Bamboozled, hornswoggled and hoodwinked?

Byz, I guess this is where the problem arises for me: at certain points in my life, autonomous choices and self direction were what were killing me. No metaphoric speech intended. At some point many of us patients go through periods where we aren't really in a position to make decisions for ourselves, or even to see when we have reached that point. This does not mean that we atay in that stage, or that we all have to go through it, but there are those of us who go to get help and find ourselves given istead plenty of rope and lots of questions about "now, what do you think you can do with this+ What else? can you describe that further?" with all that help, I got a couple of lovely nooses knotted in those ropes... What I had needed was someone who said "you need to sit here and not move while I call an ambulance and your husband to take the baby, it's going to be OK, but you are going to need some help to get back on your feet. It's not normal for a new mother to feel this way and hear what you are hearing."

There is also another problem. Even ethical therapists influence their patients. There were studies dne where even Carl Rogers was seen to influence what his patients brought up in therapy and how they "developed" just from the subtle ways that he sat, nodded, and looked up at the patient in sessions. Rogers was not trying to unduly influence his patient. He was very against such things, but even as well train as he was, he was human, and humans communicate our views, emotions and expectations through more complicated ways than those we learn to recognize in training as psychologists, but which we as members of the species use and read none the less.

One of my professors used to say: "ethics are a fine place to start, but they are by no means sufficient when it comes to how you should treat a patient or how honest you should be with yourself." Soemtimes, you even have to go against eithics codes to do the right thing, but those things are not really related to what we are talking about.
Thanks for this thread, Byz! I do LOVE them mental gymnastics! HUGGGGSSSS!

Hello, lonegael. Yes, I totally agree with you. There have been quite a few times when I did not have the capacity to make even informed choices. My incapacity was both a function of my illness and my ignorance.

For years, I did not even understand I had a say in my treatment. The therapist that helped me the most talked about getting better as a requisite to more autonomy. He worked very hard to reverse the burnout that had consumed me so I could resume practicing law. When I told him I would no longer be a lawyer, he was very disappointed.

When practicing law, I would not tell clients what I thought they should do. I gave them alternatives. Of course, as you mention in the case of therapy, there are ways of influencing the decision-making process in the practice of law too.

Again, I want to stress my response is subjective and based upon my experience in therapy. As a consequence of being a lawyer I was used to dealing with alternatives. In a more general sense, I wish all of my therapists had talked about the role of clients in therapy. Frequently, I was perplexed when my therapist would not tell me my diagnosis, or why she/he was focusing on a particular subject, and did not involve me in decisions about treatment.

Therapy was very challenging for me. I really, really disliked being told I did not understand. I expect it was a bit challenging for the therapists too.

Current one has prescribed a low dose of a med 40-80 mgs that normally is 120-180 for most with my disorder but I react just fine on this lower range. \\yes... thanks for describing this

Hello, Wallowa, Glad you are doing well.

During the course of this thread, I have poked fun at those who treated me. Nonetheless, it does take two to make therapy work. When it became apparent I was not making progress during therapy, I became disillusioned.

This thread has been quite an adventure for me. Like Keynes, I have changed my mind about some things. In particular, I regret not having been a better client. By saying that, I do not mean to say I had to capacity to be one. After so many failed therapies, my expectations diminished and so did my will.

Thanks to Fool Zero and Kiya for these links that address a client's responsibility in therapy:

10 Qualities a Therapist Recognizes in a Good Client, part 1
10 Qualities Therapists Recognize in Good Clients, part 2
Protecting Your Therapeutic Relationship and the Therapeutic Community

After reading these articles, I have a better understanding of why I was told I did not have a personality that was conducive to therapy. I did not plot to be a difficult client, just as I did not set out to be mentally ill.

This Kathy Brody comment I found interesting:

These qualities, in my opinion, have nothing to do with mental illness. I have worked with some very disturbed people with huge issues, and yet, they possessed these qualities, and they made huge progess in their healing. I’ve also seen some folks who appeared to be rather high-functioning, and yet, they did not, or could not grasp some of these basic ideas. http://discussingdissociation.wordpr...lients-part-2/

The highlighted part seems to speak to me about why so often I was told I did not understand. Oh well, I am doing okay these days.

http://mentalhealthce.com/courses/co...B/secCB29.html

Despite being Bamboozled, hornswoggled and hoodwinked? You've come out the other side pretty darn good! ((((((( TheByzantine ))))))))

Pachy, you are right. A person can not re-cover something they never had. Would that mean we "covered?"

There's a saying I heard in group once that I've taken to using. "Normal" is a setting on the dryer." To me "good mental health" means being able to function on a daily basis. It means I experience a full range of emotions that are related to the world around me.

TheB, thank you for starting this thread. And thanks to everyone who responded. It's been an enlightening read.

Byzantine,

Glad you were able to get a bit (well more than a bit) more out. I'm sending you another just plain 'ole hug' but well intended.

My observation is that you don't give any of us anything that you haven't thought through (as much as you could/can) and I really like that.

lonegael's comment about autonomy and self-direction got me thinking. On more than one occasion, I was without the ability to function. Twice I lived in what I will describe as a structured home. My psychiatrist would come to the home to see. I thrived at the structured home. I had the most restful steep there. Doing what I was told was my only responsibility. The morning did not bring to bear the stress, anxiety and fear I was used to. The recovery model would have been folly for me.

As lonegael stated, ethics and patient rights at times may be problematical. There must be some flexibility to allow treatment that is in the best interest of the client.

There are many articles discussing the merits of the recovery model. Here are some of them:

http://stopthrashingaround.wordpress...ecovery-model/
http://www.cmha.ca/data/1/rec_docs/7...al_illness.pdf
http://en.wikipedia.org/wiki/Recover...l#cite_note-17
http://www.psychologytoday.com/blog/...-part-the-cure
http://www.empowermentcouncil.ca/PDF...ay%2014-03.pdf
http://psychservices.psychiatryonlin...ull/52/11/1462
http://ps.psychiatryonline.org/cgi/c.../full/52/4/486

Going against ethics would mean it's UNethical, right? Ethical: conforming to accepted standards of conduct <ethical behavior> so then going against ethics, being unethical means going against an accepted standard of conduct. I find it hard to think of any time when a professional would find something that is "right" that is unethical.

I suppose there is a strong reason as to why this gentleman was a professor and not a full time therapist.

I agree with the first part of his statement, because the idea of ethics does not explain actual treatment options and indepth therapies. However, the second half negates his wisdom because being ethical and being unethical are opposites. You cannot be unethical and "do the right thing." In my--and many other professional's opinions.

Thanks for letting me share this, it's upsetting to think that a professor is teaching this and --gasp---students are believing it!

Hey--have a good new year's start!

In retrospect, I've had some of my worst times when I wasn't sure I was even headed in the right direction, never mind taking the right steps to get somewhere. Even now, I seek out situations (at work, for instance) where someone else decides what needs to be done and I get to figure out a suitable way to do it. Of course I get to choose whether to take on that particular project or even work for that particular person (and if I do, to negotiate satisfactory terms and conditions).

If I'm helping to carry out someone else's plan (whether or not it's meant for my personal benefit) and I trust them, that tends to make it very easy for me. What I hate most is someone telling me what I should do (or even worse, what I should have done) but never bothering to check afterwards on how their suggestions work(ed) for me. Trivial example: when I was in my teens I had an acne problem. My father was firmly convinced that it was because I wasn't washing my face often enough. It didn't seem to matter to him that when I'd try washing it three times a day for a while, my acne would stay the same or even get a little worse. He took credit for having known what I should do and having told me to do it; I got the blame for (obviously) not having done it, whether I actually had or not.

A few years later, when it wasn't about trivial stuff like acne but about what I should do about school, my mental health and my life, he still seemed to be following the same model. I found I preferred to avoid him, his advice, and whatever I saw as the principles he was trying to teach me. I remember thinking quite a few times that if I were to flunk out of school, joining the marines or killing myself felt like better options than living at home and having to put up with more of his guidance.

In your example, I'm sure it would make a huge difference whether I trusted the program I was in and the people running it.

It's not quite that simple, is it? This means that ethics is defined by a majority of some kind. Is that what you believe?

The original quote was

"Soemtimes, you even have to go against eithics codes to do the right thing"

Here he speaks of ethics codes, which are not identical to ethics, I think. I would prefer a person who has thought things out and is willing sometimes to go beyond codes of the moment, if he is prepared to take the consequences. There are dangers, yes, but there are dangers on both sides.

Pachy, ethical codes exist to protect the client/consumer/patient. The codes were developed as a result of harm done to others. Many times these people thought they were "doing the right thing", but were misguided.

Now, may I suggest that if anyone wishes to continue this discussion of ethics they start another thread rather than highjacking TheB's thread?

The American Psychological Association's Ethical Principles of Psychologists and Code of Conduct provide:

Introduction and Applicability

The modifiers used in some of the standards of this Ethics Code (e.g., reasonably, appropriate, potentially) are included in the standards when they would (1) allow professional judgment on the part of psychologists, (2) eliminate injustice or inequality that would occur without the modifier, (3) ensure applicability across the broad range of activities conducted by psychologists, or (4) guard against a set of rigid rules that might be quickly outdated. As used in this Ethics Code, the term reasonable means the prevailing professional judgment of psychologists engaged in similar activities in similar circumstances, given the knowledge the psychologist had or should have had at the time.

In the process of making decisions regarding their professional behavior, psychologists must consider this Ethics Code in addition to applicable laws and psychology board regulations. In applying the Ethics Code to their professional work, psychologists may consider other materials and guidelines that have been adopted or endorsed by scientific and professional psychological organizations and the dictates of their own conscience, as well as consult with others within the field. If this Ethics Code establishes a higher standard of conduct than is required by law, psychologists must meet the higher ethical standard. If psychologists' ethical responsibilities conflict with law, regulations, or other governing legal authority, psychologists make known their commitment to this Ethics Code and take steps to resolve the conflict in a responsible manner in keeping with basic principles of human rights. (Emphasis added)

3.10 Informed Consent
(a) When psychologists conduct research or provide assessment, therapy, counseling, or consulting services in person or via electronic transmission or other forms of communication, they obtain the informed consent of the individual or individuals using language that is reasonably understandable to that person or persons except when conducting such activities without consent is mandated by law or governmental regulation or as otherwise provided in this Ethics Code. (See also Standards 8.02, Informed Consent to Research; 9.03, Informed Consent in Assessments; and 10.01, Informed Consent to Therapy.)

(b) For persons who are legally incapable of giving informed consent, psychologists nevertheless (1) provide an appropriate explanation, (2) seek the individual's assent, (3) consider such persons' preferences and best interests, and (4) obtain appropriate permission from a legally authorized person, if such substitute consent is permitted or required by law. When consent by a legally authorized person is not permitted or required by law, psychologists take reasonable steps to protect the individual's rights and welfare. (Emphasis added) http://www.apa.org/ethics/code/index.aspx

JD Byz and all, I think what the general point is is just what is outlined in the second paragraph; there are usually codes of ethics in professional fields where people from different faiths and moral codes are brought together to work and must agree on a standard of behavior. the standard of behavior is generally in line with the beliefs of the majority of the people of the area in which the professionals practice and with that of the professionals themself, in addition to that of the larger world community in which the academic tradition that the professionals are trained in. As in all such constructions, there are holes and conflicts and placs where things just don't always jive with the times, and therefore there are times where one's conscience must come into play, the ethics must be rediscussed, and at some point, the ethics themselves must be shown to be unethical.
At one point here in Sweden, in the seventies it would hav been considered unethical to allow a child of gypsy ancestry to go to school alongside of children of other European background. The risk of them "infecting" the good Swedish children with their, well, cognitive inferiority among otherthings was not considered worth the risk and it was not even legal. My best friend here is half gypsy and hid it most of her life. Her son and my son are best friends. Nowadays it would be considered unethical to even mention the fact in signing up her son for school, really.
My great grand mother used to explain social rules as "It's not the rule themselves that are important, dear. they are just a guideline for the people who hav no natural sense of how human beings should be treated. Personally, I only put so many forks on the table so I don't have to crawl under the chairs every time I drop one." It's a short hand for the paragraph that Byz cites above HUGGGS!

Byz back to your articles; I was thinking that the definition of "recovery" is indeed tricky: What do you say about those like me who have been sick for almost the whole of our lives? The attempt to extract something valuable from waste or some thing like that they were saying? Does it have to be a copy of the past we are trying to get back to? what if the past helped to screw us up? HMMMMM.

In mindfulness terms (as in ACT for example), it's not what's in your past that matters nearly so much as the context in which you now hold it.

^ That's very shorthand for an otherwise very long explanation -- which still wouldn't do much for you without some sort of demonstration. Steven Hayes's book (see the ACT link above) tries to get a start on such a demonstration.

My goal in the general sense is to come within the World Health Organization's definitions of of health and mental health:

Mental Health refers to a broad array of activities directly or indirectly related to the mental well-being component included in the WHO's definition of health: "A state of complete physical, mental and social well-being, and not merely the absence of disease". It is related to the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by mental disorders. http://www.who.int/topics/mental_health/en/

Mental health is not just the absence of mental disorder. It is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community. http://www.who.int/features/qa/62/en/index.html

SAMHSA:

Wellness means overall well-being. It incorporates the mental, emotional, physical, occupational, intellectual, and spiritual aspects of a person’s life. Each aspect of wellness can affect overall quality of life, so it is important to consider all aspects of health.1 This is especially important for people with mental health problems, because wellness directly relates to the quality and longevity of your life.

The Eight Dimensions of Wellness2

Social - developing a sense of connection and a well-developed support system

Physical - recognizing the need for physical activity, diet, sleep, and nutrition while discouraging the use of tobacco, drugs, and excessive alcohol consumption

Emotional - developing skills and strategies to cope effectively with stress, challenges, and conflict

Spiritual - searching for meaning and purpose in human existence

Occupational - deriving personal satisfaction and enrichment from one's work

Intellectual - recognizing creative abilities and finding ways to expand knowledge and skills

Environmental - fostering good health by occupying pleasant, stimulating environments that support well-being

Financial - feeling satisfied with current and foreseeable future financial situation
http://www.promoteacceptance.samhsa....0/default.aspx

Here too:

http://www.uic.edu/depts/wellctr/dimen.shtml
http://hanofharmony.com/how-to-create-meaning-in-life/

My earliest memory is of a trauma. I have some gaps in memory which I now believe to be trauma-related. Use of the word "recovery" obviously is a botheration. "Recovery" has several meanings. Here are two:

recovery -- (return to an original state; "the recovery of the forest after the fire was surprisingly rapid'' )

convalescence, recuperation, recovery -- (gradual healing (through rest) after sickness or injury)

The second sense is more in accord with what I understand the recovery model to be about.

I have said enough; more than enough; maybe too much.

"Botheration" Good word. May I use it? I would have to agree with you and your definition of recovery. Both you and Fool Zero more or less sum up my general feelings on where I am attempting to take my process right now. I assume it will be a life long process, in fact. I would add that it seems as though at no point do I ever feel like any of these eight points is close to being even with each other as to where they are in well being; I am often much better off in one than I am in another at any given time! Something that I noticed with chronic pain patients which working with acceptance. Lots of parallels there!

lonegael, when I am talking to people about recovery, I encourage them to develop a vision of what recovery looks like, to them. For some, it might mean getting a job, or an apartment, or a relationship, or not being frightened, or feeling competant, or learning how to cry, or not crying at the drop of a hat, or getting off the meds, or finding self-acceptance, or not feeling angry all the time, or any combination of factors. Thereafter, whatever steps they take that move them closer to the vision they hold for themselves, that's their recovery.

An individual's recovery vision must be self-initiated. If someone else determines what their recovery should or shouldn't be, it becomes an imposition, a standard they might want to exceed or perhaps, feel they can't meet. In those cases, the imposition can become a crippling factor that serves to impede their personal recovery. It's not about comparisons to others, it's about living your own life to the best of your ability.

Nonetheless, there do have to be some guidelines. As a case in point, over the years I have encountered some people who said to me, "I'm not taking medication either! I must be recovered!" but some of those same people were homeless, they didn't work, go to school, or engage in other forms of productive activity. They were estranged from family and friends, they were drinking or using recreational drugs to excess, they were not functioning well. In terms of schizophrenia and psychosis, I don't believe we can assess recovery as based on medication status, rather, we must look to how well an individual is functioning.

Awesome discussion! I have really enjoyed reading this thread and the linked articles. Thanks Byz for taking the readers and contributors on this exploration. I know I am late to chime in but I will go ahead and share some thoughts just the same.

I have to say I have great respect for you and the others who have navigated your way through the maze of psych therapy to be able to examine the journey. I find it boggling the challenges you have faced in your determination. While you make reference to being considered treatment resistant I refer to myself as being treatment phobic. I fear the vulnerability of that kind of disclosure. I fear being bamboozled, hornswoggled or hoodwinked by the world of medicine and psychology.

My experience with psych therapists is very limited. When I was 18 I was forced to see a therapist or be institutionalized following a suicide attempt. A regression exercise sent my racing out the door in tears. I never went back. Fortunately no one cared to follow it up.

At a more recent major life or death crisis I found myself at the local mental health office talking with a psych nurse. I saw him every day for a couple of weeks until the crisis passed and then a couple of times a week for another week or two after that. It was useful to have him to talk to and I am forever grateful to him for sitting in on a dx appointment with a pdoc. There came a time when I asked him about more formal therapy. We concluded that what I really needed from him was accountability. I needed someone who would hold me to account to do what I knew I needed to do to realign the balance and harmony required to manage my symptoms.

Sadly, for me, he took a leave of absence and I was assigned to a different nurse therapist when I called for a check in appointment. I guess because I was not in crisis and perhaps the clinic is only meant to service people in crisis she seemed puzzled about why I was there. I mentioned the value of accountability to my functioning but it didn't seem to register with her. I never went back. I wouldn't know where to look or how to go about getting the kind of ongoing therapy that members here talk about. I do have counsellors and advisors in my life; Traditional and spiritual community elders and teachers to whom I confide and who provide me teachings, ceremonies, guidance, support and accountability. I am blessed to have them in my life.

Considering some of the discussion these days about mental illness in general I am struck by how much dx's are on the rise. I think it is getting way out of hand how quickly and casually people are being dx'ed with a mental illness. Seems every time I turn around someone else is dx'ed bi polar. I have a few different reactions to the stats. On one hand I feel uneasy about my own dx. Can I trust they called it right when they assessed me bi polar or am I just another fool buying into the broad conspiracy?

My more serious concerns with the rise in mental illness dx's relates to an underlying theme of this discussion. Specifically with the social and environmental conditions that feed this trend and bring into question the effectiveness of the institutionalized response or treatment. It seems to me that our westernized culture has institutionalized so much of our lives that even when it fails it commands authority. Where once we thrived together attached to large extended families and close knit communities we now survive alone attached to isolated systems. I think our current social constructs are the cause of the epidemic of mental illness and the failure to re-humanize our communities is what is perpetuating the crisis. If we follow the money we know why it is financially rewarding to have 1 million people in America (and a proportionate number in every westernized country) on some kind of psych med. If we follow the money we know why alternative treatments and preventions are under-researched. When we follow the money we find big businesses with their hands on the strings and in the purse for sure but we also find a vast maze of other interests benefiting from a populous dependant on social systems to sustain them. We talk all the time about eliminating poverty but economists will tell us that whole economies would collapse without poverty feeding the middle class social structures. I think the same may be said about the diagnosing and treatment of mental illnesses.

I suppose in my ramblings I have gone way off track from the discussion. I know primarily the thread has explored the role of therapy and a therapist in the process of recovery. Underlying the journey has been the question of confidence in a system of health care that provides questionable results. That is what stirred a response from me. I get that it is complicated -- genetic and or environmental and all that -- but at the end of the day remains the question of why is mental illness on the rise and why is treatment broadly so ineffective. As has already been mentioned recovery suggests a return to some previous state of wellness except there may never have been such a state in the first place. Thus the recognition that what we really seek is a state of well being that allows us to function ‘happily’. To live in balance and harmony with ourselves and each other is the goal. I think we are soon to discover that what institutionalized care lacks has existed all along in community. The magic ‘it’ factor of wellness can’t be reproduced in a capsule with a trained professional in a structured program. It must be human.

Perhaps that is why so many find themselves conflicted trying to define their relationship with a therapist. It stands apart from the more natural community living. It is institutionalized and separated. The therapist is human but the relationship isn’t natural. Where once our parents, grandparents, aunts, uncles, brothers and sisters, friends and even neighbours listened, loved, and supported, now we are more and more conditioned or required by circumstances to seek other sources. Thusly we have bred the incarnation of an institutionalized approach to wellness from a treatment perspective. What remains lacking is support for healthy communities modelling wellness from a prevention perspective. If our relationships in community were solid and functional would we need institutionalized models? Is this all a response to loneliness... a quest for the recovery of our communities.... a yearning for human touches that stimulate personal wellness?

Good to see you, sanityseeker. Thank you for your thoughts.

I'd agree that my relationship with my two therapists (years ago) didn't feel especially natural -- even less so, my relationships with two other therapists in the school counseling service whom I saw briefly before that. I think their main job was to get me settled down a little and off their books.

But: they were a very different kind of unnatural from my relationships with my family of origin. What I was looking for was a path out of there. All in all, therapy didn't feel like all that great a path but it did provide me with a few useful stepping stones when (or not long after) I
needed them most.

With any of my relatives, or my teachers or my peers (all but a very few), I almost never felt listened to, loved, or supported. I thought their objective was usually to steer me toward being (or at least looking and sounding) more like them.

Hi Fool Zero. I am sorry your childhood was absent of love and support from family and community. I hope life has since brought you much love and kindness. I think you make a good point about the value of a therapist in the absence of other supports.

I think you speak for a vast number of people who were denied access to healthy relationships and role models as children. No doubt this reality fills many therapist waiting rooms every day. To me it is a sad reflection of disconnected community. It is also an indication of the power of people to create mechanisms to serve a high need when required.

I appreciate that my views are framed by my own experience. I was fortunate to grow up in a small community where everyone knew everyone and everyone had everyone else's back. There was never a shortage of places to turn for support. Sometimes I went to family, friends and even neighbours to help me with a situation. Sometimes I just kept things closed up inside of me. Still I think it was always a comfort to know help was but a call away any time of day or night. I also think there was great value to growing up being there for other people whether they were family, friends, neighbours or strangers.

As an adult I have lived for many years in First Nations communities. In between times I lived in a Christian commune, a Jewish kibbutz and among the nomadic Bedouin people in Israel. In all of these situations I have experienced the power of community to strengthen individual and collective wellness. To be left alone one would need to leave the community otherwise everyone is in your business.

Like in my childhood if someone is in need of help there is a circle of people surrounding them to lend a hand. The roles of leaders, elders, men, women, children are recognized, respected and honoured. At the same time individuality and talents are nurtured.

My experience has been to witness a greater representation of happiness in these communities then I witnessed other places. Yes there are problems, yes people fall through the cracks, yes people even in strong communities can loose their way, can be plagued with suffering, can be subjected to abuses, may even reject their home community and cut off community ties but they always know their way home again. I think people need to know where 'home' is even if that means creating it for themselves.

Communities of involved citizens can form in cities just as easily as they form in rural and remote areas. It is not geography that determines community but a sense of responsibility to family, neighbours and fellow citizens that opens doors and invites people into one another's life. We have gone through a few decades of community breakdown. Fear has raised a couple of generations of kids kept from playing outdoors, sheltered amid a small circle of people, told not to talk to strangers, living long distances from grandparents and other family members.

It is my hope that people are beginning to recognize the importance of broader rather then tighter human relationships again and finding ways to regenerate connected communities. They will take on a different profile and no doubt social networking will play a role in the process. Just as social network is giving people access to a broader range of support then can be met by a single therapist.