“Madness is a full and legitimate human experience”

This is a quote from Mary O’Hagan, user of mental health services in New Zealand, and Mental Health Commissioner.She was the keynote speaker at last year’s Scottish Recovery Network conference.

Her speech was one of the best summaries of ‘recovery’ as it applies to mental ill health, mental wellbeing and service developments that I have heard for some time. Recovery has been a theme on this blog for a while- here and here for example. You can listen to it all below.

All the more important at a time when nearly all media portrayals of mental illness are negative and dangerous to others, according to this report.

And if you think that this stuff does not apply to you- then consider this- mental ill health comes to all of us directly or indirectly. And even if the shape of your life keeps periods of crisis at bay, then I would contend that we learn far more for the human condition through coming to an understanding of mental distress than we do from a lauding only of success.

For those of us of faith, the hope of recovery is saturated with that most precious thing-

grace…

Recovery stories, and how we understand mental ill health…

I have been reading a few of the personal stories on the SRN website, and it set me thinking again about this thing called mental illness.

For those who are unaware of the powerful and life giving concept of ‘recovery’- in this use, is applies to a way of understanding mental illness that is radical and yet very simple. For too long, the dominant way of understanding mental illness has been through a medical paradigm-

Dysfuntion——————–Diagnosis———————Treatment

But for years, there have been voices saying that this way of seeing mental illness just does not work on any level.

Dysfunction?

What is ‘dysfunction’ when we apply it to mental health? We all have problems. We all have fluctuating mental health. One in four of us seek medical help because of this at some point of our lives. For the most part- we just get on with it, life goes on.

It is such a subjective experience. What you experience and cope with, I might experience and not cope with.

It might relate to a dreadful life event, like bereavement, or it might be because of vulnerabilities that we have carried since childhood. It also might have a biological/genetic element- although no-one has ever been able to agree how much of our vulnerability is nature, and how much is nurture. Because of this, the same ‘dysfunction’ may in fact relate to very different issues.

But there is no doubt that many of us do hit the rocks emotionally, psychologically and spiritually. Some of us will need help, so we go to the experts.

Diagnosis

Then we come to all the labels that psychiatry has come up with in an attempt to categorise dysfunction. Each one with its own set of sub categories- some examples below:

Schizophrenia (simple, paranoid, hebefrenic, etc)

Depression (reactive, chronic, manic, agitated etc)

Anxiety disorder (panic disorder, phobia, obsessive compulsive disorder etc)

Now all of these categories have a set of symptoms that we look for, and even (in today’s parlance) a ‘care pathway’ that people will then be expected to follow- with recognised assessment processes and evidence based interventions lined up and ready.

But make no mistake- researchers have looked in vain for a virus, or a brain-wiring fault, or any kind of identifiable physical, testable, observable location for these disorders. They are not like a broken leg, or a cancer, or other kinds of medical issue that are diagnosed according to observable scientific observation. Rather they are always nuanced, individualistic, mixed in with all sorts of personality/life experience/drug use stuff, and all that messy, unquantifiable humanity.

So what we have is a changing picture (we currently use international standard diagnostic classification version 10) of fairly loose observationally based, subjective categories, albeit applied as consistently as possible by highly trained and experienced doctors. The edges of the diagnostic categories are blurred, and their usefulness still much disputed.

Check out this decent summary of labelling theory.

Treatment

When we have our diagnosis, then we have associated treatments- usually drug based, intially from our GP. Sure there are lots of other ways of getting help- often called rather condescendingly ‘talking treatments’- counselling, psychological therapy etc, but these are not universally available, and the middle classes get far more than their fair share. Also because of the dominance of the medical model (which assumes some kind of biological basis for serious mental illnesses like schizophrenia) then most of this talking stuff is aimed at people who are regarded as ‘neurotic‘- as if these people are some how totally different in their needs to be listened to, understood and helped towards a greater self knowledge and self worth.

Most of the drug treatments are very ‘dirty’- in the sense that they are loaded with extremely debilitating side effects. The activity of the drug companies, and the power and position the system allows them to take within hospitals has to be seen to be believed. There is always a new wonder drug just round the corner- a new ‘lilly the pink’.

And yet, research would suggest that ‘getting better’ is not the goal of all this treatment for many of us. Rather it is aimed at alleviating some of our symptoms, and ‘maintaining’ us in some kind of stasis.

For some, this is OK- they are grateful and satisfied. For many more, the effect of the psycho-medical machine is to give a half life, or even a no-life. People lose just about everything- job, relationships, income, role, self worth, self determination, hope. Is there any wonder then that suicide rates are so high?

At the same time as experiencing all these losses people gain a few other things- a label, a new ‘sick’ role, benefits that have diminished in value in real terms. It is a poor exchange. Because in gaining this kind of identity- or rather being expected to live within the boundaries of this kind of identity- we are condemned to a dependent life. And transcending this can be extremely difficult.

Perhaps it might be far more difficult than the mental distress that started us down this road in the first place…

So, returning to the recovery stories.

These are records of people who have decided that it is possible to experience good mental wellbeing despite the presence (or the absence) of mental ill health.

They describe the landmarks on the journey towards a different kind of recovery- one that is less concerned with diagnosis or treatment, and much more motivated towards real life issues like

Hope

Self worth.

Real choice.

Friendship.

Meaningful activities.

Fun.

Please read some of them- because I suspect that there is more of the Kingdom of God in one of these stories than in a thousand sermons.

Hope for recovery…

I spent an afternoon meeting with some people who came together to discuss the establishment of a Recovery Network for people who have experienced mental ill health in Argyll.

The Recovery movement is one of the most exciting things to happen within the mental health world for years. It is a grass roots movement, turning the power relationships in psychiatry upside down. It’s persuasive idea is that we need to stop doing what we are doing, because it is not working- rather we need to equip, empower and inspire people towards control of their own choices and decisions towards building real and meaningful lives.

I was reminded again yesterday of the word HOPE.

Because recovery does not depend on the presence or absence of illness- for most people mental health ebbs and flows. For some of us, this ebbing and flowing can be more severe.

But recovery very much depends on the presence or absence of HOPE.

And where hope is being raised, it makes visible to me a kind of humanity that make clear that we are beautiful creatures, made a little lower than the angels.

But let us make no mistake- hope is a dangerous and scary word. It contains all possibilities, but also the danger of disaster and failure. It is something that we need to hold on to firmly but tenderly, like a bottle of nitro-glycerine.

And we need to acknowledge that for many, there is a recovery journey that begins first in daring to use the word again…

Here is a little more Foy Vance-

If theres one thing that I know
It is the 2 shades of hope
One the enlightening soul
And the other is more like a hangman’s rope
Well it’s true you may reap what you sow
But not that despair is the all time low
Baby, hope deals the hardest blows

There was once someone I loved
Whose heart overflowed his cup
And his shoes got covered in blood
Oh but he never knew cos he only looked up
Well he was in trouble and so
Had known pain more than most I know
Yet it was hope that dealt the hardest blows

And the girl that holds the hand
Of her somewhat distant man
Though she did everything she can
Still his heart set sail for distant lands
And she wonders sometimes if he knows
How she feels like a trampled rose
Baby, hope deals the hardest blows

Well some people think their sin
Caused the cancer thats eating into them
And the only way that they can win
Is by the healing of somebody’s hands on their skin and praying
But when the cancer does not go
Baby, hope dealt the hardest blows

And now all these truths are so
With foundations below them
They were dug out in a winter’s cold
When the world stole our young and preyed on the old, well
Hope deals in the hardest blows
Yet I cannot help myself but hope

I guess that’s why love hurts
And heartache stings
And despair is never worse
Than the despair that death brings
But hope deals the hardest blows, dear
The hardest
Hope deals the hardest blows

Making recovery real…

To Oban today to a Scottish Recovery Network conference on the promotion of ‘recovery’ as a concept and driver for mental health services, and more importantly, for those of us who experience mental ill health.

It snowed, and so we were a bit worried about the drive, but in the end Audrey, Victoria and I got there and back with no trouble.

The challenge and critique brought to services by the change of thinking and shifts in power required to move towards a recovery based system (rather than an illness based system) has been the stuff of my working life for a while now. I have found that it has had the capacity to reignite my passion for the work that I do.

I have spoken about recovery before- here and here, but for those who have not come across the concept before, here is the definition from the SRN website-

“Recovery is being able to live a meaningful and satisfying life, as defined by each person, in the presence or absence of symptoms. It is about having control over and input into your own life. Each individual’s recovery, like his or her experience of the mental health problems or illness, is a unique and deeply personal process.”

It is about trying to stop expecting people to fit into hierarchical burearocratic structures, but rather shifting power from the institution to the individual. It is about creating opportunities for people to rediscover hope, and to re imagine what a fuller life might look like.

You could say that it is about the redemption business- the Jesus business. And where he is, I want to be near.

But lest you think that I am doing that familiar paid helper thing, and dividing the world into us (the professionals) and you (the recipients of our expertise) then let me confess that I too am in a process of recovery.

Or should I say sometimes I am.

Because we were asked today to consider what might contribute to our own ‘wellness’, and people gave the usual answers- love, relationships, long walks in the country, meaningful activity, meditation and rich ruby wine… But I was led once again to reflect on my own mercurial sense of wellbeing, and how fragile it was at times.

Because sometimes it seems as though I am merely a victim to unfolding circumstance. Things happen, and I have little control over them, nor my emotional reaction to them. Of course, this is not true. There are lots of things I do, or avoid doing that make me who I am.

It is perhaps more like one of those slow unfolding accidents, that give you chance to react and minimise the inevitable impact- which is nonetheless still painful and shocking.

Of course there is such blessing in this journey of mine too- and I am so grateful that I do not walk alone.

So by way of celebrating these continuing outbreaks of redemption, almost in spite of my own ability to miss them- I offer you this lovely poem by Gerard Manley Hopkins-

As kingfishers catch fire, dragonflies draw flame;
As tumbled over rim in roundy wells
Stones ring; like each tucked string tells, each hung bell’s
Bow swung finds tongue to fling out broad its name;
Each mortal thing does one thing and the same:
Deals out that being indoors each one dwells;
Selves—goes itself; myself it speaks and spells,
Crying What I do is me: for that I came.
I say more: the just man justices;
Keeps grace: that keeps all his goings graces;
Acts in God’s eye what in God’s eye he is—
Christ—for Christ plays in ten thousand places,
Lovely in limbs, and lovely in eyes not his
To the Father through the features of men’s faces.

‘Road to recovery’, and ‘spiritual capital’….

BEWARE- this is quite a long post, but please bear with me dear readers, as I think it deals with rather important stuff… but then I would say that, wouldn’t I?

recovery

Powerful image from here.

I love it when you come across something unexpected that reeks of the Kingdom of God…

I spent all day yesterday at a development day and Annual General Meeting for the Cowal Council on Alcohol and Drugs. I am one of the volunteer directors of this company, who provide counselling and support for people with addictions in this area. I am proud to be part of the organisation, which like all such voluntary sector small companies has had some challenging times.

At present, I think it is a good healthy place to work, and brings genuine help to people who suffer from addiction to drugs and alcohol in our area. Our area (the west of Scotland) has seen too many lives cut short and families devastated by addiction. But there are many people who we are not able to help- and the purpose of yesterday was to try to consider how we might set our agenda for next year to do better.

I was part of a discussion yesterday about the concept of ‘recovery’.

Recovery is a word that I am very familiar with from the point of view of mental health services- in this context, it is life giving and hope enhancing. Check out the Rethink website, or the Scottish Recovery Network site. I seriously think that any Christians interested in seeing the words of of Isaiah 61 made real in our time should become familiar with what is happening in the area of Recovery- a lot of the sites are full of personal stories that make you weep. Chains are breaking, and we people of faith ought to celebrate and support as much as we can.

Until recently I was not aware of how much the concepts of recovery are starting to cross over into the the field of addiction.

This is an excerpt from a recent Scottish Government document called ‘The road to recovery‘, which specifically addresses addiction to drugs-

81. What do we mean by recovery? We mean a process through which an individual is enabled to move on from their problem drug use, towards a drug-free life as an active and contributing member of society. Furthermore, it incorporates the principle that recovery is most effective when service users’ needs and aspirations are placed at the centre of their care and treatment. In short, an aspirational, person-centred process.

82. In practice, recovery will mean different things at different times to each individual person with problem drug use. Above all, people aspiring to milestones in recovery must have the confidence that they can achieve their personal goals. For an individual, ‘the road to recovery’ might mean developing the skills to prevent relapse into further illegal drug taking, rebuilding broken relationships or forging new ones, actively engaging in meaningful activities and taking steps to build a home and provide for themselves and their families. Milestones could be as simple as gaining weight, re-establishing relationships with friends, or building self-esteem. What is key is that recovery is sustained.

83. Recovery as an achievable goal is a concept pioneered in recent years with great success in the field of mental health. The Scottish Recovery Network has been raising awareness of the fact that people can and do recover from even the most serious and long-term mental ill-health. 32

84. The strength of the recovery principle is that it can bring about a shift in thinking – a change in attitude both by service providers and by the individual with the drug problem. There is no right or wrong way to recover. Recovery is about helping an individual achieve their full potential – with the ultimate goal being what is important to the individual, rather than the means by which it is achieved.

‘Recovery’ is essentially a collection of grass roots movements growing out dissatisfaction by users of services who are sick of being ‘done to‘ by professionals, and are looking to break free- not only from the specific difficulties affecting their lives, but also from the industry and economy generated by medical, social and political attempt to ‘cure’ them. The fact that recovery is now forming a part of government documents is both a triumph and a threat. It is a threat because there is a real danger that the word becomes just a word. It stops to carry any passion, or any hope…

But back to our discussion yesterday.

One of the things evident to anyone seeking to discuss the possibility of recovery with people who have been forced beyond the edges of society by addiction, mental illness or stigma and discrimination, is that there can be no recovery without mental wellbeing, and there can be no mental wellbeing without real opportunities to build friendships, find meaningful activities and participate in our towns and communities as both recipients and a contributors.

I have blogged several times about the idea of Kanyini, and how the loss of identity, purpose and spirituality amongst Aboriginal people has led to a loss of their very selves. Anyone who has spent any time amongst people with addictions (who have may also have lost everything) will resonate with Kanyini. Bob Randall speaks movingly of how his own people have fallen into addiction, isolation and mental illness…

There was a discussion yesterday about how we might be able to encourage these things in our organisation, and more importantly, our community-

  1. Recovery capital- how do we give power and control back to people who use our services, and provide change opportunities, not ‘slots for treatment’?
  2. Social capital- how do people find meaningful social connections, from a position where trust and opportunities have all but disappeared?
  3. Spiritual capital- this gave some pause for thought, so more on this one below!

What is ‘Spiritual capital’? I suppose this rather depends on your definition of spirituality- but lets not get into that just now. In this context, I think Spiritual capital refers to MEANING. The meaning on life, the meaning of love, the meaning of small stuff, and the biggest stuff.

Most of us do not need to dig into this too much- we have no time, and the scaffolding around our lives- jobs, marriages, mortgages, etc- means that we are insulated from the biggest questions. But people who have none of this scaffolding and have reached the end of all their coping, even the bottom of the bottle- these people have a whole different place to look at spirituality from.

Interestingly, the discussion in one of the other groups seemed to get into RELIGION. There are some Christian organisations involved in addictions work. Some of them use high octane charismatic deliverance kind of stuff- which to be honest, I kind of find slightly disturbing. But then again, if it is meaningful and helpful to people involved, great. My fear is that one addiction is replaced by another on, called GOD- and this can indeed be a dangerous addiction for some…

But I wonder if Spiritual capital can be seen more commonly in encouraging people to consider things relating to the heart of who we are, rather than the material stuff that we surround ourselves with…

And in this, I think people who have suffered addiction, or experienced mental health problems, have much to teach the rest of us…

As for me, it started me thinking about a writing project, and I had a great conversation about the possibility of a ‘recovery cafe’ with my mate Ali…