Clyde Dee's Blog, page 23

When Mad People Become More Mindful of Their Culture

I am convinced that amazing growth can occur when mad people come together and share their mad experiences in a safe and inclusive arena. Over the past eight years, I have led group therapy and trainings that go towards mad experience to explore it further. I have found that in listening to very unique mad stories that cultural themes start to emerge from vastly different kinds of experience. If each kind of mad experience is like a letter in the alphabet, put them together in vastly different lives and the likeliness of unique experience becomes immense. But helping people identify mad experiences and cultural themes in themselves and in others has led me to conclude that in reality we belong to an oppressed culture.

Once participants in groups that I have led learn that they belong to what I suggest is a culture, they start to look at their own stories in a new light. The level of trauma decreases and the flexibility and social functioning increases. In effect, I am convinced that learning more about other peoples’ mad experience and cultural themes in general has many positive effects.

 

Creating Safety and Inclusion in a Group:

For years I operated groups without delving into the details of madness. I concealed my own mad experiences, reasoning that I was not in a safe climate. I had a paycheck to earn. However, once I became licensed, I was introduced to WRAP. I started to take the necessary risks and found not only that there was a whole world of good that I had been missing out on. I was wrong about the safety issues in the group. I found the experience of defining madness with the mad to be inherently safe, but have developed and documented my own style of keeping things safe.

In general, when one person takes a risk, especially the leader, others follow suit. Often the rhythm and disclosure in the group increases the level of safety.  Newcomers may need time to listen, but often once they have heard enough, the floodgates open and the story emerges.

Even when upsetting things happen and the stakes of re-traumatization are high, I find that people are so committed to the opportunity to share their story, that safety can be restored easily. To keep the group safe I have developed a few ethics that are indicative of my leadership style that help reinforce and move the group through its stuck points.

Firstly, I set the expectation bar high in terms of what the group can handle.  I remind group members that I cannot protect them from life and death circumstances that messages bring. I remind them that they may have faced immense trauma just to make it into group.

Secondly, I let group know that risk takers need to be honored.  I teach a little about the pain associated with trauma and emphasize that if a group member is traumatized the group need to maintain a positive perspective on the suffering endured, that it can lead to healing. Encouraging others to talk about it if they feel re-traumatized also helps.

Thirdly, I try to teach the importance of inclusivity through words and deeds. I think that many times mad people will put forth a high level of testing that requires a high level of patience. While I encourage a group to talk about oversharing and am known to try to prompt others occasionally, I honor testing and use the subjects I initiate and my personal experiences to past trust tests.  I find that once people trust better, they can bring a lot to the group.

I do believe other types of leaders can manage safety in other kinds of ways.  Some of these simple techniques to restore safety, may certainly be handled in different ways by different characters.  But I think group members need to be aided in understanding the leaders’ character and the ways she or he will address issues of trauma and inclusion.

 

Replacing the Double Bind with No-Way-Out-But-Win Circumstances:

When people openly share experiences with madness they learn both ways they are similar and ways they are different than others.  I’d argue that in a well-tended group that both realizations can lead to growth with winning results.  In contrast, I would suggest that the frequent interaction with others who judge, abuse and have an agenda of changing mad culture tends to result in no-way-out-but-lose situations. The double bind occurs when people are asked to change things that they cannot possibly change.  It happens when they are told that things that they must accept and learn from are unacceptable.

I start out with a reconstructed model of what “psychosis” is. I have collected eight universal experiential elements that message receivers can relate to as a means of defining our culture. The first universal experience I suggest that we all have is the special message: roughly twenty six ways of getting information that trigger our alternate realities. Once special messages are received, there are seven other types of cultural experiences that mad people can relate to. Participants can’t help but see that they do in fact belong to something larger than them. They gain a sense of validation. At the same time, when individuals realize that they don’t experience every element of mad culture that others struggle in ways they don’t, it doesn’t tend to make them start to suffer more. I have not observed madness catch in this way.  In contrast it helps them realize some of their strengths and get perspective on their own experiences.

Speaking for myself, as I have heard the experiences of other mad people I don’t necessarily think they are right about all the conclusions they are jumping to, yet I can relate.  For example, when I learn about voices, visions, and tactile experiences—things I didn’t realize I was potentially experiencing—and the conclusion that people jump to about their meaning, I relate to central themes of what is being experienced.  I think back to what happened to me and I think that some of those traumatic hard to believe coincidences suddenly might be explained in new ways. Maybe some of those distressing message I was receiving that told me the mafia was following me were visuals or voice illusions, not reality. Maybe I wasn’t really being poisoned by laxative powder, maybe I was being struck by a tactile hallucination that caused me to have diarrhea. Moreover when I realize others have gone through what I went through and worse, it removes layers of trauma, not enhances it.

Thus, differences make people rethink their own experiences just like similarities make them realize that they are not alone. I believe that learning more instead of less about who we are as a culture is a win-win in this manner.  When I become aware that someone that I think is delusional, is judging my experience as being delusional it is vastly different than when I am confronted by someone who thinks I am ill.  When I find from that same person that we share other things in common it validates and bonds us together and has a natural tendency to make me check myself a little more.

What follows is a made up version of a phenomena that I have repeatedly witnessed. A mad subject is unwilling to share in group and eventually becomes trusting enough to admit that they believe others in the group may be working as a spy against them for a government agency.  I ask the group if we have any spies amongst us and sure enough a peer identifies themselves as a high level but unpaid operative. The situation is discussed and information about the persons experience as a spy is laid out. Their view of the organization of law enforcement is laid out. This ends up helping the mad subject realize that they are not the only person who is dealing with these spy issues.  Suddenly they realize they are not alone and they feel validated and reflective. Instead of feeling less safe because there is in fact a spy in the room, they feel an amazing sense of relief and are willing to talk about themselves.

 

What it would be like if Mad People were Truly Working Together:

I’d argue that sharing mad experiences adds dimensions of wellness even to those of us who are functioning and even to those who are leaders of the movement. Healing in community and becoming more aware of mad diversity can help people work together and share. It can help those of us who are doing better reach out and help those who are still struggling. Much as often happens in twelve step communities, there can be a sense of paths toward social rehab that can be reinforced through less formal networks.

In addition, redefining or reconstructing eight common elements of “psychosis” across diagnostic categories, I have created eight different coping skills that mad people tend to utilize to enhance their functioning, that can guide them towards social rehabilitation. Most mad people can relate to these solutions and better realize when they are engaging in unrecognized solutions. Learning that others are unrecognized and may have (to a certain extent) given up as a result of being unrecognized is a great way to get m receivers recognize each other better and make new commitments to each other.  I find most mad are craving a sense of culture and a sense of belonging. At the same time they may not want to admit they belong to a mad culture.  This is where a creative and (perhaps) a humorous facilitator is needed.

Learning that one belongs to mad culture ultimately enhances insight so that people can distinguish mad from “normal” culture.  It gives people an ability to drop in and adapt to mad culture for a little while to help out and leave with a stronger sense of self and more of a willingness to function in differing communities (like work) that can financially sustain them.  Increasingly it is diversity and adaptability skills that are most important in many work settings and what better place to learn them than through really getting in there and studying the diversity that rests within the mad community.

Social Integration: Learning Life’s Lessons in the Least Likely of Places

 

I look out the window feeling like I am straight out of the mental institution as my wife’s SUV pulls off the freeway toward the Marriot Hotel. We are on our way to visit my wife’s dear friend and goddaughter at an Irish Dance competition. I know I will be feeling straight out of it: trying not to let my face go flat; exhibiting all the buoyant pleasantries. It is one of those rare occasions that I will be integrating with the “Normal” folk. I dread this. Often all I learn in these kinds of contexts is that I am less than.

Perhaps I feel this way because I work nine to five in a mental health ward that serves inner-city Boston in the Roxbury neighborhood. I have done this for thirteen years.  I work with an extremely deprived lot of people and it can be hard to leave it behind.  Before that I was underemployed for a significant amount of time having just moved into Boston from an out-of-state, State Hospital where I was an inmate for three months.

My wife’s friend is a stay at home, decorative home-schooler who lives off family money and has expensive tastes. I am not proud that this is the way I see her.  She is certainly nice enough. They live in a hippy town out west along the Masshole Turnpike.

At least I can say that my wife does not have to pressure me to do an event like this.  She supports me emotionally and I am genuinely motivated to put on a good show for her. Our relationship is solid.

***

Once parked, we struggle to find the proper side entrance though the clutter of prepubescent girls that are taking over patio and lawn. I note the anxiety, practicing, and perfectionism and wonder what it’s all about, really. I don’t even know what Irish dancing is. I spot a boy or two on the way in. Sure I was lucky to have baseball games and have my parents attend too. But coming face to face with insulated childhood innocence is gearing up to really blow my mind.

We enter the ball room and navigate the crowd scanning for her friend.  We find each other and there are hugs and pleasantries and I wonder if her friend is angry at me.  The last time we paid her a visit in hippy land I lost my cool when her husband ordered the most expensive meal when it had been clear we were paying. But to make matters worse, my wife topped it off by buying her friend some thirty dollar bottle of grape juice. Yes, grape juice. That was just too damn much for me.  I thought of the poverty of the people who I employ after work trying to help them get on their feet after catastrophic mental health break down and I just could not keep my eyes from bulging in their sockets.

My wife managed me well and respected where I was coming from. But somehow I don’t see her friend as being so humble.

My wife’s friend is hosting her parents who are in from out of town.  I have met them before and they are okay.  They’ll talk about their struggles to bring it in and will tolerate their daughter’s expensive tastes with some degree of eye roll. I give them all hugs but my mind is already consumed with the dancing that is going on in this massive marble ball room. They have imported mobile wood floors that are getting good and stomped on in rhythmic patterns.  The get-ups are like nothing I have ever seen before, polyester and doll-baby, yet Irish. I presume they are only worn for these statewide competitions and imagine they are costly.  Many girls are wearing wigs to look more Irish.

The thing that gets me is the privilege involved with spending hours training to put on a show that only Irish lace people would really dig. I go on as we are all seated and my wife is whispering to her friend, thinking about the way people honor such waste in this society and develop these truly idiosyncratic traditions; for what: so that one girl can be better than the next. We are totally surrounded by lace lovers that are stroking their knees, taking pictures, and perpetuating grandiosity.

***

When I work on a mental ward—either as an inmate, a hostage taker, or hopefully, with some skill, a dream maker—it is hard not to see something like rank as being anything but highly hurtful. Although we charge our clientele a high level on their insurance, we stay in an old dilapidated section of the hospital. With hard work the place has gotten better over the years, but there is that yellow stain that runs from the urinal to the drain of the men’s restroom from years of neglect that just won’t go away even when the floor is glossed. Everything is old. The window panes are crusted with soot while the rest of the hospital is renovated. Bubbled widows in the hall that you can’t see in or out of only just got removed two years ago. And though many of us do all that we can, to create a healthy and healing environment, there are still institutional lines that form in front of the decaf coffee among other signs of overcrowding. Just outside the unit is the stench of a trash compactor that the clients who smoke illegally must breathe. And we are located right next to the morgue.

Just witnessing this ballroom reminds me about the importance of ranking up and somehow being deemed talented and worthwhile. My wife points out a dancer that her friend and daughter are appalled at.  Sure she is bow legged and a pinch awkward but she’s getting good exercise and is clearly deserving of love too. I know that if she can’t find love, she will one day get driven into the squalor that I deal with on a daily basis.  And yet it is so important to the lace bastards of the world to worship the best.

In support of our goddaughter, the whole lot of us keep shifting and moving around as a unit.  Eventually, the parents leave and my wife’s friend starts complaining about the fact that her parents snored last night. She can barely stand it.

I look at the competitive display going on right in front of our eyes, each girl trying to take center stage in front of the judges. I lean over and whisper in my wife’s ear, “Why is it that all I can do is hear these girls in my mind saying things like, ‘you bitch,’ and ‘you cunt.” I have distorted my voice a bit when I say the expletives. I probably repeat them a few times.

My wife laughs hysterically and I am a little surprised that I got away with the “c” word.  I mean, it was funny but I really know better than to be using such derogatory language.

As our goddaughter takes a turn, I take notice that the outfit of her troop is simpler than the troops of other girls.  My wife’s friend is madly trying to make her stomp shoes appear a little less old by covering the worn portion with black ink.  All the moves our goddaughter makes look perfect and eloquent but our goddaughter looks a little bit tall and lanky as she does her stuff. And her dress is just a bit wilted made of fuzzy fabric rather that spanking bright polyester.

It is not long after that when I see the one girl that really stands out. She is the only one out there who dances with the grace and ease that tells you she knows she is the best. She is the true doll baby of the ballroom. I hear my wife’s friend comment that the costume she is wearing costs eight hundred dollars.  This girl comes from one of those wealthy districts who can dare to give them the advantage of requiring eight-hundred dollar uniforms for their special girls.  She dances next to a teammate who also has good moves but also bears just a little extra weight in a way that makes her socks look like their pulled up too high.   Yep, the teammate is definitely second rate.

And suddenly we are all scrambling to get to a distant dance floor where our goddaughter has been moved.  The grandparents are back and we join a different crowd of parents that are all collectively clapping for all the dancers.  Somehow all these dancers have advanced and they sure do look better with the community clapping for them. We clap and clap.

I think about all these little egos getting that community boosts and think about how the little girls back in the ghetto block where I stayed back in college had nothing quite like this going for them.  One of them that first hits my memory had a mother who had been developmentally delayed, raised by her maternal grandmother. The way they loved the hell out of us when we gave them attention, told us they had to fight for everything they got with fisticuffs. Maybe they danced well in the double-Dutch but they didn’t experience the ballroom clap.

I think about what it’s like to be a parent and have to drag yourself to all these events.  Yeah, this must be when it gets worthwhile when you get to contribute to your child being clapped at. This is what it’s all about for the parent: contributing to boosting you little girl’s notion of superiority. Though I am clapping to fit it, I feel like we’re all a bunch of assholes.

Just after the clapping stops, I see one mother at a little girl’s throat. How dare the little girl want to go sock-less like her friend! I feel oddly validated. We may all create community for a minute, but it is all dog eat dog in this crowd the minute we have to deal with anything that displeases us. It’s not that I like to see abuse.  It’s just somehow comforting to be reminded that this sense of community is in fact built on façade.

We have to wait around a while for our goddaughter to get her results and I am starting to get that itch. We are just waiting and waiting. I have seen enough to know that our goddaughter will only end up in tears for the most dumb-ass of reasons. I feel that what makes her awesome in my book, the fact that she did not push to get up front and be seen by the judges, is not likely to be respected in this crowd.

I need to get away from here, I think. I can’t learn a damn thing about anything that is going to help the world endure in future generations in a place like this. I am so sharply bias in this manner. The whole days a wash.  I didn’t get any writing done. I really don’t have too much time away from work and this just a royal goddamn pain that isn’t going to help my spirit in any manner whatsoever!

***

And then it dawns on me.  I think of one of the male peers I have worked with back on the crumbling mental ward.

This particular “patient” had been a true twisted character. My colleagues were frustrated with him and talked disparaging of him.  He lost all his board and care placements. He wouldn’t follow rules and sit in groups. The unit felt all but hopeless for him. At one time a competitive swimmer, from wealth and privilege, he went homeless repeatedly. He was incapable of making a friend. And what was worse was that we couldn’t bill for him.  He was utterly useless.

I remember how, myself being the only staff person who could actively demonstrate that he know what “psychosis” feels like, he’d talk to me. He had this terrible chronic pain in his back that made him unable to stand up straight and stay have patience for group.  But then many of my colleague would negate that because on break he would go into the hall and start dancing.  I can’t count the number of times staff made fun of him for his dancing. There was Sid dancing in the hall like a full on lark, making the mental ward just a pinch loonier.

It dawns on me that he was doing Irish dancing. All those fancy moves had looked oddly familiar.

Suddenly I have an ability to understand his behavior on our unit, in the homeless shelters and board and care home that force him into our dilapidated setting.  Finally, I can see the thing that is keeping him going in spite of his pain and in spite of his “psychosis.”

I can see that this lace culture is the one thing that helped him feel valued and that continues to give him hope in all of his squalor. Though I imagine he now feels conflicted about it, I now understand better how disparity in his life make him unable to accept anything else. I think of my own behavior and the way people despised it during incarceration and believe that in time, Sid will overcome all the bullshit and return to health much as I did.  I held onto the privilege of my past to endure minimum wage work, poverty and madness, all at the same time. In spite of all the harassment and humiliation I made people sandwiches so that I could keep afloat and out of the hospital. In like manner, Sid danced in the halls to tolerate being an inmate.

Although I have not seen this man for a year, it is so nice to be reminded that he will be okay. Social integration into the Irish Lace community has helped me decode his existence.  And now I don’t have to look at all this hype with quite the same edge.

***

I always wish I could help some of the other staff I work with not to be so negative and critical toward characters like Sid. I know I need to have more compassion for my fellow staff.  Some are used to being treated to Marriot Hotel-land. They are fighting hard to give their kids that lift and afford these dance competitions. One or two might even feel bitter that they have to come in and work with the dilapidated losers to maintain their career. I wish I could help those on our staff who don’t like what they do see that they work with the greatest people in the world. I wish more of us would be motivated to crack the case of Sid, the Irish Dancer, as I have just done.

People often don’t like to learn the lessons they most need to learn. They don’t feel comfortable when you put them out of their comfort zones. Not everyone integrates gracefully into the squalor or institutionalized poverty. I certainly didn’t initially. But there is hope that as they survive in this wide world we travel through that they will learn the really important of life’s lessons. It is only stigma and oppression that differentiates the people in the Marriot and the people in the inmates in the county hospitals.  I am still the same person I was when whistle blowing landed me in the State hospital and in years of Mad crisis.

As we mount our hybrid SUV and prepare to leave this la la land, I hope and pray that I will continue to learn my lessons so that when I end up back in the institution in old age without a child to take care of me, that I will have learned enough to endure and be humble enough to accept my place in this society. I hope I will find a few staff that actually care about what they are doing and will learn from my experience. I hope that I will enrich their lives the way people like Sid enriches mine.

Three Ethics to Consider when Making Money off the Mad

Making money off the Mad is not a privilege to take lightly when one believes in recovery.  Many of the Mad in the system, depending on how much experience they have, will presume you’re going to treat them like a commodity or property as many provider-folks have done previously in their history. I believe that a large part of gaining trust involves demonstrating that the best interest of the Mad person needs to honored above and beyond the money made.

When I first set my eyes on being a Mad-Recovery-Provider about twelve or thirteen years ago, I saw a lot going on that was not honoring this principle. The level of alienation I felt between myself and other providers was very high. I became effective at managing this aspect of the therapeutic relationship and achieving trust.

As time has moved forward and I have seen the amount of recovery lost to unhealthy clinical families, failure of providers to collaborate, and interagency and interdisciplinary infighting, I have changed my perspective.

No longer do I believe that maverick success alone is acceptable. As I have gained experience, I have come to see more of the limits of my own recovery perspective and the Mad diversity out there. While I do not deny that it is a dignified option to just stick to helping those who fit a mold that you are good at helping, I have avoided this route to keep my services accessible to everyone. For other recovery providers who work in the system, changing agency culture towards recovery and decreasing impact of mental health silos gets added to the list.

Now the recovery provider needs to on top of all they do to move the Mad person forward toward social integration. This entails promoting recovery not only on your own team, but also with other service providers from different disciplines. Providers are not often enough trained to realize how our own egos or chips on the shoulder towards each other contribute to treatment failure.

Because in my mind, the Mad in the system are clearly subjugated beneath the provider community, I now feel prepared to identify three ethics to making money off the Mad that ethical providers might consider: 1) acknowledging their privilege and responsibility; 2) working with others to adapt a recovery culture; and 3) resisting the temptation to silo up.

1. Acknowledging Privilege and Responsibility

Acknowledging I am taking a strong stance, I am going to stick to my guns and argue that the Mad-Recovery-Provider needs to be able to negotiate the financial oppression going on within the relationship.

As a psychotherapist, in the past fifteen years, I have gone from renting a closet of a room with a landlady who helped herself to the little that I owned, to owning a house and sustaining a marriage. Because outside my marriage, I have received limited amounts of support, I personally feel indebted to those in the institutions who support me. That is partly because I come from the institution and worked hard for several years to get up out of the street and be able to maintain housing and move into a closet of a room.

While I have seen some of my Mad brothers and sisters move up and out of the squalor of the confines of the program I work in—with jobs and relationships and other signs of dignity—others have aged and continue to give and give while remaining in smoky confines of homes that are on war-torn blocks. Some have significant cultural dignities and capital to hold onto, but many don’t.

Acknowledging the inequity of the relationship is key to establishing the recovery track with the many that don’t have cultural capital.

Thus, when providers feel entitled to their lifestyle, or perhaps resentful that they are not privileged enough for the work they do (and many are barely paid a living wage,) they may not realize how much they are comparatively being helped by the work they do. Not getting this, can significantly interfere with seeing the Mad person as a human being.

Acknowledging that you are sailing on a slave ship is a first step to facilitating escape. For me, this involves taking ownership of the fact that you are nothing but a buzzard until you work through the issue. Are you comfortable with balking out: “CAW CAW!”

 

2.  Working with Others to Adapt a Recovery Culture

Okay, so that said, it is extremely important to work with other people in ways that do not undermine what they do. Slapping someone who bears a different perspective in the face is not a good way to influence them.  See what I mean?

Some of what I have done to increase my level of success is to run groups in a way that utilizes my own experiences of Madness. Because I operate in a different manner and with a different perspective than most, I have been very careful, writing extensively on the weekend to give myself ground to stand on, in the event that I am challenged. I have done this in part to invite co-workers to know what I am up to.

When you color both inside and outside the lines with the intention of improving care, it can be cause for some to alienate you.  It is important to tolerate that without fighting back and still honor what other people are doing and learn from the good they do. I have often had to hang in there with naysayers until over the years some have started to listen to what I have to say. I believe that learning how to promote health and simultaneously help change the culture of the institution is a slow process. Staying honorable, humble and submissive has been key for me.

My experience with an effort to accelerate the recovery process too quickly, something I hopped right on board eagerly to do, taught me that this does not work. I believe that quick changes will cause individuals to silo up and go after you in ways that make survival untenable. When I served as an exposed Mad leader on multidisciplinary teams, it was very hard to change different teams minds. There was a tendency for individuals from different disciplines to attack and not respect what I had to say. I believe there needs to be a clear give and take, and a co-worker needs to be open and slowly and gently impressed with the care you can bring.

When you stand out too strong and say too much too quick your co-workers may feed on you like sharks.  While you are getting attacked by others, the money and energy that could be going to care for the Mad person is actually getting expended on destroying you. Other people can and will go to great lengths discredit and diminish your efforts. Things can become very negative.

 

3. Resisting the Temptation to Silo Up

So often there is a tendency for different disciplines and organizations to form mental health silos.  When workers focus only on meeting the requirements of their deliverables and get territorial with regards to who does what, or who works with who, I feel that recovery can easily be lost.

When, for example, one therapy organization competes with another and fails to encourage its participants to connect with the local peer movement for fear of losing income, recovery is lost.

When a peer organization sees this and discourages people it works with from going to a therapy organization when they need it, recovery might be lost. When a therapist fails to use a psychiatrist because they don’t believe in medication and a client suffers and them becomes bonded to the psychiatrist and becomes highly critical of a therapy process, recovery may get lost.

When a recovery provider encounters behavior from another discipline that is not recovery focused, they need to still find ways to respect and work with it.  Much like working with others on your team, promoting your ideas of recovery is a long, slow, and, for me, a non-confrontational process.

Indeed to list just one example from my hometown Lincoln Nebraska: I had to persist for years to get a peer recovery organization to have permission to come to my agency to give our therapy seekers a vision of other constructive community activities.  Then when I finally succeeded the peer organization refused to come for a while for reasons I could not understand. I heard a key leader in the organization make fun of me for what I do providing therapy suggesting that it’s not worth all the money that gets made.  Finally, the presentation did happen and it helped, but what was all the infighting about?  Whether through grants or insurance, money is being made and the salaries are fairly comparable.

Thus, the Mad-Recovery-Provider who pushes and shoves others for not believing in recovery, and fights hard so that his vision of recovery can be realized may ultimately impede and slow down recovery.  Interpersonal turmoil within or across interdisciplinary teams needs to be avoided so that clients aren’t pushed and shoved around. Mad need to get affirmation from more than just one relationship. In this manner, they can learn to have different kinds of relationships with different supporters and can feel a sense of safety, self-direction, and self-determination.

Although there are times when a Mad person may rightly need to stay grounded in only one therapeutic community, it is very important that they have the right to make their own choices over their treatment. It is unfair for treatment providers, in my opinion, to impose or influence the Mad when something is clearly in it for them, the money.

 

Silos are for Corn, Not Mad People!

Do not be fooled! Having someone paid handsomely for the services they provide for you stings when you yourself are left in a state of absolute deprivation. It may be easier for a Mad person who likes you to presume they have a condition that can’t get better, than to acknowledge that you are temporarily taking advantage of them.

Silos are for Corn, Not Mad People

Making money off the Mad is not a privilege to take lightly when one believes in recovery.  Many of the Mad in the system, depending on how much experience they have, will presume you’re going to treat them like a commodity or property as many provider-folks have done previously in their history. I believe that a large part of gaining trust involves demonstrating that the best interest of the Mad person needs to honored above and beyond the money made.

When I first set my eyes on being a Mad-Recovery-Provider about twelve or thirteen years ago, I saw a lot going on that was not honoring this principle. The level of alienation I felt between myself and other providers was very high. I became effective at managing this aspect of the therapeutic relationship and achieving trust.

As time has moved forward and I have seen the amount of recovery lost to unhealthy clinical families, failure of providers to collaborate, and interagency and interdisciplinary infighting, I have changed my perspective.

No longer do I believe that maverick success alone is acceptable. As I have gained experience, I have come to see more of the limits of my own recovery perspective and the Mad diversity out there. While I do not deny that it is a dignified option to just stick to helping those who fit a mold that you are good at helping, I have avoided this route to keep my services accessible to everyone. For recovery providers who work in the system, changing agency culture towards recovery and decreasing impact of mental health silos gets added to the list.

Now the recovery provider needs to on top of all they do to move the Mad person forward toward social integration. This entails promoting recovery not only on your own team, but also with other service providers from different disciplines. Providers are not often enough trained to realize how our own egos or chips on the shoulder towards each other contribute to treatment failure.

Because in my mind, the Mad in the system are clearly subjugated beneath the provider community, I now feel prepared to identify three ethics to making money off the Mad that ethical providers might consider: 1) acknowledging their privilege and responsibility; 2) working with others to adapt a recovery culture; and 3) resisting the temptation to silo up.

1. Acknowledging Privilege and Responsibility

Acknowledging I am taking a strong stance, I am going to stick to my guns and argue that the Mad-Recovery-Provider needs to be able to negotiate the financial oppression going on within the relationship.

As a psychotherapist, in the past fifteen years, I have gone from renting a closet of a room with a landlady who helped herself to the little that I owned, to owning a house and sustaining a marriage. Because outside my marriage, I have received limited amounts of support, I personally feel indebted to those in the institutions who support me. That is partly because I come from the institution and worked hard for several years to get up out of the street and be able to maintain housing and move into a closet of a room.

While I have seen some of my Mad brothers and sisters move up and out of the squalor of the confines of the program I work in—with jobs and relationships and other signs of dignity—others have aged and continue to give and give while remaining in smoky confines of homes that are on war-torn blocks. Some have significant cultural dignities and capital to hold onto, but many don’t.

Acknowledging the inequity of the relationship is key to establishing the recovery track with the many that don’t have cultural capital.

Thus, when providers feel entitled to their lifestyle, or perhaps resentful that they are not privileged enough for the work they do (and many are barely paid a living wage,) they may not realize how much they are comparatively being helped by the work they do. Not getting this, can significantly interfere with seeing the Mad person as a human being.

Acknowledging that you are sailing on a slave ship is a first step to facilitating escape. For me, this involves taking ownership of the fact that you are nothing but a buzzard until you work through the issue. Are you comfortable with balking out: “CAW CAW!”

 

2.  Working with Others to Adapt a Recovery Culture

Okay, so that said, it is extremely important to work with other people in ways that do not undermine what they do. Slapping someone who bears a different perspective in the face is not a good way to influence them.  See what I mean?

Some of what I have done to increase my level of success is to run groups in a way that utilizes my own experiences of Madness. Because I operate in a different manner and with a different perspective than most, I have been very careful, writing extensively on the weekend to give myself ground to stand on, in the event that I am challenged. I have done this in part to invite co-workers to know what I am up to.

When you color both inside and outside the lines with the intention of improving care, it can be cause for some to alienate you.  It is important to tolerate that without fighting back and still honor what other people are doing and learn from the good they do. I have often had to hang in there with naysayers until over the years some have started to listen to what I have to say. I believe that learning how to promote health and simultaneously help change the culture of the institution is a slow process. Staying honorable, humble and submissive has been key for me.

My experience with an effort to accelerate the recovery process too quickly, something I hopped right on board eagerly to do, taught me that this does not work. I believe that quick changes will cause individuals to silo up and go after you in ways that make survival untenable. When I served as an exposed Mad leader on multidisciplinary teams, it was very hard to change different teams minds. There was a tendency for individuals from different disciplines to attack and not respect what I had to say. I believe there needs to be a clear give and take, and a co-worker needs to be open and slowly and gently impressed with the care you can bring.

When you stand out too strong and say too much too quick your co-workers may feed on you like sharks.  While you are getting attacked by others, the money and energy that could be going to care for the Mad person is actually getting expended on destroying you. Other people can and will go to great lengths discredit and diminish your efforts. Things can become very negative.

 

3. Resisting the Temptation to Silo Up

So often there is a tendency for different disciplines and organizations to form mental health silos.  When workers focus only on meeting the requirements of their deliverables and get territorial with regards to who does what, or who works with who, I feel that recovery can easily be lost.

When, for example, one therapy organization competes with another and fails to encourage its participants to connect with the local peer movement for fear of losing income, recovery is lost.

When a peer organization sees this and discourages people it works with from going to a therapy organization when they need it, recovery might be lost. When a therapist fails to use a psychiatrist because they don’t believe in medication and a client suffers and them becomes bonded to the psychiatrist and becomes highly critical of a therapy process, recovery may get lost.

When a recovery provider encounters behavior from another discipline that is not recovery focused, they need to still find ways to respect and work with it.  Much like working with others on your team, promoting your ideas of recovery is a long, slow, and, for me, a non-confrontational process.

Indeed to list just one example from my hometown Lincoln Nebraska: I had to persist for years to get a peer recovery organization to have permission to come to my agency to give our therapy seekers a vision of other constructive community activities.  Then when I finally succeeded the peer organization refused to come for a while for reasons I could not understand. I heard a key leader in the organization make fun of me for what I do providing therapy suggesting that it’s not worth all the money that gets made.  Finally, the presentation did happen and it helped, but what was all the infighting about?  Whether through grants or insurance, money is being made and the salaries are fairly comparable.

Thus, the Mad-Recovery-Provider who pushes and shoves others for not believing in recovery, and fights hard so that his vision of recovery can be realized may ultimately impede and slow down recovery.  Interpersonal turmoil within or across interdisciplinary teams needs to be avoided so that clients aren’t pushed and shoved around. Mad need to get affirmation from more than just one relationship. In this manner, they can learn to have different kinds of relationships with different supporters and can feel a sense of safety, self-direction, and self-determination.

Although there are times when a Mad person may rightly need to stay grounded in only one therapeutic community, it is very important that they have the right to make their own choices over their treatment. It is unfair for treatment providers, in my opinion, to impose or influence the Mad when something is clearly in it for them, the money.

 

Silos are for Corn, Not Mad People!

Do not be fooled! Having someone paid handsomely for the services they provide for you stings when you yourself are left in a state of absolute deprivation. It may be easier for a Mad person who likes you to presume they have a condition that can’t get better, than to acknowledge that you are temporarily taking advantage of them.

How I Overcame the Revolving Door of Insanity, by Don Karp

Guest Blogger

Don Karp, helps young adults recovering from schizophrenia with practical, science based self-care. Check out his free video, 7-Step Self-Hypnosis Process, by signing up here. His book, available on Amazon, is The Bumpy Road: A Memoir of Culture Clash, Including Woodstock, Mental Hospitals and Living In Mexico. He is a regular contributor to Quora.com and LifeHack.org. His twitter handle is @donsbumpyroad.

 

Early Development

“Stand up straight!” Don’t pick your nose!” “Speak like a man!” These

are some of the commands from my mom that I endured as an

adolescent. Dad once said, “I heard you got an A on a report. How

come you didn’t get an A+?”

No wonder I felt stupid, ugly and clumsy growing up. I was in pain but

didn’t know where or how to express it. I was shy, and isolated myself

from my peers.

Fortunately, Mom sent me to camp every summer year after year. I

learned to appreciate nature and developed curiosity about much that

I’d observed. I found some answers to nature’s riddles in science

classes and was more comfortable with test tubes than people.

Mental Patient and Dropout

Entering college, I had a dream of becoming a Ph D biochemist, doing

teaching and research. Eight years later, from inside a mental

hospital, I made my decision to drop out. The dream ended. I was too

sensitive to continue in the academic lifestyle, with its competitive

publish or perish, backbiting, old boy’s club and other harsh realities

as part of the game.

In those days there was no Freedom Of Information Act. I did not have

access to my personal file. After many unsuccessful job applications

(note that employment was not so scarce in the ’70’s), I got suspicious

and had the file sent to a friend. He disclosed my professors

“recommendations”: Don is a campus goodie-goodie.” “Don is brilliant

but remote.” In my opinion those professors acted immorally out of a

conceived stigma, and should have instead told me flat out that they

could not recommend me.

The Counter-Culture Conflicts With My Lifestyle

During the late ’60’s, while still in grad school, I became involved in

the emerging counter-culture revolution: radical politics, communes,

alternative schools, rock music and psychedelics. For me the wonder

of attending the Woodstock Festival was not so much about the music

as it was about genuine brotherly love—sharing and caring for one

another. During the storm our neighbor’s tent was destroyed. We had

no problem taking him in.

This era gave hope for a better world and was quite a contrast to my

academic lifestyle. I’d invested so much, I couldn’t just drop out. The

conflict of lifestyles was exacerbated when I gained awareness from

my inner experiences–experiments with psychedelics. Eventually I

began having flashbacks to those experiences without the drugs. I

thought that someone was putting drugs in my food, that I was being

watched and followed, and I started hearing voices.

Some people ask me if taking psychedelics made me crazy.

I think that they opened the doors to the reality of who I was and to my

past. This was too much for me to comprehend, and created the

psychosis.

One day I took a drive out into the suburbs to get away from it all. I

thought I heard a helicopter following me and, to escape, drove my

car off the road, hitting a tree. I was not hurt and the car undamaged.

Mom brought me to a psychiatrist who listened to my story for ten

minutes and said that I needed to be hospitalized. I didn’t know what

else to do. He was the authority and I had no alternatives.

Ten Years of Hospitalizations

Yearly hospitalizations became a routine for me when I had psychotic

breaks. The stays usually lasted a month, the time it takes to evaluate

anti-psychotic medications.

My brother had spent some time in Berkeley, California, and

suggested I go there because they had more knowledge of how to

handle dropouts like me. I took his advice and my life became a

steeper roller coaster ride, with even deeper lows and highs.

I joined a group at the Berkeley Rap Center, a free clinic using Eric

Berne’s transactional analysis, and embodying the ideas of The

Radical Therapist, that the main cause of mental illness was

capitalism. To overcome my shyness, the group’s leader gave me an

assignment. I was to go to the campus and meet young women. I

approached one and said, “Hi, my name is Don. My therapy group told

me to meet women on campus.” Her response was: “Hi. I’m Sylvia

and I have the clap.”

One hospital stay was at Napa State. My therapy there was talking to

a medical doctor for ten minutes once a week. He told me that

similarly to a diabetic with insulin, I’d need to take Thorazine the rest

of my life or I’d have psychotic attacks. I was lucky to get out of that

hell hole. I’ll not go into that story here.

As a young adult I was back living with my parents. This became an

increasingly intolerable situation. Finally, after a few months, I acted

out and Dad brought me to the hospital with the same result:

medications and boredom.

How I Beat Recidivism

This was my fifth hospitalization. I was fed up with the revolving door,

and made a firm resolution that when I got out I’d never return again.

As often happens when we firmly take our fate into our own hands,

the Universe cooperates. Three actions helped me to conquer this

malady.

First, against the advice of my friends, who said it would be

impossible, I got an apprenticeship at the university with a professor in

the fiber arts department. While in California, I picked up a simple

form of weaving and wanted to get more seriously involved. It was a

very meditative and relaxing activity resulting in a physical product.

This gave me new identity as an artist and kept me busy and off of the

streets and away from the bars.

Second, when I got out of the hospital I did not follow their

recommendations: medications, outreach programs and living in

neighborhoods with other ex-patients.

Third, I entered therapy with a very special psychologist after waiting

two years for her appointment calendar to clear. We had two sessions

with Mom and Dad. She told me that there was a family problem and

that I displayed the symptoms.

She used the Gestalt therapy method, and trained me in dream

analysis. She advised that whenever I heard voices, I should check

out where there might be rejection in my life instead of listening in.

Using this approach, over time, the voices decreased.

During my hospitalizations I was a member of the local chapter of the

Mental Patients Liberation Project whose purpose was to alert the

public of the dangers of psychiatric oppression. We distributed

pamphlets, spoke to classes of nurses in training, held a panel

discussion on suicide and did some advocacy work in hospitals.

Understanding My Purpose

Fast forwarding over many years, I experienced therapies, workshops,

men’s groups and living in intentional communities. In 2003 I retired

from a career as a chemist and moved to a small magical city in

central Mexico.

To keep in touch with friends and relatives I sent out a short blog

every few months. Although I’d not seen myself as a writer, I got a lot

of good feedback to that effect.

In ’95, using my journals, I began writing my experiences as a mental

patient, hoping that this might provide some closure on those dark

times.

In 2007, I met a woman who had won national writing awards. She

asked me to send her my manuscript. Her response was: “I got so

involved in reading it that I forgot to go to my yoga class.” She also

sent me several helpful editorial comments.

I began attending a weekly writing group and read several how-to

books on memoir writing. I now wanted to publish, and as I mentioned

earlier, when an intention is strong, the Universe provides for it.

I was in the “zone!” I met my cover artist in a hostel in Oaxaca,

engaged with a web designer I met on the beach who also introduced

me to social media and I got a friend to help me with formatting. I selfpublished

with an online firm that placed me on Amazon with a

paperback and Ebook.

Then came the next hurdle—promotional speaking engagements. In

the audience were friends and relatives. Also there were many

strangers. “Who cares about me and my story,” I thought. I got up my

courage and overcame this fear, finding that everyone has a story and

we all have overlap we can identify with.

As my legacy, I help people who are in trouble as I was . I provide

young adults, recovering from schizophrenia, different forms of online

self-care, as an adjunct to the mental health mill. My goal is not only to

see recovery, but to assist them in actually thriving in life.

I hope my story has given you some encouragement to rise above

your problems and help others. Please add your comments below. I’d

love to see your thoughts.

Clyde Dee’s Podcast Interview with Web Weaver Books

Just click link to hear interview with author CK Webb:

http://www.blogtalkradio.com/webbweaverbooks/2016/01/30/webbweaver-books-proudly-presents-author-clyde-dee

Issues that Divide the Mad Community

As a psychotherapist who works with other Mad individuals in an L.A. county facility, it seems to me that the wider Mad community is not always aware of the diversity that exists within. While I am grateful for every person who has survived in spite of the limits of therapeutic environments available to many, rich and poor; survivors seem to promote what has worked for them without consideration for what other Mad individuals are dealing with. Many of us who have survived may fail to see the privileges that we have that have enabled ourselves not to get sucked into the institutions. We may think our way of making it is the only way. We may take for granted what we have used to survive. And we may not always learn the diversity lessons that we need in order to be there for our brethren.

Historically we are divided by DSM labels and social inequality and we may easily reinforce those divisions without knowing it.  Some of us may consider ourselves members of a spiritual emergence narrative rather than a schizophrenic episode; many even argue that these are separate conditions requiring very different treatment. Others in recovery profess safety in a functioning bipolar community rather than among individuals who are genetically impaired with schizophrenia eugenics.  Some want to divide up into individuals who hear voices verses those who are just delusional. And then there are the individuals who evade intrusion by coding up their words. And of course differences in heritage, class, gender and relation to historical trauma are likewise things that many survivors may not completely acknowledge. And still further, those who are wrapped up in the current debate in the Mad community over the use of medication run the risk of dividing us further without acknowledging the diversity of peoples experience and trauma.

The claim that I really object to is: this works for me, therefore it must be what everyone else needs.

Demands for Inclusion in the Movement:

Having gone from one day being a mental health worker who risked everything for social justice to being treated with the worst of what a state hospital has to offer; and, then, to return to a career in which I had to thrive with (instead of for) partners as a licensed professional, I experience the social order in the local survivor movement to be cutthroat. The demands for inclusion make many in it seem intolerant. From my vantage point, to really become promoted in the survivor community, you have to be off your medication, able to afford the conference circuit, able to volunteer, bearing of a prestigious university experience, or open to using stigmatic discernment in terms of who you do and so not associate with. When I interact with both the “chronically normal” and survivor communities, it is easy to feel invisible and irrelevant.

I have to admit that I was given fair warning when I heard local African American people say, “The thing about the recovery movement is that it is clearly a white movement.” Still, amid the very repressed individuals I work with, I have promoted recovery and inclusion with success. I have pointed individuals in the direction of the survivor community and then bound like a puppy into its arms only to face dominance. To my relief, some of the people I have helped may have fared better than me, but I also can say that I understand why a large concentration of brilliant people do not want to change what they are doing and embrace the rank of the movement. Perhaps because I make money off my own brethren: that would be an argument for exclusion that I could respect. But wellness leaders in LA County also make sustainable income as well.

Fitting in with the Misfits:

To be fair to local movement leaders, not fitting into community is something I have a lot of experience with. It has been easy for me to sniff out familiar things that have alienated me in the past, go flat and withdraw. Although in my group work with “psychosis” I teach Mad people that social skills are extremely important to counteract our retaliating and reacting to our Mad experiences, I still do not always use them. I still am known to get off popping in some ghetto references amid stodgy and insulated contexts. Walking like an Egyptian in Rome is a hard habit to rid myself of. No doubt this is one of the times when I need to take my own advice, but when I see mad people in a group setting feeling and acting alienated, I can and do relate to them. Maybe being excluded is part of what make me who I am and it is very easy to go back there. Maybe I just need to accept those feelings and persist.

A Little on my Vision of Learning from Mad Diversity:

But I have seen in Mad groups that Mad learning can come from Mad people connecting with Mad diversity. Higher levels of flexibility, humility, social functioning, and social justice can result.

For example, when I see those who have positive (syntonic) spiritual experiences mix with those who have more paranoid conspiracy focused (dystonic) ones (or any mix thereof); when I see more irritated mania Madness mix with the more dysphoric numbed out or catatonic type; or when I see those who hear voices and see visuals mix the people who code words and get magical intuition from interpersonal information; when I see those who are underprivileged mix with those who are provided for; and finally, when I see those who can go without medication mix with those who have come to a self-determined acceptance that they need it: when all this happens, the individual can gain a bigger cultural sense of who they are. They can become more aware of what advantages and strengths they have. It is an extremely diverse learning environment. And the diversity can be very healing. I see participants learn how they might use the differing perspectives of others to become less stuck with the current situations that limit them.

What I have come to believe is that although Madness made me grow happier and healthier (through a lot of pain and suffering) which fits the narrative of spiritual emergence, I relate very strongly to those still experiencing the pain and suffering.  I believe that if I believe in them it is more likely to help them.

Indeed, some message receivers may be more the victim of trauma, some may be more spiritually endowed, and still others may be more afflicted with being scientifically different than others. When one voice rules the Mad nation and imposes their views on the others there is the potential for so much learning and cultural exploration to be lost.

Just Saving the Privileged?

I resist the general sense that treatment must skim the useful and talented from the top of the Mad pile to save them from going into the meat grinder and having horrific experiences. Once you have experienced the meat grinder or try to honor that experience, you may be seen as damaged goods. You may be seen as not worthy of promoting the true virtues of health. On days that I feel highly alienated from the movement, I often feel that I am seen this way.

From where I sit on a swivel chair, being horrified and appalled by repressive environments; unilaterally attacking them in a polarized manner with rank generalizations that alienate and dehumanize individuals who must accept them and learn from them in order to heal is not helpful. I’d argue that it is the proliferation of alienating stigma that divides Mad people instead of accepting and learning from them. Much as happened with the civil rights movement in the U.S., it can be easy for the oppressor to turn us against each other, keep us attacking each other, and recapitulating the pain and hatred we experienced on each other. Sometimes Mad people, myself included, may use one study or piece of evidence to presume they are right about the whole phenomenon.

Many of our early intervention programs are built in this very manner with this mentality. The root of cognitive therapy comes from a culture of privilege and may not be functional for those dealing with generational trauma and without financial support, those buried in oppression. What if the institutional qualities of the mental health corridors fit the familiar experiences you experienced in an institutional high school? The familiarity of the ghetto community may speak to you and help you heal. Then you have these rich kids are fighting for change and make the institutional feel more pretty, and this would alienate, trigger, and perhaps displace you?  What’s worse is the imposed fidelity measures that denies the role of culture in such kinds of diverse contexts.  While I do agree that cognitive therapy can be vitally important when people are in the stage of trying to socially rehabilitate and facing Stigma, knowing when and how to use it in the process of therapy is important in my opinion.

Diversity Lessons that can Eradicate Stigma:

The thing that makes the Mad community great in my mind is the opportunity to culturally grow and eradicate the role of Stigma in society.  However, we can’t do this if we are so focused on our own experience that we clique into power coalitions and impose our will on others. If we spend our time creating research to prove that the lessons from our recovery can be replicated and applied to all of our people, we may not be envisioning the extreme diversity of our people. In fact, our understanding of ourselves may be more limited as a result of us not learning from people who have had vastly different experience. This is the very way our own hurts and biases can come down like an ax and guillotine people when we are not conscious of doing so.

Learning to Work Together:

Having persisted in the meat grinder, I now try to have a different relationship with it. I honor people who use it to improve their lives. I hope that the next time I need it, that I can do it with more sense of dignity. I know I won’t get that externally.  It will have to be internal. And yet, I am faced time and time again when I reach out to the Mad community that people like myself get hurt and excluded when confronted with others who are different who don’t fit their vision. I do this and they do this. We hurt. Many times I have had to remind myself that I am not going to let a bunch of people who care nothing about what I’ve learned in my journey, bully me into not taking my medications or judge the people who use therapy to grow.  For the most part I find myself warding off pain and persisting with relationships. I find myself ignoring the bruises and trying to learn from them instead of bruising back. I believe this is necessary in order to avoid just being another force that is used to exclude and create factions that divide Mad people and keep them from learning the diversity lessons that I do believe can lead to healing. I pray this will lead to healing. It is what I need.  Perhaps it is what the community needs to overcome being so divided.

 

 

Coming Out Mad on a Medical Model Unit

Coming out Mad, as a professional with a Marriage and Family Therapy License has been a rocky journey over uncharted, and lawless terrain. I share my experience to help embolden others who have experienced trauma, stigma, and institutionalization to be mentally transparent and come out in an authentic manner in their therapy practice. I believe that the mental health field and the many who may feel stuck and ineffectual in it (both clients and providers) need us to do so badly. At the same time I  write with hopes that those who do so experience less pain and isolation than I have in the process. Although historically, people who have themselves suffered (From Freud to Fritz Perls to Marsha Linehan) have often proven key to improving care, the climate in many agencies in mental health arena, may not always support those who wish to do so.

Mad Rumors Leading to Secrets:

In the middle of my career, I was incarcerated in a border state hospital while trying to escape to Canada to seek asylum. In the years that followed, I was barely aware there was a survivor’s community, I was so busy scratching to survive in the economy to avoid more institutionalization.

Truthfully talking about what I had went through with anyone else during the licensing process just didn’t seem to make sense. When I initially failed at a three month trial period re-entering the clinical world after two and a half years of underemployment, those who either liked me or could sense my desperation, kept in touch by inviting me out even though I didn’t drink. Many let me know that the Mad rumor was circulating. The one professional I kept up with said she was glad when I landed on my feet. She would later admit she had been afraid I was going to end up living in a tent.

Instead of returning to homelessness, I got a solid part-time job on a medical model unit that could lead to more. I also participated in a therapy internship for Foster Care kids and went back to work at the Deli I had been underemployed in.  Every other week I got a half a day off.  At all three sites I started off fresh, knowing new people. I entirely faked it in all locations. Honesty and mental transparency had little to do with it.

Class Deficiency Leading to Silence:

Although I was successful at that first Foster Care internship (perhaps because I lived in a ghetto for six years and had street competency,) I got cut at years end by a doctor who I offended.  They didn’t tell me that they needed the ten loyal clients I built up for next years’ doctoral students. Instead the director let me know that I clearly came from a different class and was incompetent to associate with the rest of the staff because I was so ignorant as to call them by their first names. I should have known that the fact they called each other by their first names didn’t give me that same entitlement.

In selecting a new internship in order to get child and family hours, I did not think that transparency would pay. I was solidly surviving now. My sense that treatment involved a phony class divide was reinforced. So, I misrepresented myself in order to get hired. When asked a leading question by an interviewer who looked at my resume (and perhaps the color of my skin,) I contained the salty spite I felt.  I agreed that I was ready to come home to insulated suburban reality and start the real work.

Surviving Jim Crow Laws:

Though I now did not trust the agency in the least, internships were hard to come by. Still, when given an intake questionnaire which asked me if I’d ever had delusions, I argued with myself. The first internship had not asked. I knew for a fact that I was wrong about parts of my experiences.  But I still, to this day, have enough evidence to have a sense that I was a political prisoner.  I went through a true conspiracy. Because I knew not to argue in public that the FBI is in fact, the worst gang to accidentally mess with, I answered no.

Though I got strung along at that internship for four years, I knew I needed it to some degree. I had to take from the poor (from the ghettoized “mentally ill”) for a spell and donate my time to the rich like most Americans do. It wasn’t until I thoroughly studied for the New York State Exams, I learned that I wasn’t supposed to work more than forty hours a week in order to get my hours.

Learning about this was frustrating! Coming back from State Hospital, I couldn’t have gotten the hours any other way and still paid rent! Laws and education are not built to acknowledge or be fair to homeless, African Americans, mentally ill, Native Americans, single women with children, immigrants or poor people. Sure there are many other sub groups I could add to this list. What are the slew of us social deviants to do: sit in an institution the rest of our lives or find ways to overcome the Jim Crow laws that keep us down?

Opportunity to Come Out:

By the time I got to the point where my learning-disabled ass passed those sucker New York State Exams on the first try, I was getting to be pretty good at what I was doing at that medical model unit. At the suggestion of a new manager, I attended a WRAP group and carried out the necessary steps to bring the consumer-driven mode of therapy to the unit.

In my first visit to an introduction to WRAP group, I joined trainers and a local agency. I listened to a staff member talk specifically about the same border State Hospital I did my time in.  She acknowledged the whole place was so backwards that so many people checked in there and never came back the same.  Another person talked about a time he biked ten miles a day and upheld a job. My period of underemployment flashed in my mind when I was doing the same on a cheap bike. There I was sucked in, realizing that I was not alone. That day I spoke publicly about my story for the first time.

I also now had time to figure out the internet enough to learn about the National Empowerment Center and the work of Patricia Deegan. However, in starting up a group for “psychosis,” I decided to create my own.  I built the “psychosis” curriculum around the retelling of my story and I started to attract large numbers of clients.  Together we went through a semi-structured format that functioned as a learning process.  I noticed that convincing the group that I was for real and could relate to them caused many to open up and tell stories.  I noticed that this authentic experience caused many to be confronted with reality checks and to make monumental changes in their willingness to consider that they were, in fact, not alone.  Instead of denying that I was delusional, like I did at the internship, I found myself getting sucked in to conceptualizing ways that I did fit in with others who were delusional. Taking in more and more information caused me to restructure the way I presented the material.  I drafted and drafted.

During this time, participants on the medical model unit flocked to my groups.  The support was unrelenting.  However, I persisted in spite of a perceived sense of alienation by some cliques of disgruntled co-workers. One stole a copy of my developing curriculum and turned it in to a Manager expressing concerns about me. I went back to my poker face and pretended not to notice as I several times heard people refer to me as Crazy Clyde. I continued to be loving and out-work colleagues who toted stigmatic political cartoons on their desks.  I had only one co-worker acknowledge me, the middle manager who had encouraged me to pursue WRAP.  He let me know he knew and thought it was great.

Surviving Hostile Environments:

Though things were good, incidents of disrespect mounted. After three years, I thought I could do better. I jumped on a county pilot project in which I would supervise peer counselors and represent the peer support domain. I continued to run Mad groups and started the process of being openly Mad and out for two years. But this was a political quagmire.  People were very forthrightly attacking my credibility to an extent to where those little issues I had back on the medical model unit were rendered marginal in the mind.

Invited to come back to the Medical Model unit, though not without strain, I had a realization: not telling my colleagues openly and directly that I was Mad, had consequences. Sure I didn’t like that they called me Crazy Clyde, but not discussing it wasn’t working. I started to talk to people directly about my history and experience.  Sure I didn’t like the dirty looks, and the jokes but coming out Mad and proud was now the way to go.  I came out so frequently that it only took a couple of years for the team stop having it’s complicated issues with me. This time I had people who supported me; therefore it wasn’t so bad.  I am now supported by many co-workers who are willing to read my book.

Austin Powers, we’re really not that different, you and me!

And yet another part of me wonders if my professional survival is not really all that much different than it is for many others without a history of State Hospital incarceration and Madness, and a history of an eating disorder that led to ghetto marginalization. I still feel like I have done it all wrong, but I have done the best I could, accepting what lays before me in as spiritual a way as I could. I think as many therapists evolve into being authentic people they may grow to become less stigmatic, more transparent over time. It is my hope that others who have undergone a structure of education that seems devoid of personal exploration; or that seems created for people who are treated to it; may identify with my path. Treatment may be ruled by a class system that imposes mindless and unreal clinical boundaries, but not everyone falls for it. And now that I am a supervisor, I am learning that some (non APA accredited) schools (if you can afford them) even promote mental transparency and support those who don’t fit the standard mold.

To others who are currently mad, traumatized, and in a comeback zone dealing with stigmatic world of care providers and the degradation of the “mentally ill” keep up the good work. You are needed more than you imagine! And together, we can make it better!

Shortcomings of Evidence Based Practice in Community Mental Health: Part 2

Looking further at evidence based practice, I want to use professional experience to look at how putting-the-cart-first treatment translates into wasted public dollars and second class services. In this article, I take myself out of the State Hospital, and insert myself thirteen years later in the ranks of the mental health workers.  Not only are we perhaps wrongly trained in the universality of counseling theories (as part 1 on this series suggests,) but additionally we are the rank and file that get hired into local systems that use fidelity measures to promote proven recovery practices.

Much like with economics, it can seem to be widely presumed among administrators that recovery services can only transform via academic trickle down guided by research. I contend that this reductionist view is self-serving to the power structure not taking into consideration the nuances of local culture and recovery itself. In this article—part two, coming at you from my work in Shy Town, Illinois, I am here to reflect opinions of the sometimes underestimated rank and file. While administrators depend on evidence that a practice will work, the potential for doing damage and being wasteful rises exponentially.

I have seen evidence based practices in community mental health perpetuate myths, stigma, unstable relationships, and limit healing.  They may be used to fuel programs that are chasing money and more concerned about silos and statistics than the community.

I, like many in the rank and file, have a hard time counting on a person with a highly reputable background come in from out of town who says, this is the best way to do it. I now look at their culture and wonder what they in fact know about the systemic history of their subjects. I wonder how much money they are going to take and waste. I could do this and that alone could easily prevent a researched recovery principle from materializing.  Evidence based practices as I’ve seen them play out presume that there is no such thing as class, race and gender biases or local distinctions that are going to get in the way of implementation.

They need to.

A Social Experiment: Three Competing EBPs

Four years ago I left my job in a community I love and have since returned to, to join an effort to jumpstart recovery via importing three evidence based practices. In 2008, Cook County imported the Housing First best practice; the IPS employment model; and the best practice of Peer Support by a leading out-of-state company.  Clients were given all three practices at the same time and expected to transform into work and end their dependence on Social Security.  Teams were set up with representatives of all three of these best practices and these teams were led by case managers from seven local case management teams.

I came on board during the second year of operation as the back-up administrator of peer support.  I completed a comprehensive and experiential peer-employment training with a new team of workers and my first task was to attend all the team meetings and represent the peer workers.  Sure enough, I would find many of our peer workers, just out of the system and battling external and internal stigma, being bullied into silence at the meetings.

After I made the rounds, on a day when the top administrator and our boss were present, a worker who seemed most effective, and on-the-ground respected came into my office before meetings commenced.  He shook my hand and told me I was walking into a bee hive.  As soon as he was gone and the door closed, I found out that the top administrator had a file on this worker, who was a racial minority; he was on track for being fired along with another minority worker, who was axed that day.

Sure enough, the man of a minority race was trying to provide for his family on wages that barely cut it according to the local standard of living. The things he had done, in my mind, demonstrated his economic need. Memories of my own sense of financial hopelessness were triggered. Indeed, the more I took inventory, I quickly became alarmed about what I considered to be racial and class in-sensitivities: workers who had harder inner-city backgrounds seemed to me to be more heavily scrutinized. I felt that the best thing to do was to send an email expressing my concerns to the boss.

Meanwhile, as I was feeling quite bullied and insulted at the tables, I quickly got feedback from my own company that I didn’t know how to present as a professional; however, the feedback from the program evaluation came back that I was well received in the eyes of the local workers.

Time passed and the worker who warned me about the bee hive was fired. Likewise, a minority director who I had forged a relationship with was replaced.  I continued to observe the other male minorities to be not treated well from my perspective. The new director formed a close relationship with my domain boss, who, though rarely around seemed to be very offended by my email.

The bullying at the table overseen by the county’s new director was now escalated. I was told my actions weren’t intelligent when I was at the center of a table attack.  One time, I was likened to Stuart Smalley. On another occasion, I was ambushed with several domain leaders present and accused of influencing and enabling “psychotic” clients to be against medication.  When I explained that I myself believe in and take medication, a worker from another domain who supported me was written up for not being a team player. I experienced no sense of an apology. I was accused of being paranoid by my domain leadership when I complained. Shortly thereafter, I was vanquished from the meetings.

Meanwhile, back on the company’s ranch, the top administrator was out on disability. I hoped that the fact that our domain’s productivity numbers were steadily growing with me as the temporary leader, and that our specific company boss was replaced with someone who seemed to respect me might mean job security. I was not looking for control of the program I was fine with being number two. I was most interested in being in a position to advocate for better wages for the workers. From my perspective, this was key to promoting quality services making a permanent stay in the county. Then after two years, I got the word that at the call of the county’s program director, I be demoted and put in charge of the charts.

My powers were totally stripped.  When a worker was sick I was not allowed to release them.  They had to work until my rarely responded to emails gave me the approval. There were many examples suffering that occurred from unanswered emails. Meanwhile the productivity sank. At the same time I was micromanaged. Company people were brought in who publicly sabotaged my credibility in front of the team.

It occurred to me as the bosses hired the wife of the lead author of the collaborative program that letting productivity tank could justify my demotion. I was told that I was disorganized which is true, but never had been brought to me as a concern. All details of the job that I was responsible for were factitiously done on time because, I worked sixty hour weeks. I never realized that disorganized people who have a history of success conducting therapy, were only gifted when it comes to taking care of charts.

I made a rapid exit to a part-time gig at my old place and opened up a private practice for Medi-Cal clients. My application to be a Medi-Cal provider mysteriously stalled at the county’s highest level for reason that did not make sense.  I pinched pennies, worried about mortgage payments, and eventually got back to full time back in the community I love.

Looking Beyond my own Scars:

I learned a lot about community dysfunction caused by EBPs from this experience. I believe it’s possible that this kind of experience has happened before in history as streams of funding and innovation have come in. Training changes and as our nation gets impacted more by trauma and poverty and we struggle to know what to turn to.

Ultimately, the county closed this expensive collaborative program and the out-of-state company I worked for lost its contract.

It was true that the company I worked for had some pretty awesome training and that they have successfully expanded. Much of what they have to convey about mental health, I continue to agree with. I wouldn’t even be so brazen as to conclude from what I experienced that they unilaterally discriminate against racial minorities.  But I do contend that they did not know the ethos of the community they were operating in. Though not their fault that local people were insulted that they got the contract and attacked, the unhealthy attack back mode made a few heads roll, mine being one of them. In the process, the strong local consumer base was denied the opportunity to run the peer support.

I believe what happened in Cook County is likely when a practice uses research to proclaim that their fidelity measures are going to work anywhere. It’s a false sales pitch. It presumes there is no such thing as politics. It presumes that an academic elite is needed to train the masses of people who may well have walked a different path. It releases all or nothing funding streams without taking into account the fact that there are cultural factors at play, personalities, egos, cliques and competing financial incentives.

In the bee hive that I was hired into, competing fidelity measures didn’t match up.   Local case managers and the employment IPS domain were highly critical of the peer domain in part for survival purposes: if peers could do what they could, jobs might be lost, or pay cut.

In sum, with a high need for collaboration and an enormous amount of political infighting recovery was not promoted. Perhaps some will say it’s the clients’ faults. That was certainly the pervading ethos of some of the more disenfranchised workers.

I contend that recovery cannot be replicated in a uniform manner. I’d argue that what is more important is a healthy family mental health system that is in a cultural state of learning in order to meet people where they are. In this Illinois experiment, it seemed like the companies who own the best practices came and scooped up the money and the rest of us suffered and were more likely to walk away hurt and burned out.

In spite of all this, though, I saw the pilot program did transform some lives on the ground in ways that weren’t measurable. I like the other workers also learned a lot about a number of different EBPs that I will take with me.  But clearly what is most memorable is the dysfunction.

Yet, my intial question stands: did all the money for all the promises of the evidence based practices trickle down into the lives of the people served? Would the county not have been better off going to its strong consumer base, taking the ideas from these evidence based practices and co-constructing locally sensitive recovery? Was imposing change in top-down ways based on the notion of a superior intelligentsia cost effective?

This entails, much as my part-one article did, that Theorists need to first define themselves culturally and then assert themselves locally. They need to interact with their local consumer base and not gear themselves up to sell their experience on a global market. When it comes to practice of mental health a theorist and a therapist need to constantly define the limits of themselves and not focus on growth so as to impose their values and experience in universal terms on others. It is time administrators understand this and ease up on the evidence based demands.

Reviewed By Rabia Tanveer for Readers’ Favorite

Review Rating:

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Reviewed By Rabia Tanveer for Readers’ Favorite

Fighting for Freedom in America: Memoir of a “Schizophrenia” and Mainstream Cultural Delusions by Clyde Dee is a non-fiction book that focuses on some of the harshest realities of life. Clyde Dee was a mental health counselor when his life was turned upside down. Taking a job at the Section 8 housing project was perhaps the worst (or the best) thing to happen to him. Embroiled in politics and games, his life becomes increasingly difficult when he is incarcerated in a psychiatric ward. After three months, he comes back to the real world as a changed man. But he is homeless and jobless; however, he has the will and strength to face down his fears and conquer them. Now he has empathy for the mental health patients and how they survive day after day.

Clyde Dee is such an inspiration for people who deal with mental health issues day after day. This book would be informative and very encouraging for people who are either suffering from mental illness or who treat people with a mental illness. For an average person like me, it was insightful and instructive. I finally understand what a person with a mental illness feels like, lives like, and how he fights for his sanity and his life every single day.

You cannot help but feel their pain and hope for the best. Life is very tough and the way Dee described it, things are even harder for the mentally ill. This book has compassion, passion, understanding, and a force of will that will allow any person to become better and make peace with themselves. Great job.