“Heartbeats of Hope: The Empowerment Way to Recover” – A Book Review

Ron Unger, LCSW

We seldom have a chance to hear from someone who combines the perspective of a longtime psychiatric survivor and activist with that of being a psychiatrist! So, I was happy to read this heartfelt book by Daniel Fisher, where he brings together an integrated vision of what a wise and humanistic approach to mental and emotional crisis might look like.

Heartbeats of HopeDaniel starts by sharing his personal story, and that fascinating story alone is enough to make the book worth reading! He outlines a variety of factors in his earlier experience that set him up for having a severe crisis, such as his taking on the role of “golden boy” in his family, the sexual abuse he received from a teacher, and his later efforts to suppress his feelings which he believed were interfering with his thoughts. He then describes his “descent into the maelstrom” which left him mute and catatonic, followed by his being hospitalized and diagnosed with “schizophrenia.” And then he describes what led to his recovery.

But few who recover become psychiatrists! Daniel clarifies that this was not easy, as most psychiatric training is not set up to support those with humanistic inclinations, much less psychiatric survivors. He wrote that “it seems that professional training and elevation in status tends to select out the qualities most essential for helping another human being through a crisis.” But then when he sought support through a peer group, he found that now it was being in psychiatric training that was creating a barrier to fitting in and getting support! The Mental Patient’s Liberation Front (MPLF) informed him that he could only attend as an ex-patient, not as a psychiatric resident, but he felt unable to go as only half of himself. Later, a group formed called Friends of MPLF, and he was finally able to get the support he needed and meet people like Judi Chamberlin, with whom he later collaborated.

While “schizophrenia” is often thought by professionals to be a “thought disorder,” Daniel’s story illustrates the way difficulty in relating to affect, to feelings and emotions, can really be at the root of the apparent “symptoms.” As Daniel recovered, he learned to accept his feelings and his relations with others as central to his existence, and then this perspective informed his treatment approach once he did become a psychiatrist.

Regarding relations with others, he wrote that “something about being in deep relationship allows the variety of my seemingly independent selves to come together into a community of selves that I call my self.”

The later parts of the book explore what mental health care focused on healing looks like.  He emphasizes supporting personal empowerment, the promise of dialogical approaches, and the basic process of attunement through “emotional CPR.” Detailed examples of how these approaches work are included.

As I read the book I noticed myself disagreeing with only one significant point. That was in regards to a statement made that a person does not have to be off all medications to show “complete recovery” from “mental illness.” This notion is supported by pointing out that many in our society take psychiatric drugs but maintain their social role and are not considered “mentally ill.”

I found that way of talking about the issues to be unclear and unhelpful. First, I don’t think we should frame anyone as being in recovery from “mental illness” as that term is, as Daniel himself admits, not very helpful to describe what people go through.  And if we describe it instead as being a mental and emotional crisis, then it seems a bit contradictory to say that one is “fully recovered” from such a crisis and yet still in need of medical assistance. It may be fine to point out that a person is no longer disabled by the crisis and is functioning as well as many who have never been hospitalized but who are taking psych drugs themselves to cope with less extreme mental or emotional difficulties; but I would reserve the term “full recovery” for getting to a place where no further “mental health” assistance is needed. I think this is important, because we need to make it clear in the way we speak that outcomes where drugs are no longer needed are possible. This is essential if we are to fight back against the system’s tendency to hook people on drugs without much hope of ever getting off. Claiming that people still reliant on drugs are already “fully recovered” suggests that no further recovery is possible, and thus tends to cut off hope that getting off the drugs successfully might be possible.

There are those of course who would frame the whole concept of “recovery” as unhelpful, and as a term co-opted by the mental health system. I would agree that there are problems with the term and with the way its meaning has often been twisted, but I think it remains important as something to talk about when offering much needed hope to people from whom almost all hope has been stolen. “Heartbeats of Hope” makes a strong contribution to a possible future when hope for recovery will be kept alive within mental health treatment, and people in crisis will be offered human relationships and help in resolving the crisis, instead of being offered the currently popular mix of coercion, lies, and attempts to use drugs to suppress any and all unwanted responses to life difficulties.

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  1. a person does not have to be off all medications to show “complete recovery” from “mental illness.”

    I believe I have completely recovered from alcoholism and addiction but I still party pretty hard sometimes if and only if I know its going to be a fun time. I guess that’s off topic a little but I am completely recovered but the psychiatric and AA version of recovery says otherwise. Maybe I should leave AA out of it they only suggest total abstinence but the psychiatric version calls it a relapse.

    I am so brainwashed by the whole thing, do I post this? A few people know my screen name … He is not sober not in recovery he is still sick some would say.

    That word recovery is so tricky.

  2. 1st objection. My, oh, my, but isn’t Heartbeats of Hope a sappy title. Get back to me when you aren’t addressing your book to saps. Look up a slang definition for sap, and you will see what I mean. The acronym ‘sap’ is for ‘sad and pathetic’, and applies to fools.

    I always saw recovery as a matter of recovering from the mental health system and its abusive mistreatment. Recovering from a personal crisis? I don’t think so. Crises are things people resolve rather than “recover” from.

    Now how do we “cure” all these “mental health” professionals from their professional ‘calling’ disorder, that is the question.

  3. Hi Ron,

    Thanks for the review. Daniels experience is very inspiring.

    As regards medication my main problem was with the disabling side effects and severe adverse reactions, but I also found the drugs very dependency forming.

    I came off injection type medicine in 1984 and I tapered with oral medication. By 1990 I was consuming 25 mg/day* of mellaril (a dose suitable for a 7 year old with hiccups). In 2005 I was switched to 25mg /day Seroquel, and I consumed about one quarter of this and then eventually nothing.

    I was getting worrying “drops” on heartbeat with the Seroquel; plus my chest was bright pink and the rest of me white, on awakening.

    *I believe Seroquel at under 150 mg /day is considered non thereuptic for “SMI”.

  4. Thanks Ron for great review of my book. Here are my thoughts about the question “can one have recovered completely and still be on medication?”
    First I know of a number of people who have recovered a full life though still take a smaller than usual dose of medication.
    My point is that recovery is defined by seven characteristics especially having control over the major decisions of one’s life and passing as no more disturbed than neighbors (see http://www.power2.org). On page 130 I state:”The primary distinction between a person who is labeled ‘mentally ill’ and a person labeled ‘normal’ seems to be whether the person has experienced a major interruption in the development and life that resulted in others making decisions for them.” So by my paradigm of recovery of life, taking or not taking medication is not the main criterion of being labeled mentally ill. After all there are many in our society who take medication but maintained a major social role and therefore were never labeled “mentally ill.”
    As far as the title being sappy, as Ron points I have found that recovery of my life depended on my retiring my capacity to feel and experience my emotions.

    • Hi Daniel, perhaps the real question is an existential return to the era of alienist questions of what Maslow called ‘homo-normalis-rationalis, who Reich said where emotionally evasive and dishonest compared the emotional authentic desire of the so-called schizophrenic. And from R.D. Laing’s perspective on our human post-hypnotic trance state, induced during the behavioral initiation period of infancy. Does, the mistress of all our Muses. memory created a post-hypnotic suggestion, as we see the objects of the material world & instantly name it?

      From Laing’s question about the possibility of ‘love’ in a know thy-place, paternalistically organized the social world, actively block, by the base affect-emotion of fear, the existential questions of humanity that needed to be asked right now. Like, is the word ‘heart’ my experience of my heart & do I act-out the sin of self-ignorance, by simply taking my experience for granted?

      During infancy, we explore the material world by grasping objects and experiencing them with a visceral sense that is a mix of our five senses capacity to know reality. Without realizing it, do we grasp at words, with our minds in the same sensate, experiential way? Imagine a shift in the tactics of political experience, by humorously asking mind doctors an existential question, based on Socrates retort to emotionally adolescent critics; Know Thyself.

      And imagine a Marilyn Monroe lookalike asking in that famous “Mr. President,” super-sensual way, a question of existentially conservative, hierarchically dominating men; So you know the mind’s of others and being human, you naturally can walk and talk. Can you say a few words about ‘how’ (Reich’s most intuitive word of human experience) you do that?

      I asked this question of a young American male, still too young to fear loss. He instantly began to move his right foot forward, as his right arm moved upwards, then stopped (a flight-fight-freeze reflexive response?), and being an authentic type, he said; I don’t know. I’ve made a comment on Michael Cornwall’s last blog about gently turning the tables in an existential way, by raising my hand before my face (Gestalt awareness of foreground/background phenomena; saying the ‘hand’ then wiggling my fingers to ask, is the word ‘hand’ the experience of my hand. The non-plussed look in response hovers on the event-horizon of an epiphany.

      Then, just as Reich describes in ‘Character Analysis’ the habituated muscular/vascular armoring blocks it. Which, from the Buddhist perspective on Void mind, is, I suggest, the fear of ‘self-emptying’ Jesus alludes to on his ‘conscious-cross.’ Is it time to turn the tables, through this community’s lived, experiential wisdom, that we are not mad or ill, we just experience the call to awaken through the nervous system’s evolved or created wisdom. And finally, do know the wise story of the ‘handless maidens’ who literally create so-called history?

      I invite readers of this thread to google the ‘axial-age’ and follow their heart’s to current theological and philosophical debate, on fate & destiny. Marvel not, when I say you must be born again. -The Nazarene.

      Yeah but ‘how?’ cry the youth of today: “Jaspers described the Axial Age as “an interregnum between two ages of great empire, a pause for liberty, a deep breath bringing the most lucid consciousness”. It has also been suggested that the Axial Age was a historically liminal period when old certainties had lost their validity and new ones were still not ready. -From https://en.wikipedia.org/wiki/Axial_Age

      Some witty street philosophers ask; are you barking up the wrong tree, of knowledge? While the Buddha sat down on the right side of the tree & the Christ said; cast your net on right side, my shepherds to the sheep.

      While in ancient India, where Val Resh lives, the brain is known as the. ‘net of gems.’ Don’t go sowing seeds in the field of consciousness now, though, will you? Or gleaming in the field of consciousness and sorting the wheat from the chaff either, like Ruth in a certain book, way too old to take seriously. Parables of the human condition are just Myths, aren’t they? Just like the myth that we really do know ourselves.

      What a heroic journey the human story is.

  5. The Mental Patient’s Liberation Front (MPLF) informed him that he could only attend as an ex-patient, not as a psychiatric resident, but he felt unable to go as only half of himself. Later, a group formed called Friends of MPLF, and he was finally able to get the support he needed and meet people like Judi Chamberlin, with whom he later collaborated.

    Don’t know what this implies to the author, but it is an approach regarding survivor activists’ relationships with professionals which made sense then and, I believe, makes sense now.

  6. Hi Dr Daniel,
    I’ve seen you speak before on video. There’s a lot of resources being invested into a cure for “Schizophrenia”. Could I ask you what you would consider a cured person to be – what would the person have to achieve to be cured?

      • Then recovery is not about cure but about recovering a full life in the community.

        What if one lives in he U.S. and there is no “community,” and few preconditions for a full life, and the available schools and working conditions only compound the problem?

        • Is the life glass half full or half empty? Wait a minute, I think we’ve still got a pulse. Let’s give him the benefit of the doubt and say “half full”.

          Community is a participant sport, and it starts wherever you happen to reside. I think community is something you help make, but in order to do so, you have to first see it as important.

          Marginalized is fancyshmancy for scapegoat. Even marginalized creates opportunities for community. Turn the tables, and we’re getting somewhere.

  7. First, on issue of recovery of full life in community, I agree that there has been a breakdown in community and I have worked within my neighborhood to develop community through a cooperative day care etc.
    second, I make a distinction between recovery as a restoration of one’s place in society compared to healing from trauma which led to label of MI

  8. Dialogue helps both ways as meaning is being created. The way I distinguish between recovery and healing I feel is critical. To continue your tennis player analogy, I see recovery of full life as a sociopolitical term describing her position relative to other players and the association of tennis players with its rules whereas healing is a more psychophysiological description of her intrapersonal struggle. So using your tennis player analogy: she had a trauma to her arm and psyche and as a result she could not compete well enough to qualify for membership in the association of players who qualify for major tournaments any longer. With rehab, belief in her by others in the qualified group, and a brace she fully recovered her membership and once again qualified. Her arm continued to heal even after she had fully recovered her position as a member of the association. She became more sympathetic towards others who struggled to stay within the qualifying range, providing them peer support. During the healing she resorted to an earlier style of play but as her healing progressed she could return to developing new moves she never knew herself capable of. This was a trauma activated growth of her capacity.

  9. This issue of whether people who take medication should be counted as being in recovery is a very unfortunate one from my perspective. I believe that as a culture people who experience madness or what I prefer to call special messages are extremely diverse. I think that historically we have been divided by so many different labels that we as a people aren’t seen as a culture. And what’s worse we aren’t treating each other as brethren when we clique up and reject people who decide that based on their experiences that they want to be on medication.

    At least for me, recovery from special messages was so hard, I needed to use all my resources, my strengths, my passions, my inclinations in order to recover. I really don’t like being judged because I chose to continue medication. There are things I am blessed with and things I am not, but I was able to come back, and I am grateful.

    Being in message crisis was a degrading and dehumanizing impoverished experience, and I feel further dehumanized when someone who doesn’t the least bit about me makes a decision to exclude me because I do not measure up to their standards. I believe that some people may have gifts and blessings to get off their medications and I am happy for them and some people may have been so hurt or be facing enough obstacles that they cannot, or choose not to.

    I work with some very deprived individuals many of whom have lost their freedom to institutionalization. The horrors that they experience are hard to bear witness to and they are exactly what I experienced for two and a half years. I am compelled to continue to break through and it works and we have a valuable community with great people in it. But are we to create a caste or class system that is choosy about who we honor. If someone was unsupported and homeless instead of getting a free pass to school, I do not think that they should be penalized for it in a recovery community. Mad diversity is so complex. I have been very excluded and really have not found shelter from it away from the community in which I work. I am sorry but it hurts dearly. At the same time I am so lucky and privileged to have found some stability in my life and I am not taking that for granted.

  10. Thank you for response. I just feel when someone who doesn’t know my history and situation says I could be better healed like they are it implies that they know something that haven’t yet learned. This has led me to feel marginalized in groups and adds to my isolation. But you are right, my language was exaggerated and hearing your response helps me take more responsibility for my feelings and helps so thank you. I am suppèr sensure to discourse that excludes.