Wow, Stacy, I am so honored by what you wrote. I am grateful for your rebellion and work as well. It is good to know others are out there working hard for improvements to care. You’re writing is very eloquent and you communicate the key to effective work so amazingly here. I think I needed to read this sooner than I did. It really is extremely supportive and helps me enormously. Thanks

I guess it’s always possible our efforts at connecting, respecting, and valuing people will ultimately go nowhere, but I have hope that as these ideas grow in pockets around the world, that they may eventually make a dent. Maybe it’s me being overly idealistic and naive? But I believe that in the short term, you and I (and the many other rebels) can have positive and meaningful connections with people even as they are stigmatized and dehumanized by others. And that those moments in which someone feels no judgment or urging to be different than they are and instead consist of humans being vulnerable and genuine, with all their flaws and their gifts, trying to understand each other — those are worth it regardless of whether the system at large is still crappy.

I noticed when working with you a few years back that your clients could tell you wanted to actually connect to them and that you valued their experiences and their perspective of the world. Seeing you convey a genuine belief in their value and the unique abilities they bring to the table that early in my career gave me hope that there were positive ways to connect to people even within a system that does’t encourage it.

Thank you for your thoughtful reply. It is good to be reminded that the medical model views were meant to be less stigmatizing.

What you’ve said help me reflect on the reality I encounter, that people become very unmotivated to be in relationship with others. It is easy to blame the medical model for that when really it is the fact that society doesn’t respect encourage or teach people to accept and be in relationship with people who are experiencing these things.

I feel the experiences have value and can help people contribute in unique ways, but too often people end up being so shamed they cannot share their experiences and thoughts with anyone. I tend to believe that the medical model makes people less communicative and makes people give up any hope for connection. It can justify poverty and warehousing. I tend to rebel against that.

My work is an attempt to create a more accurate picture that can promote inclusion, but ultimately I don’t know that it will get anywhere and if it does that it will not create new problems for people who are different.

I understand the desire to move away from the constant message from family, peers, and society that your suffering is because you aren’t trying hard enough, are too weak, or you’re exaggerating. But I don’t find the medical model less punishing or less invalidating— it just attacks from a different angle. Professionals tend to tell some version of the same story – due to your genes, your brain, or your brain chemicals, you had a biological propensity for mental illness and once diagnosed with this ‘disease’ you’re usually told it’s not curable (but manageable); you’ll probably need to be on medications and in treatment for the rest of your life, and may be limited in your functioning academically, occupationally, and socially. The medications they insist are necessary usually have side effects (ranging from uncomfortable to intolerable), but stopping them will result in relapse of symptoms and drop in functioning.

So instead of feeling your character being attacked (as lazy, weak or overdramatic), we switched to a model that can make you feel inherently flawed biologically. While the message may seem better because it appears on the surface to be less judgmental (ie. you can’t help it, it’s a brain disease), it carries with it a message that you couldn’t change it even if you wanted. It leaves people feeling helpless and hopeless, not wanting to try to recover because the professionals told them there’s no cure.

It’s not usually that the psychiatrists and other mental health professionals intend to convey hopelessness or think of what they do as inflicting punishment. It’s often well intended, with the desire to help. But our field is one with a bad track record of mistreating people while thinking that they are helping (forced institutionalization, solitary confinement, physical and chemical restraint, lobotomies, fever therapy, insulin/come therapy, electro shock therapy, etc). Most of the people implementing treatments that were later seen as barbaric thought they were helping. This does not inherently mean that current methods will follow the same pattern of later being viewed as barbaric, but it does suggest that your motivation being pure doesn’t protect you from causing more harm than good.

Your post is a good reminder that the perception of treatment from each side of the therapy couch can be extremely different. To lose sight of our impact (intentional or not) is to lose sight of the people we would like to help.