One problem I have encountered in my journey through mental illness, is when people see mental illness as such an all-encompassing problem –  or when they see the illness as the whole picture before seeing the person behind it.  It is natural to do this.  The results of it can be disastrous, and sometimes when someone is ill, sickness can be the only thing that is visible.  But I entreat you to look deeper. In my experience, when someone acknowledges your suffering, but sees the whole person – that you are unconditionally well, behind a veil of illness, you can reach beneath it to the person who is always a lot more than their particular composite of symptoms.  We are not our diagnoses.  And This is not just a catch phrase.  We have to see a person’s value ourselves as clinicians, or how can we expect them to see it?  We have to envision something if we expect it to ever be possible.  The danger of seeing an illness first, is that you see the purpose of treatment as symptom reduction only.  But we are not symptoms to be reduced.  When we have confidence that a person can return to wellness, when we focus on the inherent wellness of the person instead of the symptoms, we can then circumvent this traumatic clinical battle against some slippery, almost undefinable disease, with the patient as the battleground.  Now, how does it feel to be the battleground? Some of you can tell me at the end, I’m sure.  From my experience, it sucks.  You end up fundamentally hating a part of yourself, or living in fear of it emerging.  Those parts you are often taught to push away– they ARE you.  Different parts of you.  And only when you can face them, accept them, and embrace them, can you hope to dissolve them and reabsorb them into the well from which they came – you.  And the you, is basically fine.  If the patient can be seen as basically good, filled with potential, that their case, their trajectory, is workable, and our coworkers and bosses and family members can all be seen in the same way, we resist the urge to project our ideas onto them and fix them, because we trust that they’re words are valuable, that they are simply people in need of assistance – people whom WE are serving, and that they are a part of this process too. And slowly, we learn to see not just our own role in the helping process, but also, simply the people front of us.

When we see a patient as a person, we can hear what people are saying to us, instead of looking for key words to help guide us into putting their concerns into little boxes of diagnositic criteria.  Suddenly, then you can communicate better, and you collaborate better.  Slowly, when the ego and the fear normally propagated by our training and by the existing medical model fade into the background, wisdom mind, and the true ability to heal and be healed, will begin to surface.  And when I’m having a particularly unenlightened day and I think this all sounds flaky, I ask myself if that’s my fear and my ego talking, or my intelligence.  And then I laugh at myself, swallow my pride, and my defenses relax a bit.

But seriously, We have to expand our notion of human potential if we are going to surpass cynicism and open to the possibility of real healing, and not just bandaid solutions, and revolving door treatment; but like pioneers and revolutionary thinkers in all cultures, one has to take a journey into unknown territory first,.  For one, psychiatry, although essential, does not replace the wisdom of having worked with one’s own mind on the level that peer support workers have had to. With their complimentary expertise, they could also be leaders in the health care world – they get it, and are examples of healing in the face of many voices which say it is possible, but don’t really expect it.

Regarding peer support: It is Interesting – med school goes beyond the experience of most patients and family members– most are not doctors, but so too does mental illness transcend and move outside the realm of direct experience of most psychiatrists – how then can they be the only  guide in healing someone when their knowledge is theoretical, and  does not really know the territory with first person experience, and have not known what it is like, and perhaps don’t know what it is they are healing?  When they don’t agree with the patient on what they are healing?  I’m not saying they aren’t knowledgeable and that they shouldn’t be commended for their essential and powerful healing role, but peer support is like the oldest type of healing on our earth –shamanism – where one who has transcended common perception of reality or suffered in some extraordinary way steps into their suffering, and beyond it, to help others  – peer support is, in a way, a resurfacing, of some very important and ancient aspects of healing.

Peer support also validates that a patient might have some wisdom – integrating peer support is part of establishing this unconditional wellness and wisdom view in the mental health system.  And, when dr.s and nurses see former patients working and benefitting their team, it can help to reduce the stigma that is actually present and natural in the mental health system.  It is important to recognize that we do carry stigmatizing views as mental health professionals.  Because we have a tendency to see worst case scenarios and acute cases in front of us, we sometimes forget that there is life after and outside of the hospital or the clinic.  No one is trying to provide false hopelessness, but as I (and Daniel Fisher) would argue, the inadvertent communication of false hopelessness is a much more harmful systemic danger than false hope. We need to leap.  We need to restructure our systems around how we can go forward, and envision more for our clients.  Daniel Fisher, who I just mentioned, a psychiatrist and former ED of the US National Empowerment Center, often talks about how we must dare to love our patients, to care deeply and to give them hope if we are to influence them in a positive direction in their most vulnerable of states.  Daniel Fisher might be considered radical in his proposed empowerment of people with mental illness, but he has not come up with these propositions out of nowhere.  Daniel Fisher is not only a psychiatrist.  He also lives with paranoid schizophrenia.  He has experienced the system, and has seen what makes a difference from both sides.  He talks about that one person he met who listened, who told him he could fulfill his dreams – in his case, going to Med school to change the system.  That person made all the difference.  We are more powerful as influences in each others’ lives than we may think.  Just as that nurse stayed up with me in the Bridgewater psych ward  7 years ago and validated my concerns, and offered me realistic hope, all of us can be that voice that changes a life.

And evidence is behind me in this regard.  But vision always precedes evidence.  Courtenay Harding had to have the faith that her radical psychosocial experiments with people with schizophrenia could produce results, or she would never have been able to convince others to get behind her in performing these large-scale, longitudinal studies.  She needed to trust her instincts, that these people weren’t irrevocably damaged.  And, as many of you know, she found that– people get better not with standard care, but with holistic, psychosocial, collaborative, community-centered care and a view that these subjects, these patients, these human beings, were not broken– still, this study published decades ago, and others, have not managed to infiltrate the predominant medical model to the degree that many of us have hoped.  It is true that multidimensional, psychosocial and early treatment programs are emerging, but as you know, we still have a long way to go.

We don’t necessarily need one more nurse, a different psychologist, a more cooperative, “compliant” patient; we need a bigger view; we need a systemic shift in purpose and a return to awareness about the reasons why we are helping these individuals who are struggling.  In helping them, we help our larger society.  If we propagate insight, and not neurosis, we create more wisdom and resiliency.  How we treat our sickest people is how we treat ourselves, and vice versa. – they, or we, do not need the paternalistic, categorical problem-solver of old – we need people who can see past our struggles and remind us of our own healing capacity and wisdom, our own unconditional value underneath all of our supposedly wrong views or behavior.  Remind us of our agency and dignity, and we will rise to your challenge.