The Social-Emotional Distress Field, or How I Divorced “Mental Health”

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For two and a half years, until last April, I worked as an occupational therapist in two public mental health inpatient units in Melbourne, Australia.

During my work, I experienced a devastating process of disillusioning and moral injury, witnessing the mental health field’s harmful behaviours towards our clients. This experience brought me to the edge of madness, as well as many physical illnesses.

At this crisis point, I realised that resigning from my job was not enough. I needed to divorce from the Mental Health field as a whole.

Inspired by testimony therapy, I decided to write a document combining a divorce declaration (following the traditional Jewish divorce format) with a rationale for my divorce, a testimony of what I witnessed at work and my commitment to a better alternative.

A woman looks to the side in distress, while holding a wedding band and a pen to sign divorce documents

The personal is political
—Anonymous

And if you should desist from deceiving
And if you should confess to the crime
It won’t be enough these days to say sorry,
Sorry won’t save you this time.
—Karine Polwart, “Sorry”

…because he always wanted to be different from what he was, but he didn’t want to change
—Michael Ende, The Neverending Story

Occupational therapists may be among the last to give up hope for effective treatment
—Lorna Jean King

On the 25th of May, 2023; on the 5th day of the Jewish Moon of Sivan, year 5783; the evening of the Shavuot holiday—the Day of Script Giving,

In the Melbourne metropolis, AKA Naarm, on the land of the Wurundjeri people of the Kulin nation, sitting on the Yarra River,

I, Tamar Ben-Barak, Daughter of Zilla and Jacob, also known by the nicknames Ima, Tamari, Tamaroola, Timie, Tehini&Honey, Gooli, Mip, Doobah and Kushkush,

Initiated by my own will, with no pressure or coercion,

I hereby divorce, dismiss and discharge the Mental Health field from being my professional partner, and declare it disqualified for marriage: an unsuitable partner, disrecommended to any faithful professional who wishes to work with people experiencing emotional distress.

Just like many of my divorced girlfriends, I found this partner too toxic for me, and too abusive for my moral, ethical and professional stance.

I base this declaration on my observations of the Mental Health field as a developmental OT who worked in two Mental Health Inpatient Units, on certain familiarity with the Field’s research literature and academic libraries, on my personal experience as a trauma survivor, and the many conversations, lectures and testimonies of Psychiatric Survivors I was exposed to.

I suggest that the Mental Health field is an unsuitable partner for the following reasons:

1. The term “mental illness” does not fit for purpose. It doesn’t reflect the social-emotional and developmental etiology of extreme emotional distress. Many psychiatric diagnoses have poor validity and reliability. Furthermore, often they poorly reflect the person’s understanding of themselves, and offer little practical support to recipients.

(Note: some psychiatric diagnoses can be beneficial for certain people, depending on the person’s choice, circumstances and the person-centred features of the diagnostic process)

2. Currently, the Mental Health field seems to be dominated by a biomedical approach. Hence, it has limited ability to expand its view to include social-emotional and developmental processes in its core framework and baseline practices. There are a few different forces that maintain this and a big question mark about the nature and availability of the counter-forces needed to change it.

3. But even more so, the Mental Health field has a rich, prolonged history of professional aggression, cruel practices, disrespect, un-listening and trauma induction towards its recipients.

4. This history, and the continuation of these elements in current practices, have not been well-processed by the Field.

Mental Health professionals are not given systemic, adequate opportunity to reflect on this past-present continuum. They are not encouraged to process the emotional and intellectual themes of trauma, shame, guilt and responsibility encompassed in it. Hence, as a cohort, we cannot fully recover from past and present traumata inflicted on our clients by our professional ancestors, our colleagues—and ourselves.

5. This unprocessed guilt and shame, combined with the common change-resistant pattern of human institutions (medical institutes in particular), often leads to highly defensive responses, including further aggression, trauma denial and victim-blaming.

6. The concept of “insight” plays a significant role here: while it is recognised in some professional guidelines that insight is patchy by nature, the widespread norm is to identify people in distress as having either “good insight” or “poor insight”, and use it as a blanket term to describe the person as a whole. Thus, as soon as someone is identified as having “poor insight” in some respect, ALL their reflections about themselves, their needs and their healthcare are likely to be dismissed and ignored.

This pattern perpetuates the widespread stigma against people in extreme emotional distress.

7. As a result of trauma-induced interventions (together with treatments’ physiological properties), many psychiatric interventions and Mental Health services are directly and indirectly responsible for increased morbidity and mortality among their recipients. However, these are not well captured by research. For example, the prevalence of service-induced PTSD and suicidality and their main driving factors are yet unknown.

This stands in contrast to other areas of healthcare. For example, it is fairly easy to discover the rate of post-surgery infections (usually 2-7%, with up to 13% for urinary procedures, if you care to know) and the main healthcare workers’ behaviours that drive them. There is also evidence about post-traumatic features emerging from medical interventions (14-28% in children post-surgery, 50% following ICU admission). But psychiatry still didn’t internalise the tight correlation and likely causation between traumata and “mental illnesses”, and doesn’t take full responsibility for its actions.

8. Mental health professionals are not properly taught about trauma. In addition, many training programs over-emphasise “severe mental illnesses”, and under-cover anxiety and post-traumatic stress.

As a result, when assessing their clients, many mental health practitioners have a bias towards psychotic symptoms and away from post-traumatic features. Severe flashbacks, founded fears or defensive responses to intimidating interactions might easily be misinterpreted as “psychotic”. That can lead to escalation, wrong interventions, over-medication and unnecessary (and damaging) use of force.

9. Hence, the many good-hearted health professionals who wish to work well with people in distress are repeatedly failed by the field.

Many entre the field as new graduates. They follow their seniors’ lead and adopt inadequate norms and beliefs that hamper their ability to see the harm done in the name of treatment. Many others recognise this wrongness and try to work against it. I was one of them, and had many such good colleagues in my team. But over and over again, while creating small impacts in some situations, we rarely managed to impact the norm, change practices or influence the culture. The tide was way too strong.

10. All these features are not attributed to a single service, system or professional discipline: they stem from the Mental Health field itself. They are maintained by textbooks, libraries, university curriculums, widespread clinical norms, research priorities and research methodologies. Varied between different countries, this is still an international trend.

    • But don’t fret, there is hope around the corner 🙂
Engagement Declaration

While divorcing the Mental Health field, I am still committed to serving its recipients.

Hence, I hereby declare my engagement with the emerging field of Social-Emotional Distress.

By Social-Emotional Distress field, I mean the many initiations (many of them Lived Experienced-led), aimed to provide alternatives to Mental Health thinking and practices.

This includes (but is not limited to):

Clarifications

I am aware that the Social-Emotional Distress field has not been formally defined as such.

But I believe that there is a strong common thread between the frameworks and initiations mentioned above: prioritizing people’s experiences and opinions about themselves, and seeing their internal distress in the ultimate context of inter-personal and external forces.
I believe that grouping all of us under this conceptual umbrella is both theoretically valid and can be practical and beneficial for our cause.

I am also aware that many professionals who support and advocate for the Social-Emotional Distress viewpoint identify themselves as mental health practitioners. Some of them are deeply committed to working within the current mental health structures. This stance is to be respected.

Yet, I believe that the Social-Emotional Distress principles are fundamentally different to the core theories, frameworks and practices of the Mental Health field.

I also believe that a real integration of the Social-Emotional Distress frameworks in the Mental Health field is not feasible, due to the sharp contrast between the two. More often than not, integration attempts would lead to tokenism, superficial language change, add-on duties that add to the professionals’ workload while not challenging or omitting conflicting actions (hence are prone to failure), and ongoing attempts to employ many Social-Emotional agents in the Mental Health institutions, keep them busy under the Field’s constraints, distract them from sensitive issues and prevent them from creating real impact. As has been visibly done so far.

For me, there is no real hope in such “integration” or “evolution”. I agree with the voices who say that the mental health system is “broken beyond repair”: this system is built upon a rotten field’s foundations. When building your house on quicksand, surely it is bound to crack.

Hence, I choose to see the initiations above as forming a valid, respectable field in the making.

I choose to identify myself with this field and differentiate myself from the Mental Health field.

I choose to believe that these two fields are incompatible.

And for the next four or five years, I choose to team up with others who work in this space, and together help this potential field to be established.

I choose to hope that with time and effort, this field would prove itself trustworthy, reliable and cost-effective in responding to people’s distress, and—big hope!—will eventually replace and dominate Mental Health-based services.

On the practical level, I choose to avoid working in “mental health”, until I find a designated Social-Emotional Distress service—or create one as an independent practitioner.

NOTE: According to the traditional Jewish law, a couple who has been divorced is not allowed to be in Yihud, which means “intimate seclusion”. That is, the former husband and wife should not live in the same living complex, and should not be together in a defined space with no other people to witness them.

Hence, I shall choose to operate in organisations that are tuned to Social-Emotional Distress thinking. When engaging with Mental Health agents, I will use my language smartly to avoid upfront conflict while upholding my values and affiliation. I will also connect to like-minded colleagues to avoid “mutual seclusion” with Mental Health agents. It might be tricky, but I will try it and see if it works.

Personal Note

I am a woman of strong emotions and even stronger attachment patterns. It is not always convenient, but this is the Tamar I need to live with. I cannot be someone else.
Regardless of how it eventuated, I accept that my professional identity is a significant part of my personality, and that professional belonging is highly important to me.
Hence, the Social-Emotional Distress field is where, for the time being, I want to belong.
Tamar's signature

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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.

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18 COMMENTS

  1. Wow! Very powerful, very comprehensive explanation greatly appreciated. I agree completely, dropped out decades ago due partially for health reasons but also extreme discomfort with what I was being taught in the field. As an observer ever since, am convinced the medical (pharmaceutical) model cannot be “fixed” from within. Good luck to you on your journey.

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  2. Thank- you. Such a creative, beautifully written piece.

    Thank you for calling normal reactions to abnormal events, distress and not an illness.

    And thank you for divorcing the system that is so very cruel to its victims- that took courage, and even more strength to call it out.

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  3. It’s a very moving set of acts.

    I could not agree more with the decision, aware it must be painfull in several ways*.

    I do feel, however, the points are somewhat lacking. It sounds to me like people who can’t see what they are doing in terms of harm and immorality are somewhat devoid of responsability for choices of whom to become. Like they were dough, pliable to the teachings, demands, requirements set forth by the system and it’s enablers. As Adults!, nonetheless…

    That holds historical parallels: I did what I was taught and told. Without personal responsability, asuming some sort of moral blindness inherent in all of us. Which is partially true, but many of these practitioners are not only professionals, but presuposed to have a stronger moral fiber, a deeper sense and understanding of ethics, pain and sorrow. A stronger compasion driving them to alleviate the suffering of others…

    In the mental health field that probably is false. Many of those practitioners choose such field precisely because it plays their tune… that’s my opinion, of course.

    * I retired early of medicine, among others, because it can’t repair it’s damages. It has had little impact in increasing survival, it employs more and more irrational treatments/diagnostic tests that are “approved” with mere empiricism of the deceitful kind, even later proved more harmfull than doing nothing. Has not addressed it’s overoptimistic rhetoric of efficacy, while minimizing it’s complications, again and again. In my country, individuals with authority are no different that the average “psychopath test” maybe yes, maybe no, positive. And it is sickening, diagnosing more people diseased, without any evidence, and despite contrary to it, that it can benefit other than practitioners and the industries supporting such diagnostic and treatment expansion. Among others.

    And most physicians are ok with all of that. Despite I was more or less secluded from much of those problems. Just my participation looked to me like an endorsement, sort of part of the racket, so I quitted. I don’t regret it frankly, if I wanted to help people with medicine I probably would have collaborated with computers, even robots doing medical care, I tried, but familial violence prevented me from going that path. But for me it was a process that took almost a decade, eventhough the problems were there from the start as a med student.

    ***
    I wish you the best, I had a long process, so I imagine how it most feel. I quitted doing science more than a decade before medicine, so I am a double quitter!, that didn’t take that long, a mere short stay at a top “scientific” insitution, and the offer to be in another, no more than 4-5yrs evolution. Different reasons, same problems, sort of thing 🙂

    Now I am trying to do what I did best since childhood, but I am physicially ill. Haven’t quited on that yet!, but it’s slow going, like a sloth. 🙂

    Again, I hope you get the best out of everything, I really do. Without prognosticating, obligating nor inducing: someone else might benefit if you do get the best out of everything. That is rare…

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    • You raised a good point here.
      I agree that we should hold adult people responsible for their actions.
      But we need to understand how so many people who DO have good intentions, who came to the field to express these good intentions, end up participating in harmful actions – or at least, don’t protest about it as loudly as I think they should.

      In my opinion, learning is powerful, and social norms are even more so.
      Also, I know from my own experience how hard and gut-wrecking it is to face harm done in the name of treatment. I was there. I had to go through it myself. and then, one day, when I sat with one of our young psychiatrists, explaining to him the basic dynamics of working with people who’d experienced interpersonal trauma, and more so people who experienced psychiatric trauma – facing this hard truth brought him close to tears.

      And how, when speculating with another team member what would we find out if we applied the Mental State Examination on the generic mental health professional – not any individual, but us as a cohort, what would that tell us about our insight and judgement, average attention span and collective memory. She raised her hands to her ears and said “I don’t want to think about it”.

      My intention in this article was to speak as much challenging truth as I could while creating as minimal defensive responses as possible.

      I wished to enable at least some mental health practitioners to read this article to the end, without feeling personally attacked, in the hope of engaging with their frustration (which I know exists), their sense of our practices’ wrongness, and their good intentions. In hope to prompt them into a higher level of critical thought, and hopefully into further action.

      In other words, I wanted to achieve the best outcome possible with minimal adverse effects.

      Pushing people into hostility, deepening the “us” and “them” divide that already exists, is not useful and far from desirable. This is not my cause.

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    • Thank you. The more, the merrier 🙂

      I believe that people who work in the system need more networking and a fair bit of ethical and strategic support. I would have benefitted, for example, from someone who’d remind me to lodge more incident reports, and from teaming up with other team members to coordinate a firm response in certain cases.

      Despite what the system tries to sell us, We won’t be able to “make a difference” as individual practitioners working in this field.
      We could do it only if we team up and organise well, join one another, and support psychiatric survivors’ campaigns while accepting their leadership.

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      • I thank YOU for challenging the Status Quo — which usually requires a network of dedicated people like yourself working together to make lasting change — and goodness knows there’s safety in numbers.

        Your courage is something I deeply admire 🙂

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  4. I have already said my piece about agreement, best wishes and where I come from.

    Here at MIA I have admitted some of my wrong doings and beliefs of psychiatry.

    However, I think it’s important to be aware WE cannot make excuses for other people.

    We cannot asume there are “good” people working for or within psychiatry.

    They have to explain themselves. We cannot do that for them.

    Wrongdoers, even good doers, within psychiatry and clinical psychology can not be justified because of conditions, the work, demands or “needs” of clients or their harmers. No one can invoke the “system” to explain their actions without explaining their actions. That’s a “the devil made me do it” fallacy*.

    THEY have to do that, they have to explain themselves, their choices and actions.

    As a perverse human rights lawyer who sided with my victimizers told me: They have to explain what they did to you, not you. Aware he was conceling his own wrong doings.

    Sounds off topic, but people critical of psychiatry and clinical psychology who trained and work in those fields have to explain themselves too.

    If for nothing else, because it will potentialy prevent harm for patients/clients and future trainees.

    And, as far as I know, they have not done that. Claiming the “try” to do better without explaining themselves is repeating the racket to me, in a different guise, a different form, but still concealed.

    * When people use that defense/excuse there is a simple defeat strategy: Explain to me how the devil made you do it. I know, he?, is too clever, just tell me explicitly how he did it…

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    • I appreciate you coming again for more feedback.
      Please see my comment to your first comment.

      In addition:
      You said ‘We cannot assume there are “good” people working for or within psychiatry’.

      Unfortunately, this is our reality and can happen in many situations, not just in mental healthcare.

      We can see it in children who join the bullying of another child while despising themselves for their violent acts.
      We saw it in the Milgram experiment.
      I saw it many times at work.

      And I think about the vital difference between making excuses and understanding causes.

      Making excuses is wrong because it justifies and maintains the status quo.
      Understanding causes and forces that influence people is imperative to developing the right action and achieving change.

      I am in for effective change, not for endless attacks and counter-attacks.

      These days I am developing a workshop that would explore the alternative, the Social-Emotional Disctrees field as I see it. I want to gather more responses and opinions from other people and help further develop this alternative.
      The more this alternative is established, the easier it will be, I hope, to challenge the wrong practices in mental healthcare and demand we put an end to them, and the less tolerant we’ll be of clinical incarceration, coercion, disrespect and the heartbreaking phenomenon of medical rape.

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  5. Thank you so much for this incredibly moving, powerful, and fierce testimony and commitment to action.
    I resonate so deeply with everything that you wrote.
    I am extremely grateful to you for articulating this, for taking action, and for sharing your process, which, I hope and trust, will help further galvanize the needed mass change in paradigm and practice.
    Thank you, thank you, thank you.

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  6. Psychiatrists and the field Psychiatry as well as psychologists, PA’s, NP’s, OT’s are part of the medical industrial complex which is a business based on misery that is – exploiting the misery of others and sadly exacerbating people’s misfortune and misery for endless profit till the bitter end of life. The goal is “treatment” of the “consumer/patient” only in methods and ways that generate profit and jobs for the industry. Labeling/diagnosing, coding and drugging/therapies are the solution to everything. Endless treatment with all the hundreds of toxic psychotropic drug compounds and with the now 700+ different psychological/psychotherapeutic modalities including the newer “confessional/witness therapy”. Long term outcomes don’t matter at all. If they were compensated based outcomes they would be out of business.

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  7. Human suffering is so complicated when it is emotional. It is so much clearer how to help people when they are hungry or cold or need shelter or medical treatment. When people suffer emotionally you will encounter some well meaning therapists who entered the field due to their own emotional issues, whether it is trauma or neglect. So this business of helping others emotionally is fraught with the jumble of emotions between therapist and client. The more injured the therapist, the more those issues get triggered by the client’s issues. The therapist’s response can vary from ineffective to damaging. There has been a trend over many years for Universities to give preference to those applying to become therapists to those who have relevant emotional injuries. The consequences are more therapists with unresolved issues. Meanwhile the numbers of people who need a compassionate intelligent well trained therapist continue to increase. So most people cannot find a therapist or cannot afford one. A partial solution is for people to do their own work. The mental health field is only beginning to discover the usefulness of the REM brain state. ………………………………………………………………………………………………………………..
    In an article by Carolyn Todd in the NYT Dr. Dasgupta was quoted, “REM is critical to our emotional health and brain function – and even potentially our longevity”. Matthew Walker, professor of neuroscience was quoted, “If you’ve ever gone to bed upset about something and woken up noticeably less bothered, its likely a result of the emotional processing and memory reconsolidation that happens during REM. There’s evidence that your brain divorces memories from their emotional charge – removing the sharp, painful edges from life’s difficulties. REM is like a form of overnight therapy”. For the first time in history, humans can benefit from being awake during the REM healing process.
    You can do this at home with Se-REM.com.

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  8. Your article is meaningful, and true as well. I hope you will be brave and recognize that you are at a point of insight, and disturbance, in your life, and that you will continue with the courage to follow where you now want to go. I like best the idea of treating social-emotional distress, and dropping the “mental illness” designation for depression and anxiety. Surely when I think of young doctors, who are in a sea of potential social and emotional distress, I feel enthusiastic about this idea for their therapist helpers.

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