This post is a critique of mainstream mental health and what can be done to improve it.
Apologies upfront; this is a soapbox rant. I’ve worked in the mainstream mental health field and it’s appallingly bad. I’ll tell you why.
First it might be helpful if you know a bit about me.
I worked for thirteen years at the Behavioral Health Clinic of our local hospital until 2013 when I retired. Actually the new CEO made hospital-wide cutbacks – and I was one of them. But I was 69 years old and it was time to leave.
Now I could relax into the home based counseling practice my wife Amy and I now have.
I have no degrees and no university training, except for one psychology semester, which explained to me why this field was rotten to the core.
I understood why Dr. Roger Callahan, the founder of Thought Field Therapy said that it was much easier for him to teach those who were untrained in mental health than professional mental health practitioners.
That semester deserves an article of its own.
I am an ‘alternative’ therapist/healer, and here I am in a ‘mainstream’ Behavioral Health Clinic.
How did I pull it off?
Well, they had an opening for a psycho-social rehabilitation instructor. Fancy name for someone who will play dominoes with the mentally challenged. All it needed was a high school diploma which my boarding school back in England provided.
I was in!
I had wanted to see how mainstream mental health worked. It had been heavily maligned, in the alternative training I’d had: shock treatment, mind destroying drugs and lobotomies – all bad.
The therapists were all women, and all social workers. In New Mexico social workers can do therapy which has driven out the more expensive training in psychology. Social work is about helping a person get on in the world around them. Psychology is about getting on in your own internal world. Two different things.
Oh well, who cares, I’m in.
My clinical boss is Dr. T. a man about my own age -a psychologist. Despite disagreeing on most things we got on well. Age, gender, our appreciation of each other’s intelligence, and my willingness to be submissive to his decisions allowed us to be good friends for the many years we worked together.
My relationship with the female social workers was trickier to maintain. A mixed bunch, some fresh out of university, some old and cynical. With all I played it cool, made connections where I could, always calm and agreeable with a cultivated pose of bland indifference. I was the odd one out. Had to play it safe to survive.
Only when I got home could I vent my outrage to Amy.
Therapeutic techniques aside there are important fundamental differences between alternative and mainstream mental health. Of course I am generalizing here. There are great and lousy therapists in both fields. The alternative viewpoint is well defined by the anti-psychiatry movement. But anti-psychiatry is a lousy term, it’s entirely negative. What are you for? What is the alternative?
None of the social workers at the clinic had heard of anti-psychiatry. They are taught a narrow, uniform, standardized curriculum. This disallows critical thinking but makes for a standardized product. A treatment plan, for example, will look the same from one social worker to the next. Like a field of genetically modified corn.
This is how it works:
1. Intake Assessment.
3. Treatment Plan.
4. Drugs and therapy.
5. 30 minute sessions to check on your compliance and progress.
You are sent to someone you’ve never seen before and for 90 minutes they ask you questions about your private life. Drugs you’ve taken, sexual history, childhood abuse. Things you wouldn’t normally tell a stranger.
That is interrogation. It’s coercive. You don’t have the choice to say “I don’t want to answer that question.” They’ll tell you they need the information to make a diagnosis – so answer the question!
Now they tell you what’s wrong with you. They have to find something wrong with you, otherwise insurance won’t pay up. The diagnosis is a label and once that label is applied you’re stuck with it. It will never leave you because nobody cures anything in mainstream mental health.
The treatment plan lays out in excruciating detail the steps the social worker is going to take to make the patient normal again.
I wrote treatment plans as required but never followed them.
People are different from one day to the next.
I had a very simple approach. My overall goal for everyone who came to me for help was “Happy and healthy without the need for drugs”.
The one question I asked was: “How can I help you today?” and we’d take it from there.
No diagnosis, no invasive questions. If you don’t want to tell me something – don’t. It’s your session.
Drugs and therapy:
Drugs are always prescribed as the first action. Some patients refuse them. I’m not entirely against them. They can help to calm things down in an emergency, and the correct drug in the appropriate dose can help long term. But when someone comes to me staggering against the walls, drooling, and unable to speak clearly I suspect they’ve been over-medicated.
I prefer my clients on a minimum of medication. I want to see what’s really going on so I know if I can help. Mostly I can, and if I can’t then drugs might help.
That’s the sequence of events that indoctrinates the client into their role.
It took about a month for me to figure this relationship out: the relationship between therapist, provider, counselor and client, patient, consumer (take your pick).
It was this:
“You’re fucked up – I’m not. I know what’s best for you. This is for your own good. Do what I say.”
And when I told the social workers what I thought was going on they agreed. No sense of humor about it. No thought that maybe there’s something wrong about this approach.
“Yep. That’s pretty much how it works around here” They’d say.
It’s a benevolent paternalism at best. You could also say: Parent-child, master-slave, dommy-subby. Take your pick. Any way you look at it, if you need mental help, then somewhere in in your mind you feel you’ve failed, you’re broken, damaged goods – a loser. Whining and self-pity is all you’ve got going for you.
The goal in the clinic was always to have a ‘compliant’ patient. ‘Non-compliant’ meant you were troublesome.
I am so not that.
We’re all fucked up to one degree or another. Unless you’ve lived your life in a coma, you’ve experienced pains and losses and the unresolved memory of them colors your life today. They may not rise to the clinical definition of PTSD, but you would certainly be better off without that burden. And if you have spent your life in a coma, well that’s a trauma too.
We’re all somewhere on that scale. I am not better than you. We are equals in this game. I’ve just got a few tricks up my sleeve that could help us out of this mess.
I don’t know what’s best for you. That’s why I ask you what you want from me. Maybe I think it’s your stupid parents, but you want help with your stupid boyfriend. O.K. It’s your stupid boyfriend then.
I’m not the boss of you.
And if you sit there waiting for me to tell you what to do, think again. It takes both of us to get anything done. It’s like climbing a mountain and I’m your guide. You want to climb this mountain? O.K. this is how you do it; but don’t expect me to carry you.
I did best with the rebellious, obstinate non-compliant ones who refused to take their meds and pissed everyone off. There is some energy there I can work with.
But they are few and far between. By the time they get into the system any rebelliousness has been wrung out of them.
When I first got there I asked them what their cure rate was.
Even for cancer they have cure rates. Five year cancer free counts as a cure.
But no, I was told we were never allowed to use the “cure” word.
“Never” she replied.
“Because someone might get sick again and then they could sue us for saying we cured them.”
“Has that ever happened?”
“No, because we don’t cure patients, they can’t be cured; but their disease can be managed and sometimes they can even go into temporary remission.” She smiled.
Wow! That lets everyone off the hook. The bar is so low it’s a stick just lying there on the ground.
“So once a patient has been given a diagnosis they’re stuck with it for life?”
She looked at me like I was stupid: “It’s brain chemistry. Brain chemistry doesn’t just – go away.” She waved her hand in the air.
“But we’ve got some good drugs” she explained. “If they take their meds it can help. But I’m telling you, if you use the word “cure” you’ll be fired.”
After the 90 minute intake interrogation you get your diagnosis. The diagnosis is the final blow, the bullet to the brain, a life sentence. You’re no longer normal. You’re now a broken machine.
The diagnosis is a label, a label that obscures more than it clarifies.
I’ll give you some examples.
We had a woman who told us she was schizophrenic.
“Why?” I asked.
“Because I see colors around people.”
“That’s it? Because you see auras?”
“Yes, they said I was schizophrenic and now I’m on meds.”
An elderly woman is assigned a new doctor who she describes as “very brusque”. She’s asked what her major problem is: “depression” she replies. She is put on meds. Not a single question as to why she is depressed. No offer of help. Just drugs.
A client comes to me diagnosed with OCD (obsessive compulsive disorder). He can’t leave his house without checking that his doors are locked a dozen or more times.
I asked when this started.
“About three years ago.”
“What happened about three years ago?”
“I was robbed.”
We resolved the trauma. No more OCD. (I use the word “resolve” in place of the forbidden word “cure”.)
Stuff happens to all of us. We all suffer pain, losses, upsets, disappointments; all the events that travel with us and color who we are. Only if you lived your life in a coma would you be free of traumatic experiences. But then being in a coma is in itself a traumatic experience. And by traumatic I mean not just the clinical DSM diagnosis but anything that’s happened in your life that stlll haunts you, affects you adversely in any way.
E.G. “I’ll never forget that look she gave me.” That’s a trauma.
We’re all somewhere on that line from “mostly normal” to “really messed up”. And that allows me as the therapist to address my client as an equal. We work together to resolve painful memories. I’ve got some techniques that can help us do that. They’re pretty effective and I’ll explain everything we’re doing as we go along because this is something we do together. And maybe I’ve had some experiences something like what you’re suffering from, and I’ll share them with you, because we’re in this together and I’m not someone so much different from you.”
We laugh. I’d get comments on it.
“You’re always laughing with your patients.”
“Of course, when it’s gone, when the pain is gone – what else is there to do?”
Thanks for reading this. I feel a lot better. Now I can think about something else.