Most popular posts of 2015 – #12 – Hope is created in community

hopeAcross the disciplines, we see a movement away from individually focused understandings of hope to more communally and relationally dependent models. Many focus on connectedness as a central aspect of hope. This takes the form of friendship, solidarity, and bearing witness as central relational aspects of hope. Within the recovery model and other models of care, the relationship with caregivers is central for engendering hope. Caregivers are often required to carry hope on behalf of those for whom they care. Hope exists as an interpersonal possibility reflecting the extent to which humans are made for relationship, for love. When we are living in relationships of love, hope is present. Isolation, lack of belonging, and lack of connectedness reflect that which distances from hope. The experience of connection with another, even in the midst of pain, opens up hope’s possibility. . . . Hope is created in community.

Pamela McCarroll

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.    

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 solution. 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.

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.

raising hope up and living our mission

speraFrom Victoria Safford via Maria Popova (emphasis mine):

I have a friend who traffics in words. She is not a minister, but a psychiatrist in the health clinic at a prestigious women’s college. We were sitting once not long after a student she had known, and counseled, committed suicide in the dormitory there. My friend, the doctor, the healer, held the loss very closely in those first few days, not unprofessionally, but deeply, fully — as you or I would have, had this been someone in our care.

At one point (with tears streaming down her face), she looked up in defiance (this is the only word for it) and spoke explicitly of her vocation, as if out of the ashes of that day she were renewing a vow or making a new covenant (and I think she was). She spoke explicitly of her vocation, and of yours and mine. She said, “You know I cannot save them. I am not here to save anybody or to save the world. All I can do — what I am called to do — is to plant myself at the gates of Hope. Sometimes they come in; sometimes they walk by. But I stand there every day and I call out till my lungs are sore with calling, and beckon and urge them in toward beautiful life and love…

There’s something for all of us there, I think. Whatever our vocation, we stand, beckoning and calling, singing and shouting, planted at the gates of Hope. This world and our people are beautiful and broken, and we are called to raise that up — to bear witness to the possibility of living with the dignity, bravery, and gladness that befits a human being. That may be what it is to “live our mission.”

Privileged access

charles outreach accept

Peg O’Connor offers an interesting perspective on self-trust in addiction.

Complicating the matter is the belief that each person knows herself better than others can know her. In philosophy we call this “privileged access.” On this view, each person has an access to her beliefs, desires, thoughts, emotions that no one else can have. Each of us can turn a light to even the darkest, most remote corners of our mind; no one else can see those corners and what lurks there.  On that basis of privileged access, each person can say, “I have the best perspective on Who I Am.”

However, the relationship between privileged access and perspective is muddy, and confounds the question of how much trust to have in myself.

I found myself experiencing a little ambivalence reading this. Reflecting on my own behavior and those of clients, so many decisions look and sound like acts of self trust. Running our lives into the ground, asking for help and then disregarding other’s experience and advice looks like hubris

In truth, when I disregarded suggestions given by others, it wasn’t that I had so much trust in myself. Rather, I had less trust that others fully appreciated my circumstances, options, needs, goals, motives, etc. On a scale of 1 to 10 my self-trust may have only been a 2, but my trust in your accurate understanding was only a 1.5.

However, it looks like there isn’t an way around the matter.

So, given all these complications, how can one end this vicious cycle of unreliability–>lack of self-trust –>untrustworthiness –>unreliability…? It involves embracing something of a paradox. Sometimes one has to trust others before she can trust herself. In a sense, one may have to borrow the trust someone else has in her until she can begin to generate it for herself.

The person who sees herself as untrustworthy may need to grant that someone else may have a useful perspective on her. Another has some distance and hence perspective on us. This is the equivalent of holding the printed page further away from the face.

That reminded me of two things:

First, Nadia Bolz-Weber’s observation, “I don’t think faith is given in sufficient quantity to individuals necessarily. I think it’s given in sufficient quantity to communities.”

Second, Bill White talking about the recovery coaches of Project Safe and their process of developing “hope-engendering relationships”.

It strikes me that we’re asking these very scared and frightened people to grant us “privileged access.” This is an honor and a gift. Helpers who treat it as an honor and a gift are much more likely to earn that trust.

O’Connor tosses in a little folk-wisdom from Aristotle:

More concretely, Aristotle has some useful suggestions. If we become who we are by what we do, we should act in different ways if we want to become different people. Aristotle instructs us to act as a virtuous good person does even if we do not yet have the same character. By mimicking, we can begin to act in ways that can become virtuous as we begin to develop a virtuous character. This is the philosophical forerunner of “fake it until you can make it.”