Pat Risser has extensive experience as a trainer, facilitator, presenter, author and consultant. He has been a human rights activist and mental health advocate for over twenty-five years. His lived experience includes working as an Intensive Case Manager, work as a therapist on a locked, acute inpatient unit, over ten years as a “mental patient,” developing self-help groups, building and directing a statewide consumer network and directing a patients’ rights/advocacy/self-help program. His special expertise is training on trauma issues, recovery, self-determination and on employing consumers as part of the mental health workforce.
By Pat Risser
“Speaking the truth in times of universal deceit is a revolutionary act.” George Orwell
In my years as a “mental patient” I was hospitalized over twenty times including a stint in state hospital. I used to get locked up for telling a mental health professional that I felt suicidal. They would panic and I’d get locked up. Eventually, I realized that my being locked up was more a function of their panic than my feelings.
I had a good therapist. One day I told her that I felt suicidal. She kind of “ho-hummed” and asked how my impulse control was doing that day. She clarified that I was merely being human and expressing a feeling but, if I felt some strong need to act on that feeling in a self-harming way, she would be professionally obligated to lock me up to try and keep me safe.
Whether it was due to how I was raised or some other reason, I had always thought that to be “honest” my feelings and actions had to be congruent. In other words, if I felt sad, I had to act sad. If I felt angry, I had to act angry. If I felt happy, I had to act happy. If I felt depressed and suicidal, I needed to go home and take an overdose or make some other suicide attempt. My therapist was challenging that concept. I thought about it and realized that I can’t control my feelings but I can control my actions. I might feel suicidal and can put a loaded gun to my head but I would still possess enough control over my actions to be able to either pull the trigger or not. No one or nothing else controls my actions. I have free will and can decide for myself.
So, I checked with my “impulse control” and found that I was able to just sit and talk about my “feelings.” That was the beginning of my “recovery” from being a “mental patient.”
I still feel suicidal. I notice this “feeling” regularly (at least once a week or more). However, I no longer get locked up because I no longer panic those poor mental health professionals and I have learned to cope with my feelings in ways that are not self-harming.
Therefore, my question is, am I “mentally ill?” Was I “mentally ill?” Was I ever “mentally ill?” I certainly had the diagnoses and the behaviors and everything that went with and warranted the description but, I don’t accept that I ever had a disease, disorder or illness. I don’t believe that my thoughts, moods, feelings and emotions are a disease, disorder or illness; they are me, the essence and gist of who and what I am as a person.
I’ve noticed that if a person were to have their “energy” level be too high or too low and they go to a regular physician, they’ll likely have some blood tests done and eventually, a possible diagnosis of a thyroid out of whack will be reached. The doc will prescribe some medicine aimed at the thyroid imbalance and it’ll soon be fixed. However, if that same person were to go to a psychiatrist, the odds are that there’d be no blood tests. Instead, the psychiatrist will observe the behavior (or listen to self-reports) and based upon that behavioral analysis, the psychiatrist will prescribe either anti-depressants or Lithium. To me, that is misdiagnosis/malpractice.
Just where and under what circumstances can we determine whether “mental illness” is real? How are we to determine whether it is a function of someone experiencing a “feeling” or whether it is some psychiatrist rendering judgment on behavior? Should it even matter?I don’t think it matters what we call the phenomena or process that happens within us. I don’t think it matters how we philosophically approach that phenomena. I don’t think it matters whether we call the phenomena a “medical” issue or a “psychiatric” issue or a “social” issue. To me, what matters is how we cope and the acknowledgment that we can and do cope.
I don’t care if you hear voices. What matters is that there are many ways to cope with that phenomena. First, no one will even know if you don’t do something that “gets in other people’s space.” If you hear voices in private and even interact with those voices in a loud and belligerent manner, it won’t matter at all. It will only matter if you interact in a loud and belligerent manner in a crowded store where you “get in other people’s space.”
I don’t care if you like to be naked. What matters is that there are many ways to cope with that phenomena. First, no one will even know if you don’t do something that “gets in other people’s space.” If you want to be naked, it’s fine if you do so at home with your blinds and doors closed. It’s fine if you go way back up in the woods to an isolated place. It’s fine if you go to a nude beach. It will only matter if you get naked in a way that “gets in other people’s space.”
Does it matter whether I am or ever was “mentally ill?” No. What matters is that I’m successfully able to fit in and abide by the social values of my shared communities. In other words, I’m able to “pass” as “normal.” I’ve found ways to cope with my thoughts, moods, feelings and emotions that don’t get in “other people’s space.” I don’t believe in labeling my experiences as “mental illness” but rather as responses to trauma and other impacts on my earlier life. I have learned ways to respond that are either socially acceptable or that don’t intrude on other people’s “space.” I believe that others can also learn to cope in similar ways. In the mental health realm, this is often called “recovery.”
What is “recovery?”
What is Mental Illness? According to medical practitioners and others in the mental health realm, mental illness is a diagnosis as defined by the DSM-IV (Diagnostic and Statistical Manual, Fourth Edition). This manual is held in such regard that a diagnosis from the DSM-IV is the standard by which insurance companies define mental illness. The DSM is published by the American Psychiatric Association and it is from the ranks of psychiatric practitioners that the various diagnoses are defined.
The DSM is not without controversy. As the primary fundraising book published by the APA, many contend that there is a conflict of interest in using this tool. Many other psychiatric practitioners contend that the book lacks in scientific development. Even greater criticism comes from within the psychiatric survivor community (people who have “survived” psychiatric treatment or mistreatment). Survivors claim that there is no proof of mental illness. By proof, they mean, to be able to scientifically “demonstrate a reliable association between a clearly specified pattern of observables and other reliably measurable event(s) which operate as antecedents.” This fits TB, cancer, diabetes, etc., but doesn’t fit any DSM “disorder.”
This does not mean that the phenomenon of “mental illness” does not exist. There certainly are human conditions that deviate from the norms. However, that does not mean that we should call those conditions a disease, illness or disorder. There are studies that have examined the harm (stigma and discrimination and worse) caused by such labeling. Further, the conditions of human suffering and deviations from the “norms” does not mean that psychiatric practitioners should be the ones to legally define social deviance.
“I believe that each of us yearns for freedom, independence and self-determination. I believe that we seek and must have a sense of pride or else we walk through life soul dead. Our spirit yearns to be proud and free.”
Part of the problem with the DSM is that what is being diagnosed are our thoughts, moods, feelings and emotions. What is necessary is to instead look to our behaviors. Someone may “feel” suicidal but that is just a feeling. If the person never acts upon that feeling in a way that is self-harming then we should not label them as having a mental illness. Our thoughts, moods, feelings and emotions may not be able to be controlled, but we can learn to control our actions or behaviors and the way we respond to our thoughts, moods, feelings and emotions. So, just what is mental illness? I contend that it is a state of mind where a person loses their sense of self and suffers a loss of hope.
Like most who come to the mental health system, I was taught from infancy that if I had a problem then I should go and see a doctor, trust doctor, that doctor would fix it and make everything better. So when I went to a psychiatrist for help for emotional distresses, I offered myself submissively for assistance and the psychiatrist accepted my submission and dominantly (and perhaps arrogantly) offered his ability to heal and treat.
“I don’t pretend that my path was an easy one. I spent over ten years as a “mental patient.” Ten years of my life are gone, given away to the mental illness system. Ten years of my life are missing and will never be returned.”
There is an old saying that says, “Give a man a fish and he eats today. Teach a man to fish and he eats forever.” I was given lots of treatment and I accepted it all without challenge. I expected to get well from the treatment and when that didn’t happen, I didn’t blame the doctor. Instead, I blamed myself. I believed that doctor couldn’t be wrong so the fault must be mine.
I must not be doing the right things or not trying hard enough or not accurately conveying my symptoms or something. The longer things didn’t get better, the more I blamed myself. This sort of self-blame is common among abuse and trauma survivors and perhaps among others.
Self-blame may be a dysfunction that primarily affects those who have suffered from abuse and the effects of trauma. It may affect others to some extent but given the high percentages of people who get labeled with mental illness who have survived abuse or trauma, it may approach universality.
As I sank into a quagmire of self-blame, I started to lose my self.
We each have many roles in life. I was husband, father, student, worker, friend, brother, son, neighbor, etc. However, my primary role evolved into and became “mental patient.” What that means is that if my wife or children needed something and I had a therapy appointment, I would choose to attend therapy. My life revolved around being a mental patient. It became almost all consuming. The more I blamed my self for not getting better, the more I lost hope and the more I became primarily a mental patient as that role became the dominant feature which defined my life.
I contend that the more I sank into the role of “mental patient,” the more I lost my self. I lost my self-esteem, self-admiration, self-confidence, self-glorification, self-love, self-regard, self-respect, self-satisfaction, self-sufficiency, self-trust, self-worth, self-determination, self-exaltation, self-importance, self-assurance, self-interest, self-possession, and self-pride. I lost hope as my identity became more and more just that of “mental patient” and my loss of self-pride resulted in a loss of self.
At the time, had someone pointed this loss out to me, I would probably have been confused because I had always associated pride with that negative sort of excess that has been labeled self-absorption, self-worship, selfish and self-pity. My life revolved around my “mental illness” to the exclusion of everything and everyone else. I became one of those helpless, hopeless and overly dependent patients who lived from Big Gulp to Big Gulp and for whom time was measured from one cigarette to the next.
Slowly it came to me that I had lost my sense of self. I had lost pride in myself and in my life. Pride is essential to our concept of self. A smart person could probably get away with stealing all of their life and yet most do not. Why not? Because of pride! “To thine own self be true, and then it follows as the night from the day, thou canst not then be false to any man.” A proud self-image is the strongest incentive you can have towards correct behavior. Too proud to steal, too proud to cheat, too proud to take candy from babies or to push little ducks into water is what separates us from the animals. A moral code for a community must be based on survival for that community, but for the individual correct behavior in the tightest pinch is based on pride, not on personal survival. This is why a captain goes down with his ship; this is why “The Guard dies but does not surrender.” A person who has nothing to die for has nothing to live for.
One definition of the opposite of pride is shame. As I lost my self, my self-pride, I had grown ashamed. I was ashamed of my life. I was ashamed because I was weak and couldn’t work, I couldn’t support my family, I couldn’t support myself, I couldn’t do anything. Certainly, I couldn’t do whatever was necessary to “heal” myself. No matter how hard I worked at it, I was still suffering from “mental illness” or a disease or disorder. I had grown paralyzed emotionally because I lost my self. An enormous amount of shame comes with a history of abuse and trauma but, the system played upon that vulnerability and amplified my sense of shame by treating me as a mere mental patient, a chart number, a diagnosis.
Each human being must free himself; freedom cannot be thrust or forced upon people if they are to be truly free. Force cannot be abolished by use of force. Freedom must be obtained by voluntary means, accomplished by reason and persuasion. Freedom is not free! Unless we mean “freedom” as defined by Orwell and Kafka; “freedom” as granted by Stalin and Hitler; “freedom” to pace back and forth in your cage.
I had to liberate myself. I had to recapture some sense of pride. I had to “recover” my self.
I began to question and to challenge. It was terrifying when I first stood up to staff and asserted my self. I felt that I could potentially lose their approval but worse, I could also be kicked from the program and perhaps lose my primary “self” identity as mental patient. My “mental patient” identity was so strong that to risk losing it was very frightening. I wasn’t sure what “self” I might have left if I were to lose my primary identity of “mental patient.” Who and what might be left? However, when I did question and challenge, I felt some small sense of pride. It felt good to stand up for my self somehow.
With each episode of standing up and questioning and challenging, I felt better and stronger. I felt better as I became more self-determining. I slowly began to regain my sense of self. I grew stronger in my self-esteem, self-admiration, self-confidence, self-glorification, self-love, self-regard, self-respect, self-satisfaction, self-sufficiency, self-trust, self-worth, self-determination, self-exaltation, self-importance, self-assurance, self-important, self-interested, self-possessed, and self-pride. I acquired a renewed balance in my roles in life. Instead of my life being dominated by my mental patient role, I became more of a husband and father. I got into the workforce and developed a strong sense of pride in my work and even in my ability to work; something that had been missing for many years. That sense of self-pride grew to impact more and more areas of my life and the sense of accomplishment was tremendous.
So, just as I had lost my “self” I worked hard to recover that lost “self” and pride was the key. In losing my “self” I lost my pride in who and what I am and I became “mental patient.” In recovering my “self” I rediscovered a sense of pride as I redeveloped into a self-determining adult.
Most people, instead of climbing the ladder of success, keep looking for an escalator. I had climbed quite far and quite climbed quite far and quite successfully a long way up my life’s ladder. When I fell into “mental illness” I crashed hard. When I tried to “recover” initially, I tried to resume my life’s path at the point where I’d left off. Imagine trying to levitate back up a long ladder to the point at which you fell.
For years, frustrated myself trying to “wish” myself back to that point. Eventually, I found that I could reach that point again but only by taking it one step at a time and reclimbing a ladder. I wouldn’t have to retrace every step. I wouldn’t have to graduate from college or high school again but to get to where I left off, I would have to touch certain rungs all over again and rebuild my “self.” I learned again how to socialize with “normal” folks. I learned again how to tolerate and even enjoy (have pride in) working. I reconnected with my family and took pride in them and in my roles as husband and father.
I took pride in overcoming and recovering from “mental illness.” The saying, “One day at a time,” became prominent as I learned to control my actions and behaviors. Much of the time the saying for me was more like, “One moment at a time.” I learned that my thoughts, moods, feelings and emotions just are. They hold no magic power or ability to dictate my actions or behaviors.
“There is no panacea. There is no magic bullet. Recovery can and does happen, with or without the mental illness system’s interference. Recovery is an individualized process.”
I learned that I might feel suicidal but I didn’t have to act in ways that were self-harming. As I exercised my abilities to control my actions and behaviors, I grew stronger and the unpleasant thoughts, moods, feelings and emotions grew less and less in both strength and number. I don’t pretend that my path was an easy one. I spent over ten years as a “mental patient.” Ten years of my life are gone, given away to the mental illness system. Ten years of my life are missing and will never be returned. I also spent years in recovering. To learn to socialize again was difficult and painful at times. I was awkward but with each small success, I grew in self-confidence and pride and thus, I grew in my recovery. In some ways, the role of “mental patient” is easier. It can be easier to have others take care of you. It can be easier to not have to have any responsibility for yourself. However, I believe that each of us yearns for freedom, independence and self-determination. I believe that we seek and must have a sense of pride or else we walk through life soul dead. Our spirit yearns to be proud and free. (Spirit is that which drove Beethoven to write beautiful symphonies that his ears would never hear.)
I believe that all who have been labeled as having “mental illness” can recover. All who have been labeled based upon a diagnosis of their thoughts, moods, feelings or emotions can learn to be proud and free. Granted that there are physical issues that can occur within the human body that will cause people to exhibit unusual behaviors. However, these physical issues need to be properly identified, diagnosed and treated.
A malfunctioning thyroid should not be diagnosed solely upon behaviors and thus treated as “bipolar disorder.” That would be gross malpractice and yet it happens regularly. Psychiatrists need to remember and act first as physicians and not as social control agents. Psychiatric drugs need to be recognized as the “feel good” agents they are and placed on a continuum with a drink with friends at a local bar. The potential risk and harm of psychiatric drugs needs to be recognized and proclaimed loud and strong.
There is no panacea. There is no magic bullet. Recovery can and does happen, with or without the mental illness system’s interference. Recovery is an individualized process. What makes one person feel proud or motivated to positive action is not necessarily what will work for another. I believe that each person can and will recover if they rediscover their self-pride.