Bringing an Inside Perspective to Mental Health Services

Whenever possible, I try to promote shared decision making between the person and the clinicians working with them. I seek to create open democratic spaces where people can have a say in how they move forward in their lives. Use of the open dialogue approach—a systemic approach to psychosis—has shown that the creation of collaborative networks around people who have psychotic experiences can significantly improve their outcomes.

All medications have pros and cons. I was coerced into taking medication for my mental health, and this coercion made me feel very resentful toward both the medication and the psychiatric professionals working with me. I think it would have been preferable for me if my psychiatrists had treated me as an equal and worked with me collaboratively in finding ways for how best to manage my experiences. Medications can help regulate emotions, so when people want to reduce their reliance on psychiatric drugs, I suggest that they have to find new ways to learn to manage their thoughts and feelings. Such management might include support groups, exercise, mindfulness practices, and different forms of creative expression.

When I sit down with people, irrespective of their diagnosis I work with them to find the meaning in their experiences. This approach involves understanding links between what they think, feel, and believe and the social contexts within which these experiences have emerged. I think it is important to do so in a respectful and power-sharing way. I don’t presume that I know how best to see things or that I need to educate the person about my preferred perspective. Rather, I see such conversations as an exchange of knowledges and viewpoints.

During the time of my psychotic episodes, I got chest pains and became worried that I had a gadget inside my chest that could be used to kill me. This belief was very bizarre for people around me, and they seemed not to know what to say. What I would have found helpful at that time was initially for someone to validate emotionally how frightening this experience was and later suggest an alternative explanation (for example, that the pain may be caused by stress and muscle tension).

I think we may be afraid to empathize with someone who appears paranoid or suicidal because we may be worried that we might give the impression that we are concurring with the beliefs the person holds. But empathizing with a person does not mean that we agree with his or her views. For example, I remember working with a person in an inpatient setting who reported feeing suicidal and did not want to meet with me. However, she tolerated my company when I consistently showed empathy for her situation instead of trying to change her mind. She later told me she found this approach very helpful.

Often, I might respectfully agree to disagree with people about their interpretations of events but still try to explore with them how they feel and what they want or need. For example, a person may believe that they have the devil inside who threatens them. I may empathize with the person by acknowledging that the relationship they have with an inner voice (which calls itself the devil) is a very difficult one that can fill one with self-doubt and fear. However, I also may share that I think that the devil is a voice that may be linked to trauma the person may have been through. I might suggest that, ultimately, they may need to learn how to stand up to the devil voice and build confidence in themselves. Eventually, I might also encourage them to be both assertive and compassionate toward their devil voice.

After being discharged from the hospital the second and third times, I went to a day hospital that had a lot of different activities, including pottery, art, and yoga. I found these activities helpful for developing a routine. In my work, I see a lot of people with mental health difficulties struggle because they don’t have purpose and a supportive structure to their lives.

As mentioned above, a good friend visited me a lot when I was in the hospital, and I think the visits were what gave me new hope and a sense of belonging. Knowing firsthand how friendships I made in the hospital helped me have hope and rebuild my confidence, I have always been interested in groups and peer support networks to help people build supportive relationships. Although I do not and never have heard voices, I have learned a lot from working closely with the hearing voices networks (i.e., networks of people hearing voices self-help groups).

Social injustice is often an important part of people’s internalized distress. For example, some people may hear voices that treat them very harshly. Or people may be very critical of themselves. These critical voices or thoughts usually arise from key experiences someone may have had when growing up when they were treated judgmentally or abusively. I teach people to learn how to compassionately communicate with themselves and, if they hear voices, apply the same compassion to the voices. This approach may involve learning to stand up for oneself and assertively letting the voices know what the person needs. It also involves helping the person learn skills to listen to the voices to find out whether there is anything they can constructively and compassionately help the voices with. I use nonviolent communication principles to teach this by using a nonjudgmental approach to communication that focuses on underlying feelings and needs in interactions that have conflicts and misunderstandings.

My work helping people make peace with their inner voices also has made me aware of the need to use those principles in my work relationships. Rather than judge colleagues who hold beliefs and values that are different from mine, I try to understand their feelings and needs better before I engage in discussions and negotiations with them.

In my work, I ultimately seek to promote real respect for a person who is in a mental health crisis. I like to break down the them-and-us thinking that sometimes can be strong in society’s approach to mental health. All of us can be confused and experience distress at times. So rather than holding to a dualistic idea that there are people with mental illness and people who are mentally well, I prefer to think that all of us are operating on a continuum. If we as health providers can put ourselves in the shoes of the people we are trying to support and if we can think carefully about how we would like to be treated if we were in their position, we can create environments that enable people to learn how to be gentler with themselves and each other.