Wednesday, September 9, 2009

So Much Yet to Learn

Tomorrow marks the one month anniversary of my job at a locked psychiatric facility and I finally feel like I'm close to getting the hang of things. On the other hand, there is so much I don't know and that does not have concrete answers. Things like, how should we be treating mental illness? Should we even think of it as "treatment" (considering that many of the disorders we deal with don't have cures)? Should we focus on rehabilitation or simply harm reduction? And, importantly, what are realistic goals? (many of the clients I've worked with have been institutionalized the majority of their lives). Today we had one of our recovery conferences in which the recovery team (which consists of me, the social worker, the charge nurse, the rehab therapist and counselor, the psychiatrist, and the psychologist) meet to discuss a few clients in depth. Today's meeting very quickly aired on the philosophical as the psychologist asked a seemingly simple question "What do we want from this client and how can we help him achieve it?" The psychiatrist put his two cents in, saying that in his ideal world we would have a completely different system that involves a reliance on behavioral interventions like a token economy (people get points or tickets or money when they perform a wanted behavior), and to some extent, forced treatment. This kind of approach was very popular in the 60's and 70's and is still used a fair amount today, but not at the facility I work in. We focus exclusively on the recovery model which gives the clients as much autonomy as possible, letting them make their own decisions (within reason), and practicing living in the community. Concretely this means that if a client doesn't want to go to a rehab group or meet with his or her doctor, or take his or her medication, he or she does not have to (the medication, if the client is a danger to self or others, can be injected however). Since starting my job, I have heard both great praise and great scorn of this recovery model. I'm still unsure how the recovery model is taken from theory to practice and next week I have a seminar on it, so I hope I learn more then. What strikes me however is the fundamentally different theoretical perspectives members of my team have with regard to mental illness and its "treatment". Some are very concerned with how the clients are feeling and with talk therapy and integration into the community, whereas others are simply concerned with severity reduction and compliance. The doc said something that stuck with me. He said that in many ways our approach to the mentally ill was better in the past than it is now, in which it is getting too radical (i.e: letting the clients do what they want).

This took me on a tangent in my head with regard to the history of mental illness. Last summer I read a great book called "Mad, Bad, and Sad: Women and the Mind Doctors" which is about the history of clinical psychology from a feminist perspective and I loved it.

It didn't really go into treatment approaches however, so I am now on a hunt for a good book that does that. I'm thinking maybe:

"Treatment and Rehabilitation of Severe Mental Illness"
by William D Spaulding.

As for my history fix: "A social history of the asylum: Mental Illness and its treatment in the late 19th and early 20th Century" by Thomas G. Ebert,


"Reinventing Depression: A history of the treatment of depression in primary care, 1940-2004" by Chistopher Callahan, MD (since my research interests in particular lie in depression). Both sound good.

I'm thinking I'm also due to read "Toxic Psychiatry" by Peter Breggin. I've been sort of avoiding him (he's gone so far as saying mental illness is a myth and doesn't exist), but I think hearing his voice is still useful, if for nothing else, for the impact he's made on our perceptions of mental illness.

Wow, it looks like I have a lot to study up on and these books are kinda expensive (maybe the company will pay for books for enrichment?) ;) I, of course, welcome any other suggestions. Right now I think the best thing I could be is a sponge. Wish me happy reading.

*correction: I was talking about toxic psychiatry when I was really thinking about "The Myth of Mental Illness" by Thomas Szasz. Always get the two mixed up. Toxic psychiatry is also good though.

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