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Mental Health — A BioPsychoSocial Perspective
A Praxis Course at Bryn Mawr College Spring 2002
Made available on Serendip Using the Social Aspect of the BioPsychoSocial Model to Heal

Using the Social Aspect of the BioPsychoSocial Model to Heal

Cass Barnes

Quite different from the psychotic treatments long ago, today we find there are more community based programs for those who are suffering from mental illness. I work at a residential home that is designed to provide skills for the residents to become independent and eventually live on their own. This community mostly consists of those diagnosed with Major Depression, Bipolar Disorder, and Schizophrenia. This program is designed to help the residents with their medications and provide nightly meals. It is hoped the rest of their time will involve social activity. Whether this is attained through work, attending various workshops or classes, it is up to them. A part of the philosophy here is to keep professional therapy separate from the residential community because it can make the residents more vulnerable to others. In addition, I have noted that the staff does not need any form of training to work with the residents diagnosed with a mental illness. Not only do they have the lowest training, but the least education, lowest pay and highest attrition rates. What this creates is a negative model for proficiency where it is most needed, while breeding a continuous turnover rate, resulting in a lack of seasoned care providers. This is why my role as an observer and interested listener is referred to as a "luxury", because there is someone who can provide the residents with a form of self-therapy (talking) while not having to be compensated. Allow me to explain a little more of my experience, observations, and opinions.

One of the things I have noted is that the resident's therapy work is separate from their living environment. Although the staff knows most of the patient's history, therapy sessions are done outside of the community. The separation of the therapy to the person's living environment, is a form of vulnerability protection and also makes sense since they are trying to create independency. Since this residence is transitional, although some may spend years here and possibly their whole life, it would be very difficult for residents to adjust to a new living environment where there was not therapy. Therefore, the separation of therapy and living serves as a meaningful purpose. However, recovering from mental illness is a hard thing to do with help only once a week from their psychiatrist or therapist. Sometimes, the residents want to move beyond talking with each other to someone who knows more about their problems, like the staff.

The staff has a very clear understanding of the patient's history and is very willing to talk with them and continue to help in their healing process. However, since the staff is very small and one person's job is mixed in with others, they have to take care of many things, such as case management, cooking, cleaning, and driving residents to appointments. This leaves them nearly no time for "counseling". I call it "counseling" because they do not have degrees in therapy, but learn as they go along. There are certain days when all the resident needs, is someone to talk to, have direct them, and boost their attitude, but the staff does not have enough time to dedicate in helping them. It may also be due to the laziness of the staff since the pay is marginal. What I think is most important about this, is that often times, not all the time, residents feel like they are being told to go back to their apartment, and that their problems are not that big of a deal. What they think of a big issue is not at all to us, and I think unconsciously the staff wants to just cut them off and not deal with their petty problems. This is too bad because even though they may seem like small issues, they should not be pushed away. The resident obviously felt as though it mattered, or they would not have brought it up. These simple daily interactions if you will, add up to a lot of stress and dis-ease in addition to their original mental anguish. To add complexity, this pushing away of the resident may be totally unconscious because they are so used to John Smith being a nuisance, they just tell him to leave. It is almost an unconscious behavior. Interestingly, the residents sometimes notice this, but do not tell the staff that it bothers them. They avoid this because they feel that if they tell the staff they are bothered by something, they won't really even listen anyway, and then they will have wasted their time. The truth of the matter is, the staff will consider what the problem is and work through it with them so that they feel better. Unfortunately, they don't really care if it hurts or heals them in the long run. It is silly to them, but they will work through it just to please the resident. However, this represents their lack of care and interest in their actual recovery. When the residents are not strong enough to bring up an issue, they begin to repress these feelings and become upset with their environment, or hold resentment to certain staff members.

It helps a great deal to have me there. I am there to listen to them when they need to talk about their horrible day, why they are the way they are, their life course, and also what has been improving. I think this is a good thing because it allows the staff to do what they need to do, and not be "bothered" by them. Although, I have a feeling that if I were not there to talk with them, they would leave unheard and undirected. When I am there, the residents go away feeling satisfied, and possibly have added insight of which they would not necessarily have had before.

I find it interesting to see who is willing to talk to me and who is not. There are two women I have come to know, suffering from Bipolar Disorder, who seem to most cheery when they see that I am there (this may be due to the manic stage I have noticed as well). They are very willing to talk to me, which they said is because I am "easy to talk to" and I am a "neutral person". I am neither a resident nor a staff person. It may seem obvious, but their reasoning behind being able to talk to me, whether about community issues or their own, is because I am not diagnosed with a mental illness and I am also not an authoritative figure. Therefore, they can talk to me without the fear they usually have when they talk to the staff, but with added insight they may not have received from their peers. Personally, I do not mind this "luxury". Those who are suffering with any mentally illness, need someone to talk to as Bonnie said on "Recovering from Mental Illness". If I can provide this for them, if it makes them feel any better, then I am certainly happy to. Of course, I am able to learn about their persona and illness at the same time, which is naturally fascinating.

What I have observed though, is that there are only few that are able to talk to me. There seems to be an interesting connection in that those who talk to me seem more actively involved in their healing. It is not uncommon for those who are diagnosed with some mental disorder and are in the process of recovery, to say that "you have to want to change". I believe that those who are further along the road to recovery, are more willing to talk to me, because they care about themselves, and in talking comes some form of higher understanding of what they are going through. For example, the two women suffering from Bipolar, almost always reach some deep level of conversation with me, within the first 10-15 minutes. This is whether I am sitting down with them to talk, or if it is a casual interaction. This also holds true when they are in their depressed and manic stages. These two women seem to wear their emotions right on their sleeves, and always enjoy the intense attention and caring, as well as new perspectives. In addition, they both ask me how they can be more positive and how I am able to do it. They are interested in learning about their own healing, and it seems as though they are more interested in their care because they are willing to talk about their illness. One of these women is self-medicated, meaning she can take her medication in her apartment, while many others have to be constantly reminded and pushed. However, the other woman diagnosed with Bipolar Disorder, has been in the facility for more than ten years, and it is most probable that she will make this her long term home. This disparity makes me wonder if then the talking is a good sign for recovery.

There are other residents, such as a middle aged male suffering from Schizophrenia who is seemingly very angry, paranoid and "agitated", as he calls it. He does not seem to want to talk to me unless I go out of my way to sit with him for at least an hour or two. The rest of the time he is mostly in his own world, noncompliant with is medications, disturbed with thoughts, defensive, and rude to the other community members. His behavior conveys that he does not care about anyone, especially himself, and that there is no possibility of healing, so he might as well be miserable for the rest of his life. However, this may be his own way of asking for help. It may be a twisted way of asking for help and showing the staff that the more angry he is, the less he is being helped, and the more help he does want. Or, his behavior may simply be an outward manifestation of his intrinsicities that he can't figure out which are caused by the symptoms of schizophrenia. It is inherent that his anger is directed at his environment, so he places a lot of blame at certain people. It is interesting to note that in his case, and many others, the social aspect of the BioPsychoSocial model effectse his mental state. That is, his outside environment causes his anger. At the same time, his mental state ef One "problem" with him, is that the symptoms of Schizophrenia create several delusions. I can sit at the kitchen table and listen to him talk about how he was a General in Vietnam even though he was only eleven at the time, his wife Madonna, his king father and sixty seven brothers, the chip the government put in his brain, and so on, and I wonder if that explanation of his distorted thinking is helping him at all. I am not sure if it is, because it may only be reinforcing the delusions he has. At the same time, it may be helping him sort things out in his head. Then, I observe that with those diagnosed with schizophrenia, a lot of communication is a language barrier. He tells me that Madonna, the famous singer, is his wife. Then after more than one hour of discussion, it comes out that after being down and out for so many years, he was lying on the couch one day and a Madonna video came on. He understood it so deeply and connected with all of it, telling me that he was married to her was the same to him as saying that they think the same way. Thus the language barrier. Or that could plainly be a communicative message that created a delusion.

It is hard to say if a person with these kinds of condition will ever "get better", and whether or not talking helps them. Does it make sense to say that those who are willing to talk to me, are further on the path to recovery? I am not sure. But I do know that there are many people in the community find it difficult to talk to me, and difficult to take medication, and they are not as well off as some of the others. The ones who talk to me more often never express words of death, like the others do. It seems for the most part, the notion that those who want to be helped, and who want to change, are more willing to talk with me. This leads me to believe that their illness will become easier to deal with, because they want to achieve contentment. Whether talking to me is a sign that they are more willing to become at ease mentally or not, should not matter. What I find most important, is that I can offer an ear to them. I can listen, question and challenge them, and in the end make them feel better about their depression or themselves as a person. It may be that I only helped them for that one day, or one hour, and did not at all contribute to their recovery. But hopefully, the way I listen and the affirmations I tell them, will end up sticking with them so that they can remember them when I am no longer there. It may not matter to them in ten years that I baked one of them a homemade cake for their birthday. When they feel all alone, like an outcast, and decide the only thing they can do is give up on themselves because no one else cares, it might matter that there was an intern years ago who baked him a cake who cared about his health. Maybe those little things, the daily conversations and interactions will show them that they have the strength to continue to live, and that they are much more than nothing. Perhaps it is that I am a luxury to the staff because they do not have to take that talk that one time, but it probably does not matter. They will continue to do their job. Most importantly, I serve as a luxury to the ones who are suffering from mental illness every day who need my help, even if the help is small. The listening ear may not help in ten years, but it helped one day at a time.

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