Wednesday, November 2, 2016

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. Some how, 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' 

As a factual matter, this approach just doesn't stand up.  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. People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top. Nor are the effects confined to the poor: the social gradient in health runs right across society, so that even among middle-class office workers, lower ranking staff suffer much more disease and earlier death than higher ranking staff.' 
'Both material and psychosocial causes contribute to these differences and their effects extend to most diseases and causes of death. Disadvantage has many forms and may be absolute or relative. It can include having few family assets, having a poorer education during adolescence, having insecure employment, becoming stuck in a hazardous or dead-end job, living in poor housing, trying to bring up a family in difficult circumstances and living on an inadequate retirement pension.'
'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),

Here is how this plays out - as a practical matter - in behavioral health.  In behavioral health 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 in at least one major dimension (economic, social, developmental) of our lives.  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),

This is why we need a new recovery.  The recovery we need is way bigger than healthcare.  It is not about treating sick or unwell individuals. It is about how we treat each other as human beings.

At core, it is about an entire social fabric that needs to change.  Currently as neighbors, communities, entire nations - we are operating in ways that produce devastating, irrevocable harms.  These harms are predictable, repeated affects of social conditions and attitudes.  We are poisoning our relationships with each other 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 on.

It is time to stop blaming the victims.  As a practical matter, it simply won't work.  It's like expecting people with beater cars to take all the responsibility for fixing the potholes on local roads.  Almost nobody responds well to being kicked when they are down.  Moreover, you're not going to make much progress by focusing on those at the bottom rungs of the ladder.   They have the least power and the fewest resources to actually make the changes needed.

If things are going to get better, the responsibility must be shared.  We need to get beyond labeling and segregating so-called problem people into so-called problem demographics.  We need to stop shaming and blaming so-called problem people and demographics for the human hardships that affect us all.

Don't get me wrong.  I'm not against personal responsibility.  In fact, I'm totally for it.  Peerly Human is all about taking responsibility.

In a very real sense - each and every one of us has a non-delegable obligation to vote with our lives for the world we want to live in. To know what this is and what that means, however, each of us has to search our conscience.  We have to develop a vision, take risks and try things out.  Sometimes it works, some times not so well.  That is the essence of lived experience and how we learn from it.

However, any way you look at it, this active soul-searching and engaged learning is a highly personal, highly responsible process. No one else can know what we are called to contribute. No one else can take the action that we alone must take to try to make our vision real.

This fundamental belief in the worth of every single one of us is what we need to recover.  That's not just my opinion.  It is the opinion of people and nations all around the world.  In the Univeral Declaration of Human Rights,, the world community defined our fundamental nature as human beings:
  • We are all members of the human family.
  • We are all endowed with reason and conscience. 
  • We are all equal in dignity and rights. 

This is our birthright as human beings.

This the real work of recovery.  And it is not, at core, a healthcare issue.  It is a human issue.  It is about recovering, together, our sense of being in this together.  It is about recovering our right to belong.  It is about recovering our humanity and the best that we have to offer each other.

In a very real sense, it is about learning to see each other differently.  It is about learning to be true peers on this human journey.  It is about learning to treat each other as 'equals standing', rather than as superiors and subordinates or experts and advisees.

It is about learning to see the worth and value of everyone, everywhere.  It is about learning to honor the experiences, perspectives and wisdom of anyone, anywhere.  It is about learning to appreciate the window to a deeper understanding that each human life gives us into what it means to be human.  It is about coming to value every lived experience, however difficult or painful, as potentially contributing to our collective wisdom.

It is about taking the time to connect the dots.  It is about recognizing that connecting the dots is important - not just for the brilliant successes but also for the horrible tragedies.  It is about asking ourselves what we can learn - when the stakes are highest and the chips are down - if we take the risk of viewing each other as 'peerly human.'  It is about making a commitment to see each other as equals in dignity and rights instead of judging, blaming or demonizing.

It is about believing in and affirming our mutual capacity for reason and conscience.  It is about trying to nurture and access that in ourselves in our deepest darkest moments.  It is about trying to access that in each other across differences and conflict.  It is about asking ourselves why we are fighting:  What do we both need here...? What can we learn from this about the nature and challenges of being human...?   It is about finding out for posterity what future people who care could do differently to make a difference in similar circumstances.

This is the real recovery.  It is the work of social justice and human rights, not just healthcare.  It is about recovering our shared humanity, not just our individual health and well-being.

It is something we can all make a start at.  But it is also something that none of us can do alone.  We need each other.  We need support to do this work.  We need to support each other to start figuring out how each of us can do our part.

This kind of work is more of a hope than a promise.  It's takes real commitment and real courage - something akin to unilateral disarmament in a nuclear age.

We take the initial steps in good faith.  We try to develop the trust and confidence that will inspire others to follow suit along the way.   We hope against hope that what is good and kind and generous about humanity will ultimately prevail.  We dig into the dream and trust in the words of the prophetic Reverend King:

“The arc of the moral universe is long, but it bends towards justice.”

We are recovering justice.  In Peerly Human terms, this means we are rcovering respect, dignity, fairness and belonging for all of us.  Not 'just us.'

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