Theory matters. How we think about "mental illness" and particularly, what causes it (etiology) informs treatment and
greatly influences what choices are made available for people with mental illness. The fact that I phrased the last sentence this way indicates that people with mental illness "should be provided" with choices, by "normal people." Later we will discuss whether you can provide someone with rights and choices, or if they already have them. .
In the 1800s there were many prevailing theories of etiology. Benjamin Rush thought mental illness was the result of circulatory disorders...so he created the "spinning" treatment. The text will discuss that other folks theorized that mental illness came about from "problems in living."
What are the prevailing etiological theories in psychiatry today? What do these theories lead us to DO to (and with) people labelled with mental illness?
Answer these questions, and respond in detail to at least 2 of your classmates' answers.
Bowlby attachment theory was established and finalized in 1990. The theory states that if children have a secure attachment with an adult at a young age and are cared for the child will be a successful adult. If the child experiences trauma in early childhood, they are more likely to experience mental health problems in the future. Attachment is essential, and I think it is vital for new parents to realize how much their child is developing mentally during the early years. I think theories like the attachment theory cause psychiatrist and other mental health professionals to realize there is more than one way to treat patients. Many years ago, it was believed that one form of treatment would "fix" the person this is not true. For example, if a child who experienced trauma in childhood is now an adult with bipolar and mood swings, they may need to take, but along with the medication, the patient should be receiving other therapy to help her find tools that can also help her when she gets angry. Patients need to realize the power they have to be motivated to be an active member of society even though they have a mental illness.
ReplyDelete-Victoria C
DeleteThe Bowlby attachment theory is an interesting theory and also seems to easily explain many situations for children who experienced trauma, abuse and neglect from their primary caregivers early on in life. Then I think it's interesting to read about studies about babies who were adopted at birth and grew up with supportive, loving parents but at some point in their life experience difficulties with substance use/abuse and mental health symptoms (which were the things their parents experienced and sometimes being the reason for their lack of parenting the child). So then the question becomes what becomes more of a factor, the environment a person is in or their genetic factors. And I know this can become an ongoing debate that I think can never truly be determined because people's situations are all so different and unique.
DeleteAbove post by Lindsay Hill
DeleteLindsay, You make very good points. Children could have amazing parents but at somepoint in their life take a wrong turn.Many factors can impact a child's behavior and choices.
DeleteThanks for your input!
Lindsay,
DeleteI am such a fan of this theory because it demonstrates the need for connection! There are a lot of interventions counselors can introduce to rewire the client's ability to make healthy attachments with others. Addiction and trauma are the most observed forms of poor attachment but I think codependency is really interesting to examine as most people have some form of codependent relationship in their life. Thanks for addressing attachment theory, such a great comment!
Becca I also agree with you about the importance of connections! The attachment therory is also one of my favorite theories to exsamine. Working with children in the past this theory has helped me to understand why connection is so impoartanat and how it efects the brain development.
Delete-Victoria Codrey
Victoria,
DeleteI am such a firm believer in the totality of making connections. Attachment, or the lack-thereof, can be such a scary part of someone's life, especially going untreated. For those who saw, my youngest kiddo popped in during our first Zoom class. She has not been formally diagnosed with an attachment disorder; however of all of my experience in the social work and as a foster parent, I think I could make an educated guess that presence of one has been within her. She has lived with us for over a year and a half, now. When she first moved into our home, she did not smile, speak, emotionally regulate, or tolerate touch from others. This was back in January of 2018. Fast tracking to today, she is a total different child with a healthy, strong attachment to others. There was no magic wand, pill or fix to help her. What we did was provided her with love, boundaries, guidance, supervision, consistency, and attention to show that we would be loving caretakers to her. Of course, this didn't go without ups and downs, a little dancing in the kitchen and having cake for breakfast! :)
-Ashley Williams
You have an amazing story to tell Ashley about the strides that your daughter has made in a year and a half! You spoke of all the things that kids needs from their primary caregivers- love, boundaries, guidance, supervision, consistency, attention and of course cake for breakfast because every kid should enjoy that experience! For some of the hot summer days we have had this summer, we have done ice cream for breakfast :-)
DeleteAshley, I am so happy your foster daughter is now thriving. It is amazing how people can change when they are given love, attention, and structure. I am so happy there are people like you in the world who foster children and allow them to gain the skills they need to be successful! My hope for the future is more foster parents can help build the children up instead of tearing them down.
DeleteThanks for Sharing!
As soon as I read the blog and the information about “Bedlam” this week I began to think of my work and what seem to be the hot topics or new (more frequently) used diagnosis. I instantly thought about Fetal Alcohol Syndrome (FAS), it's increasingly something we are hearing more about amongst adults and interestingly being discussed in comparison to previous diagnoses and long term prescription regimes.
ReplyDeleteWhat I think comes of this is the need to look at an individuals symptoms, barrier, and impediments as unique to them, this will hopefully enable us to assist them in their own recovery and not with a recovery from a dx or new side effect of some other drug. FAS brings with it its own challenges and needs for support from housing to employment and many areas in between. Some people need more structured support while others may need to be treated for trauma and family treatment due to not realizing the past of their mothers during pregnancy. But again it is important to treat that individual with FAS because we do not know how someone may react to a dx never mind what treatment they will need for the symptoms that brought them to our door in the first place.
Posted by Sean Keegan
DeleteSean, I found it very interesting reading about your post since I have little experience with Fetal Alcohol Syndrome. I also like how you stated that each patient is different, and you do not know how they are going to react to a certain kind of medication or treatment. Recovery is a word nobody used for a long time; it is good to hear it is possible for people with mental illness also to understand they can recover.
DeleteThanks, like we discussed last night in class, it is interesting how systems and understanding of disabilities shape the current treatment models. These theories have created a culture of appropriate "cocktails" which merely treat a small percentage of the issue and more frequently are targeting side effects of something else. While working at the Clubhouse in Augusta it was always good to think in relation to each individuals road to recovery and pick them up where every they where at on that journey.
Delete-Sean K
Sean, just adding to your point about our culture and the "cocktails" that are so quickly handed out to people with all types of life problems, I just think this whole situation stems from our cultures need to "fix" life's problems in the quickest amount of time possible. When I step back and think about our day to day lives, we have the answer to most questions within seconds thanks to new technology like phones, and high speed internet, I think most want that same speed when it comes to curing health symptoms as well. The "cocktail" that is medication is, in my eyes, a quick solution to larger issues. It makes me think back to the whole idea of empowerment actually, as a kid my parents would tell me "anything worth having in life takes hard work", the whole rehab process could be seen the same way I think, but putting in the hard work is a sense of empowerment. Slowing down, and viewing each person's qualities, personality, and life in general is hard work at times, but absolutely needed to get the full benefits of the rehab process.
Delete- Spencer
I was the first Unknown on Sean post.
DeleteVictoria Codrey
With psychologists and scientists making new findings almost continuously, and with these findings being so easily accessible to the public, I am constantly amazed by the wealth of information we are being exposed to in this field. The history of Empowerment Theory is one that I have found myself looking into more and more out of sheer curiosity, as it appears to be prevailing as an etiological theory. According to our reading this week, the Empowerment Theory views individuals who have been diagnosed with a disability as individuals who can also fully recover from them. In order to do this, an individual must be involved in a combination of supports to gain self-management, decision making, and social skills in the community that he or she lives in. The individual must participate in both peer support and self-help therapies to work toward recovery. After working through this model, the individual is viewed as a person who has recovered from his or her mental illness. This theory is of particular interest to me because it helps to destigmatize individuals who have been “labeled.” It gives power back to an individual who may have felt that his or her power had been taken away from them due to a diagnosis. Furthermore, it encourages individuals who would otherwise be separated from the general population to return to it once and for all. I appreciate the goal behind this because I have worked with countless individuals who have been diagnosed with a disability struggle to have a voice. These individuals often are left with the belief that their choices are not theirs to make, and that others know them better than they know themselves. This theory does just as it is named – it empowers individuals who have been marginalized. Though it is my opinion that this theory is certainly not a perfect one at this time, and I do have questions about how to best support individuals once they are post-recovery, I am interested in continuing to learn more about it.
ReplyDelete(Posted by Kaitlynn Littlefield)
Kaitlynn, I love the empowerment theory in a previous class. I was able to learn about the theory and how it truly helps patients be involved in their treatment. Sometimes as professionals, I think people forget that not every patient is the same and that the patient needs to be apart of the treatment. Most populations we work with always have experienced negativity, so I think it is crucial to empower them and lead them to their strengths.
DeleteKaiti, you have brought up a lot of great reasons why Empowerment Theory is such a great theory to use with clients who have disabilities. I think the reasons you provided also highlight why we do the work we do as VR counselors. Our mission is to help individuals become employed in their communities in jobs that they enjoy working in and in jobs where they can utilize their skills and abilities. And you're right, many of the clients we work with feel like they do not have a voice so by providing them the ability to make their own choices and decide how they want to change their life, we are able to help them move forward in their recovery.
DeleteAbove post from Lindsay Hill
DeleteI was the other unknown who first commented on my classmates post.
DeleteVictoria Codrey
After reading and analyzing the modules for this week, I became very interested in the connections (and differences) between several different etiological theories regarding mental illness. The Network Theory states that "mental disorders arise from direct interactions between symptoms," (World Psychiatry. 2017 Feb; 16(1): 5–13.
ReplyDeletePublished online 2017 Jan 26.) For example, a person may go to a psychiatrist because they're experiencing symptoms of depression (low energy, apathy, loss of interest in things that were once enjoyable, lower sex drive, etc.). These symptoms are causing roadblocks in their life: they miss work, disconnect from supports, isolate or possibly use substances to self-medicate. The point of network theory is to find out first and foremost, why this depression is occurring? Is it biological, environmental, circumstantial? Is it all three? Usually, there are several different factors contributing to the mental illness. Once a theorist or psychiatrist can get to know the person that they serve by learning about their history, only then can they begin to diagnose this person and/or support them in managing the symptoms of their mental illness. Having personal experience with this mental illness, my most helpful tools have been through medication and psychotherapy combined to treat the symptoms of my illness and to stay in recovery by disclosing important information to an unbiased source.
Hi Unknown,
DeleteWhat an interesting theory the Networking Theory is! I love how it looks at the whole entire person instead of just one aspect of their illness. There are so many causes, as you mentioned, between biology, the environment and circumstances. I am so glad that you mention this, because at times I feel like it is overlooked. I am glad to hear that you have found helpful tools and that they have been successful for you.
Kaitlynn Littlefield
While many of the articles this week provided insightful, interesting, and frankly fascinating information on a variety of theories, I found myself gravitating most to the Empowerment Theory. As I have continued to grow as a professional, I have found that the Empowerment Theory has become present in my practices as well as my personal life. The Empowerment Theory embodies a versatile, holistic approach of support to an individual who has been diagnosed with a mental illness, mainly around social roles. With this holistic approach, an individual can be supported on multiple fronts (social, emotional, environmental, and so on) with a combination of natural and formal support networks on their journey to a state of recovery. Through this weeks' reading, the article provided by the National Empowerment Center provided a more in-depth look at the Empowerment Theory revealed that recovery does not mean an individual is 'cured' from a diagnosis of mental illness or that there is no longer a need for support to an the individual in one way or another. Rather, the Empowerment Theory empowers individuals to regain a state of stability of self for socioemotional and social statuses. With that being said, and while I am firm supporter of the Empowerment Theory, I do question its ability to be a stand-alone theory of practice. I would be interested to see additional articles and research on the Empowerment Theory being a stand-alone practice versus the Empowerment Theory being coupled with another theory.
ReplyDelete(Posted by Ashley Williams)
Ashley, thank you for this insight! I too agree that the Empowerment Theory is a critical tool in the treatment for people with mental illness. I can relate personally to the theory that people are never actually "cured" from their illness, but instead are in recovery one day at a time based on their willingness to continue seeking support. As counselors, we must empower individuals to truly believe they are purposeful members of this world. I think that this theory combined with The nEtwork Theory that I mentioned above, would work well, as both approaches are holistic and focus on all the factors contributing to mental illness.
DeleteYes, I completely agree! Each individual theory has its pros and cons, as a whole and as for each individual therapist that uses its approaches; however, the beauty of the Empowerment Theory is it being versatile with any theory. Furthermore, I think the positivity the theory encompasses can be a powerful tool for all aspects of mental health and/or symptomology that results from mental illnesses.
Delete-Ashley Williams
ReplyDeleteReading though this weeks material I found myself most drawn into the Rehab or Recovery article. Being a Rehabilitation Counselor, as I started reading the article I wanted to be excited about the rehab model, however, this was not the case. It is in fact the Empowerment theory that makes me excited to be a counselor and work with people experiencing all ranges of disabilities. The Empowerment theory mentions that treatment is part of self-managed care, and the goal is to assist people in gaining greater control of their lives and regaining valued roles in society. It was also noted that the primary goal of treatment should not be to control the person’s behavior. To me, that is the root of empowerment in itself, allowing people to control their own journey and life path without others telling them how to live or behave. The Empowerment model would see the helper or counselor as just another member of the person’s support system rather than a facilitator of a plan like some other approaches. It was great to see a section of this article dedicated to the role of work in recovery. In one instance the article notes that boring, unfulfilling work can lead to stresses that contribute to mental illness. This topic is something we have been talking more and more about in our office. Simply getting any job is just not enough to feel empowered, empowerment comes from truly meaningful experiences in work, and life in general. This article made me feel confident in the direction that services like VR is heading as the focus is shifting from simply getting folks employed to now, slowing down and working more closely with people to find more meaningful employment. Maybe before long we will be considered Empowerment Counselors rather than Rehab Counselors.
- Spencer
Spencer, I think you have definitely connected how VR services can be so meaningful in a person's recovery! I think we end up practicing pieces of the Empowerment theory by encouraging and guiding people to think about what they truly want to do for meaningful work and then assisting them in how to achieve their goals. I think a lot of the work we do with clients can help to ignite their self awareness, self advocacy and self confidence because they are able to see what they can do as an individual contributing to our society and not view themselves as a person with a disability who can't do this, this and that.
DeleteAbove post from Lindsay Hill
DeleteHi Spencer -
DeleteI love that you've connected empowerment theory to your work as a rehabilitation councilor. I think that you are so right in that in order for true recovery to happen, folks have to have meaningful experiences, whether or not that is at work or in treatment, or elsewhere. I work down at Preble Street with veterans experiencing homelessness. I struggle sometimes when folks who don't know too much about what homelessness is like judges the folks that I work with, and ask "why don't they just get jobs" or "why don't they just find an apartment." I think that people don't understand just how defearting and humilaiting the experience of homelessness can be. On top of feeling like they have failed themselves, my clients are often told by society that every bad thing that has happened to them is their fault and that they don't deserve to be a part of society with everyone else. This is where empowerment theory can really help. My colleagues and I do the best we can to help the veterans we work with just what their strengths are and (hopefully) they can begin to recover for the experience of homelessness.
Spencer, I love the name Empowerment Counselors instead of Rehab Counselor! So many times I introduce our program to teenagers and they are turned off by the word "Rehabilitation". They think of people that are addicted to alcohol. One student said to me, VR, like virtual reality. Yes, I replied. You envision where you want to go and that is the goal we work toward. I do by into the theory that clients are the experts on themselves. I agree that self advocacy and self awareness is so important. This is the part of my job that I love to work on with youth. Your point of slowing down is a great one. Often parents or teachers want to rush, but much of our work is establishing a relationship and creating a strong foundation. Thank you for your post.
DeleteThe primary etiological models of mental illness that I am aware of are the Recovery Model and the Biomedical/Disease Model. The Biomedical model leads us to label people with a diagnosis from the DSM as an explanation for symptoms and behavior that they are experiencing. Then, a treatment plan is created with hopes of alleviating symptoms of the "disease," similar to the medical model used to treat physical illnesses. The treatment often involves medication as a primary strategy but may also include psychosocial interventions like individual therapy. The Recovery Model, which we are reading about this week, offers a different approach. While people are still diagnosed with specific disorders within the Recovery Model, support approaches are tailored to the person's individual needs and choices. There is more education involved in the Recovery Model so that the individual can make informed decisions (self determination). The Recovery Model offers a wellness approach that encourages people to learn and practice coping strategies and lifestyle shifts that nurture their well-being on a holistic level, rather than just addressing individual symptoms in isolation. Medication may be involved in the Recovery Model, but within this model it is important that there is education around side effects and many options presented. Peer support is also an important component of the Recovery Model, as well as alternative and complementary therapies, collaboration with mental health professionals, employment or other meaningful roles, and more.
ReplyDelete- Brenna
Brenna,
DeleteI am amazed by the differences among the different models that we have come across in both this class and in our own lives. I have always had a hard time subscribing to just one model of anything, because I believe that every person is different, and what works for one person may not work for the next. I feel that we as providers must look at our client first as a whole, and then work with them on what would be most beneficial for them. Sometimes the answer is medication, other times therapy, and other times something completely different. Do you have a model you gravitate more towards?
Kaitlynn Littlefield
It seems like our society believes two things about the underlying causes of mental illness: that it's either the result of a chemical imbalance in the brain (as Dr. B. mentioned in the Zoom meeting earlier), which requires prescription medication and is ultimately incurable, or it's the result of a lack of "moral fiber", "inner strength", or a simple inability to cope with the stresses of day to day life. In response to this type of belief, people usually recommend self-help, peer-support, or individualized counseling options. Often, I hear people argue that mental illness is hereditary, and if someone in your family suffers from X Disorder, you're more likely to be diagnosed with it. All of these unconscious or conscious beliefs about mental illness affect the way researchers collect data, providers interact with clients, and the general population treats individuals dealing with mental illness. The first text I was ever assigned to read as a graduate social work student was an article called by Dr. Anne B. Donahue called, "Riding the Mental Health Pendulum: Mixed Messages in the Era of Neurobiology and Self-Help Movements." In it, Dr. Donahue describes her personal experience with depression and the various treatments/advice she received throughout her journey toward recovery, some of which were pharmaceutical in nature and some which involved various types of talk therapy. I remember being incredibly moved by her account of different providers blaming her for not taking her wellness seriously enough, ignoring her issues with medications, etc. She concludes by saying: "At the time of that state of utter despair, instead of receiving understanding of the erosion that stigma creates on the withering soul, I received double doses of the guilt message: plenty of leftovers implying character flaws from the days before the promotion of biological causation, heavily spiced with the new language of my failure to take responsibility for my wellness. And the most obvious answer was never offered to help me sort out my illness: the inextricable link between mind and body. Different professionals pursue and present their own perspective, and particular interest groups stress single source answers, without respecting the ranges of reality. That swinging pendulum is covering a true spectrum, not false extremes, but it took me years to figure that out on my own, the day when I suddenly reflected in my journal, 'and it's actually a mix, right?'"
ReplyDeleteThat article seems really interesting! I'll have to read it some time. I have been seeing posts recently in social media about how the wellness industry and wellness fads can be harmful to those struggling with their mental health. For example, it's probably pretty frustrating to someone with severe depression to hear, "Haven't you tried yoga?" or "Just drink celery juice every morning!" While I think that self help should definitely be part of a person's overall plan for wellbeing, we should be wary of how the rise of the wellness industry and popular trends in health can lead to misinformation when they're really driven by pseudoscience and profits. If we swing the pendulum all the way to the extremes of the wellness industry, people who are struggling will be made to feel like they are not taking their wellness seriously enough if they aren't subscribing to fads.
DeleteI also remember reading this article! I think that Dr. Donahue is so right, in that we must see that mental illness is complex and layered, and it's a mix of things out of one's control, but there is also room for treatment in which the patient is an active participant. However, it is also important that practitioners do not shame clients in the way that Dr. Donahue was shamed, for not taking "enough responsibility for her wellness." It is also important that we treat each and every patient uniquely, because they are unique in what they will need for recovery.
DeleteI completely agree with your posting as well as the above comments. Mental health and illnesses are incredibly layered. I think too often our society jumps to trying to "fix" things. We (speaking in general terms) want to resolve issues and cannot often settle until we know we have "corrected" all of the "issues" and are not completed satisfied until we have crossed all of our t's and dotted our i's. Social work challenges just that -- we take the need for resolution and turn it into a process.
Delete-Ashley Williams
Megan, Thank you for the great quote. Dr. Donahue seems to have a great perspective. By sharing her struggles with mental illness she helps to break down the stigma. I love the words she chooses- "withering soul", this seems to capture the sadness people experience.
ReplyDeleteIn light of our conversations during class last night, I reflected on the current trend of treating addictions. There does seems to be a trend of treating addictions with medications such as Suboxone. In doing a quick google search, one can find that the medication is known to block the pleasure seeking neurons and thus blocking the high individual's experience while taking drugs. In simple terms, when someone does not feel the high, they may crave drugs or alcohol less. As the Opiode crisis is high in my home state. The New Hampshire Attorney General Department of Justice reported that we had 470 deaths due to drugs in 2018.
ReplyDeleteI am wondering about the treatment options for addictions. We have learned about harm reduction treatments, self-help groups, and medical interventions. In talking to a taxi driver who shared he is a recovering alcoholic expressed to me he was not a fan of the medical treatments. He drives individuals to there Suboxone appointments, but feels it is a useless effort.
https://www.doj.nh.gov/medical-examiner/documents/drug-data-update.pdf
https://www.mayoclinic.org/drugs-supplements/naltrexone-oral-route/proper-use/drg-20068408
This makes me think of the current debate around harm reduction strategies like needle exchanges. This NPR article (link below) profiles a "Church of Safe Injection" chapter in Maine that passes out clean syringes, naloxone, and other supplies to increase safety among those using drugs and to prevent overdose deaths. The Church of Safe Injection chapters are volunteers who operate outside of official needle exchanges (and outside of state law, in Maine at least) to distribute supplies to people on the streets. The public debate around harm reduction strategies like this (is it saving lives or is it enabling drug use?) is summed up in these quotes from individuals in the article:
Delete"The only reason I struggle is the inner conflict, you know? It's preventative maintenance yet at the same time it's enabling, you know?" he said.
A woman in the apartment, who also didn't want to be identified, chimed in: "I understand, but what are you supposed to do? If someone isn't able or ready to go to treatment — should they die?"
This debate only exists because the mental health system has failed to support people struggling with substance use disorders. I think this failure can at least partially be blamed on a common harmful attitude about SUDx etiology that substance use behavior is a choice and that people would just stop using substances if they wanted to.
https://www.npr.org/sections/health-shots/2019/02/12/693653562/church-of-safe-injection-offers-needles-naloxone-to-prevent-opioid-overdoses
Brenna, this is such a good point! "I think this failure can at least partially be blamed on a common harmful attitude about SUDx etiology that substance use behavior is a choice and that people would just stop using substances if they wanted to." Our society continues to struggle when it comes to understanding substance use disorder, and it's so plain to see when you look at the legislation in the U.S. that passes (or doesn't pass) to address the Opioid Crisis. Or even at the language used to describe people dealing with addiction (especially from our current administration). The whole "pick yourself up by your bootstraps", hyper-individualistic kind of ideology bleeds into every facet of our culture, and it often leaves people dealing with addiction out to dry.
DeleteBrenna, Thank you for the NPR link. I'll listen to it.
DeleteMegan, I think we could add the idea of "wait till they hit rock bottom" to the list of thoughts that might prevent helping those in need.
Breanna, you have a great example of the struggle between enabling substance abuse or preventing it. In my internship seminar class, a student presented a case for the class to review and the client is a person who has a diagnosis of schizophrenia and is also a heavy substance abuser. The student was saying his treatment team is divided about his course of treatment because some feel he should be in a substance abuse facility because of his heavy use and his drug seeking behaviors while others believe he should be receiving mental health treatment which may alleviate the substance use cravings. I understand a primary diagnosis has to be chosen but it surprised me that both of his symptoms (mental health and substance use) can not be treated at the same time because it seemed so obvious to me that they are co-occurring for a reason. I do believe when people are using drugs, it is to self medicate for underlying mental health symptoms so I think treatment for substance abuse and mental health needs to happen at the same time in order for the person to have a chance at recovery.
DeleteBiopsychosocial model is a current model that is used when treating patients. It takes into consideration a person’s physical health, mental health and environmental factors when a person is experiencing symptoms and how to move forward with treatment. The purpose of the model is to promote a more participatory clinician-patient relationship while addressing the complexity of physical and mental illnesses. It can promote self-awareness for the patient and increase trust in therapeutic relationships. I think this model makes a lot of sense and works well for individuals if it is executed properly. I think sometimes the way our health systems and mental health systems operate make it so this model doesn’t work the way it is supposed to. Many community mental health agencies do well in providing clients with services they may need for their mental health treatment such as medication management, individual and group therapy, case management, housing and employment services. It can be beneficial for clients to be able to receive all these services from one agency because one service may recognize the needs for another service and can quickly do a referral. I think there can be a lack of connection between community mental health providers and healthcare providers. Being able to advocate for yourself as the patient or having someone to assist you in advocating becomes so critical in this situation because the care you receive for your physical health can impact your mental health and vice versa so having the professional clinicians and doctors be able to communicate and understand your personal situation is important. One thing I have learned in this program is the importance of recognizing symptoms and realizing the possibility of reasons they are occurring and not automatically assuming they are happening because of a mental health diagnosis or because of a physical health diagnosis.
ReplyDeleteI wanted to include a picture of the biopsychosocial model because I think it helps to understand and visually see how physical health, mental health and environment all interact. Here is the link to the article with the picture I wanted to share.
https://www.physio-pedia.com/Biopsychosocial_Model
Post by Lindsay Hill.
DeleteThis is a really interesting model to look at, Lindsay! When I think about the "prevailing etiological theories" of today regarding mental illness, I don't think most people (outside of clinicians or those in academia) necessarily recognize that health and wellness are the result of a combination of multiple different factors. Our mental, emotional, physical, social and spiritual health are interconnected - when one is affected, so are the rest. I definitely think there are times when we (the provider) focus too much on treating the symptoms rather than addressing the underlying causes.
DeleteNaturally, I am drawn to the Substance use recovery articles. Substance use is still a controversial topic because there are many negative labels inflicted on the users and at the same time there is a scare that anyone can have a dependence or addiction drugs and alcohol. Substance use has been known to be the cause and effect of other mental health disorders. Individuals use substances and it increases symptoms of mental health disorders like depression, anxiety, and psychosis. On the flip side, many self medicate to numb the symptoms of their mental health disorders. I am actually a big fan of psychiatry and find it absolutely fascinating however, I understand that it has its limitations, just like counseling interventions have their limitations. I believe the two fields can create a strong recovery process as long as there is a coordination of care between the psychiatrist and the counselor. Becky mentioned Suboxone treatment for individuals that have Opioid Disorders and this highlighted that many people find it as a bandaid, not really helping the source of the addiction. Medical Assisted Treatment is a harm reduction model that I have witnessed to be successful in treatment of addiction. It is not just an option for individuals addicted to opioids but also individuals with alcohol use disorder. It appears Medical Assisted Treatment is most effective if there are three components in alignment: Coordination of care, motivation, and introduction of adaptive skills. If the counselor and MAT prescriber are not on the same page then the client can be at risk to use their medication as the cure without addressing the underlying addiction symptoms. If there is little motivation from the client to address underlying behaviors in counseling, then there is a risk that the client will relapse because the addictive behaviors are still prevalent. Furthermore, if the counselor is unable to introduce adaptive skills to address the client holistically then there is also a risk for relapse. SAMSHA recovery 10 guiding principles demonstrates the knowledge the client needs to learn to create a connection with something outside of their maladaptive skills, using drugs/alcohol. In AA they say that addiction is disconnection and recovery is connection. By looking at the client holistically and helping them understand their power to create healthy connections, the client is likely to succeed accomplishing their goals whether it's to be sober long term or to make it through a craving which typically lasts 20 minutes. MAT helps ease the cravings so the client has the ability to work internally. There is research that addiction alters brain connectivity and if medication can help ease the symptoms without masking them, then I think why not. Make the journey easier because in counseling sessions, the client has to do the hard work of addressing past mistakes, learned defenses, exploring shame and vulnerabilities, and often exploring trauma.
ReplyDeleteBeing in recovery from drugs and alcohol, I identify with your message. It's very common to have co-morbid disorders when dealing with mental health and addiction. My experience was just as you spoke of in terms of feeling disconnected, wanting badly to feel connected, and using drugs and alcohol as a way to self-medicate for that pain. Once I got sober, I had to recognized that I still experienced a lot of anxiety and depression. It went on for long enough that I sought help, but I wouldn't have been able to do that if I had not first gotten sober. I was led to AA by a drug and alcohol counselor, which makes me excited to pursue the same career and hopefully help others!
DeleteBecca I can completely can agree with your post about how the disconnection of those in recovery can be so challenging. I think this can also happen with mental health too. As you noted it can be so important for individuals to address past mistake, defenses and vulnerabilities but it can also be so easy to divert to past habits. I think it is just so important to support individuals through these experiences and also know, old habits will arise. Great post!
DeleteAfter class on Thursday, I thought more about some of the current trends in the world today revolving around our field of work. Most of us being VRC's I think we probably are all familiar with the theory that people who do not work are "working the system" or lazy, or a number of other totally false stigmas. In class people shared stories about how the system has failed in the past. One way in which I feel the system is failing, and one situation that I see non stop in my own caseload is the lack of transportation for folks to even attempt to explore employment. In most small, rural places around Maine taxi's are few and far between, and also cost a hefty amount. Even when available, the money for a ride is hard to come up with, making taxis difficult to utilize. Also, not a lot of 16 year old students have $400 bucks available to take drivers ed naturally either. Overall, I think our system that stigmatizes folks who are not employed, holds these same people down with a lack of available resources to even start the journey to employment. It makes me very thankful for what we are able to provide to folks at VR, but also discouraged by our natural resources. Anyways, I thought this would be interesting to point out given our zoom conversation earlier this week.
ReplyDelete- Spencer
Spencer, I could not agree more with you. 95% of my caseload is based in Somerset county, where there are no cabs or public transportation. I work with youth and although I am fortunate to be able to meet with them at school, I am not as lucky when trying to organize meetings with their parents, support systems, or during non-school hours. Many of my clients' families struggle financially for many reasons, and this lack of community support/transportation is a major barrier to their successes. This problem runs so incredible deep, and is one that I am trying to creatively help solve with my clients. Unfortunately, it often gets the best of all of us. I continue to try to support them by finding ways to get them to meetings, but once they start working, we find a new set of concerns. -Kaitlynn
Delete(Above posted by Kaitlynn Littlefield)
DeleteWe have come a long way in the way that we view and treatment people with mental illness. I took a look at the link with the photos of the women and men who were forcibly locked up in Bedlem hospital. They were likely treated cruelly and inhumanely, whether they had a true mental illness or not. One of the biggest changes that I mark in the change of theories of etiology in the treatment of mental illness is that of agency of the patient. For example, those locked up in Bedlam were locked up there for life with the belief that nothing could be done to treat them. Further, in the realm of psychiatry, Fried looms large. His theories are based on the belief that his patients had deep seeded issues that they did not know about, and that those issues then controlled their behavior, unbeknownst to the patient. Treatment was available for these patients, but their agency might be little, depending how deep rooted their issues were. Luckily, as we have moved forward, we have developed more of a true understanding of mental illnesses and psychiatric disorders, and those that live with them. One of the biggest things that stood out to me in patricia deegan's speech was the section in which she discussed how important hope was in her treatment. Once she began to hope that she could and would find some sort of recovery, she became and active participant in her treatment. This is reflective too (at least somewhat, there is always room for improvement), of the change in etiology. We now see mental illness as complexes and layered, a combination of genetics and lived experiences. This shift has then allowed for a hope for recovery to creep in as well. Take the theories behind CBT, for example. This treatment is used to work with folks with depression, anxiety, PTSD, etc, and it gives patients an active role in their treatment. It identifies some root causes of suffering for the patient and then gives them tools in which they can address the issue and begin to feel better. This shift is an important one - it allows for the patient to know that there is hope for recovery, and that they are the ones in control of that recovery.
ReplyDeleteThank you for your perspective, specifically your comments regarding hope. One of the greatest symptoms that plagues many people with mental illness are of defeat and hopelessness. People feel that their illness is their only reality and when counselors diagnose them like Patricia Deegan's did, hope for recovery and a full life seems a very long way off. This is why newer etiologies, as you stated, strive to involve the person with mental illness in their own path of recovery, by making goals, finding healthy coping strategies, seeking better relationships. All of these things allow a person to have hope and with that comes motivation and action to make changes.
DeleteErin, it has always been so interesting to me how Freud played such a major part in the realm of psychology and all the came after him. Theorists of whom I have always found to be very interesting, such as Adler, all seem to have at one point or another subscribed to Freud's theories. It baffles me that we have come as far as we have, and I am so grateful for that. I at times will consider what it would be like if we continued to agree with Freud and his beliefs. Where would our society be at now? There would be so little growth, and there would be so much confusion. Our personal lives would be, honestly, a mess. I agree that we have luckily moved forward. Even though our culture and society as a whole can seem rigid and difficult to change, we have also made such great strides in being accepting, understanding, and evolving. Instead of sitting on a couch, our clients can be active in their own rehabilitation, recovery, and success. They can be a part of their community, contribute to society, and reach goals that they could not have even a few decades ago. I am so grateful to see this shift, and I am excited to see where it will go in the future.
Delete-Kaitlynn Littlefield
Erin, Thanks for your thoughts! As you stated we have made progress in the mental health field. More theories are followed today and people are staring to realize how important recovery is to a person who has a mental illness. I look forward to more growth in our field and more people focusing on recovery instead of maintaining.
DeleteI found the article “What Recovery Means to Us” by Mary Ellen Copeland and Sheryl Mead very profound and meaningful to the work I do as a case manager. The article discusses the importance of hope and the idea of “boundaries being redefined.” This struck me because I think often as a society it feels as though if individuals do not meet a certain criteria they are categorized as less than. I think this can also apply to clinicians/practitioners as well. Often, we have ideas of what will “fix” or “improve” the lives of the individuals we work with even when our ideas don’t align with the client’s ideas of what will work for them.
ReplyDeleteThe article also ask the question, “What are the things getting in the way of us stretching and growing?” which aligns with the person in environment theory. This social work theory discusses that an individual’s behavior (both past and present) is due to historical roots based on their environment and the complexities the environment can hold. I think that often when working one on one with individuals we can forget how much their environment (work, lack of work, school life, family life, etc.) can have a huge impact on their ability to make progress or be hindering their ability to make progress. For example, as a case manager I have found it could potentially be very beneficial for a child to have in-home supports, however their environment would not sustain this. A concrete example is a child I am currently working with who is struggling with significant social skills and behaviors in the community/home setting however the family currently lives in a one-room apartment and mom does not feel comfortable having providers in the home. Therefore as a provider, I need to adapt my way of supporting this family and become more creative with interventions.
-Jennifer Luja
Jenn, I could not agree with you more society often tries to label people denying access to certain services. I believe it is crucial we try to work with our clients towards recovery instead of trying to fix them. I was also asked the question was is holding us back from growing as a profession. I enjoyed reading your post!
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