Saturday, April 22, 2017

Chapter 1-3: Aren't You Just Quibbling with Language?

Well, yes and no...

Yes, language is where we are going to start.

No, language is not where we will end.

Yes, this is about small shifts in wording that nearly everyone can make.

No, this is not a quibble.  For some of us, it may even be the difference between life and death.


The best illustration I've come across on the power of language  in mental heath is Shery Mead's Intentional Peer Support: An Alternative Approachhttp://www.intentionalpeersupport.org/wp-content/uploads/2014/12/IPS-An-Alternative-Approach-2014-First-Chapter.pdf.  Developed in the 1990s, this classic text is a consciousness-raising workbook for the consumer, survivor, ex-patient movement.  It is the mental health equivalent of Our Bodies, Ourselves in the women's movement.  It contains a lot worth understanding - not just for those of us who are living the experience, but also for professionals, families and allies.

To demonstrate the importance of language - I'll basically just do the exercises in Shery's work.  It's kind of amazing how far these simple practices can take us - and how quickly and effectively they show us what is at stake with the subjects at issue in this guide.

Two Stories

Story #1. The story the mental health system and conventional society tells about me:

Sarah is a 55-year old woman on Social Security Disability for Bipolar I Disorder.  Her life is an example of the tragic progression of mental illness.

In retrospect, Sarah had always been mentally fragile.  She demonstrated poor impulse control and emotional dysregulation beginning in childhood.  There were recurrent emotional outbursts at home and school. Her mother reports that Sarah had difficulty making and keeping friends and that the family had to 'walk on tiptoes around Sarah's moods.'

In her teens, Sarah developed an eating disorder.  She became obsessed with body image, compulsively exercised, and binged and purged large quantities of food several times a day.  This behavior continued into college, and ultimately led to Sarah's loss of a prestigious appointment as a cadet at the United States Air Force Academy.  As a cadet, Sarah entered her first psychiatric hospitalization, before being medically discharged for Obsessive Compulsive Personality Disorder.

Despite her emotional difficulties, Sarah did well academically.  She was a straight A student and valedictorian of her high school class.  She graduated law school cum laude, and had a promising career ahead of her.  She obtained a coveted clerkship with a judge on the United States Court of Appeals, and then obtained employment as an appellate attorney with the Justice Department in Washington, DC.

But a few years later, mental illness struck again.  Sarah had a psychotic break and had to be hospitalized.  In her delusional state, Sarah maintained that she was 'Jesus Christ in the Second Coming'. With the aid of anti-psychotics, Sarah was able to return to her work at the Justice Department under clinical supervision.

A few years later, against clinical advice, Sarah decided to make a career change and pursue graduate studies in Pastoral Counseling. Sarah did well academically, but completed her clinical internships only with difficulty.  There were serious conflicts with supervisory staff at two out of three settings.

Sarah worked for several years as a licensed therapist for Catholic Charities, but conflicts with supervisors and poor professional boundaries with clients led to further breakdown.  During one episode, Sarah dissociated so severely that the family pet died while unattended in a car on a hot summer day.

Eventually, a new medication regimen and psychotherapy enabled Sarah to return to work under close clinical supervision. However, Sarah experienced considerable difficulty performing her job responsibilities in a timely manner.  This caused further difficulties and tensions at work.

Ultimately, Sarah decided to seek less stressful employment. She obtained a position as the Director of a local Wellness and Recovery Center run by a peer mental health group. Sarah related well to the clients, but had difficulties managing paperwork.  Conflicts with the the Board of Directors led to Sarah's resignation after little more than a year.

After that, Sarah's functioning continued to deteriorate.  She was unable to maintain steady employment, even as a peer support worker.  Over a period of 6 years, Sarah was hired for positions with 6 different peer organizations in three different states.  Yet, conflicts with supervisors and co-workers abounded.  None of these jobs lasted more than 6 months.

In 2015, Sarah was awarded Social Security Disability on the recommendation of her psychiatrist of 15 years.  She currently sees a psychiatric, a therapist and takes her medication regularly.  This has helped her stability immensely.  She now uses peer support as a wellness tool and finds it helps her very much.


Story #2: The story I tell for myself

I have a great life! Yes, it is true that my existence doesn't amount to much by conventional definitions.  I will probably never work again in a professional role.  I would not last long as a Walmart greeter.  I can't pick vegetables fast enough for Monsanto.  I will screw up the registers at the local supermarket or Bank of America.  My computer skills don't qualify me as a secretary, much less for a corporate role at Microsoft and HP.

It is equally true that, yes, my life path has been pretty messy.  There have been a lot of things to make sense of that no one seemed to understand.  I didn't find many reliable guides in this culture. That was pretty frustrating, and I did a lot of lashing out at people who didn't deserve it and were only trying to help.  I wish I had known how to do it differently at the time.

That being said, I've come to believe that my own process has some value.  The most important thing has always been to find and follow my own truth.  I've worked really hard to understand what's been going on for me, and to make sense of my experience as a human being on this planet.  Admittedly, I've made a lot of mistakes.  Some of those have been appalling - unbearably painful - for others as well as myself.  

On the other hand, I think I've learned some things along the way that are worth knowing. That includes the really awful stuff which, ironically I now find is the most useful.  At the very least, it gives me some empathy for others who are going through similar struggles.  But it gets even sweeter than this.  I can be a lot more honest now.  So, instead of just helping each other 'get over it', we often stumble our way into sharing our deep concerns, fears and regrets.  More often than not, we end up finding out (surprise!) that we're not the only ones.  This helps to ease the pain - and sometimes even point a way forward - for both of us.

These understandings - really just basic tenets of human rights and peer support - not only seem to work for me. They help me connect in ways that conventional treatment still doesn't 'get.'  It also reinforces my belief in the value and wisdom of every one of us.  This includes the value and wisdom of other so-called 'chronics' and 'treatment failures' like me.

I find it really screwed up that the conventional world remains so keen to manage and contain us. They think that this is essential in order to keep healthcare costs down.

I actually find that the opposite is true.  The fact is I need conversations that matter like my body needs vegetables.  The white bread diet of conventional small talk just doesn't do it for me.  I suspect it is starving the social fabric of our entire culture.

In actuality, there are boatloads of wisdom and riches in the feelings, thoughts and actions that the dominant culture sees as 'mentally ill.'  We are, in essence, the canaries in the gold mine of modern society.  We're intuitive, sensitive, and tuning in.  We are listening with our hearts and minds wide open to the emotional and relational tenor of what is happening around us in the modern world.

What we are picking up on is unsettling to say the least - and at times outright terrifying.
A lot of us are aware, on a gut level, that something is happening in the space between human beings that is drastically wrong. It's killing us - our families, our workplaces, our communities, our planet. We sense this because we are connected with our truth in ways that others have learned to disregard.

Just as important, however, the messages we are getting are totally confusing.  They are at odds with what we are being told by trusted others - family, friends, neighbors, teachers, employers, civic leaders, the media - you name it.

The choice we are up against - all too often - is claiming the truth of our knowing versus social acceptance and fitting in.   The disease model - and the huge weight of authority behind it - gives us a way out.  Instead of learning how to recognize our truth and do the difficult work we are being called upon to do, we can write off our dis-ease to bad biology.

I know this myself.  I did it for years.  What a relief!  I remember saying to myself.  How much easier, safer, more sociable to cede my responsibility and conscience to expert knowledge and the majority will...

The truth be told, if I could have made it work for me, I probably would still be there. But I couldn't. I was getting worse and worse instead of better and better with the best the medical model had to offer. At some point it became apparent, if I wanted a chance to have a life, a different journey had to begin.

For those out there who still feel pretty lost, believe me I get it.  I've been there - overwhelmed, alone and totally baffled. Wanting to jump out of my skin with no end in sight and praying to die.  Quite possibly, I'll be there again someday.  I hope not because it's hell on earth and I wouldn't wish it on anyone.

At the same time, I find some hope and some comfort in how things seem to be turning out:

The most important stuff in my life now is not happening is because I succeeded at conventional treatment.  It is happening because I failed miserably at it, and I had to find another way.  

Perhaps in the end, you, like me, will conclude that these struggles we are having are not about our faults or failings.  All of us have faults and failings.  We wouldn't be human otherwise.

The question is whether  the disease model and the disease way of thinking is the most useful way of understanding source of our difficulties and what to do about them.  It may be for some, but it isn't for me.

I doubt that I am alone in this.  My conversations with others suggest that a lot of us have our eggs in more than one basket.  Depending on our situation, we might pay considerable lip service to medical approaches - aggressive interventions, treatment compliance, medication monitoring, yada yada.  But, the longing for a better way is not particularly unique.

 So...

  • If you're looking for a path forward with integrity and heart...  
  • If you would like a path where you get to keep your truth and live your highest values... 
  • If you would like a way to tell others to get off your back, stop policing your reality, and do their own work as human beings...


Then come along for the ride, because that's where we're trying to go!


To read more of this guide: 


Not Broken Biology: Getting Beyond the Disease Model Paradigm of 'Mental Illness'  
http://peerlyhuman.blogspot.com/2017/03/not-broken-biology-getting-beyond.html





Wednesday, April 19, 2017

Chapter 5-3: Putting the 'Experts' in their Place

The implications of the Survival Reactivity approach to mental well-being are revolutionary.  In this chapter we talk about why.

Here is what we have learned already in the previous chapters of this guide

  1. Much of what passes for 'mental illness' is actually High-Stakes reactivity
  2. High-Stakes reactivity often feels bad, but it is actually our friend. 
  3. The point of the High-Stakes system is to help us discover and address the real life needs and concerns that are bothering us. It wants us to feel safer and be more secure in the world. 
  4. The key to turning off the High-Stakes system is to find solutions that restore our sense that "All-Is-Well" in our relevant world. 
 (See Part IV, and Chapters 5-1 and 5-2),

What does this mean?


It means we now have a clear picture of what is creating 'mental illness'  It's not an illness at all! It's a normal reaction to high-stakes situations.

Better yet, we also have a clear understanding of what to do about it.  Our 'symptoms are not really symptoms at all.  They are warning signs, alerting us to potential dangers in our lives.  All they want is for us to be safe.  So, to get them to leave us alone is not that big a deal.   We just need to figure out:

  1. What are the real life concerns that are stressing us out or gearing us up? Part III of this guide can help with that.
  2. How to get back to feeling like 'All-Is-Well'?  This can be achieved, in both the short and long-run, either by fixing the problem or learning to cope with the discomfort. For ideas on this, see Chapter 5-2, and also the chapters that follow this one.

It's that simple.

Implication #1: The age of "expert interpretation" as the first response to human distress is over


For a long time, we thought mental health was really complicated, - far too complicated for the average person to grasp.  As a result, people had to go to 'experts' with the most important questions of their lives.

The Survival Reactivity theory changes that. It gives ordinary people a way to make sense of what is going on with them.  It puts the power to understand and interpret our own lives back in our own hands.

Very simply, we are the most important source of information about us.

  1. Our bodies are reliable reporters as to the fact of our distress and how big a deal it is to us.  
  2. Our minds are reliable reporters as to what it is that we actually are concerned about.


The take home message:


If we want to maximize mental health and well-being, we shouldn't start with all the complicated genetic, chemical or psychological theories.   Those things might be helpful or enriching at some point.  But to get started, first and foremost, we need to listen to ourselves.  We also need to listen to each other.  Equally important, we need to address the real life concerns that are bothering us as human beings.

Here is why:

High-stakes reactivity is driving the extremes that are scaring us or others. As the concerns that bother us are addressed or coped with, our High-Stakes reactivity ('symptoms') will ease and lessen. As we experience less and less High-Stakes reactivity - and become more able to understand and work with it - the fears that we and others have around it ('the mental illness') will lessen as well. This, in turn, will result in more and more resources being available - better sleep, nutrition, energy - for healing our bodies and brains.  As we heal and get stronger, we will have more and more resources available to address and remedy the high mental and physical price ('trauma') that we, our families and our communities have been paying for business as usual (social dynamics of power and privilege) in the modern world.

Implication #2:  We must put Medical Model in its proper place 


As part of listening to ourselves and each other, we need to seriously reconsider the role of common conventional treatments - like  drugs and electroshock.  Such approaches often add - rather than reduce - the stress on already burdened bodies and minds.  No less important, these strategies often have serious effects.  They can be toxic, even deadly, to some people.  Not surprisingly, this heightens, instead of lessens, High-Stakes reactivity in many people.

Additionally, both drugs and shock carry another risk.  Electro-shock - and many psychoactive drugs - reduce our capacity to stay clear-headed and figure out what is going on with us. They can wipe out the clues we need in order to understand ourselves.  They can obscure or even block awareness of the real sources of distress that are driving the High-Stakes system.  This is especially true when combined with pre-existing High-Stakes activation, which, as discussed before (Chapters 4-4 and 4-5), takes its own toll on mental functioning

A good analogy is like having your hand on a burning stove.  High-Stakes reactivity is designed to pick that up, figure out where the threat is coming from, and get you to move your hand.  In the case of burning flesh, it happens in an instant.

But High-Stakes reactivity resulting from a lifetime of social stressors - poverty, abuse, discrimination - can be much more subtle.  When we complain to our doctors about this kind of pain, only rarely does the medical system help us identify or escape these damaging - often deadly - social threats.  Rather, the standard response of our doctors is to give us pills.  These pills (often sedatives or tranquilizers) shut down the Survival Response.  As a result, many of us no longer care that we are in danger.  We can no longer feel the warnings our bodies are trying to give us.  Nor can we detect the damage that is continuing to be done to us.

In other words, the medical model approach is the equivalent of killing the signals that are telling us our flesh is burning.  Instead, they write of our real concerns as 'mental illness' and leave our hands burning on the stove!!

 Given that approach, it is hardly surprising that those of us with 'severe mental illness' end up dying  - on average - 15-25 years before the rest of the population.  Yes, you heard me right: that's 15-25 years on average.  In other words, it is not just that some of us with the big name mental labels will die 15-25 years before everyone else.  It's that every single one of us loses on average 15-25 years off our lifespan in our present day system dominated by medical model approaches. McLaren, N., Mainstream Western Psychiatry: Science or Non-science?, https://www.madinamerica.com/2017/03/mainstream-western-psychiatry-science-or-non-science/)


Usually the medical model blames that on us. They claim we would do better if only we took all the pills they gave us. (Not true! The longevity studies suggest that we actually do worse. See, e.g., Whitaker, R., Norway Orders Drug-Free Treatment in Psychiatry,  https://www.madinamerica.com/2017/03/the-door-to-a-revolution-in-psychiatry-cracks-open/)

Or, they say we aren't doing enough to take care of our health after they give us the pills.  (This overlooks the fact that the pills actually dope us up, disrupt digestion, and cause rapid weight gain - all of which interfere with our ability to take care of ourselves. See, e.g., McLaren, N., supra.

Far more close to the truth of the matter is this:  We are living in circumstances that, in actuality, are dangerous to human health and well being. We know this is true. The World Health Organization tells us how important the social determinants of health are to human health and well being.  The National Council on Behavioral Healthcare tells us that some 90 percent (90!) of behavioral health populations grow up with trauma, violence and neglect of basic needs. See Chapter 2-2: Social Determinants of Behavioral Health, http://peerlyhuman.blogspot.com/2017/03/chapter-2-social-determinants-of.html.

Yet, medical approaches do little - if anything -  to help us address these harsh realities of our lives. On the contrary, the main 'treatments' we are offered are designed to dull and disable the very biological warning systems that tell us something is wrong!  In other words, our bodies doing their best to wake us up to the fact that our lives are at risk.  At the same time, the medical model is doing everything in its power to shut them up.

When you understand this, the life-shortening effect of medical model treatment is no longer a mystery.  The treatment, quite literally, is killing us.

The Proper Place of the Medical Model


Please do not mistake what I am saying here.  I am not against psychoactive drugs.  Many people have been helped by them, and there clearly is a role for them.  Some people also report being helped by electro-shock and psychosurgery.  So, possibly there is even a role for those things too.

At the same time, we need to think very carefully about why, when and how these powerful, potentially deadly, interventions are used, if ever.  Do they help mitigate harmful effects of the survival response.  If so, why. Specifically, we need to think about:


  1. Do they help mitigate harmful effects of the Survival Response?  If so when, why, how and for whom? 
  2. Are such interventions the only tool -short or long term - that  a person can use to restore their sense of safety and turning off the High-Stakes system? If not, why aren't other options - e.g., massage, unconditional positive regard, childcare, a weekend stay at a spa - being offered.  Certainly these things are comparably priced, and far less aversive to the standard emergency room/ psych ward stay.  
  3. When, where and why (if ever) would someone find medical model interventions the most effective, best-suited short or long-term strategy for damping down their High-Stakes reactivity and returning their body to All-Is-Well?  Again, it comes down to choice, transparency and customer preference.  Rarely if ever are meaningful, cost-comparable choices being offered in this in the medical model monopoly of our modern times.
  4. If a person is deemed a danger to self or others, how likely is it that medical model approaches will actually reduce their Survival reactivity? What would be the response of the average person in a state of fear or heightened concern, if we removed them from their lives and force drugs, restraint or shock on them?  When if ever would we predict that such unilateral actions would increase a person's sense of well-being and safety and help them return them to All-Is-Well?  Given the high probability that people already in trauma will be further traumatized by such forcible domination when if ever is it worth the risk?  What is more, should such approaches ever be considered the first intervention of choice - as they all too often are in our current hospital system.  Equally important, if force is not the answer, then what is...? 

These are important questions that deserve an answer.  We will address them in detail in future chapters.

A Brief Word about Medications

Do your homework. Don't stop them abruptly.  These are powerful substances.  They really do alter our mental and physical functioning - some times irreversibly.  At a minimum, their effects can be long-lasting effects and extremely entrenched.  As life-diminishing as many of them are, it is wise to respect that.  

I say this because it has been my own journey.  Like some who may be reading this, I felt empowered when I first got information about alternatives to the medical model. I subsequently decided to taper off a medication I had been on for 10 years.  I went too fast.  It didn't go well.  

As a result, I still take a small dose of this medication.  Not because I think it has made my life better on the whole.  Not because I think it was 'the answer' to what I was going through at the time I started it.  But rather, because, after a decade (now 2 decades), the way my brain and body function are no longer the same.  In other words, taking this medication is 'harm reduction' for me.  It protects me from the damage that, I believe, the medication itself caused.  I'll say more about why I think that is in a later chapter.  

For now, my advice to you is to proceed slowly, gather information, evaluate results.  A great place to start is the Harm Reduction Guide to Coming Off Psychiatric Drugs, http://www.willhall.net/files/ComingOffPsychDrugsHarmReductGuide2Edonline.pdf.  
It will walk you through the considerations and help you learn the ins and outs.

Please also note that a lot of people think they have to find a willing provider to help them taper.  The research doesn't bear this out.  Don't get me wrong, a willing, knowledgeable provider is worth their weight in gold. Sadly, however, on average, they still aren't widely available.  As a result, the success rates historically have been about the same whether people taper with the blessing of a physician or taper on their own.  Harm Reduction Guide, supra, p. 28

Chapter 5-2. Turning Off High-Stakes Reactivity

The beautiful thing about the High-Stakes System is that there is a simple effective way to turn it off.

Think about it.  High stakes is turned on when things feel insecure:

  1. We're either feeling threatened by something - so we gear up to protect against the threat; or
  2. We're afraid we'll lose an important opportunity- so we gear up to protect against the loss.


For example, suppose you have a big project due at school or work.   High Stakes might keep you up all night thinking about it, even when you really want to sleep.

Or suppose a police officer approaches you as you're walking down the street. High Stakes might make you so activated that you can hardly resist running away even though you know you should do your best to appear cooperative and calm.

In other words, the main thing that keeps the High-Stakes system turned on is the perception that something high-stakes is going on around us.  As long as we feel uncertain, insecure or on edge, the High-Stakes system will keep us activated, on guard, and ready to roll.

At the same time, High-Stakes activation is hard on our brains and our bodies. Vital organs and tissues can't get what they need to maintain their functioning and repair the wear and tear of every day living. So, generally speaking, our bodies and brains want us to get back to All-Is-Well.  But, before that can happen they need you to feel safe.  It would be dangerous if High-Stakes turned off - and let you sleep for example - if your village was about to be attacked by the Huns.

On the other hand, the moment the threat goes away - and you feel safe in the world again - High Stakes reactivity is no longer needed.  You know this when it happens.  The Huns are defeated - or you find out it was only fireworks in the distance.  Subjectively, in your heart of hearts, you breath a sigh of relief, shake it off, and begin to return to All-Is-Well.  It might not happen the instant the threat is objectively over.  You might still worry and mentally prepare for a Hun attack for quite some time.  You might turn in your school paper or work project and then start fretting about your grade or review. Or, you might feel outraged for a while after the fact that the police stopped you for just walking down the street in your own town.  But, eventually, as the threat gets further and further away, and you begin to feel relatively certain that you're going to be okay, High-Stakes shuts down, and All-Is-Well returns.

Here is the point:

Our brains and bodies are our allies here.  They want the High-Stakes system to turn off.


An Exception to the Rule


Right now some of you are probably thinking:  That's not true for me!  I love the High-Stakes system.  I'd spend all my time there if I could.  That's how I get things done.

Yes, the activation and excitement of the High-Stakes system sometimes feels good.  There are the hormones (like adrenalin and natural morphine-like pain-killers) that we produce in activated states.  A lot of us become dependant on these High-Stakes mechanisms to feel ok.

In the long run, however, this 'addiction' to High-Stakes activation is problematic.  It is in direct conflict with the natural inclination of our bodies and brains. They tend to prefer the All-Is-Well state, and are usually trying pretty hard to get us back there.  This is so they can rest, repair and process the effects of negotiating life on life's terms. In a nutshell, it is the All-Is-Well state of mind and body that enables us not only to restore capacity, but also to learn and grow from the lived experiences that we have.


Knowledge is Power


Let's state the rule again:  Our brains and bodies are our allies.  They want the High-Stakes system to turn off.

Now that you know this, you have some power.  There is all kinds of reactivity you can turn off on your own.  The way to turn it off is find a way to make your world feel more secure.  Once the high-stakes system is satisfied that 'All-Is-Well', it shuts down.  There's no more need for the intense activation.  So High-Stakes lets go of the reins.  The moment that happens, routine functioning begins to resume and healing and restoration can begin.

In other words, the key to addressing High-Stakes responses, is:


  1.  Figure out what is driving the system: What turned High Stakes on? What is the underlying need?
  2. Find a way to make yourself feel more safe and secure - short or long-term.   Address the problem, fix it.  Make it go away if at all possible. 
  3. Find a way to cope.  Life is full of discomforts we can't make go away.  When that is the case, the trick is to figure out how to tolerate, manage or accept the stuff you can't change or control in the moment. 
It's that simple.

That being said, here's a few words to the wise. The process we are talking about is really straight-forward.  Learning to use it, and continuing to practice it, however, is actually pretty challenging. Especially when your first starting out.

So, here are a few tips:


  1. If you think you might be in High-Stakes reactivity, but you're having trouble figuring out why, take a look at Part III of this guide. Part III is full of reasons why all of us almost anyone might feel insecure.   It not only speaks to the 90% of us who have had it rough from the start.  It also suggests why even those of us who have done well in modern society and have all the advantages anyone could hope for might still feel like the Stakes are High.  As an added bonus, Part III has lots of reflection questions that you can ask yourself.  These will help you figure out if your High Stakes activation is about stuff that is happening now, or, if like many of us, you have past experiences - sometimes decades old - that are still keeping you locked in High-Stakes reactivity today.  
  2.  Despite its reputation in pop psychology, the High-Stakes system is not your enemy.  And, it certainly is not the out-dated 'lizard brain' that some 'trauma-informed' neurological approaches have made it out to be. To the contrary, the High Stakes system is your ally in protecting you. The point of the High-Stakes system is to discover and address the real life needs and concerns that are bothering you.  It wants you to actually feel safer and more secure in your world. It therefore insists on solutions that feel trustworthy to you.  That is the point of the High-Stakes system. 
  3. The key to restoring your sense of safety (and thereby turning High Stakes off) is to focus on your subjective (felt) experience:  Do you feel safer or not?  The point is not to look around and try to intellectually convince yourself that you are safe because you can't see any threat.  If you still feel threatened, then something threatening still needs to be addressed. We will talk about this more in the following chapters. But for now, recognize that we are not asking you to bull-shit or brain-wash yourself. We also don't care whether others feel you are safe or secure enough. The High-Stakes system doesn't work that way.  It is accountable to you and you alone.
With that in mind, it is worth saying a word or two more about the art of coping.  Many of us have gotten dug in pretty deep.  There are ingrained patterns and life circumstances that may take a long time to remedy and heal.  In this situation, it is really important to find strategies that create as much of the "All-Is-Well"experience as possible for you right now. Everyone is different, but at a minimum, these strategies should be: 
  1. Reassuring or affirming to you; and 
  2. Reliably damp down your High Stakes reactivity around stuff isn't likely to change any time soon (if ever).  

The good new is that this may be easier than you think.  For example, one of the most worrisome facts of our existence is that we all are going to die some day.  Yet many of us don't spend a lot of time worrying about that.  It's something we know.  It's always there in the back of our minds.  But mostly we focus on the task of living. We do our best to enjoy and make the most of the life we do have.  If that is the case for you, the fact that you have learned to cope with the ultimate uncertainty can be reassuring. It means you can probably find ways to cope with lesser challenges as well.

On the other hand, some of us are really freaked out about death,  It bothers us all the time, and the worry is hard to shake.  In this case, learning to cope may be a more gradual process.  We might have to try out a lot of things before we find something that actually ramps down our Survival reactivity around this ultimate deal-breaker. In the end, maybe spirituality, meaning, or friendships will provide us some comfort.  Maybe music or art will resonate with our fears so we feel less alone. Maybe we will forget our fears though love, laugh at them with humor, engage them creatively, or work them off with exercise.  Whatever rocks your boat.  The good news, again, is that if you can find your way to All-Is-Well while death is staring you in the eyes, then pretty much every other fear is yours for the baiting as well.  

Hopefully, this Chapter has given you a framework for understanding and and beginning to work with High-Stakes reactivity.  In subsequent Chapters, we will go into more detail about working with High-Stakes reactivity in ourselves, others, and when we're both reactive at the same time.

Tuesday, April 18, 2017

Chapter 5-1: Why We Need a New ‘Recovery’

Whatever recovery group we're in - mental health, substance use, criminal justice, anger management, stress management, the list goes on - we've been told we are defective. We've been told the problem is us. Somehow, some way, in someone else's judgment, we didn't do it right or get it right:  Our biology is wrong, our thinking is wrong, our feelings are wrong. We behave badly. We don't measure up.

For a lot of us, this is a familiar story.  We grew up with it and so did our families.  In schools, neighborhoods, communities, with key people in our lives. The misery and failings are our fault. Everybody else got it right, but not us. We need to work harder, try harder.  It's up to us to make it better.

 As adults, it's the same words and attitudes, but coming out of different mouths. The very people and systems that are supposed to be helping us are telling us, all over again, that we are the problem. Perhaps it's in kinder gentler words. 'It's not what's wrong with you, it's what happened to you.'
But the essential message is still the same.  In the opinion of some expert somewhere - whether self-appointed or officially licensed:

'The problem with you is [fill in blank]. It's your responsibility to fix it. Here's what you have to change and how. That is just the way it is.' 

That is the position the medical model takes on our lives, as we discussed in Part II.

As a factual matter, this approach just doesn't stand up. As we argued in Part III, the recovery we need is way bigger than mental or behavioral health.  It is about an entire social fabric that needs to change. The social determinants of health are well-known.  There really are some things that all of us need in order to live and be well.  According to the World Health Organization:

'Poor social and economic circumstances affect health throughout life….'These disadvantages tend to concentrate among the same people, and their effects on health accumulate during life. The longer people live in stressful economic and social circumstances, the greater the physiological wear and tear they suffer, and the less likely they are to enjoy a healthy old age.'

Social determinants of health: the solid facts (2nd ed.) p. 10 (Wilkinson, R. & Marmot, M. eds. 2003), http://www.euro.who.int/__data/assets/pdf_file/0005/98438/e81384.pdf.

In Parts III and IV, we showed how this plays out - as a practical matter - in mental and behavioral health. Across these demographics, adverse life experiences are nearly universal.  Roughly ninety (90!) percent of mental health, addictions, corrections and homeless service users have grown up in conditions of fear and want, whether social, economic or developmental.  The consequences are devastating and speak for themselves:
Trauma occurs when an external threat overwhelms a person’s coping resources... Untreated trauma that begins in childhood — which is often intentional, prolonged, and repeated — exerts a powerful impact on adult emotional health, physical health, and major causes of mortality in the United States. ... It is widely accepted to be a near universal experience of individuals with mental and substance use disorders and those involved in the criminal justice system. ... We cannot hope to rein in healthcare costs and improve healthcare quality if we don’t attend to trauma and its consequences. 
National Council Magazine: Breaking the Silence: Trauma-Informed Behavioral Healthcare, p. 10 (11:2012), https://www.thenationalcouncil.org/wp-content/uploads/2012/11/NC-Mag-Trauma-Web-Email.pdf

Currently as neighbors, communities, entire nations - we are operating in ways that produce devastating, irrevocable harms.  We are poisoning our relationships in the same way that we are poisoning the air we breath and the water we drink.  We are killing - rather than nurturing and developing - the good will that our collective survival depends upon.

We've said this before in this guide, but it is worth revisiting again:

Think about what it's like to be treated unfairly, go hungry, be thirsty, have nowhere safe to sleep at night or no meaningful way to make a living. Think about what it's like to be disrespected, hurt, called names, beaten up, pushed around, held somewhere you don't want to be, forced to do something you think is bad for you, work for an unlivable wage, be treated as a cog in a corporate wheel that could be thrown out at any time if a better model comes in…

This kind of treatment is distressing for most of us. Nobody does well when their basic human needs are ignored or violated.  The normal response is to feel threatened and insecure. If nothing changes, this can grow into full-blown mental distress and even chronic or extreme states. We can end up totally disconnected from ourselves, others and the communities we live in (anxious, depressed, detached, unreachable).  We can stop feeling like living or being alive (suicidal). We may stop caring how our actions affect others (apathetic, amoral, criminal). We may look for anything that deadens the pain of feeling so unbearably hopeless or alone (self-indulgent, impulsive, addictive).

If things are going to get better, we have to radically rethink what we mean by ‘recovery.’

  • We need to get beyond labeling and segregating so-called problem people into so-called problem demographics. 
  • We need to stop shaming and blaming each other for the widespread social dis-ease and human hardships that affect us all.  


As a practical matter, our current practice of treating so-called ‘problem’ individuals simply doesn't work.  It's like blaming people with beater cars for all the potholes on local roads.  They might be an easy target, but nobody is ever going end up with a smoother ride. To the contrary, the very people society tells us to focus on are, in actuality, the least likely to be able to make the changes we are asking for. As a group, they have the least power and and the fewest resources to make the positive changes (better jobs, better relationships, more community spirit, more life satisfaction, more vibrant beautiful public spaces) that practically everyone would like to see.

Even more important, our 'blaming the beaters' approach practically guarantees that things will get worse instead of better.  We spent Part IV explaining how devastating the survival response is to human health and well-being.  There is no better way to keep a class of people in survival mentality than for the rest of humanity to treat them like pariahs.   It is a recipe - not a remedy - for the very kind of extreme, irrational, impulsive self-focus that we say want to heal or change.

No less important.  This kind of behavior is NOT happening because:


  1. People are that way naturally; or 
  2. It is our chemical, biological or genetic destiny.  
To the contrary, it is simply what the survival response does.  In a word:

  1. People perceive a threat
  2. They feel scared
  3. Self-protection becomes the core focus and top priority. 
  4. The survival response gears up to aid with self-protection
  5. Biological defense processes are activated and energized.
  6. The defense processes go on hair-trigger reactivity.
  7. Something small sets them off.  
  8. The survival response 'shoots first, asks questions later'
  9. In the aftermath, when things have calmed down, everyone is shaking their heads wondering how things became so extreme. 

It is not a mystery.  It is not a disease.  It is the biology we were born with.

No less important.  Consider the following:


  1. Human beings are social animals.
  2. We want to be well-regarded by others.
  3. We want to be treated well by others.
  4. We need the regard of others to get lawful employment.
  5. We need the regard of others to be treated well.
  6. Many of our material needs (food, shelter, heat, healthcare) depend on the regard of others.
  7. It is difficult - and sometimes impossible - to navigate social systems without the regard of others.
  8. A lot of our safety (e.g., protection from predation or disaster) depends on whether others (police, courts, neighbors, passers-by) think we deserve it.
Now think about the effect of being labeled a social pariah - mentally ill, addict, criminal, homeless -by the rest of your community.  No one regards you as trustworthy or valuable.  No one sees you as having anything to offer.  No one trusts you, so you can't get a job. Most people make active efforts to keep you away.  You have few if any options for meeting your basic needs.  Few people see you as someone with potential.  Few will take the risk of reaching out or trying to help.  You are hungry, cold, tired and rejected almost all of the time.  You have few if any legal options to shower or relieve yourself.  Everyone is more than happy to tell you what is wrong with you and what you should do to fix it. Almost no one cares about how you got to where you are or the zillion things you've already tried and found miserably wanting.  


In short, this kind of outsider labeling is a a sure-fire way to bring up survival reactivity  in almost anyone.  

That isn’t to say that we should overlook or gloss over these issues.  These issues have become entrenched and problematic for good reason.  At a minimum, there is mutual distrust on both sides. There are also ways that responses we have learned - on all sides of the social equation- are keeping the vicious cycle going.

Any worthwhile solution will need to address this. Otherwise, as a race, we will continue to trigger each other and simply stay stuck in the survival mode.

But, before we can address it (see Parts VI and beyond), we need to realize:


  1. What we are up against: Survival Reactivity! 
  2. What we can do about it:  How to work with it - and Turn It Off
That is the purpose of Part V of this manual.

Saturday, April 8, 2017

Chapter 4-8: Why ‘Mental Illness’ is a Vicious Cycle and a Catch-22

Think about it. The High-Stakes response is activated when, in real life, the stakes are high. That means those of us who grow up in really difficult life circumstances will be in “High-Stakes” reactivity a lot of the time. As we have shown in prior chapter (4-5, 4-6, 4-7), their is massive overlap between the 'symptoms' of so-called mental disorders and the effects of the High-Stakes system. Accordingly, we can predict a lot of ‘mental illness’ being diagnosed among people who have had a rough time of it.

That is in fact exactly what is happening.  As it turns out, a whopping ninety (90!) percent of us in the public mental health system are 'trauma survivors.'  We have grown up without reliable access to basic human needs.  Things like:

  • nutritious food, habitable shelter
  • safety of person and property
  • dignity, respect and fair treatment
  • meaningful participation and voice
  • support for our families to stay together and make a living
  • opportunities to develop ourselves across major life domains
  • freedom to make sense of experience in our own way


As previously discussed (Part III, chapter 3-2), these things are not optional.  They are essentials of life that every human being needs in order to feel well, live well and be well.

This is also not an individual issue.  Far too many of our families and neighborhoods are living without secure access to basic human needs as well.  Yet, without such access, neither individuals - nor the human family as a whole - can be well.

Once in the system, there is virtually no way out.  In behavioral health populations, “High Stakes” is the norm.  We are broke, unemployed, barely housed, victims of crime, targets of discrimination.
When we speak up about this or try to self-advocate, it is often treated as a 'symptom' of our ‘illness.’

The stakes for us are literally 'High' all the time.

This is the real biology behind what is getting diagnosed and treated as ‘mental illness.’ The source is not broken brains or individual genetics.  Our brains and bodies are working fine.  They are doing their job - which is to inform us of the very real, very threatening material, social and developmental circumstances we are currently facing in our real lives.  These circumstances are made worse - not better - by the fact that society sees us and labels us as 'sick' and 'disordered.'

There is nothing abnormal about us. To the contrary, our collective distress is a call to action. Our biology is telling the truth about the desperate circumstances of our lives.

The remaining question is what we can do about it and where to go from here.  That is the subject we will spend the rest of this guide attempting to tackle.

Chapter 4-7: Why The Dis-Ease Keeps Getting Worse

You hear a lot these days about how 'mental illness' is progressive and therefore requires early detection and intervention.  There are several problems with this:

1. It's not an illness.
2. It's not a progressive illness.
3. Longevity research suggests that many of would us do better without any treatment at all, as opposed to getting caught up in what the conventional treatment system has to offer.

However, there is a lot of truth in the fact that things tend to get worse rather that better over the long haul.  While these challenges may say something about us, they say at least as much about the world we live in and how modern society needs to learn and grow to meet the real needs of its citizens.
Here is why:

High-Stakes reactivity is a natural, predictable outcome when basic human needs -material, social, developmental - are violated, overlooked or ignored.  High-Stakes reactivity takes a tremendous toll on human minds and bodies. Under the influence of High-Stakes reactivity, the body's energy and resources are mostly being shunted to our muscles, heart and lungs.  Our hearts pound, we breath hard, and our muscles are tense and primed for action.

In this state of high alert, almost no one is able to relax, digest food well or get a good night's sleep. Our muscles are tense all the time and therefore burn up the needed resources (oxygen, nutrients) that should be going to our brains and vital organs.  As a result, we can't process nutrition effectively and therefore become progressively malnourished over time.

Adding insult to injury, we can't sleep - which is when our bodies and brains are perform routine maintenance and make needed repairs.  In actuality, our bodies are nature's surgeons.  Every night while we are out cold they perform complicated operations to repair our vital organs and delicate nervous system circuitry.  If we don't sleep well, they are limited in what they can do or fix.

If we just think about this a little bit, it is also not hard to see why so many of us:
  • Feel exhausted, depleted and unmotivated
  • Have trouble with memory and keeping track of things
  • Are concerned we are missing something and not thinking well
  • Have trouble making decisions or setting priorities
  • Experience ourselves seeing/ hearing things that others don’t seem to 
  • Feel totally out of touch with the outside world (our brains can barely pay attention to the inside one)
  • Experience the world as playing tricks on us or out to get us (something sure is!)

Given the continual stresses we are under, and the fact that we hardly ever get a break, our minds and bodies simply don't have the support they need to heal and help us get us back on or feet.

When we put these factors together, it is relatively easy to understand the social and employment effects of ‘mental illness.’ As a group, our people have taken a tremendous amount of flack for 'isolating' and 'being unmotivated.  But, when you think about it, almost no one would feel capable of going out or navigating the world in the above frame of mind. Applying for work or trying to make friends when it's gotten this bad is a recipe for disaster. All too often we end up being judged or rejected as a result of the difficulties we experience under the influence of prolonged High-Stakes activation.  Or we lose important paperwork or get robbed or ripped off because it's too hard to pay attention once we've become this depleted and run-down.

Here is an analogy:

Imagine your body is like your car.  Every so often your car needs an oil change and routine maintenance.  If it doesn't get that sooner or later it is going to break down.

Now imagine continuing to drive your car like that for weeks, months or years. Even worse, imagine driving your car with the same oil and no new servicing for a life time.  That is basically what is going on with the profound kind of trauma that some of us have had. You know if you've had that kind of trauma because you've never, ever really felt safe.

In these circumstances, you don't know exactly what is going to break down.  But you can be certain that sooner or later something is going to malfunction:  This is your brain in the High-Stakes system.

Simply stated, just like your car, the general rule is this:


  1. The longer our needs go unmet, and 
  2. and the more severely our needs are neglected...
  3. Then... the more extreme are the issues that will arise,
  4. and the harder it will be to fix them.


This rule clearly explains why many of us keep getting worse and worse.


  1. We've had important needs that have gone unmet
  2. We've lacked the resources we needed to address them... 
  3. So... they've stayed unmet for a really long time, 
  4. and our problems have compounded, making them really, really hard to fix.


Once we understand this, it's not so hard to see what is going on with so-called ‘serious mental illness.’  Of course we experience things like 'psychosis', 'delusions', 'perceptual disturbance' and 'irrational thinking'!  (Duhhh!)

The fact of the matter is that, in High Stakes circumstances, human brains don’t get what they need to reliably function. They don’t get the energy or resources needed to pay attention to the ‘big picture.’ They don’t get what they need to effectively read the environment or make sense of the wide variety of incoming information.  The longer and longer this goes on, the worse and worse it gets.  It therefore is predictable (not surprising) that many of us are breaking down under the impact of our stressful lives.

It's also pretty easy to see why conventional treatment makes things worse instead of better for so many of us.  Conventional treatment (meds, hospitals, shock) focuses mostly on our 'symptoms.' However, as we've seen, our 'symptoms' are there for a reason:

They are alerting us to the fact that 
IMPORTANT NEEDS AREN'T BEING MET!   

Yet, for the most part, conventional  treatment does very little to address these important pre-existing stressors.  At best, the drugs mask our symptoms, or we are taught 'coping strategies' to adjust to the fact that our lives aren't working.  Rarely is anything done to address our real problems - the very real material, social and developmental needs that every human being has - that are going unmet for so many of us in conventional society.

In other words:


  1. There is nothing inherently defective about our brains of bodies. 
  2. The challenges we have been facing are very real.
  3. Many of us will break down in such circumstances
  4. This is not an illness -- and it is not even surprising.
  5. It is a 'normal', predictable outcome of how conventional society is operating. 
  6. It is what human minds and bodies do under prolonged stress when we can't access the resources that everyone needs to feel well, live well, and be well. 
This is a social dis-ease, not an individual one.   Many, many people in our modern world are in this situation.  It is going to progress until we make progress.  The most important progress we can make is to start treating each other better.  At a minimum, we need to ensure that everyone of us can access the material, social and developmental resources that all of us need in order to feel well, live well, and be well.  Conventional treatment - with its focus on medical expertise and treatment compliance - has not begun to scratch the surface of the human needs that really matter.  



Wednesday, April 5, 2017

Chapter 4-6: Explaining Particular ‘Disorders’ and Symptoms

The Three Basic Responses

When the stakes seem high, human beings are wired to respond in one of three ways:  fight, flight or freeze.  This keeps things simple in trying times.  It also capitalizes on the action tendencies that are created during High Stakes activation. For example:

1. Fight. 


The 'fight' response goes after threats and opportunities.  It takes them on or brings them down.  The hope here is to act in ways that make the world safe and get us what we want. In essence, we are using our High Stakes activation to overpower opposition.

2. Flight


The 'flight' response avoids threats and opportunities.  It gets away (runs, hides) as fast as possible. The hope here is that someone else will fix things or the problem will take care of itself.  In essence, we are using our High Stakes activation to escape opposition.

3. Freeze


The 'freeze' response hides in plain sight.  It shows no apparent reaction (it de facto disappears), giving others nothing to notice or chase.  Sometimes, the hope is to not be noticed.  Other times, the hope is to not notice what is going on inside or around us.  It’s all too overwhelming, and we simply don’t know how to handle it. In essence, we are using High Stakes activation to ignore or go undetected by the opposition.

The Incredible Diversity of High-Stakes responses


We are adaptive beings. The purpose of High-Stakes is to maximize that.  It wants us to live as long as possible and as well as possible, given our options.  As a result, even though evolution started us off with mostly physical responses, human beings actually fight, flight and freeze in countless ways.

Here are just a few examples:

1. Fight


Maybe we’re not so good at fighting physically, but we’re really smart. So we fight intellectually- we argue and argue until we get the last word in.  Or we fight emotionally or verbally by getting angry, resentful or yelling.  Socially, we might envy others, compete with others, or try to 'win' friends.  Or maybe we fight spiritually by becoming spiritual 'high achievers' or prayer warriors.

2. Flight


Maybe literally running away is not an option because we’re not very fast on our feet.  No worries, we can run emotionally or with our imagination.  We can mentally change the subject or the picture in our mind.  We can also run socially, for example, by backing down or apologizing profusely.  Or maybe we run from awareness or feelings, using work, politics, tv, sex, video games, the internet, drugs or self-injury as distractions.

3. Freeze


Even with freeze, there are a variety of options.  We might actually be driving a car, but so lost in thought that we are not even aware of the road. In a school or at a party, we might keep talking, but go numb inside. We might stay put physically but escape into fantasy or an entirely different reality in our minds.

Specific Examples


Understanding the above dynamics help to make sense of a broad variety of mental phenomena.

1. Anxiety


For me, anxiety is what gears me up to try to address something I think is going to go bad. Metaphorically, I feel like prey trying to escape a predator. The High Stakes system helps me do this.

2. Depression


The difference for me with 'depression' is that I've usually given up hope. The situation just seems too big and overwhelming. I still feel lousy because the High Stakes response is still there telling me that All Is NOT Well. But, in effect, a part of me has decided to stop wasting my energy trying to fix it.

3. Dissociation


Dissociation, for me, is a close cousin to anxiety and depression.  It happens for me when reality is painful and entrenched, and I want to avoid noticing how it makes me feel.  I do this by getting lost in thought or slipping into fantasy.

4. Altered Perceptions 


At one point, I deliberately pushed myself into a spiritual reality, because I felt so overwhelmed and discouraged about my ability to meet the demands of my life on my ordinary human resources.  In that reality, I heard things, felt things, and saw things that others around me did not.

5. Bipolar, Addiction, Aggression


The second function of High-Stakes responding is less well-known. This is where I go after something I want. Metaphorically, I become the hunter hot in pursuit of a tasty meal. The High-Stakes system helps me mobilize the resources I need to do this. The intense activation of the High-Stakes system - including its single minded focus and the 'thrill of the chase' - for me, explains a lot of what gets diagnosed as 'bipolar.'

A close cousin is so-called ‘addiction.’ Anticipation of pleasure and relief from pain are both attractive goals.  Since most addictions supply this, they tend to activate High-Stakes reactivity in a lot of us.  Once that happens, we are off !  Our brain state in survival reactivity insures that we will be able to recall the consequences of our last binge barely if at all.  So, despite our best intentions in a calmer state of mind, once again, we find ourselves pursuing and tracking down something we are convinced will make us feel better.

The High-Stakes 'hunter' energy can easily manifest as aggression as well.  Winning a fight or competition - or even a better job - are attractive goals that often activate High-Stake reactivity.  As with any High-Stakes situation, a brain-deprived 'survival mentality' is quick to follow.  This practically ensures that such aims frequently will be pursued with little awareness or concern for our impact on others.

Diversity is Good for our Species

Despite the obvious pitfalls, High-Stakes reactivity is a tremendous asset to our species.  It has made our survival possible for thousands and thousands of years.

Just as important is the fact that:


  1.  We see different things as threats and opportunities; and 
  2.  We react to threats in so many different ways

Both factors are crucial to human survival.  When an entire community is facing a threat, this promotes resilience and survival overall.


  1. The fact that we are tuned into different things ensures that, as a species, there will always be someone to alert us to a potential harm or benefit.
  2. The fact that we react differently - even in similar circumstances - is also a good thing.  It ensures that humans will respond to challenging situations in numerous rich and creative ways. 


 If we all responded the same way to danger or opportunity, a single threat (predator, disease, disaster) could wipe us out. We need the extremes that people tend to under stress to safeguard group survival.

On the other hand, when the stakes are seemingly individual, the virtue of diversity can get obscured. Since only one person is reacting, this can look rather odd to everyone else.  As we mentioned above, this has led to a lot of us getting labeled 'mentally ill' when, really, we were just experiencing High-Stakes responses.