Coming Out Mad on a Medical Model Unit

Coming out Mad, as a professional with a Marriage and Family Therapy License has been a rocky journey over uncharted, and lawless terrain. I share my experience to help embolden others who have experienced trauma, stigma, and institutionalization to be mentally transparent and come out in an authentic manner in their therapy practice. I believe that the mental health field and the many who may feel stuck and ineffectual in it (both clients and providers) need us to do so badly. At the same time I  write with hopes that those who do so experience less pain and isolation than I have in the process. Although historically, people who have themselves suffered (From Freud to Fritz Perls to Marsha Linehan) have often proven key to improving care, the climate in many agencies in mental health arena, may not always support those who wish to do so.

Mad Rumors Leading to Secrets:

In the middle of my career, I was incarcerated in a border state hospital while trying to escape to Canada to seek asylum. In the years that followed, I was barely aware there was a survivor’s community, I was so busy scratching to survive in the economy to avoid more institutionalization.

Truthfully talking about what I had went through with anyone else during the licensing process just didn’t seem to make sense. When I initially failed at a three month trial period re-entering the clinical world after two and a half years of underemployment, those who either liked me or could sense my desperation, kept in touch by inviting me out even though I didn’t drink. Many let me know that the Mad rumor was circulating. The one professional I kept up with said she was glad when I landed on my feet. She would later admit she had been afraid I was going to end up living in a tent.

Instead of returning to homelessness, I got a solid part-time job on a medical model unit that could lead to more. I also participated in a therapy internship for Foster Care kids and went back to work at the Deli I had been underemployed in.  Every other week I got a half a day off.  At all three sites I started off fresh, knowing new people. I entirely faked it in all locations. Honesty and mental transparency had little to do with it.

Class Deficiency Leading to Silence:

Although I was successful at that first Foster Care internship (perhaps because I lived in a ghetto for six years and had street competency,) I got cut at years end by a doctor who I offended.  They didn’t tell me that they needed the ten loyal clients I built up for next years’ doctoral students. Instead the director let me know that I clearly came from a different class and was incompetent to associate with the rest of the staff because I was so ignorant as to call them by their first names. I should have known that the fact they called each other by their first names didn’t give me that same entitlement.

In selecting a new internship in order to get child and family hours, I did not think that transparency would pay. I was solidly surviving now. My sense that treatment involved a phony class divide was reinforced. So, I misrepresented myself in order to get hired. When asked a leading question by an interviewer who looked at my resume (and perhaps the color of my skin,) I contained the salty spite I felt.  I agreed that I was ready to come home to insulated suburban reality and start the real work.

Surviving Jim Crow Laws:

Though I now did not trust the agency in the least, internships were hard to come by. Still, when given an intake questionnaire which asked me if I’d ever had delusions, I argued with myself. The first internship had not asked. I knew for a fact that I was wrong about parts of my experiences.  But I still, to this day, have enough evidence to have a sense that I was a political prisoner.  I went through a true conspiracy. Because I knew not to argue in public that the FBI is in fact, the worst gang to accidentally mess with, I answered no.

Though I got strung along at that internship for four years, I knew I needed it to some degree. I had to take from the poor (from the ghettoized “mentally ill”) for a spell and donate my time to the rich like most Americans do. It wasn’t until I thoroughly studied for the New York State Exams, I learned that I wasn’t supposed to work more than forty hours a week in order to get my hours.

Learning about this was frustrating! Coming back from State Hospital, I couldn’t have gotten the hours any other way and still paid rent! Laws and education are not built to acknowledge or be fair to homeless, African Americans, mentally ill, Native Americans, single women with children, immigrants or poor people. Sure there are many other sub groups I could add to this list. What are the slew of us social deviants to do: sit in an institution the rest of our lives or find ways to overcome the Jim Crow laws that keep us down?

Opportunity to Come Out:

By the time I got to the point where my learning-disabled ass passed those sucker New York State Exams on the first try, I was getting to be pretty good at what I was doing at that medical model unit. At the suggestion of a new manager, I attended a WRAP group and carried out the necessary steps to bring the consumer-driven mode of therapy to the unit.

In my first visit to an introduction to WRAP group, I joined trainers and a local agency. I listened to a staff member talk specifically about the same border State Hospital I did my time in.  She acknowledged the whole place was so backwards that so many people checked in there and never came back the same.  Another person talked about a time he biked ten miles a day and upheld a job. My period of underemployment flashed in my mind when I was doing the same on a cheap bike. There I was sucked in, realizing that I was not alone. That day I spoke publicly about my story for the first time.

I also now had time to figure out the internet enough to learn about the National Empowerment Center and the work of Patricia Deegan. However, in starting up a group for “psychosis,” I decided to create my own.  I built the “psychosis” curriculum around the retelling of my story and I started to attract large numbers of clients.  Together we went through a semi-structured format that functioned as a learning process.  I noticed that convincing the group that I was for real and could relate to them caused many to open up and tell stories.  I noticed that this authentic experience caused many to be confronted with reality checks and to make monumental changes in their willingness to consider that they were, in fact, not alone.  Instead of denying that I was delusional, like I did at the internship, I found myself getting sucked in to conceptualizing ways that I did fit in with others who were delusional. Taking in more and more information caused me to restructure the way I presented the material.  I drafted and drafted.

During this time, participants on the medical model unit flocked to my groups.  The support was unrelenting.  However, I persisted in spite of a perceived sense of alienation by some cliques of disgruntled co-workers. One stole a copy of my developing curriculum and turned it in to a Manager expressing concerns about me. I went back to my poker face and pretended not to notice as I several times heard people refer to me as Crazy Clyde. I continued to be loving and out-work colleagues who toted stigmatic political cartoons on their desks.  I had only one co-worker acknowledge me, the middle manager who had encouraged me to pursue WRAP.  He let me know he knew and thought it was great.

Surviving Hostile Environments:

Though things were good, incidents of disrespect mounted. After three years, I thought I could do better. I jumped on a county pilot project in which I would supervise peer counselors and represent the peer support domain. I continued to run Mad groups and started the process of being openly Mad and out for two years. But this was a political quagmire.  People were very forthrightly attacking my credibility to an extent to where those little issues I had back on the medical model unit were rendered marginal in the mind.

Invited to come back to the Medical Model unit, though not without strain, I had a realization: not telling my colleagues openly and directly that I was Mad, had consequences. Sure I didn’t like that they called me Crazy Clyde, but not discussing it wasn’t working. I started to talk to people directly about my history and experience.  Sure I didn’t like the dirty looks, and the jokes but coming out Mad and proud was now the way to go.  I came out so frequently that it only took a couple of years for the team stop having it’s complicated issues with me. This time I had people who supported me; therefore it wasn’t so bad.  I am now supported by many co-workers who are willing to read my book.

Austin Powers, we’re really not that different, you and me!

And yet another part of me wonders if my professional survival is not really all that much different than it is for many others without a history of State Hospital incarceration and Madness, and a history of an eating disorder that led to ghetto marginalization. I still feel like I have done it all wrong, but I have done the best I could, accepting what lays before me in as spiritual a way as I could. I think as many therapists evolve into being authentic people they may grow to become less stigmatic, more transparent over time. It is my hope that others who have undergone a structure of education that seems devoid of personal exploration; or that seems created for people who are treated to it; may identify with my path. Treatment may be ruled by a class system that imposes mindless and unreal clinical boundaries, but not everyone falls for it. And now that I am a supervisor, I am learning that some (non APA accredited) schools (if you can afford them) even promote mental transparency and support those who don’t fit the standard mold.

To others who are currently mad, traumatized, and in a comeback zone dealing with stigmatic world of care providers and the degradation of the “mentally ill” keep up the good work. You are needed more than you imagine! And together, we can make it better!

Author: Tim Dreby

I am an award-winning author and practicing psychotherapist

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