Back to the cliff….again coercion

IN my last post I used the metaphor of some people living on the cliff.  Multiple factors increase the stress, the pressure, the misery, the general unhappiness and the danger of life.  They live life on the verge of big problems (falling off the cliff).  Something interferes with life and sometimes making it through the day unscathed is, or it least it seems like, a major miracle.

Some people believe that coercive interventions should be the core of the mental health system.  Far too many people fall off the cliff.  Far too many dont even realize they have fallen off the cliff.  Far too many people are willing to seek help for falling off the cliff and when they do they far too often do not follow through with the recommendations of that help.

Another way to look at things though is not that too many people fall off the cliff.  Too many people live on the cliff.

In the previous post I talked about some of the things that tend to put people on the cliff.

In this post I address getting off the cliff.

Some of the things that make life harder are social things: poverty, lack of housing, lack of food, lack of access to health care etc.  They are about justice and a fair chance at life.  The experience of chronic injustice has a major impact on the way we lead our lives.  If you want to help people find a better life you must give them a better space to live in.  Increasing justice in life circumstances is basic to helping people who must live and cope everyday with that lack of justice.  A large part of mental health advocacy is increasing the experience of justice in the lives of those who have known precious little of it.

Part of that injustice is what it has come to mean to “have a mental illness.”  That label for many defines the person they can be, the opportunities and treatment available to them from others and what others can expect from them.  It is a label with real consequences they influences how you are treated, the jobs you have, whether or not you are accepted in many social groups, your relationships with others and a million other things.  It affects how the police treat you, the degree to which doctors listen to you and take you seriously and the rights other people feel like you should have.

Some people believe nothing will really change.  They have little hope and less faith.  No promises have worked out.  No answers have really ever answered anything.  I know I have been there.  It is not that you dont want things to get better.  At its worst you dont want to get disappointed again by wanting anything.  Life is about finding some way to feel better or some way not to feel at all.

Getting off the cliff is first about believing there is a chance to get off and deciding to take a chance.  The first step is to believe it can get better and to buy into that possibility.

The coercion people will tell you that people with serious mental health issues just dont invest in the process of treatment.  Some will tell you they cant because of some kind of brain damage they are assumed to have.  Kind of  a “,,,you dont listen to me and that is proof you are brain damaged…” statement.

But they seldom talk about investment and what has to be true for someone to invest in anything.  For people to invest in anything they must come to believe several things are true.  For some people their experience of the mental health system is that none of these things are true.  For some people their experience is that all these things are true.

1.  They must come to believe there is something in it for them.  There is a something worth doing, worth having or worth learning that makes a difference in their life, that they can do and  is worth the effort to do.  In some real way “help” must be a source of opportunity and not a source of deprivation or disappointment.

2. They must come to believe they have something to give.  They have an integral, important and valued role in this “help.”  It is not something people do to them, but with them.  They are empowered.  They have real choices.

3.  They must come to believe that it is safe.  This does not mean it may not be hard.  It doesnt even mean there is no danger involved.  It means there is some basic trust that it is what it seems to be and there is some reasonable chance with effort, persistence and support that some things in life can get better.  It means that you believe that people are being honest with you both about what they know and what they dont know.  Before you trust what people are trying to do you must first trust the people trying to do it.

4. They must come to believe someone cares.  They are a person and it matters that they are a person.  They are more than a diagnosis, more than a history.  Someone believes that they as a person are important and that importance is the source and starting point of everything.

The things, the situations, the people I “buy into” satisfy these conditions.  The therapists that have helped satisfy these conditions.  The relationships that are important to me satisfy these conditions.  Those that dont I leave, dont listen to and treat as unimportant.   I have know important psychiatrists.  I have known very unimportant psychiatrists.

Recovery (getting back from the cliff) is about preventing the things I can prevent, coping with the things I cant prevent, and surviving the things I cant cope with.  It is about trying to change what needs to be changed and learning to live with what cant be.  It is about knowing that many things are difficult and may be always difficult, but that I am more than what is difficult for me.  It is about knowing that life is not a symptom, that what I feel, what I value and what I think is as valid for me as it is for anyone else.  It is about knowing that other people can care about me and me about them.  It is about knowing my life is not denied purpose.  It is about knowing I may sometimes come to the cliff and I may even sometimes fall, but that life can and is so much more than that.

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