As far back as the middle ages, society has had negative beliefs toward the mentally ill. At that time, the predominant belief was that the mentally ill were possessed or in need of religion. These beliefs set the foundation for our later treatment of those who had mental illness with confinement, poor conditions and abuse in the United States.
In the mid 1800's Dorothea Dix spearheaded efforts to created specialized institutions where the mentally ill could be cared for. However, although well-intentioned, these institutions became plagued with widespread abuse. The predominant underlying attitude for the mentally ill was one of contempt. In the 1940's compulsory sterilization laws existed in over half of the countries in the United States. In the 1950's Watt and Freeman began to perform Lobotomies on the mentally ill and soon after electroshock therapy was introduced as a treatment widely used on those suffering from schizophrenia or other mental illnesses. This barbaric therapy was a far cry from the current and effective Electroconvulsive therapy (ECT) used to effectively treat people who are suffering from paralyzing depression.
Deinstitutionalization began in 1955 with the widespread introduction of chlorpromazine, commonly known as Thorazine, the first effective antipsychotic medication. The movement over the next decade would be towards community-based care and was considered more humane for the mentally ill. However, it was not adequately implemented or funded. Today many of our jailed and homeless consist of the mentally ill. We still live in a society where the mentally ill are an underclass: abused, exploited, misunderstood, and in need of advocacy.
Many of my clients come to my office complaining of the lack of compassion in the previous service providers, specifically those they encountered during their hospitalizations. I repeatedly hear they feel like they are treated more like criminals than people who need help. Hospitalization experiences are more often traumatizing than healing. This is unfortunately even more true for children and teens than it is for adults. They report these experiences to be shaming and their interactions with staff to be ones where they feel demeaned or criticized. Of course, this is not the case with all facilities and all providers, this is just generally the experiences my clients report to me. The sad fact is that as a society we still tend to stigmatize the mentally ill and to lack compassion for them. Furthermore, so much of the work I do with my clients is around OVERCOMING STIGMA. I fully believe if there wasn't so much judgment and stigma, they would be much more functional.
Current Method of Diagnosing Clients
One of the dilemmas I have as a treatment provider is that of diagnosing clients. It automatically causes me and my fellow clinicians to look at clients through the lens of deficiency. While it can be helpful to secure needed services in the workplace and school setting, as well as insurance payment, it sets us up to look at fellow human beings as if they are less than, and we as the treatment provider as superior. With power differential comes an array of issues. I am torn between the benefits and possible harm it does.
Gail Hornstein a professor of psychology at Mount Holyoke College rejects the idea of labeling patients with a diagnosis and questions our traditional treatment methods for those who struggle with mental illness. She believes peer support and empathetic listening should replace our traditional methods of treating the mentally ill. This model also rejects the hierarchical nature of the traditional therapy model.
She refuses to even use the term mentally ill because she believes it's pathologizing. In her interview with The Sun in The Voices Inside Their Heads: Gail Hornstein’s Approach To Understanding Madness she discusses how using the term emotional distress would be more helpful for people because the expectation would be that they could recover, and they would be likely to be treated with compassion by society.
She also discusses in this article how diagnoses can be limiting. If we label someone as schizophrenic, or bipolar, or as having major depressive disorder, it can cause us to make assumptions and those around us to make assumptions. Those judgments and assumptions might be harmful to the way that a person sees themselves as well as how everyone else sees them. They also limit our compassion and in turn limit our client's growth.
Peer Led Groups Help Those Who are Struggling to Give and Receive Compassion
Additionally, she discusses the harmful myth about the mentally ill that they are unable to offer empathy to others. Her experience with those who are severely mentally ill is that when allowed to offer each other kindness, compassion, and support, in a setting where they are valued they are very empathetic and that they show improvement. This is true for people who have been diagnosed with severe mental illness and made no progress through traditional vehicles of treatment.
She advocates for treatment in the form of peer support where they can offer and receive kindness in this way. In a peer setting, people who are suffering from, hearing voices, for example, are allowed to see that others suffer in the same way. This decreases the sense of isolation that so often exacerbates whatever emotional distress they are struggling with.
'Another organization that practices this philosophy is Hearing Voices. She discovered this organization when researching her book.
This organization provides support and education for people ( in a nonstigmatizing way) who for whatever reason are hearing voices and struggling with their own and others judgment about this. Groups are led by peers not therapists. The hierarchical nature of the therapeutic relationship is often the source of issues for people who have struggled with mental illness.
In my work with clients who have struggled with mental illness, I have noticed that often professionals have difficulty listening to the clients. When treatment options don't work, rather than looking at the nature of the interventions, or the treatment of the assumptions providers are making, we often will assume it's the clients fault. To have compassion as professional we must listen so we can understand what another person is truly going through, and the mentally ill rarely feel that they have a voice. One of my adolescent clients shared this frustration with me a while back.
" If you have a mental illness, there isn't anything that you can ever do or say that is independent of it. Sometimes I say and do things that are just because of me, and not my bipolar disorder. Sometimes my reactions are reasonable and healthy, but others just don't take responsibility and scapegoat my illness ."
Part of the difficulty lies in our treatment models, diagnostic practices and the history of how we conceptualize mental illness.
Paul Cezanne/ The Four Seasons, Winter
Frisch, T. (2011, July). The Voices Inside Their Head. The Sun. Retrieved from https://www.thesunmagazine.org/search?q=the voices inside their heads