Mental Illness: If you have a question ask the expert.
Child abuse, trauma and its effect on children are issues I have worked with for decades. Because of my own experience with child abuse I have always approached my work with a great deal of empathy.
I have dedicated my life’s career to working with victims compassionately. My interest in working in this field is obvious. The focus of my work became incidentally that of educating the community and my colleagues about the reality of child abuse and the understandable challenges faced when working with victims.
What I experienced throughout the years is that there is still a skepticisms and blame factor when dealing with people living with mental dis-ease. Whether working with or observing social workers or clinicians, I have found that too many of them become frustrated and give the patient the message that they should just “get over it” or that "it was in the past and it’s time to move on”.
I have worked with clients who found themselves homeless, addicted to drugs and/or committing crimes, issues that are usually treated on the surface. The homeless are assisted in getting an income and subsidized housing, the addicted clients are sent to “rehabilitation”, the ones committing crimes are arrested, given the punishment of doing time, and we consider it a job well done.
While the presenting issues need to be addressed, I have seen very little effort to look into what is really going on with this person. There might be some admission that these individuals “may” have some mental health issues but perhaps if we help them with the presenting (crises) problem, they will appreciate our efforts and do better. The rate of recidivism that I alone have witnessed tells me this is not the answer.
There is a common phrase that states that the “definition of insanity is doing the same thing over and over and expecting a different result”. I suggest that the system is approaching some of these issues in the same manner and expecting a different "outcome". Millions of dollars are spent for social services that seem to make no difference in the number of people presenting with these "unacceptable" behaviors and conditions.
I contend that we are not only asking the wrong question but the wrong “expert”. We in this field tend to observe unacceptable or “abnormal” behavior and we try to figure out what is wrong with this person. We sometimes go as far as blaming it on “up bringing”, anti-socialism, race or lack of education. Some of these factors may have some relevance but can’t be the only reason for the epidemic we are witnessing in our society.
Instead of asking, “What is wrong with this person?” we should be asking, “what HAPPENED to this person?” Additionally, we should not be rushing over to the hundreds of books and articles written for all the answers. We should be asking the client.
That person’s reality is individually unique and thus different from ours. As clinicians I believe that we are doing the client a disservice when we insist that we know better than they.
Modern society has indeed progressed immensely in its treatment of mental illness. Other than the use of drugs to subdue the mentally ill, gone are the days of chaining them in dungeons, performing lobotomies, isolating them in padded cells (for the most part) and using strait-jackets unless absolutely necessary. These measures of course are archaic and were born of the “dark ages”(1600 B.P. – 100B.P.), a “post-Christian” age where thoughts of demonic possession and the evil prompted such protection from these patients. Let us also not forget the “witch hunting” era. Ironically, I found in my research that people’s reaction before modern times was like today fueled by fear and accusations of evil (in essence blaming the victim).
I found one such report that stated; Documentary evidence exists (Bromberg, 1963) that some 3400 years ago Hindu physicians prescribed “kindness and consideration” in alleviating mental suffering, and appears to have been somewhat ahead of the Greeks in the form of Thales, who some 1000 years later, appeared to have introduced the idea that natural forces and not only supernatural or magic forces played a role in the world. Healing practices thus became inspired by a balance of rationalism and supernaturalism. The rationalism was as important in that for the first time a scientific spirit was brought into mental treatment (Bromberg, 1975).
“Kindness and consideration” was actually considered best practice some 3400 years ago. I am not insinuating that mental health practitioners do not treat patients with compassion and kindness but considering the perspective of the patient seems to be limited. Some tolerate the behaviors but it soon begins to wear on these practitioners I have observed, and they are then back to suggesting that individuals move on and stop using their past as an excuse for their behavior.
As soon as a person acts in a reasonable manner, there is no issue. If they are taking their medication and being a “good” patient all is well. Too many times they are pitied, infantilized and/or simply tolerated.
If they are not behaving in a reasonable manner (acting out) then they are considered resisting treatment. I ask, what exactly is “reasonable”? We know that the brain is a marvelous organ that files experiences for later use and when confronted with a similar situation, pulls the file out and links them together experientially. This tells me that if a person is abused by one they once trusted, they will react with distrust when we approach them. This even when we “assure them” that they can trust us. Their distrust is certainly a reasonable reaction in my opinion. However, we become inpatient with the individual and run back to our books to figure out “what’s wrong with this person”.
If they are in crisis, we call the crisis team who comes and determining that they are “not rational” and can possibly be a danger to self or others, whisk them away (by force some times). A person who has suffered physical assault or has been made to do something they do not want or as a child been locked in a closet, let us say, may absolutely react aggressively in the attempt to protect themselves. If they are in fact going back to those “files” in the mind that recognize the present reality as one that feels similar to a past trauma, one can pressume that the individual's “reaction” is reasonable. Yes, there are psychotic breaks where the patient can become aggressive without a trigger. The incidents of events I've observed where the situation is escalated due to the “reaction” of the social worker/clinician far out weigh those random few I've seen.
So, why can’t we get it right? Why is mental illness so hard to “heal” without the use of medication? I would suggest it is because of the stigma and mysticism we continue to perpetuate in this country.
We minimize the effects of trauma and abuse by labeling it depression. Moreover, unless the person presents with problematic behaviors we look no further to see that there may be some significant psychosis going on. We are much more aggressive with diagnosis such as Bi-Polar disorder, PTSD, ADHD or DID. I wonder what most believe cause some of these diagnosis?
A chemical imbalance is often determined but what caused the chemical imbalance? If for instance a woman who has a productive life, is a professional and suddenly after a family “event” begins to have panic attacks, lost of appetite and insomnia, is it enough to diagnose her with “clinical depression”, give her some anti-depressants and call it a day?
This particular woman had a challenging situation years later and again starts having anxiety attacks. A new therapist looking further realizes that she has PTSD and her “depressive” reactions to these incidents are attributed to the Post Traumatic effects of childhood events. Again, no one ever asked “what happened to her?”. They simply heard a list of symptoms and provided a pill that would "make it go away".
I mentioned earlier that part of the problem is our society’s perpetuation of a stigma attached to mental illness and a mysticism of the same. We can see this in our books and media all the time. In fact, a recently released movie demonstrates this ongoing portrayal of those that have a mental illness. The Roommate (2011) may make for great entertainment but it again depicts this woman as having a troubled past and becoming some homicidal maniac.
We have many examples of movies that portray the character with mental illness as dangerous and homicidal. I have done some work with individuals living with DID and have a couple of dear friends living with this diagnosis. I recall one of my friends asking me why movies that address multiple personality disorder (MPD) always make the person a violent or dangerous person. Good question! Some other examples are: Primal Fear, American Psycho and the classic...Psycho.
I am not suggesting that there are not cases of individuals with DID having an alter, inner self, “little”, that may be aggressive or combative but the portrayal of such extremes only helps to instill fear in this society.
I write this all to implore clinicians as well as “lay people” to educate themselves on mental illness and if you need to understand further what any one individual is experiencing, ask THEM. A sincere and kind approach to seeking to understand will only enhance your "expertise” and help dispel the myths that are rampant in our society.
By Evelyn Rivera Beaudreault (C) Copyright 6/28/2011