Who Dares to Teach Must Never Cease to Learn.

 This is the third in a series of three essays exploring recovery from mental illness, the stigma associated with mental illness and the work that we do to support recovery and reduce the stigma experienced by those we serve. 

Over the past three weeks I have shared with you some of the recent research on the stigma associated with mental illness.  Understanding this research has helped us to understand why all of our efforts at community education were largely unsuccessful in reducing the negative attitudes often expressed by the New London community.  So if education does not work in reducing the negative attitudes that are often expressed about those with mental illness what, if anything, will?

Recent research has suggested that stigma is reduced when those with mental illness are integrated into the community.  Further, focusing on skill development and improving and highlighting the strengths of those with mental illness also result in long-lasting stigma reduction.  Put simply, focusing on recovery and helping clients develop and maintain the skills they need to integrate into the community will, across time, lead to stigma reduction. 

So who in our agency has the greatest impact on stigma and  who can do the most to improve the lives of these we serve.  I suggest to you that  it is those direct service staff who work with our clients daily helping them to learn new  skills, maintain existing skills and  support community  integration. 

The importance of a highly competent and caring teacher, or case manager, or recovery specialist, or rehab specialist or employment specialist in assisting a client in learning a new skill became very clear to me a few weeks ago.   Perhaps you, like me, have forgotten how difficult, anxiety provoking and just plain scary it can be to do something you have never done before.   When was the last time you attempted something you never wanted to do or had never done before?  Putting myself in such a situation has given me insight into what our clients must face on a daily basis and a renewed appreciation for the work of our line staff.  Let me tell you about learning how to ski!

 Now just to be clear, I have never wanted to learn how to ski- I always thought it was dangerous and I really don’t like snow or being cold.  When Michael, my oldest son invited me out to Vail, Colorado I was not aware that he had arranged skiing lessons for me.   When I expressed my significant reservations about his plans I imagined the worst, being cold and wet all day, broken bones, embarrassment at my total lack of skill etc, etc.  With all the impatience of youth, Michael assured me that skiing was a skill I really should learn, that I had really waited too long and that there was no time like the present-  does this sound like what we tell our clients?  Well needless to say I was not at all convinced and considered giving the whole thing up until I met “Bones” Corsetti.    Bones Corsetti, was my ski instructor. For an entire day, Bones worked with me and 6 other beginner skiers.  He is perhaps one of the most gifted and generous teachers I have ever met!  And while I have spent much of my professional career teaching people how to teach. I had forgotten what it was to be a “student.” And I had forgotten what our clients must experience on a daily basis as they struggle to recover.

What made Bones so special? Clearly it was his unconditional positive regard for those he taught and his ability to encourage.  As we waited at the bottom of the mountain for all members of the class to arrive he got to know each of us and connected with who were.  Then it was time to go up the mountain-  OMG 10,000 feet up-  what a long way to fall! Once at the top of the mountain all I could imagine was careening from the top to the bottom  in some type of awful out- of -control fall.    But Bones continued to reassure that all be would be fine and that we would have the best day of our lives.  What then happened was nothing short of amazing.  As the absolutely worst student in the class, and I do mean worst,   Bones gently guided, encouraged, corrected and modeled how to ski.  He recognized what I needed to be successful- he skied backward so he could hold my hands,  skied immediately if front of me, skied next to me so I could mirror his movements, etc., etc .  And there was a never ending dialogue that encouraged, instructed and corrected.   And all of this was done with the utmost kindness and humor. Just amazing!   So by the end of the day I had actually ALMOST skied all the way down the bunny slope without falling!  But perhaps, more importantly, as a result of Bones I am already planning on another trip out to Vail-  I am ready to try again!.  So thank you  Bones-  you not only taught me a bit about skiing  while I had a genuinely good time-  you also helped me to understand what the people my agency serve  experience as we  teach them to live more fully in the  community!!

So hats off to all direct service staff, staff that on a daily basis encourage, teach and support recovery and community integration.   Your work is and continues to be some of the most important work that we do.

Be well!

Gail 

"Who dares to teach must never cease to learn."        John Cotton Dana, http://en.wikipedia.org/wiki/John_Cotton_Dana

Can We Learn? Do We Learn?

This is the 2^nd in a series of blogs discussing Recovery.

It does seem to me the popular media capitalizes and exploits the fear of mental illness that many people in our society experience.  Just a quick look at many of the popular television shows including CSI, Criminal Minds and the Law and Order franchise, the person who commits what is often a frightening and despicable crime is usually someone with mental illness.   And I am sure the way in which those with mental illness are portrayed in the popular media results in stigma. 

What is stigma exactly and how is it experienced by those we serve?  The classic work on stigma was written by Erving Goffman (http://en.wikipedia.org/wiki/Goffman), a Canadian born sociologist and writer, in 1963. In Stigma: Notes on the Management of Spoiled Identity   stigma is defined “…as a visible or invisible ‘mark’ that disqualifies its bearer from full social acceptance.”   According to this idea mental illness marks affected individuals as having “blemishes of individual character,” the acquisition of which “spoils their identities and removes them from their place within the social hierarchy.”  Reflecting on this definition gives some insight to what many of those we serve must face on a daily basis and energizes us as professionals to help reduce the stigma of mental illness!

In order to address the stigmatizing attitudes in our own community toward those with mental illness,   First Step applied for and was awarded a grant in 2003 to hire a Community Educator whose job it would be to inform the community at large about mental illness.  The idea at the time was that the stigma, fear and anger associated with mental illness could be successfully combated with education.  As the theory went, the more you knew about mental illness the less likely you would be to be afraid of those with mental illness and the less likely you would be to discriminate.  First Step hired a talented and committed individual to fill this important role.  Jennifer Gross, the now Deputy Director of the Eastern Region Mental Health Board held the position of “community educator” for almost four years.  Jennifer was a skilled writer and presenter who spent much of her time writing and working with community groups to foster greater awareness and understanding about mental illness.    Jennifer penned many op-ed pieces, letters to the editor and topical articles that appeared in the local newspapers all of which were aimed at reducing the stigma associated with mental illness. 

First Step and subsequently Sound Community Services expended much time and resources on this educational approach to reducing stigma.  Jennifer worked for our agency for almost 4 years-   and each of those four years she wrote many articles and op-ed pieces, organized community presentations and activities and did whatever she could to reduce stigma.  And I was always dismayed that much of what we did seemed to have very little long lasting impact on the attitudes of the New London community. The City of New London Planning and Zoning Commission still refused to give us a zoning permit for our Social Rehab program and as recently as 18 months ago when we tried to  move our agency to 21 Montauk, the vehemence of the  public  “hate speech” at the hearing held by Planning and Zoning was appalling.  I vividly remember the individual who at the public hearing complained about how dangerous our clients were and how we interfered with business in the downtown area!

I never understood why we were so decidedly unsuccessful in changing attitudes in any meaningful way given our considerable educational efforts until I ran across some recent research that statisticians call meta-analysis.   In a January 2010 article, A Review of Interventions for Reducing Mental Health Stigma, David Godot points out that while educational interventions are the most frequently used and studied interventions for reducing stigma, the empirical research does not support the effectiveness of such approaches.  According to Godot, although many studies have found significant reductions on stigmatizing attitudes through exposure to college courses or informational sessions, the magnitude and duration of the effects tends to be limited. He further notes that the effects of educational interventions correlate to participants’ knowledge of mental illness prior to participation in the educational programs, indicating that the effects of education-based interventions may primarily reflect the attitudes of participants who had already agreed with the programs’ messages- a “preaching to the choir effect!” 

So all the work that our community educator did probably had a very limited and at best only a short term effect!  And for me personally, my belief that the solution to any problem is “more or better training or education” has been challenged.

So if education does not work to reduce stigma what does?

See next week’s blog for more on this topic!

Be well!

Gail

The Euphemania Treadmill

Have you often wondered why the vocabulary in our field changes so frequently? Today the accepted terms for describing the difficulties we address and the people who experience those difficulties are "behavioral health" and "person served."  But not so very long ago the accepted terms were "mental illness” and "client". And if you look even farther back the terms “madness” and “patient” were used.  This change in language is interesting because if you are forgetful or foolish enough to use the old terms you would likely be considered insensitive or disrespectful to the individuals involved. Let me give you a more graphic example of this- as a young student of developmental psychology, the textbook that was chosen by the course professor was a relatively old one and the terms used to describe individuals with significant cognitive impairments -what we call developmental disabilities today- most of us would find disrespectful and repugnant.  The terms that were used in that textbook were “idiot, imbecile and moron.”   Not long after I completed that course, the terms used to describe individuals with cognitive impairments changed.  The terms “idiot, imbecile, moron” were viewed as pejorative and disrespectful and were replaced by the terms “mild”, “moderate” and “severely mentally retarded."  The term mentally retarded was in fashion for several years but eventually this term too was viewed as disrespectful and was replaced by "developmentally delayed."  And if history repeats itself, eventually the terms we now use will be replaced by some other terms which popular opinion and perhaps even scientific opnion will consider to be more appropriate, descriptive or respectful to the individuals involved.   

Are these changes in language merely an exercise in political correctness or are these changes in language indicative of some other issue?  A recent book by Ralph Keyes  (http://www.ralphkeyes.com/ ) examines this very interesting phenomenon and suggests some answers they may be helpful to us as we strive to foster recovery for those we serve. 

In his 2010 book Euphemania, Keyes postulates that we use euphemisms to discuss any topic we feel uncomfortable with.    In other words, euphemisms are a way for us to confront and deal with what we find distasteful or frightening or wish to avoid.  Keyes provides as evidence for his argument the euphemisms our society uses to describe death. For example when someone has died we say they have "passed." In a more humorous vein we may say the dead are "pushing up the daisies.”  In France, the French use  "eating the roots of dandelions" to describe someone who has died.  The use of these terms allow us to confront what we find ultimately and innately unpleasant and distasteful.

We have seen the same type of “euphemism treadmill” that Keyes describes in his book in the language of our field. The terms that have been used to discuss or describe behavioral health needs including “madness”, "mental illness" etc. eventually were replaced by a terms that are viewed as more descriptive or respectful.   The term mental illness have been  replaced  with  "behaviorally disordered" and people who receive treatment for their difficulties are no longer called patients or clients but consumers.  And in the last few years the term “consumer” has begun to lose favor and is slowly being replaced by the term "person served."  In fact, our agency began using the term person served about  three years ago.  We did so in part because the term “consumer” implied someone who used  up the community’s resources without making a contribution back to the community.

Is it possible that the euphemism phenomenon that we observe in the language we use to discuss mental illness  underscores the fact that our society continues to find  mental illness frightening and something to avoid.   Is the answer to the fear that drives the euphemism treadmill more education to reduce the stigma associated with mental illness?   See next week’s blog for the surprising answer to this question! 


This is the first of three essays addressing recovery and how we as an agency can foster recovery and greater acceptance by the community of those with mental health needs.




Be well!!


Gail

This is the first of three essays that addresses recovery and how as an agency we can better understand recovery and assist those we serve in integrating into the community.