Seven ideals for kinder mental health care

 Today’s question is about taking the idea of modelling self-acceptance into adult mental health services: How would services look if we compassionately accept that socially unwelcome thoughts and feelings are normal human experiences, and see them as misguided attempts at self-protection rather than intrinsically dangerous urges that must be chemically suppressed, amputated or locked away? 

I don’t have a full answer. But in a sense I have been working on this question for my whole career. So here are some basics:

1. We are all in this life together, learning as we go, trying to balance our needs with the needs of others, our uncertainty with some general rules. Every day we learn something new, see something differently, realise our earlier mistakes, understand where others were coming from. We need to be working alongside the suffering person as a fellow traveller, rather than ‘doing something to them’ or ‘knowing better’ than them. We need to be ok with knowing how much we don’t know. About them, about ourselves, and about what life’s all about.

2. Getting to know them as a person, rather than focussing on technically collapsing the treatment options. This goes against the psychiatric training that says ‘form not content’. I’m not saying you should do this instead of making a proper diagnosis, I think we need to do both. 

Another way of saying this is we need to discern the meaning of their symptoms in their life context. Sometimes discovering and describing the system meaning of their symptoms clearly to someone, and supporting the subsequent changes they make, is all that’s needed for them to get unstuck. Doing this helps them to trust that we are genuinely interested in helping them. Which we know is a basic requirement for effectiveness of a therapeutic interaction. 

3. Being clear about the boundaries of your responsibility, and what it would take for you to ethically cross them. What I mean by this is that I believe deeply that each adult is morally responsible for their own behaviour and the consequences of that behaviour. That is how we grow. Taking away a person’s responsibility or the consequences of their behaviour actually slows or stops their personal growth so should only be done literally to save a life. Not just because we don’t like the way they’re behaving, or because they’re making mistakes or currently not taking our excellent advice. 

4. We are all works in progress. If we can intend to model ourselves and others as ‘imperfect but fundamentally worthy of respect’, that would go a long way to making life better for all of us. 

5. A healthy society requires the input of people with all sorts of different perspectives, interests and obsessions. Some of the most creative or successful or attractive people are driven by their neuroses. What if a person’s obsession or overvalued idea is what drives intellectual progress, elegant design or a song of great beauty. Sometimes a person’s oddness is a gift to us all. Evolution has selected for neurosis - it is valuable, as long as we are able to see it as a gift. 

6. A healthy body and a healthy mind are inseparable and mutually reinforcing. We need to attend to the basic animal needs of our patients and ourselves. 

7. We work with multiple different philosophical models across our different treatments and organisational structures. We need an underlying model of the human condition that will help us know whether we are applying them in the best way for the person, and for our evolving culture.

What do you think about these ideals? Do you have any to add? Any objections? Put it in the comments - I’d love to know. 

Here’s the link to Today’s Truth - short videos from the limping shrink The Limping Shrink: Today’s Truth