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.

I went to work in a section eight housing project and alerted the press and challenged the police. A resident warned me to stop bucking the system, or the same thing could happen to me. He was right.

Now, seventeen years later, most of my clients live in warehoused conditions and need help adjusting to them. Many have lost family support and lived this way decades. Of course, I do what I can do to help them be free; but learning to do so has taken some time. For clinicians new to working with warehoused individuals, I have just five suggestions to make.

 One, don’t presume it is easy to leave these very real experiences behind:

Once subjected to warehouse conditions, people may have a need to honor their experience and have a hard time leaving the neglect behind. Many tolerate and honor things that don’t make sense to the observer. In fact, many observers might have a hard time believing that what warehoused individuals report is real.

How could it be, for example, that in the land of the free, that the only job that a privileged white man with a master’s degree and a beef with organized crime and the police could find was at an Italian Deli with a four-hour daily bike/train commute? It was not for lack of job applications or resumes, I assure you.

During a two-year period, I had to learn not to snitch. I had to accept that people were breaking into my apartment and stealing my things, just as they had done when I was warehoused three-months in the dilapidated Montana State Hospital. Maybe you can’t believe it possible until it’s happened to you!

For people like me, it can take years of revolving door hospitalizations to get to the place where they accept warehouse living to start with. Then, to move on can be a lot for the ego to manage. It is hard to say all the warped things they learned from their experiences in incarceration were unnecessary. It is hard to abandon the post because, often, warehoused people know first-hand that things could be worse.

Two, don’t presume that you could get out of the very real holes they are in:

In working with warehoused people, it is important to temper the amount of advice you give them about how to be empowered in their situation. Just because you have power, doesn’t mean that they do. Thinking that they don’t know how to assert themselves is a good way to diminish the amount of trust that develops.

I have seen clinicians burn out because their advice is never heeded. Maybe they leave behind their duties physically or emotionally because they don’t believe the oppression is real. Many clients have seen this happen repeatedly. Here comes another staff person they are responsible for training. Now, they start from scratch, just so they can get their weekly check.

No matter how seasoned you are, it is always wise to be thankful when your client teaches you something that deepens your understanding of the layers of oppression they face.

Many workers may not realize that they couldn’t manage themselves what they are presuming their clients ought to.

Many clients, like the section eight resident who tried to warn me, know better than to try to fight the system politically. They will see advice or action towards that end as simply being naïve and insulting. Really, they usually know what’s up! Respecting the power structure but talking about how oppressive it is may help.

Three, find ways to address the fact that you are financially exploiting them in the context of the relationship:

Many would say it is cynical to look at the mental health industry and say that there is a lot of money reinforcing the suppression of its subjects into mental house warehousing. Seeing the mental health industry from this vantage point makes it seem like it is a plantation industry with finely educated suits with six figure salaries making decisions about how to keep the peasants maintained.

Clearly, not all the people I work with see managing the trauma and strife in their lives from so cynical a perspective. Still, I believe a therapist who works with people who have been warehoused needs to be prepared to work through these realities and feelings as they get unpeeled in the relationship. At times, I have found that it is important to argue the cynical perspective to help people become sensitive to how being warehoused has impacted them. It may be necessary to help people see and remember the value that they really have. This may help reinforce social rehabilitation.

Many warehoused people will appreciate it when you acknowledge your buzzard role in nickel and diming them and picking through their bones. At least talking about it will help them know you will do what you can not to get caught up in that trajectory.

Although I was only warehoused for a short time, the therapy I got at 125$ an hour while I was making 9$ an hour at a Deli seemed ridiculous. Talk about financial exploitation—for years it was. My parents mandated it and paid for it from a nest egg, but would not give me money for a car.

 Four, know that therapy is still valuable and walk the line:

In retrospect, and knowing the business as I now do, I am just grateful that my therapist did not refer me back to the hospital so that I lost my job and my apartment. If I had seen an intern who wasn’t making top dollar, I likely would have overwhelmed them and their supervisor and been incarcerated back in the system where it would have taken me much longer to heal.

Having a therapist for warehoused individuals is important even if they don’t seem to like you. And good clinicians need to be tolerant, competent with what they are dealing with, and maintain unconditional positive regard.

Supporting your partners is ways that help them make well thought out slightly empowered improvements in their interpersonal situation is possible. In doing this, it is important not to act as if you know, but to collect a lot of information about the barriers in the situation with curiosity.

I think good therapy advances the mindset that it is possible to help warehoused individuals pursue healthy integrated activities that can mitigate the effects of warehousing. That is what I did maintaining a job. Many amazing people have taught me that a bed in a warehouse is just what it is. One can still do their hygiene up and go out and find healthy activities and connections. I now see and support people doing this every day.

Five, help!

And yet when I look at the workshops available to me as a licensed individual, there is little out there in my trade organization that encourages therapists to learn to work with these conditions and limitations.

I wish that more therapists would learn to specialize in helping warehoused individuals. For practitioners who care about social justice, there really is no better way to be of service in the community than to develop specialty practices that can reach out and include such individuals.

Currently we know this population growing exponentially in our local homeless encampments, our flooded shelters, our barrack-like board and care homes, our county jails and over-crowded prisons. Know people can recover and gain back their freedom! Help!

The post How to Work with Issues of Mental Health Warehousing as a Professional appeared first on Redefining "Psychosis".

Perhaps one of the greatest ways to oppress a people is to convince them that they don’t exist.

In America, this is what many people who have experienced psychosis face in standard treatment.  In the absence of a sense of a supportive and functioning self-support community, many who have experienced psychosis don’t feel we belong to a rich, interesting, and meaningful culture.

Consider all the categories that the DSM V has that includes the phenomenon of psychosis. I have collected a rough list below:

Schizophrenia
Catatonia
Schizophrenia Spectrum and other psychotic disorder
Brief Psychotic Disorder
Schizophreniform Disorder
Delusional Disorder
Shared Psychotic Disorder
 Attenuated psychosis syndrome 
Psychotic Disorder NOS
Schizotypal personality disorder
Psychotic Disorder due to a medical condition (many)
Schizoaffective Disorder
Bipolar with psychotic features
Depression with psychotic features
PTSD
Disassociative Identity Disorder
All Substance Induced Psychotic Disorders (ten different types)
Dementia of the Alzheimer’s type with early onset with delusions
Dementia of the Alzheimer’s type with late onset with delusions
Vascular Dementia with Delusions
Postpartum psychosis

Above, the construction of tall differentiated towers of illness, often grow taller and more isolated in the current system of care. Most provider-folks who use these words to bill would not want to be faced with the limited life they envision for their clients.

The concept of illness is so embedded in our system of care that we don’t often consider that we are treating peoples as though they are not just irreparably sick or ill, but uniquely so.  We don’t think that when we go to work we are systematically attacking a history, and imposing eugenic concepts. And people in America are so quick to attach eugenics with people who enter psychosis, that many of us deemed ill learn to believe that we deserve no companionship.

Divided by labels, many of us who experience psychosis turn inward and our fight against the world intensifies. Indeed, the poverty, neglect, and deprivation of institutional living can be quite extraordinary. It can result in tremendous trauma and damage.

Still, the bulk of treatment, money and current policy is focused on incarceration, forced medication and facilitating marginalization into socially controlled environments.  All this for the sake of suppressing rather than accepting associated experiences. I am writing to contend that ultimately suppression alone is a treatment concept that just doesn’t work!

Some fight against psychiatric oppression by differentiating some individuals into a spiritual emergence narrative. This well may be true! However, I believe that this spiritual emergence narrative is true for all who experience psychosis. Perhaps some of us just need training.

That is precisely why those, like me, who are afflicted with negative experiences need to learn to work together with those who experience what might seem like overly positive experiences. I have found that this is a much better way to support those suffering. At least treating it as a culture teaches us to be curious about ourselves. Treatment needs to refer sufferers to a group that is full of peers who have learned a bit about their culture of psychosis, accepted it, and resumed their place in society, penetrating cultural enclaves and utilizing multi-cultural skills.

Contrast this vision, to the most common intervention, those famous five words: “Did you take your medication?”

Thus, I contend that in America’s history, those who have experienced psychosis join many marginalized groups who are treated as though they are a threat to the status quo.

I ask: does dividing psychosis up into a variety of medical illnesses translate into denying sufferers a voice in clinical settings? Does it function as a legitimized form political abuse? Is it any different than a counterintelligence campaign aimed at squashing a grass-roots social movement? Are we torturing our spiritual healers instead of giving them meaningful work?

In twenty years work as a provider in mental health I have seen providers, even highly trained ones, believe that letting a person talk about delusions or hallucinations will only reinforce them. Thus, groups without the influence of the Hearing Voices Movement are often run according to the norms of the provider culture. There is no consideration for the wisdom that lies within something that sounds different.

Sadly, no treatment has ever been made that encourages co-exploration of what is inside the rabbit-hole. Treatment successes may sashay around with the Normals bearing painful and unspoken secrets. The privileged may end up insulated and hermetic in a back room; the abandoned, enduring impoverished circumstances on the street; and the majority, going from the hospital to oppressive institutional circumstances, with stints on the street or in jail.

Instead, of learning to work together, we are taught and perhaps programmed to turn our hate on each other and fight like screaming crabs in a pot of boiling water.

In our distant history, message receivers have played important roles in society.  It is arguable that before the foundations of the modern world, we were spiritual healers in our community.

Many of us face great genocidal dilemmas internally and have faced enormous apocalyptic tragedies, evil, and spiritual guidance.  In this era of environmental petulance, spiritual warfare, immigration exodus, racist drug laws, heightening class divide, and massive denial about who really rules the government, isn’t it time to create a sub culture that can stand on its own two feet and get past the medicalized oppression that has it marginalized and going from the streets to the institutions for so many years?

The post Reconstructing a Culture of Psychosis Across Diagnostic Divides appeared first on Redefining "Psychosis".