A Recovery Movement Jedi Master, Bill Anthony, Died Recently

Is the movement slowly dying too?

Mark Ragins, MD
10
1479

There was a great disturbance in the force last week. Bill Anthony, founder and longstanding executive director of the Boston University Center for Psychiatric Rehabilitation, founding board member for the Foundation for Excellence in Mental Health Care, and recipient of the Distinguished Service Award from the President of the United States died at age 77. I would imagine that a man of his grace and thoughtfulness touched many people in many ways, but I, like so many others, know him for his work in psychiatric rehabilitation and recovery.

I feel like a giant upon whose shoulders I have been standing is gone.

The first time I met Bill was in 1991, when he came to the Village when it was barely a year old to write about Martha Long’s leadership style. He was working on a book about leadership. I was just a couple years out of residency, and he was already the legendary “father of psychiatric rehabilitation.”

Bill Anthony

The first paragraph in my book “A Road to Recovery” tells the story: “In 1991, when Bill Anthony, Ph.D., a well-known leader in psychiatric rehabilitation from Boston University, came to visit the Village, I asked him what he thought the next big movement in mental health was going to be. He answered “recovery,” and I nearly fell off my chair. At the time, we were only one year into building the Village. I had just begun thinking about recovery and it still seemed too extreme to ever become acceptable.”

Recovery has always been an “outsider movement” that has drawn many rebels. Years ago, I created a PowerPoint slide that listed among our ranks:

  • People with mental illnesses – “consumers” – fighting for themselves and helping each other
  • People with experience with the 12 step-recovery movement, wanting to integrate mental health and substance abuse recovery
  • Psychosocial rehabilitation and psychiatric rehabilitation programs
  • Civil rights advocates
  • People who don’t like following the rules and are naturally pragmatic rebels
  • People who prioritize trauma over illnesses and want to focus on trauma recovery
  • Staff who came to mental health for personal reasons who are “abnormal in a certain, special way so our hearts go out to people normal people would avoid,” who want to connect to their clients authentically and reciprocally rather than reduce them to cases
  • People who heavily value cultural contexts, understandings, and services
  • People who are “doing God’s work” and find spirituality to be forcibly excluded from our current system

Bill was a leader of the rehabilitation contingent, which included many of my coworkers at the Village and our collaborators.

From my viewpoint in California, his contributions spread across a range of options for promoting recovery we would all do well to emulate, including:

  • From early on, with Judi Chamberlin, he collaborated meaningfully with people with lived experience, profoundly valuing them.
  • He insisted that people with mental conditions, even with ongoing symptoms, instead of being marginalized, deserved the chance for rehabilitation, to return to school and work, just like people with physical conditions.
  • The “choose, get, keep,” model for supported employment services literally begins with client choice.
  • They put together training manuals, lessons, and textbooks for rehabilitation practice, giving it the consistency and accountability needed to push for CPRP licensing and compete for official reimbursement.
  • For years, he edited the Psychiatric Rehabilitation journal creating a place for person-centered rehabilitation and recovery research, techniques, and scholarly interchange to compete with the biologically dominated professional journals.
  • He committed early and fully to the recovery model as an organizing set of values for the entire mental health system, carrying it to the highest levels of government.
  • The Foundation for Excellence in Mental Health Care is developing credible alternatives to the pharmaceutical company dominated treatment narratives.

The last time I met him was about 15 years ago when we were both members of SAMHSA’s Partners for Recovery Advisory Board. He was working to connect us with the contingent from substance abuse treatment and prevention. He was building bridges and creating allies. I also learned then that he had late-onset multiple sclerosis, which may have explained why he’d been championing taking naps.

I admired most that he was not the “easy” kind of rebel, who fans anger and destruction while building very little.  His strength was in using our recovery values to build concrete practices, programs, training material, even administrative structures. I have his article, “Implementing Recovery Oriented Evidence Based Programs: Identifying the Critical Dimensions” from the Community Mental Health Journal on my computer and used it to build my “Recovery Culture Progress Report.” He knew how to implement our values.

But, despite his efforts, the recovery values haven’t become embedded in standard practice.

While I, unlike many others, don’t consider the current “medical model empire” to be an evil empire, I do think that it is widely repressive. People choose to work in mental health because we want to help people, to share their struggles, and because our heart goes out to them because of who we are, reflecting both our gifts and wounds. But the “medical model empire” represses our “hearts” by insisting on professional distance, scientific objectivity, and dehumanizing reductionism. People choose to work in mental health because we are awed and fascinated by the mind and all its variations. But the “medical model empire” represses our “minds” by limiting our understanding to reductionistic descriptions of brain circuitry, simplistic diagnostic categories without causes, and generic treatment algorithms. People choose to work in mental health because we think we can make a difference in people’s lives by using our personal talents and experience to help others. But the “medical model empire” represses our “hands” by being almost entirely medication-focused and only funding illness-centered services delivered by indoctrinated professional staff using their insider-approved, “evidence-based” practices.

The medical-model empire remains very strong. It controls all the academic centers, the research and publications, the public education and advocacy organizations (including NAMI, MHA, and the National Council for Behavioral Health), the media’s mental health narrative, and, of course, the DSM 5. They have two formidable sources of power:

  • Massive funding from pharmaceutical companies who, by federal law, can only promote their medications within a medical, illness-centered model. They heavily promote it to sell more and more pills. Pharmaceutical companies directly or indirectly fund and influence everyone, promoting the medical model.
  • All insurance, private and public, including Medicare and Medicaid, who pay for mental health care, are medical model based. The require psychiatric diagnoses, “medical necessity” for treatment, and “evidence-based” treatment directed at relieving that illness. These requirements funnel all the treatment money into medical model services, starving more holistic approaches.

I don’t know if Bill would have agreed with my formulations, but it seems to me that he was unsuccessful in diverting either of those funding and power sources into recovery and rehabilitation. Two of his most compelling assertions, “Recovery can occur even though symptoms reoccur” and “Recovery from the consequences of the illness is sometimes more difficult than recovering from the illness itself,” are still rebellious assertions, limited in their power because they’re starved of funds.

The four values underlying his Recovery Oriented Mental Health Systems – person orientation, person involvement, self-determination/choice, and growth potential – give us a compass for “value-based practice” that is still widely repressed.

It’s up to all of us to carry on the rebellion even though the force has been diminished by his death, even though we’re still outsider rebels. We can still do it by applying his value-based compass to our various efforts:

  • Education and advocacy organizations can adapt illness-centered, professionally-driven programs like Mental Health First Aid and QPR suicide prevention to include those four values, and favor programs like emotional-CPR that already embody recovery values. What if we created ads that said, “If your antidepressant is only partially working, there’s a lot more you can do to recover besides adding an antipsychotic medication”?
  • DSM could be pressured to replace increasingly broad diagnostic labels, especially bipolar and ADHD, with meaningful, individualized formulations, focusing on what happens to people instead of what’s wrong with them, and the growth they can aspire to. What if we put “developmental trauma disorder” in the DSM? What if “grief” – not “pathological grief” or major depression” or “adjustment disorder” – but normal, devastating, potentially life-threatening grief was included? What if “gender dysphoria” was replaced with the desire to be whole?
  • Pharmaceutical research protocols could replace paying people to be in rigid dosing protocols measuring symptom response outcomes with surveys with engaging people to use medications to fit their goals and needs, and measure their ability to exploit the medications to resume growth and get off the meds. What if instead of trying to eliminate and “control for” placebo effects and side effects, which are the actions of the person’s mind working with and against the medications, they studied enhancing placebo effects and decreasing side effects?
  • Training programs could focus on person-focused, growth-oriented practices (like Carl Rogers’ person-centered therapy or narrative therapy) and relationship building (like open dialogue and non-violent communication) instead of on short-term coping skills. Prescribing training could emphasize engagement, goal-driven, client-driven, shared decision making, resilience building skills.
  • Service payment and auditing could be focused on the person, their relationships, and their growth to interdependence rather than on illness reduction. What if engagement, empowerment, collaboration, and graduation from services were paid for?
  • Public health prevention and early intervention approaches could be moved from looking for early genetic vulnerability, diagnosis, and proactive medication treatment to building protective factors, relationships, and resilience. What if we really focused on prevention of childhood abuse, strengthening families, increasing attachment and mirroring, and developing people’s self-identities? What if we focused on relationships and community building? What if we focused on enhancing connection to our bodies, to nature, to spirituality?

Bills’ death can give us a moment to stop and reflect upon where we’ve been, the current state of the recovery movement he fought so long and hard for, and what we can still fight for. Despite his efforts we’re still a disparate group of rebels facing a powerful, repressive empire.

10 COMMENTS

  1. “While I, unlike many others, don’t consider the current “medical model empire” to be an evil empire, I do think that it is widely repressive. People choose to work in mental health because we want to help people, to share their struggles, and because our heart goes out to them because of who we are, reflecting both our gifts and wounds. But the “medical model empire” represses our “hearts” by insisting on professional distance, scientific objectivity, and dehumanizing reductionism. People choose to work in mental health because we are awed and fascinated by the mind and all its variations. But the “medical model empire” represses our “minds” by limiting our understanding to reductionistic descriptions of brain circuitry, simplistic diagnostic categories without causes, and generic treatment algorithms. People choose to work in mental health because we think we can make a difference in people’s lives by using our personal talents and experience to help others. But the “medical model empire” represses our “hands” by being almost entirely medication-focused and only funding illness-centered services delivered by indoctrinated professional staff using their insider-approved, “evidence-based” practices.”

    Hi Mark, I’m sorry you lost your friend and mentor.
    You don’t see Psychiatry as evil, yet refer to “dehumanizing” and “repressive” “medical model”. If you see “illness” you must believe in the “medical model”, which it is indeed not. The mere practice of prescribing chemicals has nothing “medical” about it.
    When you say “people go into “mental health” because of wanting to help people”, I wonder who those people are?
    That statement confuses me because on one hand you say “medical model empire” in your opinion is not evil, and you state they enter it wanting to help people, yet refer to the repressing and dehumanizing. What is helpful and not evil about dehumanizing? Or is dehumanizing just a tiny little covert problem?

    I’m all for recovery since I think as humans we are in that constant state anyway, call it what we want. In psychiatry though, only some remain in a constant state of recovery, thereby remaining constantly ill. Even IF one reached a “recovered” state, psychiatry treats it as “once an alcoholic, always an alcoholic”.
    So there’s really no point even, is there. We can’t prove ourselves to psychiatry lol. And I think you are well aware of that and are trying to be in both camps.

    ” I had just begun thinking about recovery and it still seemed too extreme to ever become acceptable.”
    That is understandable, considering what school taught you, or your own prejudices. You refer to “empowering people”, which I find is very difficult for people who are in the same breath looked at as ill. If your “provider” sees you as “ill”, how is that empowering?
    There are very demeaning elements at work when the “MH” worker gets to be the “compassionate” observer, who gets to empower people. Although it works wonders in keeping the status quo alive.

    No, people’s minds are not there for anyone’s musings and entertainment, no matter how well meaning. And I agree with you, I doubt the “movement” will get far as long as they don’t call it as they see it, EVEN IF “anger” is the driving force.

    If you think you can get anywhere with psych by reasoning with them, good luck. I think ultimately, you are best off doing your own thing. Hopefully that includes empowering people by realizing you and the guy in your chair are both very imperfect.

    • Now after thinking about the “splashdown” from the past weekend as i offered posts in synch to the event, the idea of inner and outer space still surfaces to this site’s connection.

      How the formatting is categorical and an imperative does not quite advance the creative nature that occurs when one’s realities are altered and then committed into the nightmarish treatment programs that never were funded in mental health. The whole of the program as defined by a politics of arrogance is an embarrassment to the inner space travel of our country and globe. Howie the Harp along with numerous others would give SAMSHA Hell for the stingy behavior that would unfold around Alternatives.

      In a recall of the past, I would teach in Helena under an emergency certification in classes in physical science, chemistry and physics. I had lost a job working in a bank and the challenge to start a career again was a challenge. While teaching and staying a day ahead, Pirsig would be read along with Bronkowski and Einstein. Star Trek would show up at the local theater and the students would be wondering about the Jedi. And I could not yet explain to them about Black Holes in space, film and Hollywood. Though to understand thermodynamics and balances were another thing in a town where cotton would be compressed for shipment by STEAM. To be able to reconcile different disciplines of knowledge with value and values for LIFE, as in The LIGHTS articulated seemingly were not settled enough to realize the type of career I would long for. Years would pass and the journey brought me into Kentucky, at times up in the Hills from the Flatlanders I would come to know.

      Surviving in Kentucky, I was able to hear Dr. Anthony speak before an annual conference. In a state culture that breeds race horses, there seems to be a problem with drugging of the beast and human. And while Recovery became popular within mental health culture, now I marvel with the experience of Reel Recovery in Trout Fishing, a program for Men and Women who find recovery from cancer in group process.

      More importantly, if we are serious about the Jedi in California Film or in the landscape of Kentucky (or parts of the globe and space), how can the dollars be created and allocated more equitably when the very financiers and elected ones communicate to the individual their insights have no value?

      Looking back further, but indicative for these times, there seems to have been an issue between Cardinal Bellarmine and Galileo discoveries of importance and thinking differently. And there was no Edward Tufte to make the story plausible in a visual computer language.

      In the past Sunday’s NYT, there were two articles of equal importance for these times in need of understanding. One was written by Adom Getachew, “The Slow Road to Real “Decolonization””. The other was written by a Damon Tweedy, “Racism That Lingers in Medical Schools”.

      In working on the Masters in the 80’s time was spent traveling to Boston University. And though Dr. Anthony was not known then, time would be spent trying just by chance to visit Elie Wiesel’s Office. Upon leaving the Theology School, the sun would be setting behind the MLK Doves of Peace Statue. Thus how can We, as C/S/X along with others, not a War in Space, but rather convey an ethics that honors LIFE, that is the gifts?

      Will a “Jedi” appear?

  2. How is the broadcast talking about “loss of signal” compare to not being able to read the the communication in human interaction? W/O drugging into altered realities that seemingly be more difficult to experience than a space-walk? If the Broad Institute generates huge data that does not focus on one, then how can the program where Teams work like crazy, at what point will reconciliation begin to occur?

  3. Mark,
    the fact that you would leave SO’s and families out of your PowerPoint list of people in your ranks is incredibly dispiriting and indicative of why, I believe, this movement continues to falter. Our son and I single handedly kept his mom/my wife out of the mental health system by giving her 24/7 coverage for 5 years when all hell broke loose as we started our healing journey together. 7 years later I still do all kinds of things to help and support her. I have always had her 100% full recovery in mind and work every day toward that goal doing ‘whatever it takes’ to see all the trauma and dissociation healed and reintegrated into her personal narrative.

    There is a small band of us on the frontlines despite the lack of affirmation here and elsewhere. I hope some day that changes and what we have learned and accomplished is recognized as integral to the fight against the dehumanization of those who have suffered mental health trauma/distress.
    Sam

    • Thank you for your comment. Although I’ve worked with many families individually as part of my clinical work, it’s been a persistent deficit of mine that I have had limited recovery advocacy collaboration with families and significant others. I’d be interested in learning about, and especially connecting with, families and significant others who have been heavily advocating for recovery as an alternative to illness-centered medical model approaches. Do you have anyone you’d recommend?
      Mark Ragins

      • Mark,
        I wish I could give you a ‘big name.’ I started a blog 10 years ago geared toward SO’s and families and to teach them how to be involved in the healing(recovery) journey. My wife and I gravitated toward attachment concepts as the best means to hold all of us (including our now adult son) together as we walk thru the various issues created by her extreme childhood trauma and dissociation. Though we haven’t ‘arrived’, she has recovered to the point she tells me she just doesn’t fit in most survivor/trauma boards online.

        But the blog never gained the traction I had hoped for though I met others doing similar things. My best guess is that those of us who are doing this are so involved we just don’t have much time for anything else. And I’m unaware of anyone else advocating for this, but I can’t believe I’m the only one.

        Personally, I wish I could team up with Open Dialogue, but there’s no one in Ohio who does that and so we largely continue to walk on our own, outside the mental health system.
        Sam

      • Don;t know if you are interested in the history, but I found a reading of Anton Boisen had merit. He would realize a drawing that also some context for family,. The electrics now of how people connect or not, can be part of the issue around social-technical systems. What does that mean with regards to “family”? and ability to sense some expressions of shared identity?

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