In a previous post I talked about the difference between a downstream and upstream mental health system. That post is linked above.
It would seem the hardest thing in the world is to move upstream.
This post talks about the challenge of doing that.
The best way to help people who are hurt and injured is to do something about the things that hurt and injure. It is to move upstream. It is to know that what happens to people defines the context of their lives and anyone who tries to understand people apart from that context is reading scientific tarot cards. Anything that makes injury less likely or failing that less impactful helps. Even if you can’t do anything about the injury just knowing that it happened matters.
Yet much mental health theory is the idea that some people just come injuried. It is the idea that all that is important is the downstream person. Their voice, their ideas, their judgement the theory continues are an artifact of that injury and as such should be treated as less than credible. Choice, for them, the argument continues is not about empowering them as people but denying the basic impairments that will always be part of and define the limits of their lives.
Mental health reform in some ways is simply a demand for democracy. I have a voice that matters, that should be protected, that should be respected and even if other people know things I may not know they still do not have the right or power to minimize or ignore my voice. It is the idea that I am the basic unit of value in the mental health system… Not the doctor… Not the pills… Not the facilities… Me. Simply me.
It is the most radical of notions and threatens many. The nature of all power is to have an ideology that defines your exercise of power as valid, as worthwhile…. even as common sense and the ideology of the mental health system does all that. The democratization of the mental health system does not mean that its knowledge no longer matters. It does not mean they don’t help anyone. It means they don’t have the choice any longer and that there is some recognition on their part that the denial of my choice or the choice of anyone who comes for help has been the primary source of injury for many, many people.
I don’t think you can help anyone to deal with the injury in their life without taking serious the injustice, the assaults, the trauma that cause those injuries. Many people just don’t have access to the resources necessary for better life that I talked about in the previous post. It is hard for me to understand any push for mental health reform that would not at least talk about building a better world to live in.
I don’t know if we can move upstream anytime soon. We spend too much time arguing about who should have the most downstream territory and the loss of territory scares far too many people.
In the end it is all about helping people to build a better life and the lie of the mental health system is that a better life is all about mental health. Maybe when we realize the limits of that statement, when we know reality has many more shades and many more colors maybe then we will actually begin the move upstream.