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26 Jan 2022

Category: Self HelpCategory Archives:

Recovery and self-Determination: being authentic with our mental health practices

The Fear 

When people carry a mental health diagnosis there is an almost constant fear of relapsing. Whether from a long-standing chronic condition or new diagnosis, the fear of symptoms re-activating or worsening, is a real problem for people who suffer from mental illness. 

Some common questions are: 

Will I always feel like this?.

What if my symptoms return?

When will I be recovered?

The Myth

First, let’s dispel a myth. People are in control of their health and healing. People are not a the disposal of their illnesses. Keep in mind you have complete control over your mental health and do not need to live in the fear of a lifetime of arbitrary and unexplainable turns in your daily health.

Despite what some people believe, mental health can be managed and maintained with some rhythm and predictability over the long term. There are contributing factors impacting our feelings and what we think, but these are just markers. 

Self-Determination

I believe in self-determination. For people to maintain their mental health, recognizing new symptoms when they activate and working on eliminating the impact of extraneous factors contributing to limited or poor mental health is truly a great place to start self-managing. Additionally, self-determination is the mobility needed to work on ourselves. With enough self-awareness, people will soon realize their strengths, as well as limitations, come from within. 

Sure, some people are put in impossible situations. Some are born into poverty, victimized, abused, and maltreated. Still, even in these circumstances, some rediscover resilience and make it, despite the seemingly disparate nature of their problems.

A Lifespan of illness: Chronicity

People fear relapsing. People, regardless of the success often lose sight of the bigger picture. For people in recovery, the road ahead can seem long. Seem long, and belong if your illness is chronic and likely long-term. For young and even middle-aged people a lifetime ahead can seem like a lot of work or too much effort to sustain long-term across the life span.

Maintaining good health will only make a living more manageable and tolerable in the long term. Creating and allowing for more solutions during difficult situations and making everything more manageable, aside from remembering this reasonable explanation for why people lose sight of their recovery plan.

Recovery plans, self-care, and being authentic with our health

Remember, rationalizing or discontinuing behaviors promoting healthier decision-making is a step back from acceptable self-management practices. Instead, consistently engage in everyday routines and self-care measures during the tenure of their illness. Due to several reasons. Sometimes people deem themselves as cured. People often encounter a seemingly impossible situation created by their negative behaviors as a result of playing out symptoms of a disorder.

Whatever the reason, there are many, almost infinite self-rationalizations people can manifest to discontinue critical self-care practices. Negative self-messages people create usually become cognitive distortions, seemingly real and authentic, but at the root of it, are untruths and outright lies your minds manifest. 

Self-CBT

Distortions are maladaptive, unhelpful, and sometimes frightening, and if we follow these negative thoughts to their horrific conclusion, they are disturbing to most of us from experiencing them. Self CBT, disputing and challenging these rationalizations every day, and when they first occur, will go a long way in sustaining your positive behaviors and persisting towards your goals for yourselves and good mental health.

Ultimately, when people are left to their devices, they set limits and create better solutions.  Life can sometimes seem like we are on a ride or just passengers in our lives. Driving your health forward at a rate and speed and course of your choice is the safest bet. I recommend allying with your therapist, treatment team, and close peers with a vested interest in your mental health, establishing a deep trust with those who have close personal contact with you every day.

In doing so, collaterals may detect an extreme and toxic abnormality in your health. Feel safe to take stock in their advice and concern very seriously. Sure, no clinician or friend can get a perfect read on our health. But for those of you without a great deal of self-awareness or drive to look after yourself, there are still options and strategies to stay healthy without relying entirely on your own devices. Indeed, not everyone cares enough about their health to self-monitor all the time. 

In other cases, the priority of the day will capture our attention, e.g., paying the rent, housing, and employment. Disruptions to our mental health and even put our lives in jeopardy regardless of diagnosis. Regardless, taking your health and the quality of your mental status into your own hands is the best way to maintain good mental health and reduce the likelihood of relapse.

Plan ‘B”

Staying connected with collateral contacts to delegate health needs is a great plan “B”. When your self-care takes a back seat to the priorities of life, working towards good mental health might mean leaning on a friend or family member for help. A second more short-term plan can always be handing out responsibilities or delegating. 

Upon feeling too overwhelmed to get chores and other ADLs done, ask family, friends, and those you trust to help. For some of us, our disorder disrupts our capacity to stay connected to reality. Disruptions can take the form of elaborate delusions, which complicate our interpretive eye to know what is truly happening with our health.

Impression

In the end, manage your own mental health and be independent. Have a plan, and have another goal when the original road map to better health becomes unworkable. Ultimately, whether you have a chronic condition or an acute diagnosis, relapse is only to be feared when you aren’t doing what you need to do to work towards better health and healing. 

Relapse is real. Relapse is awful. But it isn’t the end of the world. Relapsing and experiencing the renewal of old symptoms can still remind you to get back on track with your recovery. Keep going! Don’t stop! When you stop taking care of yourself, be prepared for your worst fears not just to haunt you but become the grim reality you feared so vehemently instead of investing the same mental energy in health and healing.

Psychotic ‘Break’ Survival Skill Kit

https://anchor.fm/max-guttman/episodes/Psychotic-Break-Survival-Skill-Kit-e1canv1

Psychosis can potentially otherwordly, highly new and intoxicating, and downright baffling when the symptom becomes too intense and outpaces your understanding and connection to the world. Do you already experience psychosis symptoms? Do you know a friend or family member is psychotic? If the answer to either question was ‘yes,’ you already know this symptom of mental illness is extremely difficult to navigate without the help of mental health professional. Medication, collateral support, and the information here will only help you support a friend or family member who is psychotic and assist a person experiencing the symptom firsthand.

People with severe mental health symptoms experiencing psychosis deal with a cluster or group of interrelated symptoms. Many people dealing with psychosis rooted in a schizophrenia diagnosis do not know they are sick or are psychotic. This troubling lack of insight and self-awareness is called anosognosia. Some folks who are psychotic are aware of their distance to reality and the distortions that complicate their connection to the world. In most cases, psychosis builds and intensifies without medication and therapy. In rare cases, symptoms stabilize without professional help and medication. People generally need immediate psychiatric intervention to slow down and interrupt the thought disorder.

Most people don’t realize something is wrong with their thinking. Even when people begin to see and view the world differently, delusions and other cognitive distortions can make it seem like these are natural changes in your mind’s perception. Upon the first diagnosis of psychosis, try to self-evaluate the impact of psychosis on your life. 

In many cases, psychosis will impact various domains of functioning and living your life. After all, your brain and its health directly impact your mental health. When psychosis activates, different thought processes are interrupted and derailed. With the help of mental health professionals, you and your treatment team will learn how to identify each of these blocked and broken aspects of your thinking and cognitive functioning.

There are methods to self-manage or at least monitor psychosis symptoms. After all, you won’t always have 24/7 access to a therapist or psychiatrist for counseling or support. You are learning how to self-manage psychosis symptoms as best as possible without the help of a professional is vital to making gains in your recovery. 

People who are severely impaired will have greater insight and self-awareness are more likely to be in and out of the hospital. Therefore, begin to evaluate how psychosis impacts you on a moment-by-moment basis. Through ongoing mindfulness and self-reflection, and practice, you will be better prepared to self-manage active psychosis symptoms in your living environment.

On a moment-by-moment basis, begin to review and pay closer attention to your patterns of interactions, habits, and MO. Take notice of even the most minor changes or interruptions to any of these behaviors. Changes in your behavior can indicate changes to your thinking and sometimes worsening psychosis. Begin your self-imposed observation of your behavior and thinking with your external world.

How are other people in your life evaluating your mental health status? Checking in with friends, allies, and peers is also an excellent litmus test for assessing the quality of your thinking. Friends will never always agree with you. Even if you are on point, friends will not always agree. To be safe, consider alerting your prescriber and therapist when friends and family are baffled by your speech or the quality of your thoughts.

When negotiating your relationship with your living environment, be more mindful to pace yourself. If every detail seems important, that can signal an issue too called referential thinking. Just take notice of your thinking more globally across your day or week. People generally don’t look for changes or speak about alterations in your clothing and its appropriateness unless there is a massive issue with how appropriately you groom yourself and take care of your hygiene.

However, people do pay attention to the profundity of your thoughts. So, ask yourself:

Am I communicating well?

Do people understand the message or my ideas when I speak?

How is the quality of my thinking?

Are my behaviors congruent with my goals and actions?

The answers to these questions will begin to determine how to track the meaningfulness and effectiveness of your interactions. If you have a complete break, you will still need to communicate with people about your basic needs. For example, you cannot walk into a supermarket and buy groceries without speaking with a cashier. For obtaining medication, you will need to communicate with a pharmacist. At the onset of your diagnosis, you should become familiar with these people and their life processes (how do they respond to you when you feel normal? How do they respond when you don’t feel so well?) Remember how you behave under either circumstance to get what you need and do so without incident, and doing so with the slightest chance of harm is critical.

To be as safe as possible, be ready to execute these activities of daily living without incident at every level. You must function well enough not to alarm others or cause distress (to yourself and others) even during a “break,” so always be prepared! Knowing how to complete these tasks at different levels of functioning will be critical for achieving them seamlessly when you’re operating at diminished capacity or during a “break.” Reflect on your experiences. 

Ask yourself questions about how you felt the task could have been completed differently or improved upon, or done with less distress during increasing distance from your norm. Even in the wake of pain, healthy intersections are stable and nonjudgmental.

Many psychotic disorders are life-long illnesses. It would be best if you always were practicing your survival skills. Remember to establish and maintain a stable connection to medical offices, access to food and nourishment, and other resources to sustain locomotion (from point A to B). Keeping safety as a goal and knowing your weak points during illness will improve your possibilities for navigating a break each time and, more importantly, your safety.

Solid Ground and the Rescue Line

Peer specialists risk getting bit in the ass. If it is not the illness, it is the people we are supposed to be helping. How much do we disclose to them? What is the limit on honesty and openness?

I disclosed early on in my career. I just could not be bothered hiding the fact that I was just as “out there” as the people I helped. The difference was that I had gone through training and learned how to live with the “normals”. I knew how to talk with them. I competed with them on their academic turf. In short, I straddled both worlds. They were sometimes howling in the hospitals, other times having drinks and finger food with the boss.

My first time having my diagnosis shoved in my face was with a woman in one of my groups.

Everyone knows you have problems

EMB

Peer workers work in two dimensions. On the one hand, peers get paid to use their experience effectively with the clients. On the other hand, they go home to live somewhat marginalized and jeopardized by the illness. If not correctly put in its place, the insidious, dangerous condition threatens to wreak havoc with hard-won economic, social, and psychological gains.

I supervised peer interns from Howie the Harp. For the most part, they were terrific. I met my match, however, in a wild little devil that insisted on reporting me as unfit because I had told her to comb her hair and button her shirt. Luckily, the staff had my back.

I had had enough. The next intern insisted on going over my head to the director and workers she considered more competent because they weren’t peers like I was. So I went offline and waited for her internship out in the psych spa. I came back when she was gone and told my director I was through supervising peer interns. I knew my limits.

Peer workers are people who somehow pull themselves out of a hole. Now they stand on solid ground and throw a rescue line down into the abyss. Jealousy, resentment, and rage get in the way.

No matter. It is a crazy happy day in the neighborhood, and no one is going to mess with my high!

RESPONDING TO A MENTAL HEALTH CRISIS: WHO IS THE MOST QUALIFIED?

The ongoing spirited conversation about emergency mental health reform and community response protocol is getting tired. When I say exhausted, I mean it is about time we reach a consensus.

Today, and I’ve said it before, we stand at an impasse—the boiling point of new reform just around the bend. 

The issue that hinges on the docket today is Emergency Mental Health. More specifically, crisis intervention, crisis calls, 911 mental health dispatches, and other emergent mental health crises in the community. 

I am so fearful that this process (the legislative process that dictates the provision, execution, and law, how it is defined and carried out, etc.) will get hijacked and derailed. We advocates must focus on how all this talk will translate into a workable framework for handling emergency mental health interventions.

This subject has only gotten more controversial over the last few years. In my opinion, the rift between advocates and lawmakers, and mental health professionals have more to do with the definition of response than with how to handle the implementation of theory and practice in the field when responding to a real crisis. This is because definitions vary across disciplines, state lines, and mental health professionals. 

With the reinvigoration of social justice issues plaguing our country, this issue will only get more attention. As our society reevaluates the intersections of disability, mental health, and social inequity, we can be sure the ‘spirited’ nature of this debate will drone on and on without an answer. I only hope all the enthusiasm is put to good use. Hopefully, some of this good use will be through this blog article and real productive debate and reform will come.

For the same reason, advocates argue with each other. Passionate people from all walks of life don’t always agree with the way things are in society or should change in the future.

But is that true with this conversation? Specifically, why are we still at odds? Why haven’t we reached a consensus and passed the debate phase of how this talk will translate into the new policy. When are we going to reform the way crisis intervention works in the community?

Probably, when more definition is laid out around ‘crisis’. I am a social worker. I am also a person with lived experience. I can tell you that what is a crisis for one person, may look totally different than for another person, even with the same disorder or problem, or diagnosis. Now, imagine, two people are presentation totally differently and then add in location (city versus rural), context (domestic situation), etc., etc. My point is that every situation is different, even for ‘mental health crisis in the community. Therefore, it is so hard to come up with a protocol for each situation and how to train and educate responders is so complex and needed, and urgent.

Without a consensus at the level of language, ‘camps’ have formed. Experts are divided on which mental health professional (e.g., psych nurse, social worker, peer advocate, psychiatrist, paramedic, etc.) and intervention strategy is best equipped to respond to emergency mental health ‘crises’ in the community.

Right now, as it stands today, there are several approaches, both programmatic, and stylistic, depending on the professional bend of the worker and his or her education, training, and experience practicing. 

In terms of programs, some do a prescreen. Programs will screen people in crisis ahead of time either through a provider that calls out of concern or through the person in crisis calling to self-refer themselves in lieu of going to the ER or calling 911.

This sort of ‘soft landing’ in the mental health system is what NYC and other cities are now doing to divert traffic to ER’s and other mental health crisis triage centers across the country. They also act as a hospital diversion competent to systems where hospital beds are short and in cases that are more social than psychiatric which the hospital is an impropriate fit.

I learned much about what it means to be in crisis, and about the systems in place to address them as a social worker, and as a peer advocate. While I don’t think social workers make great first responders in some crisis situations, I think peers make even less of a fit in these situations. Certainly, social workers do not belong going into homes where there is the additional risk of violence without other, auxiliary professionals present.

Social workers need to be part of a larger community response. But right now, the system is limited. 

When it comes to fulfilling the vision of community response there are few options after ER rooms and the few cities with limited and overextended crisis response teams assisting folks in crisis to a softer landing in the system.

When it comes to sending in a wide network of collaterals, organic, paid, and specialized personal, right now, ACT Teams and the CAHOOTS model are the nation’s front runners.

ACT, CAHOOTS, and other interdisciplinary teams) utilize prescreening methods, and go out on crisis interventions with folks already enrolled and in treatment on their census.

For people in crisis and not already on the census of an ACT or CAHOOTS team are new to the systems radar. These folks who are off the systems radar may present a degree and risk of violence to a crisis response team.

Even less clinically prudent, there are crisis’s and no prescreen mechanisms in place to the hand of clinical information to team responding in the community. Talk about a double-blind nightmare. This is also the reality of clinicians every day who respond to mental health calls in the community without enough data to safely handle crisis intervention.

In the end, more work, education, and training need to be invested in the social work education and clinical training before social workers should walk into potentially threatening environments without other seasoned responders.

My recommendation, which is already beginning to become a reality, is to have police and social workers working side by side. Right down the setup of the police station itself, these social workers can be regular members of the police force and community to cross-pollinate intervention strategies with the prescient and its staff.

For nonthreatening interventions, in many states, including my home state of New York, and the county of Westchester, ACT Teams call the local police department for every emergency crisis intervention for patients on their census. In other states out west, CAHOOTS teams respond to non-threatening situations, and even act as a mobile hospital diversion team for many homeless, and substance abuse related issues. CAHOOTS is known to respond to folks that aren’t even on their roster or are new the mental health system. 

When it comes to ‘crisis’ response, the readiness and effectiveness of crisis intervention will require more education, practice time, and to a lesser extent, additional training for all field workers. 

In social work, the Social Work Accreditation Boards, the ASWB: Association of Social Work Boards and other regulatory bodies credential and assess content areas’ rigor in disciplines of education and curriculum. A lot more is lacking but let us start somewhere. Curriculums needs to bridge an academic understanding of what it means to be in ‘crises. We can start with arming peers interested in doing this work with real skills and interventions beyond Social Work 101. I am afraid learning ‘Motivational interviewing’, and basic de-escalation strategies is not a sufficient skillset to take on emergency response calls.

We also need to think about what practice means given the current state regulatory instruments already established for determining if which of these disciplines, IF ANY, are ready and competent to perform the crisis work.  The heart of my recommendation is to advance both the curriculum of the peer workforce and practicum towards readiness in crisis intervention AND social work education in addressing violence and safety issues in threatening environments. 

What would this look like, and how can states, and local agencies roll it out? One pathway forward, on the level of education and practice, is to require peer internships to have a much more elaborate and specific crisis intervention component beyond what is currently offered as a tandem or extra component to their certification. In my opinion, the current broad ‘forensic’ certification, simply isn’t enough when we are talking about peers going into potentially dangerous environments alongside with police.

This just seems like a terrible plan. Before we make a big mistake and prematurely throw both peers and social workers in precarious situations where there can be the potential loss of life, why not pause and reevaluate these aspects of the peer education and social work intervention first? In the very least, lets agree what a crisis is before we intervene in one.

Going to Social Work school with a Schizophrenia diagnosis

Everyone needs to dream big in life. Goals are the waypoints to those dreams. It was always my goal to go to graduate school. After my ‘break’ from first-episode psychosis in undergraduate school, my goal to graduate school was on the brink of failure. My goal was so important to me that I was uncompromising in my recovery to heal and move on with my life. When goals are critical to us, people will do everything in their power to reach them despite the obstacles in their path.

My obstacle was my schizophrenia diagnosis and the residual symptoms that medication didn’t manage. These obstacles didn’t stop me from applying to a social work program two years later when I finally reached my goal of enrolling in a graduate program. Because I was marked as ‘sick’ and mistreated due to revealing my psychiatric history earlier on in my education, I kept my mental health issues to myself in graduate school.

Aside from my girlfriend, a few close classmates in my cohort, and the people who already knew my schizophrenia diagnosis, I kept my mental health to myself. Not sharing and being utterly private about my mental health history meant a few things:

  1. I would have to be ultra-careful about managing my schizophrenia symptoms.
  2. Be mindful of blips or changes (however minor) in my mental status so faculty and other students would not liken the lability to a possible mental health disorder.
  3. Be very careful about who I confide in about my history to avoid information falling into the wrong hands or people that might be stigmatizing and discriminatory.

There were times when I could do it all, be mindful, careful about disclosing, and super self-aware without incident. Other times, I found it more difficult to hide who I was and my history as a person with lived experience. When I was happy, content, and not very stressed, being mindful of all of these aspects of being secret about my identity was easy. When there was an exam or a vital essay due, I found myself becoming sad and pensive. It was during these stressful times that I got angry and self-loathing. I became upset about my history and how I was less than completely authentic about who I was and my past.

Graduate school in social work has a big self-reflection piece. One of our educational goals is to become more self-aware of our ‘stuff’. Together, in class, we unpack the microaggressions and discrimination we’ve internalized our entire life. Meaning, we learn why how our perception is shaped by the societal apparatuses which inform our everyday mindset and way of interacting with our peers and family. So, when this aspect of graduate school came around, and it was my time to reflect and learn about myself, I knew I would have to be very careful about how I went about this process.

I didn’t have the option. I could not openly reflect on my past because I had chosen to keep that piece of me a secret. I could make up a past and reflect on a fictitious history to practice the art of telling a compelling yarn. For a while, this is what I did. At first, it seemed phony. The content of the stories I spoke about my past were all made-up lies. I made up some outrageous stories. When it came to writing my autobiography, an exercise we all had to do, I was left with the creative freedom to enmesh my history into an outrageous, downright hysterical backdrop. Other students laughed when I told these stories, and they were so artfully crafted and congruent with social work theories of human development the professor couldn’t deduct points.

I was relentless about lying when I needed to defend my history. But when it came to being honest, and opportunities presented themselves to be me without any of the phoninesses, I made the most out of it each time. I was brutally honest, so honest. It almost seemed to align with the phony storylines I created earlier on. I still remember a professor talking to us about our dreams to motivate us and get to know a bit of what we were interested in for the end-of-the-year research project just around the corner. I remember the first few responses. “Getting married, owning a big house, being a social worker of the year…” and so forth. No one was expecting to hear what I was about to say.

“I want to move into assisted living,” I told the class. 

My classmates laughed harder than ever. But I was serious this time. They just had no idea why. I was exhausted from being overmedicated and extremely tired from my graduate school program. After all, I was in a state hospital two years before this, and now I was in graduate school and a relationship. It was a lot.

So when it came to my dream in life. It was to finish the program, get my master’s, and move into a setting where the assisted living center took care of my meals and cleaning. I certainly didn’t want to move back in with my parents. They were exhausted from caring for me to this point.

With my master’s in social work and a full-time job, I figured I could pay for an assisted living center to do everything for me. I could then focus on taking care of myself and my reaching my goals. When you are tired and overmedicated, goals seem further away. They might even feel or seem unreachable at times when someone is cooking your meals, cleaning your living space, and basically, managing your ADL’s (Activities of Daily Living). There is more time and energy to focus on goals, a job, and doing everything everyone else does but with some assistance at home.

“What? Max?” Another student said. “You’re kidding, right?” said yet another student. That was when I explained myself. I didn’t disclose my mental health disorder. But I did explain how tired I was a lot and how much time and energy housekeeping can be and absorb. I explained how all this energy could be invested into pursuing my dream career or any goal I set for myself.

When I put it in these terms, ‘energy’ and ‘time,’ suddenly everyone knew what I was talking about with my assisted living response. If I had said my answer was because of a mental health disorder, everyone would have pitied me and felt awful. When I made it about being savvy about how I expended my energy and time, everyone thought I was intelligent, innovative, and so forth. My point is that stigma goes deep, and if people let themselves become blinded by discrimination. Suppose people choose to be more open and nonjudgemental with their thinking. New ways of understanding the world and reaching their dreams might be next.  

This is a PRO Tobacco Use Argument in Mental Health Settings

The growing trend in most mental health centers is banning tobacco products and their use on campuses that deliver treatment and other supportive programs.

This trend defies the age-old image of ‘mentally ill’ folks pacing around outside their treatment center or a hospital smoking like chimneys. What is the result and impact of these bans on the folks in my image?

When I first entered the mental health system in 2003, I was an adolescent in an inpatient unit in New York State, and smoking was already banned for adolescents. After all, you would be hard-pressed to find a smoking section in a restaurant anymore. Adults still could smoke, but only in certain restricted areas and at certain times.

Before the banning, adolescents could smoke outside the building when they were granted outdoor privileges, similar to adults. The rationale, staff told me at the time, were minors weren’t allowed to purchase cigarettes in the community. They shouldn’t be smoking in the hospital. 

I accepted with a giant grain of salt. After all, I was a smoker, irritable, but appreciative enough of logic in a place and time where reason wasn’t readily available. 

However, when I was hospitalized in the New York State Psychiatric Center in upstate New York a mere five years later, smoking was banned for all patients, staff, and visitors on the hospital campus. At this point in my inpatient career, I drew a line in the sand and took issue. 

As an adult in the hospital, I wasn’t just agitated. I was dysregulated, manic, and psychotic. I needed something to self-soothe, and meds and therapy were not cutting it. 

Given how bewildered, uncomfortable, and upset I was back from new active schizophrenia symptoms, I couldn’t understand why I wasn’t allowed to smoke cigarettes.

I needed relief and quickly. To be even blunter, I needed a cigarette. 

My theory about smoking in the hospital is straightforward. My idea is also within the margins of psychology and elementary logic. When a person is so far from a baseline that all previously learned coping skills don’t work anymore, why deny people the use of their existing mechanisms for finding relief in the most challenging moments of perhaps their life? Why take away the only coping skill that has been working to date? Why must we throw additional barriers in someone’s way to deescalating and finding a moment of peace in a disordered mindset when someone is so sick? 

I understand the need and push to ban tobacco use in community health settings. Sure, teach people to access coping skills free of tar, toxins, and health-compromising chemicals. Instead, we need people to learn how to lean on healthier supports and access community resources. In this vein, I am not suggesting pushing cigarette smoking on people who do not already smoke. We certainly cannot allow tobacco companies to come into the hospital and hand out products to vulnerable people and get them addicted to another chemical they will need to manage moving forward discharge. 

However, for people with existing habits and already smoke. Why limit, restrict, and agitate these folks further when they could be enjoying a smoke outside like at their own home and maybe feel the impetus to work towards discharge to do just that. 

People at the out-patient level are more likely to use other coping mechanisms to find relief instead of smoking or waiting until they get back home at the end of their session or program. Still requiring research is the threshold, that space where the risks of smoking outweigh the benefits of non-smoking and wearing a nicotine patch until that is ultimately discontinued, especially for highly disordered, chronic, and comorbid smokers. 

In my opinion, this new shift in so-called healthier practices and wellness overlooks a part of human nature, personal freedom, and introductory psychology. Some people with cognitive deficits and symptoms are so intense that learning new skills will not outpace the cravings or pleasure of puffing a cigarette. 

These people will not learn new coping skills fast enough to benefit from not smoking and will be even more uncomfortable and agitated during a tremendously already agitating point in their mental health.

When people are pushing freedom and personal choice in treatment, I am genuinely shocked the hospitals were so fast to embrace the smoking ban. I have been so sick that I wouldn’t get out of bed for days at a time. It wasn’t a pill or the promise of deep breathing that motivated me to get out of bed. It was a cigarette and coffee.

When a person is genuinely symptomatic, in terms of coping skills, it is genuinely about going back to the basics and clinging to what works, what you know, and what you feel will make you feel better in the moment. I genuinely hope the hospitals discontinue this movement and revert, at least in part, to an earlier time when life’s pleasures weren’t removed or banned without consent or our choice.

 

 

Vitor Sallys Story according to His siter Vitoria Sallys

Vitor Sallys Story according to his sister Vitoria Sallys 

Brazil has lost its Humanity in the Era of Fascism. Fake news and lies now persist while the vulnerable die by execution, torture, electric shock, and all kind of aggression, physical and psychological, inside psychiatric institutions and so-called Therapeutic Clinics. 

Vitor Vinicius Sally was a Brazilian 21-year-old gay man who needed help and support with his many emotional and psychological issues. He Struggles constantly with his sexual orientation because of society’s hatred, ignorance, pressure, and discrimination against gay people. Vitor kept to himself his feelings and fell into substance addiction. His sister told me Vitor’s life history. She told me how Vitor’s death happened. The family is seeking justice, and I am advocating for Vitor’s and his family. They want justice, all involved in Vitor’s death should be held accountable for participating in this heinous crime.

According to Brazilian law 10.216 of 2001, the mental health system brutally violated Vitor’s rights. They neither protect nor respect the law forbids any ill-treatment, action, and discrimination against a person with a behavioral mental health diagnosis. Law 10.216 of 2001 prohibits institutions and individuals from acting or discriminate against people with a history of mental illness. There is also another Brazilian law, 7.716 of January 05 of 1989, that guarantees Vitor’s rights which states that under this law, all crimes resulting from discrimination based on race, religion, ethnicity, prejudice against sexual orientation, and homophobic practice. These two laws did not protect Vitor’s life and neither his rights as a vulnerable person. These violations are punishable by two years in prison. 

Five years ago, young Vitor Vinicius Sally’s mother had to commit him to a psychiatric institution for drug misuses treatment, Nina Rodrigues hospital of Sao Luis, MA. After three days in the Nina Rodrigues Hospital, he was transferred into the Neuropsychiatry clinic of São Francisco. Right after Vitor and his mother arrived at the Sao Francisco Clinic, the clinic’s psychiatrist and a nurse told Vitor’s mother that she could not stay with her son and that her presence in the facility would only interfere with his recovery. However, the clinic staff told the Victim’s mother that she could come back to visit him after 15 days. 

Vitor’s mother could not wait 15 days to see her son, so she went to the clinic several times to see her son, she tried to look at him even if was from a distance, but her effort was in vain she was never able to see him because the clinic staff would not allow her to see her son. They refused to let her in to see him. After 15 days, Vitor’s mother returned to the clinic. Upon arriving there, one of the nurses said it would not be possible for her to visit her son because, according to them, Vitor was doing very well, and he even gained some pounds. He has even become a little bit chubby. If she saw him, she would be interfering with her’s son treatment and recovery. 

Vitor’s mother feeling powerless, cried and begged them to let her see her son, even if she could not speak to him. She won’t see him from a distance. She even promised the clinic staff that if they let her see him, she would leave and would not let him know that she was there. So once more, the clinic staff did not allow her to see her son, not even from far away.

Vitor’s mother did not give up seeing her son, so she walked around the clinic outside to see if she could see Vitor, but unfortunately, all her effort was in vain. Again, she couldn’t see Vitor. Three more days passed in a total of 18 days that he had been in Sao Francisco Clinics. The Victim’s sister said, “They called our neighbor saying that my brother was very sick at the hospital of Socorro II. Saying that he had pneumonia, they fabricated all kinds of lies to justify their crimes.”

When the Victim’s mother arrived at the public hospital Socorrao II, in the emergency room, “everyone there was already aware that she was the mother of the boy who had was admitted there already lifeless. They tried to make a fool of my mother. When she arrived at the hospital around 6:30 pm, they all denied that he was there. Only around 10-pm did my mother locate my brother’s body”. 

“All of Socorrao’s staff nurses told my mother that Vitor wasn’t there.” The Victim’s mother kept looking for her son from 6:30 pm to 10 pm. Even the hospital’s doorman told Vitor’s mother that her son was not there while she was looking for him all over the hospital. Finally, the same doorman of the hospital, seeing my mother there at 10 pm, still unable to find Vitor, told my mother to speak with a specific nurse who would tell my mother where she would discover Vitor. 

“The nurse tried to brainwash my mother’s head, telling lies after lies after lies about my brother’s condition. She even told my mother that my brother had been involved in a fight with the other patients. She also said that my brother had suffered two cardiac arrests. He had died of pneumonia. She then said that the hospital had done everything they could to save my brother’s life, telling my mother that he had been in the ICU, the operating room, then in the infirmary. After that, he passed away.  

“My mother was in such distress when hearing that my brother was dead, that she got to the point that she was carried by one of our neighbors who had gone there with her”. She was carried by one of our neighbors who had gone there with her”. When reaching the morgue, she opened the black bag in disbelieve at what she was seeing in front of her.

My brother’s body was badly beaten with black eyes, broken nose, broken teeth, broken ribs, one arm broke, the other arm was purple with electric shocks from top to bottom, his toenails were ripped off, his private parts full of marks of electric shocks. My mom said that “his head looks like that was a smash because it was all sawed up with stitches.” My mother said that he already had a rotten smell. They couldn’t even say that he was already dead when he was admitted to the hospital. 

 “We buried Vitor”, said his sister, “We gave interviews to all the newspapers in the state of Maranhao. We held a demonstration in front of this clinic. While we were doing the protest, my mother could come in to talk to the psychiatrist who admitted my brother. The first day that he got into the clinic before her son was killed. My aunt came in and spoke to her. The other clinic staff told their version about what had happened to Vitor. 

“The psychiatrist even had the nerve to say to my mother and my aunt they were silly and dramatic about Vitor’s death. The psychiatrist of Sao Francisco Clinics said that “Whatever they were doing would not bring Vitor back from the dead.” Vitor’s mother replied to the psychiatrist, saying, ‘No matter what happened inside the clinic, that was not a justification or reason to rip his toenails, electrocuted his private parts, break his ribs, break his teeth, his arms and head’. Vitor did not deserve to die, and even worse the mental health system dehumanized him in the ways his body was left and what was done to him. After the brief conversation, the psychiatrist told Vitor’s mother, ‘Oh, but he was gay, and he had HIV.’ She was implying that what they did to him was because he was gay.”

Vitor’s sister asked me if this was why they tortured him. Did they do that to his body because he was gay, and he had HIV? 

“Is that really the reason why they kill my brother? These were no reasons for the clinic’s staff to mutilate his body and electrocuted his private parts for any reason? They killed him and they never gave us the test with the AIDS results. I don’t even know if he had HIV. Now I wonder what about the others who suffered there and the others who are still at risk of losing their lives inside that clinic. Will they die too? 

“You know, various former Sao Francisco Clinic’s staff, after Vitor’s death, came by to our home and told us that the patients in the clinic are denied food, water, clothes, they sleep on the floor, and women are full of lice. They let the patients have intercourse with the male participants. They beat the patients. There is no breakfast, only coffee in the morning for everyone. There are no female personal hygiene products. Everything is dirty. There are no mattresses, so the patients sleep on the cold floors. When they asked to speak with their families, the Clinic staff would not allow them to make a phone call.

“According to former staff of the Sao Francisco Clinic of Neuropsychiatric, the patients in the clinic are mistreated and dehumanized by the institution. Vitor’s family stated that during the demonstration, for justice, some of the clinic staff were leaving the facility with attitudes that indicated no remorse for what they had done to Vitor. Upon leaving the clinic’s grounds, the psychiatrist who looked at Vitor’s mother and threw a kiss over her shoulders and started to smile at Claudineide Sallys.” Vitoria said, “It looks like she was mocking our pain.”  

Vitoria told me that while her brother was hospitalized in the Sao Francisco Clinic, “My mother would take fruit, clothes, a towel, toiletries, a new slipper, for her brother, but he never got any of these items. And yet, he still died in an old slipper with a hairpin underneath.” She explained to me that “the lawyer we had handling Vitor’s case, he initially was interested and told us that would be easy to win my brother’s case.

“However, suddenly, the lawyer went missing for about a year. Later, he showed up and told us that Vitor’s case was not a winning case. To make things worse, we didn’t have any more news about Vitor’s medical report that was supposed to get in a month. We could only get it after a year. Vitor’s horrifying death in the medical reports only states that his violent death was only bacterial pneumonia.”   

Vitor’s sister says, “My brother had suffered so much while he was alive. He was humiliated and tortured. To make things worse, they only delivered his body to us in states of putrefaction. Yet, they are still claiming that he had just died in the emergency room. He was being beaten day and night and killed as the result of these beatings, he was tortured to death, and nobody helped us get justice. 

“The Socorro staff and the media later had the nerve to tell us that Vitor passed away from an acute infection and did not explain his broken body and the signs of torture. Some former clinic staff told us that inside this Sao Francisco clinic is a hell on earth, and they asked not to mention their names as they are afraid of threatens, intimidation, and being murdered.”   

Vitoria said that “My mother and I want justice. It’s been five years since Vitor’s death, and nothing has been done about it”. 

She mentioned that she could only imagine the ill-treatment inside the clinic in question remains the same as before her brother’s murder. According to her, “These abuses continue to take place daily. The inhumane treatment continues to happen, and nobody has done anything to stop it. My brother was not the first to be killed there. I am quite sure that he will not be the last.” Vitoria says. She tells me that she wants justice to be served. These slaughterhouses shut down for good. To conclude this narration, Vitoria says that “Her brother’s body has gone missing from the place where he was lied to rest. To this day, nobody knows where the body is. The suspicious fall over the Sao Francisco Clinic, but there is no proof (Vitoria).

We all asked these questions:

Why was Vitor tortured to death?

Was it because he was gay?

Was it because they suspected he had HIV?

Human Rights Coalition for Latin America Mental Hygiene & Social Justice

The human rights of the mentally ill are violated in Brazil every day. The crimes continue without end. I am writing to introduce Dr. Marcelo Henrique, the founder, and CEO of OBDH. 

Dr. Marcelo Enrique has a long history of human rights activism in Brazil. He is a scholar, a lawyer, an advocate for social justice, and a strong voice for public health reforms. He and his colleagues created the institute of The Right of Defense to assist judicially the incarcerated population and those with behavior mental health history behind bars. In addition to being a lawyer, Dr. Marcelo has written articles and a book about Human Rights and Health Accessibility in Brazil (Directions Humanos e Accesso a Saude No Brazil). He is also the founder and the CEO of OBDH, the Humanitarian Organization that judicially helps and supports the less fortunate Brazilian population. Through the OBDH professor, Marcelo and his colleagues have been helping a lot of people throughout Brazil.

OBDH is an organization that juridically helps and supports the less fortunate Brazilian population and the rights of people being violated and tortured just because of their mental illness. At the root of it, OBDH is a human rights organization fighting for Social Justice, Helping the less fortunate, Educating for Justice, and Advocating for Reform for the Public Health system.

It was an honor to attend the live session on August 12, 2021, hosted by the OBDH, a Brazilian non-profit organization fighting for Human Rights in Brazil. The OBDH (Observatorio Brasileiro de Diretos Humanos) have been working intensively ever since its creation helping and supporting all Brazilian people who at present are in great distress. 

Max E. Guttman, LCSW, was one of the guests of honor of the live broadcast. He shared his experiences and insights into mental health systems and the treatment of mental health disorders. He spoke on how different Brazil and the United States are regarding their treatment of people with mental health diagnoses. 

“The disparities are staggering, and the need to globally address this crisis is more urgent than ever,” Mr. Guttman commented on the crisis plaguing Brazil and much of South America.

I was very proud to be part of this event. I am also looking forward to contributing more to OBDH. For this reason, I have created a virtual group that aims to work with many American professionals. Each professional assists and supports, helping alleviate the pain and the suffering of the Brazilian population by sharing their expertise and work experience to help save lives in the South American nation.

Brazil is in crisis, and people with behavior mental and dual diagnoses are facing great peril. These people are marginalized and treated like animals are considered dangerous people to Society in the South American Nation. According to Blogs like G1, O Cubo, Maranhao do Povo, and others, this population has published the atrocity that these populations are suffering. The Brazilian news has shown the lack of humanity toward this particular community. These populations are subject to oppression and discrimination. They are being raped, tortured, and starved to the brink of death.

People are in cages!

Thirty-three women in Ceara in Crato, Brazil, were kept imprisoned in small enclosures that are no different from human cages. People killed inside Brazilian psychiatric institutions. 21-year-old Vitor Sally was found dead inside the Clinic Sao Francisco with ribs, broken arms, and teeth.

In the spirit of seeking justice for the marginalized community, I have created the Human Rights Coalition for Latin America Mental Hygiene & Social Justice with one of my colleagues. 

This social justice group’s mission is to create awareness about the uncountable Human Rights Violations against the most vulnerable populations living with due diagnosis (Mental Health Disabilities), forensics issues, and Gender-Based Discrimination and Violence in Latin America, especially Brazil. We aim to create a coalition with a diverse group of professionals with expertise in different fields to assist and support our voluntary work. Brazilian and American bloggers who have published Vava history, Francisco history, Vitor Sally history.

We are standing up for justice and humanity.

Cases in which families have experienced their relatives tortured and killed by Therapeutic Clinics in the country. Vitor Sally’s case, a 21-year-old young man, had his body broken, mutilated, and his private parts electrocuted. All while inside a psychiatric clinic for substance misuse treatment. 

Vava’s case (Jose Vandeilson Silvina de Sousa) was a 17 years old boy denied help when he had a mental health crisis—mistaken for a person who was drug-addicted and not a teenager who was having psychosis. He went missing for ten months. 

And the-less fortunate, Francisco Osvaldo, like Vitor Sally’s, was a victim of the same Clinic that Vitor Sally was killed five years early( according to Vitor’s relatives’ story). Francisco, too, suffers ill-treatment due to the torture and starvation he was forced into while inside the clinic for treatment for his Bipolar disorder. When delivered to his family, Francisco was very feeble, disoriented, and with an abnormal belly. Three days later, he passed away. Therefore this great scholar is doing all these work free of charge to the victim’s family. 

One of his earliest works in the country is where he and his colleagues created the entire SUS diabetes protocol designed in the light of regional actions, cooperation, and the partnership that Dr. Marcelo made with the Federal Public Ministry.

Through the work of Dr. Marcelo and his friends who believe in his career and together with his many friend and supporters, the OBDH was created on February 20, 2021. The day of Social Justice. 

Before creating OBDH, Dr. Marcelo Enrique and his allies and friends worked to charter the Principle for the Rights of Children and Adolescents with Type I Diabetes. The entire SUS protocol was designed and created by him and his allies and friends. This cooperation & partnership was signed between him and the Attorney for Citizens’ Rights, at that time under the command of Dr. Jefferson Aparecido Dias.  

The Brazilian Observatory of Human Rights is the light and beacon of hope for many Brazilians. The Brazilian Observatory of Human Rights’ primary mission is to alleviate Brazilians’ pain, suffer, support, and help the less fortuned judicially throughout Brazil. The organization operates, offering its services to all with no cost, totally free of charge. OBDH never asked anybody for a financial contribution.

As I continue to learn about his work, Dr. Marcelo has a long history of humanitarian work. He has been doing this for a long time throughout the country, helping the vulnerable groups and the underserved, marginalized population in the Brazilian Society. 

This article commemorates his achievements. 

The Impact of Words on our Psyches

Two evenings ago, while speaking with the Editor-in-Chief of Mental Health Affairs, Max E. Guttman, my homie, Max, told me that he felt like he was going to oversleep tomorrow.

 

If you know me well, you know I rapidly and automatically reject predicting a negative future.

 

I consider the thinking that tomorrow is probably gonna suck, or anything of the sort; a self-fulfilling prophecy that you can count on!

 

Where did we learn this crap, Max?

 

This is a direct question, and as you are the person who is posting this blog, can you please answer this question.

 

Max, where did we learn this crap?

 

To be quite honest with you, Craig, I learned this type of jugdgemental and self-critical behavior from other peers. Deep down, I know, as we talked about privately, that I take a whole lot of medications to manage my mental health disorder. Some of these medications are sedating. However, after needing to reschedule a few meetings with this one peer because I needed to rest, I found myself blaming my body and its need for additional sleep. This is absurd!

 

It is absurd because I shouldn’t blame my body for needing anything natural, especially sleep. Also, because I was defending this internal need to a fellow peer who should have been more supportive and understanding of this typical side effect of psychotropic medication. Instead, I began to internalize this situation because the peer shamed me and made me feel like this wasn’t normal, and something that made me a ‘sick’ person. Something I had to correct so I could function at his level and pass as healthy. 

 

And Max, what do you think will happen if you, and me and others, all continue to restate ourselves with respect for the impact of our words on our psyches? 

 

Restatement is key, Craig. We need to first identify these negative messages we have been internalizing and redirect them. The very energy that gutting out these messages and toxic behavior, I am quite certain, will yield the most fruitful sense of worth yet for many folks out there who engage in this sort of self-criticism. 

 

You see, I was raised by narcissists. That is why I know this stuff. I know how psychologically derailing it is to experience the mere suggestion that something “bad” can happen and knowing that sometimes those really “bad” things do happen. I know how crazy it can make me to not be 100% sure. This is a “Mind Fuck”. If you are still reading this, you know what I am talking about.

 

My response to Max was this voice message↓

My response to Max was this voice message:

 

He told me he liked my perspective. He acknowledged that “words are spells”. I was taught that by someone who hurt me deeply, nevertheless, they were and are correct, what we say matters a lot. We don’t just impact ourselves; we impact those around us.

 

I admit that sometimes I do the opposite of what I am saying here. I would prefer to view myself as a work in progress, and not something less flattering. But so what? That is exactly my point!

 

Every moment is ours to make a choice in. How much more simple of a choice can most people make than saying something one way and adjusting it to another way?

 

This is about you doing you, because no one else can do you better.

 

Although I cannot relate personally, most people from an early age, God willing, associate their birthday with knowing that a celebration of some sort, in honor of them is coming and it is all about celebrating your life and future.

 

This is an analogy.

 

If you associate tomorrow with something uplifting or satisfying or anything of decent value to you; then tomorrow will be that much more of what will be good for you. The result is much less important than the process. 

 

That sounds like recovery to me.

 

So I hope that with each day forward, perhaps there is a way to think about tomorrow as “I woke up when my body was rested enough for me to wake up. Some of this is not in my control so  I don’t need to feel bad about it. Even if I wake up much later than I would have liked;  I could do something good, and healthy, and hopeful and kind and self-loving and transform myself into the man I deserve to be in this moment and do it again and again and again.

 

At some point it gets a little easier.

 

One last thing, a while ago Max asked me to write about friendship and peer support.

 

It immediately dawned upon me that this is a good example of what friendship AND peer support is.

 

What a cool blessing it is to create something good, via an honest and true process, done for the right reasons.

 

That reason being that you care about others and you know that it is a gift, giving of your heart and experience to others, especially when they also do the same for you.

 

If you want to know more about how Craig processes and applies these concepts, please check out his newly published book ‘The Craig Lewis Guide to Surviving the Impossible’ 

 

 

The Law does not mean anything to Brazil’s Psychiatric Institutions & Therapists

Francisco’s Case

The Brazilian Law 10, 216 of 2001 clearly states and prohibits all Brazilian psychiatric institutions and asylums in the nation from any forms of bad practice, ill-treatment, and torture against people with behavior, mental health diagnosis, and all kinds of inhumane practice, according to the Law. However, the psychiatric clinics continue to, again and again, follow cruel rules. These include raping, torturing, killing, kidnapping, forcing people into institutions, beating the patients to death, and even starving them to death literally, and there has been very little accountability. 

Francisco’s death is evidence of these abuses, violence the lack of accountability for these kinds of crimes. Francisco Osvaldo, a patient at the Sao Francisco Neuropsychiatry Clinic, died three days after returning home with signs of aggression and abuse. 

Francisco Osvaldo Dias de Sousa was 38 years old an inventor, a strong, healthy man who lived with his mother in São José de Ribamar, in the metropolitan region of São Luis – MA. Francisco suffered from depression and bipolar disorder. He had been using controlled medication continuously for about 13 years. With the pandemic, he lived a healthy and everyday life, the Unified Health Service (SUS), which gave the inventor the medicine. 

The UHS suspended the medication supply.

According to information from family members, the employees claimed that the reason for Francisco Osvaldo not getting the medication that he needed to treated his condition was caused by the COVID-19 pandemic. And that the medicine did not reach the State Pharmacy of Specialized Medicines (FEME), to pass it on to patients. 

Mr. Francisco Osvaldo was working and an inventor that he even created a ( patent) brand for the automotive market. The family started to buy the drug that Francisco needed. However, due to the period, he was without treatment, which always guaranteed him the quality of life. Francisco started to have outbreaks of crisis. He had to be taken by medic emergency (SAMU) to Nina Rodrigues Hospital on 11/24/ 2020. 

The following day, 11/25, 2020, he was referred to the São Francisco Neuropsychiatry clinic, located in the Operária City neighborhood in São Luís. According to Francisco’s sister, Sidney de Dias, visits were initially allowed on Thursdays. However, when Francisco’s mother realized that he had signs of maltreatment, in his body like bruises, over his body the visits were suspended. From 12/31/2 the suspension continued on the grounds social isolation was needed due to the COVID-19 pandemic. 

On 03/05/2021, the mother tried at least one phone call in an attempt to speak with her son, but the social worker claimed that it was not possible to talk to him because he was troubled and agitated. Strangely, on March 10th, that is, five days later, he was delivered to the family, without prior notice, in the company of the same social worker who informed her that he was already well and with a guide for treatment at the CAPS”, says the sister. 

According to the family members’ reports, the young man’s health status was frightening: Forty kilos (40 kg) thinner, with marks of aggression on his body, bite, black eye, and total confusion. His health was already so fragile that he died three days after being delivered to his family. With evidence pointing out ill-treatment, torture, and total medical negligence, which would have led to the man’s death after a long pilgrimage to the hospital, he could not resist passing away.

To this day, there has been no public condemnation about the institution that has harmed and caused Francisco’s death.  

After Francisco’s passing family started researching and seeking the truth behind Francisco’s sudden death, they learned that he was not the only victim and was not an isolated case. Five years ago, a young man name Vitor Vinicius Sallys died at the age of 21 at the same clinic in very similar condition. Young Vitor Sally’s Mother found him dead inhumanely, with broken teeth, fractured arms, and ribs. 

We also know the other patients are currently suffering and are at risk of life and death because of the abuses.  The Law 10, 2016 of 2001 prohibited psychiatric clinics from applying any inhumane treatment of the old asylums continues disregarding the Law. 

Mental Health Affairs 2022

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