Does ‘mental illness’ work as a metaphor?

February 15, 2020

Metaphor

Suggesting that mental illness is a metaphor is not intended to disparage psychiatry. Rather, it is an attempt to answer Thomas Szasz’s (1974) now infamous critique that psychiatry has no medical or scientific basis, but is purely descriptive, grounded, rather, in legal, ethical and philosophical issues.

Szasz’s view might be that ‘schizophrenia’ as a diagnosis a medical fiction but is a great label for a set of behaviours and experiences that are not widely tolerated as normal.

Be clear, of course, there is something important going on with those experiencing, for example, schizophrenia, autism or ADHD, which is very real for those who suffer from the symptoms. The impact of such symptoms is high: one in four people in the UK suffer from a mental health episode each year, which commands poor resourcing for intervention in comparison with high-profile physical illnesses such as heart disease and cancers. Mental illness still attracts stigma and is hidden in the fabric of culture.

For PositiveWays, metaphor is a more imaginative way of communicating the impacts of mental illness. In fact, some metaphors themselves can appear irrational; What is the meaning of ‘their goose is cooked’.

The paradox being, for example, those living the delusional world of a ‘schizophrenic’, seemingly fail to distinguish the metaphorical from the literal or real world. The schizophrenics may be collectively defined as taking metaphor literally, or embodying (being an expression of or give a tangible or visible form to) a metaphor while in a disembodied (or separated from reality) state.

Psychiatrists seemingly use metaphors, such as ‘the body as machine’, to make sense of and communicate their patient’s angst and experiences. Ironically, a symptom reported by patients suffering from schizophrenia is that machines place thoughts into their heads by ‘thought insertion’ or in hypnotherapeutic terms, auto suggestion.

The very imaginative qualities we associate with literary use of metaphor, transferred across to rational human behaviour, and were seen or interrupted as abnormal. With the arrival of the DSM, now in its fifth edition, conditions became concrete representations.

Slowly, the DSM became more excessively intricate or elaborate as it attempted to classify a messy social world of complex and context-dependent psychological behaviours, while the same behaviours were systematically reduced to commonly shared brain mechanisms that collapse the historical, cultural, social, and local or idiosyncratic. This is not to say that neuroscience has simplified brain mechanisms. Rather, the simplification comes with the reduction of difference in the social world to self-versus-same in the brain’s anatomy and functioning.

Psychiatry has been described as using a system of knowledge ‘that is not a copy of facts but a representation of them’ (Martinez-Hernaez 2013, p. 1019) – a culturally specific ‘folk knowledge’ disguised as objective science.

In the process, actual folk People or patients’ individual differences and experiences have been eradicated and may be lost to us all.

 

The language of DSM makes claims for an asocial and universal character of mental illness categories (at the same time as it multiplies up those categories, or fine-tunes them into a complex almost statute state) for clinical practice and judgement as neutral and non-moral

Categorization of mental illness then proceeds, paradoxically, as ‘the concealment of metaphor’ and these metaphors, in turn shape psychiatry.

At the cultural level, psychiatry has bought in to the general metaphors of the body as machine and medicine as aggressive and competitive (‘let’s beat mental illness’).

Rosenman (2008a, p. 391) suggests that a category such as (by exposing the metaphors) assumed:

  1. chemical imbalance (metaphorical because there is an assumption about what a normal ‘balance’ of neurotransmission in the brain might be – balance then becomes a metaphor rather than a measure);
  2. degenerative (based on assumed wasting away of specific brain structures – a metaphor of the ‘unseen’);
  3. ‘toxicological’ (assumed exposure to an abstract ‘noxious’ psychological environment, and not measurable chemical changes such as nitrous oxide levels in the air);
  4. material damage to the brain as a result of psychological stress (again based on the unseen);
  5. deficiency of neurotransmitters such as serotonin (based on a metaphor of lack without any measurable baseline);
  6. reference to a ‘medical mystery’ paradigm-shifting breakthrough (a metaphor of pending ‘discovery’);
  7. evolutionary benefits (it helps us adapt to poor circumstances)

Metaphors are helpful. They teach us to tolerate uncertainty. We should be pleased to find a medical specialty that trades in metaphors without embarrassment

We must warm to, or befriend, metaphors – we cannot afford to leave them out in the cold, they cannot simply be applied cold, and they do not drop into our laps as cold calls. Metaphor works only if there is intention and audience reception and understanding.

So, ‘my husband is a clown’ appears to be a metaphor, yet in this case Mrs Jones’ husband does in fact put on make-up, a wig, a funny nose and huge feet and apes around entertaining children at parties as a paid professional. Nobody would laugh at Mr Jones’ clowning if his intentions and his audience’s expectations did not match – all through the medium of metaphor. Mr Jones throws a bucket of confetti ‘as if’ it were water and the kids duck; he hits himself on the head with a hammer, but everybody knows the hammer is made of rubber; he mimes climbing a ladder and we all agree that the ladder is not there.

We then co-create metaphors as a common social endeavour – again, they do not simply fall out of the sky, and they do not work solo in front of a mirror. Brains alone do not do this – language and performance, along with the use of artefacts (such as cooking utensils, shelter, spectacles, books, computers and transport), knit brains together.

Yet, it can be argued that the expression and the reception of mental illness do not work in this co-creative way of shared production. In fact, their dynamic may be entirely different. A mentally ill person might indeed stand in front of the mirror and, in misrecognition, circulate metaphors amongst herself and her alter egos.

Studies of dissociative identity disorder (DID) suggest that multiple identities, or subpersonalities, are metaphorical in nature.

Imagine a contemporary scene update:

Macbeth Act 5, Scene 3, page 3

MACBETH: ‘How’s my wife?’

DOCTOR: ‘She’s overwhelmed by visions that will not allow her rest.’

MACBETH: ‘Can you not treat an ill mind by taking away her memory of sorrow? Can you not use some drug to erase the troubling thoughts from her brain and ease her heart?’

DOCTOR: ‘In that respect, the patient must heal herself.’ So, the patient must indeed look in the mirror and ask, ‘Can I make sense of this – or, in what way might this make sense?’

 

Adapted from; Bleakley, Alan. Thinking with Metaphors in Medicine: The State of the Art (Routledge Advances in the Medical Humanities) (p. 112). Taylor and Francis.


Illiberal – Sneaky Power & Surveillance Systems as Anti-Social Behaviour

January 18, 2020

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“For most of us, most often, justice means that we get our way, receive what we believe is our due, and punish misdeeds according to our values – and hormonal levels at the time”.  Flavio Zanchi

Punishment & Discipline

Michel Foucault tells us that punishment has moved from public and physical admonishment (like hanging), and towards and more psychological forms of punishment, including imprisonment, intended to discipline and control the populace’s mind. Punishment was intended to ensure that citizens’ rights were, and seen to be, protected, so that social order was maintained.

Small ‘c’ conservatives and small ‘l’ liberals might disagree on the purpose of punishment, but not that it should only be applied ‘lawfully’, meaning in accordance with the social contract. Even when it is applied lawfully, the populace often protests at the severity of the inept, cruel and overzealous government in power or decision makers.

Watch ‘em all the time

Bentham might say that what the power brokers did in response, was to make those who may need punishment, at some point in the future, feel constantly under surveillance. Bentham described the Panopticon, a prison in which the governor can always see the prisoner, even in their cell, at any time, but the prisoner can not see the government controller.

In this way, ‘prisoners’ have no choice but to behave as if they are being constantly watched. Power of controller’s mind is exercised over independent mind. Power is exercised by three prongs:

  1. Surveillance – constantly and sneakily
  2. Normalisation – make it acceptable to watch at a whim
  3. Examination – (and worse re-examination) to correct or punish those who do not fit the mould.

Conservatives might justify the controller as protecting the social contract. They could not argue that it is acceptable, for an individual or neighbour, to exercise such control over another, by say, constantly scrutinising, by sneakily editing videos & surveillance, unfairly reporting, and gossiping about another. That seems abhorrent and illiberal, especially if it is unlawful too.

Play by the rules

This is because private CCTV should be used to ensure the security of the property it is installed on, rather than recording the activity of neighbours. The boundary of a garden/property is a very good guideline beyond which activity could be considered intrusive. Security of the home is only breached if the boundary is crossed by someone intent on causing damage or committing a criminal act.

Additionally, personal photographs or video material should only be used for the purposes of assisting authorities to prevent or detect anti-social behaviour and not for publishing or wider use, particularly if they identify persons and reveal personal information about them.

So, we know what the law is, we know that conservatives would back the law, would liberals agree that privacy and dignity should be protected?

 


Peering into the Future

June 3, 2019

Mutual Aid

Peer Support is an emerging and evolving approach to Transformational Learning (TL), in which we commit to behave with dignity and to encourage self-determination for everyone, through Support, Hope, Advocacy, Personal Responsibility and Education (SHAPE).

The simple premise of Positive Ways Peer Support – PWPS – (adopting DENT©  principles) is that people and peers are; good enough; have the resources they need; can co-operate; are sometimes in need of confidence; but together, through mutual support and encouragement, they can make things happen.

PWPS provides many pathways to contribute, participate, join and influence group matters. It is an open form system, which means all can contribute and we are clear on how we work. We are all volunteers and so transparency is paramount, which means we explain our ways of working, investing and reporting.

This is because, TL is best achieved when we commit to the long term relationship, stay willing to resolve and settle relationship tensions and collaborate with others, both inside and outside of our group. Our aim is to build, solidarity, develop alliances and feel able to welcome those who may feel marginalised, to our groups.

This is because peer education is about expanding self-awareness and understanding experiences, especially those that are not our own; that is in understanding another’s perspective. To learn, peering must be approached with humility and a willingness to accept and give feedback.

Part of that humility and acceptance includes decision making being led by consensus rather than by majority rule. This is slow, frustrating, especially when people insist that either they are not good enough or insist on being told what to do, and requires calmness. Yet with patience and tenacity, TL is facilitated, a healthier approach to choosing evolves and better-quality decisions arise.

To be effective, Positive Ways encourages Social Enterprise from within the group and through the Adept Living Foundation (ALF) which ensures that we always provide what is valued and we are not therefore reliant on others to fund or decide our priorities.

Note:

DENT© Dynamic Experiential Narrative Theory (DENT) is grounded in Social Constructivist approaches which informs leadership, organisational development and the growth of the human potential. It’s core and pragmatic proposition is that individuals are collective more successful when they have clear purpose, negotiate mutuality with their peers, integrate their personal and world view with the needs of their social world and co-operate together.

https://www.researchgate.net/publication/328190677_Dynamic_Experiential_Narrative_Theory_-_A_position_paper_on_leadership_organisational_development_and_human_growth


Neigbour Disputes – “She’s offside Referee!”

April 20, 2019

Neighbour Disputes

One of the key factors in mediating and resolving neighbour disputes is having lived experience that enables a liberal, objective and local approach to be agreed.

The referee or mediate can do the deal if the parties are fair minded.

A good referee or mediator brings community harmony. This is because, unresolved long running neighbour disputes can waste community resources, upset other residents and led to unnecessary and unpleasant experiences.

The Adept Living Foundation (‘ALF’) Community Interest Company is coming up to the end of its second year of providing and developing peer support services to the community.

Alongside developing peer support groups, a peer support certificate and an enterprise arm to fund its community activities, ALF has introduced a local cost ‘Neighbour Dispute Mediation Service’. Such a service under pins ALF’s members desire to live and contribute to harmonious community.

‘Lived experience’ is the term to describe how, especially those of us who are more senior (!), by virtue of existed amongst others and in the world, we will have needed to address and resolve certain challenges.

For example, having lived through a neighbour dispute and mediated, then negotiated, a confidential settlement, will provide the mediator with empathy for how challenging such matters maybe. The impact on the wider community can be unfair and distressing.

In ALF we always take a or an:

  1. Liberal Viewpoint – which is that everyone is supported until they can develop their own healthy beliefs and values, and to be responsible and accountable for their life, emotions and actions.
  2. Objective Approach – meaning that the overall aspiration is that decision making, and action taking, should be unbiased and not influenced by personal feelings or opinions, but just a proper consideration and representation of the facts.
  3. Local Focus – this means considering all the impact on the neighbourhood and residents, who may unfairly be dragged in to a dispute which is private and should be contained.

Our local politicians, administrators, police and news makers have a duty to contain the fall out. Truthful, reconciled and peaceful communities should be their aim.

ALF will do its part by offering low cost neighbour dispute mediation and fully funded family child contact meditation.

 


The Purposefulness Model

January 10, 2019

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The Positive Ways approach to good Mental Health means weaving together the Medical (or Illness) Model and the Recovery Model to advocate the ‘Purposefulness Model’.

The main difference between the three models of wellbeing concerns the degree of optimism each has toward how a person can engage with their future in a positive way. For me this means having an optimistically, future orientated, purposeful and growth outlook on life. It advocates building and sustaining mutually supportive relationships and in holding personal view in which life simply ‘makes good sense’.

The Purposeful Model sets out to meet that for me by; treating people as responsible, capable, active and being able to both learn and to influence their environment, especially in co-operation with others. Purposefulness includes holding the expectation that we can a lead a rich and vibrant life, and be capable of suitably overcoming or incorporating illness, and accommodating any other limitations in order to be contented. To that extent positiveness and optimism are not ‘Pollyanna’ like attitudes but are rather about aclimatisation and Adeption in the face of challenges.

Alongside Purposefulness, the model values mutuality. People often struggle to find the balance in their relationships, with others and with organiations, which results in power struggles and conflict, which can cause illness. The Purposefulness Model places importance on mutuality for good mental health.

The Recovery Model focuses on inspiring the person to take responsibility for their goals, to become well. This is a worthy objective, but seems to isolate the person, not necessarily deliberately, but seemingly. The recovery model suggests that individuals need to find their way simply because they have been assigned ‘self-determination’. This might overly imply isolation. This appears a healthy step towards empowering individuals but may not take account of the individuals current depleted motivations and or their current developmental needs.

Because these individual aspects can exist in individuals, the medical profession has traditional taken a paternalistic approach to overcoming illness. In the Medical or Illness Model, the medical professional consults with and listens to the patient. Information is gathered, a diagnosis is made, and the expert delivers the healing advice, which the compliant patient is expected to dutifully follow.

The difficulty with the Illness model, is that it is less empathetic and fails to fully take account of the patient’s perspective, and thereby undermines the personal responsibility that the patient should take for their own recovery. The patients can become disempowered and may not be proactive in their own health. Very often patients are left feeling that they are their illness (or diagnosis) rather than a person. In some cases, the illness/diagnosis becomes a label and some people may research and even adopt the behaviour and even feelings, and symptoms described in the model. To that extent the Illness Model may become self-sustaining in that the person may feel that they are and will continue to remain helpless.

The argument for paternalism, on the other hand, just sometimes some people need to accept help, support and care of others, because they simply cannot cope for themselves. For example, very recently I suffered a series of small strokes. Because I consider myself to be independent, I initially refused to be taken into hospital. In hindsight, I now accept that was a step too far and what I needed, and eventually after I finally passed out, was to be taken into care and administered to by people who simply knew more. This suggests, that there are times when we should all ask for and receive help.

However, the Illness Model treats the disease and unwittingly can thereby exclude the individual needs, treating the person as if they were the disease. The Illness Model position then becomes ‘that the best the person can do is stabilise their situation, moods and behaviour by simply being compliant. This may sometimes mean that (in the UK it is called ‘sectioning’), some suffering persons may be subjected to custodial health care, enforced medication and imposed talking therapies.

In the process, those dispensing the ‘care’ may consider themselves superior to the person, which can lead to conflict, disempowerment and in some cases neglect and abuse. This is may be made worse if the professional carer is not well trained, lacks empathy or is unable to build appropriate rapport with the person. This is compounded when approaches relied on in the Illness Model, like diagnostic tools (such as DSMV) and the use of pharmacology (drugs), are criticized as being about ‘maintaining’ the individual ‘in the system’, that is are serving profit before recovery.

The Recovery Model, in contrast, favors a focus on the patient/client having an influence or control over their mental health, which it assumes is possible. This becomes achievable because, the person is treated with respect and is presumed to be self-determining (I say presumed, because there may be times where a person has become so instituationalised or dependent on the system that they are simply not confident in making decisions, they then need support to become self-determining).

What I appreciate about the Recovery Model is that it accepts mental health challenges, as normal and does not disempower the person or need to assign those challenges to any diagnosis or illness.

The Recovery Model advocates a process through which a person with mental health challenges can co-operate with the ‘system’ in a way which leaves them responsible for their own health. The ambitions of the Recovery Model seem to be to; remove the stigma of mental health suffering; make interventions more individually sensitive; and to enable collaboration between all stakeholders in the individuals caring process.

In the UK this became a model known as ‘Care in the Community’, which whilst professing that principle, seemed to be more like an economic cost saving approach, which simply left unprepared sufferers and their familial carers struggling to cope. This persisted for some time, but then seem to improve with the introduction of professional carers with ‘lived experience’ into the system. This means caregivers can be more empathic, because they may have had and experienced the system and their own challenges. In this sense, introducing empathetic and experienced carers into its approach, the Recovery Model starts to address elements of any unnecessary power imbalance that may have existed under the Illness Model.

For me, it seems that the Recovery Model was helpful in encouraging a sense of ‘shared decision making’. i.e. that individuals (like me and my stroke), still need interventions, but they should and could be treated as self-determining, that is in deciding what action should be taken (unless they are incapacitated). The proviso is that this is wholly dependent on the individual being discerning enough to know when they need help. Given that, I can understand and appreciate that there are times where ‘the system’ needs to behave in a paternalistic manner. None-the -less, the recovery model sets out for a degree of personalisation in the care delivered and should lead to more empowered and engaged persons.

My main concern with the Recovery Model is that it could still allow a person who had not acquired enough knowledge of, or adopted suitable attitudes towards their challenges and options, to be disenfranchised. The Purposefulness Model attempts to overcome this by arguing that care should be delivered in a manner that encourages shared responsibility and a greater sense of community and togetherness. That is through mutuality.

Even more validly in my view, more importantly, the Recovery Model encourages the bigger picture for a person’s life in that they are more than just their challenges or illness. The Purposefulness Model encourages the individual to live a life of meaning and purpose.

The Purposefulness model focusses on support, hope, accountability, personal responsibility and education as guiding principles, for a holistic approach to the client/individual recovery or healing ‘journey’. The individual is encouraged to move beyond just health and is treated as person, who can develop a sense of being able to bounce back from any setbacks on the path to recovery, which is termed hardiness (and more they can live a productive and full life in community).

The word ‘journey’ is used, because the individual may experience setbacks as they ‘travel’ move on in their lives. In the process, professionals, friends and the community collaborate to ensure that everyone’s needs are met, including to move to an even bigger and brighter future.

The ‘Purposefulness’ model encourages individuals to move even further on through their journey, focusing on their hopes, wishes and dreams, by encouraging them to develop their gifts, strengths and talents. Wellness and Purposefulness can be a voyage of self-discovery and of personal growth; whereby experiences of mental illness can provide opportunities for change, reflection and discovery of new values, skills and interests, not just alone, but in deep collaboration, or mutuality, with others termed peers. In this process the individual becomes a supportive peer.

My sense is that the three models can and should work in some form of symbiosis. This is because persons are not always competent (me with my stroke, others with the psychosis or schizophrenia), who may not understand their illness or diagnosis and want, out of fear (or in my case sheer bloody-mindedness), to escape the system. They may even refuse to accept that they are unwell. This could leave them and other stakeholders at risk.

One of the areas that I find of interest, is the consideration of medication. The Illness Model has been accused of over-prescribing and may have been attacked by some in the Recovery Model, and even if it was not attacked, may have been a necessary evil. Under the Purposefulness model, my view is that, medicine is seen as a choice and is imbued or taken with knowledge and as a welcome addition to the overall health of the person. This likely to enhance the efficacy of the drugs through placebo effect. I found this when I started to take my heart medicine, it was more effective when I knew about it and took it as part of my overall movement towards health, not as a resigned attitude of dependence.

This is even more effective under the Purposefulness Model, because those who have experienced recovery and movement towards wellness, become the peers for those still suffering and struggling through the uncertainty of healing. My sense and anecdotal evidence are, that taking responsibility for an optimistic future often needs the negotiated support from those who have travelled the journey already, like a Sherpa. They are called Peers.

 

The beauty of peering is that we all take primary care for ourselves and then equal responsibility for the care of each other.


What is Adept Living all about?

December 31, 2018

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“I believe that imagination is stronger than knowledge. That myth is more potent than history. That dreams are more powerful than facts. That hope always triumphs over experience. That laughter is the only cure for grief. And I believe that love is stronger than death”. Robert Fulghum
This quote, more than many others, encaptures and enraptures what the Adept Living Foundation (ALF) is all about, namely:

  1. That the way we use our imagination, either to empower or disempower each and everyone of us, is vital to our health and enjoyment of a full life. In ALF, we teach you how to have and use a healthy imagination.
  2. That stories and they way we tell or narrate them can lead us into or away from the enjoyment of that life. In ALF we demonstrate good story telling and lived experience in action.
  3. That an optimistic outlook leads to ongoing growth and change. In ALF we use SHAPE – Support, Hope, Accountability, Personal Responsibility & Education to create greater opportunities for successful change.
  4. That a healthy and delicate dose of humour enables us to look at what ever is disturbing and difficult from a distance that changes how we experience it. In ALF you will always find a listening ear, a cup of tea and a warm smile.
  5. That when we feel cared for, valued and able to contribute to others, we can meet our challenges with a confident smile. In ALF you will be met as an equal who shares with their friends and community in a meaningful and mutual way.

ALF offers community based peer support working from the principal that our lived experience can inspire and help others.

http://www.alfcic.org


Mutuality for Social Action – we are never absolutely free

December 28, 2018

5329871139_03cd4e8dd3_zThe human has, relatively, attained in the last 150 years that which they have often sung about, yearned for and claimed to desire above all things; freedom. Although not perfect, we, particularly, in the West are less subservient and freer from the absolutism of princes and the determination of religion than we have ever been before.

But, freed from the judgement of both, the Western Human has discovered that not having ‘moral dictatorship’ and not having to be ‘well behaved citizens’, means we must work out for ourselves what the rules are for social co-operation. We must take personal responsibility, lead ourselves and act accordingly. Praxeology is the idea that humans always act purposefully, with a goal in mind and in the process of working out what we should now do,  that is steeling our values, has caused as to fret and fracture amongst ourselves.

Without direction on how to act, we suddenly realise that the concepts of what is good or bad, fair or unfair, truth or lies,  and what we are willing to do in response, must be worked out by ourselves, which where true healing lies. In the 1980’s, we were taught that it was the price that we were willing to pay for the tangible goods and services we consumed. But it was never just that. There are a whole host of intangible, value judgements and reflexive responses we make too, before we decide and act. The fret and the fractures make it seem almost like it has become too much for us personally to deal with (before we even consider the needs and views of others, we need to socially co-operate with!)

This is because the idea of ‘absolute freedom’ is a falsehood. We must all compromise something to be effective; a parent to their children; a worker to their market; or a vulnerable person to their carer’s benevolence. This implies two things for healing the fret and fracture: 1. We need to know what the rules (or values) of exchange are 2. We should seek mutuality in all things i.e. to leave each other feeling good after each interaction.

The economic price is rarely ever the only factor that drives our decision making  (if you meet someone for whom it is, I suspect you will enjoy very few transactions with such an individual), so make sure you understand that we cannot be absolutely free, so we should work out what our values, needs and contributions are and understand the same for others. Then in all things you do, seek much local influence as possible, that is where the value of true mutuality lies. And remember, words do not matter, only action does.