Becoming political: defeating the Treatment Advocacy Center

August 22, 2014 by

There are assisted outpatient programs in almost every state in the union and in most of these states those programs are unused, inconsequential and irrelevant to the operation of the wider system. Many times these programs were set up with massive legislative approval and public support.  Yet each state had the testimony of previous states to look at and seldom did.  For many people who self identified as being anti-psychiatry or psychiatric survivors the fight against AOT was perhaps their primary battle.  Yet as far as  I know they lost every single battle they fought.  The Treatment Advocacy Center, the primary proponents of AOT won every battle they fought and we have AOT in virtually every state.

There is not a lot of professional support for AOT.  People who actually work in the field (not those who “study” it) will tell you that involuntary participation in treatment is normally fatal to any prospects of success.  There is tons of research in the field of social psychology that talks about the very real limits of coercion as a change strategy.  For most people it is just common sense.  There is a difference between people who are forced to do something and people who choose to do it.  There is a study which purports to show AOT is the best thing since sliced bread out of New York, but since New York pours at least $32,000,000 a year into the program, the relevance of it to other states is at best questionable. 

Now there is a major push to federalize the AOT program.  A program that in its biggest incarnation (New York) serves 1/3 of 1% of those served by the mental health system is being pushed as the answer to virtually everything.  And it came close to becoming law.  The Murphy Bill is not dead.  In the next term the new Murphy Bill will once again join the conversation.

Behind it all is the Treatment Advocacy Center.  Regardless of what you believe about their ideas and theories their political skills are real, proven and effective.  They know how to influence legislation.  They know how to turn out the personal stories of people in favor of legislation.  One of their chief spokesman is an advertising man and yet his word is accepted as gospel, his status as “mental health expert” is sacred and their pieces are printed in major newspapers and magazines without question or critical comment.

Common sense tells me they cant win.  But yet they have won at every turn.

The consumer movement has been splintered and fractured and abysmally ineffective.  They for the most part have been unable to resolve arguments amongst themselves let alone provide any kind of real opposition to the TAC people.  In fact you could make the argument that TAC relies on the impotence of those who oppose them to get their laws passed.  The consumer/survivor/ whatever term you want to put in there movement has become the fall guys, the “boogeymen”  of every TAC campaign.  Witness the Murphy campaign.  They have seriously  tried to sell the idea that “anti-psychiatry” forces control the mental health system and their bill is a valiant effort to save it from the oppression of those who dominate it and deny services to the “severely mentally ill.”  We may know it is pure nonsense but an amazing amount of people have drank the kool aid.

If we dont become effectively political we will leave the argument to those that are:  the Treatment Advocacy Center.  There will be more than a Murphy Bill.  There will be a Murphy Law.

In recent weeks there has been a shift in the conversation which holds promise of real fruit.  A Stop the Murphy Bill PAC has been formed.  Its goal is for the ideals, values and goals of the people who stand against the strategies and methods of the Treatment Advocacy Center to become politically effective.  It has talked about the idea that the best way to effect legislation is to effect who is elected.  It is in its infancy right now but I applaud its intent and effort.  It has more than a little chance of making a difference.  I have joined the Facebook group of the PAC and hope I can be part of the move to political effectiveness.

This is so important.  If we dont do what is necessary to win, if we are incapable of pulling together and working to make ours an effective political voice that goes past blog posts and fancy speeches, we will lose.  Again the track record of the Treatment Advocacy Center is clear.  We have lost in the past at every turn.  If we just do the same old things we will lose again.

If there is to be qualitative changes we must change what we do and hang together and work together and never  give up.  It is time to have clear focus on who the real enemies are and it is not the people who share your concerns however you question their methods..  The Treatment Advocacy Center is not playing.  They intend to win.

It is on us.

The Murphy Solution: Does it solve anything for Tennessee

August 22, 2014 by

hopeworkscommunity:

On murphy…. from the archives

Originally posted on Hopeworks Community:

The core of the solution to change the mental health system according to Representative Murphy resides in a few core ideas.  Most of those ideas have relevance to Tennessee directly.  Will they make the difference he says??

1.  Increase the use of psychiatric hospital beds.

A state hospital bed in Tennessee costs, depending on the level of care between $145,000 and $340,000 a year.  To put in a Tennessee perspective the peer support centers in Tennessee serve about 3500 people a day.  Most, if not all of them, would qualify in Murphy terms, as “severely mentally ill”.  They cost $4.5 million.  Their biggest success is in keeping people out of psychiatric hospitals.  Over 90% report a marked decrease in psychiatric hospitalization.  To add 12 beds for the highest level of care would basically equal the budget of a program that serves 3500 a day and prevents people from needing hospitalization. …

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Murphy misunderstandings

August 22, 2014 by

hopeworkscommunity:

On murphy …from the archives

Originally posted on Hopeworks Community:

Rep. Murphy has not went gently into the good night. Dr. Torrey will never go gently into the good night. They are trying it sounds like to provide cpr to their bill. Rather the things that didnt work the first time will work on second effort is anyone’s guess. I think sometimes it is really hard for annointed national spokesmen to realize they are not and never were.

But this post is not about that. It is about a fundamental misunderstanding of the American mental health system that was part of the reason that may have doomed the Murphy Bill from the start.

Murphy seemed to believe we were doing far too much for too many. He thought people who were doing better in the system were robbing those who were doing poorly of help and resources. And he thought if resources were properly allocated things would be okay. Using…

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Dear Rep Murphy: On the meaning of reprehensible

August 22, 2014 by

hopeworkscommunity:

On murphy….from the archives

Originally posted on Hopeworks Community:

You say that it is morally reprehensible for anyone to help a patient question the medical advice a professional gives him.

Let me tell you about reprehensible.

Where I live bipolar disorder is as much a function of the doctor you go to as the symptoms you display. One doctor basically believes everyone is bipolar. He says that the fact he consults and does “education” for a pharmaceutical company has nothing to do with it. Another talks about people “feeling bipolar” to him. They never seem to have the right symptoms for the right period of time but still…. The psychiatrist at the psychiatric unit basically doesnt believe anyone is bipolar. He thinks it is way over diagnosed and way over-dramatized. He normally cures people from bipolar really fast. He just tells them they dont have it. Considering they deal in “medical science” that seems reprehensible to me. How do…

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The 90th letter: 25

August 21, 2014 by

http://wp.me/p4E9xY-6Z

On the Myths of the Myths of the Murphy Bill

August 20, 2014 by

Myths about the Helping Families in Mental Health Crisis Act (HR 3717)
http://mentalillnesspolicy.org/hr3717/hr3717myths.html
【from Next Browser】

The post above was written by DJ Jaffe of mental illness policy.org. Jaffe is an interesting person. It is his answer to the critics of the Murphy Bill. Jaffe is best I can understand an advertising man by training. His primary qualification as a mental health expert is that he is an advertising man. He sells things and does so superbly.

He is a relentless advocate for Murphy and Torrey, basically functioning as the bad cop of the trio. He has absolutely no hesitation or reluctance to bash the character or motivation of anyone who disagrees with him or Dr. Torrey and does so passionately and aggressively. Before he became an established “mental health expert” his claim to fame was the piece he wrote to family members that if they called the police on a mentally ill family member to make sure all the furniture was turned over before the police got there where they were sure to get the “right impression.” I dont know if he still favors turning over the furniture or if he has moved past that.

Jaffe starts off, ” Groups representing high functioning individuals with a ‘lived-experience’ and other recipients of SAMHSA funds have made numerous claims about The Helping Families in Mental Health Crisis Act (HR 3717) that are inconsistent with the facts. The following compares the claims with the facts….”

Jaffe lumps critics into two groups: “high functioning with ‘lived experience’ and those who have a stake in continued Samsha funding. There are so many problems with this it is hard to know where to start.

One of the biggest problems with Murphy and company is their belief that no one can have an honest disagreement with them. Anyone who disagrees must have a distorted perception or ulterior motive. This has left them severely deficient in trying to build support from people who do not totally agree with them and is one of the big reasons that they did not succeed in their first go around. Instead of connecting with people they try to conquer them and seem unable to realize that the solution to alienating those they seek support from is not to alienate them farther.

Jaffe dismisses critics as “high functioning with lived experience.” He doesnt seem to understand that many of the people most critical of Murphy have the most serious of diagnosis, a history of hospitalization, multiple suicide attempts etc. They have lived what he is selling and found it not the path to health but the biggest stumbling block in the way.

The Murphy people coined a term: “worried well.” The most polite thing I can say about it is that it is one of the stupidest notions I have ever heard. It basically implies that the people who disagree with them have problems that are insignificant and they dont know where people with real problems are coming from. It is usually described as people who are very selfish and dont care about people really hurting. This is what Jaffe means by “high functioning with lived experience.” It displays a great consistency with the fundamental approach of the entire Murphy campaign: the best way to deal with people whose message differs from your own is to shoot the messenger. Only in Jaffe/Torrey terms does doing well in recovery mean you are out of touch with reality.

The people who are only trying to protect their samsha funding according to Jaffe are the organizations like Bazeldon and Mental Health America who for the most part have opposed Jaffe/Torrey for years. Again rely on smear and if you do it well enough perhaps you will never have to rely on argument. There are ton of other problems with his introduction, but in the interest of brevity I need to move on.

The myth
“HR3717 greatly promotes stigma and discrimination by its unfounded and damaging connection between mental illness and violence.”

The fact
HR 3717 does not make any claim that persons with mental illness are more violent. However, provisions of the bill have been proven to reduce violence by those with untreated serious mental illness. It is violence by this minority that stigmatizes the majority, so it can be expected HR 3717 will reduce stigma.”

The myth about the myth
Distortion battles lies that battles rationalization and I dont know which one wins out. This is playing word games. The bill may or may not link violence to mental illness but Torrey, Jaffe, and Murphy strongly do. In the last year I dont know if Rep. Murphy has missed one single violent tragedy to advertise his bill. Every time some one dies his first response is “This is proof that someone needs to pass my bill.” He has done it so often he is beginning to look very opportunistic and shallow.

The sentence about “violence by this minority that stigmatizes the majority…” seems so strange coming from him since the Treatment Advocacy Center for years has tried to do exactly that. When throwing stones it is always nice to make sure they ultimately dont come your way.

The notion that violence by a few is the ultimate cause of stigma is naive at best and willful blindness at worst. It is so much more than that and if that is all they can see people should be very careful about the agenda they are selling.

The myth
HR3717 virtually eliminates the main system of legal representation for Americans with psychiatric disabilities

The fact
The Protection and Advocacy for Individuals with Mental Illness (PAIMI) program was founded to improve the quality of care received by the most seriously ill. It now focuses on ‘freeing’ them from treatment and lobbying states to oppose policies that can help the most seriously ill (ex preservation of hospitals for those who need them. HR 3717 returns PAIMI to its original mission and reigns in their ability to use funds to lobby against treatment needed by some of the seriously ill.

The myth of the myth

I think most people define a lie as telling an untruth and knowing you are telling an untruth and still choosing to tell an untruth. By that criteria this one is a lie.

Paimi was not founded to improve the quality of care received by the most seriously ill. (personal disclosure. I am a member of the Paimi council in Tennessee) The phrase “now focuses on freeing them from treatment and lobbying states to oppose policies that can help the most seriously ill….” is simply not true. It is not even close to being true. Paimi protects peoples rights. In Tennessee like many other states the track record is of the successful exposure of abuses for many many people. It does not lobby the state for any changes in policy. It deals with individual issues period. My personal opinion is that if I was going to prescribe a policy like AOT with so much potential for the abuse of individual rights the last thing I would want to have is an organization in place that protects the rights of the most vulnerable. The overall message of Torrey/Jaffe/Murphy is that anyone who dissents from the program they have laid out is irresponsible, selfish, unprofessional and simply doesnt care about the plight of the severely mentally ill and their effort seems to be to try in many different ways to get them out of the way.

From everything I have been told this provision of the bill is one of several poison pills. I dont think that if some version of the bill does pass it will pass with this provision in it.

Note: Throughout his discussion of critics of the bill he talks about their stake in seeing it defeated. He passes over or glosses over the idea that the Treatment Advocacy Center is far from a disinterested party in this process.

The myth
The bill would amend HIPAA and erode privacy rights for people who have a mental health diagnosis and strip away privacy rights for Americans with psychiatric disabilities.

The fact
HIPAA and FERPA require doctors to keep parents in the dark absent a specific waiver by the mentally ill individual. Mentally ill individuals who “know” the FBI planted a transmitter in their head are unlikely to sign the waiver. Parents who are caregivers need the information about the diagnosis, treatment plan, medications and pending appointments of mentally ill loved ones so they can ensure they have prescriptions filled and transportation to appointments. HR 3717 writes very limited exclusions into HIPAA that allow parents who provide care out of love to get the same information paid caretakers already receive.

The myth about the myth
Always beware of arguments that start with the execution of straw men. Murphy is talking about far more than people “who know the fbi has implanted a transmitter in their head…..” Then he says all they want is “have the medications filled and transportation to appointments….” This aint what they are talking about.

People have rights. Inconvenient for those who would like to have power but they still have rights. And there already is an exclusion in Hippa. ” A health care provider or health plan may also share relevant information if you are not around or cannot give permission when a health care provider or plan representative believes, based on professional judgment, that sharing the information is in your best interest.”

Again there is a larger agenda at work here. Mr Jaffe and company believe in and push the value of coercive mental health care as the cure for much of what ails the mental health system. They wish to shut up organizations like Paimi that might stand in the way. With Hippa the goal is far more than making sure people get to appointments on time. It is to give family members the ability to force “loved ones” to accept treatment that they believe is not in their best interest.

The myth
Incentivize needless hospitalization and civil rights violations

The fact
The Institutes for Mental Disease (IMD) provision of Medicaid prevents states from receiving reimbursement for persons with mental illness who need care in a state psychiatric hospital. So states kick the seriously mentally ill out of hospitals. Many wind up incarcerated. Patrick Kennedy called the IMD Exclusion federally funded discrimination against the mentally ill since Medicaid reimburses for hospital care when the illness is any organ other than the brain. HR3717 makes small revisions in Medicaid so those who need hospital care are more likely to receive it. It does not require anyone to be hospitalized or gives states an incentive to hospitalize.

The myth about the myth
Again word games. Jaffe and crew have been very vocal about the fact that they believe the cure for people in jails is people in hospitals. This is not a minor part of their argument. It is central to it. How many times have you seen some mention of the story from the Treatment Advocacy Center that there are many more mentally ill in jails that there are in psychiatric hospitals. It is normally quoted in such a way as to imply that incarceration is a defiency of hospitalization.

The problem with hospitalization is not the IMD exclusion. Basically fewer and fewer people believe. The ship has sailed. Past crisis stabilization (and some would even question that) fewer and fewer people believe in the efficacy of psychiatric hospitalization to deliver anywhere close to what it advertises. From what I have been told this is another poison pill provision in the bill and if it does pass in some version this is unlikely to be there. Again though it is the same argument: Coercive treatment is good- Shut up the people who might question it (paimi), encourage families to pursue it (hippa and aot) and make it where it is paid for (imd and aot).

The myth
Redirect federal funds from effective, voluntary community services to high-cost, involuntary treatment, including outpatient commitment

The fact
HR3717 does not redirect funds away from voluntary community services. It does give states an incentive to help people who were offered voluntary services and refused to accept them. For example, Assisted Outpatient Treatment (AOT) is for people who fail on voluntary treatment. It is often the last off ramp before hospitalization or incarceration. By replacing hospitalization and incarceration with community treatment, it cuts costs in half.

The myth of the myth
Mr. Jaffe successively slays another dragon. But only he sees it. I dont know of a single person who has made the claim he talks about. No one I know believe that HR3717 redirects federal funds. In the next thing though that he describes as “the fact” he changes what he is talking about. “…does not redirect funds away from voluntary community services.” Federal funds are no longer mentioned. The problem is that Aot does take away from community services because the funds to pay for it must be found somewhere. The reason I believe it is such a minimal, inconsequential program in most states is that the states have experienced first hand how much it costs. Since state budgets are so limited the funds for big ticket items must come from some where. In Tennessee 1 person was served in AOT for a price tag of roughly $25,000. The behavioral health safety net serves over 33,000 at about $750 a person. It is way too little bang for way too big bucks.

The New York program serves about 2000 people a year for $32,000,000 a year plus investments in each year in new programs and infrastructure. Tennessee’s $32,000,000 is coming straight out of community services and people who are suffering from lack of services will then find out how to suffer with no services.

In a way they cut their nose off to spite their face. It matters what you commit people to. There is no reason to believe that skeletal services administered in a coercive way works any better than the same services provided on a voluntary basis. With a full fledged AOT program the expense of that program would make it very difficult for a state to afford to improve the level of services it offers.

Jaffe has two or thre more points. But I am not going to do the same exhaustive point by point analysis on them. This is already far longer that I meant for it to be and so the remainder of the post will be brief.

He agrees that the Murphy Bill is trying to destroy Samsha, but basically just says they deserve it. His biggest complaint I think is that SAMSHA does things he doesnt agree with like treating recovery as an important part of the mental health system. (Jaffe prefers the “mental illness treatment system. I think he doesnt want for anyone to get any high hopes. He wants you to know it is a life time curse.) And it again it follows along with the same process: silence potential threats-paimi, make it easier to commit people- hippa, make it financially viable- imd and aot and control the conversation by gettng rid of anyone who disagrees with you- samsha.

He likes to use the term evidence based treatment. I just dont know of any the bill supports. Psychiatric Hospitalization is not an evidence based practice. Medication is not an evidence based practice. Aot is a law, and not an evidence based practice since the actual services people are exposed to would differ from state to state. If you look at any list of evidence based practices you can find you will find a very large list of practices that fall under that rubric of peer based or peer support practices. Again it is word games. But Mr. Jaffe can sell. Man can he sell.

He has another myth about AOT. Most of what I wanted to say is said in the previous point about that. The one thing that really does stand out for me is the question of why when virtually every state has an AOT law why we even need to have a national law. In the queen of AOT heaven in New York 2000 people out of 675,000 people in the system are served per year. That translates into 1/3 of 1%. The biggest problem with AOT is simply that for the most part it is inconsequential. The idea that it is a far ranging reform for the mental health system just doesnt look at the facts. One of the justifications for AOT is the idea of anosognosia. Supposedly 50% of the people with severe mental illness dont know they have a problem and that is why they need to be committed. If you do the math in New York state that means about 370,000 people should have anosognosia. AOT serves 2000. 368,000 are missing.

He says that the bill by funding AOT would support the Olmstead decision about individuals being served in the most intergrated setting. The bill in whole identifies people with mental illness as people who should not be allowed to make decisions for themselves and that pose a real and increasing risk to the community. Somehow that doesnt seem like inclusiveness. And the assumption that Jaffe makes that the bill through the use of AOT would reduce people being in jails is one giant assumption. More than anything I just think it would be inconsequential. Again think New York. 1/3 of 1%

In his final point Jaffe talks about research showing peer support programs dont work. He does say what research or how that conclusion is reached or does he mention the reams, literally reams of research, that show exactly the opposite. I guess if he says it must be true. At least he seems to think so.

I think this post is too long and apologize for that. Jaffe says so much it seemed important to try to deal with as much of it as possible. You may find things misstated in your opinion or that I have taken liberties with Mr. Jaffe’s ideas that are not warranted. That is ok. It is not my intention. And if I have I certainly apologize.

The mental health system is in trouble we all know that. Personally I believe the Murphy Bill (at least the parts he did not borrow from other people’s bills) is not reformation but deformation. It seems that Mr. Jaffes ideas are normally accepted as gospel and that is a shame. He can say the most outrageous things and as long as he does it with passion and outrage it seems that little he says is seriously questioned. We can do better.

The bigger truth and more important truth that Jaffe does show is the deep divisions among those people who care about mental health. Jaffe is right when he says the treatment of those with mental illness in jails and prisons is a national disgrace. But until a vision can be developed that unites people in their common concerns I wonder how much chance of real change there is.

Self Care

August 19, 2014 by

With grateful appreciation to my friend Roger Stewart

The first rule is self-care.
The last rule is if you forget all the other rules go back to the first rule.

Self care does not mean life is about you.  It means that it is for you.  Sometimes the things that are about me are not for me.  This is a crucial distinction.  Self care is not about selfishness or self centeredness.  It is exactly the opposite.  Both those things are destructive in the end.  People with supreme egos are not into self care.  It is a quieter, wiser, and stronger approach to life.  In the taking care of me is the key to living a life that is about more than just me.

Dear Commissioner Varney

August 19, 2014 by

I know that there are meetings being held around the state right now to discuss feedback on the mental health system and to look at possible changes and recommendations.

I have one I hope you will consider.

One of the most recurring themes I hear from all throughout the state in my conversations with people is the issue of how people with mental illness are treated by and interact with the correctional system: police officers, courts, jails, and prisons. I have been told a steady stream of stories by mental health consumers and family members of dealing with police officers that did not have the training or ability to deal effectively with crisis situations they were involved in and someone was needlessly hurt or a big problem got bigger. There have been disasters and close calls enough.

I know that you are familiar with CIT training. In some format it is taught in different areas of the state. There is no state wide mechanism to make it happen that I am familiar with. Whether or not officers receive training is largely a local matter. It depends on local finances and the degree to which local officials buy into the need. And in some communities because of some combination of these two factors CIT trained officers are sparse or not available at all.

What I am proposing is a state center of CIT training. Federal funding is available through the Byrne JAG grants I believe. I think there are a couple of other laws which also provide funding. The need for state funding might be minimal. I know you have the resources to investigate this and I hope you will.

The state center would be responsible for providing training to local departments and by making it clear that having CIT trained officers is a state mandate it would make it more likely more departments would comply.

Not only do police officers, but those who work in jails and prisons also need to be trained. Some states already have a program in place like this and I really hope that Tennessee can also develop a program.

Having a mental illness should not be dangerous. And for too many people it is. Commissioner I hope you will consider my suggestion.

Yours truly,

Larry Drain

Being dangerous is about much more than mental illness. It is about being a human being

August 18, 2014 by

hopeworkscommunity:

From the archives

Originally posted on Hopeworks Community:

1. They think they are justified in hurting you. The less ambivalence the more danger.
2. They dont see themselves as having any other options they can live with. The less ambivalence the more danger.
3. They see the consequences for you as something you deserve and the conequences for them as positive or unlikely if negative or as something they can live with if likely. Hurting you is worth it.
4. They see themselves as having the ability to hurt you.

Basically to the degree someone believes:

— You deserve to be hurt.
— It makes sense to hurt you.
— It is worth the effort to hurt you.
–They have the ability to hurt you.

they are likely to hurt you. It is possible for someone with mental health issues to come to these conclusions. It is even more likely and more possible for someone without mental health…

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Core beliefs of recovery

August 16, 2014 by

hopeworkscommunity:

From the archives

Originally posted on Hopeworks Community:

From the archives.

The following are, I believe, the core beliefs of recovery.  Each of them implies an opposite belief.  Where you fall on a continium between the two beliefs probably defines a lot about how you approach life.

1.  Life can get better…… You are stuck.  What you got is what you got.  Try to make the best of it.  The truth is that it is more likely to get worse than it is to get better.  Hope vs despair.

2. I can help make it better.  It is within my capability, my reach to do…… I can’t really make a difference.  My ability is limited in a basic way.  I have defiencies which will limit my ability to govern my life.  Empowerment vs. Helplessness.

3. I have the abilities and skills I need to make a difference or can learn the skills and abilities I need to make a difference.  I have competence and am…

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Suicide equations

August 14, 2014 by

How can anyone ever try to end their own lives??  It seems so incomprehensible to most of us.  Until the thought passes your mind…Or God forbid someone you know or care about tries.  One person every minute in this country.  It doesnt even seem human….but it is the most human of things.

I think it is the interplay of at least 3 things:

Perceived desperation:  What matters is your perception, your truth.  At its worst the problem is no longer the problem.  Life is.

Perceived isolation:  Again what matters is your perception.  Can you tell?  Will you be heard??  Will it matter??  I knew someone recently who died.  He laid down in front of a train.  No one even knew how alone he was.

Impulsiveness-  Do you have the ability to put the brakes on your impulses?  What takes away from your brakes?  What adds to them?  How likely are you to do what you feel like doing because you feel like doing it?? 

Decrease desperation….Decrease isolation….Decrease impulsiveness…

Save lives.  No one has to die.  We can do better.

The case for being right: explaining Robin Williams

August 14, 2014 by

The tragic death of Robin Williams has given every person who tends to make public pronouncements about such things ample evidence that what they believed explains things still explains things.   Everybody found confirmation of what they already “knew.”  Nobody discovered anything new.

For some it was evidence of the lethality of depression.  Still others saw it as evidence of the side effects of psychotropic medication.  Some saw it as disease. Some say it as choice.  Some thought he didnt try hard enough and had committed an act of cowardice towards his family.  Rep. Murphy saw it as  proof of the need for his bill to be passed.  And of course Rush Limbaugh thought he died of being a liberal.

None of them knew.  None of them could know.  But that never really mattered.  Everyone analyzed.  Everyone tried to give his death a name.  Everyone tried to decide what category he fell into to.  And everyone found reason to put him into the categories nearest and dearest to them.  His death became proof of their mental health narrative.

It is a curious way we deal with tragedy.  We all find reasons to explain the worst of things by giving them a name and then find ourselves defending our name against the name others give.  The biggest thing I have seen so far is how angry people get at the people who dont  believe the same way they do.  It is almost like we believe if we are convincing enough the problem will be solved.  It wont.

I dont know what happened to Robin Williams.  I dont know anyone ever will.  I have known several people who attempted and lived and I have listened to what happened to them.

They talk about suicide as kind of a seduction.  That what was forbidden and unthinkable in time became all they thought about.  One person told me that it came to make good sense and she couldnt figure out a way to make anything else make sense.  She started off being scared of dying, then became ambivalent and then when she lost her ambivalence saw no reason not to die.  And as she lost more and more of her ambivalence she saw less and less to talk about with others. 

The decrease of ambivalence along with the increase in impulsiveness seemed to be the most lethal combination.  One friend put a shotgun in his mouth and pulled the trigger and lived.  He lost most of his face but he lived.  I asked him how it happened.  “I got drunk and what I had been thinking about made such perfect sense and there just didnt seem any reason to say no.”  Some people told me how they tried to take away the ability to say no:  becoming more isolated from others,  alcohol and drugs,  treating it as a heroic or romantic choice. 

One person was even more blunt.  “I stopped being scared of myself and it almost killed me.”  He told me “he played so often with the idea of death it stopped being play and just seemed to make sense.”

Another person told me, “I didnt want it to be true.  But in time it seemed the truest thing…”

I dont know the answer.  It has something to do with helping people to find a lie in their desperation.  It has something to do with not giving desperate people easy access to impulsive moments.  It has something to do with knowing it could be any of us.  It has something to do with making sure  no one lives in a solitary hole. 

Perhaps it is in knowing that life is not a test to be passed and death not a grade we are given. 

Maybe.

What does what you are advocating for have to do with….

August 13, 2014 by

*Making sure that people have access to the help they need…
*Making sure that the most effective services are offered….
*Respecting the dignity of those who seek help…
*Making sure that people have access to correct information to enable them to make decisions about their own lives.
*Supporting people in making those decisions
*Enabling people to acquire the skills and tools that really make a difference in their lives.
*Providing real support to people who struggle with significant life stress and pain.
*Addressing issues of homelessness, joblessness, and poverty that are so often part of what it means to  be labeled with a mental illness in this country.
*Addressing the dismal state of health care that so many people with mental health diagnosis receive.
*Addressing the very real issues of discrimination and prejudice that is a core element in the life of everyone who has a mental health diagnosis.
*Addressing the very real limitations and risks of some treatment particularly medication.
*Addressing the national disgrace of the treatment of those with mental health issues in the jails and prisons of this country.
*Addressing the national calamity of suicide. 
*Addressing the growing issue of trauma.  Moving mental health from a whats wrong system to a what happened system.
*Addressing the issue of cracks.  The issue of not the people who fall through the cracks in our society but those who seem destined to live there forever.

These are some of the issues that will define whether or not the mental health system really does get better.  I really dont have much faith in the one thing solves everything approach.  It is so much more important and so much more complicated and difficult than any agenda that any specific group, organization or viewpoint espouses.  One too much time is spent in people trying to establish their turf or territory.  Way too much time is spent on war and far too little time is spent in making a system that really works and changes the system for the best.  Mental health reform is not any one thing.  It is not a competition of gimmicks.  There are a lot of hard questions.  We just need more people asking them.

Do any of us know: a poem about suicide

August 13, 2014 by

Do any of us know
how much we mean to others
how much we give
and the hole left by our leaving
when life seems a problem
unsolvable, unbearable, and too heavy
and death an answer
and touch so far away
and so inconsequential
and thoughts come unbidden
and loud and scary
“it will be better if you are gone….
there is no other way…
people will be better off without you…
it will never get better….”
where do we turn
with whom do we share our terror
our sadness, our guilt
our desperation
the worst mistake
is to accept the verdict
without appeal
it is not done
it is not done
tell someone
always tell someone
terror and fear and
desperation deserve no secrecy
someone wants to know
so much has power within us
that has none shared
lift the veil and open the sun
you have courage untapped
And this too will pass
perhaps the war will never be won
is it for any of us
but it is no reason to concede  the battle
your life is  precious and needed
you are a treasure that cant be replaced
know that death
solves no problems
and let us help you find better life

Life in hard times

August 12, 2014 by

Know how things are going.  Too often we dont.  We are shocked when things go poorly.  It seems like it comes out of nowhere.  And we miss so many good things.  Sometimes I wonder where I was.

Think about momentum.  Going better…..Going worse.  Bad things are less likely in going better.  Good things are less likely in going worse.  Do things on purpose that impact the momentum of your life.  A thousand things too.  None of them by themselves tip the scale but the accumulated weight of them may tip the scales of your life.  Keep a pulse on the direction of life.  What can you do differently that makes a difference.

The more effectively you deal with getting worse the less often you will have to deal with worse.  Have a plan.  Make sure it is a plan you can do, want to do, that you can tell if it works, and that you can continue to make better as times go on.  One friend told me the secret to not getting run over by a car was to learn not to stand in front of them.  See the cars coming.

Dont do life alone.  Support and be supported.  Talking to yourself is okay but as the only thing on the menu it isnt much.  Life is best shared.  It is not a solo act.  Other people have a way of seeing when you cant see, hearing when you dont listen, caring when you dont care and cheering even when you think you dont deserve it.

Do things that matter.  Live life like it means something, like it about something.  We need something to complete us.  Without purpose we paddle furiously but never get anywhere.

Learn.  From everything.  Define events by what you take a way from them.  Learn things that matter and make a difference  Even the worst of times offers a chance to learn something. 

Wait.  When you cant do anything dont.  Just wait.  Make sure when you can you do.  Some things are just survival. 

Remember feelings are not facts.  They are just hypotheses that you must check out.  They are meant to be listened to but listening need not mean obeying.  Pay attention but know paying attention means listening to more than one thing.

Life is an infinite procession of invitations:  to be angry, to be sad, to be glad, to be scared, to be proud, to care, to not care.  An invitation means you decide.  What invitations do you decide to take???  What invitations do you normally miss?

Noise.  The noise around you does not have to be the song you sing.

Count.  You count.  Nothing takes away from that.  You can ignore it.  You can act like it is not true.  You can hope it is not true.  You can try to make it not true.  But it is true.  There is a difference between the package and those things that wrap it up.  You are more than ribbon.

Life sometimes must be hard.  Sometimes it must seem too much.  Sometimes it must seem pointless.  Otherwise how would we ever know when it is not?


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