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Sunday 29 September 2013

THE MENTAL HEALTH DEBATE = A GREAT ARTICLE - "At War With Ourselves"- By Rufus May, a Psychologist from Bradford U.K. - Courtesy of Mad in America Website

At War With Ourselves

September 15, 2013

If we call someone mentally ill, in some ways we may be recognising their predicament as a powerful one, and their need for support.  However, we may also be judging their state of mind as faulty. But what if what seems a faulty mind is much more than that?  What if it is an expression of emotional conflict that needs, not to be cured, but to be understood and reconciled with?

We can go deeper than trying to say what is wrong with someone, how ill they are, or what category they fit into. We can instead ask: How do parts of them feel? What might different parts of them need? And what are the contexts in which these experiences have emerged?

We may also see the social context as an important place in which to create change.  An individual’s difficulties are intertwined with their social network.  Therefore, rather than seek to merely fix the faulty individual, we may want to bring the people around the person together and find new – and more helpful – ways of relating that benefit everybody.

A challenging mood or behaviour can be seen as having its own logic; its own purpose that needs to find new ways to be heard and new ways to express itself. For example, a young person’s refusal to eat may be a way to seek control in a life where the young person has felt they had very little control.  If we can give that person the experience of trusting relationships. Then, gradually, new forms of safety will be experienced and the reliance on controlling food intake will be likely to diminish.  If we merely call this behaviour an eating disorder and attribute it to mental illness we may miss the opportunity to learn from the behaviour about what is lacking, and needed, in the young person’s life.

Calling someone mentally ill may allow us to not think about our role in the development of their distress, and what our role could be in ameliorating it.

I once sat with a young man who had paranoid ideas – and his warring, separated parents – for an hour and a half in my kitchen. By just having a meeting based on dialoguing principles the son’s paranoia lifted significantly.  I am not offering a blame-the-parents model here. We are all connected, and affect each other. We all have different sensitivities. Responsibility is shared. Moving towards understandings of painful events that acknowledge responsibility but also avoid blaming and morally judging each other are important in any peace process.

But if we assign someone the role of being mentally ill, we begin a cold war against their distress. We refuse to listen to possible reasons for their distress in the social contexts around them. Reconciliation will be unlikely to occur.

Personally I prefer the terms ‘confusion’ and ‘distress’ to the term ‘mental illness,’ although ultimately all terms are limiting in their own ways. Many people hold onto the term ‘mental illness’ to signify the extremeness of what they have been through.  So, in offering alternative conceptualisations we need to tread carefully and acknowledge the intensity of people’s experiences. I think if we can broaden the language about our individual sense of disharmony and turbulence we can have greater freedom to understand our complex lives.

We have in the UK a national mental health anti-stigma campaign called Time to Change. They have spent over 25 million pounds on media initiatives aiming to reduce fear and discrimination for people who have been given psychiatric diagnoses.  Time to Change says it’s good to talk about mental illness.  The argument goes; the more we talk about mental illness the more acceptable it will be in society and the less discrimination people will face.

I agree it’s good to talk about a taboo subject but only if that talk – as well as encouraging empathy – uncovers new ways to see problems and find solutions.  I recently challenged Time to Change about how much they use terms like ‘mental illness’ – and diagnoses -because I think, used rigidly, they can add to stigma and misunderstanding.  Even the concept that 1 in 4 people have a mental illness encourages a conceptual division – between those thought to be sane and those thought to be insane – that may make empathy more difficult.

If we replace the illness model with one that sees suffering and confusion on a continuum, then it is easier for us all to relate to each others’ predicaments.  This feels more inclusive, rather than separating off the ‘ill’ from the ‘well’ in an artificial and compartmentalised fashion. A group of us are planning to write to Time to Change about the language they use.  This article is about an alternative way of looking at what gets called mental illness. But first I will share a few reflections on this tension between wanting to embrace this phenomenon many call mental illness and the desire to re-frame it so we can embrace it more wholeheartedly.

My impression is that many people accept the term mental illness and find it useful in their lives. I don’t want to offend them, I don’t want a war of ideas with them where I hope to get them to convert to my way of thinking. I do want to suggest that many people may wish to hold the term mental illness very lightly or not even use it at all. In my eighteen years working as a psychologist I have generally found non-medical terms to be more helpful in trying to help people find more peace and agency in their lives.

However, the term ‘mental illness’ may be helpful to use if you need to access a health service or a state benefit. Some people may like to see themselves as having an illness because it conveys a certain level of suffering, and that it is not something they are choosing but rather something that happens to them. In this way some may find it is quite validating of the level of distress or confusion they at times experience.

In an individualistic society people who fail are often blamed for their failures, to be ill means you can seek some refuge from this blame. On the other hand, the other side to this exemption from blame is that the identity of being ill can lead people to feel helpless in the face of their emotional and social difficulties.

The one thing people are in agreement about is that there is fear and discrimination towards people seen as having mental illness and that this needs to change. Not only is mental illness often seen as dangerous, it is also seen as embarrassing.  It’s embarrassing to talk about our experiences of confusion and distress because we risk being rejected by others.  Also, we are not used to talking about it so we don’t have much of a vocabulary when it comes to talking about troubled minds.

The ‘mentally ill’ person is often represented culturally as a sad pathetic creature or an out-of-control maniac; possessed, we assume, by biological demons.  Stories in the news and in entertainment often feed into the cultural fear of mental illness.  Because madness is frightening and embarrassing we don’t try and understand it in everyday conversation or in schools.  There seem to be two approaches to diminishing this fear of confused minds.

One is to try and get everyone to accept that this thing we call mental illness is nothing to be ashamed of or to be unreasonably afraid of.  The second approach is to say that to reduce the stigma, the fear of mental illness, we need to completely re-conceptualise it.  We need to replace the language of illness with something more inclusive and socially meaningful.  Rather than an individual flaw it’s an understandable reaction to life events. Maybe these two movements of either accepting mental illness or re-conceptualising it are two different ways of trying to get to the same place.

However, when we call an experience mental illness we often then assume the content is meaningless. If on the other hand we see difficulties as meaningful reactions to difficult life events, then we give it a place of learning in our communities, not just something to be sympathised with.

If a word opens a door for us we tend to like it. If, growing up, my mother is from time to time bedridden for weeks – overwhelmed with sadness and unable to communicate with me – it may make sense to me to see her as having a mental illness. It’s a shorthand that lets others know something about the discomfort she is in and how difficult we both find it to deal with. In the absence of a richer vocabulary and a community that responds to this sadness, designating someone as mentally ill gives us a framework through which to see things and a hope of a medical solution.

However, there is a problem with seeing distressed parts of ourselves, or confused behavior, as mental illness in need of a medical cure.  If we see distressed or confused minds as being diseased, like a cancer – to be battled with and got rid of – this takes the inner conflict we are experiencing to a new level of warfare. We are pitching ourselves against ourselves. A more holistic model of illness and healing sees the body’s dis-ease (i.e; lack of ease) as a way to deal with toxins that needs to be worked with, not against.

I am keen to promote alternative ways to view overwhelming mental and emotional experiences that seek to both empathise with the situation, and also understand the deeper possible meanings they point to. Rather than see ourselves as singular individuals with one personality I have found it useful to understand the self as made up of  lots of competing parts that need to be heard and express themselves.  While some of these parts feel in our control others may seem to have a mind of their own and to feel and act in ways we may not be conscious of, or when we are aware we find them challenging. An example is: when we get angry, we may say and do things we normally would refrain from doing.

When someone is distressed or appears confused, rather than seeing this as an affliction that needs to be battled with I find it more helpful to see it as an inner conflict between selves that are in opposition to each other.  The way forward is not for the well-self to defeat the sick-self, which may be what is attempted in a more medical approach to healing. Rather; healing is about a reconciliation between the different energies and personalities that make up the whole of who we are.

When we get mentally overwhelmed it is because parts of us are trying to protect themselves in powerful ways that are confusing to the person or those around them.  For example, in depression parts of us withdraw when they are exhausted. They are perhaps full of fear and don’t want to fail again. The person may also be overwhelmed with feelings of grief, sadness and bitterness to the point of a complete sense of nothingness and pointlessness.

In what gets called obsessive compulsive disorder a child-like part of us may be in control. It knows that – temporarily – it can protect the person from pain by creating an illusion of control in an unsafe and uncertain world. In mania, impulsive energies and child-like parts and power-hungry parts team up and overtake the exhausted responsible adult parts. They are running on suppressed energy, and often it is a powerful cocktail of pent-up frustrations and grief.

When we are seen as delusional, our magical and imaginative children may have taken over our awareness, creating stories that seek to protect us and in some ways symbolise our emotional strife and need for safety. Our heroes and our messiahs are often given a role to protect us  from painful feelings of isolation, vulnerability, and loneliness.

When we hear voices we may be hearing parts of ourselves we have consciously or unconsciously separated from and personified.  Angry voices are often parts of us that have witnessed or been subject to neglect, emotional or physical violation, manipulation and exploitation. They are angry at the person and the world that has let them down.

Somebody who experiences high levels of anxiety may be highly sensitive, and this trait needs to be honoured as an ability to feel energies and emotions strongly.  Anxiety also seems to mount up when we are trying to keep a lid on angry and frightened parts of ourselves.

Suicidal feelings come from parts of ourselves that are overwhelmed with painful feelings. They want a break. They are telling us we need new ways to look after and respond to these painful feelings. When emotional pain feels listened to or is channelled in some way into activity, it calms down markedly.

So, rather than see people who are confused or deeply distressed as just ‘mentally ill,’ we should try to understand the different parts of the person that are trying to protect themselves. Angry voices need listening to, and a safe way to act out their concerns. Manic parts need a chance to express themselves on a regular basis so they wont be over-aroused and cause a mutiny in the future. When I help someone bring parts of themselves to the peace table, I have to confront and make peace with similar energies in myself.  So when we seek help from others to reconcile conflicts we also learn from this about ourselves and we grow in understanding, too.

This is not as easy as it sounds, of course. We have a community of parts that need to be negotiated with. In my experience, for example, renegade parts that have sabotaged the person’s dreams are not easily forgiven and given a new role in the psyche.  Even though the person may logically understand that a part has sought to protect them in the best way it knows, they may still resent the damage they perceive the part has caused. If the person does not want to give space to a part of themselves they are angry with or ashamed of this need to be respected. We need to feel safe and acknowledged before we are willing to make peace with parts of ourselves we may not want to recognise, or still see as our enemy.

I don’t see brains and bodies not being involved in these psychic conflicts.  Genes will no doubt play some role in what selves we develop and will interact with our environment.  Similarly I don’t see drugs and physical approaches like diet, massage and yoga as not being relevant to helping people. A drug may help us get a temporary break from a conflict or lessen our emotional tension but its benefits should not be exaggerated. We can and often use a biological approach to deny and suppress hurting parts of ourselves, and if we sustain this it will likely lead to a back-lash of some kind. Parts that we attempt to block from consciousness may find some way to powerfully rebel and return later; stronger and more virile.  Or if suppression is successful these parts may retreat into apathy and listlessness and this energetically is likely to permeate the person’s life.  Thirdly, the anxiety created by suppressing angry or hurt parts may lead us to endlessly seek solace in addictive behaviours.

As I mentioned earlier, individual distress and confusion occurs in a network of social contexts. We need many ways to intervene in the community that promote dialogues and understanding.  I see what is seen at first as madness as a reasonable response to difficult life circumstances. The peace process required is both within ourselves and within our social contexts.  Our manic or paranoid or depressed parts are all trying to protect us when we are overwhelmed by life events.

If we just see these parts as ‘ill’ we will be unlikely to honour the needs they are telling us about. If we decide distress is a meaningless mental illness we are declaring war on our responses and attempting to force them into exile. They will not thank us for this, a listening approach will reap greater dividends in the longterm.

Rufus May is a psychologist in Bradford, England. He believes everybody can flourish with the right support network. His work is part of an emancipatory movement that includes the hearing voices movement, community development approaches and other self-help and holistic health movements.

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