It was 1995. I was seated at a banquet table to receive an award for a set of training videos useful in helping people learn to associate (the complement of dissociation). I’d had the idea that if dissociation was learned, association could be learned, too. After breaking the skill down into the requisite knowledge and skills, I created the ASk (Associative Skills) model. Looking back, the production quality of the three videos we made makes me wince. In any case, the conversation at the awards dinner kept gravitating toward the many people diagnosed with dissociative disorders the other attendees knew. Most were described as hopeless, helpless and homeless within months of diagnosis and for years afterward. I asked what they thought caused this. And as I remember it, these were some of the responses:
· Money: “those people” couldn’t afford the “treatment” they needed.
· Willingness to “get better”: some of “those people” didn’t want to get better.
· Hard work: guiding the healing process wreaks havoc on clinicians, too.
· Pathologizing: how damaged and very sick “those people” were, as if prowess might be determined by who had the “sickest”patients.
· Underlying issues of socio- or psychopathy, masked by dissociative disorders.
Clearly the models on which these clinicians based their opinions were not the people with dissociative disorders that I knew. When I appeared on the Montel Williams Show in 1992 (he was only in 13 markets at the time) I had no idea he would post my phone number on the screen at the end of the show. I received over 400 calls in the next few days, most thanking me for representing the un-represented side of dissociative disorders. The calls came from physicians, clergy, attorneys, entertainers, accountants, folks of all professions who lived and worked pretty well in spite of their diagnoses. For many, their diagnoses enhanced their lives, though they remained deeply closeted because of perceptions about “those people”—the Sybils, Eves, Trudy Chases, United States of Taras, characters on Law and Order.
The clinicians I met at this award dinner, and the vast majority of the ones I saw every day, didn’t think about these highly dissociative folks who functioned well enough. Instead, they fell into something called the Clinician’s Illusion. The Clinician’s Illusion simply says that if all you look at are the people who struggle, you’ll think that all people who are “like that” are “like them.” Because clinicians see only the dissociative people in need of help, they imagine that all dissociative people need help.
Thus is born the horrifying generalizations that help keep “those people” hopeless, helpless and homeless. Everyone else who has a similar diagnosis who functions, makes a living, has solid relationships and does well… becomes invisible. And the people with diagnoses who live full and functional lives are lumped into a category with those who don’t: it is assumed that all people diagnosed with various disorders may commit gun violence, tax mental health resources, and behave outrageously.
The real problem? The people functioning well despite a diagnosis who hide their label because of the stigma associated with it. No one wants to be “like them”—the people represented by the Clinician’s Illusion.
How does this relate to your organization?
- If you are someone who is in administration, clinical services, or any position in an organization serving folks who’ve had hard times, check yourself. Your language, writing, and interactions will tell everyone around you exactly what you expect of “those people.” The degree to which you and your culture is committed to and acting on the Clinician’s Illusion relates to staff morale, stress levels, and service outcomes. Serving people without multiple positive expectations for role models for them (and yourself) takes effort.
- Raise your expectations of people with diagnoses and encourage those around you to do the same. Instead of expecting the population you treat to converge on the low functioning mean of the people who seek help, expect them to succeed like the many, many people outside clinical settings who remain invisible.
- Encourage prescribers to take complaints about medication seriously. Zombies are no more functional than people in active psychosis; they’re just easier to manage.
- Respect the power of fear propagated by the Clinician’s Illusion in keeping successful people with diagnoses closeted. Very, very few people have enough security in their lives to be “out” about a diagnosis in a society where they are devalued and portrayed as dangerous, violent, to be feared.
- Look for and celebrate people across the spectrum because you get what you expect—and when you stereotype those with diagnoses according to the actions of the visible members who seek treatment, or whose cases are used in training, you miss the “positive deviants” that are not part of the Clinician’s Illusion.
- Recognize that on your staff of people providing services or supporting those who do, at least one in four has a diagnosis from whichever DSM you’re using. If they don’t, it could be a close family member, or relative, or friend who does. Change the conversation when you hear this, and help people talk in less pejorative ways, more and more favorably.
By the way, you don’t have to be a clinician to experience the Clinician’s Illusion. A similar illusion is at the root of all stereotypes – the belief that everyone in category X behave in Y manner. Gay, with skin tone different than our own, who speak, are formed physically or behave a certain way. It lets you imagine that you immediately know things about people, when in fact your knowledge may be exceptionally limited.
Challenge these illusions. It’s the only way to release yourself to see the people who live beyond the labels and expectations that keep one in four (or fewer) people living in silence.
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