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Articles    H3'ed 9/7/15

Working to Recover, or Adjusting to Illness?

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I've had the opportunity to spend time in peer-led facilities such as Diabasis in San Francisco. During my training, I received supervision from John Weir Perry, the medical supervisor there, and a well-known Jungian analyst and psychotherapist of psychosis. Diabasis was so much more calm than the emergency department in our hospital, and no one was on medications. However, the demand characteristics of the two environments are so different.

In the hospital, we have a situation in which people are not responsible for themselves or their actions (in the relative extreme) and we doctors are. We are responsible for preventing them from killing themselves, hurting anyone else, or generally engaging in bad behavior after discharge. We feel the tremendous anxiety that this brings and want to sedate the patients lest they do something harmful. For example, during my training, I learned that it took 28 days for an antipsychotic medication to actually work in its antipsychotic manner. Before that, it was mostly functioning as a high-level sedative. In those days, we kept people for several months and let the drugs take effect before we discharged them. We can't do that anymore. Insurance dictates that people should be well within 7 days. Insurance dictates were also the death of the peer-led facilities like Diabasis.

We feel the need to sedate people and control their behavior lest we be liable and culpable if they do something bad. Within this system, how could we grant them agency?

Once upon a time, I believed that we could transform the mental illness system in North America. I'm no longer sure. I have begun to wonder if we are not doomed to parallel systems--the underground railroad, as it were with slavery on the other hand. Recovery does not take place in a biomedical system. The goal is maintenance. Can it be any other way? Can people transform in the biomedical story about them? Or do they have to find their peers and withdraw from the system of mental illness? And who will pay the peers? Must they labor for love, forever? I certainly relate to that, for most of my work with people diagnosed with psychosis was uncompensated, for insurance would not pay. Psychotherapy and healing were outside the model.

Of the patients I see in the hospital, I estimate that it's less than 3% who leave the system and find alternatives like the recovery movement. Is that enough? How do we make it more? Given the economic nature of recovery (largely uncompensated) perhaps that's as many as can be handled. However, Ron and Karen, who are coming October 10th and 11th, to Coyote Institute in Orono, Maine, have ideas for how to make recovery economically viable. This is what I really want to hear, for I do not know how to accomplish this in the U.S. system, short of doing it as a funded research study (which rarely happens because the ideas lie so far outside the mainstream). Perhaps we need societies as in the 19th century in which we tithe time and money for the purpose of helping each other when need arises. Perhaps we should all become Quakers in the sense of the marvelous people who started lovely retreats for people who suffered emotionally throughout the 19th century, and who did so much good in helping people recover. This movement ended with the huge influx of World War I soldiers who were so traumatized that no mental health infrastructure pre-dating the War could handle them. Hence, the Quaker sanitariums were transformed to profitable warehouses for traumatized people, and the ideas that had worked disappeared.

We're looking forward to this dialogue with our colleagues from the U.K. Stay tuned to our website at, where we plan to start an internet conversation with Ron and Karen in the near future. Part of this dialogue concerns the question of whether conventional services in the U.S. can interface with a recovery model, or will it always be a question of parallel processes? Can the two models interact, or must they always remain separate? The conversations will be forthcoming".

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Lewis Mehl-Madrona graduated from Stanford University School of Medicine and completed residencies in family medicine and in psychiatry at the University of Vermont. He is the author of Coyote Medicine, Coyote Healing, Coyote Wisdom, and (more...)
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