I was thinking about another catch -22 in the mental illness system recently. I articulated it below because I think it’s something many people encounter.

caveat: Not everyone experiences the system in this way. Some people feel they get what they need. (and sometimes people end up exhibiting what David Healy calls Stockholm Syndrome as well — I did) In any case it’s clear to many of us that we do not get what we need. That is what I’m speaking to. I am expressing my experience both as a professional witnessing what organizations implemented while I worked for them and my own experience as a “patient.” I no longer work within the system nor am I any longer a patient but I sure learned a lot while I was engaged as both.

Those of us who’ve experienced the system in the fashion I express find it helpful to articulate our experiences so that we can recognize one another and know that we are not alone while we heal from the trauma that happened while there. This does not invalidate other experiences…it simply helps and validates those of us with the experience to move on and learn how to get our needs met in other ways, so that we might also help create options for others like us who get injured in the system.

The catch – 22 I thought about the other day: The mental health system tells clients/patients/consumers that they need better boundaries while expecting them to ignore their boundaries. Generally people are randomly assigned to case workers/therapists/social workers and psychiatrists. They are then expected to trust, be deeply vulnerable with, and follow the advice of such professionals.

There is no good reason for people to open up and trust random strangers just because they’ve got letters behind their names and fancy themselves knowledgeable about the psyche. To expect folks to do this when it doesn’t feel right is a demand to ignore ones boundaries. When people don’t feel safe trusting their assigned professional they are often punished in various ways instead of being encouraged to trust their instincts and perhaps being allowed to find someone with whom they feel comfortable. We know when we feel safe and when we’ve been traumatized safety and our sense of safety should always be a priority. If mental health professionals do not appreciate this and do not do everything they can to make us feel safe, they are inherently unsafe. Thus, entire systems are often unsafe because there is no attempt to help us feel safe. There is a profound lack of understanding trauma. We know this– even when we might not be able to articulate it, we feel it in our bones. We are not being unreasonable. These systems do not work for many people.

Retaining agency is not resistance to treatment. Disagreeing with the social worker is not resistance to treatment. Being in touch with our being and who we are in an authentic way is actually healthy. If our perspective is not respected and taken seriously we cannot heal. We will not thrive in such a system that claims to heal when it fact it’s a system the perpetuates mental illness.

Allowing for choice and informed consent is the only way to respect our fellow human beings. Providing options is also necessary as we are endlessly variant, kaleidoscopic beings. Our needs are different from individual to individual as well as being different as time passes with the context of one’s life. As we heal, grow and change, what we need changes as well. What is good for us now may not be tomorrow. Professionals are not generally in a position to know this stuff…at best they can help us figure it out for ourselves as we go. If they TELL us and it doesn’t ring true for us it then becomes violence if they insist upon it. We don’t know what someone else needs even if on some superficial level we think we have a lot in common with them. Context is always different for any two human beings. A basic acceptance of this is necessary if we are to respect others.

None the less contrived intimacy is forced upon vulnerable people all the time in the mental illness system. Vulnerable people who are often very in tune with their boundaries and will recognize what they need if they are actually presented with it, are then forced to do things that don’t feel good to them because mental health professionals tell them to do it. This is exactly how people are frequently retraumatized in the mental illness system.

The building of trust and rapport cannot be forced. It must happen organically. If it doesn’t happen organically no one should be made to feel it’s because they’re somehow not up to par. Healthy relationship cannot be forced. Any forced relationship is by definition unhealthy. Forced treatment is a human rights violation.