The stories we tell and the stories others feel to us make a difference. They have impact. They define the social reality, the lived experience of all of us. They tell us what is “real” and how to see what is “real.”
Stories have a momentum. They tend to create events that confirm them.
Many stories have been told about mental health. The medical model says it is a constitutional thing. Your brain, your neurochemistry, your something is different from others and because of that you experience life different. It defines what you feel and how you deal with those feelings. It defines how you think, how you make decisions, how you relate to other people, what you can expect from life and what the people in your life can expect from you. It tells you the problems are life long and that taking some kind of medication is probably essential to functioning successfully to any degree at all in the real world.
It defines problems in living as medical issues. And like all medical issues it says that decisions about those issues are properly the purview of experts– psychiatrists etc. It defines you as your diagnosis and most things about you as a symptom or expression of that diagnosis.
Being diagnosed probably to some extent defines the reality of your lived experience. You probably will have to fight to be in control of decisions about your life. If you do that you may well be told that you are in denial about your problems and need to trust the advice and decisions of professionals who “really want to help.”
Your are more likely than not:
To be poor….
To be unemployed…
To have difficulty finding a place to live….
To have adequate access to health care….
To die earlier than other people your age or in your circumstances…..
To be the victim of discrimination and prejudice…..
To be told not to hope for too much in life because your life will never be a lot better….
You may have many difficulties in life, but one of the difficulties you will have in life will be the social experience of being “mentally ill.” The word, the story, has power and impact.
There is another narrative in mental health that says what is important is not “what you have” but “what has happened to you.” It is a narrative that sees the problems we face, the issues we have as largely a result of what has happened to us, the injuries or traumas we have dealt with. It sees problems in life, not as a medical issue, but a human issue.
It says that there is more to us than what we are called, that hurting people can sometimes learn best from other hurting people who have survived and found better life. It says people should be in charge of their own lives and that that justice is an issue in life and that many people experience the mental health system as more of a source of hurt and not enough a source of help.
It says the primary issue is not how to empower and enable psychiatrists to have more power but how to empower people seeking help to regain control of their lives and find a better life whatever that means for them. It focuses not just on what is hard to do but what is also possible to do, possible to build. It does not say misery and hurt and pain is not real, only that there are better explanations than “it is what you got.”
Some people see the question as either /or. Some say it is not that simple that it is in some way both /and. They say a story that is simply biological is naive and simple minded. A story that explains life without taking living serious explains little and is easily a tool for the oppression of those with less by those that have more. On the other hand they say biology matters even if our theories explain it poorly or not at all.
Some people believe that while stories and narrative matter the real issue is who those stories serve. Bluntly they think the mental health system should be about more than pharmaceutical companies making money or the maintenance and growth of the territory and power of any professional group. They think the issue is not what any particular story or narrative explains but what it justifies. They think any explanation should be guided by honesty. What helps, what makes a difference regardless of the impact that has on the profit margin of status and power of anyone – – that is what guides them.
We are in a battle for the soul of the mental health system. It is not as many thought it would be a battle over what the research really shows. It is not a battle about medication as many thought it would be. It is instead a battle over politics. It is not about the science of mental health or even the lack thereof. It is about mental health as public policy. It is about power and voice. It is about what narrative of mental health is to be told and what narrative is to be believed.
The Murphy Bill and all the other mental health bills in Congress matter. The simple truth I believe is that mental health narratives that run counter to the dominant medical model don’t have a much traction in the political system as we would like. Even politicians that are seen as progressive have a hard time seeing the civil and human rights issues implicit in the discussion. Much progress has been made. A lot of people have spoken up, but how to change the way ordinary and average politicians make sense of mental health issues is a monumental challenge. It may be the issue that defines what it means to have a psychiatric diagnosis in this country for a long time.
The Murphy-Torrey folks tell a story about danger. They talk about people really sick, who may not even know how sick they are, whose needs are seldom met, who can be dangerous. And they say that is the crisis of the mental health system.
They have a problem though. Thousands and millions of people who meet the crittria of emotional illness can and do find a path to a better life. They find hope is real and recovery a real thing.
The Murphy-Torrey response is to use a weird form of reasoning that is simply not very honest.
1. Severe mental illness is a chronic disease which never really gets better.
2. If you have gotten better and particularly if you have gotten a lot better that is proof that you were never really severely mentally ill.
3. Since so many people have gotten better that is proof that the mental health system does not treat the severely mentally ill.
1. Because severe mental illness is a chronic disease that never really gets any better.
It proves that true which it already starts off assuming is true.
They create terms like “the worried well.” It is like saying some people are severely mentally ill and some are merely mentally ill.
The fatal weakness of this argument is that there are just too many witnesses. Many people with the most severe mental health issues have found a better life. They are in recovery and all the fancy word games in the world doesnt change their testimony or blunt their stories. There are too many inconvenient truths.
The battle is for traction. What narrative has the greatest impact, what narrative is most likely to affect public policy? What narrative is most likely to affect the way people make sense of problems in life? What narrative will define what it means to help a person in distress and how to develop and structure a system to effectively, honestly and with integrity offer that help?
The question is really two. How can we craft a story that tells the narrative of suffering honestly and realistically that at the same time talks about the ability of human beings to learn and be resilient in the worst of circumstances? How can we craft a story that life hard is not less of a life? How can we craft a story that says that people seeking help deserve access to things that honestly help? And finally how can we craft a story that says we are more than what we are called and the injuries that result from believing we are not?
Equally important…. how do we get that story to make a difference in the real world? How do we change the conversation about mental health? How do we construct a story that has traction and momentum?
Mental health legislation of some sort will probably become reality this year. Many of the things that are assumed to be true in that discussion don’t seem very true to me. Many of the things that we are told will work don’t seem very helpful to me. But yet it seems likely something will happen.
Advocacy had made a huge difference. I don’t think there is any doubt of that. One version of the Murphy Bill went down in flames. The newest version has made it through subcommittee markup and should go to the floor this year but it has faced withering attack and the final version of it is anything but clear. What will happen in the Senate is anything but clear….
But yet I am worried. Each day the pairing of “mental illness” with violence seems heard more and more frequently and seems to be achieving the status of “common sense” from people who should know better. Witness the recent actions of President Obama. Even someone like Bernie Sanders who seems to care so deeply about human rights issues seems to be unaware of other ways to look at the issue.
How do we make clear what we stand for in a way that resonates with those who wield political power? Can we? It still astounds me that 44 state legislatures voted to make AOT real in their state. It seems clear we are going uphill but hills can and are gone up every day.
What do you think? Sometimes I fear it is sometimes such a struggle for us to stand each other that what we stand for is lost in the noise.
How do we reclaim the narrative on mental health? And what are the consequences of failing to do so? The use of mental health reform as a pawn to avoid dealing with the larger issues of violence and guns in this society only increases the chances that people with psychiatric diagnoses will be blamed and found guilty for our astounding propensity as a society to shoot each other. How do we make a difference that makes a difference?