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26 Jan 2022

Tag: Self Help

What keeps me pushing forward?

I am field instructor for graduate and undergraduate student in social work going for their bachelors and masters degrees. I am also a professor of social work in a university. As a field instructor, I am the point person in the field where social work students at the university level go to their placement or “internship” where they learn social work practice skills from working with real clients.

Due to my position as a supervisor in a mental health clinic, my students, at my site, learned how to practice in a mental health setting. The bachelors students learn case management, and the masters students learn how to practice psychotherapy and have their own caseloads with clients with various diagnoses. As their supervisor, I teach my interns how to be good therapists.

Being a good therapist is sort of a loaded sentence isn’t it? What is a good therapist? I think most of us would agree treating the whole person and seeing people as individuals is a step in the right direction. That person centered approach that situates diagnosis right where it belongs. Balancing a diagnostic clinical approach with empathy, support, and all of those good things is a step further. My focus, however, as their field instructor, isn’t to micromanage their ripening skill set, or tell them how to practice. Sure, I will guide, model, and lead, but telling a therapist how to practice is walking down the path to the same narrow focus the medicalization of mental health did to the system of care.

Today, one of my former students updated me on his present work situation. He said he continues to feel unsupported by the agency higher ups and feels alone in doing the work he does as a mental health therapist in a clinic. He asked me: “Max, what keep you moving forward?” Aside from grinning and bearing the entry level nonsense and plight of the worker who sets out against a learning curve, I told him the truth. Reinforcing I kept all this in mind, and the long term goal ahead, I said keep it all in perspective. Our work matters, and our impact matters. More importantly, how do we keep all this in mind and be successful in putting theory into practice?

In the mental health profession, this is so hard to do. As a field instructor, my main goal is to support my interns in how to survive the system of care. Setting out as an entry level social worker and working within the limits of an agency is my primary concern when monitoring the success and ability of my interns to succeed. Everyday, we mental health therapists expend our valuable energy to alter, augment, and improve the quality and level of care we can provide our clients with limited resources, time, and support.

Maybe this is my focus because I have a very systems approach at the root of understanding of how care operates in this country. But I also believe the job of the classroom, as a professor, is to supply the theory and knowledge for their students to implement in their placements. As a professor, I stop at nothing to explain clinical approaches to different theories of psychotherapy, differentiate between the abstraction and practice, and supply examples through role play and discussion. However, as a field instructor, my job is to take this work in the classroom, and direct its application the in the field. Point out weak points in practice, support reflection, and above all, explain how all of this learning and growth plays out in each students long term plan for practicing as a future mental health practitioner.

Without the right support, or the right people around us, no skill, no technique and no theory will save our jobs. Even worse, our clients will no longer benefit from out help when we get walked out of the agency because our political clout evaporated over a non clinical issue or contestation of our judgement because we get a new boss or team member that has a personal issue with our character. Please don’t get me wrong. I am no cynic, but I know and believe too much in my interns abilities to allow anything other than their innate skills shine in the face of systems issues and agency politics in mental health settings

Reimagining Discharge Planning: Success Upon Re- Entry into the Community🚸

Photo by Pixabay on Pexels.com
Photo by vi Media on Pexels.com

I’VE EXPERIENCED SEVERAL SERIOUS PLANNED AND UNPLANNED HOSPITALIZATIONS AND SUBSEQUENT DISCHARGES. MEDICAL, PSYCHIATRIC, PHYSICAL REHABILITATION, YOU NAME IT – I’VE BEEN DISCHARGED FROM IT.

NHS DEFINES DISCHARGE PLANNING AS ‘A SPECIFIC TARGETED DISCHARGE DATE AND TIME REDUCES A PATIENT’S LENGTH OF STAY, EMERGENCY RE-ADMISSIONS, AND PRESSURE ON HOSPITAL BEDS.’ IT SHOULD ALWAYS BEGIN FROM THE MOMENT YOU ENTER THE FACILITY AND BECOME A PATIENT IN THE HOSPITAL. THE SAME PLANNING INVOLVED WITH INPATIENT TREATMENT GOES FOR OUTPATIENT. THE FACT OF THE MATTER IS, IF A FACILITY OR PROGRAM ISN’T PLANNING FOR YOUR ULTIMATE RELEASE AND RE-ENTRY INTO THE COMMUNITY, THERE IS AN ENORMOUS PROBLEM.

Whether its a question of lengthening your stay in the hospital or outpatient treatment program for unethical insurance reimbursement when it’s unjustified, or just clumsy planning altogether, as a patient, you should always be enquiring into your projected length of stay in treatment.

Social workers or case planners will love to defer answering questions around the projected time spent a patient will finish in a given facility or on the outpatient program census. Still, as the patient, you really should always persist in enquiring with your treatment team about your ultimate discharge.

There are several reasons why being relentless around your discharge planning is essential. Firstly, staying focused on your recovery always means thinking about transitioning to a lower level of care. Reminding your treatment team about your pending discharge will keep them motivated to put together the best possible plan.

Also, future-oriented thinking suggests to your team you have a vested interest in your aftercare. Thus, your inpatient treatment will more likely target how to handle ongoing and chronic issues, which usually put people who aren’t attentive to their own self-care and treatment post-discharge at risk of re-hospitalization. There are so many reasons to stay focused on future discharge and your aftercare plan. Depending on the basis, or precipitating factor that triggered hospitalization, it will impact the work you need to complete before you are ready to move on to a lower level of care.

For patients admitted to a mental health treatment facility or currently receiving services in an inpatient psychiatric setting, discharge planning can be very much dependent on your initial diagnosis upon admission. Other variables, including the number of hospitalizations under your belt, relative chronicity of your symptoms, the intensity of your symptoms, and prognosis will determine your length of stay. These are primarily situational and based on your personal life circumstances or psychosocial history.

Discharge planners, given the enormous task of interpreting those factors, your current mental and medical status. In general, discharge planners will begin to provide a more firm and concrete discharge day when fewer uncertainties and unknowns are to be addressed in your projected prognosis.

Aside from the known information that is difficult enough to interpret to gain a clear indication of your recovery rate, discharge planners will be more willing to commit to a window of time you will be released when these indicators become more visible during the continuing course of your treatment.

You may need to hit the ground running when returning to your life. In doing so, depending on your mental and medical status, this may be a challenge.

You must be realistic about your recovery; understanding you are on a journey and discharge doesn’t mean cured, open and honest with your supports about your situation, ready to ask for additional help or cheering on, and allowing yourself time to heal.

These are all critical agenda items for anyone facing discharge from an extended- or short-term hospitalization in mental health, and many other medical inpatient treatments for various comorbidities. For the most successful release, remembering, you don’t need to be completely healed, just very aware of the follow-up and aftercare plan will significantly reduce the likelihood of relapse or re-admission.

Re-entry into the community can feel strange. It can seem surreal, depending on the length of your stay in the hospital. Sometimes, too lengthy hospitalizations can create feelings of learned helplessness. Relying upon others and feeling less motivated to be self-driven are some of the side effects of re-entering the community after prolonged hospitalizations. Be prepared for the adjustment. Expect to feel strange, awkward, exhausted, and everything in between.

Discharge planning should always begin when you enter the facility and become a patient in the hospital. If the facility isn’t planning for your ultimate release and re-entry into the community, there is a BIG problem.

There are several reasons why being relentless around discharge planning is essential. Firstly:

  • Staying focused on your recovery always means thinking about transitioning to a lower level of care.
  • Reminding your treatment team about your pending discharge will keep them motivated to put together the best possible plan.
  • Future-oriented thinking suggests to your team you have a vested interest in your aftercare. Thus, your inpatient treatment will more likely target how to handle ongoing and chronic issues, which usually put people at risk of re-hospitalization.

There are so many reasons to stay focused on future discharge and you’re aftercare plan.

Depending on the reason or precipitating factor that triggered the hospitalization will impact the work you and your team will need to invest in discharge planning. Suppose you are in an inpatient psychiatric setting.

Discharge planners, given the enormous task of interpreting the factors as mentioned earlier, your current mental status, etc. it is unlikely anyone will give a firm and concrete discharge day because there are too many uncertain and unknowns to be addressed. Aside from the known information, which is difficult enough to gain a clear clinical picture without years of experience discharge planning for complex cases. Finding a discharge planner willing to commit to a window of time, you will be released can be challenging. Given projecting a good prognosis for psychiatric admissions is usually more unclear at day one and early on in your hospitalization than medical or rehab for acute injuries and substance abuse.

Upon discharge, you will need to hit the ground running when returning to life, and depending on your health, this may be a challenge. Being:

  • Realistic about your recovery
  • Understanding you are on a journey and discharge doesn’t mean cured
  • Open and honest with your supports about your situation
  • Ready to ask for additional help or cheering on
  • Allowing yourself time to heal

These are all critical agenda items for anyone who is facing discharge from a long or short term hospitalization. For a successful release, you don’t need to be completely healed, just very aware that the follow-up and aftercare pan will significantly reduce the likelihood of relapse or re-admission.

“After Care” plans need to be (1) tailored to your personal circumstances and lifestyle choices, (3) realistic and accessible to use even if your condition worsens or doesn’t improve, (3) contain a plan “b” or what to do next when you have to divert from the plan from either insurance issues, transportation or rescheduling of doctors appointments, or any number of things that can go wrong when re-entering the community and taking care of yourself again, living more independently, or adjusting to life outside of an institution. When revising, be prepared for anything and everything to happen.

Preparedness goes a long way when you show up for your outpatient care and intake, and they tell you there is a six-month waitlist for services or stopped taking your insurance. While these may seem like trivial snafus, many times, these admin issues, or technical problems derail people from their recovery and shift the focus away from their health. So, instead of focusing on the matters ahead directly, the problem solves the issue keeping you from connecting to your outpatient patient care. If you are too tired or exhausted and can’t work out these possible connection issues to aftercare, call the unit or case planner on the unit you were hospitalized and have them make some calls or suggest a new plan.

Re-entry into the community can feel strange. It can seem surreal, depending on the length of your stay in the hospital. Sometimes, too lengthy hospitalizations can create feelings of learned helplessness, which can come from being institutionalized. Relying upon others and feeling less motivated to be self-driven are some of the side effects of re-entering the community after prolonged hospitalizations. Be prepared for the adjustment. Expect to feel strange, awkward, exhausted, and everything in between.

In the end, enjoy all of it. There is nothing more profound than healing and recovery from extreme perilous circumstances and returning to a more normal life.

The Revisionist✍️

Far too many stories and firsthand accounts of recovery are terminal and end with a cure or picturesque life for the consumer of services or “sick” person. This recovery narrative is different. This is a story about struggle, ongoing collateral pushback from friends, and internalized self-doubt.

Chronic illness, either rooted in psychiatric or medical symptoms, can be a lifelong road with many critical junctures for risk of relapse, suffering, and systemic issues with access to treatment. I hope my story sheds light on not only the aspects of healing that serve as hope to readers but also the plight of the consumer riddled with making ongoing difficult life choices due to the severe chronicity of their symptoms.

After finally returning home from college, after my discharge from the state hospital center in upstate New York, I began my long journey. This is a journey of heartache, despair, and all the negative emotions conjured by a chronic mental health disorder. Knowing full well that without applying the right measures and putting a plan in place I would be at risk of further issues, I applied the learning lessons of my past to my situation today. This is that story. After graduating and eventually becoming a social worker and disability rights advocate, I learned how to live with my symptoms (and, simultaneously, despite them).

I am Jacques Peters, and I will explain to those reading this story that chronic means just that. Ongoing, and a continuum of symptoms that will wax and wane as this story unfolds. These symptoms will impact the very fabric and quality of my life. My story is not unique, but it is largely untold—it is taboo for people in recovery to admit that when there is no cure, the only thing left to do is never stop fighting for life. As this book unfolds, the result of not stopping fighting, to never giving up, will become obvious to the reader and a warning to everyone with a longstanding and chronic illness to stay in treatment and never resign or surrender. The implications of doing will hopefully warn the reader in vivid terms to keep close to healing, even if a full cure is impossible.

When is sharing too much? Is oversharing a real thing?🗣

I have been accused of several crimes, socially unacceptable behaviors, and a litany of outrageous transgressions during my mental illness. 

While the majority of the genuinely grotesque periods of my mental health disorder where shadowed by the gates of a locked-down unit. Many of these shameful acts were outside in the community and very much visible to other people. The covert and overt nature of how my displays range from public to private have to do partly with the disease process. More so, the visibility of my transgressions is rooted in the setup of the mental health system. Given the mental health hospital system only has open beds for the most severely disordered. My displays were rather public when left to my own devices if I was stable enough to go without an inpatient stay in the hospital. 

Back to the intended topic: when is sharing too much? To get to the root of it all, one must ask, too much for who? I have had several friendships which have been damaged, if not lost, to the ‘targeted’ expression of my activated mismanaged mental health symptoms. Meaning, my friend was the object of periods of acting out when my ability to cope with these symptoms was overwhelmed. 

Recently, a friend said to me: “Max, you expect people not to have feelings about how you behave when you are manic, or psychotic, or both. That’s absurd. ” My friend suggested that although my friends may not judge or be critical of me when I act out. My friends certainly feel a certain way about the times when I lose my shit. That, despite our status as friends, people are still are human. Like most humans, friends must process their feelings before a relationship can return to its normal position or baseline. 

While I understand that my behaviors impact other people’s feelings and that these feelings must be processed. I don’t know how irrationality and other illness symptoms can ever be taken as genuine expressions of my character and who I really am.

My long term friends have experienced my psychosis in its full-bloom and without warning. I experienced the horror of psychosis firsthand.

If given a choice, I would never experience it again or have ever experienced it, to begin with. 

Instead, I was fated to experience it. I didn’t have a choice in this matter.

Each of my friends has the choice to walk away from all of me or provide me unconditional support. I didn’t have a choice, but my friends still do.

When you have a chronic illness, your symptoms persist without end. As so-called ‘supportive’ friends, how can you pick and choose when you feel strong enough, capable enough, to be there for me and support me? If I don’t have a choice about living with this disorder, why should you have a choice about being a good friend or writing me off? 

The socially unacceptable behaviors I gestured to earlier are simply too much for some people. They can be quite disturbing.

I can separate the difference between the person from the diagnosis—the friend, from his illness. 

Nobody gets a free pass on their behavior. I never asked for a free license to misbehave or a thumbs up of approval: “Hey, Max, you were a great person even when you were psychotic.” I didn’t ask for anything like that. 

All I ask for is an honest interpretation of the reflective work I have completed. This thoughtful work is by no means suggesting I be exonerated of my transgressions. Any suggestion of this nature is a bald-faced lie. 

Ultimately, if my story doesn’t benefit you, put down the book, and ask me not to share anything further with you. Unless you make it clear what your needs are as my friend and reader, I cannot help how you are impacted by the narrative and my choice to share my life with you.

Back to the question, can a person share too much?  I have said and will always say no. Full disclosure, when appropriate. 

How do we know when it’s right? When it benefits the other person. 

When should I fear disclosing? When a person cant gives you unconditional support.

In the end, unconditional or just a friend. Supports should clarify how available they can be for you and what their limits are as friends.

Never be ashamed of your history. In cases like mine, when supports cannot handle the level of support asked of them.

Just be careful, and tread carefully.

So, is what I said too much?   

When Shaming Goes Wrong

There’s a disturbing trend I’ve been noticing of late and I want to address it as it’s something that has been on my mind for a bit. This will be a longer read but bear with me.

This need to shame folks into supporting our causes is something that needs to stop. This can extend from a variety of topics from politics, race and discrimination or even pop culture and maybe it’s because I’m around more liberal than conservative leaning people on a daily basis but on social media they are the biggest culprits of this shaming mentality. You can’t shame people into thinking like you because it’ll only create resentment and backlash in the end.

I can think of many examples of this. In politics, people want to label those who support Donald Trump or voted for him as just inherently bad people. Now I’m not going to defend Trump’s character because he is an overall sleazy person but he did a great job of speaking to the anger and resentment many feel in this country and some of those emotions are a result of these people being tired of being told how trash they are. I’d get fed up too if I’m constantly told about how privileged I am even if I’m not personally living that reality. If that’s not bad enough, I’d feel even worse not being able to defend myself because no one wants to listen to what I have to say. Say what you will about Trump but his message resonated with many people who felt forgotten about in 2016 and still does today even if the majority of us know deep down that he is a con man.

The friends who I’ve talked to that are brave enough to admit they voted for Trump know he’s not perfect by any means and don’t like him all that much but do respect his unapologetic ways and I personally can’t be mad at that because I understand where it comes from in a society that is forcing people to apologize for every and anything they said or did even if it was 20 or 30 years ago. Yup I’m talking about you Beto as you’ve been guilted to embark on an apology tour.

Surviving R Kelly

With popular culture and I’ve kept quiet on this but a lot of folks have asked me how I felt about R. Kelly and the documentary that came out earlier this year. I’ll say this, for me a lot of the outrage came across as hypocritical. I’m in no way defending his actions and assuming the accusations are true he will be dealt with but acting like people should boycott listening to his music when the man is a musical genius and has put out a lot of great music in the past 20+ years is crazy to me. It is possible to separate the craft from the person and if I feel like listening to the Ignition remix before I go out to party, I’m gonna do that.

F. Scott Fitzgerald once said “the test of a first-rate intelligence is the ability to hold two opposed ideas in mind at the same time and still retain the ability to function” and this quote certainly rings true with R. Kelly. After all, if we were to dismiss every celebrity for their past transgressions we’d be hard pressed to find folks in the entertainment industry who are of perfect moral standing. Me not listening to his past music now because of a documentary that came out two months ago is absurd, I guess Bump N Grind all of a sudden became a trash song now and I can no longer vibe to it because of Surviving R. Kelly? That’s silly and it’s not a coincidence that his music streaming went up significantly AFTER the release of the documentary.

Lastly I’m gonna talk about white privilege. I’ve talked to a few friends about this that happen to be white and they don’t deny the existence of white privilege but when we discount their opinions and experience because of their whiteness that’s a big problem too. It no longer turns into a productive conversation about us finding common ground or solutions on how we can fix things but instead turns into a one sided rant session where white people get told how wrong they are about everything. Can you see how that would create backlash?

That type of backlash creates a resentment and immediately puts folks on the defensive, some even go to the extreme of joining a hateful Alt-Right movement and while that’s a terrible thing to me I can understand the thought process behind why someone would get to that point.

The moral of the story is this, if you want support for your cause, be willing to have those conversations instead of labeling the minute someone disagrees with you or challenges your view point. Some people are brick walls and lost causes at the end of the day but there are others that want to understand and just don’t know how to go about doing so and that’s ok too. Taking the time to educate or share your experience rather than rant and rave at people who have no idea what that experience may be like will get us all further and create a more inclusive environment.

🅱️iologic Theory

Research must be wholly beneficial to the public, it must be free and rife for regard for society. As a prosumer and mental health interventionist researcher, I have sought nothing but a bold new model that works for the masses. Therapy that is both targeted, yet beneficial to all conditions and diagnosable disorders (impairments, both environmental, developmental and as this theory unfolds, at the root of it all: biological)

🅱️iologic theory is totalizing and yet person centered. Sitting a top a canon of research that suggests empirical driven, evidence based treatment must be as dichotomous as it is episodic, the vast continuum of working knowledge is mobilized and charged with the provision of care, treatment, and elaboration of mental health under the auspices of this new theory I am dispensing.

No limits, no frontier too unmanageable, just restricted and subsumed by nature itself. Biologic theory inserts itself with cautious regard for deterministic philosophy and the real limits imposed by nature and the finality of life itself. This is a prosumer approach to driving treatment forward. There is no question that the best and most effective practitioners must have a internal, real, and first hand experiential knowledge of how to implement this theory in practice.

The ultimate and proximate implications are thus not process or content driven, but wholly and inherently biological. Nature sets the quotient for change. Both self directed, internal, spiritual, and external, this is the person in his or her environment. The limits of our world mark the weak points and the strengths of each person. Our knowledge only drives us to the apex of understanding and is not defined but the process or content of the work. Meaning, only the therapist’s experience practicing and breadth of how the work works from lived experience as biological natural and interconnected people fundamentally are the real and final markers for outcomes and people’s journeys in life.

Rather than gesturing to overt or covert limitations biologic theory makes use of it instead of expelling determinism for its obvious reductionist and ableist underpinnings). Biologic theory has only two basic philosophical assumptions. These assumptions are 1) human capacity for change is limited by the biological nature of the bodies medical and psychiatric status and 2) all people are unique in their potential for change.

This dialectical approach satisfies not only deterministic, but categorical, diagnostic uses for treatment and sets the stage for empirical evidence to assemble legitimate canon of unbiased and differentiated future research. Even self deterministic views of people are satisfied and incorporated into the grand schema connecting biologic theory.

From untreatable, to the most canonical expressions of mental health disorders to acute and chronic conditions rooted in trauma. Biologic theory nurtures previous research and cultivates the conditions for lasting impact in definable treatment. Meaning, the limits of our capacity to retract, redirect or more biologically said, heal, is what this theory considers the aim of real mental health treatment. For people to be as successful in their mental hygiene as clinically possible, is both reciprocal to the material expression of their very DNA for healing will allow, and this theory implies sharply implies, driven by the reigns of the prosumer to enact this theory in practice.

For the prosumer: operating the therapist’s clinical scalpel is as important as his or her lens and gaze for interpreting the person being treated biological needs for healing. This is not based on content or process: but value. This value, for better or worse, must never be calculated for state sponsored selection for rehabilitation and assessment of greater worth to society. Instead, this theory must be applied to to society itself and the macro biological systems existent and ripe for change and urgent reform.

For 🅱️iologic theory to subsume all diseased and cancerous predating therapies much continue to harm the public and defer real, lasting, and natural means of treatment, we must test and research what I am laying out here in this constructivist argument for charging the canon of studies with biologic informed theory. We must work quickly and prudently. We must justify our work through our research.

The Cancer in Academia and Mental Health Research

I have made no secret about my skepticism in the clinical value of new research in mental health in the last decade. I am just not certain we are targeting the right areas or bodies of underdeveloped research and moving forward in the important or needed areas to truly impact mental health as a discourse or field of inquiry. As a social worker, I sit on a vast, layered, and profoundly broader body of knowledge, theoretical understanding, and foundation of information than some other more narrow-focused disciplines out there in mental health. This is why I believe it is up to social workers, prosumers (people with lived experience and professional training) and other more ornate backgrounds and experiences to jettison research into the next era.

ACT (Acceptance and Commitment Therapy), and other hot interventions like Dialogical Therapies, while sharing some commonalities, also share what has truly become a cancer in mental health research. This cancer, located at the metaphysical polarities of the clinical spectrum for accepted, empirical, and “evidence-based” research, continues to eat away, and carve out the discourse of mental health treatment from within. The acuity and esoteric nature of these hot, miracle modalities continue to overshadow what we practitioners are setting out to do. Instead of practitioners learning a vast, eclectic, and broad skill set to treat all diagnosable, or treatable conditions, the task at hand has become estranged from healing and the helping process.

Alas, clinicians are boxed into a small physiological space for learning new research, and identifying gaps in current mental health trends and community-based needs. In a sense, these mental health clinician-crats, and those that decide, what techniques, are in, and which are out, are ruling out, and marginalizing hope and healing for a segment of the population which could benefit and stand to profit from advancing research forward across the board, and not limiting future data collection to the in treatments and those practiced by those with more influence in the field than intellectual credence. I am very serious about the set of propositions I am laying out here. This is part of a restatement of claims I have made before, but this article needs to signal a giant tectonic shift in how we do things in our field.

So, who really is charged with appraising the clinical value of our research these days? Who is really validating the claims researchers are making? Scholarly work, studies, published papers, all of these outlets and mediums for dissemination good information in our field have bias. We must accept and own these biases. Peer reviewed work, blinded, however we tell ourselves our work is pure, intellectually and ethically solvent, needs to be overhauled if not torn down at the very ground floor we built the discourse on before we can call ourselves truly non bias, and platonic in our commitment to unassailable research in mental health. Let’s be totally honest here. Endorsement of peer work in academia is as rife with political intrigue, and back door funneling of money, and funding, as the White House. The difference with academia is that we refuse to talk about it, and there are no television dramas depicting our ethical and moral battles in the wings of institutions and library halls.

Similar to the perseveration of our patients, we must re-direct the very meaning-making, and re-target the areas of research which aren’t talked about. The missing or underdeveloped areas of research which continue to confound, and contest the very bodies of knowledge we hold as truly incontestable. Well, if we really being honest about what we do in mental health, we would do just that. No modality, no study, no manuscript for submission is truly above reproach. There are taboo areas of how we do things as researchers that are problematic. If we do not overhaul and turn academia, pedagogy and practice on its head sooner rather than later we are headed for disaster. I would hazard to say the destruction of this field as we know it as an accepted discourse of intellectual inquiry. So, before it is too late, ask questions, continue to go against the current, until the very armamentarium of new research moves with us towards a brighter, healthier vistas tomorrow.

Learned Helplessness Must be Stopped🔴

One of my biggest struggles as a social worker in human services is challenging learned helplessness.

Learned helplessness is a phenomenon in which clients, patients, or any person connected to a larger system, becomes so conditioned by it that they begin to need a connection to it, as if being a recipient of services becomes part of their identity and way of living. As a person who has never been that reliant upon any system, but connected to one for access to its available services (such as mental health treatment), I would never go so far as to say I find people engaging in learned helplessness to be beneath me or anything of that nature.

On a deeper level, I do find this phenomenon to be very disturbing. I am a social worker and a person with lived experience who uses the system, accesses it at various levels, but has never been so reliant upon its array of resources and services that I have been conditioned by it. What I mean by this is, if the system fails me, or my needs bump up against its interests, I will not be so jarred or shaken that my bejewelling, world view, and quality of life are at risk.

I have worked as a peer, clinician, and helper with people who cannot help themselves because they are so dependent on the system to do it for them, that they forget and unlearn how to do things independently. It pains me to watch a person so ingratiated into the system that their connection to it becomes more important than how they benefit from it.

I have witnessed this manifest in different ways. I have seen clients yell and scream at their workers in the community on a supermarket checkout line, in community centres, or in hospital waiting rooms and ER’s, just because they have no other emotional outlet to vent. Indeed, I have experienced being hollered at just because my clients are so isolated and disconnected from natural supports, that I am, as a representative of the system, and extension of its services, the only option for clients to release their extreme build-up of negative emotions and disturbing thoughts.

Cases like I am describing aren’t as few and far between as you may think. These are not always the most deregulated, most chronic, and most isolated people. I have worked within a very populated region which has a vast spectrum of needs and range of supposed functioning. In most cases, though, the converse of the scenario I described is what is occurring and really requires people like myself who have an issue with learned helplessness to get over this bias and judgemental view of interpreting the behaviours of our clients. For example, in many cases, due to cognitive issues or disconnection to reality, people reliant upon the system do not even realise they are connected to it. All the while, they are participants in a larger network of care, either government-funded or operated at a higher level than a local non-profit or community clinic.

Some people are so confused or persistently agitated that they cope by disconnecting from what is going on around them and, in turn, do not even realise they have reached the very apex of the care and system support their county or state has available. This is true also in the state hospitals where people are so disconnected they do not realise they are even in a hospital receiving treatment. Many people experiencing psychosis, who are connected to the most intensive level of services, are so symptomatic that they don’t appreciate or realise the level of support that they are getting from their providers.

Understanding our problems and issues in a larger context is the first of many steps to finding more appropriate treatments. Connecting with other peers with similar situations and creating a larger community at a level in which participation and peer networking is possible. This momentum and mobility in the recovery process is only possible when people develop and tune into their problem in a larger more global context.

This requires the type of insight building only made possible when clients begin to frame their situations through connection to others, such as therapists, case managers, family, or the larger community, and leave behind their isolating and patterns of behaviour which disconnect them from other people. These are situations in which extreme paranoia, depression, or other mental health disorders become so profound that the management of the symptom takes over a person’s life, and in order to cope, maladaptive patterns of behaviour are put in place which mask the issue, but contribute, ultimately, to the extension and prolonging of the problem and its treatment.

We need to get to know our neighbours, the people around us, those who live among us. Whether we are helpers or help seekers, living is about survival, and people are more likely to succeed when banded together and looking after one another. Being reliant upon a system and letting something else define the problem for us, instead of the community identifying its own issues, estranges us from network building and bonding with our peers.

Sure, ‘Meals on Wheels’ is important to some folks and serves a vital function for some families, but so does neighbours bringing a plate of food to the next house when we know that family is in need. We have lost the very essence of community building and the very fabric of humanity which isn’t afraid to band together and change what really needs changing. The less human contact, the less empathy, the less we care about one another and what’s at stake for our friends, families, and those we love to get what they need for themselves and be better for it.

MHBC LONDON 2018 🎩

There is no question that family participation in a person’s mental health treatment is beneficial and critical to manage the long-standing problems that surface during a person’s recovery from a mental health disorder. This message was communicated to my parents Jane and Frank Guttman when I was an adolescent receiving my first in-patient treatment. Since my first hospitalization at an adolescent, to my state-level hospitalization as a young adult, and every treatment in between, my parents have been vested in my mental health treatment.

My family has witnessed the impact of family support before and lack of it within our own familial history. Both my uncle and my aunt suffered from Schizophrenia.

 

I never met my uncle face to face. I only spoke with him once on the phone. I remember him apologizing to me that he couldn’t come to our home to visit and meet me. I only lived twenty minutes away from him. So I could never figure it out. I remember going to clean out his room after he died in the hospital from an non-life threatening illness that went untreated, which I could also never figure out. It wasn’t until much later on, when I became a social worker, and visited his apartment building with the ACT (Assertive Community Treatment Team) I was working for at the time, did I realize why he died so prematurely.

 

Living in a apartment treatment building, or adult home, my uncle, akin to many people with serious mental illness living in treatment facilities in the community, post deinstutionalization, are overcrowded, underfunded, poorly managed, and neglectful in their practices. Many people go without the adequate supervision they require or need to truly live in the community and retain some independence. My uncle’s fate was no different than a large segment of the community carrying a severe and chronic mental health condition.

My parents, all too familiar with my uncle’s fate, and my aunts, which was very similar, were determined not to let their son live the same life, cut short, and eclipsed by the disorder. Since my diagnosis of schizophrenia my parents have been relentless in this regard, and for these reasons, which, are very personal, but nationally and internationally important to everyone who is underserved by their mental health system, and at risk of early medical problems, and other medical co-morbidities gone untreated from maltreatment and neglect.

 

This is why after ten years of recovery my parents continue to support my writing on mental health, and understand how this act of writing on mental health, spreading awareness to others through blogging, and learning self-management skills is used by people carrying a diagnosis to self-soothe, and also as technique to diffuse and disrupt their new or active symptoms. For a decade now,  my parents have read every blog I’ve posted, and support blogging as a tested and effective weapon in the battle against chronic mental health disorders.

 

When Dennis Relojo, the world’s first blog psychologist and founder of Psychreg asked me to speak at the 1st Mental Health Bloggers Conference (MHBC 2018) in London, my parents again threw their support at this tremendous event to take place in the UK on December 17th. The conference, which is jointly hosted with GetPsyched, will be held in the historic Rainham Library, will no doubt set the stage for how the deep problems are in the mental health community, and grand imperative at stake in the larger international context. This is why my parents have chosen to sponsor me at the event, and make the journey across the Atlantic about Cunard’s Queen Mary 2 this December. In doing so, my family hopes to signal to the world how deep the problems run, and the need to get together internationally to truly make a difference. I am confident, at the conference, we will send a message to the mental health system in the UK, United States, and larger community that this is a global problem and together we will find a solution to it.

 

Attention Seeking Behavior(s)🤳🏽

I have a profound fascination with attention-seeking behavior(s). I’m also profoundly astute at capturing the attention of peers, family, and friends. Please make no mistake about it.

I am no stranger to these histrionic red flags into a possible personality disorder.

Let us be completely honest. People spend a great deal of time fixated on getting attention. Conversely, some people can’t get the attention of others if their life depended on it.

The level and intensity of attention-seeking behavior begin and ends with the ability, tenacity, and creativity of the person seeking attention. Attention seeking actions cited in the DSM 5 are parts of larger issues to a clinical picture. In cases using the DSM-5 for clinical work, the ‘issue’ is a mere abstraction.

The DSM-5 transformed the conversion of a neutral and non-threatening term like ‘issue’ and into something that needs further attention and concern: problem. In the end, the problem is the ‘diagnosis’. The illness’ something that needs treatment.

Patient reporting in a clinic or therapy office is under the psychiatrist’s lens—psychiatric assessment of your behavior based on reporting. The informal–yet–unassailable remarks of the psychiatrist about you become an archival record—the point of departure from symptom to medical illness.

For most personality disorders, including, but not limited to Narcissistic Personality disorder, Histrionic, and Borderline, the clinician will need to evaluate the intentions or motives of the person seeking attention.

Motives, choices, and the general goals of anyone seeking attention should be the primary indicators that someone is seeking attention to make up for or satisfy a character-logical deficit or ‘personality disorder.’

I am suggesting that if the motive is clear, the intention purposeful, and the aim is to gain others’ attention. Quenching an individual’s thirst and making up for their shorting comings or lack of insight into an interpersonal situation gone awry, then beware.

In terms of NPD, the reason or rationale for seeking attention is probably, first and foremost, to satisfy a personal deficit in self-worth or self-esteem. For people carrying a diagnosis of Histrionic personality disorder, the aim is to create hysteria to mask whatever set of bad decisions or personal choices occur or require concealing and hiding to shift the focus to something more benign and innocuous.

In terms of patients carrying a borderline diagnosis, the attention-seeking behaviors aiming at splitting and causing such chaos around. The ability to take ownership or accountability takes a backseat to the clinician focusing primarily on the week’s crisis.

These diagnoses are not the only ones in which the patients enact attention-seeking behavior. I focus on patients with personality disorders who pass off attention-seeking actions as a necessity or an undisputed life requirement in this essay.

Clinicians and friends of people carrying a mental health diagnosis need to remember why? From an epidemiological standpoint, diagnoses are merely the markers of the incidence and distribution of symptoms in patients.

From a mental health perspective, we clinicians and friends need to remember all humans seek behavior at different levels, even at cross-purposes, and always to connect with other people fundamentally. While this should be a given axiom in mental health, it is not!

Only when these behaviors create extreme distress, for the person exhibiting or displaying the action, and the people in their social world is truly diagnosable and problematic. As stated before, mastering grabbing the attention of peers and other colleagues is simple. After going through such extreme lengths to capture attention and experiencing the police show up at the door.

Rigor, persistence, and aim were so alarming and off the mark in terms of purpose that everyone was puzzled. Again, this is when attention-seeking goes awry. Over the years, this writer has been in mental health and learning to scale back and generally decrease the intensity and viability of behaviors.

This writer is very good at gaining a peers’ attention without making it clear as day from when I began to enter the social scene.

As a society, we have begun to truly mark, identify those seeking attention, and shame them for such behaviors. Not entirely sure this is the right path or the best way to handle such actions.

Collectively, we need to make it clear that such behavior is unwelcome, unwarranted, and not necessarily appropriate. We give the person seeking such action precisely what they are looking for when displaying such untoward or visibly obnoxious scenes.

I believe people need to take a more psychologically sound and driven approach when putting the blinders up. Actively ignoring and minimizing or, better yet, making it clear through our body language and words, these sorts of displays are ineffective in capturing our attention and keeping it.

Mental Health Affairs 2022

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