What are you Living for? Answer to Mental illness in this Revolution.

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“Latest Banksy Graffiti”

Why do you get out of bed every morning? To go to work? You think, “Life is about working and then someday I’ll die.” Are you living to go to school? Perhaps a student for life, the best is to gather and gather. A klepto of information.  Maybe you live, instead, to stay home and not leave. That can be worth it. Leaving home feels like going to one’s death for many, in fact, with anxiety.

Is what you are living for, worth “living for?” Why didn’t you kill yourself last night? I’m not asking for “13 Reasons” or glamorizing suicide in any way, like it is, unfortunately, being done in the media these days. I’m just asking. (Straight face. Eye contact.) Why?

Suicide is increasing, this year up by ~30%. It’s sad but I’ve heard the ignorant say, “When our world is being overrun by humans, this is just one more way to improve population management.” Why anyone would say that, let alone to a psychiatrist, speaks toward the unfortunate person saying it more than anything. Even so, these are the people that contribute to our cultural stigma and sentiment, like the wrong colloid for growth. This stigma is best diminished by peer-to-peer influence. Your voice; you speaking up is the painting over the foul-language graffiti. You speaking of your own journey with suicidality or any related diseases changes the ignorance into empathic knowledge. 

We are in the mental health equivalent to the industrial revolution. Fortune. We are wealthy in mental health treatment options. Bling! Bling! It wasn’t too long ago when we were trusting depression medical therapies to crude agents bulky, and bluntly stunning our neuroreceptors. These were a big stick coming down on a flower.

Think of the cart and horse transforming into the automobile; course into sleek and refined; slowly moving and grossly impacting changes, contemporarily working rather as specific rapid responses. Now remember your parent, or mine, who never had the opportunity to receive a treatment that would work in a matter of weeks, and without turning her/him into a zombie-blimp.

A child stands there going through his own vasovagal experience, scared and confused while watching his favorite person in the whole world performing like a broken toy. The child tries to make sense and restabilize their once clarified existence. The parent goes through this at first for about six months and then somehow “gets better.” Was it the prayer that worked? Was Momma finally able to “pull through it?” Was it because the child’s behavior finally became “good enough” to please God who then condescended to make his momma better? Momma does well for another 2 years. She’s connected. She’s filled with purpose. The memory turns into something like, “Boston’s worst winter in fourteen years;” briefly print-worthy and then thankfully, not much more.

Then momma is again dark, hopeless and staying in bed whenever she can. The child, Teddy, is now a preteen of ten. This comes back, like finding another letter from his cheating dad’s girlfriend under a magazine in the back of the closet where his golf clubs are. And instead of six months, Momma’s change lasts about two years. (Can we even call it a “change” when it lasts two years?)

The amorphic improvement comes again though, like a miracle, but who can trust it. Miracles aren’t gotten in vending machines after all. We can’t buy them with a paycheck.

Sadly, as Teddy feared, another some many months later, Momma drops again. This time she plummets rather than drops, into a drunken, more terrible condition. For longer, and the boy is now a teen. He at first appears more calloused. Yet, if questioned, he will show his grief and bewildered young self, just there behind a gentle touch, or a cluster of inquiring kind words. He loves her well. Why can’t she love him? Moms who love their kids will get up in the morning. They’ll shower and they’ll talk. They don’t write suicide notes or leave their son’s to find them half conscious when they get home from school. Not mom’s who love their kids.

Our moms, yours and mine in the seventies, didn’t have the privilege of taking treatments that worked or worked well, and rapidly. We are so blessed. How to grasp the immense difference in our Age; this Age of mental health revolution.

Now a little boy sees this change in his favorite person in the world. She is fortunate enough to receive medical treatment, and within weeks is “back to myself again.” This little family escaped years of decomposition by the ravaging damages from brain illness. 

My grandma, Elsie Louise, (isn’t that a great name!), was washing her laundry in a new machine that decreased her labor by many hours. One day, when she was daydreaming about her young handsome husband, or maybe it was the chicken she lost to the fox, when she screamed, jerking out from a terrible pain in her hand. Her fourth finger was gone. She lost it, pulled off by the twisting force of the machine’s internal grips.

Now we place our laundry in a closed lidded box we just walk away from. We don’t even think about the appendages we are allowed to retain. We don’t imagine the privilege. 

In psychiatry, it is like this. The treatments we had generations past were better than none. But, enter now into 2018, and we don’t realize how good we have it. We forgot most of the print-worthy stories back then. Not to use the treatments from this revolution, is going back to the darker ages of medicine. The treatments save lives. They bless. They make us rich in life. Bling! Bling! Look at your wealthy character. Healthy.

Why are you still alive? Whatever you answer, fight for that. Take advantage of the mental health revolution and live well.

Questions: What are some stories of those you have loved who missed out on mental health treatment? What are some stories of those who did not? Where is the difference?

Self-care tip: Speak! We need to hear you. You are painting over the foul-language graffiti of ignorance!

Keep on!

False Thoughts about Getting Healthy

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Think of walking in a rainstorm. Your clothes and hair hang heavily. They provide no protection. They offer no remedy. You take a hand towel out of your bag and try to mop up your icy wet face. Wring it out and continue to wipe. 

This is like choosing to do all the psychosocial efforts in your life, but missing the biological. Until you treat the underlying illness, much of our efforts to heal are like using a hand towel to dry off in the rain storm. We think that we can get better without medication. Or, we may reject other treatment options, like ECT or TMS. We think false thoughts. 

It’s not healthy to take pills. 

I’m better than that. 

All I need is God. 

My parents would be upset, so I shouldn’t. 

If my work found out, I’d lose my job. So I shouldn’t. 

THC is better. 

Exercise is better. 

Some of these are entirely false. But some are just partly false, encased in a disconnected truth. This “rain and the hand towel” idea is not an analogy meant to minimize or bring shame to those who choose not to engage in treatment. It is not meant to talk down. Please forgive me for the crudeness and limitations. It is just meant to crack open this idea.

Yesterday, Louise commented that her physician told her taking sertraline, or Zoloft, was like taking “a vitamin for my brain”. That clicked for her! Vitamins were ok.

Question: How has your physician helped you get past not wanting to take treatment? How could your provider do better with this?

Self-care Tip: Allow healing with medical treatment for medical disease.

Get You Some of That – Medical Treatment for Medical Illness

…Continued from yesterday.

Cole_liveCole Swindell – Get Me Some Of That

Why do I feel so horrible when I start a treatment that is supposed to help?

Medication treatments for depression and anxiety, and some other brain illnesses, often worsen how you feel before you feel better. I can’t tell you how many patients have told me that if they had known this before, they never would have stopped their mediation(s).


Yesterday, our post discussed a Dr. Jones and Presley.

Presley fired Dr. Jones when after following her directive, he subsequently experienced an extreme panic attack. Dr. Jones may not have done anything wrong in her treatment recommendations. Presley was just an individual, as compared to a “number on the curve” of treatment responders. Escitalopram, the medication discussed as an example yesterday, (one medication option out of many), may have been dosed at an initial amount that Presley’s body couldn’t handle “straight out of the gait”, so to speak. But likely, if he had started at a lower dose, maybe ½ or even ¼ of the tablet, and then waited for his body to accommodate to the medication. Then Presley would have tolerated it. Presley would have tolerated slowly increasing the medication if approached, rather, piece-by-piece of a pill. I’ll even joke with patients,

I don’t care if you lick the pill. Just get on it.

When slowly titrating a medication, it allows the individual’s neurotransmitter receptors to down-regulate whilst the agent floods the receptors. If there is a neuron targeting another neuron, there’s a baseline balance in time. There is a baseline understanding between these neurons. An agreement, of sorts. “I’ll sit here and receive your messages,” (neurotransmitters, or chemical messengers such as serotonin, norepinephrine, and/or dopamine). “I’ll then carry those messages on your behalf to their intended recipients,” (such as the amygdala or hippocampus). But then this person artificially takes a higher quantity of these messengers, for example, by way of medications, and floods the system. The receivers, (or neuroreceptors), have to adjust to this to establish a new healthy baseline. 

In this initial time of treatment, when 1st introduced to the increased neurotransmitter-load, (ex: as released by a tablet of Escitalopram), there can be a negative response, such as panic and/or depression emotions. We call this, “initiation side effect’s.” Once the neuroreceptors get used to the new load, then the response improves. 

After accommodating to the new pharmacology, the brain is allowed to experience the blessing that comes from treatments, and heal.

Some individuals are outside of the curve and cannot tolerate the standard initial treatment dosage, like Presley was. Some are inside, and can without much difficulty. The point in treatment, though, is that the person just needs to get on it.

Get on treatment. However you do it. You have to make the treatment work for you, an individual, in your own way. The prescriptions are there to serve you. You aren’t there to serve the medications. I like to analogize Jesus’ statement,

The Sabbath is there for man, not man for the Sabbath.

Make it yours as an individual and reap the benefits; the blessings inherent there. (See Mark 2:27). 

If you don’t get on the treatment, you won’t get better. Anything less than this will be inadequate. It’s like drying water off your face with a hand towel while still walking in a rainstorm.

What is your agenda in treatment? List it. Write it out. Then, go get you some!

Outside a medical approach is like flicking water off in the context of a rainstorm. If your agenda is getting to your healthy self. Get out of the storm and get dry. Then go get it. 

You have a medical condition. Treat it with the assistance of a medical professional. 

I don’t go to a plumber to help with my electrical home repair. I don’t go to an accountant or a church counselor to treat a medical one. 

The plumber, the accountant, the church counselor are what they are. This is not minimizing their efficiency in their own fields of excellence. But why do we seek care in psychiatry from those who haven’t studied this? From those who are not experts in this? Maybe stigma keeps us away from psychiatric care. Maybe misinformation directs our search for mental health treatment elsewhere. 

Self-Care Tip: Get you some medical therapy for medical illness.

Question: What are further concerns you may have about taking medications? How would you prefer your medical providers to work with you? Please tell us your story. 

Stigma from Religion

I’m just leaning on God.

Which was her reasoning for stopping her Lexapro.

Nora’s family lashed out angrily at her. “Why are you so horrible!”

Her husband had left her for another woman from their church, a “friend” of Nora’s who used to come to their house for movie nights. He said, “You’re like poison, Nora. I’m not happy any more with you.”

Nora had now lost her job. She couldn’t focus and cried too much at work. Her supervisor told her, “You are not the same.”

Nora decided she wasn’t going to take her medications any longer because what she needed was more faith to be well and to get her life back. Her plan for recovery from debilitating depression and paralyzing anxiety was to be more dependent on God by way of certain practices, mainly not taking her medication. Although she didn’t see her plan for recovery quite so transparently. She thought it was through prayer and sincere intention to be God’s rehabilitation appurtenant.

Nora did say she was still taking her anticholesterol medication. And so we spoke about the important related perspectives between what Nora saw to be “medical” verses “spiritual” illness.

  • First to lead into the matters, “What are you taking your Crestor for?”
  • Where does cholesterol come from in our bodies?
  • Where do emotions and behaviors come from?
  • Is there a spiritual element that has a relationship to high cholesterol?  How about to emotions and behaviors?
  • Is there a medical change that causes the disease of hypercholesterolemia? How about emotions and behaviors?
  • Why be willing to take medication for a spiritual illness of hypercholesterolemia? Wink.

Nora, it turned out, loved where this conversation took her thoughts. It was hard to encounter inconsistencies in her religious beliefs and practices. But she did because she is a woman of courage!

It got me thinking about what role our cultures, related to religion, play into our emotional health. Is there a source of stigma against getting life saving medical treatment for mental illness that we are missing simply from the religious culture we are quietly woven into through life?  Randy Travis’s song lyrics, “I hear tell the road to hell is paved with good intentions…” implies that we in religion justify the collateral damage, such as death and ruined lives by mental illness, by the belief in the greater good. I’m sure I do this too in my own unconscious way. And isn’t that what this post is all about? I want to take a big stick to this glass and shatter it! (Aggressive much? Smile.)

When I think of Nora, sometimes I can’t believe she actually is taking medication and doing so well now in her life journey. It’s a miracle.

Self-Care Tip: Explore the role religion is in your opinion toward medical treatment.

Questions: How does religion interweave into your stigmas? Or those you’ve broken through? 

Or maybe it’s the opposite. Religion has contributed to your self care and medical choices?

Please speak! We need to hear you!

I’m peaking in my career

  
Supposedly, I’m peaking. And this isn’t about egg yolk and marenge pie. I’m 43 years old, have been in medical practice for fourteen years, and am looking at a canyon in 360-degrees from where I stand. That’s what the data says. I wonder if I am going to do the electric slide or how I’ll boogie through the next years of medical practice. I try to think, “This is the best moment of my life, right now,” any time self stigma and fear of mortality creeps in. (That’s not saying, “This is as good as it’s going to get!” Ha!) I want to cherish the gift of practicing medicine, for however long I am blessed with it. 

It’s a popular discussion amongst my colleagues these days, about how long a physician should practice. There’s a newer’ish respected program called, PACE, that evaluates physician competency to practice as they get old.  This is a huge shift in the culture of medicine. It’s meant to respectfully assist rather than discriminate with ageism. I try to imagine what it might feel like if I were approached and asked to take the test. 

So what does a psychiatrist rocking her best jeans have to show for herself anyway, you may ask. Well, (tapping the mike), “I’d like to first say thank you to my sponsors….” Wink.  I mean my patients! Thank you. 

…Hey! This peak is crowded! Give me some room!

Ahem. But at my “peak,” at the best of my career, I thought it would be fun to play around with, “Why?” What’s in my doctor’s bag that is so special?

  • Ask, “Why do you want to be alive?”
  • Start all work-ups with a medical work-up. 
  • Give full informed consent with the 5-Treatment Paradigms of Psychiatry
  1. chemical (medication), 
  2. psychotherapy, 
  3. hospitalization (inpatient and outpatient), 
  4. alternatives (such as acupuncture, massage, sleep hygiene, lifestyle change, etc.), 
  5. stimulation therapies (such as ECT or TMS).  There’s nothing else (that I know of 🙂 ) that anyone is going to offer you in psychiatry, no matter who’s clinic you go to. 
    • Push to full treatment response. 
    • Work toward quality of life, not cure, not perfect.  Ask again, “What makes like worth living for?” Design treatment toward those goals. 
    • Routinely and deliberately consider the flow of patient’s treatment agendas with physician treatment agendas. 
    • Mood journal. Nobody believes they were “that bad” after they feel better. Everyone wants to stop treatment when they feel better. (This is why there are so many repeat pregnancies, for example!). We all need our own voice (mood journal) to look back on and speak the truth. 
    • Fight for oxygen. If your patient has sleep apnea, don’t stop working toward treatment compliance. There are no medications that can take the place or make up for oxygen to the brain. 
    • Community. More community. 
    • The third eye – a therapist. None of us can be a mirror into ourselves. We all need someone outside of the “triangle” to speak.

    I’ll be thinking of more as I try to go to sleep tonight, but it’s bed time. I’m off! Sleep hygiene! Arg!

    Self-care Tip: Evaluate your position in your lifeline, and treasure where and who you are with deliberation. Keep on!

    Questions: Where are you in your lifeline? Are you struggling with ageism? What gives you value? Please speak! I, and the rest of us, really need your voice. 

    The Perfect Doctor – Healthy With Disease

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    One of the difficulties we have in talking to psych patients is realized with the dawning truth that we are not curing anyone.  Working in those conditions of not curing, you both, patient and psychiatrist, have to come to terms with each others’ agendas.  The physician says, “(‘I’m a failure.’)  I can’t cure anything.”  Now eye contact is even tough.

    “If I don’t look them in the eye, some other emotion will surface and they’ll stop crying.”

    Rachel was crying and crying hot and hard in the emergency room.  She was unable to stop the lava flow.  It was bewildering to her.  The people around her shifted their gazes.  Those who didn’t, looked angry instead, as if to say, “Pull yourself together, Woman!”

    Psychiatrists have the advantage perhaps to these others in the lobby and receiving rooms and gurney shelves. Supposedly psychiatrists can grip and tug at the corner of the large sweater that is human behavior and say, “Emotions and behaviors come from the brain.”  They can imagine, if not entirely believing at a visceral to cognitive level, that the person they observe is responding to symptoms of what is happening biologically, at a cellular level. When they are tempted to avert their eyes, or look back impatient with the messy emotions, they can say, “This is medical.”  Impatience with emotional chaos from psychiatrist to patient, is equivalent to the ER doc saying to the trauma patient, “How dare you bleed in a public area?”

    When someone cries on the medical unit, you may hear, “Nurse! Call the psychiatrist! There’s an emotion on the ward!” Later when things are calm, I walk out and they say, “Doctor!  You’re amazing!  What did you do?”

    “Well, I bit off the head of chicken and sacrificed a goat on the patient’s chest.  Then I said, take this pill and everything will be as it should.”

    Luckily I have several chins now, and when I gesticulate, their quiver contributes to me looking very capable. As if I could cure something.  I don’t know much about art history but, The Thinker, a bronze sculpture by Auguste Rodin, is probably what that Frenchman’s psychiatrist looked like when they both came to terms with the fact that psychiatrists don’t cure anything. (Heresy.) At least he got to get nude while he did it.

    Talking to psychiatric patients can be that difficult.

    There are studies on patient satisfaction that demonstrate that patients don’t like us when they think we give them bad news.

    You see the predicament here, don’t you? So, some of the difficulty the world at large may be having with talking to psychiatric patients is that we have distorted perceptions of good and bad news. We may have difficulty with our own humanity, frailty, infirmity, and seeing it out there “without a scarf on” for decency, is a hard reminder.

    We will never be cured of so many things. All of us. And the best we can hope for…

    What is the best we can hope for?

    (We are all gluttons and all hope for many unpublishable things but please! Just humor me.)

    Say: “I hope to be healthy with disease.” There. Now we will all speak better to each other. It all starts and ends with Me.

    Questions: Have you ever had difficulty talking to a psychiatric patient? Have others had difficulty speaking with you? Why do you think that is? What could help? Please tell us your story.

    Self-Care Tip: Hope to be healthy with disease. 

    (I bet Carl D’Agostino could make an excellent cartoon with this rich irony to work with! That’s right Carl! You heard me! Maybe a blue ribbon with a hole in it?… Ah heck. I’m sticking with practicing psychiatry and leaving the toons to you!)

    Handout – How to Talk to a Psychiatric Patient.

    duck

    Finished the CME talk I did last week and thought, you might find some use for it.

    I’ve received bad press many times for not being, in so many words, legit or academic enough. Check out the comments on my ECT book on Amazon.com for examples :). Maybe this one leaning into that bosom of greatness will turn public opinion. (Sneeze.)

    …Formatting has been a real bear.

    As you go through it, please talk out. Tell me what you think. I may do it again. (That’s right. I’m not afraid to threaten. You heard me.)

    Keep on, Friends.

    How to Speak to a Psychiatric Patient

    Introduction:

    • You quack like a duck, avert your gaze, and then hold a fetal position. It’s good for core.
    • Be sure to carry your portable speakers playing zen chakra music in the background.
    • Offer cigarettes.
    • Bring a healthy white chicken to sacrifice over their chest for the exorcism.
    • Introduce yourself with an alias name. Hopefully a superhero.

    This is a fail safe method of communication to pretty much hit all the difficult misperceptions we are contending with in psychiatry – demonic possession, shame, violent tendencies, weak character, and poor moral choices.

    I’d like to give you the 1,2,3’s on how to talk to psychiatric patients. But as I researched this topic, it became apparent that this wasn’t the direction for us to go in. You have better algorithms, systems, and manuals based on research for this in your own departments. I know you have people who are specialists in the administrative side of things.

    For us today, we are going to turn rather toward the innuendos that interplay in communication between caregiver and patient.

    The is the first place for us to start, let’s just talk about it here.

    What is it like for you to talk with a psychiatric patient?

    • Identifying Me in the mental health treatment paradigm.
    • Not implying that we have skills but no awareness. We are just deliberately putting the practitioner into “it.”
    • It’s a “how to,” but first we need to address our personal limitations.
    • Why do we have these limitations?

    I: Clinician/Caregiver barriers

    II: Patient barriers

    • What’s over-scored is that the problem is on the patient’s side. The patient is sick after all. We agree. Brain illness and all that.
    • Even so, what is underscored is our side. And that’s what this talk is going to be about.
    • We want to focus on our own thoughts about this. What it says about ourselves. Who am I if my identity changes with how I feel and behave? etc.
    • And then, how do we respond to that?

    III: Understand Personal Biases – Likes and dislikes

    • Figure out where we are at. What makes it difficult to talk to patients?
    • What are the common myths? Get the myths out there. 
    • Some reasons are true and not myths.
    • What are some personal biases about working with psychiatric patients?
    • (Bias means – likes and dislikes)

    IV:   Define Stigma

    1. Prejudice – Attitudes, feelings/emotions (Amygdala)

    2. Discrimination – attitudes lead to actions

    1: Prejudice

    • Weakness of character
    • Supernatural explanations. (Statistically significant association with superstitions.)
    • The word “patient” not talking about disease, perhaps, but rather about character – something of moral value.
    • Religion. (But only a few believe that spiritual leaders can play a role in treatment! People don’t relate stigma issues to biology.  i.e., It is not biology or medicine that increase the problems, but belief that the person has a personal weakness as demonstrated by their behaviors – A conflict in beliefs, or prejudice, worth exploring.) (…But where do emotions and behaviors come from? The Brain. Thinking they come from a cloud by day or a fire by night fall into the category of prejudice.)
    • Time consumption.
    • Danger
    • Treatment skepticism – no recovery, there’s less hope for them
    • Punishment from God for evildoers.
    • Demonic possession
    • I am lessened by my affiliation with the mentally ill

    What are our fears? Fears are an emotion and/or attitude…

    • Brings into play, how do we identify ourselves? …And that part of us that remains even when we are in a changing body (identity).  I call this, “Me,” with a capital “M.”
    • Think about this when we look at responses to prejudice; “discrimination.”

    Caregiver stigma – “self-stigma” comes when we internalize public attitudes and turn it onto ourselves

    • We perceive stigma from others due to those we care for.
    • Shame/Embarrassment
    • Fears of what it says about ourselves

    2. Discrimination – How we act on those prejudices.

    Example:

    • Take “Caregivers Stigma.” We can bring this into our work place as well, from what we glean in our community.
    • We avoid patients who make us feel uncomfortable.

    Who has Stigma?

    Everyone.  It is in our community, including we who serve and are involved in mental healthcare services.

    1. Patient

    2. Clinician

    Patient

    Example: Mr. Whineheart misses his medications approximately three times a week due to logistical reasons. However, we know that Mr. Whineheart has had a long history of difficulty with treatment noncompliance. As we explore further, we discover that Mr. Whineheart dislikes taking medication. It makes him feel like he is weak. Not taking his medication is Mr. Whineheart’s discriminating behaviors against himself in response to his prejudices, (emotions and attitudes of shame.)

    Clinician

    Examples:

    • Refusing care for psychiatric patients.
    • Starting with Questions:  How do we respond to challenges to our identity? When our identity’s confronted by seeing our patients with psychiatric illnesses, our patients who demonstrate changes in their emotions and behaviors since brain illness set in, we ask, what part of us remains even when we are in a changing body and mind (identity)? How do we respond?
    • If it is positive, it is not discriminatory toward ourselves. If it is negative, it is discriminatory to ourselves and inevitably to others.

    V: What are the barriers to talking with psychiatric patients?

    • The tension is when the patient and the clinician’s personal views, life stories come together.
    • Where those thoughts collide is where the tension is.
    • That’s where the barrier is.
    • Once this tension is resolved it’s easier to go into action

    VI: Why bother about Stigma?

    Because:

    • Stigma is a feature and a cause of health problems. (Both clinician and patient)
    • Belief —> action.
    • i.e., In caregivers, emotional toll can be devastating – may lead to injury or illness of caregiver

    Because It Affects:

    • How we speak to psychiatric patients. (Human Value.)
    • Choices in our clinician-patient relationship.
    • Perceived quality of work experience.
    • “Me” and QOL (Quality of Life).

    Because It Engenders:

    • Social distance. (Comes from fear. But connection is healthy for “Me.”)
    • We are robbed of opportunities (Think – Agendas, Connection, etc.)
    • Avoidance. (Comes from belief of danger.)
    • Treatment skepticism (What is “recovery” anyway?)
    • We need to ask, “What are our treatment goals?” (Agenda)
    • Frustration and anger, negative emotions.

    Responsibility:

    • There’s an unequal level of power (Us v. patients/clients) – inherently increases our responsibility toward others to overcome this.
    • What about us?
    • Identify that. Then fear can become strength. Presence. Actions of discrimination change to actions of hope.

    VII:  Agendas

    • Part of our “belief systems.”
    • Exposing agendas, leads us toward action. 
    • Just like exposing prejudice leads to actions of hope.
    • Just like starting with Me leads to actions of accountability and presence.

    1.  Traditional agendas in the medical model:

    a.  Serve altruistically.

    • Saying we don’t have an agenda is grossly dishonest.
    • Maybe we are uncomfortable speaking about agendas because it creates tension with the classic view that practicing medicine is supposed to be Altruistic.  Altruism is just another “pressure.”
    • It’s a perfectionistic model. It’s false. To ally ourselves with it is a mistake. Brings discriminatory behaviors toward ourselves, driven by prejudices of shame.

    b.   Healing

    • The paradigm that never fits for psychiatry – cure, getting rid of something bad, not joining it and integrating it. (Presence.)
    • Can’t stop disease even with appropriate treatment – Treatment agenda changes to center around QOL experience rather than cure.
    • Caregivers in long-term care are not looking for recovery in their patients.

    c.  Serve patient (Service)

    2.  Traditional agendas of business

    • $, Profit

    3.  Quality of work experience

    • Not only do we get money, we get other stuff (biopsychosocial needs).  That affects how we talk to people.

    VII:  Solutions

    1.  Start with Me. Own that we have stigma: prejudice and discrimination.

    1.  Protest
    2.  Put own selves in the way of these treatments
    3.  Rely on evidence (biomedical conceptualization or education), not ideation (prejudice, emotions, religious causation…)
    4.  Pay more attention to emotions, senses, thoughts.
    5.  Reconsider your agendas e.g., Not necessarily recovery but rather QOL
    6.  Engender a culture of expectation (ex: We expect ourselves and each other to participate…)

    2. “Contact based” solutions.

    • The impact of experience and exposure
    • Best treatment is contact with the mentally ill vs. Educational approaches, which, although are helpful, are not as effective. Nor are psychotherapeutic approaches.
    • Maybe we overemphasize education in our culture and undervalue human relationships.
    • We see this anecdotally, but also notice that nearly all interventions studied, (multiple metanalysis, etc.,) used educational interventions primarily.

    3. Education (Still important and demonstrates degree of efficacy)

    4. Collaborate

    • Involve family

    5. Collaborate

    • Involve community, Partnerships with community resources

    Conclusion

    1. Start with at Me.
    2. More contact and exposure to people with mental illness.
    3. More education.
    4. More collaboration.

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