Friday, September 21, 2012

Recovery in social housing may depend on disclosure of the diagnosis

Monica Cassani at Beyond Meds has alerted me to an excellent article at the Wilson Quarterly.

Concerning the content of the Wilson piece, she writes:

Yes, slowly but surely there begins a recognition that what gets called mental illness cannot be explained with the bio-medical model.

From The Wilson Quarterly an article well worth reading with the recent history of how that which is called mental illness is considered in society and how that is changing since the psychopharmacological era has clearly failed:

Please check out Monica's page for a list of high quality recovery resources that she recommends. She also has a bookstore on her site where you can order much of the material.

One thing that struck me about the Wilson Quarterly article was the recognition that diagnosing someone with a mental illness almost always guarantees that recovery will be harder to achieve. For quite some time researchers have puzzled over why schizophrenia outcomes are invariably better in countries with less reliance on Western medical practices. The article sheds some light on this:

Indian families also don’t treat people with schizophrenia as if they have a soul-destroying illness. As an anthropology graduate student, Amy Sousa spent more than a year in northern India, sitting with doctors as they treated patients who came with their families into a dingy hospital where overworked psychiatrists can routinely have 10 appointments an hour. Many of the doctors didn’t mention a diagnosis. Many of the families didn’t ask. There was a good deal of deception—wives grinding medication into the flour for the daily chapattis they made for their husbands, doctors explaining to patients that they were completely well but should take strengthening pills to protect themselves from the ravages of their youth. As a result, none of the patients thought of themselves as having a career-ending illness, and every one of them expected to get better. And at least compared to patients in the West, they generally did.

It's heartening to see that the the Indian deception (the biochemical model of the illness calls this "denial"), is finding its way into the American health care system. Under the old United States' regime, as the article explains, people had to state their diagnosis in order to get housing.

The new kind of intervention simply gives people housing without asking them to admit to a diagnosis. Programs like the one that helped Susan are supported by federal funding set aside for people with serious mental illness, but the benefit is not described that way to clients. Though Susan knows that she has subsidized housing, she thinks she got it because she entered a program at a shelter to help her get off crack. Those who created programs like the one Susan is in believe that the social setting in which a patient lives and imagines herself have as much to do with her treatment as any medication. In general, the data prove that they are right. People are more likely to accept housing when offered it in these programs than in care-as-usual settings, and after they are housed their symptoms lessen—whether or not they are taking medications.  

School teachers don't encourage their students to become better students by labelling them stupid. Empowering students by bolstering their self-esteem was a revolution of its own kind - remember the dunce cap?

The recovery movement in mental health is more and more vocal about rejecting the diagnosis because it has long recognized how self-limiting for people the diagnosis can be. In my son's case, my husband and I reversed our thinking about the diagnosis and the best treatment, but it has taken us years to get the message across to my son that we were wrong to uphold it for as long as we did. I'm still not sure that our message of empowerment has trumped in his mind the original, discouraging diagnosis.

Read the rest of the Wilson Quarterly article here

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