There are two competing narratives for the mental health system. One is dominant and for the most part unquestioned. It is what I would euphemistically call the “help” narrative. It is the view of the mental health system as a product and the debate about what will make it a better product and who should get what piece of the pie. That debate is largely what has given us the Murphy Bill and much of the current debate about mental health reform.
The Murphy Bill is largely an argument for a bigger piece of the pie. His argument is that the mental health is insufficiently medical and that those services and approaches which would medicalize the system more completely need to be given more attention and more funding. For Murphy the mental health system as a better product is one that reinforces and protects the sanctity and power of the psychiatric vision and power. It is one that puts power and authority in the hands of those who “do” mental health and expects those who get mental health “done” to them to be compliant and obedient. For Murphy the benign intent of the psychiatric system is obvious and beyond question and even to question it is “reprehensible.”
Many of the arguments against Murphy are still “pie” arguments. It is from people who want and kinder and gentler system which in turn protects their piece of the pie. I have nothing against kinder and gentler. I think it has been a sizeable reason some of the more horrible elements of Murphy have been muted and that is so very important, but in the end it is still an argument about the mental health system as product and who gets what piece of the pie.
There is another narrative though. It is not widely understood and has little if any traction with the wider public. Law makers don’t understand it.
For lack of a better term I would call it the “harm” narrative. It is concerned with the mental health system as product but more than anything else is about the mental health system as process. It says that apart from any specific program or content the problem is in how we do mental health. It says that the normal order of business despite the best of intentions of many dedicated people is often the source of harm to many of the people it serves. And it says that true mental health reform will decrease that harm. It says the mental health system is not the morally neutral medical thing that it is normally assumed to be. It says that if you don’t understand the ways that the system too often diminishes, traumatizes, and limits the people it serves you don’t really understand the experience of many people in the system. It says the mental health system properly understood is about much more than how any “mental illness” is treated. It is about how people are treated. The “harm” narrative talks a lot about human rights but it is even more than that…..
It talks about a system that is often less than honest with the people it serves. Potential risks of psychotropic medications are often downplayed or ignored. At the same time the likelihood of medication having a positive effect is often distorted and overemphasized. Too many approaches continue simply because that is the way we are used to doing things and not because they work. Diagnostic labels are presented as objective facts rather than human constructions. Too much is about the vested interests of those that “do” mental health and too little is about the interests of those “done.”
It is about a system that too often tries to get the people it serves to self identify as nothing but the illness they supposedly have. It treats the behavior, the feelings, the values and hopes of people as a symptom of their “illness.” It tells people they will always be dependent on the system and that they will have chronic problems throughout their life.
It is a system that because of its bias towards constitutional explanations of human behavior inadequately deals with the suffering, the social context, the trauma, the injustice in their lives and too tells them they are the cause of things that victimized them.
It is about a system that treats the rights and considerations we consider due to people as too often in the way of real help and negotiable for “the good of the patient.”
It is about a system that views the phrase “nothing about us without us” as an indication that people don’t understand the seriousness of their impairments and the demand to have their choices, their values, their persons honored as proof of brain damage.
The “harm” narrative is all these things and more and it is largely unheard, not understood, and ignored by virtually everyone other than those with a lived experience in the mental health system. It is an argument against the massive assumption that the intent of the system is benign and all that is required to make it better is some tinkering around the edges.
The Murphy Bill passed today 222-2 and the inescapable conclusion is that the process narrative of mental health reform had little or no effect. That narrative was marginalized very successfully by the Murphy folks as being a dangerous group of people who are against people in real need getting help. They became his straw men, his designated boogeyman to mobilize support to his cause.
The challenge is real and immediate. The Senate at some point will take up its version of mental health reform. Once it passes then there will be a conference committee in which Rep. Murphy will press hard to “Murphyize” the final product. Many people I know would prefer the final choice be neither or. They would like for neither Bill to become reality. After the vote today it is abundantly clear something will be passed. It is either or.
I do not know that either Bill addresses mental health reform as building a better process. They don’t take the issue of systematic harm as a result of the normal operation of the system as a credible real thing and I don’t know to what degree anyone has found the language to express our narrative in a way that had any kind of traction with legislators. 222-2. We can’t really claim anybody got it.
For me personally I think the Senate Bill does less harm and if something has to be supported I support it. I think the way to change it is to offer specific suggestions to specific provisions of the bill instead of blanket disapproval. As Murphy proved that makes us easy targets for those that who would have everything we say ignored.
In the long run we need to find a more effective way to present the narrative we believe in. That offers the greatest opportunity for the greatest change. In the short run I believe we need to have a plan to help make sure Murphy does not walk out as total victor. We will regret it if we don’t.
Sometimes people with bad ideas win because they are more skilled advocates. We got beat. I hope we learn what we need to do to get different outcomes. And I hope that we begin to make a difference that badly needs to be made.
Murphy took 3 years to win this battle but remember it is not the war and there is much to do.