Welcome our own weakness? Really?

2931888261_c7d2bb40f2_mThis caught my attention in a recent episode of On Being. It speaks to the importance of us (helpers) needing to be able to face our own pain if we are are to help others face theirs.

MS. TIPPETT: Not just in the context of disabilities, you know, you’ve posed this question, you know, the whole — you’ve said the whole question is, how do we stand before pain?

MR. VANIER: Yeah.

MS. TIPPETT: All kinds of pain and weakness are difficult for us as human beings. Why is that so excruciating? Why do we such a bad job with it?

MR. VANIER: I think there are so many elements. First of all, we don’t know what to do with our own pain, so what to do with the pain of others? We don’t know what to do with our own weakness except hide it or pretend it doesn’t exist. So how can we welcome fully the weakness of another if we haven’t welcomed our own weakness? There are very strong words of Martin Luther King. His question was always, how is it that one group — the white group — can despise another group, which is the black group? And will it always be like this? Will we always be having an elite condemning or pushing down others that they consider not worthy? And he says something, which is quite, what I find extremely beautiful and strong, is that we will continue to despise people until we have recognized, loved, and accepted what is despicable in ourselves. So that, then we go down, what is it that is despicable in ourselves? And there are some elements despicable in ourselves, which we don’t want to look at, but which are part of our natures, that we are mortal.

 

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Umwelt

Mantis Shrimp

Mantis Shrimp have 16 color receptor cones compared to our 3. (Photo credit: PacificKlaus)

Yesterday, I was reading This Will Make You Smarter and thought that the concept of umwelt could be enormously helpful for my social work students and Dawn Farm’s counseling staff:

In 1909, the biologist Jakob von Uexküll introduced the concept of the umwelt. He wanted a word to express a simple (but often overlooked) observation: different animals in the same ecosystem pick up on different environmental signals. In the blind and deaf world of the tick, the important signals are temperature and the odor of butyric acid. For the black ghost knifefish, it’s electrical fields. For the echolocating bat, it’s air-compression waves. The small subset of the world that an animal is able to detect is its umwelt. The bigger reality, whatever that might mean, is called the umgebung.

The interesting part is that each organism presumably assumes its umwelt to be the entire objective reality “out there.” Why would any of us stop to think that there is more beyond what we can sense?

…It neatly captures the idea of limited knowledge, of unobtainable information, and of unimagined possibilities. Consider the criticisms of policy, the assertions of dogma, the declarations of fact that you hear every day — and just imagine if all of these could be infused with the proper intellectual humility that comes from appreciating the amount unseen.

I find two things very attractive about the concept. First, are these ideas of “limited knowledge”, “unobtainable information”, “unimagined possibilities” and “intellectual humility”. Second, it nudges us to consider the possibility that different clients may have different umwelt experiences. Clients with a history of trauma will pick up on environmental signals that others of us are blind to. Women or minorities will have different umwelt experiences and the fact that I can’t sense those signals doesn’t make them less real.

Maybe the concept of umwelt can help keep us out of the “expert” position and keep us in the role of curious fellow travelers. This isn’t simply a matter of attention and empathy. I may not be capable of detecting the signals someone else is experiencing, even if they’re pointed out to me. (However, if we’re tuned into the client, we may notice them experiencing something that doesn’t fit with what we observe and curiously explore rather than dismiss it as pathological.)

Also, we’re probably unaware of most of our own umwelt experience. And, even if we’re aware of it, language will probably fail us–how do you describe a scent to someone who can’t smell?

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An absence of hope

hopeToday, Bill White shared some of my favorite stories.

As I faced these amazingly resilient women, I asked each of them to tell me about the sparks that had ignited their recovery journey.  Each of them talked about the role their outreach worker had played in their lives.  The following comments were typical.

I couldn’t get rid of that women.  She came and just kept coming back–even tried talking to me through the locked door of a crack house.  She wore me down. She followed me into Hell and brought me back.

(Describing the first day she went to treatment–after eight weeks of outreach contacts)  It was like a thousand other days.  My babies had been taken and I was out there in the life.  I’d stopped by my place to pick up some clothes and there was a knock on the door. And here was this crazy lady one more time, looking like she was happy to see me.  I looked at her and said, Don’t say a word; Let’s go (for an assessment at the treatment center).  She saw something in me that I didn’t see in myself, so I finally just took her word for it and gave this thing (recovery) a try.

And she kept sending me those mushy notes–you know the kind I’m talking about.  (Actually, I had no idea what she was talking about.)  You know, the kind that say, “Hope you’re having a good day, I’m thinking about you, hope you are doing well” and all that stuff.  I treated her pretty bad the first time she came, but she hung in there and wouldn’t give up on me.  I can’t imagine where I would be today if she hadn’t kept coming back. She hung in with me through all the ups and downs of treatment and getting my kids back.    

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A culture of communion

kintsugi

Jim Contopulos writes about the beauty in brokenness he witnessed when his (now deceased) son took him to an NA meeting.

Years before we lost Nick to the diseases of addiction and mental illness, he invited me into a Narcotics Anonymous meeting. I had never attended one, but of course, I said “yes” to his invitation. I loved being with Nick and I loved watching his love for recovery. Immediately following the NA meeting, Nick asked me what I thought. I told him that I absolutely loved it, and that my only wish was that church would be more like this. Although I didn’t understand it at the time, here was my first exposure to true community – a community of brokenness.

To be sure, the men and women who crowd these smoke-filled rooms were broken. Their lives were shattered and in shambles and they needed each other. Desperately needed each other for life. As I continued on in my own room of recovery, I admired them for their courage, their openness, their vulnerability and their humility birthed from brokenness. While I was prepared to admire them, what I was not prepared for, was that I began to envy them. Yes, they are the fortunate ones.

Out of their great need, they built communities of care, honesty, openness, and service to one another. In that atmosphere, they ‘held each other’ in tenderness and understanding, while healing continued. Here, brokenness began to become something beautiful. It began to resemble the ‘upside down’ world that Jesus introduced by His Beatitudes. The world where service to each other is the hallway that leads into the ballroom of mutuality. There is no “us” and “them”; it is “we”.

I envied them, because, apart from these rooms, this ‘culture’ of communion was notably absent elsewhere.

 

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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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