. A successful recovery is not when they feel like we’ve been very helpful in fixing what’s wrong with them and taking care of them. It’s when they feel like they’ve found strengths within themselves, learned what’s really important in life, found gifts from their wounds and meaning and blessings from their suffering.

Trauma informed care is a powerful approach to reframing symptoms as coping responses, what’s wrong with them as what they‘ve gone through, and suffering as something to learn and grow from rather than to be ashamed of and removed — it is an approach that focuses on becoming survivors instead of victims.

6. Most situations can be helped with a combination of skills and supports. The more we focus on building their skills, the more they’ll be empowered, and the more their self-confidence, self-efficacy, self-reliance and independence will increase. The more we provide supports, the more dependent they’ll be on those supports and sometimes the more resentful they’ll become of the very supports they craved in the beginning.

A key component of recovery and community integration is self-responsibility. No one wants an irresponsible neighbor, or tenant, or employee, or father, or husband, or even primary care patient. To achieve meaningful roles in our society, we must achieve self-responsibility. Instead of blaming people for being lazy or “too ill,” we can help them build the foundations of self-responsibility including hope, empowerment, and especially skills.

7. Health and mental health are secured by a web of connection to our communities that reinforce positive identities, relationships and roles, not by a “safety net” that cares for people when they’ve fallen away from our community. We should be actively involved, not just in helping people be better able to belong in our communities, but also in helping our communities be a better place to belong in — more welcoming, inclusive, compassionate, and accepting.

We should actively practice community development — helping landlords, employers, families, doctors, schools, artists, etc. connect with people they’re likely to be frightened of or reject without support. We are part of our communities too.

Unless there are bridges back to community connection, we’ll forever feel burdened by caring for these people with ever-increasing caseloads stuck with us. If we work on islands on our own, eventually we’ll run out of both funds and compassion.

Taken together, I hope that these strategies provide enough of a vision to realistically believe in and enough of a guide to the skills you need to develop to make that vision a reality for you and the people you work with. Admittedly, it’s a vision on an entirely different level from the intellectual/rational one we usually teach you to focus on, but it’s likely the level you intended to focus on when you came to the field.

35 COMMENTS

  1. I think a lot of good workers leave due to frustration and being ground down.

    I think the essential skills on top of those of being caring and understanding of clients are those of being a community worker, trade union activist and political activist. At the very low level of being caring to clients those skills maybe needed if the dehumanising effect of working for psychiatric services are to b countered.

    Consider when the author says, “focus on building protective factors (e.g. safe housing, money for necessities and emergencies..” and then consider what that means in the age of Trump? Housing shortages and homelessness with low wages and precarious work patterns mean safe housing and money for necessities and emergencies are not avaialable for a lot of poeple and poverty is the biggest risk factor for getting a diagnosis for mental illness.

    Being a part of fighting back against what I shall call the stinking rich is an essential part of being a good worker who supports those who are mentally distressed.

    • And I believe that some people recognize that the system maintains its hold over people labeled as “patients” by perpetuating lies about “sick for life” and “you must always take the drugs” and the “you have a chemical imbalance”. There is almost no way that you can know this and stay working in the system. To know that the system creates harm for its own existence is too much and people leave.

      I agree that activism needs to go beyond just our particular area and we need to join forces with other groups working for some bit of social justice.

      • I knew a good worker who was part of a very small group that did theatre based consultancy to help service users get more of what they wante (we put on plays about how bad psychiatry is, they watched and then discussed them. The service users grew in confidence and supported each other better as a result). I wrote a stinking letter about her employer to the local paper explaining how badly a freind was being treated. She resigned as she felt personally attacked.

        You can’t run with the hare and the houds, as Dr Ragins is finding out.

  2. I’m not good at attributing quotes, so I’m not sure who said this, but it was something like:
    “if you see me struggle, and want to help me, no. But if you see that your struggle and mine are bound together, we should join forces.”
    Whatever the exact wording was, the message speaks to the fact that too many “helpers” are on an ego trip that makes them think they are better, smarter, more evolved than those poor unfortunate souls they are “helping.” This mindset puts everyone on an equal footing, instead of one-up, one-down. You should find the quote, and put it in your lecture.

  3. Cure the vultures of their profession, and you’re well on your way to curing their victims.

    Generally, when it comes to emotionalism, it is usually a matter of the dupers using deception to better deceive the dupes.

    Reason has been in short supply for some time now which leaves us dealing with this surplus in absurdity.

    You want my advice? Get out of the mental health profession. Find a real job.

  4. I started out with depression and anxiety. The shrink I saw put me on anafranil and pretended it was my fault when I experienced frightening hallucinations. If I weren’t schizo or bipolar none of that would have happened. 25 years of psych slavery were the result.

    I avoid shrinks like the plague. Though I would risk the Ebola virus rather than the quack who maims and kills people with no remorse at all.

    Due to all the cover-ups in the medical profession I avoid doctors altogether. Found out my current GP is a naive fool. Wants me on metformin though I don’t have diabetes! Don’t have time to relate his idiocy at length here, but I don’t think I’ll go back soon.

  5. “AA manages to combine all three levels in one program and environment, capable of moving ever deeper depending on people’s needs, hopes, and responses, but most other mental health and social service agencies operate predominantly on the rational level and in their best moments move to the emotional level.”

    The difference in AA is it’s supposed to be one alcoholic helping another alcoholic. In other words it’s an equal relationship where you can relate with one another although it’s not always perfect. In the mental health field it’s so-called “professionals” who are helping as you put it “these people”. By labeling people with phony pseudo science mental health labels you’ve already established a divide where you see the person as “other” and this in turn leads to less empathy and stigma no matter how much training there is.

    I was reading an Australian study done in 2011 on stigma by mental health professionals towards clients and according to their own research it’s a wide spread problem and in my opinion it’s not going to stop until we drop the dsm, and the pseudo science behind it.

    I could relate especially to this part: “People experiencing mental illness often feel patronized, punished or humiliated and many rate mental health professionals as one of the groups that stigmatizes them the most.”

    • I’m sorry I missed the excellent article, above, and your even more excellent comment, “WoundedSoul74″….
      I’ve been an AA member almost as long as I’ve been labeled/drugged in the so-called “mental health system”. Today, my 2 decades+ of sobriety, and being “shrink-proof”, and off psych drugs, are a blessing. But as for AA, the HEART of the AA program is the 12 Steps of recovery. Working the 12 Steps without going to meetings is better than going to meetings without working the 12 Steps! I’ve gotten FAR MORE help and healing in AA, than through the so-called “mental health system”. Overall, the system did me FAR MORE HARM than good! Thanks!

  6. A key episode in the life of Michele Foucault was when as a teenager he was sent to see a mental health worker.

    He had to learn what types of arguments to deploy and how to protect himself.

    We should be reading and writing articles about how to stand up to mental health workers and social workers, and about how to shut that entire industry down.

  7. We need people to be emotionally motivated to pursue their own healing, growth and recovery rather than being dragged by us into doing what we think is good for them.

    You need people-agree, you do to justify your salary? How much do you earn, as a shrink? There are bits of this that seem authentic but its just another shrink, spinning off some humanistic stuff – trying to be insightful – yawn

    Recovery is in the bin, co-opted by shrinks…

  8. Dr. Ragins,
    When you speak to young people about psychiatric diagnoses, do you let them know that psychiatric diagnosis is utterly lacking in validity, has no explanatory value, and has worsened in reliability over time?
    When you discuss “medications”, do you openly speak about how psychiatric drugs are not fundamentally different from other generally psychoactive substances such as marijuana, cocaine, heroin, and other street stimulants, downers, and uppers… and that these compounds do not in any way constitute medications treating a specific “illness”?
    And when you use the term “mental illness”, do you really believe this is a valid way to talk about your fellow distressed human beings?

    In my view, here is a better view of the profession to present to your students, from John Read:

    https://www.madinamerica.com/2016/03/in-search-of-an-evidence-based-role-for-psychiatry-2/

    Starting Quote: “While psychiatrists everywhere are doing their best to help people, their profession is in crisis. Psychiatry is struggling to defend itself from multiple sources of critique, and to reassert its future role. One possibility that is taboo for any profession to consider, however, is that it has little or no useful role. That possibility must be contemplated by others. An evidence based approach to evaluating what good psychiatry contributes to mental health services in the 21st century leads to some challenging conclusions.

    Psychiatry’s crisis is evidenced in many ways. Most blatant is the international outpouring of criticism at the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders [1], its latest attempt to categorize human distress into discrete psychiatric ‘disorders’. The fact that the attack on the poor science involved was led by the editor of the fourth edition [2], and the Director of the USA’s National Institute of Mental Health [3], was embarrassing.

    It seems psychiatry is now held in low regard by other medical disciplines. Medical students in numerous countries are uninterested in psychiatry as a career, seeing it as unscientific and ineffective [4]. In one study only 4–7% of UK medical students identified psychiatry as a ‘probable/definite’ career choice, partly because of its poor empirical basis [4]. In a recent survey over 1000 nonpsychiatric medical faculty members, at universities in 15 countries, “did not view psychiatry as an exciting, rapidly expanding, intellectually challenging or evidence-based branch of medicine” ([5], page 24). A total of 90% believed that ‘Most psychiatrists are not good role models for medical students’. The most negative opinions were expressed by neurologists, pediatricians, radiologists and surgeons…”

  9. I went to the London conference on Open Dialogue. It was a very friendly affair.

    I spoke to all sorts of people including a nurse who had trained in Open Dialogue and was doing that work three days a week. He liked his doing the work. He also did two days doing other work, which is what the majority of his colleagues does, and he hates it.

    He found out I was from Reading. He said the person who was his best man at his wedding was there, in Prospect Park Hospital, the local psychiatric hospital. He knows how inadaquate, damaging and bad his friends treatment is and is powerless to do anything, though he talks to his freind on the phone and internet quite often (his friend does not want to see him face to face often as it reminds him of the life he has lost).

    I wonder if Dr Ragins has any advice to that might be of any solace to the nurse who has for three days a week found a way of helping people in distress that uses few drugs and on the whole is democratic but for the rest of the week has to give out drugs, fill in forms and on the whole ignore people, some of whom are forced to be on wards where they do not want to be? Leave his job? Go part time on the Open Dialogue work and get a part time job on to compensate the loss of earnings? Found a militant anti-psychiatry campaign? Start using the drugs to slow some of his psychiatrist colleagues down?

  10. “Emotional Skills and Strategies for Aspiring Mental Health Workers”

    Dr. Ragins, you have provided your students with a sure fire recipe for being “Good Germans” in the face of major human rights violations being carried out every day in this country.

    If any would be students entering today’s “mental health” system possess even a minor amount of critical thinking skills and a developed moral conscience, they will inevitably face the following political and moral conundrums on a daily basis:

    1) A massive amount of cognitive and moral dissonance regarding the daily harm perpetrated against millions who enter today’s Disease/Drug based Medical Model.
    2) A daily unrelenting discomfort and internal knot in their stomachs related to what they see being done to people and their particular role in carrying out possibly more harm, all in the name of “treatment.”
    3) Lost sleep thinking about the added traumas from the System that those unfortunate souls entering “treatment” have to suffer, and what could, and should be done to stop it.
    4) Moral dissonance on a daily basis about WHEN and HOW to “Blow the Whistle” on the crimes that they witness. And then heightened anxiety and paranoia when they do “Blow the Whistle” anticipating the System coming down on them and most likely losing their job and source of income.

    I am not suggesting that new students entering today’s System cannot help some people, or even make a difference by challenging the “Beast” from within. HOWEVER, this is a very difficult road to follow, filled with many obstacles and pitfalls. Dr. Ragins has offered his students nothing but better ways to “go along to get along;” that is, with a full set of moral blinders covering both their eyes and their heart.

    Dr. Ragins, why didn’t you tell your students to read Mad in America; an absolutely essential tool for anyone taking on today’s “mental health” system? Perhaps if they did read MIA on a regular basis they would have exposed your bogus defense of Biological Psychiatry.

    Two years ago in one of your blogs, Dr. Ragins, you boasted about yourself as being a “good psychopharmacologist.” Please tell us what you have learned over the past few years about which particular drug cocktails are “most effective” for your patients. And also tell us how many people you have “saved” by forcing them against their will into some kind of so-called “treatment.” Please, please tell us all your success stories; maybe we could all learn something from you. You obviously have decided that you cannot learn anything from us.

    Richard

  11. I have torn my hair out for decades over the unexamined and damaging assumptions of biological psychiatry; I have fought what seems like a losing battle against the effects of those assumptions throughout the “mental health” industry. I agree with the substance of the vehement responses to this post, but am also disheartened by some of these same responses.

    In the present political climate, it should be clearer than ever that demonizing those with whom we disagree just contributes to polarization, with each side unwilling to acknowledge anything the other has to say. If we wish to be heard, we need to listen.

    I agree with much of what Dr. Ragins said here. I also believe strongly that psychiatry needs to acknowledge the lack of science behind – and damage done by – the disease model, the DSM, labelling, and treating those who suffer (or are just different) as in need of mechanical “fixes” instead of profound, respectful relationships. But I still admire Dr. Ragins’ apparent efforts to extend himself, human-to-human, to others.

    We need to be the change we seek.

    • Peter

      In all my comments over the past few years I have always bent over backwards to find something positive in an author’s blog before raising some of my concerns or criticisms. I am always respectful and try to never allow myself to resort to cheap or snide comments or personal attacks. I try very hard to raise the level of political and moral discourse in every discussion I participate in.

      I stand by my sharp and unrelenting responses to this author. Do you not see his overriding arrogance in his belief that he is truly “enlightening” his students with this pathetic message covering up for and apologizing for such an oppressive “mental health” system? And especially his insulting belief that he has been so “successful” as psychiatrist over the past 30 years.

      Please read his past blogs (and the comment sections) and then decide what he has learned over the past 2 years. If anything his MONSTROUS HUBRIS has only become more inflated, and thus more dangerous.

      When there is this level of arrogance and hubris by defenders and apologists of the system, there is no room for trying to find “common ground.” This kind of trash must be exposed for what it is, without any efforts to sugar coat the reality of what is going on.

      Respectfully, Richard

    • In the present political climate, it should be clearer than ever that demonizing those with whom we disagree just contributes to polarization, with each side unwilling to acknowledge anything the other has to say. If we wish to be heard, we need to listen.

      Don’t even play that New Age crap. YOU need to listen, should anyone feel a need to educate you as to your criminal arrogance. It’s enough for me to read this stuff without barfing.

      • Oldhead,
        1. Re “new age crap”: “be the change you want to see” is mistakenly attributed to Gandhi, but he did say substantially the same thing. He did ok for being “new age-y” – led India to independence over a militarily superior England.
        2. You seem to assume my “criminal arrogance,’ and my unwillingness to listen. My post states, “I have fought what seems like a losing battle against the effects of those assumptions throughout the “mental health” industry.” My working years were spent in public service – VISTA volunteer, 8 years as a community organizer (sometimes confrontational, sometimes not), assistant professor in a Historically Black College, prosecutor handling cases on behalf of low income tenants and neighborhood associations, director of a treatment foster care program (advocating for “what happened to him, not what’s wrong with him,” and against drugs – in court and within and outside my program). In retirement I am working on behalf of a Central American immigrant, and with a good, smart young man in inner city Baltimore who fights to make his way against hard obstacles. I was writing a book against psych drugs, until a brain injury made me stop extensive reading and writing.

        I have often raged at the injustice and oppression in my home city. But I’ve found I was most effective when I found friends to blow off a lot of steam to, and then figured out what to do/say. That doesn’t mean always compromising or getting squishy – I have risked my job and physical injury taking stands – but it does make you more effective. In my experience, calm and firm generally works better than acting mad.

        I’m guessing if we met, we’d get along.

  12. Re: “You all want to work with people that most people avoid,” and ”Being able to connect emotionally to people who are normally rejected…”

    I went voluntarily to see a psychiatrist 25 years ago because I was feeling so much anxiety and depression that was interfering with my thought process, and didn’t know why. In the end, I have a long story about psych drugs poisoning, withdrawal, and facing discrimination in the system which took me to legal action in which I succeeded to prove blatant discrimination.

    For most of these years, I worked full-time, had private insurance and was neither disabled nor part of the public system. I lived with diagnoses, worked and socialized, made it through college and then graduate school, and took a variety of psych drugs over the years which eventually caught up with me in a very debilitating way, leading to very painful and necessary withdrawal right after graduating, almost 20 years after I had begun taking them. Ultimately, this led me straight into the “disability system.” Multiple organs had been seriously compromised, it turns out, including my brain.

    That is where the shit hit the fan for me and my life took a downward spiral like never before, thanks to what the drugs and social abuse/discrimination/stigma/systemic bullying and sabotage had done to me.

    This dark period of my life was followed by extreme core changes, including choosing to heal far away from anything like this—more toward energy healing and spiritual work from a variety of perspectives. That has changed my life in a good way, finally, what I expected—to be well and back on my path of living, loving, working, and creating. I was labeled all sorts of ridiculous things as I was healing from neurotoxins, going through rapid changes, all judgments from which I had to distance myself and simply ignore in the end, as completely irrelevant–although not after all of this had done a number on me, serving to make me feel really bad about myself and rather hopeless at times. I was waking up fast.

    So overall, my path has had great meaning for me, and by acting as explicit contrast to what I would most desire for myself in life (fun, joy, freedom, creativity), the depth of healing from my experience with “mental health” anything did eventually lead me to the life I most desire, because I chose to wake up to what was really happening around me, rather than continuing to believe that something was so wrong with me and that I should just accept my fate as a “compromised” human being, attempting to be tossed to the sidelines. That’s a cruel fate, to buy into that belief.

    Still, I felt so betrayed by the system, and the entire field by this point, thinking it was there to help me, and I could not understand why I, and others around me, were being treated like “undesirables,” that’s exactly how it felt. I was trying to heal, whereas it became apparent that this was not their agenda for me, that I was supposedly “delusional”—and even grandiose!–for thinking I could heal from this particular “disability” and get on with things, as I had envisioned for myself.

    I had just come from grad school, where I was doing MFT training and perfectly respected—and even transparent about my diagnosis, which did cause me a bit of trouble with one professor and a couple of fellow students, interestingly enough–but overall, I was an excellent student and had a very active supervised internship as I processed well through my stuff.

    And suddenly, the moment I walked into social services to actually receives services, I was another person in the system—chronically ill, forever limited, and marginal to society. That was their version of me, not mine. The difference in feeling is over the top, and it is a mind fuck like no other. My world went dark, temporarily, because of all this. In the state of mind I was in at the time, coming off of 9 psych drugs, this was extremely disorienting, and it snuck up on me. I was totally naïve and unsuspecting, having trained in the field myself.

    Now I get it, with messages like these (and they merit reposting, they are so direct and powerful)–

    “You all want to work with people that most people avoid.”

    “Being able to connect emotionally to people who are normally rejected…”

    That was never, ever true for me in my life. No one rejected me and people don’t tend to avoid me (other than in the mental health world, that is a weird and ironic thing in my life, another story). But overall, I’ve always had a healthy social life, including a partnership of now 32 years. I’ve had friends and family connections, always, despite my family issues, which was the root of all of this in the first place, finally got that straightened out in my life. And I’ve been part of many communities, always in good standing, in harmony with it all.

    Although again, I’ll highlight that only in the mental health world, where I am trained, educated, and thoroughly experienced, am I shunned in just about every aspect of it, and this was all as the result of my wanting to move forward in life. It has been an interesting experience and study for me, personally.

    Of course, if you are sending people into the world with this idea in their heads, as per the above quotes– then clients don’t stand a chance! You’ve already marginalized them, before even starting!

    I really do respect others for how they walk their path of life, whether or not I am of the same beliefs or values. It’s really none of my business how others choose to live their lives, unless it, somehow, involves sabotage to the greater good, then I would feel compelled to have a say in what goes on. But even then, I defer to the universe because I am no judge of others, my perspective is human, and therefore, limited.

    But these two phrases really jumped out at me, and I now can see so clearly why I was treated this way, which others seemed to accept, and which I simply could not, I knew it was wrong, because, other than some family issues I associate with my healing journey, and then all throughout the mental health world, I’d always been treated just fine in life.

    Now I see that, from the get-go, it was assumed that I’d been marginalized in life, simply because I had turned to the system for support when I needed it. Something to do with not having money, maybe? Does that make one less worthy of respect than anyone else? Well, to be honest, grad school was expensive, as was seeing psychiatrists and psychotherapists all those years, all leading to catastrophe and disability, in the end. That was a terribly unwise investment on my part, I must say, and I will own my choices here, having examined the beliefs behind them. I’ve since shifted my belief system, as a result, and that has changed my life accordingly.

    I could go on and on, but it really spends me to think about this. It is just such a dense, dense reality, looking back on it—which I try to do less and less as time goes on, and focus simply on moving forward into a new reality feeling like myself now, and not like some social beast, which is how I felt in the system as I traversed it years ago. To me, that’s a blatant projection, because that is exactly how I feel about the mental health system—not only a social beast but also vampiristic–and I know I’m not alone in that perspective!

    I hope that, somehow, I’ve made my point. I’d really like for my experience to be valued in a way that will help others in the best way possible, not only to consider different perspectives neutrally and even-handedly (e.g. clinical vs client perspective), but also to encourage people, in general, to use their intuition that will guide them to go in a direction that will best help them when they need support, rather than tank and drain them unsuspectingly, because they are considered “undesirable.” (To whom? would be my question) Then, it would really have been worthwhile, other than for me to have found my clarity and authentic voice.

    • Your response here reminds me of an experience that I had when I first started working in the state “hospital” where I’d been held as a “patient”. I was in new employee orientation and the assistant CEO of the “hospital” came to give her little speech and welcome to all of us new employees. She’d worked at this “hospital” for 27 years and this is what she said to us: “The people you will be working with here are the worst of the worst, the sickest of the sick, people who’ve burned their bridges everywhere else and are now with us.” I sat there stunned and angry and totally flabbergasted.

      After her little speech she asked each of us to introduce ourselves and to state what department we would be working in. When it came my turn I said my name and then stated that I was a peer worker. This administrator got a puzzled look on her face and asked me what peer workers were. I said: “Well, I’m the worst of the worst, the sickest of the sick, and according to you I burned all my bridges getting here. I’m a former patient”. She couldn’t get out of the room fast enough.

      I knew before I started work that the attitudes were bad, after all, I’d lived on one of the units for almost three months. But here was an administrator stating this kind of attitude in public for all to see and hear and she thought that it was perfectly acceptable. When people at the top say these kinds of things it’s no surprise that people in the lower ranks have such a horrible viewpoint of the people they are supposed to be working for to find recovery and wellness. Thankfully, this woman retired the year after I started working. She always avoided me in the hallways until her departure.

      • Wow, Stephen, perfect response to her, you mirrored her perfectly. What’s interesting of course, is that this lady has her story, too, as to why she thinks like this, of why she would feel so compelled to maintain such a transparent illusion of power. Over whom? How about the most vulnerable of the vulnerable, easy to control, no advocacy, etc.

        The irony is that there is no power here, only the desire to feel it at the expense of others. That will never work, never has. It is an ILLUSION.

      • Stephen, I agree with AA, takes guts to speak that way to a higher up. I’m so curious how you keep from getting in trouble, and even fired. All I had to say was, “You are blatantly discriminating against me” to receive my walking papers, despite the fact I was a very effective counselor. of course, that’s illegal, because I wasn’t just blowing smoke and playing victim, I had hard proof of this. My win here was a no brainer, they were so transparent in their bigotry. But they never admitted their wrong-doing, not for a moment, and it came back to haunt them. How do you keep your job standing up to the powers that be this way?

        • What I find about all this is that the other peer worker and I are treated with a touch of paternalism but with a great deal of support and respect. Both of us have a work histories prior to our experience with the system in areas that seem to generate respect from others and both of us are capable of carrying on a conversation where we can hold our own with those at the top. I suspect that it doesn’t hurt that I was once a chaplain. It also doesn’t hurt that I work with the Division of Behavioral Health in planning programs for peer workers in the state. Division is the organization that oversees the “hospital”. I think it’s important to never shove this in peoples’ faces but it’s important to let it be known that you’re involved in these places and organizations. And I suspect that they had no idea what peer workers really do when I was hired and it’s been an experience of trying to teach them and the rest of the staff what peers are and what they’re required to do for the people that we walk with. The doors in administration are always open to the two of us and they do listen to what we have say, though they don’t go up against the doctors very often.

          The one thing that we can’t do is directly confront any of the psychiatrists. This sounds kind of Machiavellian, but you have to form alliances with those psychiatrists who have any leanings towards listening to anything different from the “drug them up and head them out” mentally. I know that many here at MIA say that this is going over to the Dark Side but I say that it’s like working in the French Resistance.

          We survive here because the administration supports us and most of the administrators are people that you can speak with honestly and freely. It’s interesting that many of them know that what peers stand for; freedom of choice for “patients” and against forced “treatment” should be the reality for the “hospital” but in this state everything dealing with “mental illness” is determined by the old paradigm, and it’s very apparent that many of the psychiatrists are not well informed at all about what’s happening in the wider world. Even the psychiatrists we can work with didn’t know who Nancy Andreassan (sp) is! They were not familiar with her two studies (2007) that prove that it’s not the “schizophrenia” that causes people’s brains to shrink but the drugs and she’s the Grand Dame of Bio-Bio-bio- psychiatry!

          I guess what it boils down to is that we’re lucky plus we’ve worked hard to be competent and professional people. We are seen, not as auxiliary staff who are there to do the grunt jobs, but staff that are complementary to clinical staff. We are not under the Dept. of Nursing but stand alone as a department of two who answer directly to the Director of Clinical Services for the entire “hospital”. The psychologist who has this position is totally behind peers and set it up this way so that we have more freedom than we would have under another department.

          I have been attacked openly by psychiatrists and some psychologists when speaking in open meetings. This usually happens when I try to introduce some different ways of “seeing” the supposed “mental illness”. All in all, we are lucky.

          • And the truly big thing that I’ve discovered about all this is that you teach better by example and by being the change that you want to see in the world than you do by haranguing people and clubbing them over the head to try and force them to change their thinking. You pique their interest by quietly going along and doing what you need to do for people and maybe they will begin to wonder and to ask questions. It’s a long and very drawn out process.

          • I’m glad to hear you have secure support and are seen for the professional that you are.

            And I agree wholeheartedly with “be the change you want to see in the world.” We cannot create meaningful change in the world without tending to our own alignment and integrity, first. Otherwise, we only create more chaos, drama, and suffering for ourselves.

            Reality is created from perspective, and we have a variety from which to choose, from one day to the next, leading to pure creative freedom. I think that simplifies the process, and makes it a bit more efficient and clear, and we see where we are at the controls of our own life experience here. What you say above is where I lost patience with the “mental health” world. EVERYTHING was a long drawn out process (and that’s putting it mildly), that usually led nowhere!

            My life changed pretty quickly when I began to perceive the bigger picture, of my soul journey unfolding. I am also a minister, so I applied my spiritual work to these experiences in order to heal from them. Also other principles of healing; but shifting to the spiritual story is what ascended me from all the double binds of this reality.

          • So finally, I want to bring this all back to my original point re the statements I pulled from this article.

            Stephen, you know like I do the enormous difference between being treated with respect (which used to be “normal” in the world I lived in, whereas today, it seems harder and harder to come by in just about any role and from just about any perspective; just look at the example from our national leaders right now) vs. treated like a second class citizen–that is, dehumanized, demeaned, deprived, and only perceived through the lens of stigma, as in the scarlet letter. These are two completely different experiences in life, internal feelings, self-perceptions (as well as perception of the world), and, therefore, realities; and it’s not a stretch to guess which one is the more desirable for at least most people I know. Still, it is rather incredible how little persuasion we seem to have over those who are determined to be abusive, marginalizing, and controlling, perceiving from what I would call an extremely limited perspective, that this is the way to “get things done.” I think that’s why we call it a “toxic society,” when this becomes the norm. Talk about teaching by example!

            I do feel there is a way to break free of this internalized very negative and limited self-identity that is imposed by the system and field of “mental health,” based on class. One has to be able to see through the illusions, and that’s hard because illusory or not, the effects of it are very strongly felt, regardless. Still, when we seek truths higher and broader than the limiting perspective which binds us to an oppressive reality, then we can perceive the way out, through our inner guidance and intuition. We all have it in there somewhere, and these negative experiences can serve as catalysts for discovering it, for the sake of survival, and then for actually getting out of the cave, so to speak, and into the light (thinking of Plato’s allegory, The Cave, here)–that is, liberation.

            That’s all I can say about the matter at this point. The rest is up to each of us to find our path and follow it. It’s humbling, without a doubt, and also incredibly empowering.

            I’m not posting here much these days, but this article did get my attention, so I stopped in to speak my truth of the matter, as it has relevance for me at the moment. Thanks for the always rich dialogue. Best wishes to you and keep up the brave work!

  13. I’ve received grief from MI workers because I’m celibate. In fact I’m a virgin at 43. Not exactly an “incel” or asexual. I’m a heterosexual woman, but I prefer celibacy to casual sex or one night stands. Having spent my entire adult life segregated with fellow “losers” often more drugged than myself, the pickings were mighty slim.

    I have decided next time I need counsel, I will go to a clergy member, a life coach (if I can afford one.) Or phone an older, wiser friend or maybe join a nearby EA chapter. Or read a good book. Despite the drawbacks to CBT, I have benefited a little from David Burns’s book On Feeling Good. Actually talked myself out of a prolonged bout of sadness while reading it and doing some of the exercises.

  14. Alex

    Your story is one of the most moving and insightful pieces I’ve ever read- you could you write a book, go back and work through the whole journey. You have an amazing ability to grip the reader I was totally immersed in your story. Thank you and go well- shine on 🙂

  15. Went to see a General Practitioner once. He told me that if I hadn’t been “Bipolar” to begin with, I wouldn’t have had a bad reaction to begin with. Does this mean if you can’t hold your liquor and get drunk you need to be dosed with massive amounts of uppers plus more alcohol? If you want to sell lots of street drugs and liquor to people you might make that argument.

    I calmly mentioned I wanted my “diagnosis” changed to avoid discrimination. Doc Dummy stared at me, “Discrimination?”

    “Yes,” I replied. “Discrimination.”

    “But most of those people are ignorant.”

    “Unfortunately all people who write for television are ignorant.”

    “I suppose so,” said Dr. Dummy with a dismissive shrug. Was he born that stupid or is he working overtime at being an idiot?

    And most people watch television Doc. And they don’t think to question the “facts” they’re presented with–fiction or not.