Sunday, September 27, 2015

Reason, Conscience and the Unaffordable Opportunity Costs of TreatmentAs Usual

[draft, still rough, comments welcome]

For decades, medical model 'treatment' has consisted largely of pressuring people to conform to dominant culture values and declaring them cured if they do.  As a culture,  we tend to favor the appearance of conformity over the development of actual capacity.  To this end, we typically 'treat' away the evidence (signs and symptoms) that people are diverging from dominant culture norms.
In this paradigm of medical supremacy, the price of admission is reason and conscience.  For far too many of us, conventional treatments impair cognition and our capacity for it. Indeed, standard fair like neuroleptics and shock (yes, they still do that) literally kill our ability to make sense of experience and learn from it.  
Long before the cortical shrinkage shows on the MRI, we know our brains are dying.  We have lost touch with what we think and feel. We no longer notice cause and effect.   The energy to care.... went...?  We are reduced to a drooling ooze that ingests and excretes, but little more. The irony is that this damage comes from the 'treatment,' not the 'illness.'  
Lets make another thing clear.  The opportunity costs are dire.  Not just for the person in question.  Also, for treaters and society at large.  It's not just individuals who are lose their capacity to make sense of experience - it's our entire culture.   

Opportunity Costs of TAU

These losses are so important, that I'm cataloguing them here:

Loss #1:  Individual Lived Experience

There is a lot of learning value in a person's experience - even an unpleasant one.  The person's reason and conscience presumably had much to tell us about their human condition as they understand it.  This includes:
  • why they were experiencing what they were experiencing
  • what factors contributed to that
  • how that led to where they are now (in terms of feeling, thinking, doing)
  • what others could have done that might have been helpful
  • how injuries could have been prevented - for them and or others
  • what could help to repair those damages now
  • what kinds of things support capacity for reason and conscience for people in their shoes; 
  • what kinds of things get in the way - or destroy it altogether. 

Loss #2:  Professional Learning

There is a lot of potential value to professionals of learning how to support people to access reason and conscience  -- especially when people are going through difficult times.  

The current assumption of the 'helping' professions, however, is that people are unreachable.  Service systems thus assume that people need to be told what to do, given clear directions and 'encouraged' to follow them. Little effort is made to learn from people who are going through distressing times how to support them to survive distressing times. 
The experience of many alternative approaches suggests that this is something that could be learned - if there were a will on the part of providers. This is a huge loss to the provider profession -  future service recipients - and society as well - are footing that bill. 

Loss #3:  Natural Supports Die an Unnatural Death

Ordinary citizens look to providers as leaders and take their cues from them.  When providers represent that people are incapable of reason and conscience, lay people usually follow their lead.  As a result, most family, friends and neighbors simply resort to doing what providers do:  They give directions, advice and push pills.
Despite longstanding loyalties, far too few in our natural social networks make a sincere effort to journey with the 'person of concern. Not help or fix or reassure or have the brilliant answers. But actually journey with -- one person to another --as fallible, vulnerable human beings on a human journey. 
That no one is sincerely making this effort with people in their hour greatest need is a travesty and a waste. Not only does it leave people essentially alone at the very times in their lives that they feel most vulnerable, it dumbs-down the supportive capacity of our whole society. Nobody learns to walk with people because nobody tries to walk with people - not as heroes or experts - but as ordinary family, friends, neighbors, schoolmates, and co- workers -- when challenges arise. 
When you think about it, this explains a lot about why relationships between families and 'identified patients' routinely go so bad. Imagine experiencing the darkest of of  life. You used to have a family that listened, took you seriously, tried their best to understand. Now all that is gone. Not because your family couldn't still do it. But because they are rotely aping what they've watched the pros do. 
On some level then, it's not really their fault. (Okay. There are exceptions). The Nuremberg standard would allow some leeway for 'just following orders.'
On the other hand, blood-tie loyalty is supposed to count for something. The typical response when outsiders break down your door, barge into your home, tackle you, shoot you up, humiliate you and prepare to drag you off on the worst day of your life is not to stand by,  take notes, and promise to help them do it again the next time you are having a hard time. Sure, Joseph eventually forgave his brothers for leaving him in the pit. But that didn't make them heroes of the Pentateuch. 

    Loss #4: Cultural Awareness to Be Gained From Mental Trials 

    We are losing our capacity as a society to think meaningfully about difficult mental experiences.  If no attempt is made to understand and make sense of difficult experiences, then meanings are not looked for and therefore not found.  This reinforces the false assumption that meaning cannot be made.  
    This dearth of initiative hurts not only current individuals, but future generations too. Literally, our kids, grandkids and great grandkids are losing out.  There is a boatload of learning that our culture could be doing now. It would help them greatly if we had the will to do it.  Instead, we're sitting around drinking industry kool-aid and watching the sugar continue to crash us.  This abdication of responsibility is not worthy of anyone.

    Loss #5:  Potentially Prophetic Messages 

    We are losing our capacity as a culture to extract the meaning value from difficult experiences.  While some meanings, undoubtedly, are personal, others can speak to an entire culture. Like other creative endeavors, some of what gets labeled madness expresses the zeitgeist of an era.  This includes meanings - prophetic in nature - that we as a culture may need to become conscious of and respond to in order to survive or transform.  (Think Beatles vs the garage band next door.)
    Examples include:

    • Numerous Black activists were institutionalized as 'dangerously psychotic' during the 1960s civil rights era. 
    • The same women who needed uppers to survive 1950s gender roles were burning bras and staffing domestic violence shelters only a couple decades later.  
    • The same 'homosexual' leanings that used to get you locked up without a key now qualify you for a life partner and marriage.   

    Loss #6:  Inherent Dignity of Our Own Minds

    When difficult experience is trivialized as nonsense the price is human dignity. It does not say much for human minds if, as a species, ours are as broken and arbitrary as psychiatry maintains.  As a species, can we really feel good about ourselves - our brains and bodies - when every divergence from the normative is relegated to the realm of a meaningless, incomprehensible marker of illness? 
    Compare that with the following alternative, which seems just as plausible if not more: 
    Our experiences, while difficult, can be understood.  Our minds and bodies have a wisdom of their own. We can learn to  understand what they are trying to tell us if only we try. There is much to be gained - both personally and for our culture - from making that effort.  

    Which 'brain story' would you prefer for our species? Which of species above would you feel better about belonging to?

    Loss #7: Belief in Our Capacity for Mental Resilience

    Over the past several decades, our faith in the resilience of our species has taken a terrible dive. We have been talked out of believing in our own resilience and into believing that we need what the medical industry sells. As a consequence, we no longer see our species (overall) as capable of developing the interior qualities needed to transform and grow beyond mental difficulties.
    We believe we need a pill. Or, even if we don't, most people do. 
    The way the reasoning goes:
    Minds are disease-prone things that should not be left unwatched. The fact that people so often have difficulties 'proves' this. The appearance of difficulties shows that illness is present and biologically inescapable. You know the illness is there because you see it come up when a difficulty arises.  
    Human beings simply cannot handle the difficult mental states that arise at these times.  That is why people need pills. There is no hope of a different outcome due to how the brain is. This is why we give people pills and why people need to take the pills we give them. 
    If your 5 year old was trying to learn to ride a bicycle would you put up with this logic? What parent says: 

     I see that you had difficulty balancing when you tried to ride. That means you have a balance problem. It stems from a genetic defect that you will never overcome. We know that because you had trouble balancing when you tried to ride
    So here is the solution: So we will put  training wheels on your bike. You will need to use them for the rest of your life.  Otherwise, you will never be able to keep your bike upright. If you try, you will fall. We are certain of this. Your genetic balance problem guarantees it. 
    So make sure you ride with the training wheels on. Without them, your balance problem is sure to act up, and then you are certain to fall. 
    Suffice it to say, this is stunted logic. The difficulty proves nothing in and of itself. Neither does its continuation under the conditions prescribed. No improvement occurs because there is no new learning. No learning occurs because there is no opportunity to learn. 
    Listening to this kind of stunted logic, is stunting our growth - and not only as individuals. When individuals fail to learn, so do families, communities and entire cultures. We are literally stunting our growth as a species.  

    (Thanks to Chris Hansen of Intentional Peer Support for this example.)

    The Penultimate Loss (revisiting #5)

    The penultimate loss in all of this is that our reason and conscience are there for good reason. They are usually trying to tell us something. And given the nature of conscience, the message is probably important.  Most likely,?colossally important compared to the customary social value of putting up a good appearance.   
    But if people area going bonkers - whether individually or collectively - and no one tries to understand that, then we'll never know what the meaning is. We can bet that we're missing something.  We can bet that it's important. Should it really take disaster to wake us up?  That seems kinda,     erhm....  diagnosably unsound. 
    It's like the story of the three little pigs - on steroids.  Psychiatry, Pharma and Corporate America are out there reassuring us that it's just fine to build our houses out of sticks and straw.  According to them, the main purpose of life is to feel good and play.  
    While this message has a certain appeal, my conscience isn't buying it.  My gut is actually pretty clear there is a wolf coming.  Yep, wolf is a feeling that just won't shake.  
    Partly because floating over the wolf of my hallucinated world is a cloud. Inside the cloud, an endless line of zombies stagger down a two-forked path.  At the end of one fork, there is a bomb that never stops exploding.  On the other fork, the tide never stops rising. The choice of which fork does not really matter. The people that are reaching it died long ago.
    The way out of that, my reason counsels, isn't more pills.  There is also the question (pretty rationale) of whether you can trust the corporate-types and Trader Pros (who reliably push the pills) to also reliably push the zombies in the direction of a better world.  
    The clincher however goes to conscience. The fight is exhausting. Like Wreck It Ralph, there are fantasies of changing my game mid-course:  You could be a 'good-guy' too. Why not just pretend these people know what they're doing? Yanno, go along to get along?
    I could live with the grinding stomach.  But the wagging finger behind the eyes gets me every time. Don't ask me how a finger can frown, then scrunch up quizzically like a goblin face. Still, when it snorts itself into the head of a mare, and disgust kicks up from the hooves like dust, l remember...
    There's a stockpile of bricks and a house to build! 
     Aww, shucks...  No rest for the weary again today. 

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