Psychiatric Disorder and Society - Essay Example

INTRODUCTION This discussion on the survivors of various mental institutions will highlight the impacts on the subjects as well as outline the possibilities using relevant scholarly sources to back up these examples. The analysis will first begin by incorporating the persona of the survivor into a clinical context. Using examples including the recovery process, recuperation as well as indicating how beneficial the stories that the survivors tell are to the rest of the psychiatric world in general, the analysis will also discuss the ups and downs that survivors must face in order to survive in a society that may or may not accept them because of the fact they were in a mental institution. The concluding part of this discussion will present deinstitutionalization and outline how this aspect can affect the people involved. Once again, critical research information as well as primary sources will be used to present facts relating to this matter. Studies that have been made for community treatment will also be looked at towards the end of the analysis. Community care procedures, government agencies and various other kinds of “help” that are available for patients once they leave the institutions will be covered in considerable depth, as well as showing how beneficial they are to helping these people recover. FROM OBJECT TO SUBJECT Psychiatry is not always able to see its clients as they really are: as people with a past, a present, and with hope for the future. Psychiatry is a medi­cal science: it deals with the pathology of the individual. It is not really concerned with the contexts in which mental problems develop. Conse­quently, on entering the psychiatric institution people are reduced to car­riers of a mental illness, or they are even seen as the illness itself. In order to classify the disorder, their behaviour as well as their stories are analysed for symptoms (Anto­novsky, 1987; Mooij, 1988; Thomas, 1995). Only what is signifi­cant to the diagnostic examination is seen and heard. Clients are examined but not really seen; they are listened to but not heard. Psychiatry does not regard its clients as serious dis­cussion partners: after all, with a disorder you cannot speak. Clients’ stories are not heard in psychiatry. This is unfortu­nate, as clients’ stories could teach us a lot. They would tell us about their lives, troubles, and their recovery, about what helped and about the battles they engaged in (Van Weeghel, 1995). Clients’ stories are about how they survive, and how they pick up the pieces. What do they do to promote recovery from their mental problems and their consequences? How do clients survive, recover and resume their lives after being labelled mental­ly ill? RECOVERY How should we go about understanding recovery? This is a difficult ques­tion to answer. Recovery is hard to describe in just a few words. The dictio­nary defines ‘recovery’ as ‘cure’ but most strongly disagree. ‘Cure’ sounds too pas­sive, as if it's something a physician brings about, or you take pills for. No‑one can do your recovering for you, and there are no medicines which will do it for you. Recovery is something you have to do on your own. And it is a continuous process: it is not an end in itself, nor is there an absolute finishing point. Recovery is an attitude, a way in which you look at life and what happens to you (Deegan, 1993). RECUPERATION An ever‑present factor in recovery during the first few years after a survivor has left an institution is the need to regain their strength. On being discharged from the institution, they may not feel strong enough to build on themselves. It takes time to regain strength once they have experienced how unlivable life can be beyond certain borders. Once they know these borders, little can ever be taken for granted again. They are confronted with an overpo­wering vulnerability which must be surmounted. They have to test themselves again. The world and all it contains must be rediscovered. Yet they have been drained of self‑confidence, which makes it a hazardous journey. A right balance must now be found between when to act and when to leave well enough alone, between protecting themselves from the dynamics of life and participating in life. The recuperation phase is precarious. It is not without reason that most readmissions take place in the period shortly after discharge (Van den Hout, 1985). Inadequate resilience is partly, but by no means entirely, responsible. There's also a transiti­on to be made from being a psychi­atric patient to full‑time citizenship. They must resume daily life. Psychiatry doesn't teach you how to do these things. Psychiatric treatment does not show a person how to arrange finances, find accommodati­on or turn it into a home. Forms have to be filled out, visits have to be made to the social services or housing corporati­ons and job medical assessments are needed. These are daunting tasks for anyone and all which require plenty of resilience. Rules and procedures are complex, waiting is endless and people can be unfriendly. And even if they have not been recently discharged from an institution, this is all very unpleasant. UPS AND DOWNS It is no easy task for survivors to look back at what has happened to them. It is impor­tant, however, to determine for themselves what led to their admission into a psychiatric institution (Deegan, 1993). This is the only way to come to terms with their life. This process of under­standing their life history takes time and will have its ups and downs. It is not necessarily a story of success with a happy ending. It is essential to realize that the process of recovery is not one upward line. There are numerous lines along which recovery develops. The only thing they have in common is that not a single line leads straight upward. It is important to learn why this is so. THE PRINCIPLES OF RECOVERY Recovery does not mean that everything will turn out alright. Some things never will and survivors must learn to live with that. In literature, these are called handicaps, but some prefer to call them vulnerabilities. If survivors can iden­tify them they can make allowances for themselves. It saves them a lot of misery. And it saves their energy for what you they do. This will build up their self‑confidence. This is what could be called the princi­ple of increa­sing recovery (Henkelman, 1995). NEW TRAUMAS Survivors not only have to recover from mental problems. They also have to cope with having been a patient in a psychiatric hospital. This is a place where new traumas are likely to be experien­ced, and where even more abuse may be undergone or witnes­sed (Deegan, 1993). However you look at it, mental institutions are reservoirs of human suffering. Other people’s misery you see there is ad­ded to your own. This, to some, is one of the contradictions of psychiatry: we herd together people who are suffering and then expect them to feel better. Even someo­ne who is relative­ly stable will be affected by the hectic and ever‑changing tensions of an admission ward. So how can a person suffering from psycho­sis, at such a place with all these tensions, ever return from his or her psychosis? (Mosher, 1975). DEINSTITUTIONALIZATION In the early 20th century, the public state mental hospital was the primary site for treating severe mental illness (Dickey, 1997). Widely circulated media reports in the 1940s and 1950s about the inhumane conditions in state hospitals featuring locked up, abused, and isolated patients provided the major impetus for massive deinstitutionalization. Other factors, notably the introduction of new psychotropic medications (such as Haldol and Thorazine), several important court decisions, and the Community Mental Health Centers Act of 1963, have contributed to a 90% decline in state hospital census since 1955 (Dickey, 1997). For example, a Massachusetts court decision played a significant role in closing Northampton State Hospital. The 1978 decision in Brewster v. Dukakis required the development, funding, and execution of dozens of community programs so that patients could be treated in less restrictive settings (Smith College URL, 2001). In more recent years, the rhetoric behind the push for deinstitutionalization has centered on two major premises: that newer medications have allowed mental health consumers to become more integrated into the community and experience a better quality of life, and that community-based care is more cost-effective (Kamis-Gould, 1997). In practice, cost considerations seem to be given more weight. Mental illness prevalence rates are increasing, and many in the mental health field fear that community-based programs are simply replicating hospital practices (Huskamp, 1999). In fact, many argue that “deinstitutionalization” from state psychiatric facilities has just led to “deinstitutionalization” on wards at general hospitals and in nursing homes, with a heavier reliance on psychotropic drugs. According to one estimate in the mid- 1980s, nursing homes accounted for 29% of national expenditures on behalf of the mentally ill (Frisman, 1989). Given the continued exodus of mental patients from state institutions, this number has likely increased over the past 15 years. A federally sponsored community program called the Program for Assertive Community Treatment or “PACT,” now active in 26 states, prides itself as being a “hospital without walls.” One goal of the National Alliance for the Mentally Ill (NAMI) was to have PACT programs in all 50 states by the year 2002 (Oaks, 2000). However, with their strong focus on medication compliance, many current and former patients view programs like PACT as a failure of deinstitutionalization, experiencing them as “wards in their backyards”. Federal disability policy and recent court rulings reflect the continued need to integrate people labeled with disabilities with the rest of society. The historic 1999 Supreme Court decision in Olmstead v. L.C. upheld the Americans with Disabilities Act's integration mandate, requiring that patients be treated in the “least restrictive setting” and that interaction between those with and without disabilities be maximized (Bazelon Center, 2001). To add further complexity, patients and ex-patients often find themselves in Neighborhoods that are suffering from a lack of civic engagement and a breakdown of community. Membership in community organizations, voting, church attendance, and even such things as participation in bowling leagues have fallen sharply in recent years (Putnam, 2000). McKnight (1995) argues that this increasing lack of civic engagement has led to an over-reliance on professionals and institutions. He asserts that professional institutions and service systems have effectively “colonized” communities, rendering neighborhoods impotent to solve their own problems (McKnight, 1995). For example, in the past family, friends, and neighbors were more expected to provide support people who just experienced loss or a traumatic event. With the advent of the “grief counselor,” people who have gone through tragedy are more likely to be referred to “experts.” McKnight argues that this type of specialization actually manufactures problems and undermines community capacity to take care of its own. Ironically, deinstitutionalization, supposedly a step toward community, has been accompanied by an increasing reliance on institutional structures. These institutions and the professionals that represent them generally view "mental illness" through the lens of the medical model. REFERENCES Antonovsky, A. (1897) Unraveling the mystery of health. How people manage stress and stay well. California/London: Jos­sey‑Bass Publishers. Bazelon Center for Mental Health Law (2001). Studies of Outpatient Commitment are Misused. Revised March 16, 2001. http://www.bazelon.org/opcstud.html Deegan, P.E. (1988) Recovery: the lived experience of rehabili­tation. Psycho­social Rehabilitation Journal, 11, 4, p.11‑19 Dickey, B. (1997). The Cost and Outcomes of Community-Based Care of the Seriously Mentally Ill. Health Services Research, 32(5):599-614. Frisman, L. & McGuire, T. (1989). The Economics of Long-Term Care for the Mentally Ill. Journal of Social Issues, 45(3):119-130. Henkelman, L. (1995) Paper delivered at the congress ‘Rehabilitation in the City of Utrecht’ organized by the Rümke Group, RIAGG (Regional Institute for Ambulatory Mental Health Care) in Utrecht and the Utrecht Association for Sheltered Housing. Huskamp, H. (1999). Episodes of Mental Health and Substance Abuse Treatment Under a Managed Behavioral Health Care Carve-out. Inquiry, 36:147-161. Kamis-Gould, E. et al. (1999). The Impact of Closing a State Psychiatric Hospital on the County Mental Health System and Its Clients. Psychiatric Services, 50(10):1297-1302. McKnight, J. (1995). The Careless Society. New York: Basic Books. Mooij, A.W.M. (1988) De psychische realiteit: over psychiatrie als weten­schap. (The psychological reality: psychiatry as a science.) Meppel/Amsterdam: Boom. Oaks, D. (2000). Talking Points: Why Forcing Psychiatric Drugs into Your Home is a Bad Idea. Dendron, 43:20-23. Putnam, R. (2000). Bowling Alone. New York: Simon and Schuster. Smith College URL (2001). http://www.smith.edu/nsh/dein.html (November 28, 2001). Thomas, P. (1995) On the nature of professional barriers. Pa­per based on a lecture given at the Hearing Voices Congress in Maastricht, the Nether­lands. Weeghel, J. van (1995) Recovery. Vo­cational rehabilitation of psychiatric patients. Dissertation. Utrecht: SWP. Read More