Stigma May Create Opportunities for Recovery

Stigma May Create Opportunities for Recovery

NYAPRS Note: The following inspiring piece comes to us from our dear friend, Ed Knight, who has been a national leader in the recovery movement for over two decades and was the founder of the New York-based Mental Health Empowerment Project.

In my experience:

Stigma may create opportunities for recovery

By Edward L. Knight, Ph.D., CPRP

Sometimes stigma creates opportunities. Here is how stigma gave me an opportunity to work on my recovery.

One weekend in the state hospital, I was having a full-blown panic attack. I approached the social worker on duty, told him of my panic, and asked if I might talk with him. "Are you suicidal or homicidal?" he asked abruptly. "No," I replied. "Well, then, you can't talk to me. I'm here for emergencies. You'll have to talk to your own therapist on Monday. In the meantime, learn to tolerate it." He turned and walked away.

We need not internalize stigma by believing its message. In this case, the message was that I wasn't worth talking to, or that I might 'abreact,' i.e., act out. (In some psychotherapeutic circles, there is a theory that one ought not to engage people diagnosed with psychosis in exploring their emotional problems because it might make them psychotic.)

When I have described this encounter and my subsequent actions to colleagues who are psychiatrists, they comment about the stigma demonstrated by the social worker and the resilience I showed.

I decided to face my anxiety and tolerate it. The social worker gave me no advice on how to do this and I was given none by any other professional. Instead, I drew upon my powers of concentration.

It is extraordinarily difficult to pay attention to anxiety; everything in your being tries to drive your attention elsewhere. I knew the process would take many painful hours. I practiced, and continued to strengthen my attention when not in panic by focusing on a tree, first with my eyes open for a minute and then with my eyes closed for a minute. Slowly I increased the time I was able to concentrate.

In "The Meaning of Anxiety," by Rollo May, which I found in the library, I discovered the theory that schizophrenia (my diagnosis) was once thought to be related to an anxiety neurosis. May did not elaborate, but what I imagined was that people often become afraid of their emotions and, on top of that, become afraid to feel that fear.

Fear of fear is one of a group of processes that I call emotions about emotions. I may have primary emotions, like anger, fear, sadness. Then I may have emotions about these emotions. For example, I may get angry about my fear or sadness. These feedback loops make coping quite complex; nevertheless, they can be sorted out and dealt with. However, professionals are sometimes afraid to explore these processes with you because of stigma, as described above.

I set about understanding my anxiety. Using the concentration techniques that my Sufi meditation teacher had shown me, I explored the images and memories attached to the anxiety. I located the anxiety in various parts of my body rather than experiencing it as free-floating. Sometimes the memories or images that I saw brought on a flood of very painful emotion, and I would start to "space out." I feared that if I became frightened of spacing out, or of going insane, the panic would worsen.

Experts in the field of cybernetics, the theoretical study of communication and control processes in biological, mechanical, and electronic systems, especially the comparison of these processes in biological and artificial systems, call this a "positive feedback loop." The feedback loop is not "positive" in the sense that it is "good"; it is positive in the sense that it increases in power. I was in a positive feedback loop of fear: I feared and then feared my fear, thus making this negative emotion increasingly powerful until I would find myself going out of control.

I discovered that I could refocus my attention away from anxiety, negative emotions and fearful images. I paid attention to the tree, or to my breath going in and out, and in this way I rode out the panic. I reduced the power of the positive feedback loop of fearing fear. Occasionally, I would hear my demons talk to me when the panic got bad enough. I rode that out by refocusing as well.

By watching my own emotional and mental processes, I discovered that I had a fundamental fear of people unless I was talking with them about abstract, intellectual things. I faced my fear. As I walked around on the hospital grounds, I began to engage strangers in chitchat. I became an expert at weather: gardening weather, fishing weather, swimming weather, weather creating difficulties in getting to work. I learned to socialize without being an intellectual.

I had done something about a very common "trigger" in my life: people ceased to trigger anxiety. Ignoring the trigger and substituting something else, like paying attention to a tree, would mean no contact with people. Continuing to intellectualize would mean no "real" contact with people. Instead, I had assumed responsibility for my "trigger." It was me, not the environment, that I needed to adjust.

After my success in using my spiritual practice to begin to face anxiety, I would read that anxiety is the great spiritual teacher, as Kierkegaard points out.

There are real processes that can be understood in the chaos of mental illness. Many consumers have insight into these processes, which deserve to be explored by formal qualitative research. Stigma keeps this from happening. After all, we, the "mentally ill," are "incapable of insight."

We may also be considered incapable in general. For example, when I was in the state hospital I already had earned my Ph.D.; but when I told my psychiatrist that I wanted to do mental health research or start self-help groups or publish, he said I was having delusions of grandeur.

Luckily, a psychologist on my next treatment team told me never to give up on my delusions of grandeur. "Those are your goals," he said. I have since accomplished all of these goals.

It is vital for mental health professionals to rid their minds of stigma and adopt a more enlightened approach in order to help those they are mandated to serve to achieve their own goals.

Edward L. Knight, Ph.D., CPRP, is Vice President for Recovery, Rehabilitation and Mutual Support at ValueOptions, a large managed behavioral health care company; and Adjunct Professor of Rehabilitation Science at Boston University.

Source: ADSCenter

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Last Updated on 12/28/04 webmaster@namiscc.org

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