Retaining agency is not resistance to treatment…it is in fact a sign of health

I was thinking about another catch -22 in the mental illness system recently. I articulated it below because I think it’s something many people encounter.

caveat: Not everyone experiences the system in this way. Some people feel they get what they need. (and sometimes people end up exhibiting what David Healy calls Stockholm Syndrome as well — I did)  In any case it’s clear to many of us that we do not get what we need. That is what I’m speaking to. I am expressing my experience both as a professional witnessing what organizations implemented while I worked for them and my own experience as a “patient.” I no longer work within the system nor am I any longer a patient but I sure learned a lot while I was engaged as both.

Those of us who’ve experienced the system in the fashion I express find it helpful to articulate our experiences so that we can recognize one another and know that we are not alone while we heal from the trauma that happened while there. This does not invalidate other experiences…it simply helps and validates those of us with the experience to move on and learn how to get our needs met in other ways, so that we might also help create options for others like us who get injured in the system.

The catch – 22 I thought about the other day: The mental health system tells clients/patients/consumers that they need better boundaries while expecting them to ignore their boundaries. Generally people are randomly assigned to case workers/therapists/social workers and psychiatrists. They are then expected to trust, be deeply vulnerable with,  and follow the advice of such professionals.

There is no good reason for people to open up and trust random strangers just because they’ve got letters behind their names and fancy themselves knowledgeable about the psyche.  To expect folks to do this when it doesn’t feel right is a demand to ignore ones boundaries. When people don’t feel safe trusting their assigned professional they are often punished in various ways instead of being encouraged to trust their instincts and perhaps being allowed to find someone with whom they feel comfortable. We know when we feel safe and when we’ve been traumatized safety and our sense of safety should always be a priority. If mental health professionals do not appreciate this and do not do everything they can to make us feel safe,  they are inherently unsafe. Thus, entire systems are often unsafe because there is no attempt to help us feel safe. There is a profound lack of understanding trauma.  We know this– even when we might not be able to articulate it, we feel it in our bones. We are not being unreasonable. These systems do not work for many people.

Retaining agency is not resistance to treatment. Disagreeing with the social worker is not resistance to treatment. Being in touch with our being and who we are in an authentic way is actually healthy. If our perspective is not respected and taken seriously we cannot heal. We will not thrive in such a system that claims to heal when it fact it’s a system the perpetuates mental illness. 

Allowing for choice and informed consent is the only way to respect our fellow human beings. Providing options is also necessary as we are endlessly variant, kaleidoscopic beings. Our needs are different from individual to individual as well as being different as time passes with the context of one’s life. As we heal, grow and change, what we need changes as well. What is good for us now may not be tomorrow. Professionals are not generally in a position to know this stuff…at best they can help us figure it out for ourselves as we go. If they TELL us and it doesn’t ring true for us it then becomes violence if they insist upon it. We don’t know what someone else needs even if on some superficial level we think we have a lot in common with them. Context is always different for any two human beings. A basic acceptance of this is necessary if we are to respect others.

None the less contrived intimacy is forced upon vulnerable people all the time in the mental illness system. Vulnerable people who are often very in tune with their boundaries and will recognize what they need if they are actually presented with it, are then forced  to do things that don’t feel good to them because mental health professionals tell them to do it. This is exactly how people are frequently retraumatized in the mental illness system. 

The building of trust and rapport cannot be forced. It must happen organically. If it doesn’t happen organically no one should be made to feel it’s because they’re somehow not up to par. Healthy relationship cannot be forced. Any forced relationship is by definition unhealthy. Forced treatment is a human rights violation. 

What I’m describing above is a societal problem. These assumptions are in all healing professions and medicine in general. We’re supposed to unquestioningly submit to the “experts,” — to “authority” -the fact is those with “authority” in these systems routinely abuse and misinform. They most often do it unconsciously (they’re generally there because they think they want to help and thus have the proverbial “good intentions”) but that doesn’t matter. We still have to protect ourselves.  We must question and find those who welcome those questions. When the questions are welcomed there is a good chance that the person/system is safer. On the other hand  when people are dogmatically attached to what they’ve learned in their training they are often dangerous. It’s okay to say  NO THANK YOU to such people if they’re not willing to listen to you. Let us create a world in which we respect each others boundaries, needs and limitations. May all those who call themselves healers, therapists, etc have the humility to remember they never really know what is right for another (and in fact, having been in that role too, it’s pretty clear that healers often do not even know what is right for themselves…haven’t done the deep work they need to do in order to really deeply be present for those they are working for (clients, patients, consumers etc). In my experience this included myself, my colleagues and the professionals I engaged with for help.

Ideally we find partners in our care. Those can be professionals or like minded friends, colleagues etc. No one has magic bullets and we’re all learning together, whether we’ve got letters behind our names or not. Everyone is learning how to do life. It’s a mystery for every single person on this planet and we’re all winging it. I learn from everyone I encounter these days. On occasion I still use professionals too. I don’t rule out anyone but I’m very discerning and careful about whom to trust with deep vulnerability, always.

May we all honor the mystery of our individual paths.

We can develop systems of care among ourselves too. For some of us this is the most critical care we get.  Speaking out and finding each other is the first step. I’m doing that with all my work on this site and state it more explicitly below. A message to those labeled by psychiatry: We can recognize each other and help one another heal in that recognition:

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For a multitude of ideas about how to create a life filled with safe alternatives to psychiatric drugs visit the drop-down menus at the top of this page or scroll down the homepage for more recent postings. 

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About Monica Cassani

Author/Editor Beyond Meds: Everything Matters