Monday, October 10, 2011

World Mental Health Day: Speaking Truth to Power

The Quakers - more properly known as The Religious Society of Friends - have often used a phrase for which I have much respect, It is speaking truth to power.

I hope all the special events and programs planned for today, World Mental Health Day, and the mental health weeks now under-way succeed in creating a more enlightened public understanding of what mental health and mental illness are. Fervently, I hope as awareness grows, we will see prejudice, stigma, and shame associated with mental illness wither away.

I know there are some benefits from all that is being done around this World Mental Health Day.

But many organizers of this day, and of the mental health weeks which pop in various countries throughout the world during the year, neglect for any number of reasons to put psychiatrists, psychologists, and other mental health professionals on notice that they are, in an objective sense, failing their patients.

If you scan the tags which appear to the rights of this post, you can see what I have already written on mental illness and on trauma. I invite you to peruse those posts if you have not already done so. There will also be future posts with detailed references and arguments to back up what I am saying here.

You'll see I have written about what I see as the number one issue facing mental health professionals and their clients/patients, as well as society.

And that is trauma. Well more than half of all people hospitalized with a mental illness have a history of trauma, most often childhood sexual abuse, but also adult sexual trauma, combat related trauma, trauma from violent accidents, and so on. Judith Herman's excellent book, Trauma and Recovery, provides reference,

One would expect, being familiar with the rich depth of knowledge we have about trauma, to see chart notes, assessments, diagnoses reflecting the reality of trauma.

And I tell you, it just isn't happening most of the time, except in the very few places specializing in trauma treatment.

So we have people diagnosed with depression, anxiety, OCD, personality disorders (often borderline personality disorder) but whose trauma history might as well just not exist. And we wonder why they seem "resistant" to the various treatments shown to be effective for those conditions. Especially if the patient has been diagnosed with borderline personality disorder, nurses, psychiatrists and other professionals will sometimes blame the patient for not progressing: "she's really quite manipulative;" or "he just doesn't want to help himself."

Why the silence on trauma?

With trauma and it psychiatric sequellae (all that follows in its wake) shrouded in silence - how ironic that just as silence and the secret is the curse often of those who have been traumatized that the very professionals who should be offering the most hope and acknowledging and dealing with that reality,  themselves stay silent when trauma is concerned.

The psychiatrists are medical doctors, sworn to "first do no harm." And most believe they follow that pledge, yet harm can be done through acts of omission as well as commission. The silence, the non-action around trauma, in fact prolongs suffering, and thus does cause needless harm.

Psychologists, clinical social workers, nurses, and other professionals generally would pride themselves in first, doing no harm. But again, the silence often remains. And with silence, the harm we're committed to not doing naturally follows.

Not only is trauma the 800 pound gorilla in the room, for all intents and purposes, it has become invisible.

There are reasons for the silence. Perhaps some professionals just are not sufficiently aware of the vast literature on attachment, development of the self, and trauma to draw the obvious conclusion that something important is missing from their work.

Psychiatrists by and large define and dominate the mental health care systems. In future posts I will explore how such phenomenon as "biological psychiatry," cost constraints, lack of competence or knowledge of psycho-therapeutic modalities, and the ability to make greater income when the main focus is on prescriptions (four 15 minute appointments an hour, for example), have warped how the people at the top of the system perceive their discipline.

There are, of course, numerous examples of psychiatrists who are attuned to trauma issues, who research them, who write about them, and who make a positive difference for their clients. I will write more about them also, and share their findings.

The voluntary not-for-profits whose aim is to advocate for people with mental illness must push for those who essentially control the mental health system to break their silence with regard to trauma. Yet again, it is not all so simple. In various places, in Canada for example, some of the those organizations also receive funding from regional health organizations for programs which benefit people with mental illness, and help them to live better in the community. When such is the case, one cannot help but wonder how organizations balance advocacy needs against the need to keep dollars flowing for their programs.

The psychiatrists and regional health organizations, or the big insurance companies, all benefit from maintaining the status quo. They love it when organizations and individuals campaign against stigma and prejudice, and everyone looks progressive through this very sanitized view of mental illness. But just don't challenge them about how trauma hurts the very people they should be helping. Providing proper trauma care to all who need it would be prohibitively expensive, though in the long run savings from more effective care could balance start-up costs.

I share with all the organizers of all the mental health weeks and mental health days the passion to make life better for people who live with mental illness. Like them, I believe we can do so much more, not just to improve quality of life, but also to increase the amount of healing people experience.

But to do that, we must develop strategies and communication which address some of the core issues of why people with mental illness suffer as they do. We need to deal with that invisible 800 pound gorilla in the room - trauma. Perhaps the other 800 pound gorilla in the room is the inertia which comes when some professionals and bureaucrats are too comfortable doing what they always do.

We need to confront the mental health system with the valid, empirically derived data, which is readily available to anyone - and to demand that information is reflected in how people are treated.

We need to speak truth to power - our silence leads to immeasurable suffering and, even, death.

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