Intro and context (dry stuff at the beginning, skip if not interested)
I have chosen to review the WHO Quality Rights training modules, based on my understanding that the Mental Health Policy and Service Development team (Michelle Funk and Nathalie Drew) officially and publicly upholds the CRPD standard that requires abolition of involuntary treatment and involuntary detention (i.e. involuntary admission/retention) in mental health services.
This is a major step for WHO, as they are the health agency associated with the United Nations (though technically separate), and have a considerable influence in the health policy of countries throughout the world. A number of activists/advocates in the users and survivors of psychiatry/people with psychosocial disabilities movement have been involved with writing and reviewing the modules to date, as well as UN experts who contributed to the CRPD standards. Also there are psychiatrists involved. It has been a large and diverse group.
An obstacle to more activists taking part in the review is the large amount of time needed for the volume of material, without remuneration. I will describe why, for me, it has been worthwhile – not necessarily to encourage others to do the same, but to start a conversation among ourselves, raising the same underlying question and related ones:
- What is mental health policy following CRPD?
- What is the place of mental health policy within the overall goal of implementing the rights of people with psychosocial disabilities under CRPD?
- What are the possibilities for CRPD-coherent ways of understanding not just alternatives to conventional mental health practices, but alternatives to mental health treatments/services and their underlying perspective?
In particular, I am interested in exploring alternative forms of support that do not conceptually separate people or any of their experiences from the community and its ways of working with emotions, spiritual dimensions, and mental states.
Lesbian feminist community, healing, and capabilities of communities
In this post I am going to talk about lesbian feminist community, about healing, and about what it has to do (or not) with concepts of ‘recovery’ and ‘mental health’.
In my life there have been different threads that come together, diverge, come together again, in larger and larger groups of coherence. (Think of it as joining strands into a thin rope, and then joining the ropes together to make a thicker and stronger one, etc.)
Lesbian feminist community, coming out as a lesbian, female autonomous spirituality, have been threads that diverged and came back together perhaps more than once, with deeper understanding.
Spirituality and healing began as separate threads and then converged. I can’t recall how this even felt when they began as separate, but I recall marking the change when they converged.
Healing began for me as healing from psychiatric assault, then deepened into wider aspects of my life that needed to be healed. At first it was healing from identifiable trauma but it has also become healing of anything that is hurting, any way that my life is in pain.
Healing the psyche began as separate from physical healing, but that too is converging. As I get older, there is always a greater sense of physical vulnerability and mortality, and awareness that my body isn’t and never will be very well explained by conventional western medicine. I haven’t gotten to explore other systems of healing in depth, or found practitioners who have worked any miracles with me. Instead I find myself faced with more choices about conventional medicine and its risks, and also am attuned to psychic aspects of my body and its healing.
Lesbian feminist community has always been a space where women found healing. Just being free of the constraints of the male gaze, knowing we had to do it all for ourselves and finding strength we didn’t know we had, connecting with each other on deep levels that let us know we are not alone. There is a great joy to this connection, and to throwing off shackles, and we find we still have our core flame when we come back into the ordinary world where we need to be more armored to deal with men, with patriarchy, with everything that patriarchy feeds as barriers between people: racism, anti-semitism, ableism, capitalism, and more.
Is this healing something that lifts us out of any idea of our craziness? For me, it has been. Craziness is unworthiness in some sense, it is only a part of me that ever has separated out and judged, ‘that’s crazy.’ It’s a part of me that is defined by fear of crossing over a line that other people define in some way. It’s an alliance with others’ judgment, against myself. It feels like a kind of self-preservation and it is at bottom a kind of instrumental self-hatred, that may or may not help you to fight your way through a situation that is life-endangering (being institutionalized) but that is harmful in the long term.
It seems to me that many people find their way to this point (I am not crazy), from a number of different paths. It seems like it is the product of a journey, and retroactively defines the journey. Even if you know it intellectually, it is the emotional feeling of connection that makes you know it for real, come home to yourself in a way that cannot be undone.
Another thread that may be relevant here, a conversation I had with a good long-time friend, who articulated what happens when ‘long-term goals are so important, you are afraid of fucking it up, so in the short term you avoid it.’ I have had that fear, and I love how my friend put it so non-judgmentally. I have that fear now, that saying the connection, and not-craziness, ‘cannot be undone,’ will undo it. But my mind goes there, and I cannot help but take the step, and rely on my faith and trust in the thing itself, which got me here.
Can the healing I’m talking about be relevant to anyone, at any stage of their journey? It took me so long to be able to receive it, in the way I describe. I was working on my healing for a long time, and when I didn’t even say I was working on it anymore, this came.
Does it make sense to talk about valued communities of any kind, as holding the space for all of us, including those who don’t feel it? I used to hate it when people told me that they would hold open friendship for me to come back to, as their way of announcing the friendship was over, or that they loved me while I knew they were deliberately excluding me from collaborations in which I had an interest. This is still a rejection, clothed in sanctimony and self-interest. In some rejections, there is an underlying affirmation, a willingness to keep exploring our own boundaries and each others’; despite the potential for this to be misread as an endorsement of misogynist rape culture ‘no may be yes’ it is something that happens. We don’t have to be rapists, we can be attentive and care whether there is ever a yes and whether it is real or just a belief in the need to appease.
And, not everybody who is eligible will find their way to a particular community or feel it as home. Not the psychiatric survivor or peer community, not the lesbian feminist community, not the Jewish community. But can these communities in themselves, defined by shared values and beliefs, as well as shared experiences, history and traditions to a greater or lesser extent, foster and contain within themselves the ability to keep space and keep faith with all of their members, in good times and in bad? Can healing be the same as reconciliation, or as finding home for the first time in a society where so many of us are effectively rootless?
This may be the same vision as the Beloved Community that Martin Luther King envisioned not only for activists but as transformation of the world. Yet we can’t be naive or vague about what it means to create healing, to open the door to healing, to create space for healing, to invite healing. Healing is messy, loud, it comes with conflict. It doesn’t need to go somewhere else to happen – it doesn’t taint the space.
Maybe sometimes healing is trying to happen without asking, and may or may not be what’s happening when someone annoys you and persists in doing so. How can we deal with that? How can we get on with our agendas, if we need to, and not get derailed while also allowing this other thing to happen?
‘Recovery’ and ‘mental health’
And finally, what if anything does this have to do with ‘recovery’ and with ‘mental health’?
Like some other survivor activists, I dislike the term recovery and do not use it for myself. I feel also a kind of judgment and shame in not doing so, does this mean I am not ‘recovered’, that I am ‘still mentally ill’? Well, no. I reject the idea of ‘mental illness’ because it takes ‘craziness’ a step farther and says ‘there is something wrong with you’. There is a pseudoscience and a set of experts and a way to fix that thing, and it is inside you and you have to be taken apart to get it out.
I’ve talked about my definition of mental health. I don’t actively use that concept in my life, it was an exercise in how I can connect to an idea that I can understand as a value, but that ultimately is too commodified to be coherent with my own values and beliefs. I don’t pursue mental health, I live my life and try to feel good in my whole self and to be in harmony with creation. To say this is not to define it as a goal or objective of any kind, rather a description of what I gravitate towards as plants gravitate towards light.
I am also committed to making coherent discussions between my point of view, and what it means for people to understand themselves as dealing with mental illness or working on recovery, or taking a recovery approach (in relation to themselves). Our experiences don’t have to be the same, and I want to understand the nature of the differences: to what extent is it a difference in beliefs and values, to what extent a difference in the kinds of challenges we have faced?
WHO uses the ‘recovery’ framework in their materials, drawing extensively on work done by or in collaboration with users and survivors of psychiatry. The understanding of recovery is not a simplistic one as ‘recovery from mental illness,’ rather it is (from Module 10):
- ‘a lifelong journey of growing and learning, gaining resilience, managing setbacks and celebrating successes’;
- ‘happening when people can live well in the presence or absence of a condition, diagnosis or symptoms’;
- ‘about regaining control of their identity and life, having hope for their life and living a life that has meaning for them whether that be through work, relationships, community engagement or some or all of these’.
There’s a lot to value there despite the criticisms I am making in the review process, where, like in this post, I am looking through two sets of eyes – one my own experience as someone who has no use for the mental health system (literally, I simply have no use for it, the same as, being a lesbian, I have no use for men as sexual partners), and the other my awareness that the mental health system is the social institution in modern societies that responds and takes responsibility for needs that I describe as healing and reconciliation. Maybe this is what is happening: the mental health system is the way that modern society calls people back to itself, to its values and belonging, and it is the underlying beliefs and values of that society itself, reflected in the mental health system, that require self-hatred and alienation, separation and classification rather than creation and contribution from within.
Or maybe there is always a need to see with two sets of eyes, one that sees separation and another that sees the whole and calls it back to itself.
What I like about the recovery approach is building the person up rather than tearing them down (‘building on the person’s strengths and assets’). The recovery approach could be an expression of emerging values in modern society that are turning back towards cooperation and respect for nature, including human bodies and inner knowing. Our own innate capacity to heal and the creativity inherent in our movement and choices at every moment and throughout life. (This is said to be related to Hannah Arendt’s concept of natality, which I have been meaning to research.)
WHO also assumes the necessity to challenge a person’s ideas and keep these challenges in balance with support. I would reframe to say that it can be valuable to offer a different perspective that occurs to you, that the other person may not be considering and that balances and complements the strengths they’ve been leaning hard on. It may be something you have been thinking and then in a conversation the words come and the person can hear. This is not ego and it is not a recipe or a practice. If you go around challenging everybody, listening for holes and trying to fill them, you will be a smart-ass or a bully. It’s part of building the person up, building on their strengths, and not a contradiction; not ‘here’s what you’re missing,’ but ‘consider this too.’
Back again to the experience of avoiding in the short term, something you deeply desire in the long-term because you are afraid of fucking it up. This relates to what the recovery approach calls, ‘taking positive risks’. But again it can’t be a recipe, and it can’t be ‘risk management’ where life is a negotiation between you and your therapist. It’s ok if you mess up. When you mess up is when you need to focus again on building yourself up and not tearing yourself down.
Implications for policy
Mental health systems should continue to learn from natural communities and supports – without trying to become them or to enfold them into its own structures, bring them under its governance (through regulation, funding or theory) or treat them as assets to be exploited in working towards a person’s recovery. Mental health needs to keep its hands off my community and my healing, acknowledge its power, acknowledge that some people who use their services also have access to other spaces that do some of the same things and may do them better.
The dialogue and cross- fertilization can be useful – assuming we are taking CRPD absolute prohibition of coercive practices as a starting point – if both sides are recognized as being on equal terms, and imbalances in resources and institutional power and hegemony are acknowledged and compensated for. The aim might be, to narrow the gap so that eventually the public service functions related to healing and reconciliation are no longer separated from natural communities and natural communities have the strength and capabilities – and the power and freedom – to deal with all aspects of life for ourselves, not as an extraordinary time or isolated place but permeating and assuming the technologies and responsibilities needed everywhere.
tastethespring 