I try to praise the mutilated world

I often wonder what it will look like to reach the point of not just surviving my misfortunes but being simply and profoundly grateful for every single thing that has ever happened to me. And why people who want things like that are so perplexing to those who don’t. Those who wonder, in their golden ways what’s so funny about gallows humor, the sole comfort of those who’ve escaped the hangman and an affront to those who have no knowledge of his existence.

Welp, there it is, in black & white, no less.

Thanks

by W.S. Merwin

Listen
with the night falling we are saying thank you
we are stopping on the bridges to bow from the railings
we are running out of the glass rooms
with our mouths full of food to look at the sky
and say thank you
we are standing by the water thanking it
smiling by the windows looking out
in our directions

back from a series of hospitals back from a mugging
after funerals we are saying thank you
after the news of the dead
whether or not we knew them we are saying thank you

over telephones we are saying thank you
in doorways and in the backs of cars and in elevators
remembering wars and the police at the door
and the beatings on stairs we are saying thank you
in the banks we are saying thank you
in the faces of the officials and the rich
and of all who will never change
we go on saying thank you thank you

with the animals dying around us
our lost feelings we are saying thank you
with the forests falling faster than the minutes
of our lives we are saying thank you
with the words going out like cells of a brain
with the cities growing over us
we are saying thank you faster and faster
with nobody listening we are saying thank you
we are saying thank you and waving
dark though it is

Jimmie Dale Healer

Welp, I went ahead and signed up to put in my time and am delighted to find the Obama campaign has impeccable taste. Tonight’s local debate party will be kicked off with music by the world’s most charismatic outlaw who’s sly compassion is as legendary as his high and lonesome zensoaked warble. Jimmie Dale Gilmore is a Saint. This is not hyperbole, but a well-known fact. I can’t find the words and believe me I’ve tried. Anyone familiar with my (cough cough) oeuvre might recall I spent year one in Austin determined to self-destruct in a flamboyant way but what you don’t know is it was Jimmie’s weekly supper gigs at Threadgills that kept me tethered to the planet.

And I didn’t have to pretend I wasn’t hateful, alienated and falling down drunk or the last thing I wanted to do was gather round a picnic table in red-checked oil cloth, pass catfish platters to the homespun hippies sitting next to me and literally rub elbows with women who wear their hair down to their ass in 110 degree weather. Navigating his fan base was not for the squeamish but they are what they are and blessyerheart, we’re not in Kill City anymore.

All this was almost 2 decades ago, a single year that’s now a Texas legend, singing and supper with Jimmie at Threadgills, who saved me on a weekly basis without a single word between us and I know I’m not the only one.

I can’t find any Threadgills footage at youtube but here’s JDG in Norway around the same era doing his single hit Dallas. Heartfelt thanks to the Democrats for putting him on the bill tonight, now I got me some memories and buses to catch.

Psychodynamic Psychotherapy

I likes it.

Via, an old wiki entry that’s been replaced by a more clinical definition, alas:

“The goal of psychodynamic therapy is the experience of truth. This truth must be encountered through the breakdown of psychological defenses. Simply stated:

[psychodynamic] psychotherapy teaches the client to be honest.

Individuals suffering from “psychological disorders” or deep-rooted “personality disorders,” often come from confusing, manipulative, dishonest, or even violent families in childhood. Being honest with ones feelings is a difficult, even terrifying process for these people.

But there is a silver lining. If the patient client is willing to face up to their hidden secrets they will discover the unconscious reason for many of their feelings, and therefore obtain self-understanding and relief. In essence

the more honest and direct one is with his/her life,

the more “symptoms” will

dissolve,

and the more one’s childhood and defenses are understood.”

Read a decent exploration of how all that comes together at Mental Health Net: The HBO TV show In Treatment: Understanding how patients ‘lie’ to themselves and others is at the heart of dynamic psychotherapy.

WaPo good, Huffpo bad

It’s enough to make your head spin, these two posts I read one after the other with my morning swear words. Liberal bastion Thorn in my side Huffington is screaming for forced drugging and involuntary commitment (Britney, et alia) —

It’s outrageous that she was released from the hospital …all the experts say she needed to have been held for a minimum of 30 days!

while the wingnutty Washington Post says flat out that the medical model has got to go.

Here’s the problem: The WaPo piece says nothing about forced commitment and the HuffPo piece says nothing about the medical model; but I can say with assurance that these 2 posts are general critiques of the other, that in mental illness discourse we shake out on partisan lines and this has got to get more explicit or it’s just circular wankery and talking past each other.

There is a disconnect underlying most of what passes for learned opinion regarding mental illness in the blogosphere. The disconnect is on writers who don’t know what they’re talking about because they haven’t done their homework. Pundits should be conversant with the various models of mental illness and the body of scholarship that underpins each, at the very least they should recognize when they are promoting the medical model, and what that means, because when you don’t understand something you can make it mean anything. Is that too much to ask? So of course when a knowledgeable commenter like the following comes along and offers a recognizable critique he is shot down for being a pedant, complicator, and delusional ex-patient with an ax to grind:

No other medical condition is the basis for incarceration. Those of us with mental illness are denied rights that everyone else enjoys. Thanks to people like you who have no concern for our rights and have no understanding of our illness, we are singled out, stigmatized, imprisoned, ridiculed and ostracized.

…Were it not for you and those who are likeminded singling us out in the ways just described, we might be more accepting of ‘help.’

That comment in the Huff post is an implicit smackdown of the medical model. The same model explicitly identified and shitcanned over at the Washington Post today:

Larry Davidson, a Yale researcher on recovery from severe mental illness, has examined the data and found that this model is flawed, at least in the field of mental health. “In the medical model, you take a person with a mental illness, you provide treatment in the hopes of reducing symptoms, and then they’re supposed to approximate some notion of normality,” he told me. “Our research shows the opposite. You take a person with a mental illness, you then reduce the discrimination and stigma against them, increase their social roles and participation, which provides them a reason to get better in the first place, and then you provide treatment and support. The issue is not so much making them normal but helping them get their lives back.”

These are fighting words. They sound so benign that it’s easy to overlook that fact, that when we hear someone talk about social support, engagement, participation and community roles they are not speaking in a vacuum, and they are not talking about a subordinate adjunct to the medical approach, but invoking an alternative, social model of distress and recovery, which has all but been silenced by the dominant paradigm whose signifiers are doctor, hospital, medication, stabilization, biology, genetic, heredity, bloodlines, as in tainted, etc. These are the dogwhistles that point to a belief system known as the medical or biological model of mental illness. So it’s about language, and learning the words that the bad people use.

Is this necessary? Why not just say, gosh, with so many conflicting and complex models to choose from, why not have the consumer do the homework and direct their own personal care and treatment, whether medical or alternative or an eclectic mix of both, or decline all of it and que sera. But to make this assertion is itself a partisan stand, because any alternative to the medical model will, by definition deviate from the medical model, and that’s the mortal sin. It’s not the particular treatment choice under fire, but choice, period. And so every alternative falls under the single rubric of “filthy hippy healthcare” coined by medical model monster E. Fuller Torrey, who wants you to believe irresponsible advocates would force bipolars off their evil meds, when what we actually demand is that bipolars be empowered to make fully-informed decisions ourselves, without penalty, and with the understanding and expectation that we will make mistakes and change our minds just like everybody does, with the same right to learn the hard way, while do-gooders suck it up and wrench their garments in dread, too bad, so sad.

I’m pretty sure the WaPo author would agree with me; his piece indicates we share the same politics, the HuffPo author not so much, because oddly enough we don’t. Once again it looks like I dared to take the true blue liberal stand on a mental health matter at a liberal blog. Or thought I had. I don’t even know anymore.

As long as I’m free to complain and orient myself like this I’m happy that people are talking more openly about mental illness in the blogosphere. I can’t say why anyone would deny their own bias, but I know one way to shut down the opposition is to pretend there is no opposition, and some people do operate in total bad faith like that, but maybe others just don’t understand enough about the terrain they’re on, and deserve to be given benefit of the doubt while they navigate the learning curve, yes, with feet held firmly to the fire, on notice that teh willful stoopid will not be tolerated without one minute of surcease, seriously, it’s embarrassing. An opening salvo? Yes, I’d be delighted:
Mental illness is a political issue.
Will political liberals kindly step up and take THE goddamn LIBERAL POSITION?

Our overlord Foucault is at it again

A witfree friend of the mentally ill left a comment at ama’s blog, claiming that the SPMI have all but been abandoned by the “consumertocracy literati.” Doesn’t that just roll off the tongue. The myth that we are hippie pomo philosophy majors with no real world knowledge of what we denounce is standard low-hanging fruit, but for the sake of clarity I’ll have at it. I look for how oriented people are to this debate, and that’s the sort of comment I hope will someday be seen as instantly dismissible, but better to go over the ground again than wish you had. Too much at stake to leave potential allies lost in TEH bewilderness.

As I see it, our current location begins a few years back, when the president’s New Freedom Commission declared the US mental health system a shambles. Then came the SAMHSA Transformation grants, awarded to nine states, as a mandate of TRANSFORMATION, from decades of inertia to a “Consumer-Directed, Trauma-Informed Recovery-Based MH system.”

SAMHSA has a definitional page on Transformation:

The scale of desired change is large and will result in a significantly different enterprise

Reinvention implies “something tantamount to changing the very ‘DNA’ of public organizations”

It is complex and chaotic in nature

It requires years to complete, with multiple phases and stages of major changes

The rules of the game change, including the norms, guideposts, values, and guides to behavior.

Enterprise redesign is depicted as revolutionary rather than evolutionary.

Under the grant several US states have been charged with a five year project to overhaul their MH system, and create changes that will lead the nation’s TRANSFORMATION from abuse to empowerment. In other words, we are in process. Systemic Transformation is the mandate. What has been inert is now in motion. Change is difficult. Many will resist. Boo-fucking hoo, we will roll over you.

Vermont, for instance, has applied for a transformation grant, and its new State Commissioner of Mental Health is one of many public servants now talking the proper talk. The following excerpt is from the Winter edition of Vermont Counterpoint, an interview with consumer advocate Steven Morgan:

As the top leader of mental health services for the state of Vermont, Michael Hartman brings to the role a wealth of experience and keen vision for how the system should progress.

He sees a definite role for people with psychiatric diagnoses to be involved in the system and “shape what services look like,” whether through employment, voluntary organizations, or participation on influential committees.
“The mental health department really needs to be pushing the agenda that services by people who are or have been consumers is an important aspect for services and recovery, and for consumers.”
He said that in many cases, “peers hold
other peers responsible for things at a much higher level than other professionals do,” and they may push each other to achieve more than is traditionally expected.

On trauma-informed care, he noted, “the first step is getting people to recognize that you need it, (that) the system as a whole sees the need for trauma-informed care.”
Trauma histories often present as psychiatric illness, which complicates diagnosis and the ensuing treatment, he said.
“The trauma kind of weaves in and out of various areas,” he pointed out.
Further, without an awareness of and sensitivity to an individual’s history, care providers may unintentionally trigger and re-traumatize someone without recognizing why or how they are doing
so. There is a need for more awareness around these issues, and how involuntary treatment may play a damaging role for trauma victims, Hartman said.
“There’s likely no involuntary treatment that wouldn’t be a trigger to a trauma victim,” …and it isn’t an issue he takes lightly….the taking away of civil liberties is “least ideal.”
…“When we are not giving enough options and involuntary treatment is the outcome, that’s a need that the system has to try and create more options.”

So much for the fancy divisive head-in-the-cloud elitist consumertocracy. Of course there is a concerted and bankrolled attempt to polarize, silence, fragment and obscure. This Republican State Representative lays it out with kitchen table plain-speak in an op-ed entitled, hallo

Involuntary medication acts to divide

We have begun to recognize how much the pharmaceutical industry is driving medical decision-making, both through conscious marketing to us, and more subliminal impacts upon physicians. Those same companies provide substantial funding to national public advocacy groups as well as to political lobbyists.

…Instead of spending the time to work towards mutual agreement on a treatment plan, many more Vermonters would be forcibly injected with risky drugs to get them out of a hospital faster. Some of those same drugs are now known for such side effects as diabetes, a chronic, debilitating and expensive illness – one of those facts that pharmaceutical companies knew and hid and for which they are now paying out billions in damages.

…Instead of progressing on parity of treatment approaches and integration of care, we now look to divide further, and to conquer by force.

As David Byrne put it, don’t worry about the government, I know when it is on my side, now I can relax with my loved ones.

I see the states, across this big nation
I see the laws made in Washington, D.C.
I think of the ones I consider my favorites
I think of the people that are working for me

P/S: Steven Morgan is a name to watch. His open challenge to NAMI has been making the rounds, and can be read here in all its unwarranted, open-hearted and diplomatic goodness.

To softer times

I went to 2 policy meetings today, which usually leads to the cussing, not-safe-for-work diatribe you’ve come to expect following these forays into the lions den. But institutional mental health is being re-organized in Texas, on the local, state and federal levels, and some demonstrable, incremental changes have happened since just last month, that appear to be good faith efforts, and maybe a start.

Both groups are grappling with the lack of consumer involvement. On the local level MHMR’s director of the Consumer Council has some proactive and tolerable measures underway, one includes inviting a speaker to Austin who runs a CSX peer operation in San Antonio. He didn’t describe her that way in the meeting, but whatever, I’ve seen her website and heard her testify and CSX is what she does. This new director is the ex-NAMI player I’ve been ranting about, for taking over the organization that used to be run by one of us. I was surprised to hear his plans to lobby for a new law to expunge criminal records of those arrested with mental illness and applaud these efforts, but that’s just me, progress, not perfection, and truth be told, I want to applaud.

But the real laughs came out of the next meeting across town, the SAMHSA Transformation Workgroup. It’s a five-year federal grant, the entire first year was devoted to planning, and they’re just now beginning to deal with the SAMHSA mandates and hammer out policy based on that consensus statement of recovery. The presenter said they are having real problems with all the rules about “consumer-driven” this, and “consumer-driven” that, and the term itself is creating profound challenges for policy-makers. Seems the folks having the most problems with it are psychiatrists, who are in the stage of Sputtering Disbelief, which I myself regard as an amusing/maddening and altogether necessary pre-verbal, or stage “one” of a long and stimulating journey toward their personal and overdue self-transformation.

There’s something to be said for the gobsmacking of your opposition. They really cannot get their heads around this idea of “giving the keys to the consumer”, and I likened the blustering befuddlement of the pdocs to an entire world of I can has lolcats.

We can use this. They can stumble around in shock and dismay while we implement the outwitting. Sputtering disbelief means they have yet to invent their corruptive framing. They will attempt to bastardize the Consensus model with the mental health version of Rovian talking points, just as they twisted stigma by ignoring our warnings about the biopsych model leading to more, not less discrimination, as they insisted it would. They turn themselves inside out to avoid saying what they really think, and use smoke and mirrors to turn black into white, but by staying a step ahead and anticipating the reaction to come when we talk about using alternatives to neuroleptics — and if it seems they’ve treated us like children before, wait til they hear what it is consumers are holding back — but we know they will argue from authority, use the stock fear, intimidation, pity and discounting by status, because that’s all they have. They are not ready for this and don’t know how to DO equality, and all that Transformation commands them to learn. So let them flail askance, we’re focused on constructing our own rhetorical framework, with Laingian talking points and naming the horrified disbelief as evidence of the power-grubbing it is, even though the feds themselves are telling them the old days are over, and the time is now to become one with the mandate.

Everyone seems to agree the biggest problem in TX is lack of consumer input, and SAMHSA just gave the Transformation team a grant to promote peer-based consumer support and participation. They have to bring us in. Someone mentioned the possibility of one-on-one dinners between consumers and providers, and said this is what they’re going to have to do, that it will come to this OMG, sitting down at a table, breaking bread, person to person, now guess which one is Carl Rogers?

But hold that thought. A family member in the workgroup gave a teary-eyed presentation on a D.C. conference he attended with interested parties. Of course I was predisposed to dislike the family advocate, who stood up and turned to his colleagues and said what he learned at that conference was

“We do not speak for the consumer.”

He described conversations he had with folks who have been so harmed by the mental health system that they call themselves survivors, and he learned that activists have been arrested and put in jail for demonstrating in front of mental hospitals, and that is a violation of their civil rights. He said stigma is the main barrier to recovery and that stigma is generated by us, in the mental health system, our programs and policies and language is filled with prejudice and stigma, and it serves us in ways we have to examine and eradicate. We do not lead the consumer, he said, we work with them in partnership, with the consumer in senior position. We are going to have to get used to this, these are new and serious ideas, and it is going to involve a change of heart. The real goal of transformation is that it happen with the policymakers, and he said he felt this process of transformation stirring in himself while in dialogue with the survivors. And that he was grateful to them most because they treated him like an equal.

I had to leave then to absorb the moment but I gave written remarks underscoring all that, almost verbatim, which I had written in advance of his speech, and reminded the Workgroup that consumer-driven recovery means inclusion of trauma-informed psychological services for those of us who reject the medical model of mental illness. Put that in your pipe and kthxbai.

So I’ve been sitting here wondering if hell’s freezing over or I’ve gone soft. Either way, that’s the idea.

How to kill empathy

This was especially useful tonight, but his speeches are often a thing of beauty, both intellectually and emotionally, and there are a ton of them at youtube.

I’ll save my own impressions for later so as not to mar the experience of the viewer, but just offer thanks for Dr. John Breeding, who has taken his place on the side of the angels.

Dear God, your sockpuppets are calling

That would be the self-named Chosen who speak as icons of lucidity, praying to the Flying Spaghetti Monster on behalf of the crazy folk. Included in this week’s devotion to exploiting the children they deny they drove insane, NAMI held their National Day of Prayer for Those with Mental Illness on Tuesday. Though I myself adhere to the rational, evidence-based and Atheist religious affiliation, I confess to finding the prayer itself so deeply moving, I bowed my head over a porcelain throne, with eyes closed and fire in the belly, and upchucked a fairly gushy stream of my own.

From NAMI’s website:

O, God, we gather here together today, as people from many different faith communities. We come before You, remembering all those persons whose lives have been touched by mental illnesses. We give thanks for those persons here who have given of their time and talents to do what they are able to help persons who are dealing with mental illnesses in their lives and in the lives of their families and friends. We give thanks for the improvement in medication and treatment programs that have enabled persons with mental illnesses to live productive subservient lives. We pray that our society would do everything possible to make early diagnosis and treatment a standard operating procedure. We pray and ask that stigma be removed, so that persons and their families would get the appropriate help neuroleptics as soon as symptoms appear. Guide each one of us, and help us, as we endeavor to bring help and hope more of this to those families and individuals.

We remember in our prayers those persons with mental illnesses who need to obtain access to their prescribed medications, treatment services, and counseling in the Gulf coast states where Hurricanes Katrina and Rita left devastation in their wake. We remember in our prayers all those who are in mental health crisis as a result of the horrible experiences they had during the storms and the devastation they experienced following the storms. We pray that our nation can respond in a timely and humanitarian way to this urgent mental health care need. We pray that in our own local communities, we can provide the appropriate health care for mind, body, and spirit to enable individuals to be on their journey of Recovery. Amen

Read in unison:

The faith community says to those people who suffer from the symptoms of mental illness, and to their family members:

We will walk with you. And God walks with you. You will not go through this alone.
~~~
A walk through the apple-blossom field of historical fact brings up a whole nother side of our pious neighbors who have been so provoked. O well, another place, another time:

March 15, 2002 Psychiatric News Online, CMHS Budget Cuts Harm Consumer Involvement:

The full announcement read, “NAMI urges the Bush administration move to terminate federal support for nonprofit organizations that actively challenge the scientific basis for mental illness and its treatment or forward an ideology that undermines the role of families in treatment and recovery (particularly so-called ‘psychiatric survivor’ organizations) that promote an agenda hostile toward increasing access to mental illness treatment services.”

Within a few days, the statement was withdrawn by NAMI’s new executive director, Richard C. Birkel. Birkel wrote to [Mindfreedom’s David] Oaks, who had requested a meeting, saying that NAMI had not and would not “engage in actively discouraging federal funding for any groups simply because we disagree with them.”

Who can say what NAMI stands for? And that’s the point, the strategy of all abusers, to sow confusion, re-define the terms of meaning and rewrite history. I apply to NAMI, the Nation’s Voice on Mental Illness, that revelatory Suskind quote, referring to the unnamed aide to George Bush, who told Suskind the following:

The aide said that guys like me were “in what we call the reality-based community,” which he defined as people who “believe that solutions emerge from your judicious study of discernible reality.” … “That’s not the way the world really works anymore,” he continued. “We’re an empire now, and when we act, we create our own reality. And while you’re studying that reality—judiciously, as you will—we’ll act again, creating other new realities, which you can study too, and that’s how things will sort out. We’re history’s actors…and you, all of you, will be left to just study what we do.”

Drugged to the gills in stultifying stupidity. Stay free high!