Mainstream mental health approaches and psychiatry tend to create an us vs. them wall where people with a diagnosis of psychosis are different than the rest of the “normals.” In recommending treatment for aberrant behavior and unusual experiences, a disease model aims at symptoms that “they” have that the rest of us don’t. Things that just help anyone — common sense practices we all do to take care of us — don’t tend to be seen as “treatments” because they are somehow not specific enough to the disease. But what I’ve seen in my work with support groups, individual therapy, and my own life is that what “they” need is usually no different than what anyone needs.
A mother once asked me whether exercises to build self esteem could be good for her son diagnosed with schizophrenia. It’s heartbreaking that a mother could be so confused by the diagnosis and messages of mainstream mental health — she’s convinced that schizophrenia is a disease like a brain tumor, so it must be up to the neurologists to recommend treatments for her son’s brain. Worse, it’s as if she was saying: Now that my son isn’t human, do you think some of the things recommended for humans might help him anyway?
Of course, my response wasn’t “Yes, self esteem exercises (such as self-affirmation, journaling, joining a sports team or loving kindness meditation) can help your son,” but rather: “Whatever your son finds helpful will be helpful.” (My next question addressed why she has become the gatekeeper of care for her son, but that’s the subject of another essay.) The experience with this mother pointed to something that comes up a lot in my work: instead of helping people with some unusual and exotic approach to their unusual and exotic experiences, most of what I do is just general human needs being met in general common sense ways. Whether it is a hearing voices group or a family therapy session, the basics tend to be what everyone needs — listening, meaningful engagement in the world, people to trust, a sense of self-determination, nature, food… and most importantly personal power. Doing the work of “supporting people struggling with extreme states” often becomes just a struggle to be human and do what humans need to do to thrive and overcome. Which means having the power to have integrity of our lives, bodies, environments, speech, and minds.
When people have what gets called “paranoia” or “persecutory voices,” often with a bit of curiosity I discover people in their lives now or in the past who actually are out to get them. Real bullies, real persecutors. And then the work becomes work that all survivors — diagnosed with psychosis or not — have to do to regain safety, trust, and empowerment.
Sadly the last few years have also meant running up against bullying, mistreatment, and misuse of power not just in life in general or in psychiatry and mental health settings, but also in the recovery movement, patient support groups, activist and advocacy groups, peer-run services, hearing voices groups, and all the alternative spaces and initiatives that make up what we could broadly call “the critical psychiatry movement” or the “mad movement.” And it shouldn’t be surprising — since the problems people with diagnosis face are usually human problems, anywhere there are humans there are going to be these same problems. Peer support groups, alternative agencies and programs, innovative services — they often have very idealistic goals and principles, but like the rest of society, even in the #metoo era we see our institutions failing at basic ethical responsibilities.
Worse, when “movement” agencies or groups fail and people mistreat each other, there are few or zero places to go for help or understanding, no ways to get conflicts resolved or to get mistreatment addressed. The harm continues, people who are hurt burn out and leave, and people around them watching it happen again and again burn out and leave. Those responsible continue to repeat the pattern (often getting rewarded and promoted in our society — as we often see aggressive and self-centered people rising to the top), but the most tragic result of all is when people who see mistreatment, abuse, or corruption feel nothing can be done, and then they normalize it, keep quiet, let it go, steer clear of controversy, avoid scandal, keep their heads down and just perpetuate it all with their complicity. Slowly the groups and institutions and agencies and programs of the “alternative mental health world” start to gradually resemble the corruption of the system itself (especially when money starts to move in, but again that’s the subject of a different essay). Eventually (I’ve already seen this in small ways) there will even be movements-to-change-the-movement, advocates for mental health reform now turning their activism towards organizations of advocates for mental health reform, and the whole pattern and cycle has just reproduced itself in mirror and microcosm.
To combat this, there isn’t really any way around each of us learning and teaching responses to workplace bullying and mistreatment. I’d love to live in a world where in high school #metoo is studied, whistleblowing skills are taught, bullying responses learned, and young people trained to respond and stand up and take action when there are institutional mistreatment issues happening around them. Until then, we can start bringing these skills into our personal lives and discussing them with others.
Here are a few things I often work with and guide people around workplace and community mistreatment and bullying:
Don’t be alone: The worst trauma is isolation. If our work is stolen, or we are discriminated against because of our race, or we face retaliation for speaking up against sexual misconduct… whatever it is, our first goal has to be finding allies on our side. Many of us discovered the alternative mental health world to be the first place where people really understood us, so it can be a shock if those people just can’t be there for us when we are being mistreated. Make sure you have friends and connections beyond just the movement and peer/survivor settings, so you can make sure to have allies when you face misuse of power. As someone who wants to speak up and get an injustice overcome, you are extremely vulnerable. You can and will get retaliated against and pushed back on. Find your allies first, make sure your truth is held solid in your body and heart, and know that you are safe.
Connect the dots with your past: Being mistreated or stepped on at work, and then not listened to or supported, can trigger some of our deepest traumas. We can be thrown back into abusive family memories and we can quickly reenact traumatizing patterns of past abuse. Make sure you identify the parallels and get help separating the present from the past. What were the past ways you responded and how can you respond differently now? Make a reenactment into a renegotiation. It’s natural to revisit our old trauma patterns: we do this so we have an opportunity to heal them by making different choices. If you see uncanny weird parallels with how you are being mistreated now with your past trauma — don’t despair. It doesn’t mean you are just doomed to repeat your past, it is actually a healthy and natural pattern of trauma renegotiation for past patterns to resurface. Yes you are in a memory repeat, but this is a positive opportunity to do things different. Make a list of how the present is different than the past. Return to #1 again, because the original trauma was based on your isolation, betrayal, and powerlessness. In this renegotiation, meet some of the same echoes with connection and not being alone, people you can trust, and empowering actions.
Tell the truth: Get a clear sense of what happened. Be honest about your own role and how you are not perfect, and neither exaggerate nor minimize your own part in things. This can be the hardest part. If we get kicked off the project unfairly, unfair is unfair — but we should be honest that we didn’t handle the project conflicts very well or we brought too much upset to the equation. Your healing and the reception you get from sympathetic bystanders will be much better served if you can say Yes, I’m not perfect, here is what I did, but the mistreatment I endured is still real and unacceptable. You don’t have to be perfect to be on the right side of the issue. Be prepared to face what happened squarely — it may shock you that a co-worker actually did inappropriately touch you, or that you got cancelled from the grant for your political views, or that you were just emotionally violated by one of the directors who feels threatened by your strength. Bad things are real and avoiding them or acting like they didn’t happen can fuel them. Mistreatment is mistreatment and needs to be named as such — for our own safety and healing. There are bad things in the world, and we can face them — it doesn’t have to turn the whole world to darkness.
Focus on self care: You may feel that by speaking truth to power you can change the world, and you certainly have that possibility (history is made by bold actions of people challenging people). But also the biggest change might be in yourself. By studying your past responses and how you might be repeating and retraumatizing yourself, instead focus on how self care can use this to renegotiate and create healing. When we are mistreated, the first thing we often do as trauma survivors is blame ourselves. We get bullied so we think there is something wrong with us. Self hatred is part of the injury of mistreatment. So work really hard to love yourself, to affirm yourself, to stand up to the inner bully and critic. Now is a time to be extra loving to yourself! Whether or not you can change the world or get the institution/agency to change, or the person doing the mistreating to be held accountable, you can still do a lot of good by healing yourself.
Your allies and community will be key with this. Watch out for trauma survivor friends who might get triggered themselves and start playing a repetition role in your situation. If your friend starts questioning you and starts turning things around to “What did you do to deserve or provoke this mistreatment,” watch out. Come back to your truth, and if the friend is off base, get far away — this is a potentially life-threatening toxic dynamic. You need unconditional love and support for your honest experience of being mistreated and abused. You are extremely vulnerable. If people around you start to echo your abuser, if the people around you start to parrot blaming yourself, that you are already inclined to do on your own, an isolation downward trauma spiral could start. For many of us that spiral leads to addiction, suicidal feelings, and self destruction. Be absolutely uncompromising that the people close to you must love and support you when you have been kicked to the ground — not join those kicking you.
In this, watch out for your betrayal abuse repeat. Is the person close to you really against you? Or did you misinterpret what they said? Are you assuming they are against you, or do you have concrete evidence in the behavior? Are you giving up too soon or did you bring your feelings and observations to them to discuss? And be careful with gossip and behind-the-back chatter. Sometimes we have no choice but to share knowledge of mistreatment behind the back, but this can also be a toxic brew of hearsay and intrigue. Find what you want to say and say it, decide who you want to tell and who not, stand in your truth and communicate with integrity. Identify steps to take with integrity and make sure your friends and allies are 100% behind you taking those steps.
Make a plan of steps with costs/benefits: Staying empowered and in greater control means having choices. Do you want to speak up? To who? Is it worth it? Will you find sympathetic ears and a process of resolution such as a grievance committee or an ethics policy? Or will you be treated like you are the problem, ostracized, and watch as the organization closes ranks and pushes you out? Years of trying to speak truth to power in mental health system settings (as well as nursing homes and beyond) has taught me that sometimes there is too much power lined up against you, and the costs are not worth the benefits. Instead of hitting the fire alarm and screaming far and wide, consider more step by step approaches that stay more under your control with careful assessment of the consequences. The fire alarm could just make the fire worse if the alarm company is part of the corruption, so be careful. Getting far away and being public might be better than staying close inside and trying to make an unchangeable situation change. Ultimately it takes a movement to change bigger institutional power. While individual acts might work, you might be banging your head against the wall with your energy spent better elsewhere.
Take your stand and love yourself: You don’t have to win, but you can try — if the costs benefits are worth it for you. You may decide that you can’t and so you have to do what you can and come to terms with it. The important thing is to maintain control of your life and set the terms. Key is the trust and love your allies and friends can offer. If you want to complain and let it go, then let it go. If you want to leave, then leave. If you want to stay and fight, or speak up and cause a big storm of controversy, okay. Make your stand, take your steps, and feel solid that you are doing the best you can. It may lead to the next step or it may lead to just letting it all go — it’s up to you. The hardest moment is when we take a stand or speak up then we self doubt and self blame. Now our inner critic seizes the opportunity and we are heading down a re-traumatization path. Instead, at each step remember your truth and trust and love yourself, knowing you are doing the best you can. You got mistreated, you are trying to heal and live in the world and be a responsible person to yourself. That’s enough.
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.