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.

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