Laura Zera

Stories to Connect Cultures

You and Mental Health: Countering the Pathology View of Hearing Voices

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There’s a t-shirt–you may have seen it– that says, “I do whatever the voices in my head tell me to do.” My guess is that the person who decided that particular expression should be screen printed on cotton had never experienced auditory hallucinations, just as the person who came up with the “Kiss me, I’m Irish” t-shirt was probably Latvian.

Voice to earWe quip about hearing voices because we don’t think it’s normal. You’ll never see a t-shirt that says, “I respond when asked a question,” or “I sleep laying down.” If we’ve never heard voices, though, then who are we to deem it (and damn it) as abnormal?

In my last mental health post, I wrote about empowering the mental health consumer by engaging them and their families more meaningfully in decisions around their treatment protocol. When working with those who deal with psychosis, however, if we pathologize the experience of hearing voices, we’ve instantly set boundaries on the discussion–and attached a certain stigma–as we dive into contemplation of ways to eradicate the voices.

A different philosophy bears consideration. Started 26 years ago as the Hearing Voices Movement and now operating as INTERVOICE, it holds that voice hearers can develop their own personal narrative around the experience, including tools for accepting and coping with the voices. Instead of labeling voice hearing as abnormal, it applies recognition of voices as meaningful and related to the hearers’ lives, possibly even linked to unresolved trauma or a difficult event. Thus, an environment is created where voice hearers are encouraged to talk about their experiences without shame and stigma.

The approach is supportive and respectful. The result is empowerment.

While many voice hearers are leading the way in changing perceptions around voice hearing (take the wonderful Eleanor Longden, for example), I’m also thinking about this with a more all-encompassing mental health shift in mind. Movement toward more meaningful mental health care, for any symptoms and illnesses, require that we approach with an open mind and suspension of some of our usual labels for what’s normal and what’s not. Stay human-focused. Try new things. Engage in deep dialogue with mental health consumers to come up with new policies. And then, one happy day, the t-shirt designers will have to respond to a savvy market and retire some of their classics.

 

What do you think about this philosophy? And are there any risks or other considerations that I’ve missed?

 

You and Mental Health: Empower the Consumer

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‘Empowerment’ is one of those words whose meaning can lose impact over time and with overuse. Or when you use it like this: “Let me reach out to my team and see if we can ignite our value proposition in a way that will empower them and help us achieve our organizational goal of scalability.” Do you gloss over when you read or hear stuff like that, or, like me, hear the voice of Charlie Brown’s teacher in your head?

Recently, two readers left brilliant comments on my blog post regarding involuntary outpatient treatment that reminded me why empowerment should never become cliché, no matter how often it is used in corporate speak or marketing materials or annual reports. It’s not cliché, nor is it easy, which is perhaps why we gloss over it and take shortcuts that will produce quicker results, even when we know we could get better results if we waited longer, and, yes, invested more.

In their insightful responses, both Marcy and Jill brought the discussion back to be one of meaningful care instead of forced treatment. This isn’t to say that involuntary outpatient treatment doesn’t have a place in the conversation, but rather, if we focus on building resources around something like that, it’s like saying, “Well, the car dealer sold us a lemon with an oil leak, but that’s okay, we can just keep adding a quart of oil to the engine after every 100 miles and it’ll keep going.”

What about the car dealer? And is it just that car dealer, or is there a culture—of expediency, of profit, of apathy or whatever—that has sprung up in the automobile industry and trickled out into all the car dealer tributaries? (Note: I mean no offense to car dealers and my own experience with them has generally been very positive!)

Thinking about what path leads to more meaningful treatment for people with mental illness, it seems to me that we need to go back and look at where the cracks and gaps in the mental health system start, and to make sure that forced outpatient treatment isn’t our version of accepting a car with an oil leak.

We don’t want to keep driving that car, just barely maintaining it until we’ve run it into the ground. We need a system that empowers mental health consumers—in a real way, not a corporate-speak way—so that they are able to advocate for their needs and fully participate in their own care, as Marcy and Jill suggested. And the vision would be that if mental health care were delivered in a more meaningful way, mental health consumers wouldn’t reach the crisis states that lead to forced treatment in the first place.

Why is empowerment so vital? It’s human nature that we invest more of ourselves in something when we’re given a role to play in the process and decisions. Just think of anything that you’ve ever worked on at a job, and what aspects of your work made you put skin in the game for one thing and not another.

I do hope that some of you guys will post references and links to organizations who participate in models for treatment delivery that engages the consumer.

In the meantime, here are a few resources from which I’ve taken inspiration.

 

 

You and Mental Health: Views on Involuntary Outpatient Treatment

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Café_Racer_Seattle image by LukobeI was thinking about a woman I never knew today. Her name was Gloria Leonidas, and she was one of five people killed just over a year ago in what has become known as the Seattle café shooting spree. Gloria was a wife, mother of two daughters and well-known community volunteer. The day she was shot started out just like any other day for her. And then she was gone.

The man responsible for her death, Ian Stawicki, had shown a variety of mental illness symptoms over the years, becoming increasingly violent in the last handful. He’d never been a patient at a psychiatric hospital, but was charged twice with misdemeanor assaults (charges that were later dropped). He owned guns. His family knew something was wrong with Ian, but didn’t know how to get help for him, and Ian wouldn’t seek help on his own.

This isn’t a unique case. Margaret Ryan was killed in Seattle last year, too, by her mentally-ill son, Brodie Lamb. He was also known to have violent outbursts, but unlike Stawicki, he’d previously been both convicted and treated with medication for his illness. He refused to comply with court orders for continued treatment of his mental illness, however. And then he killed his mother.

There are good arguments against involuntary treatment for mental illness, and I agree that no one should be forced to take medication except when they’re a threat to themselves or others. But why aren’t more states willing to put adequate money into funding follow-up outpatient care for a person with a serious mental illness?

According to a recent study on involuntary outpatient treatment, a state’s investment in such programs, where caseworkers visit patients to ensure they stay with their therapy and medication, can lead to lower overall health care costs. Researchers at Duke University found that patients in the program require fewer revolving-door hospital visits and become more productive in society. Here are the stats.

AOT - Kendra's LawForty-five of the 50 U.S. states have some form of involuntary outpatient treatment, however the level of states’ investment is so varied that for all intents and purposes, in some places, the program doesn’t exist. Other states, such as New York, have invested heavily. The program took shape there after 32-year-old Kendra Webdale was pushed to her death on the tracks of a New York subway by a man suffering from schizophrenia. But even with New York’s significant investment, it happened there again just last year, when Ki Suk Han was killed.

So where do we go from here? Do we keep trying to build involuntary outpatient programs (and plug the holes in the existing outpatient programs)? And can we do that without stomping all over basic civil rights? Or does the safety of the whole outweigh the rights of the individual in these cases?

What are your views on this issue? All opinions are appreciated.

Note: this post was updated on 08/31/13 to correct references to “involuntary outpatient commitment” where it should have read “involuntary outpatient treatment,” including in the title of the post. D’oh!

 

Let Me Give You a Quarter for the Shoes

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Image by © Royalty-Free/Corbis

He stood on a street corner, the local KFC his theater backdrop, a worn and dirty “Help Needed” sign in his hands. The traffic lights supplied a captive audience of people in cars, and he shuffled back and forth, 15 feet south or west, as instructed by the lights’ color. Well, that and probably a substance dependency issue or a mental illness. Something had led him to this spot.

I kept my car windows up and my gaze angled enough to keep him in my line of vision without making direct eye contact. He wasn’t a very big or threatening man, just unkempt, his hair having a crazy, clown-like quality to it. As the light turned green and I sped off, I noticed that the soles of his boots flapped as he walked, as detached from the rest of his shoes as his soul from society.

“Everybody should have warm, dry feet,” I remembered Janie saying. Janie owned a local thrift shop where she gave away socks for free. I was only a few blocks away from her shop, and they sold men’s shoes there. Or I could keep driving. But if I went straight home, what would that say about my own soul?

I turned right at the next light, looped back around and swung into the KFC parking lot. Now my window was down. “What size are your feet?” I called out.

“Nine.” He hopped over decorative shrubs to get to my car. “Are you going to buy me shoes?” I told him that was my intention, and he wanted to know where I would be shopping and how long it would take for me to come back (I estimated 15 minutes in case I had to hit two thrift shops to find his size). “I should be here,” he said, after thoughtful consideration. “I might have gone to the bathroom, but then I’ll be back.”

Ten minutes later, back at his corner, I handed him a lightly used pair of Skechers. “Thanks,” he said. “Do you want to have lunch?”

“Aw, no, sorry, I have to get home.”

He was smoking a cigarette that he’d hand-rolled into some strange origami, and his teeth bore the stains of tobacco and tough breaks. “You’re my friend now. If you ever want to hang out, I’m here every day, usually between 10 and 12.”

I checked that the traffic light was still red so we could continue the conversation, and then, trying to ascertain if he was independent or ‘in the system,’ asked, “Do you live alone?”

“Oh, well, I’m doing a lot better these days,” he blustered. “The devil and his legion aren’t coming after me anymore.” His eyes widened as he said this, and he nodded his head, as if I had previous knowledge about Satan’s antics as they related to him and this was just my status update. “They were trying to get at me, you know, coming in everywhere and following me around.”

He’s delusional. This, I understand, I thought, and relaxed. “Okay, well I’m glad to hear you’re doing better. What’s your name, by the way?”

Image courtesy of Microsoft“Here, let me give you a quarter for the shoes.” He fumbled in his denim shirt pocket without telling me his name.

“No, no, that’s okay, really. They’re my gift to you. To start your weekend off right.”

“Really? Thanks! You’re my friend, so you’re protected from everything.” He took a couple of steps back until he was on the sidewalk again. “Are they lace-ups?”

“Yup, they’re lace-ups. Will that work for you?”

“Oh yeah, that’ll work. I just have to bend down more.”

I couldn’t suppress my smile. “Okay, good.” The light turned green. I put my car into gear and waved as I set off.

Everybody should have warm, dry feet.

 

You and Mental Health: A Specialized First Aid Class

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Many of us have had enough exposure to cardiopulmonary resuscitation (CPR) training over the years that if someone needed CPR, it’s likely we could respond, regardless of the expiry date on that little white certification card. (If you’re not feeling comfortable with that statement, here’s a simple, one-minute video for hands-only CPR that can help.) In the U.S. alone, about 92,000 people are saved by CPR each year. Some are random strangers and some are loved ones; either way, we continue to train in and administer CPR because it saves lives.

Now let’s talk about what to do when a person’s mental health reaches a crisis state. In the wake of such tragedies as the Arizona, Colorado and Connecticut shootings, and with suicide deaths numbering around 30,000 per year in the U.S. (11 times that for attempted suicides), the conversation turns to prevention. We need to stop the tragedy from unfolding. But in the realm of mental illness, do you feel trained to identify the symptoms and equipped to do something to help? And what would the opportunity to have that kind of training mean to you? Continue Reading

Mental Health: A Link Between Depression and Dementia

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A study in the May issue of the British Journal of Psychiatry has concluded that late-life depression is associated with an increased risk for dementia and Alzheimer’s disease. After conducting meta-analysis on 23 existing studies that studied nearly 50,000 adults over several years, researchers concluded that adults with depression are more than twice as likely to develop vascular dementia and 65 percent more likely to get Alzheimer’s.

Holy crap. Them are some hefty numbers.Continue Reading

Travel-ish: Africa, Aid and Making an Effective Contribution

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During a visit to Randy’s restaurant last week (no, that’s not the travel-ish part), I thoroughly enjoyed a conversation about Africa (that’s the travel-ish part) with my two companions. Seems a rather broad topic, you say? Well, yes, and we did have a rather broad discussion, ranging on education, investment, natural resources, transfer of technology, volunteerism, environmental issues and long bus rides. All this while I munched on my six-dollar tuna melt. We weren’t even drinking (when a glass of wine is $2.75, it scares me).Continue Reading

I’m Giving Thanks that I’m Still Here to Give Thanks

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Thank you, pumpkin pie

As a childless expatriate, holidays tend to be pretty mellow events around my house. I don’t even have to cook dinner—my husband is taking care of that. The arrival of Thanksgiving has given me pause for thought, however, and I have many things for which to be thankful.

Let’s start with my home. My bathroom is so small I can clean the sink while I’m sitting on the toilet and the basement gets water ingress in a heavy storm, but it’s my cozy sanctuary, a lot nicer than some of the crack shacks I’ve slept in, and I am grateful for it.Continue Reading