The Changing Viewpoint: Psychosis & Its Treatment Limitations—Constructing a Better Way Forward
In the following, I would like to address some of the subtle, less acknowledged problems with the medical model and conventional psychotherapeutic approaches to working with people who face difficult challenges in recovery. In order to do so, I will be elaborating on key terms pertaining to recovery and examining their associated concepts. As a peer, I write from my lived experience, and as a peer professional, I offer a more analytical perspective. There are several of these terms or phrases I would like to consider more in depth, to reveal their implicit biases and underlying assumptions. It is my intention to demonstrate that much of what we take for granted in mental health settings is in fact biased toward overemphasizing the legitimacy of the dominant therapeutic view and culture at the expense of invalidating the views of those with lived experience.
Consensual Reality
What we call consensual reality is not simply about consensus; it is also normative, value-laden, often dominated by the majority and weighted in favor of those who hold the intellectual perspectives and professional powers with which to define and dominate it. In doing so, these individuals become de facto judges (and often critics) of what others believe and experience. Yet, these assumptions about who or what is are, in reality, often suspect and certainly debatable within different contexts. For example, if I were to say in a mental health setting, “You all don’t exist; you are only ideas in my head,” that could lead to receiving a diagnosis, whereas if I were to say it in a philosophy class, that would be an intellectually credible and defensible view known as “idealism.” In attempting to find agreement and perhaps consensus, we articulate portions of our internal realities while truncating other aspects. This is truly ironic and unhelpful, because the path to recovery depends upon growing beyond ourselves, not defining in advance the parts of ourselves that we will use to share and connect.
In my view, in mental health settings “consensus” is actually a misnomer. Reality itself is often complex. If participants in contrasting roles (i.e., persons served and persons serving) are able to find commonalities of perspective, we might instead call these tentative agreements or incidental junctures a “combined reality,” a “blended reality,” an “interconnected reality,” an “aggregate reality,” an “overlapping reality,” a “conjoined reality” or perhaps just a “union of ideas about reality.” These phrases do not tilt in favor of the dominant view as much as the phrase “consensus reality” does, because “consensus” unfortunately implies that if one is not in consensus then one is not in reality—a conclusion which is not only false but stigmatizing. Furthermore, there is little “co” in consensus; when the term is used it is not about “co”-creating a vision or finding mutual “co”-operation. Indeed, quite to the contrary, it is more often about “co”-opting another person’s views or “co”-mmanding another person’s behavior or even “co”-nspiring against them without their consent.
As citizens, we each get a vote on what we would like our future lives to be like based on and what we believe are the facts of our current realities. As people in recovery, it is often quite the opposite: we are denied not only the vote to determine our own process, but the affirmation of the underlying reality which would generate that particular vote, that sentiment about the present. Citizens are allowed and enabled to choose a present course of action by exercising their rights to vote in the present without that capacity being denied or undermined by past events; people with recovery challenges are often not. This disenfranchisement is attributed to what is called “impaired judgement.” But why is “impaired judgement” only ever applied to the thought processes of people who have been diagnosed, and never to the thought processes of those people who render the diagnoses themselves? Why is it not considered “psychotic” to actively participate in a system which oppresses others?
What is a One-Sided Pattern of Intellectual Domination?
Unfortunately, just as some clients may lack insight into their supposed conditions, many may lack the ability to perceive whether or not their treatments are actually effective, or how they could become more effective. If one-on-one therapeutic conversation is a kind of verbal sport, it risks becoming a game of strategy rather than an opportunity for collaboration, a contest of wills and viewpoints, credentials and credibility. Within the extremes of therapeutic misuse of power and client victimization, there are numerous but subtle gradations of negotiation that can arise. I’ll not try to list them all here, but it must be said that many of them interconnect and can be combined in increasingly risky or tenuous scenarios for people seeking help. Beneath the professional’s statements of agreement and disagreement must lie vast realms of uncertainty, not just with regard to an individual client, but with regard to the future itself, which no one can predict. Academic knowledge is a viewpoint that finds strong validation in the outer society and culture. Paradoxically, validation for clients is sometimes most elusive when it is most necessary, because the natural skepticism of others can be fickle. So when people in recovery might most need to experience these affirmations from somewhere, anywhere, someone, anyone in their lives, they may be hard to find. They then risk sacrificing the gains they may have made, losing the capacity to hope, and abandoning a personal stake in their own futures.
Professionals are used to receiving validation both from outer society and from the treatment milieu. People in recovery are often used to receiving neither. How can they hope to enter a therapeutic conversation when they arrive fresh from experiences of being stigmatized, criticized, or ostracized in the outer world? How can they frame this challenge to themselves, intuit a possible way forward, and find the skill to be able to navigate the risks and hazards of both the treatment setting and the public community setting? The public may naively assume that the recovering person’s needs and abilities are being supported and empowered in the treatment dynamic, so that when they enter the society to face their tasks, they arrive prepared and able to do as expected in order to avoid painful consequences. Paradoxically, the treating professional may unconsciously collude with the threats of the outer society, whether as an active interpreter or self-designated representative. When professional help cannot be turned to, then there may be nowhere to turn. Even if professional help is skillful and well-intended, it may simply not suffice because the complex nature of the condition does not readily lend itself to systematic inquiry from others; to the often limited time available and the professionally defined or even “prescribed” viewpoints that can rarely align precisely with the inherent variability of individual states of mind. Clients typically sense risk in both treatment settings and in the outer world.
If I may claim that the most important skill in recovery is to be able to feel one way while acting a different way, then it seems to me the second most important skill must be the ability to choose risks that are free of adverse or punitive consequences, while not allowing oneself to meanwhile become self-castigating for having taken them, because a demeaned spirit or mentality could dampen one’s prospects in recovery as well. So there is much for the recovering person to figure out about how to live their unique life more skillfully within the limits of their own lifetime.
“To generalize, most professionals have never had to grasp and contend with these challenges in the way that recovering people have had to.”
We may have begun our recoveries facing futures that once seemed impossible, but we may have learned and devised ways to chip away at the impossible until it began to seem merely formidable, no longer impossible, and worthwhile. After repeated attempts, we may have become the experts in our own processes, truly making us experts by experience.
We did not know how to face these challenges in advance in part because we may never have expected to receive such a diagnosis, and because mental health recovery is not part of standard curricula. Contributing to our challenge is the fact that a condition may be complex, intractable, layered, impactful, detailed, problematic, and confounding in ways which the professional could find difficult to discern. The professional might then resort to applying academic frames of reference, which would then shift the reality of experiencing the condition away from the reality of the person’s existence and towards the professional’s perspective. The shift in perspective might make a fifty minute discussion seem more immediately fruitful, but that convenience or sense of expediency would not offer full validity to a process that may take a lifetime to unfold.
The Quandary & Inherent Conflicts of Therapy
Treatment has a hierarchical history. Those who aspire to provide treatment are trained in a hierarchical tradition. They chose that life or career path willingly and intentionally. In contrast, those who come to treatment seeking help often do so because they have arrived at this particular point in their lives unwillingly and unintentionally. Their reality has already become one of not sharing equally or fairly in society’s implicit hierarchies. So treater and treated encounter each other not initially, and sometimes not ever as equals, sharing in a process that they co-create, but rather as historical actors in a tradition of imbalance, one arriving with a sense of fulfillment of career purpose, the other perhaps questioning not only treatment’s purpose but life’s purpose as well.
If we believe in the existence of a self and are willing to discuss it openly, then we must admit that the professional’s sense of self, and his or her accompanying reality or perspective on the treatment, are all nicely and effectively conjoined in a particular way, embedded in the person’s identity and existence, and serving their particular professional needs and aspirations. In contrast, the client arrives at treatment with a disjointed sense of self, a reality that cannot be reconciled with their idea of truth, or with an external reality, or with other people’s experiences of them, and a path laid before them of unknown duration and unknowable risk. Somehow, the client must discern and intuit how to begin navigating at all, while endeavoring to do so from the fractured and partial construct which they may still believe is their former self.
“As they encounter each other, one, the professional has a presumably intact sense of self, is trained to experience their powers, and confident that whatever they observe must be true, perhaps not only on the surface but at other depths or dimensions of human existence. In contrast, the client must hold on to what they know to be true, if they hope to be at all true to themselves. Meanwhile the client hopes that the treatment professional will seek to apply no so-called ‘truth’ which is but a form of harm known by a different name or appearance.”
As they encounter each other, one, the professional has a presumably intact sense of self, is trained to experience their powers, and confident that whatever they observe must be true, perhaps not only on the surface but at other depths or dimensions of human existence. In contrast, the client must hold on to what they know to be true, if they hope to be at all true to themselves. Meanwhile the client hopes that the treatment professional will seek to apply no so-called “truth” which is but a form of harm known by a different name or appearance.
Additionally, the client must solve the complex puzzle which has become their very existence if they hope to design and reconnect with a life’s path at any point in the future. So the client hopes, dreads and discerns, contorts emotionally and contrives an incipient reality using all of their intellectual powers. Will it be enough to protect them, even when no risk is discernible, for the recovery process itself requires long periods of safety? Will it be enough to advance them, even when there is no call for progress, for their inner spirits call out to proceed through life continually? Will it be enough to advantage them, for they have already been disadvantaged, not just now but by everything that has come before, in all of the events which preceded the circumstances in which they now find themselves?
And yet, we ask these two contrasting “realities” not to conflict, for there is a price for every conflict, but to commingle. How could they possibly hope to commingle harmoniously yet productively, share time while not sharing the same sense of the past or of the future, collaborate while for the client there is more to concede than to create? This is the quandary that we call “treatment.” In the end, some of the therapeutic field’s powers may lack ultimate legitimacy, or miss the mark, or consume time, or show one-sidedness in their rationales but demand consent. Others may be almost derived from what could possibly have worked for another time, place or person, or what would seem to succeed on paper or in theory.
The professional, even as ally to the client, can never fully relinquish their normative status as one of society’s representatives, or even more, authorities. Meanwhile, the client hopes somehow to be able to hurdle this obstacle called a “process,” for even when it helps, it demands a toll in terms of the client’s ultimate sense of personal freedom, or of authentic existence, or of their former dignity.
What Would it Mean to Say That Both Scientific or Professional Views of Recovery & Views Based on Lived Experiences of Recovery May Be Similarly Flawed?
Perhaps it could be said that treatment thrives when it is collaborative. Yet, it may equally be true that the various parties to the treatment scenario often enter with diametric perspectives. One, the professional, typically enters the treatment dynamic regarding the patient as a “problem” to be “fixed.” This further requires that the patient not merely “collaborate” but “cooperate.” This engenders a condition which further implies, based on the superior training of the professional, that the patient yields to more informed types of professional judgment or opinion, in effect thereby conceding at a minimum their autonomy, and at a maximum perhaps some of their rights, or worse freedoms. In direct opposition to this professional stance, there enters into the treatment dynamic the struggling client, in need not just of individualized help, for now of an unspecified type, and conceivably for an indefinite duration. To worsen the imbalance, the so-called “client” may not understand what they are experiencing, or how to behave, or what could be done to assist them, or how they got there or what their prospects for recovery may be. Now the condition becomes the criterion that could determine their ultimate fate. How could one possibly hope to reconcile these two views of recovering in the world, these two visions of what is or isn’t possible, or of what might even be attempted?
I would now like to offer possible alternative phrases for “psychosis.”
Twelve Alternatives to “Psychosis”
This first one is commonly used at Windhorse.
Waking dream (Podvollian or at least Buddhist)
Alternate reality
Self-defined reality
Internally constructed reality
Open mind
Expanded vision or expanded sense perception
Self-constructed environment
Disconnected self
Withdrawn self or detached self
Socially ambivalent self or overly subjective self
Hypothetical reality
Experimental Reality
The Contrast Between Professional “Reality” & Personal or Client “Reality”
Professionals in the mental health setting may have an educational advantage which confers upon them, in addition to presumed or personal authority, theoretical insight, mastery, or superiority. But as we have demonstrated, the professional’s presumed or putative wisdom is derived from multiple types and layers of inculcation, each of which may suffer from the distortions or biases of its own lens or window on reality. Yet the client’s so-called “reality” is the one that is habitually suspect, questioned, or challenged.
What if we were to reverse the two types of realities and world views, the academic and the personal, the acquired and the lived? On what grounds would we then be justified in valuing knowledge over experience, observation over sensation, theory over thee-or-me, insight over hindsight?
If I may be personal, although the therapist’s view of me may typically be considered more credible than my view of the therapist, in order to survive the process, I still need to be able to understand their way of looking at me far more than they need to understand my way of looking at them.
“To be sick is not necessarily to be crazy; to be crazy is not necessarily to be wrong; and to be wrong now is not necessarily to be wrong forever.”
Then what would it mean to say that therapeutic influence may not be overtly about power or authority, but may be about truth and correctness?
As discussions seek or work towards agreement, they draw in not just content, but values and principles. Without stating so outright, most discussions revolve around implicit notions of what is, or is likely to be, or could possibly be true. What is considered to be true often leads to what is considered to be the correct thing to do, and conversely, if a reasoning process is deemed to be incorrect then it is held that its conclusions must (or could; there are exceptions) be untrue. In mental health settings, however, there is a potential for misuse of these properties of conversational life. Foremost, it is assumed that what the professional believes, states, or validates is considered to be true; whereas what the client believes, states, or validates is often considered less likely to be true, if at all true. Therefore, by virtue solely of role, the professional holds a tremendous amount of intellectual power over the client, regardless of their respective educational backgrounds or credentialing or training.
So even if a professional intends not to control the client physically, emotionally or intellectually, by the very fact of their role and the accompanying intellectual power differential, each has a differing ability to consider a particular statement as true or not true. The differences between their abilities or inabilities to participate as equals emerge over time. Each therapeutic hour or conversation succeeds or builds on the previous one while anticipating the next one, creating not just a series, or narrative, but a kind of web of implication about what is likely to be asserted and affirmed as either true or untrue. It is difficult to contradict such a pattern that is not only about content or meaning, but about truth itself. The professional is almost an authority on truth itself, with that status having been conferred by the outside world and the society’s culture, institutions and educational credentialing process.
So how are clients to find their ways forward in a process where their personal and more problematic truths are likely to be challenged or questioned? How are they to function and maneuver, not simply on the level of interaction or feeling, but simultaneously with regard to the condition of truth itself? What sorts of compromises might they need to make, even within themselves, in order to be able to participate in and negotiate with such a process over time? This is not an easy question to answer, and it often goes unacknowledged in the treatment process, because the very notions of truth itself are so embedded in the therapeutic construct and roles, that they are constantly being assented to tacitly. It takes not just effort, but courage, persistence, and awareness to be able to hold one type or form of truth within oneself, and yet another, often contrasting manifestation of such a truth that is verbally shared and for conversational purposes and approval seeking. Perhaps this is a skill that could be learned, and should therefore be taught to clients, in order that they might not struggle endlessly, or perpetually risk incurring the consequences of having spoken words which are judged to be untrue. Yet it is precisely in mental health settings that norms and decisions pertaining to aspects of truthfulness in speech begin to reach their overwhelming potential for distortions to arise, transforming once relatively benign situations into higher risk ones.
I would like to now consider that clients may have to repeatedly interpret their experiences through the vantage points of their providers.
Discussions seek, depend on, and determine forms of agreement or disagreement between participants. Psychotherapeutic conversations or discussions are no different. Yet in a conventional therapeutic conversation or interaction, one party holds most of the power to assess or determine whether or not agreement is being reached or how it is being defined. Because of the prevalence and dominance of the medical model, clients therefore may find themselves needing to reach some form of agreement rather than risk the consequences of being totally at odds with their provider. People challenged by recovery needs may try hard to get by in an outer world of rigid consensus-based realities, but this norm should not meanwhile pervade their therapeutic and supportive encounters.
So in order for clients to remain connected to those who would provide them their support, they need to be willing to compromise by relegating their transitional realities to lesser statuses or truth value when engaged in discourse with academically trained professionals. One specific manifestation of this imbalance is the need or expectation for the client to agree to academic interpretations of shared personal experiences and perspectives. If these occurrences were infrequent, they might be tolerated and excused as individual occurrences in an otherwise successful process. But the very design of the treatment condition itself suggests, almost declares, that the client, in order to get well, must be able or made to see that their unique takes on life, on their existence, or their circumstance must be brought into alignment with professional opinion and its medical, legal, scientific, and academic realms of justification. So we admit clients to a process not only as un-equals, but in a way knowing in advance that their actual powers to participate may be very limited, even restricted, by the imposition of clinical norms and perspectives. It’s as if anything I say could be used against me, yet I may currently lack the judgement to know what not to say. It’s paradoxical.
To be cynical, we might further ask exactly when and how these impositions of perspective are most likely to occur or come into discursive being? Is it when the client most needs to experience a sense of contrast, or when the practitioner most needs to assert some form of opposition, such as needing to keep the client in a realm of thought that is more easily controlled? We are all susceptible to wanting to influence the thought processes of others at various times and in various ways. But it comprises the very essence of the therapeutic construct, that the client’s thought process may be challenged and made to conform not simply in benign ways, but in systematic forms of intellectual disempowerment.
I would like to consider how we might better understand experiences of belonging.
What Does it Mean to Say That Rights & Rules Sometimes Conflict?
As citizens, we have certain rights and are expected to follow certain kinds of rules, especially legal ones. Mental health treatment programs may design, implement, and enforce their own rules which are specific to a setting. They may even proclaim that the participants in their program have rights, whether specific ones accorded by the program itself, or legal rights which accompany their participation and exist by virtue of the participants’ ongoing statuses in the outside world. The five fundamental rights in Massachusetts are a very specific example of legal rights which follow and support a person as they enter and hopefully pass through an inpatient setting.
In an ideal world, rights and rules would be aligned or correspond. Unfortunately, this is not always the case. As mental health workers trying to support our clients, we may even wish to affirm their rights, but be unable to due to the presence of certain rules which would conflict with these individuals’ free exercise of their rights. The people challenged by recovery needs themselves may be partially or totally unaware of their rights, whether legal rights or program-specific ones. Similarly, people in recovery may not know the rules in advance, and therefore may be forced to learn of their existence the hard way, after the fact of having broken them and perhaps suffered a consequence.
Given that these dilemmas can arise, what are we to do in specific circumstances? If we fashion ourselves into rule-enforcers, we risk undermining not only people’s legal statuses but their tentative identities, states of partial knowledge or awareness, or abilities to meet specific behavioral expectations—all of which could contribute to thwarting people’s tenuous and uncertain recovery prospects. If we instead proclaim and support individuals’ rights as paramount, then we may end up compromising the perceived validity of our rules and policies. The particular domain of the person in recovery, it would seem, is to be inherently challenged by the existence of both rules and rights, and likely somewhat unable to connect with either realm or respond to either imperative successfully. So in a kind of cruel irony, mental health treatment sets itself up as advocate, judge and jury, adding to the confusion people might otherwise ordinarily experience and contributing to the internal ambiguity that accompanies the recovery process.
“A single psychotic episode, I would argue, may be viewed as a discrete event, but it is also a timeless manifestation of a soul seeking to ascend and enter an earthly realm, to transcend time itself.”
Some mental health treaters may see themselves as practicing enforcement, others as supporting processes of liberation. But either end of the continuum, either polarity, coexists with the unfortunate circumstance that the recovering individual finds him or herself in, that is, not knowing how to assert a right without breaking a rule and suffering a consequence, and therefore not really knowing how to act, or how to be in ongoing recovery. In a further twist on this dilemma, sometimes history rewards the rule makers and sometimes the rule breakers; sometimes freedom is granted and sometimes it is stolen. How is a person in a compromised state or condition to know how to be around others, in order to end up where they were once destined to be, and not where they may be forced, coerced, or resigned to being?
What Does It Mean to Say That Identities & Roles Sometimes Conflict?
To be succinct, identities may be how we see ourselves, and roles may be how we need to be seen by others in the social contexts we inhabit or share. Thus a role may be precisely defined, like a job that comes with a title, or less formal, like being a client in a mental health setting. With the presence of other people comes the intrusion of cultural values, and therefore role expectations, whether to perform a specific task or simply to behave in a so-called “appropriate” way. But for the person in recovery, the ongoing challenge becomes how to understand and be true to themselves—that is, to have a workable or useful self-concept or identity—while in some other, perhaps contrasting way, remaining acceptable and useful to others, by exhibiting the behaviors that may be implied by a particular role.
For people not facing recovery challenges, it may be a rather intuitive or even automatic process to negotiate and navigate the various boundaries, principles and practices in a particular setting. Our focus here, however, needs to be on how a person with an uncertain or problematic sense of themselves—their illness perhaps, but more pervasively, their illness-defined and constructed identities—can hope to fathom these contrasts and dilemmas between their inner experiences and the way they are expected to be with others. Almost paradoxically, it is this very dilemma or perceived conflict between who people think they are, and how they would hope to be able to function in the company of others, that becomes the proving ground of the psychosocial recovery path.
I would argue that we need to find ways of integrating people with social challenges that do not diminish the felt sense or authenticity of who they are or even would like to think they are. People need each other to not succumb to states of alienation and isolation. They do not necessarily need each other to have omnipresent critics, diagnosticians, or self-appointed authority figures in their lives. For a person to grasp glimpses over time of who or what they may eventually hope to become, they need to see those possibilities reflected back at them in the eyes of others, not undermined by having to first fulfill social prescriptions that could be as stifling to them as pharmaceutical ones.
Being oneself while with others is a process that takes a lifetime for all of us to learn. People in recovery may need these kinds of formative or adult developmental experiences more than others, yet unfortunately may be the least able to obtain them, due to the impacts of social isolation, social judgement, and the perpetual sense of risk involved. None of us can know what we might have been able to become if only others had helped us, but in a parallel way, we might not know who we might still be able to become if only others would not hold us back.
What Could It Mean to Say That Feelings and Observable Facts Sometimes Conflict?
People in recovery live in a world of both facts and feelings, but feelings may tend to be mostly momentary and constantly changing, whereas some facts are immutable. The particular challenge we in recovery face is that our feelings can overpower us and have the potential to create behaviors not entirely of our choosing. And while feelings may have a stronger basis in our mental life, the behaviors they engender may be subsequently enacted through our bodies or physical selves. We could say that our feelings dominate our mental lives, but the facts of our existence are controlled by our bodies. Though other people may seem unreal during the experience of psychosis, they become enormously real when entering into our physical space.
So the challenge for some of us in recovery becomes how could we let our feelings arise and flow, so that we could explore and express the totality of our emotional selves, without meanwhile unwittingly committing some undesirable action which becomes a known fact, such as a legal fact with consequences. This may be an ordinary or routine challenge of citizenship for others, but for us in recovery, navigating its risk and peril becomes both the path forward and the path with potential to undermine our free and autonomous statuses.
Hopefully, our feelings will be noticed and supported by treatment professionals and others, but it is the realm of facts which often governs the norms of behavior, the acceptable actions, and the likely responses to our actions. Which is more important: the tone of the words we speak in a volatile moment or the content which the words express? Perhaps that depends in part on whether we are in a defined mental health setting. The world around us often defines and assesses issues of safety differently than we ourselves might, for we may know it to be a complex, subtle and shifting matter, rather than a precise state or condition. So it becomes our task and challenge to learn to work with our feelings in such a way that the facts we create about ourselves along the way do not become the cause of our undoing. This is not a simple matter, often requiring greater skill and complexity than those around us, even those who know us well, might fully appreciate. How could I sense myself to be completely safe in one moment and completely unsafe in the next? The explanation is not always so evident, yet the facts remain fully reconcilable.
So if we are to continue to have the opportunities to recover freely, we must embrace all that which we may feel in order to heal, while expressing feelings and facts about ourselves in a sustainable way, without incurring undesired consequences. This requires having sufficient awareness to understand that when in the world, we become almost walking data points, our bodies co-existing with others in a context which must factor in their existences as well as our own. This pattern of activity occurs regardless of the facts of these encounters or their construal by others. Though we are all human, we may, and I speak personally here, not know how to recognize the significance of that shared fact. At times, our struggle in the realm of co-existence may deepen, as we work to fathom these patterns of mutual signification, event interpretation, and the meaning of human coexistence.
Two Paradoxes
Recovery is a paradox. One has to find and assemble the once discarded pieces of one’s life as a kind of puzzle, perhaps invent missing pieces, discover a workable pattern or sequence for the process, learn how to spot useful pieces as they appear along the way—all while heeding or disregarding the opinions and input of others, not knowing exactly when, where or how to begin, or how long it might take. But what makes the process truly paradoxical is that both one’s autonomy and one’s judgement may be impaired, either in fact, in a self-limiting or self-defined way, or by having internalized the views and feedback of others, or because some of those others still exercise direct control over the circumstances of one’s existence and choice-making capacities. If they do not hold true power, they may still hold influence. So any action one presumes to take may be swiftly and immediately undermined by one’s self or by others, in thought, word, or deed, if not sooner, then perhaps later or when one least expects it to be or wishes it to occur. So recovery can be a high stakes, possibly even life or death game of chance.
As if it were not enough that recovery is a paradox, treatment itself is also a paradox. One acquires additional and burdensome layers of identity through the acceptance or acquisition of diagnoses and symptom labels. Then one has one’s schedule dictated by treatment times, and one’s conduct shaped by treatment parameters. One has to learn to communicate when, where, how and about what the treatment providers deem to be essential or useful. Yet somehow, perhaps miraculously or certainly by luck or good fortune, one is expected to transform, heal, and emerge increasingly intact, but more, somehow become one’s true, illness-free self. How is it possible to become more oneself through a sustained process of learning how to be less oneself over time? And how is it even possible theoretically to be truly a free self while having played various roles in treatment and acted the parts, whether expediently or spontaneously, impulsively, or worse, even been physically confined or restrained?
So as the two paradoxes intersect and collide, one is faced with the need to participate in treatment, even though it may make one feel less like one’s true self, and therefore less like recovery is possible, or less like a person at all, but while simultaneously, almost without helper knowledge, seeking and aspiring to create a new and more workable life for oneself by reassembling the pieces of a long forgotten puzzle, or a new life puzzle to solve. One faces, directly or implicitly, the skeptics and pessimists who don’t believe that recovery is possible, or doubt its potential for this one particular person—you—or don’t see it clearly and realistically as the puzzle which it truly is. Instead, they may regard it as a process of acceptance, or worse, submission, or perhaps even far worse, the necessity to succumb to any ill-begotten fate.
“A single psychotic episode, I would argue, may be viewed as a discrete event, but it is also a timeless manifestation of a soul seeking to ascend and enter an earthly realm, to transcend time itself.”
I would say that going forward we could use treatment strategies that would help to solve the recovery paradox and recovery strategies that could help to resolve the treatment paradox.
Here I have tried to show that our ways of understanding the experiences, needs, and challenges of those in recovery may be not only limited, but flawed and unfair. It is important to continually reconsider the implications of what we may commonly take for granted as acceptable mental health practice. Although I have been critical, I hope that I have been constructive too. While my experiences in recovery have been varied, each has contributed to my overall perspective. I believe it is important for people living through the recovery process to continue to determine, clarify, and articulate what they find to be helpful or unhelpful for them personally.