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Perspectives

Standing at the Intersection of Love and Outrage

November 16, 2020

In a video for Global Peer Support Day, Pat Deegan describes how peer specialists in our field work at this unique intersection of love and outrage. One wonders how broadly this message resonates across our field. Pat talks of peer specialists in the world of mental illness. Is there not plenty of love and outrage across the entire behavioral healthcare industry?

People with mental illnesses and substance use disorders pursue recovery. Is this not the appropriate goal for any chronic condition, medical or behavioral? People with debilitating medical conditions share a sense of outrage over a system treating them more as a diagnosis than a person. They too need love and support as they confront the unhealthy behaviors fueling their chronic conditions.

Many of us share moments of outrage from poor or misguided treatment. Yet there is a different outrage as well, spurred by inexplicable social inertia in the face of behavioral health crises. Opioid overdoses have now passed from crisis to catastrophe. The CDC has identified 3 waves, starting in the 1990s with pain medications, followed by heroin around 2010, and synthetics like fentanyl since 2013.

Love and outrage abound in our field. No one segment or diagnosis has a monopoly on either. This raises a question. What about the potential value of collective outrage? We need to reduce the source of outrage, but should we not also use it and learn from it? For example, we know stigma suppresses social action. Is this not a common problem? Might we fight stigma more successfully in unison?

Pat shows us that attention to opposites is needed. We should resist labelling people and reject caregiving that reduces others to a diagnosis. We should condemn bias that devalues classes of disorders for irrational reasons. Yet the positive end of experience benefits from a collective perspective as well. We all respond well to support from people with a common lived experience.

This is the transformative power that Pat references in peer support. We feel comfort and hope just by talking with someone who has experience recovering from trauma, schizophrenia, opioid addiction, obesity or loneliness. This may be one of the common factors, like empathic listening, found in the therapeutic relationship that forms the basis for psychotherapy.

Our horizons need to expand further. What about those coping with more than one diagnosis? We want people living their lives, not their diagnosis. How does comorbidity impact this? We care about the total health of each person, not just recovery from a primary condition. We are not just battling labels or diagnoses. We reject all reductionistic thinking that diminishes our complexity as people.

The outrage for some peers celebrated on this global day of recognition relates to bad experiences with psychiatric medications. Those feelings are best translated into funding for multidimensional treatment programs, more certification of peers and the empowerment of patients. Medication responses vary greatly, and we should ensure treatment is guided by patient feedback and choice.

Let us turn this energy to power and influence. If we want attention from the public and politicians, then we must shine a light on our field and not confine it to one corner. Outrage may be more effective as a harmonizing chorus in crescendo. One part of that harmony by itself is less moving. The public is easily fatigued by worthy healthcare causes. People care about drug overdoses. Caring is not enough.

Most people cannot relate to those with a severe mental illness. They cannot imagine how anyone gets addicted to opiates. They care about such suffering, but they compartmentalize it. Our field might be better served by illuminating compartments less and highlighting commonalities more. Let us celebrate the reality of recovery from behavioral health problems and the universality of striving for wellbeing.

Let us focus on one implication of Pat’s message. We want more action taken on behalf of those with behavioral health disorders because they recover, not because they suffer. These life-threatening disorders are diverse, and yet recovery is possible with our tools today. Research may generate even better options, but we do not need to wait. Suicide and overdose are far from inevitable.

We must find the right words to describe this work. Here is a start. We treat a class of disorders that can be severe, but people regularly overcome them and lead productive lives. They may have odd and frightening characteristics, marked by extreme behaviors at times, but these are people with recognizable hopes and fears. We should invest more in keeping everyone contributing to society.

Where do we take this message? The first order of the day is internal dissemination. Our diverse industry leaders need a common playbook. We should avoid contradiction and confusion as we convey our value proposition to the public. The thoughts offered here are simply a direction. We must shape a coherent message about our field from our experts across many areas of specialty.

Pat’s dichotomy suggests a related one. Social change proceeds from the intersection of unique and common experience. For example, trauma survivors want to speak with someone who understands the uniqueness of that experience.  Discussing painful specifics forges a bond with other survivors. We have unique and common aspects of experience. Social leaders tap both dimensions for motivation.

We need behavioral healthcare executives to join our inspirational peer specialists as public advocates. We have a clear and hopeful message. Our field is broad, and we have many effective treatments that are poorly funded today. We will use new investments in behavioral healthcare to improve the health of populations. Yes, love and outrage will generate a return on investment.

Ed Jones, PhD, is senior vice president for the Institute for Health and Productivity Management.

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