Btw, hospitalized multiple times in a single year? Not saying I agree with that, but please note that the proposed IOC legislation in MA proposes at least TWO hospitalizations over the course of THREE years. What low bar hell is that?
The problem here is that often you’re comparing “AOT” vs. NOTHING. How about “AOT” versus actual quality support? Preferably before people are decimated by the “helping” systems?
The idea that “most” people put on IOC orders are “grateful” for it in the end is pure fantasy. It’s based on hugely flawed “research” of a tiny sample size from one state. I’ve been living this work for decades and its just wildly untrue.
However, you note something very important in your comment that makes what you describe happened to you not fundamentally discriminatory in the way that “Assisted Outpatient Treatment” typically is. Specifically, you name that is that you were legally involved and ordered to get treatment by the courts. This is already something that can and does happen (ie., judges ordering treatment) with some regularity after someone has something that has criminal implications.
While I don’t endorse the actions of the courts in this regard as it is full of its own problems, that is a different conversation. The bottom line is that there is an enormous difference between the legal system ordering use of force and coercion for *all* people who are legally involved versus the court *only* ordering the use of force and coercion for people with psychiatric diagnoses in spite of lack of legal involvement.
Involuntary Outpatient Commitment laws allow for highly discriminatory use of force and coercion based on extraordinarily subjective terms, commonly without any legal involvement at all. In order to earn an IOC order under the currently proposed IOC bill in Massachusetts one could do as little as having been hospitalized twice in the last three years, or having made a threat of suicide once in the last three years. The bar is extraordinarily low and discriminatory.
I’m sorry my ‘magic solution’ comment landed that way for you. I agree with you that adopting systems language isn’t helpful, and can often be harmful. I don’t think of it as systems language – at least not language I’ve heard from the system – but I hear you that that’s what it taps into for you.
For me, why I was trying to get at was this idea – from both the system and within our communities largely out of desperation – we shuffle people around as if some geographical land will have all the pieces to make a change in someone’s life… But the bottom line is that our entire system is a problem and no under funded, under resourced place with tons less power than these systems is likely to be able to make all the difference… It was less a comment *at* you then in response to you but at the systems that do all the shuffling as if that will ever solve anything at all if their main push continues to be sustaining those systems.
Anyway, like I said, I’m sorry my comment brought up those brush offs for you.
Your comments are not relevant here. You are attempting to use my pieces here as a way to get at me over a completely unrelated issue. I ask that you stop.
I don’t think anyone is arguing that privilege didn’t play a role here. I’m white. I was able to pull out some easy proof that I do the job I claimed I do. I know the system well enough to think quick and come up with something to say that was protective. I know attorneys I could check in with to see how much trouble I could get myself in by writing this piece. Sure. None of it is 100% protective, but it made a difference.
Pretty sure I already addressed these points above, but let’s try again:
1. I do regret my 11-year-old getting distressed. That wasn’t the intent. I didn’t call from home. I called from work when I was not with my child. That the police went to my home nearly two hours later was actually rather unexpected. That said, my child was just fine – not at all traumatized – once they were clear that the police weren’t there for them and everything was okay.
2. I’m not trying to ‘trap’ #988. I’m letting them demonstrate exactly who they are.
3. Researching #988 so I can share the results with my community and help people make informed decisions about whether or not they want to call isn’t a waste.
4. You better believe I’m going to protect myself if the police inappropriately show up at my door. Did you know that police are legally allowed to lie to you? I’m not going to feel bad about giving that right back when it comes down to protecting myself.
5. Ultimately, it is #988 who wasted police time, not me!
Oh gosh, I’m really sorry I said ‘Laura’ instead of ‘Lauren.’ I’m not sure where that came from. I hate getting people’s names wrong, as I know it feels crappy. Apologies for that!
You remind me of how many times I’ve talked with people about how weird this assumption is that therapy is universally, uniformly helpful. Yet so many folks assume denial, or just not having found the ‘right’ therapist, or whatever else if someone says therapy isn’t a help.
Some of the problem starts with nonsense like that, and then gets closer and closer to force as it rolls on forward.
Ehhhh, I somewhat agree that Secret Shopping can get problematic, but my secret shopping #988 (or anywhere, really) to see if they are helping v. harming is worlds apart from their secretly sending cops to my door. 🙂
Thanks, Laura! You remind me that I was just talking with someone earlier today about the importance of ‘responsibility to’ rather than ‘responsibility for’ which you reminded me of here as well 🙂
That makes sense, Nicole. The problem runs so much deeper than the police/involuntary response, unfortunately, so we’re a long way off from better I’m afraid.
Wildflower (where I work) has shared a list of some lines that are worth knowing about in our last couple of newsletters: https://madmimi.com/s/1dfa971
Thanks, Bill! I appreciate the recognition you offer of how much work it can be just to exist in this society, and how the current dominant societal interpretation of unemployment often fails to represent the layers of societal dysfunction and mis-prioritization of so many aspects of life.
Agreed, though it’s sort of typical of our society to come up with an answer that appears good on the surface but ultimately has risk of real harm and then promote it everywhere to ‘appear to be doing something’!
It wasn’t exactly surprising… Though on some level it still was for no good reason at all. And yes, I also regretted it for my 11-year-old’s sake. (They got over it quite quickly once they realized it had nothing to do with them, tho!)
Regardless, it feels important to do this work. Saying we believe something is dangerous from past experience isn’t the same as having concrete proof. It’s just not.
I’m going to be taking this article to a conference where all kinds of Vibrant folks will be present next week… If nothing else, it’ll be a bit gratifying to irritate them with it… But I do think there’s LOTS of people out there who just don’t get how dangerous this stuff is who might be open to hearing it and maybe not calling on their family member or what have you…
Oh, yeah, that AI stuff is *TERRIFYING* … They’re idea of ‘saving lives’ is unfortunately commonly limited to only “keeping you alive as long as I can see you.”
I so wish the UN and WHO held more weight when they make statements or produce guidance! My workplace has actually been mentioned in two different guidance documents from WHO and the UN, yet here we are. They aren’t listening! In fact, they seem to just think the problem is there’s not enough of the same old stuff.
Thanks so much for saying this, Derek. I’m feeling pretty baffled by Robert’s appearing to claim the importance of peer respite and preserving it while also appearing to suggest we need to compromise our values to preserve it… which really isn’t preserving it at all.
But more than anything, I was stunned into some degree of paralysis at the comparison with John Herold. As a survivor of rape and sexual abuse – and as someone who knows people that were harmed directly by John – I am extremely unsettled by this.
I was trying to come up with a response when I noticed you’d already made one. Thanks for that!
That said, I’m sorry that the piece Ira wrote here and the work of the Stabbin Wagon team has been taken over by all this. I know all too well how a messy comments section can overshadow something important. I hope people are still reading the piece itself and disregarding most of this.
I’m sorry I didn’t see this when you first wrote! I wish I could say that something being peer support made it magically somehow immune from any ugliness, bias, etc.. But of course, that’s just not the way it goes.
I also worry about when people move to a particular place for a singular resource, because nothing is as magical close up up as it may seem at a distance. Sometimes it absolutely works, and sometimes people just find themselves uprooted from all that’s familiar and still not quite finding what they want.
It’s so hard. Whether you and your son move or stay where you are, I hope you find the connection you’re both seeking!
We do have some virtual family groups if you’re interested (though they’re focused more on hearing voices and related experiences) if you might be interested. Feel free to e-mail me if you are. 🙂
(Just to clarify, when I say “we” above… I’m talking about Wildflower Alliance where I serve as Director. I actually write independently and not as an employee of anyone, but my writing is deeply informed by my work so it would be disingenuous to say they are entirely separate. I do also sometimes try to help with some of the training stuff when its piling up… I’ve been helping with Australia, Maryland, and Pennsylvania contracts recently. But I have to intentionally steer clear of most of it and leave it to our direct or of training and admin manager or I’d drown so I do so happily! Just wanted to clarify the “we” part!)
There’s a key difference here re: the ‘conflict of interest’ you’re referencing. Lund has repeatedly quoted Kevin across several articles without citing his relationship that was clearly known to Lund. It’s also an issue that’s more that goes to more than just naming the relationship. To sit on the advisory board and be such a sole source (at least from what I saw) itself is a problem, too. It begins to look tokenizing when one person is repeatedly used to represent the voice of a marginalized group. I’m concerned that Lund doesn’t appear to better understand that point given their mission and values.
Re: my so-called ‘conflict of interest’: I have no issue with it being named here. HOWEVER, it’s important to note that I was not aware of that ‘relationship’ until folks at Mad in America were notified about it. The letter was signed by our Director of Training, and amounts to promise of a 24 hour training for which they would pay $7400, most of which would be eaten up by doing the training itself.
While perhaps some would think I “would or should” know about that, we have an entire training arm that is facilitating trainings everywhere from Australia to California to Maryland and so on. Additionally, about 75% of people who ask us to say we’ll offer a training if they can get funding for it don’t end up getting the funding, and the training isn’t offered. So, I guess we can call that a ‘conflict of interest,’ but given I wasn’t aware of it at the time I wrote this piece, I think it’s not an accurate comparison at all.
I think you are still missing the point of what I’m saying regarding both Lund and Kevin, and both are somewhat different points. My point re: not speaking publicly about concerns is specifically for Kevin, not Lund. From an anti-oppression perspective, to have someone internal to a movement speaking to the *media* about their concerns is a HUGE problem. It’s not about keeping secrets. It’s about not giving a whole media system that has scapegoated, stigmatized, discriminated against, and painted our entire community as dangerous villains, incompetent, and so on unnecessary ammo. There are other ways to address those concerns than giving a public that already has such a skewed view of who we are unnecessary fodder to further stereotypes.
I am aware of your more recent coverage of Stabbin Wagon which is good. I continue to feel that your organization lacks some of the fundamental understanding of dynamics related to systemic oppression that would better inform how you approach some of these issues. I continue to maintain that – much like the Boston Globe – you’ve spent too much time villainizing folks who are multiply marginalized without putting it in the proper context of systemic oppression.
In that way, I continue to maintain that you failed. That doesn’t mean you have to keep failing.
I’m not sure how you are comparing Laysha’s work to others. Laysha doesn’t claim to be doing peer support. She’s a researcher. If she suddenly claimed to be doing peer support, that would in fact be a problem. She still gets to claim her psychiatric history and the value of people with psych histories being in charge of the research, but it’s worlds apart from claiming she’s doing peer support.
I don’t know anything about the org or person you’re defending, but what I do know is this: Even if one group can somehow magically overcome the fact that they’re really not a peer support org and do something fabulous with peer respite, it opens up the door for allllllllll the other orgs around the country that aren’t looking to do the work as carefully and are just looking for an excuse to basically justify being a clinical org that is co-opting peer support… Given that, I’m just not sure its worth debating whether or not a single org can overcome the fact that it’s a clinical org (albeit one by folks who have psychiatric and other relevant histories) to offer peer support with true fidelity to the model. There’s a bigger picture issue here…
As to Kevin et al, Honestly, I’ve heard far, far more feedback suggesting I’m right to question why this path was chosen – including other examples of concerns etc – then I’ve heard your perspective. I think it’s a complicated situation, but I continue to think it was unacceptable to air ‘dirty laundry’ in a media forum of that nature!
I know I’m not answering all that you raised… I’m a bit out of time at the moment! Thanks again for all the context you are offering!
We talk about this point in our Alternatives to Suicide trainings. To illustrate the ‘why,’ I like to quote Joseph Franklin:
Joseph Franklin, a psychologist working and teaching at Harvard University was quoted as follows:
Quote#1:
“Our analyses showed that science could only predict future suicidal thoughts and behaviors about as well as random guessing. In other words, a suicide expert who conducted an in-depth assessment of risk factors would predict a patient’s future suicidal thoughts and behaviors with the same degree of accuracy as someone with no knowledge of the patient who predicted based on a coin flip…This was extremely humbling — after decades of research, science had produced no meaningful advances in suicide prediction.” (American Psychological Association, 2016)
Quote #2, Same article, next paragraph:
“As most of these guidelines were produced by expert consensus, there is reason to believe that they may be useful and effective.” (American Psychological Association, 2016)
In other words, Joseph contradicted himself, and basically said ‘we know these things don’t work, but do them anyway because important people said they were good.’
It’s a similar phenomenon to what you’re referencing… Because it’s easier, because people in power said so, because people are overwhelmed with what it would take to truly do things differently… Just do it the same and pretend its right.
Not sure what you mean. There’s nothing wrong with turning to the media to advocate for funds, etc. There is, however, something deeply wrong with turning to the media as a member of a marginalized group to become complicit in further marginalizing other members of that group.
I just don’t think there’s any excuse for it. It doesn’t actually solve the problem, and certainly contributes to those in power gaining more ammo while members of our community lose credibility. It’s harmful.
The differences are pretty vast. Clubhouses can look substantially different from one another, but overall, they are about the “work ordered day,” do not have an overnight component, and are not centered around peer support. Most people who visit most clubhouses will find that there are different ‘units’ they can volunteer and work in, assistance finding jobs, as well as social components. They are not the same as day programs, but are much closer to day programs than they are to peer respites. Although some Clubhouses have a real ‘peer support’ component, most employees of Clubhouses are not required to have psychiatric histories or similar.
Peer respites, on the other hand, operate largely as alternatives to staying on an inpatient psychiatric unit or other more restrictive environment. Stays at peer respites range from a few nights to up to a couple of weeks depending on the respite and its particular way of operating. In order to qualify as a peer respite, all employees working at the respite must identify as having a psychiatric history or similar life-disrupting challenge that they’ve navigated. Although this can vary a bit, most peer respites focus on creating options for how to spend one’s day but are very much not highly structured or organized around work, etc.
Thanks, Mary. Power and money are certainly both big issue, you’re right about that! Unfortunately, one of the massive downsides of peer support is that when so many psychiatric survivors started taking system-funded jobs, they stopped approaching things with so much fight because their livelihoods became dependent on the systems they were trying to change because those systems employ them. It also encourages some folks to get deep into self-promotion over collective and community goals and voices, and is very related to at least some of the ‘in-fighting’ you reference. I wish it were easier to unpack all that and make it be different!
Thanks so much, Beavers. Like a previous poster, your comment affirms my overall impression of Stabbin Wagon. I wish all clinical mental health folks recognized the problems with that system in the way that you do, but I’m glad that you’re there to help shed light on it!
I don’t think we’re going to get very far here. I would agree with the State that Bay Area is not peer-run. We seem to be operating on very different definitions of ‘peer.’
I understand (I think?) that you are saying they are ‘peer run’ because the org is run by people who have struggled with related issues themself. I believe that to be an extremely problematic definition of ‘peer’ that turns it into an ‘identity’ that is synonymous with consumer, client, patient/ex-patient and so on.
On the contrary, I understand ‘peer’ to be about a way of working and being with one another that is rooted in common experiences, yes, but *ALSO* in minimizing power imbalances, not ‘fixing’, and so on.
‘Peer’ as an identity is a part of what is co-opting our work. It’s allowing people in peer roles to be pushed into doing whatever the systems want them to do because it’s simply about that role and not the way the work is done. No ‘peer’ can stand alone so there can’t ever be ‘a peer’ because ‘peer’ only exists in relationship with someone else.
What it sounds to me from what I’ve seen on their website is that Bay Area is deeply rooted in employing only people in *clinical roles* that have relevant personal histories and are willing to disclose them and use the wisdom they’ve gained in their *clinical work*. By their own report, they’re doing assessments, using cognitive behavioral approaches. They use ‘client’ language, etc. etc. etc.
That’s not peer-run, and I think we’re pretty doomed if we allow that to become the definition. (Honestly, I think we’re pretty doomed anyway for a number of reasons, but I’m not going to stop fighting to maintain as much integrity as I can…)
I *DO* think there is great value in clinical services as provided by folks with their own histories and willingness to disclose. It’s not about them being bad.
But it doesn’t make them peer run because they’re doing *clinical* work. I would have ruled them out, too.
I hear you that there are legitimate concerns in some instances. I don’t agree with how Kevin handled it at all, and I don’t agree with knocking these orgs down in any public way especially until effort has been made to really build them up and give them a fighting chance.
There are certainly things you’ll know far more about than I. However, in looking at the websites of the places you mentioned, only one (Miracle Club) appears to be led largely by non-white folks. Perhaps they would have been a great choice, I don’t know anything about them, although their website looks entirely substance focused and that isn’t always a great mix because the 12-step world is a very different sort of peer support than what the peer respite world offers! (This isn’t a universally impossible melding, but even ‘Recovery Coaching’ training tends to be awful and oppressive on issues related to suicide, etc so it would certainly be a question for me.) The issues that show up in conflict between the world of recovery from problems with substances to the peer support world related to suicide, voices, etc actually tends to not be of issue when it comes to orgs focused deeply on harm reduction around substances because harm reduction (when done right) is inherently rooted in liberation, self-determination, etc. must like good peer support at a peer respite is…
Additionally, I think Bay Area First Step would have been *hugely* problematic. I realize they’re saying they’re ‘peer-led’ but it is a version of ‘peer-led’ that is not consistent with peer respite as their identity appears to be largely clinical and they explicitly state that they provide clinical services, refer to people as ‘clients,’ etc. That doesn’t make them inherently bad, but you can’t both be a ‘peer-run’ organization and so definitively clinical, at least not by the definition of ‘peer-run’ that applies here. There’s a *huge* difference between serving as a clinician who is informed by, open about, and using their own personal experience in their work and peer support… Both have value, but in order to not become problematic we need to be clear about which is happening.
All that is to say there may very well have been some other good candidates, but it’s not so simple because for sure at least one and possibly two of your suggestions wouldn’t have lined up as being good candidates.
All I can say about the rest of what you offer here is:
1. It’s a very tricky balance. We can argue against taking risks with rewards forever, but if risks are never taken and proper support given to navigate those risks, then nothing ever substantively changes and the underfunded/multiply marginalized folks are forever relegated to the fringes. But you’re also right that if funders take risks, don’t properly support them, and then let them fail that can ALSO serve to lead to a “See, we told you there wasn’t value in this approach” response that also leaves us forever on the fringes, too. I still maintain that the right decision is to take some risks and then truly support them. Oregon certainly took some risks. And I think even better, they gave one award to a much more established org *AND* chose two less established more marginalized groups which allows for some additional balance to test the approach itself… But the support has been totally lacking, and that is what I’m largely speaking to here.
2. Going to the media – the majority of which already paints people with psych histories as incompetent, dangerous, needing supervision, etc – and giving them more ammo against us will never be the right choice. That was such a problematic thing to do… One needn’t go to the media to call out concerns. Talk with the orgs, talk with local advocacy groups about how to support, whatever it needs to be… But being quoted in multiple articles criticizing and questioning the competence of a marginalized group? I can’t ever see that as acceptable, and it certainly feels very hard to justify it as anything that would ever ‘help’ the problems you are describing either.
The situation in Oregon is complicated, and I’ve never claimed – including in this piece – that there are no legitimate issues to be concerned about. The question is what do we DO about those concerns to move things forward toward liberation, anti-oppression, and the creation of valuable, true alternatives.
Regardless, thank you for weighing in here and providing additional context.
Thanks so much for this added background, Jacek. I very much appreciate it.
Unfortunately, it goes a long way toward illustrating that the difference between change and SYSTEMIC change… Whenever change is dependent on one or a few people, it can backslide sooo quickly the moment those people change (either by being fired or just leaving for any of a number of reasons of their own accord). It can be so painful and demorailzing when good change has happened, and then its not only gone but sometimes at an even worse point than before the positive change happened!
I know we’ve talked about this on social media already, but I’ll repeat a bit of what I said there here:
I agree that getting seats on advisory boards can be a win in many instances, including Kevin’s with Lund Report potentially. However, if that power is used only to be the one who is used to check the box of ‘got a quote from this group’ (as seems like might be an issue given the prevalance of articles with quotes from him and the lack of quotes from others), then is one not becoming complicit in tokenization at times? And if one isn’t striving to use this power to bring in other voices from that same group, is one not maybe missing the point of having that power in the first place?
I don’t know why things have played out the way they have with Kevin and Lund. I reached out to ask him if he’d share more about why he made the choices he made here before I wrote this piece, and he didn’t respond.
I do, however, believe it will NEVER be okay for someone from a marginalized group who gains this sort of power to use that power to then contribute to the tearing down of folks in that marginalized group in a public media forum EVEN IF there are legitimate concerns. Those legitimate concerns should be dealt with in a different way that doesn’t contribute to the media’s relentless tearing down of our work and credibility that already exists. THAT is the huge historical issue and one that acts as an enormous barrier to our progress… Filing paperwork and such is a far smaller issue and one that could be dealt with by giving support, not public criticism.
I will offer that I have been in contact both with Stabbin Wagon and Black Mental Health, and we will/would happily offer technical support. But an uncompensated organization from across the country surely isn’t the answer I’m calling for when I say robust technical support. These organizations would need to be given funding to receive such technical support in a robust way, and that includes local hands on support, too, in order to meet what I’m talking about.
Regardless thanks for your comment. I appreciate your presence in this movement and that you hold knowledge of our history including Jeanne’s work and so on.
Thanks, Vic! Yes, I so wish people had a much better understanding of what it takes to really support groups to develop and create more equity in a system that has so often been about save dollars and rush, rush, rush particularly where there’s historical marginalizations at play!
I do actually feel like I know a lot about Stabbin Wagon, though yes, I didn’t go too deeply into that here. That said, everything I do know – whether included here or not – continues to lead me to support them. Of course, I’m not sure what you’re referring to so I’ll have to leave it at that!
Can you clarify what you mean in terms of a source to use? To you mean one that talks about some of the history of peer respite?
Soteria – developed by Loren Mosher with the original based in California – was on a separate track and did/does include more of a collaboration between people including folks in clinical roles. Their values, ways of being with folks in the house, etc. are quite relatable to the peer respite model… But it’s definitely different both in intentional inclusion of clinical roles and for the fact that folks who stay there typically stay at least 6 months and its focus is on people having their first experience of distress related to things like hearing voices, seeing visions, unusual beliefs etc (note: not all people who hear voices or see visions experience distress, and even people who do experience distress from some of those experiences also often have positive experiences too, and some of the distress is rooted in how society responds to those experiences and teaches people to fear them).
There is a book on Soteria, though unfortunately right now there’s only one single Soteria program that I’m aware of that is active in the US (in Vermont). There is also a book on peer respite (that I wrote in collaboration with Intentional Peer Support and a few others from Wildflower Alliance), and a short film on peer respite that we create that speaks to the history as we knew it at the time which omits things like Jennie Fulgham’s story. Jennie is written about in Vanessa Jackson’s ‘In Our own Voice,’ and appears in the blackhistorymovement.info leaders project as well (which was founded by myself, Chacku Mathai, and Dana Smith).
In terms of seeing everyone as a ‘peer’ I get what you mean, but I think it’s dangerous. There’s layers here.
First, I don’t think it’s helpful to see ‘peer’ as an identity. It’s a relationship and a way of being with one another that is rooted both in some common experiences with one another and minimizing power imbalances, etc. I don’t see how we minimize power imbalances when one person, say, has the power to take another’s liberty and put them in a psych ward.
I also think we really need to play high value on the experience of loss of power and how hard it is to understand what losing your liberty is like and how much value there is in being supported people who get that (and often overlooked element of ‘peerness’ b y those who focus only, say, on having been diagnosed and having particular experiences of related distress).
HOWEVER, I absolutely do wish our systems and our culture placed way more value on human experiences and the sharing of them across all people regardless of their roles, as well as an emphasis on being able to learn from one another through that sharing… Perhaps that’s some of what you are getting at!
I don’t know that I can agree that Anosognosia applies broadly. That’s the argument of IOC proponents. Although that said, I did accuse E Fuller Torrey and Paul Gionfriddo of having anosognosia in another article I wrote on here. 🙂
I appreciate your highlighting the efficacy of leaving the area for those who have the resources/ability to do so! I make that point often myself. It’s an under utilized approach for sure.
Perhaps I was remiss in not including more basics about the problematic nature of IOC and its overall lack of efficacy and harms in this piece.
A handful of things:
1. I wonder where you got the idea that IOC is helpful? Too often in this society people take action – fight for a new law, establish a new policy, etc. – simply to feel they’re doing *something* to address a problem. However, all too often, the ‘something’ they end up doing to feel like they’ve done ‘something’ is more illusion than anything else, and may even be counterproductive. IOC fits in that category.
2. You note that there is a ‘mental health crisis’ in the US. Yet, 47 states and territories of the US not only have IOC, but have had IOC for quite a while. I wonder where the idea comes from that – when things keep getting worse – the answer is more of the same?
3. You refer to people being “a danger to self or others,” but in actuality there are already provisions in every single state to respond when that is the case. For example, in Massachusetts – where there is no IOC at this time (hence this piece) – there is nonetheless the Section 12 (a and b) that allows for someone to be taken in involuntarily to a facility for assessment (12a) and held for 72 hours (12b) for further observation to assess their ability to be “safely” in the community and otherwise seek further psychiatric commitment through due process if found not to be “safe.” Now, we could have a whole nother argument about how that process works and its value and efficacy, but for now, my point is that that process exists as an entirely separate thing from IOC. IOC is expressly billed as something used when people are NOT a ‘danger to self or others’. More specifically, its billed as a way to keep people from getting to the point of being a “danger to self or others” based not on what is going on right now, but on perceptions about their past and/or future risk. But:
* Does taking away power (well demonstrated to have a negative effect including increasing risk of suicide) and pushing “treatments” that are so often ineffective (as also demonstrated by research) really *keep* people from getting to that point?
* And even if that may work for a fraction of people, what if it still harms more people than it helps?
* And even if it were helpful (I’m not saying it is, just *if*), can it be applied ethically and without being influenced by racial and other biases? (Research says no)
And so on and so forth.
If you are interested in learning more about IOC, I recently created an IOC info center on Wildflower Alliance’s website that may be of interest:
Thanks so much, Lauren. I really appreciate your response here, and your e-mail about how to more support! Thanks also for all your work supporting peer respite and Soteria nationally 🙂
That’s certainly my fear, boans… But not a foregone conclusion. If you look at some of the other stories in the exhibit, people experienced some pretty horrific things in the psych system and still came out the other end.
Hmmm. Interesting. I just did some googling, and I found some more articles that have quotes from Ben in them about the “riot,” but no other personal info like a birthdate or such so far.
I’d love to find out what happened to Ben, and have thought about what that might take. I fear it might be quite difficult if not possible, but if you or anyone have any ideas I’d love to try and pursue it.
While you’re correct that I wasn’t watching this for quite a while, I am catching your comment now. I will add in response:
I know it is very important to you to be seen as having a legitimate role in support of your wife, in your contributions to this movement, and so on. I don’t want to argue with you about that, and would never suggest that anything that you’ve offered in that regard is invalid, even if we do disagree in some other ways.
That said, I think your comment here is nonetheless misplaced because the main point here was to not use ‘peer’ as an identity label that inextricably ties someone to a mental health system and boils them down to an object of sorts. We can debate about how much ‘peer’ means ‘commonality of experience’ or what have you in a different place.
Thanks so much, Irit. Absolutely to “We *are* the balance!” I actually mention Phoenix Rising in this piece. (See 5th paragraph down from the image.)
I’m not sure I agree that 0% should be the answer we seek. I do think folks have used drugs since the beginning of time in so many different ways, and what even gets classed as a ‘drug’ (vs. a medication, vs. as neither) is hazy and often capitalistically and morally driven. I do think the actual number – if we factor in adequate supports of all other kinds – would be lower than 20%, but I don’t know about 0!
That’s fair, Gina! I’m really glad the NYT published the article in question, but so much else there serves to reinforce the psychiatrized world, that is true.
Thanks, dogworld! Yes, the comments that became the highest rated (by a relative landslide) were pretty disappointing. And while I think you’re right that the NYT could have done more to link the main ‘characters’ of the story to their work and bios, it doesn’t really seem like a lot of people would have looked. I’m not too sure a lot of people who commented actually read the article so much as responded to the title… Thank you for reading and commenting here and trying to push back in the comments section over at NYT yourself 🙂
Exactly, Steve. What I always find most interesting are the people who vehemently insist they believe in “recovery,” but then just as vehemently insist that someone must have been misdiagnosed or similar. Sometimes it’s a little hard to tell just how much they might be lying to themselves about what they actually believe.
Thanks for your comment! I can’t imagine the NYT would ever consider this piece or some version of it, but it sure would be interesting if they did. I did connect with the author of the article that resulted in this comments section as I was writing this, but not folks at NYT proper. I should indeed at least send it along to them.
And yes, they do just move the ‘goal posts’ or change the game when folks seem to ‘recover’ too much… The whole ‘oh you were just misdiagnosed’ or didn’t have ‘real mental illness’ (such as Inman and Lieberman in fact did in response to this article) response is basically a big admission even for those who pay lip service to the idea that people can ‘recover’ that they in fact don’t believe it and see any such example as nothing more than proof that those people weren’t one of the actually truly “sick” in the first place.
And yes, the Hearing Voices movement chose intentionally to focus on one of the most scary-to-the-general-public “alien” seeming experiences and named itself for it with the intent to push on what people were most afraid of and bring it to light. It’s important to do that. But also important to find the more relatable experiences that less automatically put people in the us/them place to help hook them in to seeing some of this as *about them, too* whenever possible to build bridges and all. Of course, then we bump up against media and capitalism and what is sensational enough to sell…
Thanks for your comment. I think there’s also a whole nother category of families that is more prevalent than those who have actual ill-intentions… Where they are so desperate to ‘help,’ but so unwilling or unable to see themselves as a part of the problem that they do far more harm than good… I know Open Dialogue is imperfect as an approach, but I love that they see the ‘problem’ as existing in the spaces in between people even if it is most visibly represented by one person in that network. That idea just isn’t even a vague thought in most families or networks within the US.
Hey, cynical.nihilist. Thanks for your comment. It certainly seems to me that many family members are necessarily invested in silencing or heavily minimizing the fact that family often play such a role in someone’s distress. It’s certainly not the truth within all families, but we all know its a prominent issue for a number of people… And it would seem that acknowledging that too readily (as something more than a rare exception) feels like a direct threat and accusation for a lot of folks.
I don’t disagree with any of that, Ted. I think we’ve lost a lot of our critical fight energy for the employment/peer support side of things (among other reasons, I’m sure). I’m not saying there’s not value in the ‘peer support’ side of things (where it’s not super co-opted). I do think there is value in Jim Gottstein’s Transformation Triangle lay out of how real change happens (a mix of impacting public opinion, legal action, and creating real alternatives), for example. And I’ve seen first hand how peer support can lead to people building new lives, and sometimes getting invested in pushing back on these systems. But I also think SO much has been lost by folks getting too dependent on these systems for their material survival, and their voices getting quieter as a result. I have some of the old publications of Madness Network News, etc. on my wall, and it’s always a reminder of how much more fight (of the sort you speak of) there used to be, and it’s a real problem that end of things just isn’t really audible anymore.
I – for the most part – do not think rational argument can win this. (I think I say something to that effect in at least one spot in this piece.) That said, I do think us working to fine tune our own understanding of what’s going on with the other side, name it, find ways to pull it apart and make sense of it… is important to figuring out how we want to push back.
I’d love to believe this piece might get through to all those people who couldn’t see the NYT article for what it was… Maybe it will be successful with a few who were already closer to the fence. I don’t think it will otherwise solve the problem on their end. It’s really more to give voice and make meaning on our end, I think.
Thanks, Marie! I appreciate that perspective. In some of our trainings we’ve increasingly been talking about what if ‘By any means necessary’ meant not locking someone up against their will, etc, but getting them housing, and other basic needs met. People getting so stuck in ‘more of the same’ being the answer rather than addressing basic needs or some of the other things you mention is so damaging.
I can’t help but think you may be doing essentially what I’m talking about throughout this article which is to apply your own lens and not read what’s actually there.
I *do* acknowledge in the family section that an outside perspective (be it family or otherwise) can be useful, if they’re trusted and not too caught up in their own stuff. The problem is that far too many family members aren’t that either because they were a part of causing the trauma and/or too caught up in their own stuff in trying to respond to the other person’s distress… And yet, most of society typically does see the family member as having NOT *some* input worth hearing, NOT equal insight into what’s happening, but MORE, BETTER, etc.
That’s my point there after reading so many people who wanted to know what Caroline’s family had to say, suggested in ways that honestly came across as suggesting the family would be able to overrule Caroline’s take and correct for the distortions they believe she’s offering…
If you aren’t that family member whose insisting that your voice is MORE important and more accurate that your wife’s, etc. then that section really isn’t about you.
I’ve never argued that family members are useless and have nothing to offer, and I’m fully aware they need their own support and can play a critical role in things.. Hence why I do fairly frequently talk about Open Dialogue, an why we do offer two Hearing Voices groups specifically for family/friends at my work…
I don’t know you or your wife beyond this community so I can’t say anything definitive one way or another, but from most of what you’ve said, I just don’t think that section is really about you.
Thanks, Steven! I wish I could have linked it there, too, although I don’t know that there would have been any real hope of the people who most needed to actually reading it!
I appreciate the sentiment! Unfortunately, of course, we live in a world where folks with psych histories will be viewed terribly far too much of the time if they respond with aggression even if they were in the right or doing so in self-defense.
At least at first glance, the only thing I would clearly disagree with here is that all people with schizophrenia diagnoses know the potential problems with psych drugs. Unfortunately, that information is so intentionally withheld so much of the time that many people actually do NOT have accurate information either on the dangers or the lack of consistent efficacy.
But in any case, just to reiterate… I’m still confused about your comments here… It’s not that they are bad comments. I just don’t see anyone saying that the drugs are uniformly bad and everyone should get off of them.. I’m certainly not saying that.
Yes, it’s great the article happened… I just wish the comments reflection wasn’t such an accurate reflection of how hard it is for some folks to hear and just how far we have yet to go!
I’m a little confused by your comment. My piece has nothing to do with who should and shouldn’t attempt to withdraw from psychiatric drugs, or how easy it will be if they try… The reality is that many people with privilege fail, and many people with little privilege succeed… But privilege (especially when one doesn’t need to work, raise kids, etc.) certainly does open up a world of possibilities that increase one’s chances. Neither I nor the NY Times piece would or do disagree with those points…
I truly do not want to be disrespectful, but I find myself confused by this piece.
If people hired as peer supporters are being plunked down into case manager or receptionist roles (etc) then… They aren’t actually in peer roles at all. And I worry about any writing that suggests that that is even vaguely acceptable..
And as much as I appreciate Intentional Peer Support, its not seen as the “general model” for peer support, although wed probably be way better off if it was rather than some of the persistenty medicalized and co-opted nonsense that is…
I guess I’m just not quite following where you are heading here, or what you are arguing for and I worry that some of it will confuse or appear to be validating discriminatory or otherwise problematic practices…
Well, here’s the thing… You can’t decide what it is for me, and I can’t decide what it is for you. What it is for me is decidedly not about me giving power to anyone else… and that’s fact, not opinion.
One of the greatest harms perpetuated by the system is putting one person’s beliefs onto another as if the former holds all the rights to the truth even for another person. Hopefully we can not perpetuate that here! 🙂
Rebel, You can for sure hold this view *for you.* However, it is not a global truth, and we need only look at the words of so many others who self-injure or have in the past to know that.
As I said in my longer comment here, so much of what drives so many people’s pain in this world is loss of power and control in all its forms. And having other people step in and make meaning of one’s own experiences and actions is a profound example of that loss. For some of us, maybe we *want* someone else to take that power – at least temporarily – because we are too tired or scared or overwhelmed to feel like we can hold it all or make sense of it ourselves. But many if not most of us will want or benefit from taking that meaning making power back at some point even if we don’t hang onto it right from the start.
For you it sounds like self-injury did mean a giving up of power. If I understand you correctly – allowing other people’s words or actions to drive you to harm yourself felt like giving them control. I can understand that perspective. It is your truth. It simply isn’t truth for so many others, though. For me, self-injury has absolutely felt like taking power back.
Not dissimilarly, for you, making a contract to not self-injure worked. I’m sure thats true for some others, too. However, for me and so many people, the contracts felt like a weird, infantalizing way to perpetuate shame and guilt. It’s an okay strategy to propose as an option, but should always be explored with the person rather than dictated.
I am not sure I entirely follow the moralizing piece you write about at the end…. I can only say that for many folks, moralizing about our wants, needs, and choices has also been a pathway to additional shame and guilt… And that is rarely helpful.
So, again, your truth is yours. Your experience is valid. For you. But certainly not for everyone. Surely, you are right that it can take courage to recognize something isn’t working and make real change. But it *also* can take courage to stand up against moralizing and theorizing and social norms and counter, “No matter what you say, no matter what you assume, no matter how many people may try to forcefully dissuade me, this is still my truth.”
I am having a difficult time formulating a comprehensive response to this article. On the one hand, it includes bits and pieces of a deeply personal story, and I hate to try and counter that because… Well, it’s the author’s story, and their truth. It’s not my business to counter or tell them that they are wrong about them.
However, the reality is that this piece lost me at the title: Why Do People Self-Harm, and HOW CAN WE STOP IT?
Operating from a place of ‘we must stop this’ is a fundamentally harmful and flawed place to begin. When self-injury was most prominent in my life, the people who approached me with a ‘How can we stop this’ attitude were threats in my eyes. They were people who generally didn’t care WHY I was hurting myself in the way that I was. They simply sought to define my problem as ‘self-injury’ and the solution as ‘stopping’ it, while ignoring everything else along the way.
In a world where I’d already lost so much power and control over my own life, they were there to take even more away. And, overall, loss of power and control (in the form of sexual and physical abuse and so many other things) was precisely what my problem was. Efforts to take more of it away only caused additional harm, even if it might have made others around me more comfortable or feel like they were somehow doing their job.
I’m particularly puzzled – in this article so focused on the problems with medicalization of distress (a point with which I certainly align) – why there’s so little insight on the author’s part into how identifying self-injury as a “problem to be stopped” is just another form of that very same phenomenon. Along similar lines, I’m also curious as to why there continues to be so little understanding of just how many people actually self-injure in ‘socially acceptable’ sorts of ways with drugs, alcohol, food, exercise, work, and so on. As I’ve said in my own writing on this topic, I certainly posed more risk to myself with some of the ‘socially acceptable’ ways that I was hurting myself, then by a (non-socially acceptable) burn or cut on my arm.
To that end, I’m also puzzled – and very worried – about the alarmist thread throughout this piece that suggests that so many people are spiraling toward their own inevitable demise if they continue to self-injure. While self-harm certainly can cross a line into dangerousness, the vast majority of folks who self-injure don’t do so in life threatening ways. And, in fact, one of the risk factors for self-injury moving in a more dangerous direction is precisely when someone else swoops in to take more power and control away and force them to stop (which this article may – in some ways – encourage them to try to do).
For so very many people, self-injury is a way in which they stave off death or even urges in that direction. It can be an adaptation born of trauma and other challenges that serves so many purposes. And so this ‘how do we stop it’ focus can become even more dangerous for all that.
In stead of asking ‘how do we stop it,’ and feeding into the idea that self-injury is among the worst or most dangerous things anyone could do, why not instead ask:
* How is this working for you?
* Is it something you want to change or stop?
* How has it helped you in the past, and is it still serving that purpose?
* Have you experienced negative consequences as a result?
* What does self-injury mean to you/in your life?
* If it’s something you want to continue, do you want support to explore ways to do it in the safest manner possible?
Approaching the topic as if it’s something already understood and simply to be controlled is a mistake, and a dangerous one at that. We’ll get much further by being willing to sit in the muck with people who are struggling, and being willing to support them to explore and making meaning for themselves. Having other people tell you what is ‘wrong’ with you and what you need to do about it is a profound loss of power and control. The sitting in the muck and partnering to explore is the place where some ground can be regained in that regard, and where we can find points of collaboration in supporting people to live their lives to the fullest.
I find this article troubling, and this line gets at why:
“Peer specialists are defined as those who self-identify as having a mental illness or receiving mental health services and combine their personal experience with training to support others.”
Defined by *who*? That’s just wildly inaccurate, and yet seems to be getting offered here not by the research, but by you, Gavin, as a factual definition.
People in peer roles neither need self-identify as having a ‘mental illness,’ nor be receiving mental health services. To suggest otherwise is to contribute to the worst, most oppressive aspects of this work… those that involve buying into a one-size-fits-all medicalized perspective, and the idea that we all need to be put in these awful little boxes.
There are certain elements of ‘peer support’ that are really problematic as currently (and likely ever to be) employed by the ‘system.’ But there are certain aspects of it that are also quite powerful, particularly when offered outside of a conventional clinical environment. In those spaces where there is power, people get to come with whatever experiences have interrupted their lives or led society to ‘other’ and ostracize them… They often do come with experiences with system responses (many of them – though not all – harmful), and some identify as ‘survivors’ of that system… But there is neither a requirement to be *in* services, nor to regard any current or past history with those services as a necessary thing.
Please don’t contribute to boxing us in. Some of us are doing our very best to come at all this from an anti-oppression, rooted-in-community sort of way and this frame doesn’t help.
Oof. I am having a really hard time with this article being posted in this space. It does not align with the ‘Science, psychiatry, social justice’ tagline at all. Well, maybe the middle (psychiatry) part… Nor does it align with my understanding of the mission of Mad in America overall.
That aside… Max… You literally refer to people in this article as ‘V-SPMI’… And you write it out so that the acronym is OUTside of the parenthesis and the actual explanation of what it stands for IN the parenthesis. In other words, you use V-SPMI as if it is a legitimate word and thing to be boiling human beings down into.
It is NOT a legitimate thing to boil people down into. It’s just not. It’s frightening, and unnecessary to speak about human beings as these objectified, dangerous things. Now, this isn’t to say that this is the biggest problem with what you’ve written here. But that that is your starting point is very telling, and it makes me want to talk to you about internalized oppression, and the dangers of painting a whole group of people who can be so subjectively diagnosed as ‘dangerous,’ and so much else.
This piece is SO problematic. I hope there are people in your life who can help you unpack all of this at some point, and hopefully come to a different place. I’m not talking about trying to take away what you feel is helpful for you. That’s for you to decide… But this message you are putting out to the world is dangerous.
Eh, my point wasn’t so much how great Open Dialogue is, as it was that there are some fundamental differences in power imbalances there between Dr. and non-Dr that I think are interesting and worth exploring. I do talk about Open Dialogue a fair amount because it has good examples of a lot of principles and values… Such as seeing the problem as existing in the space *between* people even if its most visible in *one* person. I love that simply because it is about not automatically medicalizing every bit of distress and knowing that it is often a product of relationships and environments. There’s also the reality that people are available right away rather than after a wait, and that the structure of their system (which is the whole system and not just a hard-to-access alternative to the system in that particular part of Finland) engenders enough trust that many people reach out at the start of their struggles rather than trying everything to avoid it until things get worse and worse. There’s also the approach to psych drugs which leads to no automatic assumption that everyone needs to be on them at all, or that – if they do use them – that it can be just short-term (and short-term can be defined as as short as a few weeks rather than a year or two)… as well as the fact that sleep meds are among those most commonly prescribed because there is a fundamental understanding there about how much meeting basic needs (like sleep, etc.) can lead to distress in a way that is pretty absent here. There’s also the principle about having discussions *in front of someone* rather than in a back room behind their back, and that two clinicians take part in the support rather than just one to facilitate that process… And that – because its recognized that problems lie in the spaces ‘between people’ – the presence a family network (with ‘family’ defined by the person and including whoever they think makes sense including employers, neighbors, whoever) to work through things.
In essence, it’s less a magical thing you ‘do’ to anyone, and more a process of building trust and recognizing that someone’s distress is often the product of what is going on outside of them rather than within. But I am not intensively trained… I’m mainly relaying what I’ve come to understand from other sources, and what I usually highlight when facilitating trainings myself because it represents so many fundamental shifts from how most places respond to people.
AND I’m absolutely not someone who says ‘Open Dialogue’ is the answer to all… It has its downsides, too, and is nearly impossible to replicate in many other areas no matter how hard people try because the trust that has been built by constructing a system that holds these principles is a totally different experience than an alternative offering that represents a little pin drop within a system that runs counter to them (among other challenges around differences in liability issues and perceptions related to psych drug prescriptions and so on).
But again, I really mainly brought it up because the massive power imbalance that exists between those called Dr. and those not isn’t true in every area, even where medical systems still exist (most of Open Dialogue is facilitated by nurses after all). And I think we’d do well to look at how to begin reducing those massive power differentials with the tools available to us as a sort of harm reduction approach. Looking at the honorific system is but one way, but I think it’s an important one because its free, and because training people every single day to call a certain set of people ‘Dr.’ absolutely and totally influences how automatically reverent they may be to them. I see this playing out all the time even where a Dr. is considered an employee of an organization that technically has more power (hire/fire, etc.) but still bends to the Dr. on a daily basis and without question even when what the Dr. is doing is blatantly abusive and/or misguided.
Thanks for your post. And yes, there is a power imbalance. However, in many regards, it is a misplaced one. As I noted in the piece above, the medical doctors (and frankly, doctors of other types as well) often spend the least time with someone, and yet have the most power over them.
I am curious if you’ve seen Daniel Mackler’s Open Dialogue film? In it, one of the things they emphasize is how the medical doctors do NOT function with such a power imbalance over others on the team. I’m actually uncertain whether or not they are referred to as Dr. Last-name while everyone else is referred to by their first name… But I’m going to find out.
My point in bringing it up, though, is that the power imbalance needn’t be so great, and we needn’t be complicit in it. I do hear you on the added confusion of so many people getting to call themselves Dr. Last-name above and beyond medical doctors… But I think it’s an issue across the board.
I’m not sure if you’ve read any of my other writing on here. I certainly don’t expect you to necessarily have! I just wonder because I have certainly focused at length on the misplaced medicalization and oppressive nature of the psychiatric system in many different ways. That said, the honorific system and the power imbalances that it makes visible play a role in that, and so I don’t think this is irrelevant. Rather, I would say that this is one of the quickest, easiest ways we could begin to dismantle those power imbalances and show our commitment to undoing the larger problems. I would also echo what Steve has said above.
I’m honestly perplexed by how stuck on wanting to ‘honor’ the efforts of a particular sub-set of people you and others seem to be. No one – myself included – has suggested that there isn’t a lot of work involved in getting through a particular degree program. However, do you really believe that that effort is consistently greater than, say, the effort put in by so many people doing so many things? Ableist ideals about basing our worth in what we can ‘do’ aside, are there not many people working very hard in this world? Perhaps even more importantly, does the salary afforded to many people with the honorific of Dr. not suffice in terms of recognition and honor? I realize that salaries will vary among the doctorate crowd, but really… So many of them (according to research) come from money and go no to careers that earn them much higher salaries than most of us… Is that not enough?
Let me put it this way: Let’s say I’m wrong, or at least exaggerating the impact of a system that elevates the title (not just in work but across all areas of life) of someone who has earned the honorific of Dr. in terms of power imbalances and the systemic oppression of others… What on earth harm would be doing by getting rid of that system? At worst, the action would be neutral. (No one has been able to provide an even vaguely convincing argument that the actual earning of the degree, the salary that tends to follow, and one’s ability to hold an actual doctor-related role is not enough to ‘honor’ and ‘recognize’ their efforts, with the exception of those who’ve argued its important *within the current context* for people from marginalized groups to claim their titles as an anti-racist, anti-sexist, etc. act… But again, that’s within the context of the existence of the honorific system, and not its having been dismantled…) At best, it would be a concretely attainable step toward undoing oppressive power imbalances that elevate the voices of those who’ve completed academic learning so far over and above those who actually work more directly/frequently with the humans over whom that power is most regularly wielded, etc.
Plus all the other things I’ve said in my other comment responses…
This isn’t a “zero sum game” as some like to say. We can care about things like hunger and housing, and *also* care about how deep the power imbalances run in some of these systems. Of course doing away with honorifics isn’t nearly so important as doing away with lack of food and housing resources. But why would that preclude us from talking about honorifics? It kind of feels like a strawman argument to me… this suggestion that that is any kind of counter argument to what I’ve offered, rather than a different argument altogether.
Some questions for you:
1. Is there really no other way to communicate who has completed a type of education or holds a license for a particular role beyond honorifics? This also seems like a strawman to me… I never said people should deny or hide their roles… just not be referred to in all aspects of life by that role (even when they’re not doing anything even a bit related to it!).
2. Do you truly believe that any honorific is actually needed, and if so why? What do you think the honorifics really accomplish?
3. Do you know of any other completely free and widely accessible way to begin to chip away at the power imbalance between ‘Dr’ and the rest of us?
4. Maybe you think that the power imbalance the honorifics represent (both in access to education and in credibility/power in the moment)… but then, what harm would it cause to do away with them nonetheless? If they do no harm, still no harm done by not having them…
Your stories are valid, but I’m unclear how they support an argument to continue the use of honorifics. Much of what you talk about references the inequity to access to education, and as I said in the piece above and in the comments section, within the context that currently exists it may indeed be extra important for people who overcame marginalization to get their degrees and thus represent that by use of honorifics. But would it be important to have a different title if the honorific system was not what it currently was? Because *that* is my argument. That the honorific system is a part of an oppressive system and should be done away with, which would change a lot of the other pieces. People could still get their ‘pieces of paper,’ and have and speak about their jobs… no honorifics would not change that. But it would immediately change how elevated they are above so many others who have also worked very hard in their lives.
I said this in the comments section over on Mad in America’s Facebook page, and I’ll repeat it here:
Oh what a world we would have if we could manage to find ways to recognize and celebrate each other’s accomplishments without needing to step on others to do so…
I tend to focus most of my critiques on the system that drives, pushes, and pulls all the roles within it rather than the individuals within it, but I hear you. A ton of harm is for sure being caused.
“Evidence, data and logic should be the basis of an opinion not the perceived “authority of the speaker””
I certainly agree with this… though I’d also argue that ‘evidence’ itself is so often manipulated and/or rooted in a system that privileges those with a lot of money (to pay to gather and interpret the evidence) that I feel cautious about that piece as well!
At least in part, I would respond by saying much of what I already wrote out to Marie… Just because it has not impacted you, does not negate the issue at a systemic level. I guess I also find myself reacting to the idea of ‘politeness’ in this context. As someone who has watched quite up close and personal hospital staff (for example) bowing to the ones with Dr. titles at the expense of some of the most vulnerable held on those units I feel really clear that the power imbalance tipping so strongly in their direction is incredibly harmful. I do not owe them any extra reverence or politeness over and above what I would offer anyone else. I would also point to the paragraph where I wrote about people with Dr. Last-name titles often being the ones who don’t show up for new learning and whose power over people is most inversely related to their knowledge of them as an example of how off kilter it all can get. And while – as I’ve said in other comments – the use of the honorific is not responsible for all that, it is a really visible symbol of it and the easiest starting point for things to change. Honestly, I find it bizarre that so many people are resistant to the idea that doctors deserve no more reverence than so many others in our world, and that it is essential that we begin to chip away at the imbalances.
I was mostly trying to refer to the price of higher education with my ‘bought’ reference, but I hear you on the stolen part. That makes sense, as well.
I would certainly agree with you that the whole educational system creates a great deal of inequity. As far as I’ve understood, countries that have free ‘higher’ education have significantly less class differences throughout their culture and that seems like a good thing… but it’s certainly not where we’re at in the US.
Thanks for reading and taking the time to comment. 🙂
Btw, hospitalized multiple times in a single year? Not saying I agree with that, but please note that the proposed IOC legislation in MA proposes at least TWO hospitalizations over the course of THREE years. What low bar hell is that?
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Wonder no more…
Meet Eric. I interviewed him a few weeks ago. He was on an IOC (aka “AOT”) order for around four years. https://youtu.be/6czp_T1ss-E?si=1_JF9C4PaxvPyI2c
Or Elliot. I interviewed him a week or two before that. Also was on an IOC order. https://youtu.be/dXAYdINvVsU?si=DykmYhVqJia4bO7f
Also, ditto what James said.
The problem here is that often you’re comparing “AOT” vs. NOTHING. How about “AOT” versus actual quality support? Preferably before people are decimated by the “helping” systems?
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MBC,
The idea that “most” people put on IOC orders are “grateful” for it in the end is pure fantasy. It’s based on hugely flawed “research” of a tiny sample size from one state. I’ve been living this work for decades and its just wildly untrue.
-Sera
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John, I’m glad you are able to live a full life.
However, you note something very important in your comment that makes what you describe happened to you not fundamentally discriminatory in the way that “Assisted Outpatient Treatment” typically is. Specifically, you name that is that you were legally involved and ordered to get treatment by the courts. This is already something that can and does happen (ie., judges ordering treatment) with some regularity after someone has something that has criminal implications.
While I don’t endorse the actions of the courts in this regard as it is full of its own problems, that is a different conversation. The bottom line is that there is an enormous difference between the legal system ordering use of force and coercion for *all* people who are legally involved versus the court *only* ordering the use of force and coercion for people with psychiatric diagnoses in spite of lack of legal involvement.
Involuntary Outpatient Commitment laws allow for highly discriminatory use of force and coercion based on extraordinarily subjective terms, commonly without any legal involvement at all. In order to earn an IOC order under the currently proposed IOC bill in Massachusetts one could do as little as having been hospitalized twice in the last three years, or having made a threat of suicide once in the last three years. The bar is extraordinarily low and discriminatory.
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I’m sorry my ‘magic solution’ comment landed that way for you. I agree with you that adopting systems language isn’t helpful, and can often be harmful. I don’t think of it as systems language – at least not language I’ve heard from the system – but I hear you that that’s what it taps into for you.
For me, why I was trying to get at was this idea – from both the system and within our communities largely out of desperation – we shuffle people around as if some geographical land will have all the pieces to make a change in someone’s life… But the bottom line is that our entire system is a problem and no under funded, under resourced place with tons less power than these systems is likely to be able to make all the difference… It was less a comment *at* you then in response to you but at the systems that do all the shuffling as if that will ever solve anything at all if their main push continues to be sustaining those systems.
Anyway, like I said, I’m sorry my comment brought up those brush offs for you.
-Sera
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Hey Luke,
Sorry I’m just seeing your comments now! Thank you, and no I haven’t seen the webinar, but will check it out! 🙂
-Sera
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Renee,
Your comments are not relevant here. You are attempting to use my pieces here as a way to get at me over a completely unrelated issue. I ask that you stop.
-Sera
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I don’t think anyone is arguing that privilege didn’t play a role here. I’m white. I was able to pull out some easy proof that I do the job I claimed I do. I know the system well enough to think quick and come up with something to say that was protective. I know attorneys I could check in with to see how much trouble I could get myself in by writing this piece. Sure. None of it is 100% protective, but it made a difference.
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Pretty sure I already addressed these points above, but let’s try again:
1. I do regret my 11-year-old getting distressed. That wasn’t the intent. I didn’t call from home. I called from work when I was not with my child. That the police went to my home nearly two hours later was actually rather unexpected. That said, my child was just fine – not at all traumatized – once they were clear that the police weren’t there for them and everything was okay.
2. I’m not trying to ‘trap’ #988. I’m letting them demonstrate exactly who they are.
3. Researching #988 so I can share the results with my community and help people make informed decisions about whether or not they want to call isn’t a waste.
4. You better believe I’m going to protect myself if the police inappropriately show up at my door. Did you know that police are legally allowed to lie to you? I’m not going to feel bad about giving that right back when it comes down to protecting myself.
5. Ultimately, it is #988 who wasted police time, not me!
Thanks,
Sera
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Thanks, Lindsey! I appreciate you taking the time to read. 🙂
-Sera
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CrisisCon… Sea of #988 folks here!
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Oh gosh, I’m really sorry I said ‘Laura’ instead of ‘Lauren.’ I’m not sure where that came from. I hate getting people’s names wrong, as I know it feels crappy. Apologies for that!
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Thanks, Nijinsky.
You remind me of how many times I’ve talked with people about how weird this assumption is that therapy is universally, uniformly helpful. Yet so many folks assume denial, or just not having found the ‘right’ therapist, or whatever else if someone says therapy isn’t a help.
Some of the problem starts with nonsense like that, and then gets closer and closer to force as it rolls on forward.
-Sera
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Ehhhh, I somewhat agree that Secret Shopping can get problematic, but my secret shopping #988 (or anywhere, really) to see if they are helping v. harming is worlds apart from their secretly sending cops to my door. 🙂
-Sera
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Thanks, Laura! You remind me that I was just talking with someone earlier today about the importance of ‘responsibility to’ rather than ‘responsibility for’ which you reminded me of here as well 🙂
-Sera
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That makes sense, Nicole. The problem runs so much deeper than the police/involuntary response, unfortunately, so we’re a long way off from better I’m afraid.
Wildflower (where I work) has shared a list of some lines that are worth knowing about in our last couple of newsletters: https://madmimi.com/s/1dfa971
-Sera
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Thanks, Bill! I appreciate the recognition you offer of how much work it can be just to exist in this society, and how the current dominant societal interpretation of unemployment often fails to represent the layers of societal dysfunction and mis-prioritization of so many aspects of life.
-Sera
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Agreed, though it’s sort of typical of our society to come up with an answer that appears good on the surface but ultimately has risk of real harm and then promote it everywhere to ‘appear to be doing something’!
-Sera
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Thanks, Ted!
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That research does in fact exist (https://pubmed.ncbi.nlm.nih.gov/28625812/#:~:text=Abstract,trends%20by%20age%20and%20gender) and as Steve said, economics and suicide rates are pretty closely tied. Suicide rates are also higher when people living in poverty are living near people who have wealth (i.e., where the disparity is substantial and visible), etc.
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I’m sorry, KateL. That’s awful… Thank you for sharing.
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It wasn’t exactly surprising… Though on some level it still was for no good reason at all. And yes, I also regretted it for my 11-year-old’s sake. (They got over it quite quickly once they realized it had nothing to do with them, tho!)
Regardless, it feels important to do this work. Saying we believe something is dangerous from past experience isn’t the same as having concrete proof. It’s just not.
I’m going to be taking this article to a conference where all kinds of Vibrant folks will be present next week… If nothing else, it’ll be a bit gratifying to irritate them with it… But I do think there’s LOTS of people out there who just don’t get how dangerous this stuff is who might be open to hearing it and maybe not calling on their family member or what have you…
So, yeah, demonstrating is different than talk!
-Sera
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BG,
Oh, yeah, that AI stuff is *TERRIFYING* … They’re idea of ‘saving lives’ is unfortunately commonly limited to only “keeping you alive as long as I can see you.”
Oy.
Sera
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john,
I’m not sure I understand what you’re referencing?
Thanks,
Sera
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Crystal,
I so wish the UN and WHO held more weight when they make statements or produce guidance! My workplace has actually been mentioned in two different guidance documents from WHO and the UN, yet here we are. They aren’t listening! In fact, they seem to just think the problem is there’s not enough of the same old stuff.
Thanks for reading 🙂
-Sera
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Mary,
You are being generous when you say “sometimes dispatchers are not adequately trained” I think. :p
I think it would be fascinating to do a research on WHO is calling for wellness checks!
Thanks for reading 🙂
Sera
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mo Bee,
Hah, yeah, there’s a not great side to that whole secret shopping scene for sure. I don’t do it too much anymore. :p
And yes, for sure, poking the bear! :p
-Sera
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Thanks for your reply here, Bill, and for recognizing Emily’s work to speak out and make change as a survivor! 🙂
-Sera
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Thanks so much for saying this, Derek. I’m feeling pretty baffled by Robert’s appearing to claim the importance of peer respite and preserving it while also appearing to suggest we need to compromise our values to preserve it… which really isn’t preserving it at all.
But more than anything, I was stunned into some degree of paralysis at the comparison with John Herold. As a survivor of rape and sexual abuse – and as someone who knows people that were harmed directly by John – I am extremely unsettled by this.
I was trying to come up with a response when I noticed you’d already made one. Thanks for that!
That said, I’m sorry that the piece Ira wrote here and the work of the Stabbin Wagon team has been taken over by all this. I know all too well how a messy comments section can overshadow something important. I hope people are still reading the piece itself and disregarding most of this.
-Sera
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Hi Yvonne,
I’m sorry I didn’t see this when you first wrote! I wish I could say that something being peer support made it magically somehow immune from any ugliness, bias, etc.. But of course, that’s just not the way it goes.
I also worry about when people move to a particular place for a singular resource, because nothing is as magical close up up as it may seem at a distance. Sometimes it absolutely works, and sometimes people just find themselves uprooted from all that’s familiar and still not quite finding what they want.
It’s so hard. Whether you and your son move or stay where you are, I hope you find the connection you’re both seeking!
We do have some virtual family groups if you’re interested (though they’re focused more on hearing voices and related experiences) if you might be interested. Feel free to e-mail me if you are. 🙂
-Sera
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(Just to clarify, when I say “we” above… I’m talking about Wildflower Alliance where I serve as Director. I actually write independently and not as an employee of anyone, but my writing is deeply informed by my work so it would be disingenuous to say they are entirely separate. I do also sometimes try to help with some of the training stuff when its piling up… I’ve been helping with Australia, Maryland, and Pennsylvania contracts recently. But I have to intentionally steer clear of most of it and leave it to our direct or of training and admin manager or I’d drown so I do so happily! Just wanted to clarify the “we” part!)
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Nick,
There’s a key difference here re: the ‘conflict of interest’ you’re referencing. Lund has repeatedly quoted Kevin across several articles without citing his relationship that was clearly known to Lund. It’s also an issue that’s more that goes to more than just naming the relationship. To sit on the advisory board and be such a sole source (at least from what I saw) itself is a problem, too. It begins to look tokenizing when one person is repeatedly used to represent the voice of a marginalized group. I’m concerned that Lund doesn’t appear to better understand that point given their mission and values.
Re: my so-called ‘conflict of interest’: I have no issue with it being named here. HOWEVER, it’s important to note that I was not aware of that ‘relationship’ until folks at Mad in America were notified about it. The letter was signed by our Director of Training, and amounts to promise of a 24 hour training for which they would pay $7400, most of which would be eaten up by doing the training itself.
While perhaps some would think I “would or should” know about that, we have an entire training arm that is facilitating trainings everywhere from Australia to California to Maryland and so on. Additionally, about 75% of people who ask us to say we’ll offer a training if they can get funding for it don’t end up getting the funding, and the training isn’t offered. So, I guess we can call that a ‘conflict of interest,’ but given I wasn’t aware of it at the time I wrote this piece, I think it’s not an accurate comparison at all.
I think you are still missing the point of what I’m saying regarding both Lund and Kevin, and both are somewhat different points. My point re: not speaking publicly about concerns is specifically for Kevin, not Lund. From an anti-oppression perspective, to have someone internal to a movement speaking to the *media* about their concerns is a HUGE problem. It’s not about keeping secrets. It’s about not giving a whole media system that has scapegoated, stigmatized, discriminated against, and painted our entire community as dangerous villains, incompetent, and so on unnecessary ammo. There are other ways to address those concerns than giving a public that already has such a skewed view of who we are unnecessary fodder to further stereotypes.
I am aware of your more recent coverage of Stabbin Wagon which is good. I continue to feel that your organization lacks some of the fundamental understanding of dynamics related to systemic oppression that would better inform how you approach some of these issues. I continue to maintain that – much like the Boston Globe – you’ve spent too much time villainizing folks who are multiply marginalized without putting it in the proper context of systemic oppression.
In that way, I continue to maintain that you failed. That doesn’t mean you have to keep failing.
Thanks for your response.
Sera
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Robert,
I’m not sure how you are comparing Laysha’s work to others. Laysha doesn’t claim to be doing peer support. She’s a researcher. If she suddenly claimed to be doing peer support, that would in fact be a problem. She still gets to claim her psychiatric history and the value of people with psych histories being in charge of the research, but it’s worlds apart from claiming she’s doing peer support.
I don’t know anything about the org or person you’re defending, but what I do know is this: Even if one group can somehow magically overcome the fact that they’re really not a peer support org and do something fabulous with peer respite, it opens up the door for allllllllll the other orgs around the country that aren’t looking to do the work as carefully and are just looking for an excuse to basically justify being a clinical org that is co-opting peer support… Given that, I’m just not sure its worth debating whether or not a single org can overcome the fact that it’s a clinical org (albeit one by folks who have psychiatric and other relevant histories) to offer peer support with true fidelity to the model. There’s a bigger picture issue here…
As to Kevin et al, Honestly, I’ve heard far, far more feedback suggesting I’m right to question why this path was chosen – including other examples of concerns etc – then I’ve heard your perspective. I think it’s a complicated situation, but I continue to think it was unacceptable to air ‘dirty laundry’ in a media forum of that nature!
I know I’m not answering all that you raised… I’m a bit out of time at the moment! Thanks again for all the context you are offering!
-Sera
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Steve,
We talk about this point in our Alternatives to Suicide trainings. To illustrate the ‘why,’ I like to quote Joseph Franklin:
Joseph Franklin, a psychologist working and teaching at Harvard University was quoted as follows:
Quote#1:
“Our analyses showed that science could only predict future suicidal thoughts and behaviors about as well as random guessing. In other words, a suicide expert who conducted an in-depth assessment of risk factors would predict a patient’s future suicidal thoughts and behaviors with the same degree of accuracy as someone with no knowledge of the patient who predicted based on a coin flip…This was extremely humbling — after decades of research, science had produced no meaningful advances in suicide prediction.” (American Psychological Association, 2016)
Quote #2, Same article, next paragraph:
“As most of these guidelines were produced by expert consensus, there is reason to believe that they may be useful and effective.” (American Psychological Association, 2016)
In other words, Joseph contradicted himself, and basically said ‘we know these things don’t work, but do them anyway because important people said they were good.’
It’s a similar phenomenon to what you’re referencing… Because it’s easier, because people in power said so, because people are overwhelmed with what it would take to truly do things differently… Just do it the same and pretend its right.
-S
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Kate,
Not sure what you mean. There’s nothing wrong with turning to the media to advocate for funds, etc. There is, however, something deeply wrong with turning to the media as a member of a marginalized group to become complicit in further marginalizing other members of that group.
I just don’t think there’s any excuse for it. It doesn’t actually solve the problem, and certainly contributes to those in power gaining more ammo while members of our community lose credibility. It’s harmful.
-Sera
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The differences are pretty vast. Clubhouses can look substantially different from one another, but overall, they are about the “work ordered day,” do not have an overnight component, and are not centered around peer support. Most people who visit most clubhouses will find that there are different ‘units’ they can volunteer and work in, assistance finding jobs, as well as social components. They are not the same as day programs, but are much closer to day programs than they are to peer respites. Although some Clubhouses have a real ‘peer support’ component, most employees of Clubhouses are not required to have psychiatric histories or similar.
Peer respites, on the other hand, operate largely as alternatives to staying on an inpatient psychiatric unit or other more restrictive environment. Stays at peer respites range from a few nights to up to a couple of weeks depending on the respite and its particular way of operating. In order to qualify as a peer respite, all employees working at the respite must identify as having a psychiatric history or similar life-disrupting challenge that they’ve navigated. Although this can vary a bit, most peer respites focus on creating options for how to spend one’s day but are very much not highly structured or organized around work, etc.
Hope that helps,
Sera
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Thanks, Mary. Power and money are certainly both big issue, you’re right about that! Unfortunately, one of the massive downsides of peer support is that when so many psychiatric survivors started taking system-funded jobs, they stopped approaching things with so much fight because their livelihoods became dependent on the systems they were trying to change because those systems employ them. It also encourages some folks to get deep into self-promotion over collective and community goals and voices, and is very related to at least some of the ‘in-fighting’ you reference. I wish it were easier to unpack all that and make it be different!
-Sera
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Hi Al,
Thanks, I hope that for Oregon and for all other states and territories, too! 🙂
-Sera
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Thanks so much, Moss! 🙂 I appreciate your taking the time to read through all of it and share your feedback!
-Sera
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Thanks so much, Beavers. Like a previous poster, your comment affirms my overall impression of Stabbin Wagon. I wish all clinical mental health folks recognized the problems with that system in the way that you do, but I’m glad that you’re there to help shed light on it!
Thanks,
Sera
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Robert,
I don’t think we’re going to get very far here. I would agree with the State that Bay Area is not peer-run. We seem to be operating on very different definitions of ‘peer.’
I understand (I think?) that you are saying they are ‘peer run’ because the org is run by people who have struggled with related issues themself. I believe that to be an extremely problematic definition of ‘peer’ that turns it into an ‘identity’ that is synonymous with consumer, client, patient/ex-patient and so on.
On the contrary, I understand ‘peer’ to be about a way of working and being with one another that is rooted in common experiences, yes, but *ALSO* in minimizing power imbalances, not ‘fixing’, and so on.
‘Peer’ as an identity is a part of what is co-opting our work. It’s allowing people in peer roles to be pushed into doing whatever the systems want them to do because it’s simply about that role and not the way the work is done. No ‘peer’ can stand alone so there can’t ever be ‘a peer’ because ‘peer’ only exists in relationship with someone else.
What it sounds to me from what I’ve seen on their website is that Bay Area is deeply rooted in employing only people in *clinical roles* that have relevant personal histories and are willing to disclose them and use the wisdom they’ve gained in their *clinical work*. By their own report, they’re doing assessments, using cognitive behavioral approaches. They use ‘client’ language, etc. etc. etc.
That’s not peer-run, and I think we’re pretty doomed if we allow that to become the definition. (Honestly, I think we’re pretty doomed anyway for a number of reasons, but I’m not going to stop fighting to maintain as much integrity as I can…)
I *DO* think there is great value in clinical services as provided by folks with their own histories and willingness to disclose. It’s not about them being bad.
But it doesn’t make them peer run because they’re doing *clinical* work. I would have ruled them out, too.
I hear you that there are legitimate concerns in some instances. I don’t agree with how Kevin handled it at all, and I don’t agree with knocking these orgs down in any public way especially until effort has been made to really build them up and give them a fighting chance.
-Sera
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Thanks so much for chiming in here, Michael! This affirms my impression of the work they do!
-Sera
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Robert,
There are certainly things you’ll know far more about than I. However, in looking at the websites of the places you mentioned, only one (Miracle Club) appears to be led largely by non-white folks. Perhaps they would have been a great choice, I don’t know anything about them, although their website looks entirely substance focused and that isn’t always a great mix because the 12-step world is a very different sort of peer support than what the peer respite world offers! (This isn’t a universally impossible melding, but even ‘Recovery Coaching’ training tends to be awful and oppressive on issues related to suicide, etc so it would certainly be a question for me.) The issues that show up in conflict between the world of recovery from problems with substances to the peer support world related to suicide, voices, etc actually tends to not be of issue when it comes to orgs focused deeply on harm reduction around substances because harm reduction (when done right) is inherently rooted in liberation, self-determination, etc. must like good peer support at a peer respite is…
Additionally, I think Bay Area First Step would have been *hugely* problematic. I realize they’re saying they’re ‘peer-led’ but it is a version of ‘peer-led’ that is not consistent with peer respite as their identity appears to be largely clinical and they explicitly state that they provide clinical services, refer to people as ‘clients,’ etc. That doesn’t make them inherently bad, but you can’t both be a ‘peer-run’ organization and so definitively clinical, at least not by the definition of ‘peer-run’ that applies here. There’s a *huge* difference between serving as a clinician who is informed by, open about, and using their own personal experience in their work and peer support… Both have value, but in order to not become problematic we need to be clear about which is happening.
All that is to say there may very well have been some other good candidates, but it’s not so simple because for sure at least one and possibly two of your suggestions wouldn’t have lined up as being good candidates.
All I can say about the rest of what you offer here is:
1. It’s a very tricky balance. We can argue against taking risks with rewards forever, but if risks are never taken and proper support given to navigate those risks, then nothing ever substantively changes and the underfunded/multiply marginalized folks are forever relegated to the fringes. But you’re also right that if funders take risks, don’t properly support them, and then let them fail that can ALSO serve to lead to a “See, we told you there wasn’t value in this approach” response that also leaves us forever on the fringes, too. I still maintain that the right decision is to take some risks and then truly support them. Oregon certainly took some risks. And I think even better, they gave one award to a much more established org *AND* chose two less established more marginalized groups which allows for some additional balance to test the approach itself… But the support has been totally lacking, and that is what I’m largely speaking to here.
2. Going to the media – the majority of which already paints people with psych histories as incompetent, dangerous, needing supervision, etc – and giving them more ammo against us will never be the right choice. That was such a problematic thing to do… One needn’t go to the media to call out concerns. Talk with the orgs, talk with local advocacy groups about how to support, whatever it needs to be… But being quoted in multiple articles criticizing and questioning the competence of a marginalized group? I can’t ever see that as acceptable, and it certainly feels very hard to justify it as anything that would ever ‘help’ the problems you are describing either.
The situation in Oregon is complicated, and I’ve never claimed – including in this piece – that there are no legitimate issues to be concerned about. The question is what do we DO about those concerns to move things forward toward liberation, anti-oppression, and the creation of valuable, true alternatives.
Regardless, thank you for weighing in here and providing additional context.
-Sera
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Thanks so much for this added background, Jacek. I very much appreciate it.
Unfortunately, it goes a long way toward illustrating that the difference between change and SYSTEMIC change… Whenever change is dependent on one or a few people, it can backslide sooo quickly the moment those people change (either by being fired or just leaving for any of a number of reasons of their own accord). It can be so painful and demorailzing when good change has happened, and then its not only gone but sometimes at an even worse point than before the positive change happened!
Thanks,
Sera
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Laura,
I know we’ve talked about this on social media already, but I’ll repeat a bit of what I said there here:
I agree that getting seats on advisory boards can be a win in many instances, including Kevin’s with Lund Report potentially. However, if that power is used only to be the one who is used to check the box of ‘got a quote from this group’ (as seems like might be an issue given the prevalance of articles with quotes from him and the lack of quotes from others), then is one not becoming complicit in tokenization at times? And if one isn’t striving to use this power to bring in other voices from that same group, is one not maybe missing the point of having that power in the first place?
I don’t know why things have played out the way they have with Kevin and Lund. I reached out to ask him if he’d share more about why he made the choices he made here before I wrote this piece, and he didn’t respond.
I do, however, believe it will NEVER be okay for someone from a marginalized group who gains this sort of power to use that power to then contribute to the tearing down of folks in that marginalized group in a public media forum EVEN IF there are legitimate concerns. Those legitimate concerns should be dealt with in a different way that doesn’t contribute to the media’s relentless tearing down of our work and credibility that already exists. THAT is the huge historical issue and one that acts as an enormous barrier to our progress… Filing paperwork and such is a far smaller issue and one that could be dealt with by giving support, not public criticism.
I will offer that I have been in contact both with Stabbin Wagon and Black Mental Health, and we will/would happily offer technical support. But an uncompensated organization from across the country surely isn’t the answer I’m calling for when I say robust technical support. These organizations would need to be given funding to receive such technical support in a robust way, and that includes local hands on support, too, in order to meet what I’m talking about.
Regardless thanks for your comment. I appreciate your presence in this movement and that you hold knowledge of our history including Jeanne’s work and so on.
Thanks,
Sera
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Thanks, Vic! Yes, I so wish people had a much better understanding of what it takes to really support groups to develop and create more equity in a system that has so often been about save dollars and rush, rush, rush particularly where there’s historical marginalizations at play!
Thanks for your comment!
Sera
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Linda,
I do actually feel like I know a lot about Stabbin Wagon, though yes, I didn’t go too deeply into that here. That said, everything I do know – whether included here or not – continues to lead me to support them. Of course, I’m not sure what you’re referring to so I’ll have to leave it at that!
Thanks,
Sera
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Thanks so much, Derek! I appreciate your comment.
-Sera
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Hi Mary,
Can you clarify what you mean in terms of a source to use? To you mean one that talks about some of the history of peer respite?
Soteria – developed by Loren Mosher with the original based in California – was on a separate track and did/does include more of a collaboration between people including folks in clinical roles. Their values, ways of being with folks in the house, etc. are quite relatable to the peer respite model… But it’s definitely different both in intentional inclusion of clinical roles and for the fact that folks who stay there typically stay at least 6 months and its focus is on people having their first experience of distress related to things like hearing voices, seeing visions, unusual beliefs etc (note: not all people who hear voices or see visions experience distress, and even people who do experience distress from some of those experiences also often have positive experiences too, and some of the distress is rooted in how society responds to those experiences and teaches people to fear them).
There is a book on Soteria, though unfortunately right now there’s only one single Soteria program that I’m aware of that is active in the US (in Vermont). There is also a book on peer respite (that I wrote in collaboration with Intentional Peer Support and a few others from Wildflower Alliance), and a short film on peer respite that we create that speaks to the history as we knew it at the time which omits things like Jennie Fulgham’s story. Jennie is written about in Vanessa Jackson’s ‘In Our own Voice,’ and appears in the blackhistorymovement.info leaders project as well (which was founded by myself, Chacku Mathai, and Dana Smith).
In terms of seeing everyone as a ‘peer’ I get what you mean, but I think it’s dangerous. There’s layers here.
First, I don’t think it’s helpful to see ‘peer’ as an identity. It’s a relationship and a way of being with one another that is rooted both in some common experiences with one another and minimizing power imbalances, etc. I don’t see how we minimize power imbalances when one person, say, has the power to take another’s liberty and put them in a psych ward.
I also think we really need to play high value on the experience of loss of power and how hard it is to understand what losing your liberty is like and how much value there is in being supported people who get that (and often overlooked element of ‘peerness’ b y those who focus only, say, on having been diagnosed and having particular experiences of related distress).
HOWEVER, I absolutely do wish our systems and our culture placed way more value on human experiences and the sharing of them across all people regardless of their roles, as well as an emphasis on being able to learn from one another through that sharing… Perhaps that’s some of what you are getting at!
Thanks so much for your comment,
Sera
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Thanks for taking the time to read and comment, Sharee! 🙂
-Sera
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I don’t know that I can agree that Anosognosia applies broadly. That’s the argument of IOC proponents. Although that said, I did accuse E Fuller Torrey and Paul Gionfriddo of having anosognosia in another article I wrote on here. 🙂
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Hi Svetlana,
Thank you for sharing this, as awful as it is. I’m sorry. I’d be interested to hear about your direct action efforts if you’d like to share.
-Sera
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J,
I appreciate your highlighting the efficacy of leaving the area for those who have the resources/ability to do so! I make that point often myself. It’s an under utilized approach for sure.
-Sera
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Renee,
Thanks for highlighting the injustice of us being painted as the problem in such the unjust chaos in which we live!
-Sera
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Thank you for sharing some of your story here, and helping to illustrate how unhelpful (and harmful) the ‘help’ can be.
-Sera
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Matthew,
Perhaps I was remiss in not including more basics about the problematic nature of IOC and its overall lack of efficacy and harms in this piece.
A handful of things:
1. I wonder where you got the idea that IOC is helpful? Too often in this society people take action – fight for a new law, establish a new policy, etc. – simply to feel they’re doing *something* to address a problem. However, all too often, the ‘something’ they end up doing to feel like they’ve done ‘something’ is more illusion than anything else, and may even be counterproductive. IOC fits in that category.
2. You note that there is a ‘mental health crisis’ in the US. Yet, 47 states and territories of the US not only have IOC, but have had IOC for quite a while. I wonder where the idea comes from that – when things keep getting worse – the answer is more of the same?
3. You refer to people being “a danger to self or others,” but in actuality there are already provisions in every single state to respond when that is the case. For example, in Massachusetts – where there is no IOC at this time (hence this piece) – there is nonetheless the Section 12 (a and b) that allows for someone to be taken in involuntarily to a facility for assessment (12a) and held for 72 hours (12b) for further observation to assess their ability to be “safely” in the community and otherwise seek further psychiatric commitment through due process if found not to be “safe.” Now, we could have a whole nother argument about how that process works and its value and efficacy, but for now, my point is that that process exists as an entirely separate thing from IOC. IOC is expressly billed as something used when people are NOT a ‘danger to self or others’. More specifically, its billed as a way to keep people from getting to the point of being a “danger to self or others” based not on what is going on right now, but on perceptions about their past and/or future risk. But:
* Does taking away power (well demonstrated to have a negative effect including increasing risk of suicide) and pushing “treatments” that are so often ineffective (as also demonstrated by research) really *keep* people from getting to that point?
* And even if that may work for a fraction of people, what if it still harms more people than it helps?
* And even if it were helpful (I’m not saying it is, just *if*), can it be applied ethically and without being influenced by racial and other biases? (Research says no)
And so on and so forth.
If you are interested in learning more about IOC, I recently created an IOC info center on Wildflower Alliance’s website that may be of interest:
https://wildfloweralliance.org/involuntary-outpatient-commitment-information-center/
In any case, thanks for reading!
Sera
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Thanks so much, Lauren. I really appreciate your response here, and your e-mail about how to more support! Thanks also for all your work supporting peer respite and Soteria nationally 🙂
-Sera
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That’s certainly my fear, boans… But not a foregone conclusion. If you look at some of the other stories in the exhibit, people experienced some pretty horrific things in the psych system and still came out the other end.
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If you look at the exhibit, you’ll see some of his story. This is also a link to the story told in papers at the time: https://www.newspapers.com/clip/32843184/ben-riley-rusk-state-hospital-riot/
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Hmmm. Interesting. I just did some googling, and I found some more articles that have quotes from Ben in them about the “riot,” but no other personal info like a birthdate or such so far.
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Yes, it is… I do think this one was long overdue… !
-Sera
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Thank you for sharing that, and yes, quite a weird coincidence!
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Thanks, ThereAreFourLights!
I’d love to find out what happened to Ben, and have thought about what that might take. I fear it might be quite difficult if not possible, but if you or anyone have any ideas I’d love to try and pursue it.
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Sam,
While you’re correct that I wasn’t watching this for quite a while, I am catching your comment now. I will add in response:
I know it is very important to you to be seen as having a legitimate role in support of your wife, in your contributions to this movement, and so on. I don’t want to argue with you about that, and would never suggest that anything that you’ve offered in that regard is invalid, even if we do disagree in some other ways.
That said, I think your comment here is nonetheless misplaced because the main point here was to not use ‘peer’ as an identity label that inextricably ties someone to a mental health system and boils them down to an object of sorts. We can debate about how much ‘peer’ means ‘commonality of experience’ or what have you in a different place.
Thanks,
Sera
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Thanks so much, Irit. Absolutely to “We *are* the balance!” I actually mention Phoenix Rising in this piece. (See 5th paragraph down from the image.)
I’m not sure I agree that 0% should be the answer we seek. I do think folks have used drugs since the beginning of time in so many different ways, and what even gets classed as a ‘drug’ (vs. a medication, vs. as neither) is hazy and often capitalistically and morally driven. I do think the actual number – if we factor in adequate supports of all other kinds – would be lower than 20%, but I don’t know about 0!
Thanks,
Sera
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That’s fair, Gina! I’m really glad the NYT published the article in question, but so much else there serves to reinforce the psychiatrized world, that is true.
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Thanks, dogworld! Yes, the comments that became the highest rated (by a relative landslide) were pretty disappointing. And while I think you’re right that the NYT could have done more to link the main ‘characters’ of the story to their work and bios, it doesn’t really seem like a lot of people would have looked. I’m not too sure a lot of people who commented actually read the article so much as responded to the title… Thank you for reading and commenting here and trying to push back in the comments section over at NYT yourself 🙂
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Joshua,
I’m not a fan of the term of ‘recovery’ either for a myriad of reasons. I talk about some of them https://www.madinamerica.com/2013/04/the-recovery-trap/. Thanks for the link, I will check it out!
-Sera
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Exactly, Steve. What I always find most interesting are the people who vehemently insist they believe in “recovery,” but then just as vehemently insist that someone must have been misdiagnosed or similar. Sometimes it’s a little hard to tell just how much they might be lying to themselves about what they actually believe.
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Hey George cLoony,
Thanks for your comment! I can’t imagine the NYT would ever consider this piece or some version of it, but it sure would be interesting if they did. I did connect with the author of the article that resulted in this comments section as I was writing this, but not folks at NYT proper. I should indeed at least send it along to them.
And yes, they do just move the ‘goal posts’ or change the game when folks seem to ‘recover’ too much… The whole ‘oh you were just misdiagnosed’ or didn’t have ‘real mental illness’ (such as Inman and Lieberman in fact did in response to this article) response is basically a big admission even for those who pay lip service to the idea that people can ‘recover’ that they in fact don’t believe it and see any such example as nothing more than proof that those people weren’t one of the actually truly “sick” in the first place.
And yes, the Hearing Voices movement chose intentionally to focus on one of the most scary-to-the-general-public “alien” seeming experiences and named itself for it with the intent to push on what people were most afraid of and bring it to light. It’s important to do that. But also important to find the more relatable experiences that less automatically put people in the us/them place to help hook them in to seeing some of this as *about them, too* whenever possible to build bridges and all. Of course, then we bump up against media and capitalism and what is sensational enough to sell…
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registeredforthissite,
Thanks for your comment. I think there’s also a whole nother category of families that is more prevalent than those who have actual ill-intentions… Where they are so desperate to ‘help,’ but so unwilling or unable to see themselves as a part of the problem that they do far more harm than good… I know Open Dialogue is imperfect as an approach, but I love that they see the ‘problem’ as existing in the spaces in between people even if it is most visibly represented by one person in that network. That idea just isn’t even a vague thought in most families or networks within the US.
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Hey, cynical.nihilist. Thanks for your comment. It certainly seems to me that many family members are necessarily invested in silencing or heavily minimizing the fact that family often play such a role in someone’s distress. It’s certainly not the truth within all families, but we all know its a prominent issue for a number of people… And it would seem that acknowledging that too readily (as something more than a rare exception) feels like a direct threat and accusation for a lot of folks.
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I don’t disagree with any of that, Ted. I think we’ve lost a lot of our critical fight energy for the employment/peer support side of things (among other reasons, I’m sure). I’m not saying there’s not value in the ‘peer support’ side of things (where it’s not super co-opted). I do think there is value in Jim Gottstein’s Transformation Triangle lay out of how real change happens (a mix of impacting public opinion, legal action, and creating real alternatives), for example. And I’ve seen first hand how peer support can lead to people building new lives, and sometimes getting invested in pushing back on these systems. But I also think SO much has been lost by folks getting too dependent on these systems for their material survival, and their voices getting quieter as a result. I have some of the old publications of Madness Network News, etc. on my wall, and it’s always a reminder of how much more fight (of the sort you speak of) there used to be, and it’s a real problem that end of things just isn’t really audible anymore.
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Ted,
I – for the most part – do not think rational argument can win this. (I think I say something to that effect in at least one spot in this piece.) That said, I do think us working to fine tune our own understanding of what’s going on with the other side, name it, find ways to pull it apart and make sense of it… is important to figuring out how we want to push back.
I’d love to believe this piece might get through to all those people who couldn’t see the NYT article for what it was… Maybe it will be successful with a few who were already closer to the fence. I don’t think it will otherwise solve the problem on their end. It’s really more to give voice and make meaning on our end, I think.
-Sera
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Thanks, Marie! I appreciate that perspective. In some of our trainings we’ve increasingly been talking about what if ‘By any means necessary’ meant not locking someone up against their will, etc, but getting them housing, and other basic needs met. People getting so stuck in ‘more of the same’ being the answer rather than addressing basic needs or some of the other things you mention is so damaging.
-Sera
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Sam,
I can’t help but think you may be doing essentially what I’m talking about throughout this article which is to apply your own lens and not read what’s actually there.
I *do* acknowledge in the family section that an outside perspective (be it family or otherwise) can be useful, if they’re trusted and not too caught up in their own stuff. The problem is that far too many family members aren’t that either because they were a part of causing the trauma and/or too caught up in their own stuff in trying to respond to the other person’s distress… And yet, most of society typically does see the family member as having NOT *some* input worth hearing, NOT equal insight into what’s happening, but MORE, BETTER, etc.
That’s my point there after reading so many people who wanted to know what Caroline’s family had to say, suggested in ways that honestly came across as suggesting the family would be able to overrule Caroline’s take and correct for the distortions they believe she’s offering…
If you aren’t that family member whose insisting that your voice is MORE important and more accurate that your wife’s, etc. then that section really isn’t about you.
I’ve never argued that family members are useless and have nothing to offer, and I’m fully aware they need their own support and can play a critical role in things.. Hence why I do fairly frequently talk about Open Dialogue, an why we do offer two Hearing Voices groups specifically for family/friends at my work…
I don’t know you or your wife beyond this community so I can’t say anything definitive one way or another, but from most of what you’ve said, I just don’t think that section is really about you.
Either way, thanks for reading.
-Sera
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Thanks, Steven! I wish I could have linked it there, too, although I don’t know that there would have been any real hope of the people who most needed to actually reading it!
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Registeredforthissite,
I appreciate the sentiment! Unfortunately, of course, we live in a world where folks with psych histories will be viewed terribly far too much of the time if they respond with aggression even if they were in the right or doing so in self-defense.
Sera
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Daiphanous,
At least at first glance, the only thing I would clearly disagree with here is that all people with schizophrenia diagnoses know the potential problems with psych drugs. Unfortunately, that information is so intentionally withheld so much of the time that many people actually do NOT have accurate information either on the dangers or the lack of consistent efficacy.
But in any case, just to reiterate… I’m still confused about your comments here… It’s not that they are bad comments. I just don’t see anyone saying that the drugs are uniformly bad and everyone should get off of them.. I’m certainly not saying that.
Sera
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Ann,
Yes, it’s great the article happened… I just wish the comments reflection wasn’t such an accurate reflection of how hard it is for some folks to hear and just how far we have yet to go!
Thanks for reading,
Sera
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Hi Daiphanous Weeping,
I’m a little confused by your comment. My piece has nothing to do with who should and shouldn’t attempt to withdraw from psychiatric drugs, or how easy it will be if they try… The reality is that many people with privilege fail, and many people with little privilege succeed… But privilege (especially when one doesn’t need to work, raise kids, etc.) certainly does open up a world of possibilities that increase one’s chances. Neither I nor the NY Times piece would or do disagree with those points…
-Sera
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I truly do not want to be disrespectful, but I find myself confused by this piece.
If people hired as peer supporters are being plunked down into case manager or receptionist roles (etc) then… They aren’t actually in peer roles at all. And I worry about any writing that suggests that that is even vaguely acceptable..
And as much as I appreciate Intentional Peer Support, its not seen as the “general model” for peer support, although wed probably be way better off if it was rather than some of the persistenty medicalized and co-opted nonsense that is…
I guess I’m just not quite following where you are heading here, or what you are arguing for and I worry that some of it will confuse or appear to be validating discriminatory or otherwise problematic practices…
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Well, here’s the thing… You can’t decide what it is for me, and I can’t decide what it is for you. What it is for me is decidedly not about me giving power to anyone else… and that’s fact, not opinion.
One of the greatest harms perpetuated by the system is putting one person’s beliefs onto another as if the former holds all the rights to the truth even for another person. Hopefully we can not perpetuate that here! 🙂
-Sera
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Rebel, You can for sure hold this view *for you.* However, it is not a global truth, and we need only look at the words of so many others who self-injure or have in the past to know that.
As I said in my longer comment here, so much of what drives so many people’s pain in this world is loss of power and control in all its forms. And having other people step in and make meaning of one’s own experiences and actions is a profound example of that loss. For some of us, maybe we *want* someone else to take that power – at least temporarily – because we are too tired or scared or overwhelmed to feel like we can hold it all or make sense of it ourselves. But many if not most of us will want or benefit from taking that meaning making power back at some point even if we don’t hang onto it right from the start.
For you it sounds like self-injury did mean a giving up of power. If I understand you correctly – allowing other people’s words or actions to drive you to harm yourself felt like giving them control. I can understand that perspective. It is your truth. It simply isn’t truth for so many others, though. For me, self-injury has absolutely felt like taking power back.
Not dissimilarly, for you, making a contract to not self-injure worked. I’m sure thats true for some others, too. However, for me and so many people, the contracts felt like a weird, infantalizing way to perpetuate shame and guilt. It’s an okay strategy to propose as an option, but should always be explored with the person rather than dictated.
I am not sure I entirely follow the moralizing piece you write about at the end…. I can only say that for many folks, moralizing about our wants, needs, and choices has also been a pathway to additional shame and guilt… And that is rarely helpful.
So, again, your truth is yours. Your experience is valid. For you. But certainly not for everyone. Surely, you are right that it can take courage to recognize something isn’t working and make real change. But it *also* can take courage to stand up against moralizing and theorizing and social norms and counter, “No matter what you say, no matter what you assume, no matter how many people may try to forcefully dissuade me, this is still my truth.”
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Removed at request of poster.
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I am having a difficult time formulating a comprehensive response to this article. On the one hand, it includes bits and pieces of a deeply personal story, and I hate to try and counter that because… Well, it’s the author’s story, and their truth. It’s not my business to counter or tell them that they are wrong about them.
However, the reality is that this piece lost me at the title: Why Do People Self-Harm, and HOW CAN WE STOP IT?
Operating from a place of ‘we must stop this’ is a fundamentally harmful and flawed place to begin. When self-injury was most prominent in my life, the people who approached me with a ‘How can we stop this’ attitude were threats in my eyes. They were people who generally didn’t care WHY I was hurting myself in the way that I was. They simply sought to define my problem as ‘self-injury’ and the solution as ‘stopping’ it, while ignoring everything else along the way.
In a world where I’d already lost so much power and control over my own life, they were there to take even more away. And, overall, loss of power and control (in the form of sexual and physical abuse and so many other things) was precisely what my problem was. Efforts to take more of it away only caused additional harm, even if it might have made others around me more comfortable or feel like they were somehow doing their job.
I’m particularly puzzled – in this article so focused on the problems with medicalization of distress (a point with which I certainly align) – why there’s so little insight on the author’s part into how identifying self-injury as a “problem to be stopped” is just another form of that very same phenomenon. Along similar lines, I’m also curious as to why there continues to be so little understanding of just how many people actually self-injure in ‘socially acceptable’ sorts of ways with drugs, alcohol, food, exercise, work, and so on. As I’ve said in my own writing on this topic, I certainly posed more risk to myself with some of the ‘socially acceptable’ ways that I was hurting myself, then by a (non-socially acceptable) burn or cut on my arm.
To that end, I’m also puzzled – and very worried – about the alarmist thread throughout this piece that suggests that so many people are spiraling toward their own inevitable demise if they continue to self-injure. While self-harm certainly can cross a line into dangerousness, the vast majority of folks who self-injure don’t do so in life threatening ways. And, in fact, one of the risk factors for self-injury moving in a more dangerous direction is precisely when someone else swoops in to take more power and control away and force them to stop (which this article may – in some ways – encourage them to try to do).
For so very many people, self-injury is a way in which they stave off death or even urges in that direction. It can be an adaptation born of trauma and other challenges that serves so many purposes. And so this ‘how do we stop it’ focus can become even more dangerous for all that.
In stead of asking ‘how do we stop it,’ and feeding into the idea that self-injury is among the worst or most dangerous things anyone could do, why not instead ask:
* How is this working for you?
* Is it something you want to change or stop?
* How has it helped you in the past, and is it still serving that purpose?
* Have you experienced negative consequences as a result?
* What does self-injury mean to you/in your life?
* If it’s something you want to continue, do you want support to explore ways to do it in the safest manner possible?
Approaching the topic as if it’s something already understood and simply to be controlled is a mistake, and a dangerous one at that. We’ll get much further by being willing to sit in the muck with people who are struggling, and being willing to support them to explore and making meaning for themselves. Having other people tell you what is ‘wrong’ with you and what you need to do about it is a profound loss of power and control. The sitting in the muck and partnering to explore is the place where some ground can be regained in that regard, and where we can find points of collaboration in supporting people to live their lives to the fullest.
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I find this article troubling, and this line gets at why:
“Peer specialists are defined as those who self-identify as having a mental illness or receiving mental health services and combine their personal experience with training to support others.”
Defined by *who*? That’s just wildly inaccurate, and yet seems to be getting offered here not by the research, but by you, Gavin, as a factual definition.
People in peer roles neither need self-identify as having a ‘mental illness,’ nor be receiving mental health services. To suggest otherwise is to contribute to the worst, most oppressive aspects of this work… those that involve buying into a one-size-fits-all medicalized perspective, and the idea that we all need to be put in these awful little boxes.
There are certain elements of ‘peer support’ that are really problematic as currently (and likely ever to be) employed by the ‘system.’ But there are certain aspects of it that are also quite powerful, particularly when offered outside of a conventional clinical environment. In those spaces where there is power, people get to come with whatever experiences have interrupted their lives or led society to ‘other’ and ostracize them… They often do come with experiences with system responses (many of them – though not all – harmful), and some identify as ‘survivors’ of that system… But there is neither a requirement to be *in* services, nor to regard any current or past history with those services as a necessary thing.
Please don’t contribute to boxing us in. Some of us are doing our very best to come at all this from an anti-oppression, rooted-in-community sort of way and this frame doesn’t help.
-Sera
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Oof. I am having a really hard time with this article being posted in this space. It does not align with the ‘Science, psychiatry, social justice’ tagline at all. Well, maybe the middle (psychiatry) part… Nor does it align with my understanding of the mission of Mad in America overall.
That aside… Max… You literally refer to people in this article as ‘V-SPMI’… And you write it out so that the acronym is OUTside of the parenthesis and the actual explanation of what it stands for IN the parenthesis. In other words, you use V-SPMI as if it is a legitimate word and thing to be boiling human beings down into.
It is NOT a legitimate thing to boil people down into. It’s just not. It’s frightening, and unnecessary to speak about human beings as these objectified, dangerous things. Now, this isn’t to say that this is the biggest problem with what you’ve written here. But that that is your starting point is very telling, and it makes me want to talk to you about internalized oppression, and the dangers of painting a whole group of people who can be so subjectively diagnosed as ‘dangerous,’ and so much else.
This piece is SO problematic. I hope there are people in your life who can help you unpack all of this at some point, and hopefully come to a different place. I’m not talking about trying to take away what you feel is helpful for you. That’s for you to decide… But this message you are putting out to the world is dangerous.
-Sera
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rasselas,
Eh, my point wasn’t so much how great Open Dialogue is, as it was that there are some fundamental differences in power imbalances there between Dr. and non-Dr that I think are interesting and worth exploring. I do talk about Open Dialogue a fair amount because it has good examples of a lot of principles and values… Such as seeing the problem as existing in the space *between* people even if its most visible in *one* person. I love that simply because it is about not automatically medicalizing every bit of distress and knowing that it is often a product of relationships and environments. There’s also the reality that people are available right away rather than after a wait, and that the structure of their system (which is the whole system and not just a hard-to-access alternative to the system in that particular part of Finland) engenders enough trust that many people reach out at the start of their struggles rather than trying everything to avoid it until things get worse and worse. There’s also the approach to psych drugs which leads to no automatic assumption that everyone needs to be on them at all, or that – if they do use them – that it can be just short-term (and short-term can be defined as as short as a few weeks rather than a year or two)… as well as the fact that sleep meds are among those most commonly prescribed because there is a fundamental understanding there about how much meeting basic needs (like sleep, etc.) can lead to distress in a way that is pretty absent here. There’s also the principle about having discussions *in front of someone* rather than in a back room behind their back, and that two clinicians take part in the support rather than just one to facilitate that process… And that – because its recognized that problems lie in the spaces ‘between people’ – the presence a family network (with ‘family’ defined by the person and including whoever they think makes sense including employers, neighbors, whoever) to work through things.
In essence, it’s less a magical thing you ‘do’ to anyone, and more a process of building trust and recognizing that someone’s distress is often the product of what is going on outside of them rather than within. But I am not intensively trained… I’m mainly relaying what I’ve come to understand from other sources, and what I usually highlight when facilitating trainings myself because it represents so many fundamental shifts from how most places respond to people.
AND I’m absolutely not someone who says ‘Open Dialogue’ is the answer to all… It has its downsides, too, and is nearly impossible to replicate in many other areas no matter how hard people try because the trust that has been built by constructing a system that holds these principles is a totally different experience than an alternative offering that represents a little pin drop within a system that runs counter to them (among other challenges around differences in liability issues and perceptions related to psych drug prescriptions and so on).
But again, I really mainly brought it up because the massive power imbalance that exists between those called Dr. and those not isn’t true in every area, even where medical systems still exist (most of Open Dialogue is facilitated by nurses after all). And I think we’d do well to look at how to begin reducing those massive power differentials with the tools available to us as a sort of harm reduction approach. Looking at the honorific system is but one way, but I think it’s an important one because its free, and because training people every single day to call a certain set of people ‘Dr.’ absolutely and totally influences how automatically reverent they may be to them. I see this playing out all the time even where a Dr. is considered an employee of an organization that technically has more power (hire/fire, etc.) but still bends to the Dr. on a daily basis and without question even when what the Dr. is doing is blatantly abusive and/or misguided.
-Sera
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rasselas.redux,
Thanks for your post. And yes, there is a power imbalance. However, in many regards, it is a misplaced one. As I noted in the piece above, the medical doctors (and frankly, doctors of other types as well) often spend the least time with someone, and yet have the most power over them.
I am curious if you’ve seen Daniel Mackler’s Open Dialogue film? In it, one of the things they emphasize is how the medical doctors do NOT function with such a power imbalance over others on the team. I’m actually uncertain whether or not they are referred to as Dr. Last-name while everyone else is referred to by their first name… But I’m going to find out.
My point in bringing it up, though, is that the power imbalance needn’t be so great, and we needn’t be complicit in it. I do hear you on the added confusion of so many people getting to call themselves Dr. Last-name above and beyond medical doctors… But I think it’s an issue across the board.
Thanks,
Sera
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I guess I was mostly responding to your assertion that you don’t think this conversation belongs on Mad in America in my response, JanCarol!
Thanks,
Sera
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Whatuser,
I’m not sure if you’ve read any of my other writing on here. I certainly don’t expect you to necessarily have! I just wonder because I have certainly focused at length on the misplaced medicalization and oppressive nature of the psychiatric system in many different ways. That said, the honorific system and the power imbalances that it makes visible play a role in that, and so I don’t think this is irrelevant. Rather, I would say that this is one of the quickest, easiest ways we could begin to dismantle those power imbalances and show our commitment to undoing the larger problems. I would also echo what Steve has said above.
Thanks,
Sera
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Whatuser,
I’m honestly perplexed by how stuck on wanting to ‘honor’ the efforts of a particular sub-set of people you and others seem to be. No one – myself included – has suggested that there isn’t a lot of work involved in getting through a particular degree program. However, do you really believe that that effort is consistently greater than, say, the effort put in by so many people doing so many things? Ableist ideals about basing our worth in what we can ‘do’ aside, are there not many people working very hard in this world? Perhaps even more importantly, does the salary afforded to many people with the honorific of Dr. not suffice in terms of recognition and honor? I realize that salaries will vary among the doctorate crowd, but really… So many of them (according to research) come from money and go no to careers that earn them much higher salaries than most of us… Is that not enough?
Let me put it this way: Let’s say I’m wrong, or at least exaggerating the impact of a system that elevates the title (not just in work but across all areas of life) of someone who has earned the honorific of Dr. in terms of power imbalances and the systemic oppression of others… What on earth harm would be doing by getting rid of that system? At worst, the action would be neutral. (No one has been able to provide an even vaguely convincing argument that the actual earning of the degree, the salary that tends to follow, and one’s ability to hold an actual doctor-related role is not enough to ‘honor’ and ‘recognize’ their efforts, with the exception of those who’ve argued its important *within the current context* for people from marginalized groups to claim their titles as an anti-racist, anti-sexist, etc. act… But again, that’s within the context of the existence of the honorific system, and not its having been dismantled…) At best, it would be a concretely attainable step toward undoing oppressive power imbalances that elevate the voices of those who’ve completed academic learning so far over and above those who actually work more directly/frequently with the humans over whom that power is most regularly wielded, etc.
Plus all the other things I’ve said in my other comment responses…
-Sera
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Jancarol,
This isn’t a “zero sum game” as some like to say. We can care about things like hunger and housing, and *also* care about how deep the power imbalances run in some of these systems. Of course doing away with honorifics isn’t nearly so important as doing away with lack of food and housing resources. But why would that preclude us from talking about honorifics? It kind of feels like a strawman argument to me… this suggestion that that is any kind of counter argument to what I’ve offered, rather than a different argument altogether.
Some questions for you:
1. Is there really no other way to communicate who has completed a type of education or holds a license for a particular role beyond honorifics? This also seems like a strawman to me… I never said people should deny or hide their roles… just not be referred to in all aspects of life by that role (even when they’re not doing anything even a bit related to it!).
2. Do you truly believe that any honorific is actually needed, and if so why? What do you think the honorifics really accomplish?
3. Do you know of any other completely free and widely accessible way to begin to chip away at the power imbalance between ‘Dr’ and the rest of us?
4. Maybe you think that the power imbalance the honorifics represent (both in access to education and in credibility/power in the moment)… but then, what harm would it cause to do away with them nonetheless? If they do no harm, still no harm done by not having them…
Your stories are valid, but I’m unclear how they support an argument to continue the use of honorifics. Much of what you talk about references the inequity to access to education, and as I said in the piece above and in the comments section, within the context that currently exists it may indeed be extra important for people who overcame marginalization to get their degrees and thus represent that by use of honorifics. But would it be important to have a different title if the honorific system was not what it currently was? Because *that* is my argument. That the honorific system is a part of an oppressive system and should be done away with, which would change a lot of the other pieces. People could still get their ‘pieces of paper,’ and have and speak about their jobs… no honorifics would not change that. But it would immediately change how elevated they are above so many others who have also worked very hard in their lives.
I said this in the comments section over on Mad in America’s Facebook page, and I’ll repeat it here:
Oh what a world we would have if we could manage to find ways to recognize and celebrate each other’s accomplishments without needing to step on others to do so…
-Sera
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John,
May your fantasy bear fruit some day :p 🙂
-Sera
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Fiachra,
I tend to focus most of my critiques on the system that drives, pushes, and pulls all the roles within it rather than the individuals within it, but I hear you. A ton of harm is for sure being caused.
Thank you for reading and commenting!
-Sera
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Willowweed,
“Evidence, data and logic should be the basis of an opinion not the perceived “authority of the speaker””
I certainly agree with this… though I’d also argue that ‘evidence’ itself is so often manipulated and/or rooted in a system that privileges those with a lot of money (to pay to gather and interpret the evidence) that I feel cautious about that piece as well!
Thanks for reading and commenting 🙂
-Sera
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Bippyone,
At least in part, I would respond by saying much of what I already wrote out to Marie… Just because it has not impacted you, does not negate the issue at a systemic level. I guess I also find myself reacting to the idea of ‘politeness’ in this context. As someone who has watched quite up close and personal hospital staff (for example) bowing to the ones with Dr. titles at the expense of some of the most vulnerable held on those units I feel really clear that the power imbalance tipping so strongly in their direction is incredibly harmful. I do not owe them any extra reverence or politeness over and above what I would offer anyone else. I would also point to the paragraph where I wrote about people with Dr. Last-name titles often being the ones who don’t show up for new learning and whose power over people is most inversely related to their knowledge of them as an example of how off kilter it all can get. And while – as I’ve said in other comments – the use of the honorific is not responsible for all that, it is a really visible symbol of it and the easiest starting point for things to change. Honestly, I find it bizarre that so many people are resistant to the idea that doctors deserve no more reverence than so many others in our world, and that it is essential that we begin to chip away at the imbalances.
Thanks for reading and commenting!
-Sera
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Someone Else,
I was mostly trying to refer to the price of higher education with my ‘bought’ reference, but I hear you on the stolen part. That makes sense, as well.
Thanks for reading and commenting 🙂
-Sera
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Rebel,
I would certainly agree with you that the whole educational system creates a great deal of inequity. As far as I’ve understood, countries that have free ‘higher’ education have significantly less class differences throughout their culture and that seems like a good thing… but it’s certainly not where we’re at in the US.
Thanks for reading and taking the time to comment. 🙂
-Sera
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