In the United States, when a person has what is often referred to as a first break, the courses of action that get taken against them may end up being a crime against their humanity.
While there can be very diverse responses from family and friends, there is the unfortunate tendency to turn to the mental health industry for support and direction. Many providers in the industry only know the standard of care which is to refer the person to a hospital and psychiatric medications.
Few providers take an interest in understanding and exploring the important experiences that lead to the break. I call these experiences special messages. Finding a provider who is curious about these experiences, skilled at understanding them, and who knows better than to try to suppress them can be rare.
Many providers fail to acknowledge the trauma involved in the lives of the people who have first breaks and that the trauma that gets worsened as the standard of care—forced medication, social security, revolving hospital doors, and warehousing—get implemented. Many presume this is a necessary process.
In fact, I know just a few providers who would not take the contention of this essay seriously: that to recover, what people really need to get their feet back on the ground and have the responsibility and roles that can most certainly include that of caring for others.
Sure, when people have a break, there is behavior that can become scary and hard to tolerate. It may be the last thing that supporters think is that this person needs more responsibility. But it is a human need that is so absent in the industry that it needs to be part of the equation. In my mind, the sooner generativity needs are addressed, the sooner the recovery.
For many supporters who do stick around, there is an amplification of shock and distress when they find that hospitalization and psychiatric medications are not even possible until there is danger or grave disability. Sometimes the thought is that nothing that can be done until the standard of care is implemented. It is enough to push many to desperately pray for hospitalizations and psychiatric medication and curse the human rights of their loved one. Some may set trajectories for permanent warehousing and poverty.
Other supporters may encourage and advocate for behavioral change without understanding the obstacles that are faced, the experiences I call special messages. Perhaps some supporters think the afflicted person can be backed into that corner where they are forced to accept consensus reality, take their medication, and return to the person that everybody wants them to be. It can become a self-defeating, tough love mentality for many. I consider this mentality to be one that profoundly misunderstands what it takes to build trust with someone who is in a break.
I don’t intend to overlook the recent proliferation of early prevention programs which is a very good idea. Such programs are just starting to be created extolling the merits of CBT for “Psychosis.” Herein, therapists just entering the field are taught a best practice that wasn’t even created for the culture of the people it tries to serve. While I would not argue that this is worse than hospitalization and psychiatric medications, I still feel there is cultural bias in it. It may save some who are skilled and supported, but for many, it does little to meet the person where they are at and meet their needs for generativity.
I personally believe that CBT for “Psychosis” offers one valid technique that can be supportive when there is so much more that is needed for a good recovery. For me personally, recognizing that my thoughts are irrationally diminishing me due to the stigmatizing ways others treat me does help; but this did little to get me through until I had escaped poverty.
For me, poverty was such an irrational experience. I needed to learn to accept it before I could overcome it. Indeed, so many like me lose everything when they have a first break. Still others are forced into such circumstances with what may be misguided tough love. Imagine being told to think rationally by the same people who are suppressing you. It can be a difficult pill to swallow.
Seventeen years after my own two- year break I tend not to get to work with people until they are in the upper part of middle age and have utterly given up. Finally, they accept that the twisted system that has guided them into permanent warehousing can offer them support. And so, we provide transportation and provide them a place to heal. In this crazy world, we save the government money by ending the revolving door of the hospital while charging top dollar.
That is not to say that many have not done a good job surviving on their own with the occasional hospitalization. Many clients I work with are just now getting services for aging as they are falling into low-income housing. It simply is not fair to categorize a program such as ours in simplistic manners.
I believe we have some of the nicest and most beautiful people one could ever experience and what we do for them is skillfully encourage them to build a community or family in which they can support each other. Once I learned the ropes, which took quite a few years, I learned to consider participants to be unpaid volunteers and to be regaining an important role—the ability care for others after terrifically traumatic experiences. Teaching people who have breaks from reality to care for each other may take some time, but doing so changes downward trajectories.
Much of what I am saying about generativity comes from observing people in the program where I work, so many of whom are in permanent warehousing circumstances.
Indeed, when I reflect on what is needed for people who have breaks from reality, I think that what they need most is to maintain the role of being responsible to care for other people or beings. What happens to most people who have breaks and face psychiatric warehousing, is that they lose everything they have and get treated as though they are a drain that others must take care of.
Thus, initiating processes of caring for others and responsibility are novel experiences that can help motivate them get their feet on the ground. I at least would propose that it be a consideration in planning any person’s future who has a first break.