Finding the Real Person Underneath the Diagnosis, the Despair, and the Disability
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Transcript of Finding the Real Person Underneath the Diagnosis, the Despair, and the Disability
Finding the Real Person Underneath the Diagnosis,
the Despair, and the Disability
Courtenay M. Harding, Ph.D.
WHAT ABOUT THOSE PEOPLE WHO SEEM TO STAY IN SERVICES?
• INCORRECT DIAGNOSIS• MEDICAL COMORBIDITIES• CO-OCCURRING DISORDERS NOT TREATED
SIMULTANEOUSLY• ADDITIONAL NEUROLOGICAL
IMPAIRMENTS• UNTREATED FOR LACK COMMUNITY
KEEPING BEHAVIORS• IATROGENIC EFFECTS OF TREATMENT• DEMORALIZATION & LOSS OF HOPE
WHAT ABOUT THOSE PEOPLE WHO SEEM TO STAY IN SERVICES?
NOT NECESSARILY VIRULENCE OF ILLNESS ( ≤5%)
• PERSONS WHO REQUIRE SOCIAL CONTROL (NGRIs & SEXUAL PERPETRATORS)
• LONG STAY FORENSIC PATIENTS FOR MISDEMEANORS NOT NEEDING SOCIAL CONTROLS
• UNRECOGNIZED AND UNTREATED TRAUMA• AXIS II BEHAVIORS MISINTERPRETED AS
CONTINUING AXIS I PROBLEMS• LACK OF REHAB OPTIONS &
OPPORTUNITIIES
WHAT ABOUT THOSE PEOPLE WHO SEEM TO STAY IN SERVICES?
• WE NEED TO TAKE A SECOND, THIRD, AND FOURTH LOOK
• WE NEED TO UNDO THE DAMAGE DONE BY THE SYSTEM
• WE NEED TO DO MUCH BETTER FOR THE “OLDER SEEMINGLY CHRONIC PERSONS”
• WE NEED TO REMAKE OUR SYSTEMS TO REDUCE FUTURE CHRONICITY
Some ideas about the recovery process
WHAT DO PEOPLE THINK THAT THEY ARE RECOVERING FROM?
• Loss of self, connection, & hope • Loss of roles and opportunities • Devaluing and disempowering programs,
practices, and environmentsPrejudice and discrimination in society
• Internalized oppression and shame(Spaniol, Gagne, Koehler, 1999)
Phase I- Overwhelmed by the…… disorder
• “Daily life is a struggle”• “Tries to understand and control what has
happened”• “Feels confused, disconnected from others” • “Often feels out of control, powerlessness in
life” Spaniol et al , 2002
Phase II- Living with disability
• “Has come to terms with disability and feels confident about managing it”
• “A stronger sense of self and feeling of confidence about managing it and having some control.”
• “A sense that one could have a satisfying life with the disability”
• Spaniol et al, 2002
Phase II- Living with disability
• “Utilizes coping strategies and assumes meaningful roles”
• “Consistency and security in the people, roles, and environment”
• “But still feels limited by disability” • Spaniol et al, 2002
Phase III – Living beyond the disability & reclaiming a life
• “Feels well connected to self and others in living, learning, and working environment experiencing a sense of meaning and the purpose in life.”
Spaniol et al, 2002
It is extremely hard work to bootstrap one’s self into recovery
process and takes time
RECLAIMING A LIFE TAKES PASSION, ENERGY AND A BELIEF THAT IT MIGHT BE POSSIBLE
An active self Taking stock Relying on self Finding supports Learning to love Increase self-esteem Tolerance/ Acceptance
Building on reality Better coping Self-monitoring Spirituality See a process Reclaim hope
Spaniol, Gagne, Koehler, 1999
Brainstorming
A person says they have no goals. What is going on here?What do you need to light a fire under them?
What If A Person Has No Goals?Davidson & Ridgway
• Is person demoralized?• Has person been socialized into “learned
helplessness” due to uninterested system?• Has person become afraid of taking risks?• Could this person have a co-occurring
depression?• Has clinical team established trust?
• Are there neurocognitive or communication problems getting in the way?
Usual Areas Reviewed
• Diagnosis & s/s• Possible deficit
syndrome• Medications & side
effects• Medical problems• Neurocognitive
status
• Street drug use• Behaviors• Personality• Sex differences• Social supports• Cultural issues• Trauma history• Coping strategies
COMPOSITE PROFILE OF STRUGGLING PERSONS
DepressedDelusionalAssaultiveSuicidalManipulativeDrinking too much caffeineSmokingPoor social skillsDemoralized
• Acting out• Angry• Unpredictable• Displays poor hygiene• Self injurious• Unpredictable• Refusing treatment• Unmotivated• Coping with serious
medical problems
But before someone gets going, they need to know that there
might be a possibility that they might be special, that they might
have a way to contribute and there might be a place for
themselves in the world
Started looking for other things
• Strengths• Interests• Early goals• Hopes • Dreams
• Helpful behaviors• Personality styles • How did the
person get into such a muddle?
SOME OF THE MANY STRENGTHS AND TALENTS FOUND WHICH WILL HELP FIND THE WAY OUTSIDE
• Intelligence• Sense of humor• Charming• Persistent• Musical talent• Artistic• Work histories• Contributing to groups
• Feisty• Cooking skills• Neuropsych strengths• Cultural heritage• Athleticism• Spiritual• Educated• Personable
THE GOAL
• Help to change someone from thinking that they could only be a patient to
• A person with a life and hopes and dreams and perhaps diminishing episodes of psychosis
SOME OF THE SUGGESTIONSTO SURPRISE AND ASTONISH
BASED ON THE PERSON’S DREAMS
• “Hyperscore”• Piano playing• Setting up a
mentoring program• “Scientific
American”• Training guide dogs
• Russian history• Jewish traditions• Connections to the
Greek Orthodox community
• Human rights commission
MORE OF THE SUGGESTIONS
• Definition of a name• “VideoEye” for low
vision• An art studio of her
own• Become a
psychologist
• Greek history• Hidden messages in
records• Celebration of other
holidays than Christian ones
• Social learning
Some Peer Suggestions on What Helps
• Local Peer-run Crisis Centers NOT Hospitals• CMHCs NOT jails• Supported Employment NOT adult day care• Peer/doctor medication reduction teams• Peer providers as 10% of Mental Health Center
Staff• Reduction of micro aggressions by staff• Personal Care Attendants NOT nursing homes• Personal Medicine , Common Ground
– (corinnawest.com + Pat Deegan)
Words of Wisdom from Manfred Bleuler
• “What is effective in the treatment of most schizophrenic patients is also effective, and decisive, in the development of the healthy individual; clear and steady personal relations; activity in accordance with one’s talents, interests, and strengths;
Words of Wisdom from Manfred Bleuler con’t.
• confrontation with responsibilities and even dangers; and, at the right time and in the right rhythm, rest and relaxation.”
– Manfred Bleuler AJP, 138:1403-1409 (1979)
THE SECRET
• Surprise and astonish by showing the person that you can see a real life for them
• Interest them in things that will enhance their sense of self
Looking for practices which match up with an individual’s clinical
strengths and needsIndividuals want to be healthy,
have a home, a job, friends, a date for the weekend, and social
justice