tag:blogger.com,1999:blog-29966724686979742302024-03-12T19:25:19.530-07:00Trauma Transformation Peer Support...Building a knowledge base and practice for Trauma-Informed Peer Support.bethfilson@gmail.comhttp://www.blogger.com/profile/16955571965042820728noreply@blogger.comBlogger5125tag:blogger.com,1999:blog-2996672468697974230.post-3786234956996649452013-06-23T10:32:00.000-07:002013-06-23T14:02:26.227-07:00Letting Go of the Past? <br />
I am thrilled to have finally had expert help in retrieving this blog!!! Thank you, Jayme, angel of mine.<br />
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A good many years have passed since I first established this site. I've had a chance to meet with and learn from great teachers all over. I now live in Western Massachusetts, "where the coffee is strong but the women are stronger." All the moving I've done since 2007 has driven home for me the importance of place, belonging, and finding a tribe of one's own, be it family of origin or family of choice. Yet finding home is one of the hardest things I've ever done. <br />
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I combined a series of images off the net to try to communicate what it actually means to me when I hear people equate recovery and healing with letting go of the past. It is a message that tries to take a short cut to healing by avoiding the hard work of making sense and meaning out of what has taken place in one's life: <br />
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<div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir5Y8VpCrBhaFEnJvnccr8avHkvKHSxAH6x0DA9_9vL21FV_rih5q5UebkULUl2rdhC8HUeX071S83Ekpqp8uI2L-eqklBI37OtO3AKKANnLVOQNadFS4gtYcX3d4rGofEPOOu4ub5Gn0X/s1600/Slide1.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEir5Y8VpCrBhaFEnJvnccr8avHkvKHSxAH6x0DA9_9vL21FV_rih5q5UebkULUl2rdhC8HUeX071S83Ekpqp8uI2L-eqklBI37OtO3AKKANnLVOQNadFS4gtYcX3d4rGofEPOOu4ub5Gn0X/s400/Slide1.jpg" /></a></div><br />
Letting go, moving on with one's life -- is incredibly difficult. The past not only contains trauma, but also one's history, lineage, family, culture,beliefs, and all our memories -- good AND bad. This means that trauma and place and tribe and identity are all interconnected. To let go of trauma is to let go of the roots that hold us to the earth, so to speak. The past - for good or ill - is the source of self. <br />
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So, the task, always, this thing called "transformation" -- using the raw material of all that I have lived to create all that I want to become. Not done. Not even close.<br />
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bethfilson@gmail.comhttp://www.blogger.com/profile/16955571965042820728noreply@blogger.com1tag:blogger.com,1999:blog-2996672468697974230.post-73566169115022641522008-10-27T22:15:00.000-07:002008-10-27T20:10:51.467-07:00Barriers to Trauma-Informed Mental Health Systems: Beliefs and Medical Necessity=<br /><br />One of the challenges for implementing a trauma-informed system is an issue of etiology – that is, the etiology of mental illness.<br /><br />I know: debating cause of mental illness is not very helpful, especially when I just want peer support. Debating cause isn’t helpful when I am trying to learn how to work again, or trying to get up enough courage to go to the gym full of strangers, or stop hating myself. But I’m afraid that we will have to share uneasy proximity to the question because it is the often unspoken decision people have already made about what causes mental illness that has created so many broken state mental health systems. What we believe about the illness informs the services the system provides. <br /><br /> So, if I believe that mental illness is caused be a chemical imbalance, then the role of the system will be driven by treatment services with their emphasis on medication therapy. It fits nicely into the medical model. It is easy to bill Medicaid based on the criteria for medical necessity. And the theory has done good work by some of us to counter stigma by “normalizing” the experience of distressing thoughts feelings, behaviors (read “symptoms”) by making it all a medical thing: same-as-having-diabetes. <br /><br />It’s not. The cornerstone of chemical imbalance theory is medication compliance. And if you aren’t compliant, then you must be defiant. I think as survivors whose needs are multi-faceted and complex, we know the terrible consequences of either “choice.” This compliance/defiance dynamic is the birthplace of sanctuary trauma. This is one of the reasons why we started talking trauma-informed systems of care in the first place. <br /><br />I was recently in a training that involved many case managers. The trainer was attempting to talk about self-directed recovery – and creating ways for such to take place in program environments. Everyone was in agreement about the importance of choice, self-advocacy, self-determination, etc. I don’t think anyone present would say that they did not believe in recovery… <br /><br />But as I listened, I started hearing how these terms were being re-defined to fit the system these practitioners were working in. What I realized - again, is that each of us defines recovery in the context of our individual belief systems: If I am bought in to the idea that people with mental illness can’t know what they need until their brain chemistry gets its influx of right chemicals through the proper medications, then I’m more likely to re-define personal responsibility and choice in the context of: “Consumers in our program can choose to take their medications -- or not; come to group on time -- or not; stay awake during day program -- or not; attend to their personal (shudder) hygiene -- or not. Forget that the group I have to go to at the mental health center is beyond boring, has nothing to do with my life, and is required if I want to stay on my SSD Benefits – since people like me can’t work. (You told me.) Forget that my personal hygiene habits you want to change so badly are the best defense I know right now against losing any more autonomy. <br /><br />The choice to comply or defy is no choice at all. These “choices” did not return me to personhood. In that system, my struggle wasn’t even my own: My illness gradually ceased to be about what brought me into services in the first place, and more and more about my response to those services. The harder the system tried to get me to comply, the bigger my acts of defiance. The bigger my acts of defiance, the greater the force used to subdue me. The greater the force needed to subdue me, the more violent my defiance...and so on, and on and on….layer after layer of violence. Who wins? There were times when I walked toward suicide because it seemed to be the only, final, recourse to self (soul) preservation. This is a description of a violent mental health system operating in the “best interest” of its patients. <br /><br />What recourse do any of us have – patient and provider – to stop the cycle of violence that is the hallmark of mental health services operating out of a really bad re-interpretation of recovery principles and values (summed up in the Consensus Statement on Recovery)? What meaning can peer support have when it is so often reworked to mean, I use my personal story of recovery to explain to you that it was only when I accepted that I was mentally ill and started taking my medication that I got better (read, “So it’s my job to convince you to be compliant.”) <br /> <br />Medicaid reimbursable peer support services are extremely vulnerable to this type of co-optation. But in creating dialogue with other peers in the realm of trauma we create a distinct support role. When we discuss with our colleagues those messages, and policies and standard operating procedures that we know from our own experience are soul-killing, then we are valuable contributors in the recovery of the system, and allies to those who want to create change, too. I see our role in creating a trauma-informed system as one in which we hold room for the human experience context as opposed to medical necessity. <br /> <br />Trauma. The word opens a door we never had before. It begs system self-examination. It necessarily requires a different tone of voice, a quietness that wasn’t there before when all we had was mental illness, brain disease. There is in the word trauma the reality of event, an implied relationship now between speaker and listener. We have always shaped our human communities out of shared events, beliefs and the history of ourselves transmitted through storytelling. We know our kin and kind because this. Take away shared event, you create “us” and “them.<br /> <br />So, what holds us back? As Peer Supporters? It has something to do with those @#$! expectations about how we are supposed to respond to our own trauma experience...I think there is a real role in the listener-storyteller relationship based on the wisdom suffering teaches all human beings. We have a right to that self-knowledge. More later.bethfilson@gmail.comhttp://www.blogger.com/profile/16955571965042820728noreply@blogger.com1tag:blogger.com,1999:blog-2996672468697974230.post-31551384793613475652008-10-22T17:31:00.000-07:002008-11-14T13:26:28.568-08:00Treatment Failure: Seclusion and Restraints<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYXE4IYF4KI8nmaKSK5f3ruyXlzvnB-BWuqAbXP_d6bRicmWPKYg_Ex4dnPc0Mqj5W_z1RUmijxol6eKoSd5wHOriVLWtt4eQh67The84jnpnQIe9iTMT6mnuDsIZH-LUxaaOLtKqYM1Ti/s1600-h/angel+on+the+wall.jpg"><img id="BLOGGER_PHOTO_ID_5260141162643433746" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; WIDTH: 226px; CURSOR: hand; HEIGHT: 320px" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYXE4IYF4KI8nmaKSK5f3ruyXlzvnB-BWuqAbXP_d6bRicmWPKYg_Ex4dnPc0Mqj5W_z1RUmijxol6eKoSd5wHOriVLWtt4eQh67The84jnpnQIe9iTMT6mnuDsIZH-LUxaaOLtKqYM1Ti/s320/angel+on+the+wall.jpg" border="0" /></a><br /><br /><div align="left">The Observation Window<br /><br /><div align="left">I quit that time and that place the moment I understood there was no possibility of freeing myself. The solution was a kind of disappearing. I collapsed time in on itself and hurried to a far off point where it was all, already, just a memory. I was simply remembering the room, the feel of the leather restraints around my wrists and ankles, the burn through my neck and shoulders. <br />While a number of psych techs held me down, another one laced the leather straps through the cuff around each ankle and wrist. He yanked down hard, fastening the tongue into the buckle’s silver teeth to force this tight, suffocating, unwarranted embrace. <br /><br />We were all almost silent – just the sound of forced breath, a stray grunt, a “got her?” More than anything else we spoke in a language of physical exertion. There should have been a great deal of discussion about this event but there wasn’t any. I retaliated with my own silence, too. A final, furious tug forced my body to bow upward trying to gain leeway. They left. <br /><br /> How many times have I been here, now? How many more times before they will get it, that this act of restraining me dehumanizes them. I understand exactly why I am here again; I know what always leads to this moment. My rebellion is an act of absolute self-possession, a statement of total autonomy. I am certain of the story I am trying to tell over and over. I maintain all reason while those who leave me here, having bolted the door behind them on their way out, they must immediately begin to un-know everything about now. Each one of them trembles with the adrenaline rush. They shake their heads, examine their skin for evidence; they try to reassure each other and themselves that this act was necessary and reasonable. They split back into their separate selves striding down hallways, each back to his respective post in this hospital when the code fist called them to hurry, hurry. They carry a faint anxiety on their skin as they leave me; I can smell it. I, possessor of all reason, I understand that they have no reason, nothing to explain what rolls in and then recedes like thunder in their minds. They feel their hearts, place a hand there. There is nothing to do but hate me. It is a natural response to the incomprehensible dilemma of relationship. How important it is to balance cause with effect, to parcel out empathy to more deserving relatives than me. <br /> <br />In the dark I run my tongue over my bottom lip and feel the chap and sore of my dry mouth. I hear my throat contract as I try to swallow. Someone else bends down to suck at the arch of clean cold water from the water cooler in the hallway. Someone drinks long and hard, then rises to swipe a sleeve across their wet mouth. There are those of us for whom the image of someone drinking is enough. This is the biological basis for human empathy, the shared event of our physical selves. We build structures for the spiritual and emotional on that foundation. We understand others because of this. <br /> <br /> In evolutionary terms the problem with putting people in restraints is that this is not a fight about territory, mating rights, food. It is about something abstract, intangible. It has something to do with meaning. How intolerably subjective the human experience! In the context of psychiatric hospitals there are only those who control and those who must be controlled. The dehumanizing element is that policy, liability, procedure have such great distance from anything meaningful. Isolated from meaning the event is simply violent. <br />Staff walk back to their units now carrying the burden of this violence, horrified that it must now be incorporated into who they thought they were. I, on the other hand, am pure. <br /> <br /> At some point the night duty nurse comes on, stares at me through the observation window. She hauls the door open and my heart leaps. Maybe she has come to start pulling up anchor? First a wrist, then an ankle, and them the other wrist, and then the other ankle over a period of an hour to make sure I am calm, won’t fight, have settled down. “I ain’t messin’ with you tonight,” she spits. “You’re staying there,” she says. <br /><br />I turn my head to the wall. Her face hates me with a passion she doesn’t have in its opposite: love. She does not know why. There are too many problems in her own life. She doesn’t get paid enough to deal with this shit. <br /><br />She will come back, once every hour – or half hour? It’s not exact due to the demands of paperwork, other patients who won’t go to bed. She’ll stand over me in the half dark waiting for me to open my mouth so that she can pour down my throat a measured dose of liquid medication listed under “Allergies” in my chart. I will not clarify this point with her. It will lessen my chances of getting released before dawn. So I let her pour from her paper cup even as an almost immediate anxiety begins to rise in my chest, seethes, shoots outward along my limbs from my ribcage. Even before the heavy door closes again I am grinding my teeth, pulling at the belts, chafing the leather cuffs around my wrists.<br /> <br /> Hour after hour I construct this future in which I am simply looking back on myself. There, that is my face framed in the tiny observation window floating in the dark above my toes. In the future, looking back on myself tied and restrained and bruised from the take-down and bruised some more by the struggle to get out of the restraints-- I never told this story. In that future I build while lying here in restraints in a dark, stinking room, I live alone—possessor of silences -- which are always more eloquent than words we come up with to try to tell our stories. <br /><br />At some future point in the space between errands I imagine how I will remember this. I decide that I will remember it the way one remembers a landscape from a particular vantage point—, how what you see of the landscape surrounding you is entirely dependent on which window you are peering from in the act of cleaning your house—how your description of the landscape keeps changing like a child first learning to lie, how we get lost in the lies until -- with some sense of relief, we expose ourselves and the punishment is almost weightless, certainly lighter than the stories that we can’t keep straight. <br /><br />I shift my body, bow upwards on my heels and the back of my head, rise off the mattress with the searing wounds of liquid metal and flames coaxing me to new heights of distance between “now” and “not anymore.” I turn to the angels slipping through the cracks on the wall. I begin to saw at my limbs until I am free. I walk out of my body to release it, and then I run, bodiless to some forest where the wind is blowing the white curtains in and I am struggling with the window until all is silent like the wide mouthed moon. The rain has a smell like turned earth and the blade of grass between my teeth is sweet and biting. I sound like birds, my cells dispersing like a flock of sparrows shuttering and dancing on the city streets. I lean into the wild and run, muscles ripping. The angels are all, like a red coal in my chest weeping and weeping. It is all, already, just a memory.<br /><br /> This is what I remember and all the restraint rooms and all that came with them, boredom, rage, the end of hope, the giving-in, the kiss-ass to just get out; pain, bitter compliance, pain --; the question: Is this what I meant? Is this what I meant? And I knew it would come to this – that someday it would just all come back to me while I was setting my own table one night, or lifting the fold of a clean sheet into its perfect triangle then sweeping the triangle under the foot of the mattress anchoring the top sheet into place on a Saturday morning. I would stand up puzzled by the expanse of white and suddenly there it would be: a blue plastic mattress – a yellow pillow; my body bowing upwards as if I am leaving instead of anchored. And my arms, their terrible lucidity - trying to tell the story even as I forget it. </div></div>bethfilson@gmail.comhttp://www.blogger.com/profile/16955571965042820728noreply@blogger.com4tag:blogger.com,1999:blog-2996672468697974230.post-34999702685201343292007-10-06T14:32:00.001-07:002007-10-08T07:04:00.922-07:00Re-Traumatizaton: When the Past and the Present Collide<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-Lxpif4Ng-pm1DsOfxnMnW1UOPqfCAgjKS8Cs0nTZMkhetqtPKBJyngi_mW-mB27dDXjpkCE6GQ-4gxXGGQ_wmI8zqnFVJr-1L_S8gxZP61Br34qPyWWEHvUOTlzQ3R5LNkQPR2CD1v6h/s1600-h/Blog_Self+Portrait_Will+Gilmore+copy.jpg"><img id="BLOGGER_PHOTO_ID_5118966240249561426" style="FLOAT: right; MARGIN: 0px 0px 10px 10px; CURSOR: hand" alt="" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi-Lxpif4Ng-pm1DsOfxnMnW1UOPqfCAgjKS8Cs0nTZMkhetqtPKBJyngi_mW-mB27dDXjpkCE6GQ-4gxXGGQ_wmI8zqnFVJr-1L_S8gxZP61Br34qPyWWEHvUOTlzQ3R5LNkQPR2CD1v6h/s320/Blog_Self+Portrait_Will+Gilmore+copy.jpg" border="0" /></a><br /><div>Lately, I’ve had the opportunity to do training for the Veterans Administration in a number of states. I’ve met some incredible people. The work you see here was done by self-taught artist and Vietnam Vet, Will Gilmore <a href="mailto:gilmorewill@hotmail.com">gilmorewill@hotmail.com</a>. Will brought this painting in to show me on the second day of WRAP training. I’d been admiring the art hanging in the hallways – which I found out was done by some of the men and women receiving services there. I asked Will why this painting wasn’t on display with the others. Will shared with me that he had been told his painting was not suitable for display. It had been deemed, “too disturbing.”<br />When the Iraq war started, Will was exposed to the images we have all grown familiar with. His past experience in Vietnam re-emerged. Will described how his past and his present collided. This is his eloquent self-portrait. </div>bethfilson@gmail.comhttp://www.blogger.com/profile/16955571965042820728noreply@blogger.com3tag:blogger.com,1999:blog-2996672468697974230.post-82153524570254713522007-09-01T13:51:00.000-07:002007-09-03T07:35:54.907-07:00We Can Own This Too!I've been questioning why we have believed for so long that in order to heal from trauma it is necessary to work with only qualified professionals. Peer support in the arena of trauma - whether as a result of combat, disaster, childhood neglect/abuse, or crime - is still a new idea, <em>still</em>. Many of us have been told that the work of moving beyond the impact of trauma in our lives is best left to professionals who are trained to deal with "it." But weren't we told the same thing about mental illness? We didn't buy it. So why do we in this realm?<br />I doubt that any of us is really willing to accept the notion that recovery and transformation must be put on hold until the mental health system has enough money to pay for trauma specialists. In effect, though, that's what we do when we cease believing that we are capable of helping one another re-connect, re-discover, or re-imagine our lives in the glare of trauma.<br /><br />These are the beginning times for peer support in trauma work. Despite the medications and the daily living skills and the supported employment and the anger management classes and even counseling, many of us go on living - not in relation to our future - but in relation to our past. This for me is the true meaning of the death of dreams: It is the death of my future.<br /><br />In an ideal mental health system, consumers would have REAL choice. Our role would be about educating each other about options. Mental health centers would just be one of many places to access services, while what we build in the community through self-help and mutual support as well as peer support would be another. Peer run respite and crisis homes staffed by consumers 24 hours a day would serve as an alternative to hospitalization. We could even go there before we got swamped by crisis. Working through crisis with peers (think WRAP) would allow us to really use crisis as an opportunity for growth as <span class="blsp-spelling-error" id="SPELLING_ERROR_0"><span class="blsp-spelling-error" id="SPELLING_ERROR_0">Shery</span></span> Mead maintains (<span class="blsp-spelling-error" id="SPELLING_ERROR_1"><span class="blsp-spelling-error" id="SPELLING_ERROR_1">mentalhealthpeers</span></span>.com).<br /><br />But we have to take ownership of trauma to make this work. We've got to start creating a knowledge base and practice in order to truly serve one another when so many of us (up to 98% of consumers in the public mental health system) have been impacted by trauma.<br /><br />The first step is to begin to question some pretty fundamental assumptions about what doing trauma work looks like, and means. We're going to have to take a look at how clinical expectations -- and what we have subsequently learned to expect from ourselves and each other as we deal with trauma -- may actually contribute to many of the extreme coping strategies that make trauma work so, well, scary? or at least off limits to us...And yet this <em>is </em>us.<br /><br />The consumer movement is built on the foundation of <em>person as expert</em> rather than <em>professional as expert</em>. Peer support has come to mean, for me, paying attention to what I know and to what my experience has been, and then finding a way to use it in relationships with others. I want to do this work. I suspect there are a lot of us out there who would like to contribute, as well.bethfilson@gmail.comhttp://www.blogger.com/profile/16955571965042820728noreply@blogger.com2