I have not found that book learning and on-the-job-training gave me the tools I needed to understand and help people. Instead I have had to use experience, curiosity, and following my own spirit or moral compass. Now, I think this is largely because I didn’t understand the realities of black market America with compassion. Without understanding the rules, the pros the cons and the oppression that results from the crime industry it can be hard to provide the necessary empathy and validation to establish connection and be supportive. Because I didn’t get that training in school, I have had to undergo a journey to learn to be helpful.
Early in my career as a social worker, I couldn’t even see the phenomenon of mental health warehousing let alone know how address the issue in a relationship. My college texts had promoted the mainstream eugenic presumptions associated with mental illness. I didn’t know what was needed to recover from things like psychosis, personality disorders, or addictions and live a fulfilling life other than to tell the client to take their medication.
Now, in my twenty-three years of experience working in the system, I have seen many other workers not really learn about the effects of mental health warehousing. It’s as if those of us who work in the field slept during social psychology lessons of Stanley Milligram and the Stanford Prison Experiments. And many of us who do understand the dehumanization process associated with warehousing may abandon the work for private practice. It’d nice it they left a little space in their practice for warehoused individuals. Perhaps some do.
Believe me, I never imagined that mental health warehousing would happen to a conscientious person who excelled in the mental health professional like myself. I used to think I was empathetic towards clients because that’s what always impressed others about me. Now I think I was just sympathetic and encapsulated! Indeed, though it could happen to most us, we rarely think that way. When I did land in warehousing, it was a real education.
In Madness and Civilization, philosopher Michel Foucault has predicted a proliferation of madness as disparities increase and modern society advances. Indeed, with psychopharmacology industry booming, rates of addiction, fueled by the opioid epidemic, skyrocketing, terrorism wars raging abroad, ongoing drug wars afflicting low income neighborhoods, escalation in homeless encampments in major cities, and a rise in bullying in schools, and even cyberbullying, it really does seem like higher percentage of people have been forced to explore their mental health struggles. While mass shootings have kept danger stigma in the media high and the media response continues to reinforce silence about mental struggles, the field of psychotherapy does have a lot more trends to address.
When I look through my state’s psychotherapy association’s annual conference, I see many of these trends getting addressed in workshops. But ever invisible is the issue of psychosis. Is it possible that the issue of psychosis functions as a significant part of the madness narrative? Is it possible that psychosis too is affecting more and more Americans as Foucault inferred?
A Need for Providers who Specialize in “Psychosis.”
I was hired straight out of college into work in the counseling field. I started to work with an adult mental health population at my second professional job at the age of twenty-three. Since that time I have been increasingly focused on how to make therapeutic engagement meaningful when working with people in “psychosis.” In the field there are many who will say or imply this is not possible. They may argue that the mental health system is the best we can do. This story is for the providers who think more can be done to help individuals who have anomalous experiences.
Working my way through graduate school, I can still remember struggling to get my dumb-ass footings as a professional counselor. I remember thinking about how ironic it is that they start you out with the most sophisticated of problems.
“Oh, you’re good,” said this vagabond homeless man who sticks out in my memory.
Through a sea of tissues and a hacking cough, I scan Netflix pressing that stubborn button on my Roku remote multiple times. I read the summations of shows for several minutes until I come across a documentary called, the 13th. Finally, I settle in. Resting is not an easy thing to do with that constant sense of urgency I live with.
I don’t know what’s worse these days: dragging through a pre-holiday week on the outpatient psychiatric unit on Dayquil; or listening to the radio talk about impending loss as the new cabinet of Trump supporters get selected.
A cross town slog into East Oakland after work on the unit one night last week revealed once again that the streets are ever-burgeoning with homeless, some of whom I know intimately. In each car encampment, I saw a distinctive cultural story that needs to be heard.
Perhaps, early in my career as a mental health counselor, I couldn’t consider the effect of mental health warehousing. Landing my second professional job gave me the financial power to leave a ghetto apartment in the most murderous city on the East Coast. Since I was only just entering a Master’s Program, I felt extremely privileged. As a result, I aligned myself with my supervisor and other more experienced workers. Without credentials, I was focused on working with people who would get my back.
One day, I received a client and was ready to get to work on housing issues, when I found out that she came attached with a more experienced case manager. Though not very talkative, she did tell me very clearly that she did not want to go to a particular boarding home, the largest such facility in the county. When I talked to the case manager who would later be my supervisor when I got promoted, he was clear about the woman’s future. She had to go to the unwanted boarding home.
“Wow, that girl is really sick!” I heard the coworker who worked the graveyard shift at the crisis house say.
Back when I was just a yuppie, I learned a few points of wisdom about working through stigma. I needed mentors to help teach me how wrong stigma is. Now, I want to pay forward some of what I learned outside the class room to some mental health academics and administrators who may not have gotten the same lesson.
I was learning to chop cheese steaks at a Korean owned deli and instantly enamored with this mentor on the grill, Mister Ray Gee. The deli was located just across the river from downtown Philadelphia, in the North Camden ghetto. This Mister Ray and I were just meeting. We were both the same skin-and-bones size, our last names went together in rhyme, and any middle aged man who didn’t have a gut was an inspiration to me.
Mister Ray took one look at me and exclaimed in one breath, “Wow you are an Asshole! But don’t worry, it’s not your fault! You were just raised that way!”
I’d like to think that if therapists like me who have been farting around with psychotherapy for twenty years or so, might be able to improve the way counseling theory is taught in graduate school. Ideally, I would like to support the development of theory that address social ills. I have found myself feeling this way when I think of all the different misconceptions that I have endeavored in over the years. Now that I have established my niche and am advocating for new movements and theories that make most sense to me, I am finding myself wanting to help budding therapists learn how to conduct the art of psychotherapy in ways that help solve pressing issues, not just apply a scientifically proven technique or pass a test.
I think psychotherapy has made a break through to some extent that doesn’t get talked about. More and more theory is being constructed that help therapists solve problems rather than exhibiting panacea proclamations. I consider panacea theory to be what I was taught in graduate school: in its most postmodern form it includes narrative and solution focused therapies. Panacea theory was often remiss to really address social ills as they exists in agencies and on the ground. I think the onset of what I would call problem-centered approaches began with movements like DBT and Motivational Interviewing.
Problem-Focused Therapy instead of Panacea Therapy:
And I think if we look at what works about the problem-focused therapies that already exist, we can learn a lot about not only about how to solve real social problems, but also how to create theoretical elements that actually help teach other therapists in ways that enhance their art of psychotherapy.