Recovery and the Conspiracy of Hope

deegan_hi_res_cropped-700x607I think Pat Deegan does a great job describing the cycle of despair in settings that don’t facilitate or witness recovery. I think this translates very well to addiction treatment providers. What it misses is those who step in after hope is abandoned and ennoblize the suffering of patients–“accepting them as they are”, but never accepting them for what they can become.

From Recovery and the Conspiracy of Hope:

From the outside it appears that the person just isn’t trying anymore. Very frequently people who show up at clubhouses and other rehabilitation programs are partially or totally immersed in this despair and anguish. On good days we may show up at program sites but that’s about all. We sit on the couch and smoke and drink coffee. A lot of times we don’t bother showing up at programs at all. From the outside we may appear to be among the living dead. We appear to be apathetic, listless, lifeless. As professionals, friends and relatives we may think that these people are “full of excuses”, they don’t seem to try anymore, they appear to be consistently inconsistent, and it appears that the only thing they are motivated toward is apathy. At times these people seem to fly into wishful fantasies about magically turning their lives around. But these seem to us to be only fantasies, a momentary refuge from chronic boredom. When the fantasy collapses like a worn balloon, nothing has changed because no real action has been taken. Apathy returns and the cycle of anguish continues.

Staff, family and friends have very strong reactions to the person lost in the winter of anguish and apathy. From the outside it can be difficult to truly believe that there really is a person over there. Faced with a person who truly seems not to care we may be prompted to ask the question that Oliver Sacks (1970, p. 113) raises: “Do you think William (he) has a soul? Or has he been pithed, scooped-out, de-souled, by disease?” I put this question to each of us here today. Can the person inside become a disease? Can schizophrenia pith or scoop-out the person so that nothing is left but the disease? Each of us must meet the challenge of answering this question for ourselves. In answering this question, the stakes are very high. Our own personhood, our own humanity is on the line in answering this question.

However, when faced with a person lost in anguish and apathy, there are a number of more common responses than finding a way to establish an I-Thou relationship. A frequent response is what I call the “frenzied savior response”. We have all felt like this at one time or another in our work. The frenzied savior response goes like this : The more listless and apathetic the person gets, the more frenetically active we become. The more they withdraw, the more we intrude. The more willless they become, the more willful we become. The more they give up, the harder we try. The more despairing they become, the more we indulge in shallow optimism. The more treatment plans they abort, the more plans we make for them. Needless to say we soon find ourselves burnt out and exhausted. Then our anger sets in

Our anger sets in when our best and finest expectations have been thoroughly thwarted by the person lost in anguish and apathy. We feel used and thoroughly unhelpful. We are angry. Our identities as helping people are truly put to the test by people lost in the winter of anguish and indifference. At this time it is not uncommon for most of us to begin to blame the person with the psychiatric disability at this point. We say things like : “They are lazy. They are hopeless. They are not sick, they are just manipulating. They are chronic. They need to suffer the natural consequences of their actions. They like living this way. They are not mad, they are bad. The problem is not with the help we are offering, the problem is that they can’t be helped. They don’t want help. They should be thrown out of this program so they can ‘hit bottom’. Then they will finally wake up and accept the good help we have been offering.”

During this period of anger and blaming a most interesting thing happens. We begin to behave just like the person we have been trying so hard to save. Frequently at this point staff simply give up. We enter into our own despair and anguish. Our own personhood begins to atrophy. We too give up. We stop trying. It hurts too much to keep trying to help the person who seems to not want help. It hurts too much to keep trying to help and failing. It hurts too much to keep caring about them when they can’t even seem to care about themselves. At this point we collapse into our own winter of anguish and a coldness settles into our hearts.

We are no better at living in despair than are people with psychiatric disabilities. We cannot tolerate it so we give up too. Some of us give up by simply quitting our jobs. We reason that high tech computers do as they are told and, besides, the pay is better. Others of us decide not to quit, but rather we grow callous and hard of heart. We approach our jobs like the man in the Dunkin Donuts commercial: “It’s time to make the donuts, it’s time to make the donuts”. Still others of us become chronically cynical. We float along at work like pieces of dead wood floating on the sea, watching administrators come and go like the weather; taking secret delight in watching one more mental health initiative go down the tubes; and doing nothing to help change the system in a constructive way. These are all ways of giving up. In all these ways we live out our own despair.

Additionally entire programs, service delivery systems and treatment models can get caught up in this despair and anguish as well. These systems begin to behave just like the person with a psychiatric disability who has given up hope. A system that has given up hope spends more time screening out program participants than inviting them in. Entry criteria become rigid and inflexible. If you read between the lines of the entry criteria to such programs they basically state: If you are having problems come back when they are fixed and we will be glad to help you. Service systems that have given up hope attempt to cope with despair and hopelessness by distancing and isolating the very people they are supposed to be serving. Just listen to the language we use: In such mental health systems we have “gatekeepers” whose job it is to “screen” and “divert” service users. In fact, we actually use the language of war in our work. For instance we talk about sending “front-line staff” into the “field” to develop treatment “strategies” for “target populations”.

Is there another alternative? Must we respond to the anguish and apathy of people with psychiatric disability with our own anguish and apathy? I think there is an alternative. The alternative to despair is hope. The alternative to apathy is care. Creating hope filled, care filled environments that nurture and invite growth and recovery is the alternative.

Remember the sea rose? During the cold of winter when all the world was frozen and there was no sign of spring, that seed just waited in the darkness. It just waited. It waited for the soil to thaw. It waited for the rains to come. When the earth was splintered with ice, that sea rose could not begin to grow. The environment around the sea rose had to change before that new life could emerge and come into being.

People with psychiatric disabilities are waiting just like that sea rose waited. We are waiting for our environments to change so that the person within us can emerge and grow.

Those of us who have given up are not to be abandoned as “hopeless cases”. The truth is that at some point every single person who has been diagnosed with a mental illness passes through this time of anguish and apathy, even if only for a short while. Remember that giving up is a so
lution. Giving up is a way of surviving in environments which are desolate, oppressive places and which fail to nurture and support us. The task that faces us is to move from just surviving, to recovering. But in order to do this, the environments in which we are spending our time must change. I use the word environment to include, not just the physical environment, but also the human interactive environment that we call relationship.

From this perspective, rather than seeing us as unmotivated, apathetic, or hopeless cases, we can be understood as people who are waiting. We never know for sure but perhaps, just perhaps, there is a new life within a person just waiting to take root if a secure and nurturing soil is provided. This is the alternative to despair. This is the hopeful stance. Marie Balter expressed this hope when asked, “Do you think that everybody can get better?” she responded: “It’s not up to us to decide if they can or can’t. Just give everybody the chance to get better and then let them go at their own pace. And we have to be positive – supporting their desire to live better and not always insisting on their productivity as a measure of their success”. (Balter 1987, p.153).

So it is not our job to pass judgment on who will and will not recover from mental illness and the spirit breaking effects of poverty, stigma, dehumanization, degradation and learned helplessness. Rather, our job is to participate in a conspiracy of hope. It is our job to form a community of hope which surrounds people with psychiatric disabilities. It is our job to create rehabilitation environments that are charged with opportunities for self-improvement. It is our job to nurture our staff in their special vocations of hope. It is our job to ask people with psychiatric disabilities what it is they want and need in order to grow and then to provide them with good soil in which a new life can secure its roots and grow. And then, finally, it is our job to wait patiently, to sit with, to watch with wonder, and to witness with reverence the unfolding of another person’s life.

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Patient or person with a predicament?

bw photo wristband2One important task in the process of recovery is learning or relearning good physical self-care. Part of this is learning how to be a good consumer of health care. Doctor Skeptic has a thought provoking post on being a “person with a predicament” versus a “patient”.

My right foot hurts. It hurts in the middle, underneath, but not all the time, and only when I walk or take any weight on it, especially when I get up in the morning, when it becomes difficult to walk. It has been hurting on and off since I did an 80km trek three months ago. It could be a stress fracture, or some kind of fasciitis, soft tissue tear, fatigue, injury or degeneration, but I don’t really care, because I am not going to have any tests or see any health care practitioners to get their version of a diagnosis. I’m just going to leave it alone. I am going to be a person with a predicament that I can cope with, and not a patient with an illness.

I’m not posting this as an argument against seeking medical treatment, just that one task in recovery is to notice a symptom and learn to pause and reflect before ignoring it or treating it as a medical crisis.

Read the rest here.

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to come face to face

scott_pilgrim__noclue_getsit_by_nippey-d31sjjcIn its etymology, the word “confront” literally means “to come face to face.” In this sense, confronting is a therapeutic goal rather than a counseling style: to help clients come face to face with their present situation, reflect on it, and decide what to do about it. Once confronting is understood as a goal, then the question becomes how best to achieve it. Getting in a person’s face is rarely the best way to help them open up to new perspectives.

White, W. & Miller, W. (2007). The use of confrontation in addiction treatment: History, science and time for change. Counselor, 8(4), 12-30.

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Bansky-Flower-Brick-Thrower.“The resistant behavior that is labeled “denial” does not just walk through the door with the client, but is strongly influenced by the way in which the therapist approaches the client. Said provocatively, denial is not a client problem, it is a therapist problem.”

William R. Miller: Handbook of Treatment Approaches

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opportunity, choice and hope

SlayingtheDragonFrom Slaying the Dragon by Bill White

…what addiction professionals have done for more than a century and a half is to create a setting and an opening in which the addicted can transform their identity and redefine every relationship in their lives, including their relationship with alcohol and other drugs. What we are professionally responsible for is creating a milieu of opportunity, choice and hope. What happens with that opportunity is up to the addict and his or her own god. We can own neither the addiction nor the recovery, only the clarity of the presented choice, the best clinical technology that we can muster, and our faith in the potential for human rebirth.

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soberooAnother tribe of the recovering community:

When Grace McClellan attends two music festivals — Governors Ball in New York and Bonnaroo in Tennessee — this month, she will be among friends who feel more like family. Their shared bond, along with a love of live music: They’re all sober.

Ms. McClellan, 31, first stopped using drugs and alcohol three years ago, and she knew then that it was a risk to attend Bonnaroo, which, like many festivals, is known for its hedonism. But the festival had been her tradition for nearly a decade, and after only 30 days in recovery, she went with her old crew of drinking buddies. “I didn’t want to feel like I couldn’t still have fun,” she said.

Yet as night fell that first evening of Bonnaroo at the festival’s sprawling farm in Manchester, Tenn., she was overcome with memories of previous visits. After only a few hours, she said, “I was going to have a drink.”

But Ms. McClellan found a lifeline: She had heard from friends about a group of festival-goers, known as Soberoo, who were in recovery and part of an onsite sobriety support system. She made a few calls in hopes of finding them.

Read the rest at the New York Times.

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We accept you for who you are and who you can become

PathwaysMost clients entering a treatment environment/ relationship do so with fear and ambivalence. The fear is fear of an alien environment, the feeling of vulnerability and lack of control, and the suspicion that they are in a place where they will not be understood and accepted… The earliest moments in the initiation of the treatment relationship must communicate the following to the client:

  • You are in the right place.
  • You are with others like yourself.
  • We understand you and the world you come from.
  • We accept who you are and who you can become.
  • This is a place where magic (change) can happen.

From: Pathways from the Culture of Addiction to the Culture of Recovery by William L. White

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