New understandings of the mind and of madness can open new doors to full recovery - thoughts from way outside the straightjacket of the "medical model." By Ron Unger LCSW

Someone I know recently challenged me when I asserted that people could oppress themselves, and said he believed that oppression required someone outside the person doing the oppressing.  I didn’t agree, but in explaining my disagreement, I came up with some thoughts relevant to psychosis which I decided to share here.

One thing that my colleague had also suggested was that the oppressiveness of our current mental health system could be relieved by switching to a peer run system.  While I think peer run systems have some advantages, most notably that they usually at least believe in listening to the people they are supposed to be helping, I don’t believe that this move alone would make the system completely non-oppressive.  We had a peer run agency in our county for a number of years, and it did some good things, but I knew a number of “peers” who found it oppressive and who wouldn’t go there, for various reasons.  The problems were often those one might call “political” – arguably, dysfunctional internal politics.  So peers being oppressive to other peers is also possible.

At one point in our discussion I pointed out that I see people as a “complex process emerging out of an interaction of subsystems, some of which can be oppressive to others or to the person as a whole.”  By this I meant that people have their own internal politics, their own organization, which can be oppressive in much the same way that the government of a country can be oppressive.

The notion that all personal oppression comes from outside the person seems to me as flawed as the notion someone might have that all oppression of nations comes from other nations.  True, there are forms of oppression where one nation oppresses another, such as in colonial domination, but nations are also commonly oppressed by their own governments.  And I think there is an interaction between oppression by another nation and the tendency to form an oppressive self-government:  nations that have had their autonomy damaged through domination by outsiders seem more likely to form autocratic governments.

I think this is mirrored in a tendency for people who have been dominated or abused by others to form rigid forms of “self government” and then to experience “revolutions” that create chaos.  The resulting mess we call “psychosis.”  I think psychosis has a lot more similarities with  revolution than it does with “illness.”  That’s why psychosis often feels good when it first starts:  like with revolutions, there is often the sense of lots of great new potential, with no sense of the enormous possible costs.  That’s also why psychosis is not infrequently “successful” and leaves the person with a better sense of self organization than before – as documented on the late Al Seibert’s website, successful schizophrenia.  Though the outcome can also be something like a “failed state” with armed groups terrorizing each other for decades:  this outcome is more likely when outside intervention is unhelpful, such as when outside forces try to prop up authoritarian systems that are themselves oppressive.

Unfortunately, most of our current mental health system does try to prop up forms of self organization within the patient that are inherently oppressive.  For example, consider the whole effort to “get rid of voices.”  There is nothing that authoritarian governments like to do more than to suppress dissenting voices.  Non-oppressive systems tend to listen to them, not necessarily listen in the sense of believe them or do what they say, but at least to hear them out and consider what of value they might have.  Our current mental health system tends to side with the factions within a person that want to control thinking and suppress disturbing voices, even if that results in widespread oppression within the person.  More progressive mental health approaches, such as Open Dialogue, or the Voice Dialogue approach advocated by many within the hearing voices movement, help the person develop a more democratic, less oppressive way of being organized where all voices can be heard.  (The Open Dialogue approach also supports this in the person’s social network as a whole.)

So what I think is most important in reforming the mental health system is that we work at making it non-oppressive at all levels.  It should be a system that does encourage all voices to be heard.  Of course, not all voices can get exactly what they want, but in a process where all voices can be heard, it is more likely that each voice, whether it is a person or a part of a person, will get what he, she, or “it” needs.

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