Archive for February, 2012
To make it better:
- Find the bright spots in life. Find the things that you do that work and do them more often. Emulate success. Nothing is a problem 100% of the time. Whatever you are doing when it is not a problem do more often.
- If a problem was solved how would you know? What would the video-tape of the solution look like? What can you do right now that would be part of the solution? Do it.
- Decide specifically what you are going to do if you want to change something. Change is a process that without a first step doesnt have a second step.
- Be part of something you think matters.
- Life your life by what is important and dont be deceived by the cry of urgency.
- Know the way you feel is important, but it is not all that is important.
- Show other people they matter to you.
- Find people you matter to.
- Know that falling down teaches you how to get up, not an excuse to stay down.
- Know where you are going and why it is important. A lot of things are bearable if there is a reason to persist.
- It is hard to stop treating something as important–even if it is messing our life up– if we dont find something more important.
- What you know in life is important but what you care about gives it direction.
- Remember you have an endless capacity to make stupid things seem brilliant.
- Remember you have an endless capacity to make brilliant things seem stupid.
- Remember nothing is forever. Good times go away, but so do bad. Be grateful for what you have, but not crushed by what you dont.
- The most difficult fight for most of us is realizing what there is no point in fighting about.
- Remember courage is what you do when you are scared, not the absence of being scared.
- Tell your story often, but listen to the story of others. There is much to learn.
- Life is not about you or me. If it was it would not be about much.
- Neither of us are God. Thank Goodness.
- Do things that help to make you the kind of person you want to be.
- Practice. It doesnt make perfect, but it does make different.
- When you can deal with the stress of everyday life, you begin to appreciate the joy of everyday life.
- When you try to do more than you can you end up not doing anything.
- Appreciate small steps.
- Be glad we dont always get our way.
- Just because we dont see it doesnt mean things dont make sense.
- You are more than what you are called.
- Others are more than what you call them.
- There are many things that make life better. The list goes far past 30.
To make it worse:
- Misunderstanding the problem. Being mistaken or incorrect about the way you identify the problem. Identify the wrong problem. Identify a problem that doesnt exist. Identify a problem that is real, but doesnt really cause the problems you are concerned with.
- Buying into the idea that there is nothing you can do to improve your life. Identifying yourself as a victim and becoming reconciled to that. Believing that nothing you do matters.
- Buying into the idea that things getting better are dependent solely on what other people do. Becoming dependent and passive.
- Buying into the idea that because of some diagosis or label that you are deficient as a person and many things that are normal expectations for other people are not normal expectations for you.
- Buying into the idea that you will never be happy and that life will always be a torture for you.
- Refusing to look at things honestly because you are afraid that what you see will make you look bad.
- Doing things that are within your control that make the stress of everyday living worse.
- Refusing to do things that could lessen stress because you really dont want to change or dont want to do something hard or inconvenient.
- Not finding people or a person you can count on to listen to you, support you, and be honest with you.
- Having no friends.
- Having nothing that you like to do in life or look forward to doing on a daily basis.
- Not feeling like you are part of something that matters.
- Having problems managing negative feelings- particularly anxiety, sadness, fear, and anger.
- Not learning to anticipate problems and developing plans to deal with them as they occur.
- Not learning to accept the things that you have no control over.
- Consistently not considering the consequences of your actions before you act.
- Not believing there is a purpose to your life or that you can find a purpose in your life.
- Trying to do more than you can do.
- Not trying to do enough.
- Finding nothing in your life to be grateful about.
- Never forgiving anyone who does you wrong.
- Believing you can never matter to another human being.
- Measuring who you are by what others think of you.
- Believing that life is about you and nothing but you.
- Having no place in your life for God or a higher truth.
- Not knowing that some things that feel bad can be good for you.
- Not knowing that some things that feel good are very dangerous.
- Not remembering when things seem so bad you cant stand it that life is about change and even the bad things dont last for ever.
- Not knowing that hope is real, love counts, and you make a difference.
- Not knowing that in giving to others you allow yourself to keep what is important.
Sometimes you want to do the right thing. Sometimes you even know what to do. Sometimes you even have the ability to do it. But many times it just doesnt happen. The pressure of the moment, the state of your emotional stability, the poisonously dumb things we all tell ourselves and believe– something or everything gets in the way. It is too much. We shut down…. go on damage control….do the very things we said we werent and end up defeated, discouraged and damaged and convinced life is too hard and better times will never come. Recovery is not just a rational process of identifying warning signs, of making plans and so on. We get in the way too often and really good plans and ideas just dont happen like we hope they will.
There are probably many ideas about what it takes to make it through difficult and hard times. Psychologist Salvatore Maddi describes some ideas that really hit home with me. It certainly describes the difference between doing well and doing poorly for me.
He call it the 3 C’s. Together he says they make up what he calls “hardiness.”
- Commitment- There has to be a something you are committed to that makes it worthwhile to struggle. There has to be a reason to go through hard times and not around them or over them or under them. There has to be something more important that how we feel that enables us to put that on hold and try to do the right thing. I dont know if you know what those things are in your life and how well it works. Commitments should energize us in hard times. When you are doing really poorly one of the things that seems true- I know it does for me- is that commitments dont seem as important as they should. Commitment is a major attribute of hardiness.
- Control- It helps to believe there is something you can do. It may be a small something. I think it can even be being still and doing nothing. It doesnt mean you can always solve things. Sometimes it just means we can make it a little less worse. I think that is part of the reason that so many of find humour in the most difficult moments.
- Challenge- When hard times are seen as a challenge worth surmounting we do better. We either see things as deprivation or opportunity. Much of what we do with anything depends on what category we place them in. If hard times are an opportunity to accomplish something worth doing, to make a gain worth making we find we more capacity than we thought we did.
I think that each of these abilities are sometimes true and sometimes not for all of us. Hardiness is a capacity we build. The more we practice at being hardy the hardier we are. The more we practice being strong the stronger we get. There are no promises but the better we do with hard times the more accessible recovery is to all of us. Think about these ideas and see if they apply to you. They describe me at my best and at my worst. Better yet they give me a plan for tomorrow.
The do not admit list is real. Their is one for virtually every hospital in this area. I applaud your efforts to put an end to it. It has the potential to really harm the integrity of what you are trying to do.
The mental health system is choking. Rising needs and shrinking resources have left a crisis situation for untold thousands of people in state after state. We are in danger, real danger, that a considerable part of our society will come to be treated, in effect as disposable people– people we either cant afford to help or who we are unable to help.
Arguments abound on both the need and resources side of the issue. Psychiatric hospitals, once the mainstay of the mental health system, seem, in many states, on the way out. Many states, to one degree or another, seem to be getting “out of the business.” They simply seem to be no longer financially sustainable. In Tennessee the same amount of money was spent for 10,000 hospital admissions as was spent for 250,000 people in the community. It doesnt take much to see that money spent in the hospital system is money not spent for community services.
Lakeshore Mental Health Institute, the hospital in East Tennessee, is closing. It had 380 staff to deal with about 80 patients. Still 25% of their acute admissions were readmitted, 15% of those within 90 days. To stay there cost twice as much as a private hospital. In a reality of dwindling bucks, there appears to be less and less bang out of these hospital bucks.
Lakeshore, like many state hospitals, is also as much about being poor as it is about mental illness. 65% of the patients there have no insurance. For every single one of them, partly because of the money the hospital system gobbles up, there are no real resources they can turn to. There is a “behavioral health safety net” in Tennessee, but it offers little to people in really severe need. To be poor and have serious mental health issues basically means to be abandoned until your life gets so out of control that you end up either in the hospital, in the jail, or homeless. There is nothing to catch you before you fall and when you fall you fall into the same all old places and simply keep falling. .
In an article today (linked right before this post) the president of the largest private psychiatric hospital in the east Tennessee area says that his hospital has lost over 15 million dollars in the last 5 years. Many people argue that hospitals are inherently ineffective and too often abusive and traumatic. I tend to agree with that argument. As the figures quoted above for Lakeshore show there is little evidence that hospitalization leads to anything but further hospitalization. Another study I saw said that 40% of people who go to psychiatric hospitals end up being readmitted. The psychiatric system for many is much easier to get into than out of. I know people who have had 30 and 40 short term hospitalizations. Their community has become the psychiatric hospital. And that is tragic.
The hospital may offer some short term stabilization, but there is little evidence of long term benefit for many people. It costs too much to subsidize and even with the increased cost many private psychiatric hospitals are losing money. In a time of decreasing resources I dont see how anything that serves few people at the expense of services for the many can long survive.
Advocates often talk about the evils of a coercive system and how traumatic and dehumanizing an experience committal is. Organizations like the Treatment Advocacy Center talk about psychiatric hospitalization as almost an ethical duty that a society has to provide for the “mentally ill.” I think the advocates position is much closer to the truth, but in the end neither position may matter. Hospitals may simply price themselves out of existence. The Treatment Advocacy Center may find out that any argument for the necessity of more treatment for fewer at the cost of more treatment for more may simply be unrealistic and unlikely to be accepted by many states in the long run.
By no stretch of the imagination is it simply about psychiatric hospitals. Florida is looking at a proposal to cut 41% from its mental health budget. 140,000 people will be denied the help they have been receiving in community based programs. The state is saying that even before this cut that it doesnt have the resources to help 170,000 other people in need. Senator Joe Negron who is behind much of this proposal has emerged as the poster child for stigma and ignorance. He is quoted in a Florida newspaper: “I would argue that the majority of things that people do that cause negative things to happen to [them] and the people they care about are not a result of the lack of information, they’re a result of a lack of willpower, a lack of discipline, a lack of character.” When I see what it means to be labeled with a mental illness in this country I cant help but wonder how many people he is speaking for.
Florida is by no means the only example, only the most extreme. The biggest question in most states is not whether people will be left out in the cold. The only real question is how many. The states that are doing the best are those who have managed to hang on to resources that are at best barely adequate. Not too many states seem to fall into this fortunate category.
There are not only major issues with the amount of resources being made available, but the quality of those resources. Many have found that involvement in the mental health system means accepting a definition of themselves that defines them as their diagnostic label and tells them they are afflicted with issues that of necessity will deny them access to the kind of life they want and see as being so accessible to other people. They will told in ways both said and unsaid that they are fundamentally flawed and that being realistic means accepting that. They find out that receiving a mental health diagnosis is not simply a neutral, objective act but one very subjective to the person giving the diagnosis and an act that has very real consequences for the way they live and others treat them. Many will find out the psychiatric medication they are told is essential to their health has side effects that are disruptive or even dangerous to their lives. Many will find out that even when side effects are not intolerable that they medication doesnt work as well as advertised or promised. They will find the search for the “right medication” long and hard. And many who find that medication does have some positive effects will be left holding their breath as they read about some of the potential long term effects of the medicines they come to depend on.
Telling people what disease “they have” doesnt really explain anything. It just gives a name to their distress. When you start believing that people’s distress is simply a function of “what they have” and not in some way connected to what has happened to them in life you remove yourself from the context of people’s experience and run the risk of simply being naive or irrelevant to the people who really need your help.
The recovery model is one of the most promising developments in the system. I think it has ramifications on both the need and resource sides of the discussion. It reframes the goal of the mental health system in a different way. It defines it as a topic of more than management and adaption. It also says people can find a way to lead transformed lives despite the distress they must deal with. It says hope is real.
With the development of peer support services it has also brought a potentially very important player into the resources end of the discussion. You need to know something about the concept of positive deviance to truly understand how potentially big of a player it could be.
Positive deviance may not be a concept that a lot of people connected with peer support know about, but peer support is a great example of a positive deviance approach. Wikipedia defines positive deviance like this: “Positive Deviance is based on the observation that in every community there are certain individuals or groups (the positive deviants), whose uncommon but successful behaviors or strategies enable them to find better solutions to a problem than their peers. These individuals or groups have access to exactly the same resources and face the same challenges and obstacles as their peers.” In other words most communities have unappreciated resources that if they can be shared can bring about the solution of larger problems.
Positive deviance has been used with everything from fighting malnutrition to aids to virtually everything else. Basically in mental health it means the success of some people facing mental health challenges can help others. People can and do learn from people who have walked in their shoes. If you read much about positive deviance the implications for peer support will jump out at you right away.
Peer support offers a definition of the problem that is life enlarging on the needs side of the discussion. On the resources side of the discussion it offers an effective way to use resources already available that will not require large investments to find new resources. It is an unappreciated jewel in the current situation.
The mental health system need not choke. We will not do better by doing the same old things I think. But the possibilities of doing better are there. In some areas and in some ways they are already taking hold. Hope can be real, not just for those who have a mental health diagnosis, but for all of us.
At my worst my life is about painting– specifically the painting that I am continually trying to compose of myself. My attention is to the color and shapes and intensities of the images that I spend my time trying to construct. It is about polishing and highlighting a vision so compelling that its truth seems self evident to everyone (including me). I paint in many ways with many implements but life is in the end a story of the picture I paint.
At my best I am a mirror. In me people can see something of what is important, what has value, and something of the beauty of life. The importance is not so much what people see of me, but what they might see of things far beyond me. It is not the value of my story, but the value of stories. It is not in my purposes, but in the value of purpose. It is not in my loves, but in the value of love.
It is in helping people to know that while our values may determine much of the way we choose to live, it is the principles we live by that determine the quality of that life and the consequences of our living.
It really matters how much we buy into things. It is the difference in just knowing something and believing in it. We know many things we dont believe are true if you judge by the way we live..
To the extent treatment is simply about management- about strategies and techniques people are always going to show an annoying tendency to be “unmotivated.” We just dont well with what others tell us with insistent intensity is best for us. In the end the patient gets blamed and the “professionals” opt for some type of coercive strategies.
To the extent treatment is about transformation people are motivated and intensely and personally involved.
Perhaps if we were more concerned with what we sell than with how willing people are to buy things might go better.
I once knew a lady who had been married for 64 years. Her husband died. About 2 weeks later she tried to fasten a plastic bag around her head and join him.
She was put in a hospital where she was medicated for her depression and they tried very hard to cure what ailed her. I talked with her once and simply said, “You must really miss him.” For two hours she told me stories about their love. Neat, golden stories. She stopped. “I really do miss him.”
She was a quiet lady with a lot of dignity. After a few days she left the hospital. I dont know if she continued to take the medication for her “depression.” I couldnt help but wonder though if any medication would make her miss him less.