I once spoke at Pike’s Peak Mental Health Center at the invitation of Dr. Honeybee Crandall, MD, to the staff working with people with severe and persistent mental illness. I asked how the patients behaved, how they functioned. Not well, I was told, because they had mental illnesses. We assume people diagnosed with mental illness can’t do well, and we are perilously unwilling to let them—and the Finnish studies on Open Dialogue are good reminders of how we can do something different. Looking at the mental health systems and practices other countries employ is helpful. We get what we expect from people. People with mental illness are expected to conform to others’ expectations and when they do, we say they’re “not doing well”. But what is doing well? Is it being “normal” (a setting on a dryer, as some say)? Instead, I know people with severe and persistent mental illness who defy the expectations and “do well” on their own terms: they hold jobs, they have friends, their lives are rich and full. I call these people athletes of the mind. Here are five keys to helping people diagnosed with mental illness find their own, unique paths to “doing well” in life:
1. Forget Insight
The old “anosgosnia” argument says we can’t get better because we don’t believe we are ill – without insight into the fact of our mental illness, we can’t change this mental illness. I’m not the only one saying it: Insight doesn’t equal change; different behavior—even without insight—produces change. Insight is the booby prize, and sometimes it can even lead to feelings much worse than the ones that preceded it.
2. Find the Courage to Look Past “Evidence-Based”
It takes a very long time for a practice or process to clear double-blind studies to earn the gold standard label of “evidence-based”. Then, the number of people who become trained to deliver evidence-based practices grows at a desperately slow rate. This system of research and testing is poorly constructed to allow new ideas. Don’t get me wrong: evidence based practices are great for the populations on whom they are tested when there are people who are trained to use them properly. But keep in mind that most “evidence-based” practices are tested on small subpopulations of one culture—and the evidence is not there for many groups. They don’t work so well with indigenous populations because they are universally Western in thinking—which means a population in desperate need is left out. They haven’t been tested to determine the impact of gender differences. Give me a treatment that I will work for me, one that helps me learn to function the way people who do well function—and let’s define “do well” first.
3. Promote Relationships
Relationships—and their power—are hard to study with quantitative techniques. Qualitative analysis is dismissed with the wave of a hand in the face of the scientific method, as if it can have no validity. And yet relationships are often the key ingredient in recovery and healing from mild to severe mental illness. Risking Connection, Sidran Institute’s flagship model for healing after trauma, gave me words for this. People who feel they are worthy of life, who have skills for managing and modulating feelings, and who have strong positive connections with others (people, animals, God, etc.) have far fewer crises. And, of course, when sturdy relationships are never developed, missing, or ruptured, or when the situation exceeds the individual’s self-capacities, problematic behavior erupts. By focusing on helping parents have more fun with their children in meaningful ways, or providing what Bruce Perry calls “kind support” we can help people reduce mental illnesses and create relationships that give rise to better functioning. By the way, have you checked out the Goldfish Fun Zone from Pepperidge Farm? It’s a great free resource for family fun.
4. Embrace Differences
We assume that differences in how people process life mentally and emotionally are bad. Yet, we value people like Einstein, Schweitzer, Hawking—we value Joan Borysenko, Marsha Linehan, and Elyn Saks. John Nash won a Nobel Prize in economics. Each of these have very different mental processing styles. Here’s an example: take hearing voices – the dominant approach is to make the voices shut up, rather than wondering what the voices have to say, trying to befriend them. We do the same with visual and sensate experiences. Only a couple of organizations like Hearing Voices and the Open Dialogue Project consider people with unique mental abilities on equal footing with those who have majority mental experiences. Other cultures do, such as the spiritual traditions of the Dagora in Africa and some indigenous communities in the United States.
5. Practice New Thoughts, Feelings
Of the many people I know who have diagnoses of some sort, almost everyone wants to believe they can be happier, healthier, and more functional. They want to be “athletes of the mind.” You don’t get there simply through awareness, or by trying to squish unique mental experiences into the small box of “normal”, or by using medications to change one’s brain chemistry without learning new behaviors to accompany it. The people who have a diagnosis and live well with it? Who function with aplomb? They get there by adopting different thoughts and feelings and practicing new ways of being. They are the athletes of the mind.
— Please join me on Facebook to discuss personal and organizational trauma, healing, ethics, and innovation.