1. Finding the Real Person Underneath the Diagnosis, the Despair, and the Disability Courtenay M. Harding, Ph.D.

2. WHAT ABOUT THOSE PEOPLE WHO SEEM TO STAY IN SERVICES? INCORRECT DIAGNOSIS MEDICAL COMORBIDITIES CO-OCCURRING DISORDERS NOT TREATED SIMULTANEOUSLY ADDITIONAL NEUROLOGICAL IMPAIRMENTS UNTREATED FOR LACK COMMUNITY KEEPING BEHAVIORS IATROGENIC EFFECTS OF TREATMENT DEMORALIZATION & LOSS OF HOPE

3. WHAT ABOUT THOSE PEOPLE WHO SEEM TO STAY IN SERVICES? NOT NECESSARILY VIRULENCE OF ILLNESS ( ≤5%) PERSONS WHO REQUIRE SOCIAL CONTROL (NGRIs & SEXUAL PERPETRATORS) LONG STAY FORENSIC PATIENTS FOR MISDEMEANORS NOT NEEDING SOCIAL CONTROLS UNRECOGNIZED AND UNTREATED TRAUMA AXIS II BEHAVIORS MISINTERPRETED AS CONTINUING AXIS I PROBLEMS LACK OF REHAB OPTIONS & OPPORTUNITIIES

4. WHAT ABOUT THOSE PEOPLE WHO SEEM TO STAY IN SERVICES? WE NEED TO TAKE A SECOND, THIRD, AND FOURTH LOOK WE NEED TO UNDO THE DAMAGE DONE BY THE SYSTEM WE NEED TO DO MUCH BETTER FOR THE “OLDER SEEMINGLY CHRONIC PERSONS” WE NEED TO REMAKE OUR SYSTEMS TO REDUCE FUTURE CHRONICITY

5. Some ideas about the recovery process

6. WHAT DO PEOPLE THINK THAT THEY ARE RECOVERING FROM? Loss of self, connection, & hope Loss of roles and opportunities Devaluing and disempowering programs, practices, and environments Prejudice and discrimination in society Internalized oppression and shame ( Spaniol, Gagne, Koehler, 1999)

7. Phase I- Overwhelmed by the…… disorder “ Daily life is a struggle” “Tries to understand and control what has happened” “Feels confused, disconnected from others” “Often feels out of control, powerlessness in life” Spaniol et al, 2002

8. Phase II- Living with disability “Has come to terms with disability and feels confident about managing it” “A stronger sense of self and feeling of confidence about managing it and having some control.” “A sense that one could have a satisfying life with the disability” Spaniol et al, 2002

9. Phase II- Living with disability “Utilizes coping strategies and assumes meaningful roles” “Consistency and security in the people, roles, and environment” “But still feels limited by disability” Spaniol et al, 2002

10. Phase III – Living beyond the disability & reclaiming a life “Feels well connected to self and others in living, learning, and working environment experiencing a sense of meaning and the purpose in life.” Spaniol et al, 2002

11. It is extremely hard work to bootstrap one’s self into recovery process and takes time

12. RECLAIMING A LIFE TAKES PASSION, ENERGY AND A BELIEF THAT IT MIGHT BE POSSIBLE  An active self  Taking stock  Relying on self  Finding supports  Learning to love  Increase self-esteem  Tolerance/  Acceptance  Building on reality  Better coping  Self-monitoring  Spirituality  See a process  Reclaim hope  Spaniol, Gagne, Koehler, 1999

13. Brainstorming A person says they have no goals. What is going on here? What do you need to light a fire under them?

14. What If A Person Has No Goals? Davidson & Ridgway Is person demoralized? Has person been socialized into “learned helplessness” due to uninterested system? Has person become afraid of taking risks? Could this person have a co-occurring depression? Has clinical team established trust? Are there neurocognitive or communication problems getting in the way ?

15. Usual Areas Reviewed Diagnosis & s/s Possible deficit syndrome Medications & side effects Medical problems Neurocognitive status Street drug use Behaviors Personality Sex differences Social supports Cultural issues Trauma history Coping strategies

16. COMPOSITE PROFILE OF STRUGGLING PERSONS Depressed Delusional Assaultive Suicidal Manipulative Drinking too much caffeine Smoking Poor social skills Demoralized Acting out Angry Unpredictable Displays poor hygiene Self injurious Unpredictable Refusing treatment Unmotivated Coping with serious medical problems

17. But before someone gets going, they need to know that there might be a possibility that they might be special, that they might have a way to contribute and there might be a place for themselves in the world

18. Started looking for other things Strengths Interests Early goals Hopes Dreams Helpful behaviors Personality styles How did the person get into such a muddle?

19. SOME OF THE MANY STRENGTHS AND TALENTS FOUND WHICH WILL HELP FIND THE WAY OUTSIDE Intelligence Sense of humor Charming Persistent Musical talent Artistic Work histories Contributing to groups Feisty Cooking skills Neuropsych strengths Cultural heritage Athleticism Spiritual Educated Personable

20. THE GOAL Help to change someone from thinking that they could only be a patient to A person with a life and hopes and dreams and perhaps diminishing episodes of psychosis

21. SOME OF THE SUGGESTIONS TO SURPRISE AND ASTONISH BASED ON THE PERSON’S DREAMS “Hyperscore” Piano playing Setting up a mentoring program “Scientific American” Training guide dogs Russian history Jewish traditions Connections to the Greek Orthodox community Human rights commission

22. MORE OF THE SUGGESTIONS Definition of a name “VideoEye” for low vision An art studio of her own Become a psychologist Greek history Hidden messages in records Celebration of other holidays than Christian ones Social learning

23. Some Peer Suggestions on What Helps Local Peer-run Crisis Centers NOT Hospitals CMHCs NOT jails Supported Employment NOT adult day care Peer/doctor medication reduction teams Peer providers as 10% of Mental Health Center Staff Reduction of micro aggressions by staff Personal Care Attendants NOT nursing homes Personal Medicine, Common Ground – (corinnawest.com + Pat Deegan)

24. Words of Wisdom from Manfred Bleuler “What is effective in the treatment of most schizophrenic patients is also effective, and decisive, in the development of the healthy individual; clear and steady personal relations; activity in accordance with one’s talents, interests, and strengths;

25. Words of Wisdom from Manfred Bleuler con’t. confrontation with responsibilities and even dangers; and, at the right time and in the right rhythm, rest and relaxation.” – Manfred Bleuler AJP, 138:1403-1409 (1979)

26. THE SECRET Surprise and astonish by showing the person that you can see a real life for them Interest them in things that will enhance their sense of self

27. Looking for practices which match up with an individual’s clinical strengths and needs Individuals want to be healthy, have a home, a job, friends, a date for the weekend, and social justice