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Things That Helped When the Despair Got Big and Loud

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Things That Helped When the Despair Got Big and Loud

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Things That Helped When the Despair Got Big + Loud.pdf

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An Incomplete Disability Justice Timeline

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An Incomplete Disability Justice Timeline

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Alternatives to Calling the Police During Mental Health Crises

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Alternatives to Calling the Police During Mental Health Crises

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This toolkit was created as part of Mutual Aid X ACP, a participatory project to invite mutual aid and care workers in Chicago to interactive activities from resource sharing to toolkit publication. The project aims to facilitate spaces where communities can come together and form an ecosystem where we could find needed support from communities in the times of crises rather than relying on policing and punitive systems. The toolkit culminates and celebrates project ACP's learnings since 2017. It can be further utilized, adapted, or built on by the groups and organizations depending on the needs and contexts. The plain text and version can be accessed here: https://tinyurl.com/bddnmv8s

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Working Draft: Alternatives to Calling the Police During Mental Health Crises

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This toolkit was created as part of Mutual Aid X ACP, a participatory project to invite mutual aid and care workers in Chicago to interactive activities from resource sharing to toolkit publication.

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Episode 1: Managing a Mental Health Emergency (Project LETS)

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In Episode 1 of our suicide prevention video series, "Managing a Mental Health Emergency," volunteers from Project LETS define imminent risk & introduce some de-escalation skills-- because calling 911 should never be the default response.

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Episode 1: Managing a Mental Health Emergency

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This Is What It Feels Like To Be Depressed

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This Is What It Feels Like To Be Depressed

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This Is What It Feels Like To Be Depressed

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You will not silence me. Check out more awesome BuzzFeedYellow videos! http://bit.ly/YTbuzzfeedyellow MUSIC Don't Dry Your Eyes On Me Icarus Licensed via Warner Chappell Production Music Inc. Made by BFMP www.buzzfeed.com/videoteam + Tonya Ingram Instagram: @tonyainstagram Animation by Caroline Miller BUZZFEED.COM VIDEO POST OF PUBLISHED VIDEO http://www.buzzfeed.com/ryanbergara/an-open-letter-to-my-depression GET MORE BUZZFEED: www.buzzfeed.com www.buzzfeed.com/video www.buzzfeed.com/videoteam www.youtube.com/buzzfeedvideo www.youtube.com/buzzfeedyellow www.youtube.com/buzzfeedblue www.youtube.com/buzzfeedviolet www.youtube.com/buzzfeed BUZZFEED YELLOW Tasty short, fun, inspiring, funny, interesting videos from BuzzFeed.

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In case you'd like to go back and look at anything :)

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Student Materials/ Carpeta de Materiales Estudiantiles

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Intersections of Disability Justice and Transformative Justice

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Intersections of Disability Justice and Transformative Justice

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Intersections of Disability Justice and Transformative Justice

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Janey Starling & Seyi Falodun-Liburd | TEDxLondonWomen

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How collective care can change society | Janey Starling & Seyi Falodun-Liburd | TEDxLondonWomen

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Suicide Note: A Poet’s Journey Through Depression 

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Suicide Note: A Poet’s Journey Through Depression 

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Suicide Note: A Poet’s Journey Through Depression | PBS Short Docs

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Sabrina Benaim - Explaining My Depression to My Mother

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Sabrina Benaim - Explaining My Depression to My Mother

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Sabrina Benaim - Explaining My Depression to My Mother

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Crisis as an Opportunity for Growth and Change

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Crisis as an Opportunity for Growth and Change

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Crisis as an Opportunity for Growth and Change

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What Kind of Support Is Actually Helpful When You're Suicidal

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What Kind of Support Is Actually Helpful When You're Suicidal

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What Kind of Support Is Actually Helpful When You're Suicidal.pdf

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Helping Your Friends Who Sometimes Want to Die Maybe Not Die

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Helping Your Friends Who Sometimes Want to Die Maybe Not Die

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I remember the first time that I learned about the buddy system as a part of organizing. It was during a five-day training held by Training for Change , maybe 12 or 13 years ago. On the first day, they paired us up with someone to be our buddy. Then they asked us to sit down with our buddies, generally share a bit about ourselves, and then to share two specific things: the ways in which we get in our own way and the ways in which our buddy could support us when/if this happened. It was really quite beautiful, and very relieving. The facilitator shared that every one of us, every single one of us, will do things that get in the way of achieving what it is that we want. Along with the truth of systemic or structural barriers, these are the self-created barriers that prevent liberation.

I knew immediately how to answer that question. How do I get in my own way? I stay in my head or I go too fast or I focus on how everyone else is doing rather than attending to what is happening within me. I withdraw and distance, studying things rather than being in them. I contract when scared, isolating myself, rather than extend into risk. I forget to pause and notice what I am learning or experiencing, instead moving quickly on to the next thing. I move away from connection and towards isolation or duty when stressed and overwhelmed. This is pretty typical individualist conditioning. Mine is the flavor that comes from white girl conditioning. Yours might be different.

I willingly told my buddy these things and then told them they could help me check-in during breaks, match breaths with me, remind me to slow down, and help me orient to the present. To pause. My buddy told me theirs, we hugged our consent out, and then mostly forgot how to show up for each other during the rest of the training. Not out of malice, but because we were still learning to hold this layered attention: what is happening in front of us, what is happening within us, and what is happening within the body of the one we are attending. We didn't completely forget. We remembered in stutters. It was clear we both needed more practice.

****

Our first world is a fluid world. Sperm meets egg and then rapidly moves through a series of complete changes before, at about two weeks, forming the home where we will spend the next 36 weeks of life. We emerge, slowly, while suspended in fluid within a sac, the amniotic sac. This amniotic sac, while still inside, is held within a uterus, a womb. This is our first home. This is our first experience of containment, of support. It is a support that has two layers, the amnio sac and womb. The sacredness of our life is held like this, with two kinds of soft containment.*

In general, the body organizes everything this way. How this happens is not the same for all bodies. Some bodies, whether how they have been shaped or how they have been hurt, are glorious in their survival with only single layers in some places and double in others. We are creative and complex. Always.

Two layers, this gift of our ancestors, which is evolution, asserts support as that important, that necessary for life. So important, that there are reinforcements. One balancing the other. From the moment we begin to emerge within our first and fluid world.

The amniotic sac itself; it has two layers. The outer layer, the chorion, is the toughest layer and it is magic. It supports the development of the placenta and it is the tissue that helps the parent's blood nourish the fetus. Lifeblood nourishing lifeblood. The inner layer, the amnion, is a cellular matrix that cuddles, hugs, holds, and most directly supports you, me, all of us as we are moving from egg and sperm to ready-to-be-born.

You can recall this, the feeling of it as an echo across your skin. Trust that feeling you have, even when it doesn't make immediate logic-brain sense.

In the earliest of days, this amnion is right up against your early fetal self, holding you closely, snuggly. Imagine yourself tucked right in, that lovely feeling where all of your shapes merge with all the shapes around you. The amnion slowly expands, giving us more space as we grow, so that we can be feet and head pushing out against womb-wall, flicker kicks against skin. There is fluid between the two layers, there is fluid within and around us as we grow, there is fluid around the entire womb, a mix of fluid and membrane which is the body of the parent.

Our first world is a fluid world, before we emerge into this world, a space of earth and air with fluid and fire woven throughout.

There are two layers of support, right from the beginning. We don't think about it. We expect it - it is who we are. It is what we emerge within. Our ancestors have organized the world in this way. We become within two layers of support: one that connects to the inside, amniotic sac like a second skin, and one that connects to the outside, womb that is the body of our outside world, our first parent, which we leave behind when we emerge.

*****

When I gave birth to my daughter, to our daughter, I felt a lot of things. Silly sentence, of course I did. But one of the things I felt was this: there were going to be more adults than just my partner and I who were keeping track of her. Who knew her. And I prayed that within that tangle of adults paying attention would be someone, at least one, who she felt safe enough with to talk to when no one else felt safe. I wanted to make sure that she did not disappear, not all the way disappear. That if anything horrible was happening to her, that there were enough people watching that, even if she hid it well, someone might track the scent. I know how the tangle of shame and abuse can make the one who is hurt find ways to hide the impact, hide what has happened, and present the front that says all is ok.

I knew that respecting a person's life boundaries means missing some things, honoring sovereignty over control, but there would be enough people listening that something, please god, someone would pick up the scent if it needed to be picked up. And people did, in a hundred small ways. And we missed things. And while all of this was happening, there were always at least two layers of support. Of protection. Because support and protection are largely the same thing: one membrane looks in (support) and one membrane looks out (protection). It's up to my daughter to name if it was enough or too much. Depending on when that question is asked, the answer is likely to change. Just like mine does.

********

Every cell in your body exists with the same two layers of support: the cellular membrane or the "skin" of each cell is made up of two layers. The outer membrane faces the outer world, assessing information, the life that is flowing through the interstitial fluid, the fluid of its out-there universe. This outer membrane says yes this can come in and it shapes itself to let this outside-thing, this protein, or absorbs this oxygen or fluid and lets it come in....or it says no, this can not, and so the membrane stays closed. It also receives that is being out from inside and releases it, bye amino acid, bye unneeded waste, floating out into the interstitial void. The inner membrane assesses what comes in from the outside and receives what has passed through the outer membrane, a final check before letting it move into the inner space of mitochondria and nucleus. It takes what is ready to leave and shapes it so that it can move through and out.

Two layers of support, woven through every single cell of your body, right this second. See if you can feel that, just for a moment. This sense of two kinds of support, containment, protection, and care with a space between and in that space there is fluid. And fluid is about movement and possibility. One of the many reasons why water is life.

Pause. Wait. More than enough, more than enough support.

Trees have an inner and outer bark. A plant has a cuticle, upper epidermis, and palisades, layers of its outside self connected to its inside self. Turtles are protected by skin below their shells and the shell itself has two layers. The inner layer is part of the skeleton and is fused to the ribs. The outer layer is formed from skin tissue and then inside, the soft vulnerability of a body that is more fluid than hard.

And fish have scales and skin layers, the youngest aging and migrating up and out before being shed off into the surrounding ocean or stream. Unlike you and I, their skin is full of mucous membranes that make their outside self slippery, viscous, so they slip through the water rather than push against it when they swim. The fewer scales, the more mucus. The less mucus, the more scales.

Human skin has three layers with again the same principles: the outermost engage with the outer world. It's waterproof, it contains the glory of melanin (whether a lot or a little) and it is part of the immune system, holding those cells that can rush in when there is a break in the skin. The middle layer is where the nerve endings live. It's where our body experiences pain and pleasure. It's where the blood flow is, where we control temperature with sweat, where the skin cares for itself with oil.

It's also where we release pheromones to communicate pleasure and pain to others. One of my favorite things is to put my nose right there, up against the crook where neck meets shoulder on my partner. Right there. It makes her squirm and laugh but it's a testing for me. Even when we are fighting or feeling disconnected, as long as she smells good to me, and she always has, then we are still here. Together.

Below all of these layers of skin is the deeper golden fat layer, this closest inside layer of skin that keeps us warm, keeps us padded, keeps stores of energy for later, and connects our outside-listening skin to our inside body. So many layers of support. So many. Fat is the inside support that is also protection. It's what that layer does.

What does it say about a people who turn this golden fluid, this sweet insulation that creates a single word out of support/protection into something to be eradicated, a sign of shame?

Always, at least two layers of support. At least two layers that provide both protection and connection, a relationship between the community of cells that is your specific body and the community of cells that is life on this earth, that is this earth.

I remember my great aunt telling me, and she had very fierce eye contact when she did, that blood is always thicker than water. You can't trust your friends, she said. They won't stay with you for the long term. It's your family that will stay with you. Always.

I was disrespectful, forgetting that she had probably survived things that made this true. I only looked at her like an old woman who knew nothing about me. She was the first full generation of children born in the US, raised in a family that was sprawling across apartments and last names. By the time things got to my generation, that family was both frayed and assimilating. People were not kind to each other, in fact, many of them were violent. And that big circle fractured into smaller circles, some loved still moved through and others were filled with harm and resentment.

For my family, that inside layer of support did not have a second layer that was focused on love and respect, on dignity and care. The second circle that was there did not support us through economic and cultural struggle, through what it meant to have so many of the sons, my uncles, return from the war without any place to put their rage and grief, through what it meant for a family to lose half of its members in a single moment. Instead, my family moved deeper towards whiteness as the second layer of support, midwestern hardworking whiteness. I think this is why my great aunt told me not to trust anyone outside. She knew that what was outside was trying to suck away the lifeblood of those who were in. She told me this even as she, herself, moved deeper into that overlap between German as culture and German-American as white.

Dominance is a spirit that pretends it is the layer outside, the one to hold us when we don't have enough at home. Dominance says yes, you whose name we don't know or care about, we will protect you as long as you do this and that. Then you will be safe. Dominance is a spirit that is constantly deciding who gets to stay in and who is out and who is punished. Dominance chooses some to be its golden bright children, acting as the visible voice for a spirit that has no heart. Dominance wraps its tight arms around that smallest of inside-circles and says, if you play by my rules, then you will be safe except for you, over there, it doesn't matter how hard you play by my rules, on a daily level, I will change my mind. Dominance doesn't like melanin or traditional ways or gender that does anything except support a binary story of hunt and submit reproduction.

Dominance sucks out the fluid that is between the layers and attaches itself, parasitic, to the inside layer. We know this, even those of us raised to be the most protected. We know this, sometimes if only hidden away inside our bellies.

********

It was from Suzanne River via Bonnie Bainbridge Cohen where I first learned the principle that support precedes movement. Anatomical physical support is what comes before the physical execution of a movement. Bend your arm at the elbow, right now. Even before the muscle fibers begin to bind and stretch, loosening and tightening the ligaments which then move the bone, there is a movement of connective tissue, of muscle and of bone that comes in as a kind of base, a kind of foundation, a support that precedes all movement. And then each of those layers that comes in to support the muscle-ligament-bone movement has their own layers of support... and so on.... and so on... and so on. Everything, always, is about two layers of support and support precedes movement. The same is true for reflexes, for developmental stages. Our ancestors were wise and saw us becoming through a series of steps, each one integrating to form the base for the next. That is what a lifetime is supposed to carry, a series of integrated experiences called wisdom which open up space for the next growth to expand. Awkward, new, shaky but not toppling.

Two layers of support. For movement to move and growth to emerge with ease and purpose, these two layers are a necessity.

Take this moment to pause and honor, with bone-deep respect, the fierce resilience and glory of every single person (name them in your thoughts, whisper their names out loud) who, even as they were targeted and attacked, even after experiencing the violence of what happens when a person or system or belief slices through that support to deeply wound, still claims and remembers the experience of support, the two layers of receiving and of giving, of support and protection.

Who are your teachers and what did they teach you?

I often think this is what eldering is or should be: the memories of those who have lived through so much and who can name it and sense it as it shows up again combined with the ability to also remember and assert the need for these two layers of support and protection; to notice when they are missing and demand that they be erected again. All of this woven through with that place where love and the joyful assertion of survival come together.

*****

I am part of an emerging project in the Twin Cities called . We work from the place of building/supporting two overlapping circles. One circle focuses on honoring, deepening, and building interdependent intimate infrastructures. You can call it pod mapping or collective care or mutual aid. It's the work of moving into community as a concrete commitment. Who do you call when you do not feel safe in your home or when you are scared for reasons that are clear and reasons that are not? When someone you love has passed? When you are ill and can't feed yourself? What skills do you and your people need to support each other more thoroughly and to turn, together, to those outside your circle and show up in moments of crisis or vulnerability? Mental health first aid training? Deescalation training? Living in homes in common? Raising and teaching children together? Growing old together? Caring for those we love who are vulnerable together? Who do you celebrate with, who do you grieve with? Who sits alongside you as you wonder-plan about how climate change will impact your grandchildren and pushes with you as you wonder what you can do for them right now? Who is going to love you hard and hold you accountable when you are sketching on something you said you would do? Who is going to remember you and love you clear when someone else is naming the harm you have caused? Who is going to remember you when you are having a hard time remembering yourself?

Infrastructure like this can show up naturally, organically, when you are part of a community or an experience that is under attack, whether economically or culturally or physically. It doesn't always last when the attack has ended. Sometimes it does. It depends on what kind of culture holds you. Infrastructure like this also doesn't show up as often when families or people are protected enough to have closed off private homes and lives. All systems of dominance depend on a binary brain; those who are safe, those who are not. Those who have, those who don't. Those who are deserving, those who do not. A profit-based system can only have a small group in the most protected category. Some of us have to relearn what it is to trust other people to hold us and remember us in the most intimate of ways. Others of us come from people and experiences who never forgot.

The work of the first circle is making these conversations explicit and direct. Helping create strategies and plans and stories. Consensual. Emergent. Intimate*.

With this first circle we say, here is the membrane that is closest in. With those inside this membrane, we agree to show up at 2am when there is a bat flying around your bedroom, and to stay over time. To be there, even when you are in a crappy mood. To keep learning together. I am 57, still young but oh experiencing the savor of 30 and almost-40 year friendships. I wish for you many years of living with people who keep remembering who you are, even as you change and get lost and come home again.

The second overlapping circle is the one that asks: what do you do when none of the close-in relationships are available or can hold this moment of crisis or vulnerability? When what is held and known inside the membrane isn't enough to meet this moment? Who can you call who you trust will hold you with love and respect as you move to whatever next step of support is needed? This is where we are working to support and train people who are able to respond to a phone call for help around a specific moment or experience. When you call, it is likely we don't know you, we have never sat inside your home and had coffee, but that doesn't prevent us from showing up with love. It's a different level of intimacy, a different shape of care and respect.

We center this work in Black love and liberation because this Black-led vision knows that if we can guarantee that every single Black person who calls is met with love and respect, then it is likely that the rest of us will be as well. Every single Black person, every single Native person, every single Brown and trans and queer and disabled and poor and struggling person, met with love and moved to the next step. We center this work in ancestral memory because not a thing being created right now is new. The fact that we can sense this at all is about what our ancestors whisper to us in our hearts and bellies and minds, the fact of another world that is possible. And we center this work in radical consent because if we do not honor that your life is sovereign to you, that your cultural community has sovereignty over how its culture is expressed, then we immediately begin eroding the trust that could be there, between us.

These are two circles of support. The first circle is those who know you, who already claim you, who remember your life. This is the circle of looking in. Support. The second circle is the circle of looking out; the circle of calling someone who does not know you, who is not in your life. Protection. This is not an individual thing, it is a collective thing. We, in the biggest sense, we got you. There are different vulnerabilities with each layer of support. There are different needs for supporting each layer of support. Collective safety does not exist without both of them.

I am writing about this here because for the past year, this work has been filling me, lifting me. But we are new. We are still in those early stages where vision and emerging structure are just sending out early tendrils of practice. We look at each other and say, we are here for ten years. Please don't ask us if this "works" or is "effective" until ten years have passed. We claim the right to time..

*******

I need these maps. Something concrete to help get through the middle stages from isolation to abundant connection. If there is nothing else to do, when I am confused about next steps, there is always relationship. I need these maps and when as a community of people we have forgotten them, I look towards the communities of cells, of plants, of birds and crawling things. Two layers of support, how an ant colony emerges, how a nest is built, whales and barnacles.

Two layers of support is the connective tissue between an individual life and a larger collective web of mutual aid. Of community. Not just between and among people, but between and among life. Something connected outside our capacity to name and see it, collective care emerges. Too big to grasp, too much to fit on a single map. So we start with what we can see and what we can touch, this foundation, these two layers of support. One close up and intimate, the other connecting us to everything.

*If this writing was useful to you and you have the capacity, feel free to buy me a cup of coffee (or a meal) as an offering of exchange!

*This is traditional wisdom. I first heard it voiced through a craniosacral training when my teacher was quoting Ray Castellino. When I have shared this with beloveds who are indigenous and raised within tradition, they tell me stories of learning similar things, named differently, as part of regular cultural knowing.

*This work honors the lineages of transformative justice, pod mapping, mutual aid, and many traditional kin practices that have practices without theory. Some of our teachers include the Bay Area Transformative Justice Collective, Mia Mingus, Shira Hassan, Mariame Kaba, and a whole bunch of elders, grandparents and aunties.

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At least two layers of support: an anatomy of collective care - Susan Raffo

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I remember the first time that I learned about the buddy system as a part of organizing. It was during a five-day training held by Training for Change , maybe 12 or 13 years ago. On the first day, they paired us up with someone to be our buddy.

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The 'benevolent' policing of social work and mental health

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The 'benevolent' policing of social work and mental health

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Introducing Ekhaya's Transformation (Part 1)

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Introducing Ekhaya's Transformation (Part 1)

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Introducing Ekhaya's Transformation – CRAZYWISE Interview Bonus

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Ekhaya's Sangoma Initiation – CRAZYWISE Interview Bonus

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Beyond Possible: How the Hearing Voices Approach Transforms Lives

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Beyond Possible: How the Hearing Voices Approach Transforms Lives

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Beyond Possible: How the Hearing Voices Approach Transforms Lives

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Community Psychology: Social Justice Through Collaborative Research and Action

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Introducing Alternatives to Suicide: An Interview with Caroline Mazel-Carlton about a New Approach to Crisis

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Suicide is a highly stigmatized topic that many people fear talking about openly (and hearing about). Often, suicidal people are afraid to share their feelings due to the possibility of being blamed, or the potential for coercive consequences such as involuntary commitment (references below). Mutual support groups can help provide a space where people can speak more freely about this topic.

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Intervoice - Connecting People and Ideas in the Hearing Voices Movement

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Intervoice - Connecting People and Ideas in the Hearing Voices Movement

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Intervoice - Connecting People and Ideas in the Hearing Voices Movement

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Connecting People and Ideas in the Hearing Voices Movement

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Our aims are to:

Raise awareness of the diversity of voices, visions and similar experiences

Challenge negative stereotypes, stigma and discrimination

Help create more spaces for people of all ages and backgrounds to talk freely about voice-hearing, visions and similar sensory experiences

Raise awareness of a range of different ways to manage distressing, confusing or difficult voices

Encourage a more positive response to voice-hearing and related experiences in healthcare settings and wider society

Some of the things we do:

Sharing information and free resources through our website, social media, e-bulletin, newsletter and email information service

Engaging with the media to present realistic and hopeful perspectives on hearing voices and related experiences

Offering workshops, training and events - subject to resources

Supporting members who want to set up a Hearing Voices Group

Some of the things we don't do

Run groups directly (we provide guidance and networking opportunities for those who do run groups)

Provide crisis or long-term support (we connect people with available resources where possible). See Getting Help & Support for more info

Contact Us

If you would like to find out more about our work, become a member or get your self-help group listed on our website, please contact us at:

National Hearing Voices Network (HVN)
86-90 Paul Street
London
EC2A 4NE
Email: info@hearing-voices.org

Whilst we do our best to reply promptly, our email is managed by a small team of trained volunteers and we get more enquiries than we can often manage. If you need help in a crisis, please call 111. For less urgent help, see our getting help and support page.

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National Hearing Voices Network - For people who hear voices, see visions or have other unusual perceptions

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Raise awareness of the diversity of voices, visions and similar experiences Challenge negative stereotypes, stigma and discrimination Help create more spaces for people of all ages and backgrounds to talk freely about voice-hearing, visions and similar sensory experiences Raise awareness of a range of different ways to manage distressing, confusing

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What to do after someone's suicide attempt

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What to do after someone's suicide attempt

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Reflections, educational resources, and an opportunity to submit artwork
that centers political, community-based, non-medical approaches for tending to grief

IDHA Statement on the Medicalization of Grief

In March 2022, the DSM-5 announced the decision to add "prolonged grief disorder" as a mental health diagnosis, pathologizing experiences of grief that lasts longer than a year. At IDHA, we believe in moving beyond medicalizing frameworks, into understanding the complex individual, collective, and socio-economic layers to our grief.

Grief manifests in many forms of lived experience, and necessitates an expansiveness toward how we tend to ourselves. We honor that grief is a human experience. We honor how much loss has occurred as a result of the pandemic in the last two years, the grief we have experienced throughout the duration of our lives, as well as the grief within our lineages and ancestries. We honor the immense losses from experiences of colonization, incarceration, and oppression. We wish to complicate and push back on the idea that these experiences be labeled "disorders" or "illness", and offer multiple approaches to the topic of grief.

Our response spans a list of community-sourced resources on the topic of grief, a self-paced course on grief and embodiment, and an open call to create art about grief.

Events

Grief, Collectivity, and Oppression

Grief, Ritual, and Transformation

Resources for Tending to Grief

Resources for Supporting Others

Writing and Art

This list is being updated on an ongoing basis. Please email us at contact@idha-nyc.org if you have recommended resources for us to add.

As part of our Crisis as Catalyst training series in 2021, IDHA offered a class called Grounding in Grief: Interrupting Overwhelm with Embodiment and Ritual, co-facilitated by Camille Barton and Marika Heinrichs.

We recently adapted the class into a widely accessible, self-paced course on our community platform Mighty Networks. The class explores how grief can serve as a teacher, an assertion of our collective humanity when allowed acknowledgement and tending. Learn more about the session and enroll here.

On April 11, 2022 IDHA hosted our first-ever Instagram Live for a conversation that sought to uplift different perspectives on the topic of grief, and reflect on its recent medicalization by the APA.
We were joined by Mangda Sengvanhpheng of BACII, and Stefanie Lyn Kaufman-Mthimkhulu of Project LETS for a discussion (facilitated by IDHA Program Coordinator Noah Gokul) about personal, cultural, and systemic relationships to grief and offer multiple approaches to caring for loss, in order to complicate the biomedical narrative on grief.

In partnership with The Justice Arts Coalition (JAC), IDHA invites our community to create artwork demonstrating the myriad shapes that grief can take, as well as the many ways that we can tend to our grief. The call opens on Friday, March 25, 2022. The deadline to submit artwork is Friday, May 20, 2022.
This project centers the power of creativity to make meaning from and heal through grief, in contrast with medicalized approaches. We invite our wider communities to share experiences of grief through art, in any medium that best captures each individual's experiences. By collecting art around this central theme, our hope is to transmute our collective grief into new narratives that celebrate the power of mutual support and community action. We are launching this project at the two-year mark of COVID-19 with recognition of the ways in which the pandemic has shaped and amplified so much grief, but the project is open to all experiences.

While all are invited to submit original work to this project, JAC and IDHA particularly seek to uplift the voices and experiences of those currently or formerly incarcerated in institutions. This includes, but is not limited to, those held in jails, prisons, psychiatric facilities, nursing homes, and group homes. JAC will coordinate the inclusion of works from incarcerated artists, and IDHA will coordinate the inclusion of works by psychiatric and trauma survivors. We are interested in bridging dialogue about these experiences with other members of our community including activists, artists, family members, advocates, and mental health providers.

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Reflections, educational resources, and an opportunity to submit artworkthat centers political, community-based, non-medical approaches for tending to grief In March 2022, the DSM-5 announced the decision to add "prolonged grief disorder" as a mental health diagnosis, pathologizing experiences of grief that lasts longer than a year.

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Access Intimacy, Interdependence, and Disability Justice

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Access Intimacy, Interdependence, and Disability Justice

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Much of trauma healing is helping the nervous system become more "resilient." Rather than spend a few hours or even days drowning in a state of terror, tension and nervousness after getting triggered, doing one or more of these exercises can help the nervous system shift into a different state sooner.

Each time you do an activity or exercise like the ones below, this teaches the nervous system to be more flexible and rebound from activation sooner.

Take Your Nervous System to the Gym

After some type of physical injury that leaves some of your muscles weak or atrophied, you may need to go to physical therapy and exercise the muscles to strengthen them again. After trauma, the nervous system is completely out of whack and the resiliency muscles, so to speak, are very weak. Practicing resiliency exercises on a regular basis is like going to a "Nervous System Gym" and exercising the healthy functions of your nervous system until they become strong once again.

In fact, going to a Trauma Resiliency Model or Somatic Experiencing therapist is kind of like seeing a Nervous System Physical Therapist or Nervous System Personal Trainer. When you see a regular Physical Therapist or Personal Trainer, they will give you homework to do in the gym or at home before the next week's session. In the same way, if you go to therapy for trauma once a week, it's good to also practice these things on your own between sessions to get those muscles worked out enough to improve your functionality over time.

10 Resiliency Building Skills to Practice to Make Progress in Trauma Recovery

Feel your feet on the ground. Feel gravity. Feel the pressure of your body on what is supporting it. Feel the texture of objects with your fingers. Name details of what you touch, see, hear, smell and taste. Place your attention on sensations in the body and monitor them for a period of time. Describe them and notice when they change. Stay with yourself even if something very uncomfortable comes up; be like Velcro. Challenge yourself to stay present and in the moment.
3. Slowing / Titration
Deliberately slow down your emotions and disturbing body sensations, like slowing down the tempo of music. Separate out and work on only a small bit of the emotions or sensations and leave the rest for later, like taking only one bite of the pie.
4. Resourcing
Create an imaginary Safe Place, or recall a safe, calming, comforting experience you had in your life. Imagine you're there and notice what you feel. Know that you can always go to this place in your imagination if you need to calm yourself down.
5. Pendulation
Be deeply present with an area of your body feeling activation, such as terror, anger, panic, tension. Then move your attention to a place of neutrality or calm in your body. Very slowly go back and forth. Build your capacity to stay with the negative. Also build your capacity to feel positive things again and to stay with the positive.
6. Contact / Self-Holding Exercises
Put your hands on the parts of your body that feel difficult sensations (tension, discomfort). Notice how the hands feel when on the body. Notice how the body feels under the hands. Notice how the space in the body located between the hands feels.
7. Community
Socialize and participate in your community. Human connection builds resilience.
8. Presence
Practice placing your awareness on any emotion or sensation coming up inside you. Say towards it, "You are welcome here." Stay with it in a loving, compassionate way.
9. Self-Acceptance
Work on reducing "should" thoughts about yourself. Allow yourself the space and time for your body, emotions and mind to embrace and pass through the processes they need to.
10. Self-Empathy
Practice being gentle with yourself. Practice self-empathy.
***

Recently, I created an online store for my blog (yay!).

Every project like this is a huge ordeal with PTSD and takes forever due to the limited energy, frequent down time to contend with symptoms, dealing with states of anxiety and panic, getting triggered, physical issues (body pains, stress related health problems, injury related issues and panicking about them) and sheer exhaustion - but I finally got it done 🙂 🙂 🙂

The first seven items in the above list of resiliency building skills are also part of an art print I created for my online store. It's kind of challenging to take the subject of trauma and make wall art and posters but the process is calming in a way so I've created a handful so far:

The above descriptions are very simple. The lived experience, however, of working with these internal states is actually more complex. Here is a more in-depth explanation of the above skills (and a few more skills):

Trauma Resiliency Model Teaches 9 Skills:

Skill #1 Tracking

Tracking involves placing awareness / presence on your sensations and finding words to describe them that are part of the language of sensation rather than the language of emotion or thought (such as "bubbling and tingling" as opposed to "happy and excited"). As these internal sensations shift and change, you continue to watch and be with them as witness, describing the changes as they happen. Tracking is an important skill to learn because tracking the sensations happening inside oneself is used while doing every other skill of TRM.

"Tracking" of TRM is very similar to the "Felt Sense" of Somatic Experiencing and Focusing of the International Focusing Institute.

Skill #2 Resourcing

The term Resourcing is very broad and pretty much all self-therapy somatic exercises act as Resources.

"Resourcing" from TRM specifically is a technique in which you first briefly focus on naming the sensations you are experiencing related with being dysregulated (highly stressed and amped up or shut down and checked out). Then you change focus and spend a little time thinking of a good resource for yourself. The resource should be anything that, when you experience it within your active imagination, brings forth in your body a better state (even just a little better will work) than the challenging state you have been stuck in. So, the resource brings about either "neutral" or "positive" sensations. This stretches your system, helping it to become more flexible and less fixed and stuck in one state. This stretching creates resiliency.

I am most familiar with the imaginary Safe Place and a memory of a settling experience, but there are many possible things you can use for this including: The moment any kind of danger or stressor went away and safety was restored, the moment help arrived, an object like a special possession, a pet, a person like a friend or relative, a special place like a park or room, an imaginary figure like a wizard, a mythical or literary character, an imaginary setting, a life experience, or an inner strength you possess like wisdom, open-heartedness, strength or determination.

When searching for a resource, it's good to allow your mind to kind of free associate without censorship and see what comes up, and just speak about whatever happens to be there even if it doesn't seem like a resource. Even if it feels too chaotic to find anything, mention whatever is there. The mind may be presenting something that has some resource in it and you just have to start talking about it to realize there is one tiny moment or some object that the body feels settled by remembering.

I think it's nice that a resource doesn't have to be positive but can be neutral. It can be such simple things like: a feeling of relief upon arriving home safe from driving, getting a moment to rest like the first moment in bed, a neutral feeling like sitting watching ducks on water, feeling settled when hanging out with a friend, a still feeling when looking at trees or plants, or just a basically OK feeling about life when talking on the phone or playing a game or brushing your hair or finding a nice sale item or just opening up your favorite snack.

Note that if you bring up a resource that's too positive for you to handle at the moment, such as the idea of winning the lottery or anything that would overwhelm you, this is called "over-resourcing," and can cause dysregulation/ the inability to assimilate or "grok." (just something to be aware of).

Bringing up a memory from the past as a resource is actually one of the more complicated skills to learn because some memories are huge multi-faceted collections of both positive and negative things. When a "split resource" like this comes up, the TRM guide will help hone in on the most resourceful aspects of the memory and contain the others to potentially work on later if needed (without repressing them). Because of this complexity, resourcing using a memory of a past event is best learned with some guidance from someone experienced in the technique.

So, back to the skill: When you settle on a resource, then you imagine being in that place and time and deepen your body's experience of it. You name many details about the experience, such as weather, colors, names of people, textures, sounds and actions you took, which help to bring it into your body more and more. It takes a full 20 seconds of focusing into the felt experience of the internal sensations brought up in the resourced or resilient state for the nervous system to "reset" itself.

The goal of resourcing is to briefly open up the negative responses and then reset the nervous system by deepening the more resourced neural pathways. Simply doing this in sequence - noticing the stress and then immediately bringing the resourced state online - demonstrates to the nervous system a new direction to take, new pathways to travel, that it had not had access to when stuck in stress. Once it resets it also brings online parts of the higher brain that were inaccessible while stressed.

Everything about this resourcing process - from the greater presence placed around the stressful sensations prior to invoking the resource, to the new neural pathways brought online by deeply experiencing all the sensations of the resource as well as all the higher parts of the brain coming alive and accessible - actually change the internal stance or response to the original stressful situation that was causing trouble. As the brain shifts and develops resiliency in neural pathways, perceptions and higher cognition/neocortex access, this slowly creates more options.

The last step of this skill is noticing this change: you describe what has changed about how your body responds to the stressful situation you had focused on in the beginning.

(This is optional) You can also pick 3 details that represent the experience of your resource best and memorize them. When you are stressed. you may experiment with bringing the 3 details back to mind and see if you can reset your nervous system this way.

Note that it's important not to unconsciously begin to invoke resources in order to try to escape, deny or gloss over bad things rather than to retrain neural pathways. It's easy to try to use positive things to repress negative things if this has already been a coping mechanism.

Skill #3: Grounding

Grounding includes processes to deepen your felt sense connection to the earth, gravity, your body, your sense of weight, location, place and 5 senses.

Skill #4: Gesturing

Gesturing is a process of bringing awareness to spontaneous gestures/movements that are self-soothing in order to use them consciously and deliberately to reduce activation.

Skill #5: Help Now!

The skills taught for Help Now! are quick, simple and practical (and easy to remember) strategies to get back into the Resilient Zone if experiencing emergency, extreme or very stuck states in which you find yourself completely overwhelmed and unable to get out of the trauma vortex. These emergency states include such things as: panic attack, meltdown, shock, "losing it," going off the deep end, mental breakdown (due to trauma), utter paralysis, completely zoned out. (Article on Help Now Skills)

Skill #6: Shift and Stay

Shift and Stay involves shifting into the Resilient Zone and challenging yourself to stay there. This is basically exercising a muscle that has gotten weak during the extreme stress of PTSD - the muscle being the capacity to remain in your Resilient Zone.

The 6 skills above are taught to the general public in Community Resiliency Training(CRM). The next 3 Skills are only part of TRM:

Skill #7 Titration

Slowing down and taking small bites of emotions and bodily sensations creates resiliency - also part of SE. Article on Titration

Skill #8 Pendulation

Gently guiding the nervous system to remember its natural process of going between being settled/calm alert (parasympathetic) and being activated (sympathetic). Pendulation is a technique to help the nervous system become more flexible, and to restore its natural rhythm and flow after it has been badly injured/disabled/harmed by trauma, Pendulation creates a little bit more resiliency within the nervous system and brain every time it is used. - also part of SE. Visit the Pendulation Category.

Skill #9 Completion of Survival Responses

This involves allowing the energies of flight (running jumping, walking) and fight (pushing away, holding off, fighting) that were never able to express themselves during the trauma work their way out of the body tissues within a safe space held by a therapist. - also part of SE

I added in these Skills as well:

Contact/Self-Holding Exercises I included Contact/Self-Holding Exercises from Somatic Experiencing in my list because of how much those exercises have helped me. They are my emergency go-to exercises. Peter Levine refers to them as "Contact" exercises because they involve placing attention on areas where you make contact with your body using your hands.

Community I added Community because connecting with people, when ready and able, can be very healing for trauma recovery. There are numerous ways social engagement, with psychologically safe (accepting, non-judgmental, present) people, bring a person out of activation/survival and stimulate other parts of the nervous system (polyvagal theory covers this thoroughly).

Presence, Self-Acceptance and Self-Empathy are all positive postures to take towards one's own process of recovery. Recovery is a real process that needs to take place. Recovery really can be something you need to make some extra time for. It can cause limitations in life for a while. Sometimes it's hard for me to accept the reality of the needs of the recovery process, like time, rest, therapy, relaxation exercises, so many things! - but I think accepting that this is part of my life right now will help me make more progress with it. Acceptance and Empathy are the exact opposite of patterns of abuse that may have gone on for years. Therefore, self-acceptance and self-empathy comprise a huge stretch internally. Anytime they are practiced, this contributes to more inner resiliency.

Actually, if a therapist can train their client (or one can train themselves through self-therapy techniques) to maintain this stance of nonjudgement, self-acceptance and even appreciation for one's own body's capability to respond to trauma in protective ways - even if this is now causing problems - this actually does many things to promote healing. Here is a quote on the importance of a trauma survivor experiencing psychologically safe environments and then learning how to make their internal environment safe as well:

"...if we are able to create safe environments,' starting with clinicians who make us feel respected and safe, 'we have access to neural circuits that enable us to be social, to learn, and to feel good.'

"Once the professionals accept reality, next traumatees can start to respect themselves, and stop judging and evaluating themselves negatively - usually for the first time since the trauma hit them.

"That creates a 'mammal to mammal' social engagement state inside the traumatized person, where their internal voices are kind and compassionate to them, rather than self-condemning as is the norm in traumatees." The quote is from the article Stephen Porges: Social Engagement Heals

The iChill Ap.

You can learn resiliency by practicing the first 6 Skills of TRM using the iChill ap.

They are described in detail here: iChill Ap 6 Skills

I just tried out the iChill ap and here are my impressions:
My Review of iChill:
In the iChill ap for Android there are 4 Skills - Tracking, Resourcing, Grounding and Shift & Stay (perhaps the iPhone/iPad ap has all 6 I'm not sure).

I found the ap very good as a way to learn the skills but didn't find it quite as useful as a way to practice them.

For Tracking, Resourcing and Shift and Stay, rather than just starting the exercise when you click on the skill, the narrator gives a bunch of preamble that I would rather not have to wait through each time I want to practice the skill. It would be nice if they had two buttons: "Learn all about how to do (Skill)" and "Practice (Skill)," rather than have them both mixed together.

I do think that iChill is a great way to initially learn the skills because you're getting the lesson narrated to you rather than reading it yourself. This makes it easier to concentrate on doing the exercise.

And one skill - the Grounding Skill - begins very soon without much preamble and can therefore be used to practice whenever you feel you need to ground.

In conclusion, I really like the fact that the iChill ap makes these resiliency building exercises available for anyone to learn for free. The iChill ap for Android can be used to learn Tracking, Resourcing, Shift&Stay and Grounding.

***

Here are another 2 prints I designed that have the Resilience building reminders:

I actually took the photo of the stream in this image 🙂

__________________

Heidi Hanson is an artist and writer in Asheville, North Carolina currently working on an illustrated book chronicling her journey healing from Post Traumatic Stress Disorder.

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10 Resiliency Building Skills to Practice to Make Progress in Trauma Recovery - The Art of Healing Trauma

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Much of trauma healing is helping the nervous system become more "resilient." Rather than spend a few hours or even days drowning in a state of terror, tension and nervousness after getting triggered, doing one or more of these exercises can help the nervous system shift into a different state sooner.

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EMERGENCY ACTION FOR PANIC ATTACKS

Helping Yourself

A panic attack is often a reaction to fear (either conscious or unconscious), and some of the strange physical reactions you experience during one are the result of your body reacting to this fear. Common catalysts of panic attacks include:

Anticipatory anxiety. You become mentally anxious over a past, traumatic event, and your body responds as if it will happen again right away. Catalysts can include photographs, conversations, or anything that triggers the bad memory.

Self-defeating visualization. You may not only picture yourself re-experiencing a traumatic event, but you may also fear losing control of a current situation and not being able to handle it. You interpret the situation as potentially dangerous, and your body secretes adrenaline to prepare for crisis.

Right away: Look around you. Find 5 things you can see, 4 things you can touch, 3 things you can hear, 2 things you can smell, and one thing you can taste.

Understanding how your body and mind work during these episodes can help you develop a healthier response to frightening situations. Although there are innumerable variations, common reactions to panic include:

Your body goes on alert. Your brain sends a message to your body to protect it against the perceived danger, and your body prepares for the pseudo-emergency. For instance, the eyes may dilate to improve vision, your heart rate quickens to circulate blood faster to vital organs, breathing increases to get more oxygen to the circulating blood, and your muscles tense in case you have to move quickly.

Your mind remains stuck on fearful thoughts. Instead of reacting to either solve the problem or remove yourself from the situation (which you'd likely do in a real emergency), you get stuck on the perceived threat and remain unable to let go of the fear.

Your breathing becomes more rapid. Inhaled oxygen reacts with your cells to produce carbon dioxide, which is then exhaled. During a panic attack, breathing rates increase so your body can absorb oxygen more quickly in preparation for any necessary action. During rapid, heavy breathing (also called hyperventilation), your lungs exhale more carbon dioxide than your cells produce, causing the level of carbon dioxide in your blood and brain to fall. The results (which may include dizziness and heart palpitations) can cause some people to panic further, thereby increasing breathing even more.

Relax Your Breathing and Muscles

If you feel an attack coming on, simple breathing and relaxation techniques can help you feel more in control. But don't wait until you're having a panic attack to perfect the techniques. Practicing them twice a day for just 10 minutes at a time may make your panic attacks less frequent and easier to conquer.

Relax your breathing. Put one hand on your upper-chest, and the other over your diaphragm (where your rib cage meets your stomach).

Take in a slow, deep breath through your nose while counting to five. The hand on the chest should stay still, while the one over your diaphragm should raise with your breath. This is how you know the breath is deep enough.

When you reach the count of five, let the breath out slowly (through your nose) at the same rate. Concentrating on your hands and the counting will help focus you and calm you down. Continue these breaths until you feel relaxed.

Relax your muscles. Find a comfortable position to sit in (or lie down).

Close your eyes and begin to focus solely on your toes. Curl them under tightly for a count of five, squeezing the muscles together as hard as you can, then relax.

Next, concentrate on your feet. Contract all of their muscles tightly for a count of five, then relax.

Continue up your body, isolating each muscle group (calves, thighs, buttocks, stomach, chest, shoulders, neck, fingers, hands, and arms) all the way up to your face.

By the time you contract and relax your face muscles, you should feel much more calm.

If you're with someone currently having a panic attack:

1. Be calm

2. Be patient

3. Don't be condescending

4. Remind us that we're not crazy

5. Sit with us

6. Ask us to tighten and relax our muscles one by one

7. Remind us that we are breathing

8. Engage us in a discussion (if we can talk, then we can breathe)

9. If we are having trouble breathing, try getting us to exhale slowly

10. Or breathe through our nose

11. Or have us put our hands on our stomach to feel each breath

12. Ask us what needs to change in our environment in order for us to feel safe

13. Help us change it

14. Usually, just knowing that we have someone on our side willing to fight our scary monsters with us is enough to calm us down

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Emergency Action for Panic Attacks - Project LETS

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A panic attack is often a reaction to fear (either conscious or unconscious), and some of the strange physical reactions you experience during one are the result of your body reacting to this fear. Common catalysts of panic attacks include: Anticipatory anxiety.

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We're so glad you found us. When you or someone close to you goes into crisis, it can be the scariest thing to ever happen. You don't know what to do, but it seems like someone's life might be at stake or they might get locked up, and everyone around is getting stressed and panicked. Most people have either been there themselves or know a friend who has been there. Someone's personality starts to make strange changes, they're not sleeping or sleeping all day, they lose touch with the people around them, they disappear into their room for days, they have wild energy and outlandish plans, they start to dwell on suicide and hopelessness, they stop eating or taking care of themselves, or they start taking risks and being reckless. They become a different person. They're in crisis.

This page offers an assortment of resources that may provide perspective, comfort, and/or tools that could be of assistance to people experiencing various sorts of tough times.

Here is a really useful set of ideas and strategies that's written for folks who are dealing with a mental health crisis Navigating Crisis:

Navigating Crisis (as a printable PDF in English)

Online Peer Support (Fireweed Facebook group and Drop-in Support Circles - These online spaces are meant to offer each other support within an anti-oppressive and social justice framework. It also comes with its own set of problems including issues of privacy and risk of being reported. Please respect that this space is closed to providers and family members and is designed for those with lived experience only.)

NAVIGATING CRISIS

SUICIDES

HOTLINES AND WARMLINES

PSYCHOSIS/ HEARING VOICES

PSYCHIATRIC DRUGS

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We're so glad you found us. When you or someone close to you goes into crisis, it can be the scariest thing to ever happen. You don't know what to do, but it seems like someone's life might be at stake or they might get locked up, and everyone around is getting stressed and panicked.

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What is a Warm Line and What Should I Expect When I Call One?

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What is a Warm Line and What Should I Expect When I Call One?

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What is a Warm Line and What Should I Expect When I Call One?

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A warm line is an alternative to a crisis line that is run by “peers,” generally those who have had their own experiences of trauma that they are willing to speak of and acknowledge. Unlike a crisis line, a warm line operator is unlikely to call the police or have someone locked up if they talk abou…

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How to Go Mad without Losing Your Mind: Madness and Black Radical Creativity

Hold tight. The way to go mad without losing your mind is sometimes unruly.
So begins La Marr Jurelle Bruce's urgent provocation and poignant meditation on madness in black radical art. Bruce theorizes four overlapping meanings of madness: the lived experience of an unruly mind, the psychiatric category of serious mental illness, the emotional state also known as "rage," and any drastic deviation from psychosocial norms. With care and verve, he explores the mad in the literature of Amiri Baraka, Gayl Jones, and Ntozake Shange; in the jazz repertoires of Buddy Bolden, Sun Ra, and Charles Mingus; in the comedic performances of Richard Pryor and Dave Chappelle; in the protest music of Nina Simone, Lauryn Hill, and Kendrick Lamar, and beyond.

These artists activate madness as content, form, aesthetic, strategy, philosophy, and energy in an enduring black radical tradition. Joining this tradition, Bruce mobilizes a set of interpretive practices, affective dispositions, political principles, and existential orientations that he calls "mad methodology." Ultimately, How to Go Mad without Losing Your Mind is both a study and an act of critical, ethical, radical madness.

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How to Go Mad without Losing Your Mind: Madness and Black Radical Creativity

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Hold tight. The way to go mad without losing your mind is sometimes unruly. So begins La Marr Jurelle Bruce's urgent provocation and poignant meditation on madness in black radical art.

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Welcome to the Artists' Grief Deck. There is no correct way to use these cards, but we have these suggestions:

Set aside time for yourself to go through them

Find or make a space for yourself

Look closely at the images

Be open to the feelings that arise

Learn More

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The ARTISTS' GRIEF DECK is a set of 60 medium format 'flashcards' that are individually designed by artists, sometimes in collaboration with grief workers.

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Decolonizing Therapy with Dr. Jennifer Mullan (Video)

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Decolonizing Therapy with Dr. Jennifer Mullan (Video)

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Decolonizing Therapy with Dr. Jennifer Mullan (Video) — Neurodiverse Counseling Services

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Decolonizing Therapy Practices Decolonizing therapy practices is a process that involves critically examining and challenging the dominant, Westernized approaches to mental health and healing and distinguishing it from the broader umbrella of social justice. Recognizing that many individuals

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Our Right to Heal: Liberatory Harm Reduction

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Harm reduction was adopted by public institutions to help stem the spread of HIV/AIDS in the 1980s. But it originated in self-advocacy by drug users, sex workers, and trans activists.

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Psychiatric Incarceration Isn’t Treatment — It’s Violence, Survivors Say

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Psychiatric Incarceration Isn’t Treatment — It’s Violence, Survivors Say

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Psychiatric Incarceration Isn’t Treatment — It’s Violence, Survivors Say

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After the murder of Jordan Neely, NYC’s mayor doubled down on his plan to disappear those who “appear mentally ill.”…

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It works in all kinds of crises -- medical, legal, even existential. It’s the ‘Ring Theory’ of kvetching. The first rule is comfort in, dump out.

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Beyond Possible: How the Hearing Voices Approach Transforms Lives

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Beyond Possible: How the Hearing Voices Approach Transforms Lives

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Beyond Possible: How the Hearing Voices Approach Transforms Lives

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I'm a psychologist - and I believe we've been told devastating lies about mental health

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I'm a psychologist - and I believe we've been told devastating lies about mental health

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e are living, we're told, through a "mental health crisis". Mental health services cannot cope with the explosion of demand over the past two years: 1.6 million people are on waiting lists, while another 8 million need help but can't even get on these lists. Even children are showing up at A&E in despair, wanting to die.

But there is another way to see this crisis - one that doesn't place it firmly in the realm of the medical system. Doesn't it make sense that so many of us are suffering? Of course it does: we are living in a traumatising and uncertain world. The climate is breaking down, we're trying to stay on top of rising living costs, still weighted with grief, contagion and isolation, while revelations about the police murdering women and strip-searching children shatter our faith in those who are supposed to protect us.

As a clinical psychologist who has been working in NHS services for a decade, I've seen first hand how we are failing people by locating their problems within them as some kind of mental disorder or psychological issue, and thereby depoliticising their distress. Will six sessions of CBT, designed to target "unhelpful" thinking styles, really be effective for someone who doesn't know how they're going to feed their family for another week? Antidepressants aren't going to eradicate the relentless racial trauma a black man is surviving in a hostile workplace, and branding people who are enduring sexual violence with a psychiatric disorder (in a world where two women a week are murdered in their own home) does nothing to keep them safe. Unsurprisingly, mindfulness isn't helping children who are navigating poverty, peer pressure and competitive exam-driven school conditions, where bullying and social media harm are rife.

If a plant were wilting we wouldn't diagnose it with "wilting-plant-syndrome" - we would change its conditions. Yet when humans are suffering under unliveable conditions, we're told something is wrong with us, and expected to keep pushing through. To keep working and producing, without acknowledging our hurt.

In efforts to destigmatise mental distress, "mental illness" is framed as an "illness like any other" - rooted in supposedly flawed brain chemistry. In reality, recent research concluded that depression is not caused by a chemical imbalance of the brain. Ironically, suggesting we have a broken brain for life increases stigma and disempowerment. What's most devastating about this myth is that the problem and the solution are positioned in the person, distracting us from the environments that cause our distress.

Individual therapy is brilliant for lots of people, and antidepressants can help some people cope. But I worry that a purely medicalised, individualised understanding of mental health puts plasters over big gaping wounds, without addressing the source of violence. They encourage us to adapt to systems, thereby protecting the status quo. It is here that we fail marginalised people the most: Black people's understandable expressions of hurt at living in a structurally racist society are too often medicalised, labelled dangerous and met with violence under the guise of "care". Black people are more likely to be Tasered, sectioned, restrained and over-medicated than anyone else in our mental health services today.

The UK could learn a lot from liberation psychology. Founded in the 1980s by the Salvadorian activist and psychologist Ignacio Martín Baró, it argues that we cannot isolate "mental health problems" from our broader societal structures. Suffering emerges within people's experiences and histories of oppression. Liberation psychology sees people not as patients, but potential social actors in the project of freedom, valuing their own lineages, creativity and experience, rather than being forced into a white, eurocentric and individualistic idea of therapy. It directly challenges the social, cultural and political causes of distress through collective social action.

This framework makes complete sense when we hear that the pandemic in the UK has affected poor people's mental health most. Does it mean wealthy, privileged white men don't experience suffering? Of course they do. We're still learning about the complicated ways these structural issues affect our everyday lives. For example, how the pressures of individualism and capitalism may lead to isolation and substance abuse, or how colonial violence towards immigrant families plays out within homes and on bodies.

Let me be clear, I'm not saying people in distress should be out there on the picket line. Pain can be debilitating. But those of us who are supporting people in distress, such as mental health workers, have a key role in social transformation. Social action is the medicine that relieves people's personal and collective distress.

Instead of trying to change "mindsets" in therapy, we need to change race- and class-based hierarchies, the housing and economic system. Universal basic income has psychological benefits, and recent studies show how it improves the "crises of anxiety and depression". As a clinical psychologist, some of my most powerful work has been not in the therapy room but in successfully advocating for secure housing for, or working in the community with, queer, black and brown facilitators in organisations such as Beyond Equality, to prevent gender-based violence. The network Psychologists for Social Change shows us a practical imagining of this work. We also need social change that is preventive, such as investing in young people and community-led services such as healing justice london and 4front. They work to shift trauma in marginalised communities through building social connectedness, social action and creativity, towards futures free of violence.

None of this is to dismiss the value of one-on-one therapy (that's part of my job, after all). But therapy must be a place where oppression is examined, where the focus isn't to simply reduce distress, but to see it as a survival response to an oppressive world. And ultimately, I'd like to see a world where we need fewer therapists. A culture that reclaims and embraces each other's madness. Where we take the courageous (and sometimes skin-crawling) risk of turning to each other in our understandable, messy pain.

Meaningful structural transformation won't happen overnight, though the pandemic taught us that big changes can happen pretty quickly. But change won't happen without us: our distress might even be a sign of health - a telling indicator of where we can collectively resist the structures that are hurting so many of us.

To return to the plant analogy - we must look at our conditions. The water might be a universal basic income, the sun safe, affordable housing and easy access to nature and creativity. Food could be loving relationships, community or social support services. The most effective therapy would be transforming the oppressive aspects of society causing our pain. We all need to take whatever support is available to help us survive another day. Life is hard. But if we could transform the soil, access sunlight, nurture our interconnected roots and have room for our leaves to unfurl, wouldn't life be a little more livable?

Dr Sanah Ahsan is a clinical psychologist, poet, writer, presenter and educator

Do you have an opinion on the issues raised in this article? If you would like to submit a letter of up to 300 words to be considered for publication, email it to us at guardian.letters@theguardian.com

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I'm a psychologist - and I believe we've been told devastating lies about mental health | Sanah Ahsan

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Street Therapy: Emotional Resistance in Action

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Street Therapy: Emotional Resistance in Action

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Care lab: How The Hell Do I Actually Do Interdependence?

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Care lab: How The Hell Do I Actually Do Interdependence?

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Leah Lakshmi Piepzna-Samarasinha facilitates journaling exercises and discussions where we unpack our histories with care and dream what we need to make a care-filled future without burnout.

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Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.

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Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.

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Caroline Mazel-Carlton. Credit... Danna Singer for The New York Times

A new movement wants to shift mainstream thinking away from medication and toward greater acceptance.

Caroline Mazel-Carlton. Credit... Danna Singer for The New York Times

Caroline Mazel-Carltonbegan hearing voices when she was in day care. Mornings, by the time she was in middle school, a bowl of oatmeal awaited her for breakfast next to a white saucer of colorful pills. Her voices remained vibrant. They weren't within her head; they spoke and screamed from outside her skull. They belonged to beings she could not see.

The voice who had been with her longest warned of catastrophes coming for her family in Zionsville, a town north of Indianapolis, calamities tied in some unspecified way to TV images from the gulf war: fighter planes, flashes in the sky, explosions on the ground, luminous and all-consuming. A woman's voice castigated her at school, telling her that her clothes smelled and that she had better keep her hand down, no matter that she knew the answers to the teacher's questions. Another voice tracked her every move, its tone faintly mocking. "She's getting out of bed now; oh, she's walking down the hall now."

Her mix of psychotropic pills shifted, expanded: antipsychotics, mood stabilizers, an antidepressant, a benzodiazepine for anxiety, a stimulant for attention deficit. The pileup of drugs was typical; people hearing voices or having other hallucinations rarely wind up on just one medication. Multiple chemicals are prescribed, often more than one similar antipsychotic simultaneously, in an attempt to quell the psyche.

At most, for Mazel-Carlton, the antipsychotics sometimes succeeded in reducing her voices to a wall of sound. This could feel more assaultive than hearing them separately. The antipsychotics caused obesity - 50 pounds of new weight - and the feeling that she was losing control of her forearms and her neck. Her hands quivered and seemed to want to flap-paddle the air. To the isolation caused by the difference of her mind, the drugs added isolation from severe side effects. Her agitation and self-disgust, her terror of being barely human, drove her to twist clusters of her hair around her fingers, to yank hard. Patches of bare scalp crept into view. Classmates taunted, asking why she shook and was going bald, calling her "fat-ass" and "crackhead."

In high school, she supplemented her prescriptions with street drugs - weed, Valium, heroin - in a quest to escape. Though her grades were dismal, she received a perfect score on the verbal section of her SATs. For years she had found partial release in literature: in "Hamlet," in "Ethan Frome," with the "delirious descent" of its attempted suicide, which she read aloud to herself over and over. She also read books aloud to her two little sisters. They adored the way she changed her voice during the dialogue and when the narration switched between characters. This talent drew from the voices she heard. It wasn't that she gave those voices to the characters in the books but more that her mind was well tuned to the nuances of speech, because she heard speech so intimately and ceaselessly. And for her, reading aloud, whether to her sisters or herself, partly quieted the people who existed neither within the books nor within the reality that her family and other human beings inhabited.

Her perfect score was enough to get her into Indiana University Bloomington, where she signed up for a neuroscience seminar, figuring, she said, "I'll learn why I'm crazy." Though answers weren't forthcoming, she loved the course. But she was also bartering sex for drugs. It was blurrier than prostitution but no softer: men in states of addiction and states of rage; she absorbing their anger, their brutality; a man battering her in the shower; she waking up in a costume of florid bruises.

After an abortion, a voice told her he would remove her fingers "one by one by one." She was arrested more than once. She tussled with cops; she raved and slammed her head against the wall of a solitary-confinement cell. Her third arrest was for stealing electronics to trade for drugs. It may only have been the wherewithal of her parents, both lawyers, that spared her a criminal sentence. She was sent to a high-end locked ward in the outskirts of Houston and then to a psychiatric farm in the foothills of the Appalachian Mountains, where, after dutifully earning the privilege of not taking her pills under the vigilant eye of a nurse, she decided to quit all her medications. The choice was impulsive but not irrational. She felt calmer at the farm, shoveling out sheep stalls and ministering to the chapped hooves of a runt donkey. And she could no longer bear the drugs' futility and harm. She did no tapering. She flushed the drugs down the toilet morning by morning and evening by evening, careful that if anyone checked her med case they would find the right number of pills remaining.

She shed pounds. Her hair grew back. Her voices seemed to be in retreat though hardly in surrender. She graduated to a group home in Asheville, N.C., where a staff member took the residents on an outing to a flat-track roller-derby bout. Mazel-Carlton expected to be repelled by a crowd of men titillated by skaters in skimpy outfits, but she sat rapt among families watching women of all builds competing in a violent sport that resembled rugby without a ball. She bought skates the next day. She practiced on her own, talked her way into drilling with the local team and soon was in the foreground on billboards around the city: pint-size, with a helmet low above her dark eyes, one of the team's key scorers. She felt she was starting to manage her turmoil and convert it to determination, and she credited roller derby, where mayhem had to be marshaled and deployed.

Around that time, in the late 2000s, when Mazel-Carlton was in her mid-20s, a new position arose in mental health: peer-support specialist, someone with what's known as lived experience who works alongside practitioners. The idea is that peers can better win the trust of people who are struggling. For Mazel-Carlton, a series of these low-paying roles took her, in 2012, to Holyoke, Mass., once home to more than 25 paper mills, now one of the poorest places in the state. There, she went to work for a fledgling peer-run organization that is now called the Wildflower Alliance, with a three-room headquarters above a desolate downtown street and a goal of transforming the way our society understands and treats extreme mental distress.

She began leading Hearing Voices Network support groups - which are somewhat akin to Alcoholics Anonymous meetings - for people with auditory and visual hallucinations. The groups, with no clinicians in the room, gathered on secondhand chairs and sofas in humble spaces rented by the alliance. What psychiatry terms psychosis, the Hearing Voices Movement refers to as nonconsensus realities, and a bedrock faith of the movement is that filling a room with talk of phantasms will not infuse them with more vivid life or grant them more unshakable power. Instead, partly by lifting the pressure of secrecy and diminishing the feeling of deviance, the talk will loosen the hold of hallucinations and, crucially, the grip of isolation.

Mazel-Carlton also worked as a sometime staff member at Afiya house, a temporary residence run by the alliance as an alternative to locked wards. The people who stay at Afiya are in dire need; many are not only in mental disarray but also homeless. Many are suicidal. There are no clinicians on staff, no security personnel, only people who know such desperation firsthand. In the living room, a homemade banner declares: "Holding multiple truths. Knowing that everyone has their own accurate view of the way things are."

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Afiya house in Western Massachusetts. Credit... Danna Singer for The New York Times

A decade after her arrival in Holyoke, Mazel-Carlton and the Wildflower Alliance are now leaders in a growing effort to thoroughly reform how the field of mental health approaches severe psychiatric conditions. Their views remain marginal to the medical establishment. The conventional mode emphasizes risk management, especially when it comes to psychosis; mainstream providers maintain that antipsychotic drugs, despite their downsides, can reduce the long-term odds of mental disintegration, suicide and - however low the odds to begin with - violent eruptions.

Yet the evidence that the medications improve outcomes is murky. And it is countered by other studies suggesting that maintenance on the drugs may actually worsen outcomes and even cause brain atrophy, though these findings have been debated. The area is devoid of conclusive science, a failure that is a prominent part of a wider problem in biomedical psychiatry: its lack of progress in treating serious conditions, or even precisely diagnosing and comprehending them. "Something has gone wrong in contemporary academic and clinical psychiatry," a 2019 lead opinion piece in The New England Journal of Medicine stated. "We are facing the stark limitations of biologic treatments," it argued. "There is no comprehensive biologic understanding of either the causes or the treatments of psychiatric disorders."

Last June, the World Health Organization published a 300-page directive on the human rights of mental-health clients - and despite the mammoth bureaucracy from which it emerged, it is a revolutionary manifesto on the subject of severe psychiatric disorders. It challenges biological psychiatry's authority, its expertise and insight about the psyche. And it calls for an end to all involuntary or coercive treatment and to the dominance of the pharmaceutical approach that is foremost in mental health care across conditions, including psychosis, bipolar disorder, depression and a host of other diagnoses. Psychiatry's problematic drugs, the W.H.O. maintains, must no longer be an unquestioned mainstay.

To back its position, the W.H.O. highlights stark words from Thomas R. Insel, who from 2002 to 2015 was head of the National Institute of Mental Health, the largest funder of mental-health research in the world: "I spent 13 years at N.I.M.H. really pushing on the neuroscience and genetics of mental disorders, and when I look back on that, I realize that while I think I succeeded at getting lots of really cool papers published by cool scientists at fairly large costs - I think $20 billion - I don't think we moved the needle in reducing suicide, reducing hospitalizations, improving recovery for the tens of millions of people who have mental illness."

Better outcomes, the W.H.O. predicts, "will depend on a re-evaluation of many of the assumptions, norms and practices that currently operate, including a different perspective on what 'expertise' means when it comes to mental health." Michelle Funk, a former clinician and researcher who is leading the W.H.O's work on mental-health policy, law and human rights and is the primary author of the report, spoke to me about the need for a radical change in prevailing clinical presumptions: "Practitioners cannot put their expertise above the expertise and experience of those they're trying to support." Present methods can do damage and undermine outcomes not only through psychotropic side effects, and not only through the power imbalances of locked wards and court-ordered outpatient care and even seemingly benign practitioner-patient relationships, but also through a singular focus on reducing symptoms, a professional mind-set that leaves people feeling that they are seen as checklists of diagnostic criteria, not as human beings. "The widespread belief by many in the health sector that people with a mental-health condition have a brain defect or disorder of the brain," Funk added, "so easily leads to overwhelming disempowerment, loss of identity, loss of hope, self-stigma and isolation."

In demanding a "fundamental paradigm shift" in the field of mental health, the W.H.O. is calling for a close to half a century of psychiatric history. In the early 1960s, weeks before his assassination, President John F. Kennedy signed a mental-health bill into law and declared that "under present conditions of scientific achievement, it will be possible for a nation as rich in human and material resources as ours to make the remote reaches of the mind accessible." American science, he pledged, would not just land a man on the moon but would triumph over mental illness.

This confidence stemmed from psychiatry's first pharmaceutical breakthrough a decade earlier, the discovery of chlorpromazine (marketed in the United States as Thorazine), the original antipsychotic. The drug brought on debilitating side effects - a shuffling gait, facial rigidity, persistent tics, stupor - but it becalmed difficult behavior and seemed to curtail aberrant beliefs. The Times hailed the drug's "humanitarian and social significance," and Time magazine compared Thorazine to the "germ-killing sulfas," groundbreaking drugs developed in the 1930s and 1940s to fight off bacterial infections. But patients didn't seem persuaded that the benefits outweighed the harm; they frequently abandoned their medication.

Thorazine was followed by Haldol, a more potent antipsychotic whose side effects were no kinder. Yet each drug contributed to a sweeping release of residents from psychiatric asylums, and by the 1970s, crude concepts emerged about how these medications work. Overactive systems of dopamine, a neurotransmitter, were thought to be the culprit in psychosis, and antipsychotics inhibited these systems. The problem was that they impaired dopamine networks all over the brain, including in ways that led to movement disorders and torpor.

By the 1980s, though, biological psychiatrists believed that they would solve this flaw by creating more finely tuned antipsychotics. Joseph Coyle, then a professor of psychiatry and neuroscience at the Johns Hopkins School of Medicine, was quoted in a 1984 Pulitzer Prize-winning Baltimore Sun series that heralded new brain research and deftly targeted antipsychotics and other psychotropics on the horizon: "We've gone from ignorance to almost a surfeit of knowledge in only 10 years." A protégé of Coyle's, Donald Goff, now a psychiatry professor at New York University's Grossman School of Medicine and for decades one of the country's pre-eminent researchers into psychosis, told me, about the end of the 1980s, "Those were heady years." Every day, as he neared a Boston clinic he directed, he saw the marks of Haldol in some of the people he passed on the sidewalk: "As you approached, there were the patients from the clinic with their strange movements, their bent-over bodies, their tremors. Not only was the illness debilitating; the medications were leaving them physically so miserable." Yet he sensed, he said, "the possibility of limitless progress."

What were christened the "second-generation antipsychotics" - among them Risperdal, Seroquel and Zyprexa - came on the market mostly in the 1990s. In addition to their assault on dopamine, they seemed to act, in lesser ways, on other neurotransmitters, and they appeared to have fewer side effects. "There was so much optimism," Goff remembered. "We were sure we were improving people's lives." But quickly worries arose, and eventually Eli Lilly and Johnson & Johnson, makers of Zyprexa and Risperdal, would pay out several billions of dollars - a fraction of the drugs' profits - in lawsuits over illegal marketing and the drugs' effects on users' metabolisms. Zyprexa caused a greatly heightened risk of diabetes and severe weight gain (Eli Lilly concealed internal data showing that 16 percent of patients gained over 66 pounds on Zyprexa). Some boys and young men who took Risperdal were affected by gynecomastia; they grew pendulous breasts. In 2005, the N.I.M.H. published a study with 1,460 subjects looking at whether the new antipsychotics were in fact better, in efficacy or safety, than one of the first-generation drugs. The answer was no. "It was a resounding disappointment," Goff said, though he advocates long-term and probably lifelong medication as, on balance, the best way to guard against psychiatric devastation.

"If you look at the treatments we have right now," Coyle, Goff's mentor, told me, "in terms of their fundamental mechanisms" - the drugs' disruption of dopamine pathways - "they're no different than they were almost 70 years ago with the discovery of chlorpromazine. That's pretty scary."

The W.H.O.'s directive points to 22 examples from around the world, from Norway to Myanmar, of the kind of care it hopes will ultimately displace mainstream psychiatric thinking. The report features Afiya house, along with the other work of the alliance, as well as the type of Hearing Voices groups that Mazel-Carlton is leading - and seeding across the country. Priorities common to the 22 are combating alienation, moving "beyond the biomedical model" that puts "psychotropic drugs at the center" and replacing "the language of diagnoses" with an emphatic embrace of "human diversity." In a sense, the W.H.O. and Mazel-Carlton are aligned with the neurodiversity movement that has begun to change society's perceptions of autism. Mazel-Carlton takes care not to diminish the suffering of people like herself and speaks of expanding "the options for healing." Yet she sees her wish as analogous to not just the mainstreaming of autism but the nascent acceptance of new forms of gender identity. "Our society needs to expand its view of what it means to be human," she says. "To expand what is affirmed and honored."

Two years into her work with the alliance, in 2014, Mazel-Carlton was overtaken by despair. It wasn't the first time. Before she left Asheville for Holyoke, her voices grew louder and more lacerating, and she planned out a suicide. This time her reeling began on the forensic psych ward of a decrepit state hospital where the alliance had a peer contract. One day a man with curly blond hair, who was around Mazel-Carlton's age, was forced down and strapped to the bed in an isolation room. She went in alone without consulting anyone on staff. She had always refused staff offers to review patient charts. She didn't want assessments; she wanted to know the people, to talk with them as they paced the low-ceilinged halls. She sat on the floor below the bound man. "He was remorseful, tearful," she remembered. "He was, 'I'm never going to get out of here now.' I think he'd been injected; typically, they would give a shot," she said, referring to the involuntary injection of antipsychotics. "He wasn't trying to free himself from the restraints, but one of the staff pulled me out of the room, saying that I didn't understand the danger. Most of them saw me as a crazy person with keys."

The incident wasn't unusual, but her voices surged, filling her car on her drive home. Her oldest insisted, "They're going to kill us." She obeyed his order to barricade her bedroom door with a dresser. "We have to kill them," he commanded.

She had no idea what to do. If she went into the alliance's office to work, colleagues would figure out what was happening to her mind. If she didn't go in, they would know just the same. She decided to ask her boss at the alliance whether she could stay at Afiya, not as a staff member but as someone in terrible crisis.

"Afiya was where I was no longer hiding," Mazel-Carlton said, recalling her time there. The house, two towns up the road from Holyoke, is a compact four-bedroom home of gray clapboard, with a chain-link fence bordering one side of a little yard and some low-end rental units across the way. When she was on the psych ward in Houston in her early 20s, or at the Appalachian farm or the Asheville group home, Mazel-Carlton concealed her voices, and until then at the alliance she hadn't confided their intensity. But somehow Afiya inspired sharing, though the house had no group sessions and no formal methods. An atmosphere without judgment pulled people into revealing conversations. In a basement den, by the hovering blues and golds of a large fish tank, she talked with a gender-nonbinary person about how they each longed to be completely open about themselves, and yearned to live as examples for other people, but also "about how much that can cost, about how there's a lot of cruelty in the world."

In a bright living room, with a guitar and tambourines mounted between windows, a staff member asked Mazel-Carlton what would help her. As she related this moment to me, the memory of the simple, genuine question moved her to tears, because she felt fully entrusted with knowing what she needed, something that seldom happens with those engulfed in their own realities; their perception is presumed to be too warped. "Some of my voices have their own tastes," she told me. "I don't know if I personally like Lynyrd Skynyrd, but my oldest voice does" - the one who impelled her to barricade herself. She told the staff person that she needed him to play "Free Bird." "He is a serious guitarist; he toured Europe." He took the guitar from the wall. "Before he even got to the solo where the guitar goes wild, I felt this peace come over that voice."

She stayed seven nights, the official limit. It's all that is feasible given the demand for Afiya's bedrooms, with residents coming via mental-health agencies and word of mouth. Fleeting as a week is, it's not all that different from a typical stay on a psych ward, to which Afiya sees itself as a better alternative. The W.H.O. estimates that Afiya is one of three dozen comparable places, known as peer-run respite houses, across the country.

Ephraim, the director of Afiya house. Credit... Danna Singer for The New York Times

In March, Mazel-Carlton, whom I first met in 2019, took me to Afiya and introduced me to its director, Ephraim, who asked that only his first name be used to protect his privacy. That afternoon, over his slender frame, he was wearing a black sweatshirt emblazoned with "Spiritbox," the name of one of his favorite metal bands. Guests, he explained, are free to come and go at any hour. Then he shared: "I feel like I want to die every day. It's one of the first things I think about when I wake up. That is normal for me. Many people act like it isn't normal. Here, we have people express that they want to harm someone. These are all normal thoughts. But people train themselves to believe that they're not. Giving space to express these things, to have these conversations, that's the healing thing, that's the magic here. When we don't allow that space, things get bigger."

"For some people," Ephraim said, "staying here is only a slight beginning. There's power in feeling able to talk and feeling truly heard, in not feeling alone. But for other people, it's transformative."

For several years now, from her cramped alliance office with a bit of roller derby memorabilia on a shelf above her computer, Mazel-Carlton has been a leader in running Hearing Voices Network groups and training others to do the same around the country, from Augusta, Maine, to Eureka, Calif. H.V.N. originated in the mid-'80s after a Dutch psychiatrist, Marius Romme, worked with a client, Patsy Hage, who was hallucinating and suicidal. Hage insisted that Romme pay attention to the content of her voices instead of dismissing what they said as meaningless. Romme went on to study hundreds of people like Hage, and in a 1989 paper in Schizophrenia Bulletin, he argued that practitioners should "accept the patient's experience of the voices"; that "biological psychiatry" may not be "very helpful in coping with the voices because it, too, places the phenomenon beyond one's grasp"; that practitioners should "stimulate the patient to meet other people with similar experiences"; and that patients benefited when they could "attribute some meaning to the voices." Romme's paper was mostly ignored, but Hearing Voices support groups cropped up, especially in Britain and across Europe. In the United States, it took much longer; some of the first were started by the alliance around 2008, four years before Mazel-Carlton began working there.

For Mazel-Carlton, one of the groups' most essential tenets is that there must be no disabusing anyone of a personal reality. Unlike on a psych ward or in many a psychiatrist's office, unusual beliefs are not monitored, corrected, constrained. Mazel-Carlton's motto is, "If I'm controlling, I'm not connecting" - and connection, for her, is everything. It defines hope.

Ideally the groups meet in person, but with the pandemic, the movement has turned to Zoom, and one day in March, I joined a virtual group that Mazel-Carlton helps to conduct. The session drew seven people spanning from North Carolina to Washington State. This particular group focuses on the spiritual, a common theme for people with voices and visions. At the outset, Mazel-Carlton invited everyone to open up by reminding: "This is where I can go if I have direct experiences of the divine. It's a place I can go, if I'm someone with a psychiatric label, to talk about spirituality without having my experience pathologized. We validate one another here."

A man described being rocked and comforted by "an upside-down angel" when he was growing up. Mazel-Carlton modeled an H.V.N. principle that prizes curiosity about other realities by asking the man for more about his experience. In reply to another participant, she said, "I'm so sorry that people are refusing to honor your soul's identity." Then a woman talked about visiting her grandmother in a nursing home during Covid and seeing her grandmother's "glowing pink orb rising from her chest" and everything as "sparkling and glowing and timeless."

The woman said, "Everything was connected; there was this pulse, this flow" - and there was a fight with a nurse when the woman, feeling that she was God, took off her mask. A psychiatrist labeled her psychotic, "so I couldn't keep telling him my experiences, because he was telling me I'm sick, and I'm not sick." In this, according to the mainstream view, she was confirming her illness; denial of one's diagnosis, termed anosognosia, is seen as a glaring symptom of psychotic disorder.

"The first time I came to this group," the woman went on, "and said something about what happened that day with my grandma, I looked at the screen and people were nodding their heads, and I thought, holy [expletive], people get what I'm talking about. And when people talked about feeling like they're Jesus Christ, I was like, Oh, my God, I'm not the only one? In group, I don't feel alone, and feeling alone is like something crushing my chest." She began to cry minimally. "Group is a place to be vulnerable," she said. "In my everyday life, I don't feel safe. I have to put on my armor."

On a wall next to Mazel-Carlton's desk, there's a map of the United States dotted with colored pins. Blue pins mark places where she and alliance colleagues have led or arranged for an H.V.N. facilitator training. "I sometimes feel like a general mapping the revolution," she said. Through her zeal, the network had grown from a handful of U.S. groups to 120, though after two years of the pandemic, the number is closer to 100. Zoom sessions can't match the reassurance and resonance of in-person gatherings.

On the map, red pins represent another campaign. They stand for cities and towns where Mazel-Carlton and the alliance have conducted trainings in their approach to suicide prevention. The workshops are for prospective founders of support groups - and within the groups, as at H.V.N. meetings, clinicians tend to be barred from the room - but they are also for practitioners and family members who want a new way to talk with those contemplating suicide.

A slide within the training protocol Mazel-Carlton has designed teaches that the mission is "to stay present" and not "to prevent them from doing that." "Stay away from fix-it mode, from savior mode," Mazel-Carlton tells trainees. "With our capes on, we can't listen." A first principle is that people must be allowed to talk freely about all that is preying on them, including the wish to take their own lives, and in the groups, a foundational pact is that no one will be reported, not to any hotline, not to the police or any practitioner, no matter what he or she expresses an intent to do. To comprehend how thoroughly this defies dominant practice, take the policy of the country's most-called - and heavily federally funded - suicide hotline. It advertises confidentiality but covertly scores risk and, each year, without permission, dispatches police cars and ambulances to the doors of thousands. From hotline to psych hospital, the focus is on risk management. It is on exerting control. By contrast, the core idea of the alliance's program is that as long as you are talking about killing yourself, and feel you are being listened to and understood, you are much less prone to end your life. There's little research that assesses these approaches or compares them. A 2020 study in the journal Suicide and Life-Threatening Behavior links a person's perception of being coercively hospitalized with an increased risk of attempted suicide after hospitalization; there is little research that looks at the approach favored by the alliance.

Under Mazel-Carlton, the groups have grown to almost 30 from three, from Boston to Denver, despite the obstacles of the pandemic. At least as important, countless U.S. practitioners have learned new ways to listen to the desperate. And a Brazilian mental-health organization, CENAT, has brought Mazel-Carlton to that country, where she has spoken on suicide to clinicians, along with clergy, law enforcement and the diagnosed in São Paulo, Vitória and Salvador. MercyCare, an Australian community-services nonprofit, has flown her in to speak in Sydney, Melbourne and Perth. Over the past two years, in the United States, she has given dozens of talks on suicide and the Hearing Voices movement to audiences of several hundred at conferences, to social-work graduate students, to staff at psych hospitals on grand rounds. In early May, she was in Indianapolis, teaching a roomful of clinicians not far from her childhood home.

'We must also combat the notion that people with mental illness are to be feared.'

In addition to leading groups and organizing trainings, Mazel-Carlton packs her days, late into the evenings, with one-on-one sessions - with a grandmother desperate to hear that her grandson's voices will not destroy his life, with a young man who is certain that his house is under surveillance and who winds up confiding in Mazel-Carlton the sources of his shame. One woman, a mother, told Mazel-Carlton that a voice was commanding that she cut off her hand; if she didn't, the voice would harm her child. Mazel-Carlton listened and eventually wondered aloud to the woman what the voice might be straining to communicate beneath its horrifying terms. She drew her into thinking about the voice's underlying meaning, that it could be expressing something about the pressures and conflicts of motherhood, especially during Covid, how caring for a child sometimes feels like a commandment to give up too much of oneself.

"As human beings," Mazel-Carlton said later, "we are drawn to meaning; it gives us a sense of power. But to get there, you can't feel only that the voice is scary. And to do this work, you have to get past your own fears."

The work, for her, is "a spiritual practice." But she can be overwhelmed by all that people bring to her, along with her own voices, which are sometimes loud enough that she asks me to repeat a question. The only medication she uses is to help her sleep: trazodone, which at her low dose is prescribed for insomnia. It often fails.

Mazel-Carlton knows that the alliance's methods are not always successful. A year ago, a close friend of hers killed herself, someone who had stayed at Afiya and participated in the alliance's groups. "When she died, there were people in our community who talked about how they should have done more," Mazel-Carlton said. "But here's the reality. As long as our wider world is deeply marginalizing of neurodiversity, we are going to lose people."

The W.H.O. report features another innovative approach, temporary residences called Soteria Houses. In Israel, Pesach Lichtenberg has founded two of a handful of such houses now operating around the world. At the outset of his career, Lichtenberg was taken with the promise of psychopharmacology. In the mid-1980s, he moved from New York City to Israel for his psychiatric training, and one day, as he made rounds with a senior colleague, a patient spoke "about demons and the messiah and so forth," he told me. "I was fascinated. I've always had the problem of being intrigued. But as we walked away from this person, the senior psychiatrist said: 'That's not him. That's his dopamine talking.' It struck me as such a wonderful insight." Lichtenberg laughed at himself almost bitterly. "Today I'm ashamed that I could think this way."

For 25 years, Lichtenberg ran the psych ward at a Jerusalem hospital. He described his patients as sodden with medication. "Half the dose was to calm the patient, and the rest was to assuage the anxiety of the staff," he said. Then, in 2016, utterly disillusioned, he opened his first Soteria House in Jerusalem. He was inspired by a book about the Soteria origin story by Loren Mosher, a former head of schizophrenia research at the N.I.M.H., who was appalled by psychiatry's heavy reliance on antipsychotics. He established a pair of treatment houses in the Bay Area in the 1970s that minimized medication and prioritized two words, "being with," as the main treatment philosophy.

Mosher's Soterias eventually closed for lack of funds; two decades later, Lichtenberg picked up where Mosher left off. Lichtenberg's two Soteria facilities, with two others in the works, can house up to 10 people; the average stay is five weeks. Clinicians are present but sidelined, hierarchies of knowledge are banished, medication is a secondary option, mostly to be avoided unless residents arrive already on drug regimens, and "being with" is carried out above all by melavim, companions - paid interns whose ameliorative mission is simply to be engaged, empathetic and curious, to leave residents feeling less alien, less alone.

While visiting Lichtenberg's houses in 2019, I sat with three residents and two melavim, who talked in an internal courtyard. One resident said that Descartes was the source of his trouble, that while at a job one night, passing the hours playing video games, he had wandered onto a website that included Descartes's dictum "I think, therefore I am." "It is stuck in my head like glue," the young man said, eyes in anguish below his bangs. Before that night, he had had issues with obsessional thoughts. Since, everything outside him was unreal. The melavim, the other residents, the courtyard's walls and benches, none of it existed. He knew his mind was awry but couldn't set it right. The melavim asked him about his experience, listening openly, no more, no less.

As I spent time with Lichtenberg, I asked about one of the pressing fears with psychosis - eruptions of violence. What he recounted was akin to what I heard at Afiya, where I was told there was just one incident in 10 years, when a staff member suffered two black eyes and was threatened with a pair of scissors. Lichtenberg said that chairs have been broken and plates smashed but that threats against other residents, melavim or staff members are rare. With the exception of one broken nose, the situations have ended with hardly more than a scratch, though one melaveh was put in a headlock before being released without injury. "If someone becomes intimidating," Lichtenberg said, "I'll sometimes put my hands behind my back, look him in the eyes and tell him, 'If you want to attack me, it's going to be so easy for you.'"

Occasionally the Israeli Soterias will insist on medication if a resident becomes too belligerent, but the drug is almost as often an anti-anxiety pill as an antipsychotic, and the dose may then be tapered down, sometimes to nothing. The houses refuse to take a small fraction of applicants because of a recent history of violence, but they have also knowingly accepted residents who, a few months or only weeks before their arrival, put a parent in the hospital, for example, or assaulted a government security officer.

Avraham Friedlander, a former director of Lichtenberg's first house, told me about a resident who, on the man's first day, interrupted a group meeting in the living room. He splintered a darbuka, a Middle Eastern drum, and began to dance aggressively. In response, Friedlander joined him in the middle of the group, dancing wildly. "Everybody made a drumbeat with their feet, stomping, and we fought in a choreographed way, a dance-fight," Friedlander said. "He grabbed me; he put me on the floor; but I wasn't hurt; and later we talked. He was asking what was happening to his mind. He was crying. I slept near him that night, and when he woke with nightmares, I sang him songs and gave him tea."

Soteria's methods may seem romantic and naïve, but Lichtenberg has won the support of Israel's Health Ministry, and two of Israel's four public insurance carriers as well as the Defense Ministry's insurance system will pay for a stay in Soteria as an alternative to hospitalization. Since Lichtenberg got started in 2016, 17 houses with practices similar to Soteria's have opened throughout Israel. This year, at the invitation of one of Jerusalem's major psychiatric institutions, Kfar Shaul Psychiatric Hospital, Lichtenberg has taken over its locked ward and begun to turn it into a Soteria facility.

In the United States, the mainstream mental-health establishment has been slower to embrace these alternative approaches, but that might be changing. I asked Ashwin Vasan, the new commissioner of New York City's Department of Health and Mental Hygiene, whose most recent work has been in mental health, about how cities like New York and San Francisco should respond to a spike in violence and overall lawlessness attributed to the mentally ill and those who don't have housing. His email reply focused on preventing crises not only by adherence to medication but also by "breaking extreme isolation." As part of this effort, he added, "We must also combat the notion that people with mental illness are to be feared."

The data does much to support Vasan, suggesting that while those with hallucinations and delusions are probably disproportionately prone to violence, this pattern largely disappears when researchers control for factors like poverty, homelessness and substance abuse. Those may be the more relevant drivers. Data also indicates that people diagnosed with psychosis are less likely to be perpetrators of violence than they are to be its victims.

Chacku Mathai, a Hearing Voices Network facilitator, in Rochester, N.Y. Credit... Danna Singer for The New York Times

Chacku Mathai, whose Indian family immigrated to the United States when he was a child, works as a project director with a large New York State-funded program, OnTrackNY, which combines an emphasis on medication with the inclusion of client perspectives about their care. And he facilitates Hearing Voices groups. During one of our many conversations, Mathai told me a parable about a traveler in a foreign land coming across a bird he has never seen before, a peacock. Thinking that such a freakish creature will never survive, the traveler cuts off its feathers to correct nature's error.

Mathai, who hears voices and has visions and was hospitalized after a suicide attempt as a teenager, is something like the peacock, except that he rejects medication that would shear away his difference. By immersing himself in yogic practices, he gives his mind a measure of rest. Still, voices stalk him, suspicious of people and full of foreboding. Sometimes, he told me, he thinks about whether, if the perfect antipsychotic existed, he would take it. "My experience is so rich," he said, "I wouldn't trade it for anything." He spoke of having a keen empathy for the singularity and solitude of others, a sensitivity that can bring a feeling of being universally joined.

Beth, who asked that I use only her first name and who has led H.V.N. groups in Western Massachusetts, pointed out that though the Hearing Voices movement wrestles against conventional psychiatry, it isn't anti-psychiatry. A former music teacher and cellist, Beth used to take medications that left her with terrible tremors and a torturous physical restlessness called akathisia, deepening the agony of a teaching career lost to her struggles. But after an odyssey of working with inflexible psychiatrists, she found one willing to chart a path of mutual understanding and compromise. She continues to have unsettling visions, but a religious practice along with a calibrated mix of drugs helps somewhat to make her life more manageable while inflicting only mild tremors, and she is playing her cello for the first time in 20 years.

Beth, who has led Hearing Voices Network groups in Western Massachusetts. Credit... Danna Singer for The New York Times

"It's like an ecosystem of dreams," Dmitriy Gutkovich said, describing his voices to me over Zoom from Foster City, Calif. Some threaten his family; others speak philosophically on entropy. He takes an almost negligible dose of an antipsychotic, an amount bordering on a placebo. More relevant, he explained, is that H.V.N. groups helped him to realize that coexistence with voices is possible. It is, he said, "about understanding them and their intentions, so that we can live in harmony; it's about relationship management." A decade ago, in his early 20s, he was "not in a period of perfect functioning," he said wryly. "The professional assessment was doom and gloom." He is now married and a new father. On the screen, he smiled beatifically about this. He is a marketing director at a magazine and oversees an eight-person team.

Sometimes, at the end of a conversation with Mazel-Carlton, a mother will ask: "When can we talk again? When?" There is nothing like the panic of a parent whose son or daughter knows another reality. In her office, late one afternoon in March, with the overhead light off and the light from the lone window getting dim, she counseled a mother for the second time by Zoom. The woman's grown son believed he was taking directions from God. In the recent past, he had been hospitalized, suicidal, homeless. "He thinks he's kind of like a savior," she told Mazel-Carlton. His ever-changing plans terrified her. "I need to know how to talk to him. I don't want to say the wrong thing. I'm trying to just be there, to be empathetic."

She knew Mazel-Carlton's lessons well, and quietly, Mazel-Carlton echoed and encouraged her.

"But I don't know how to get him to understand that I'm on his side. He's very turned off to the mental-health system. He told me I put him in the hospital. I said it wasn't me, it was the psychiatrist. I know he's going to do what he's going to do, I know I can't prevent it, but he says he was comfortable being homeless, because no one could tell him anything - and now what if he becomes homeless again? He could be killed, God forbid."

"I'm not putting this on you," Mazel-Carlton said, "but it sounds like he's had some institutional trauma. So what I might avoid is bringing things up from a mental-health lens."

"I think about the M-word," she said, talking about medication. "But I don't say it."

"I think that's wise."

"I can't help it."

"I think it's good that you don't go there," Mazel-Carlton said. "Pharmaceuticals are easily accessible - he knows that. He knows he can make that choice anytime. When a mom brings up medication, it can sound like, I don't like the way you are. Like, the way you are makes me uncomfortable."

"I'm freaking out."

"As adults, the moments when we feel that our parents trust us - that's the lottery-like feeling," Mazel-Carlton said.

"To let him be who he is," the mother said. "Not to get in his face. I'm really working on it."

"I know you are."

Daniel Bergner is a contributing writer for the magazine. This article is adapted from his book "The Mind and the Moon: My Brother's Story, the Science of Our Brains, and the Search for Our Psyches," published this month by Ecco. Danna Singer is a photographer based in Philadelphia as well as a lecturer at Yale School of Art and Princeton. In 2020, she was named a Guggenheim fellow.

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Doctors Gave Her Antipsychotics. She Decided to Live With Her Voices.

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A new movement wants to shift mainstream thinking away from medication and toward greater acceptance. Caroline Mazel-Carlton. Credit... Danna Singer for The New York Times Caroline Mazel-Carltonbegan hearing voices when she was in day care. Mornings, by the time she was in middle school, a bowl of oatmeal awaited her for breakfast next to a white saucer of colorful pills.

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Expanding the Web: Lukaza Branfman-Verissimo, Ayana Zaire Cotton, and Kamra Hakim in conversation

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Expanding the Web: Lukaza Branfman-Verissimo, Ayana Zaire Cotton, and Kamra Hakim in conversation

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Expanding the Web: Lukaza Branfman-Verissimo, Ayana Zaire Cotton, and Kamra Hakim in conversation

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Chimamanda Ngozi Adichie: The Danger of a Single Story | TED

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How childhood trauma affects health across a lifetime | Nadine Burke Harris

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How childhood trauma affects health across a lifetime | Nadine Burke Harris

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How childhood trauma affects health across a lifetime | Nadine Burke Harris | TED

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Racial Capitalism & Prison Abolition Zine

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Racial Capitalism & Prison Abolition Zine

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Racial Capitalism & Prison Abolition Zine

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This zine is written and illustrated to make accessible the theories of Black Marxist and prison abolitionist scholars including Cedric Robinson, Robin D.G. Kelley, Ruth Wilson Gilmore, Mariame Kaba, Angela Davis and others. We invite you to share this zine widely. Download the free PDF version of the zine here: tiny.cc/zinelibrary

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A lived experience

resourced offering from

folks living with suicidality

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Steps to Ask Yourself Before Calling the Police

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Steps to Ask Yourself Before Calling the Police

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A wonderful resource to use, print, and share :)

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ZINE: Myths of Psychiatric Incarceration

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ZINE: Myths of Psychiatric Incarceration

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ZINE: Myths of Psychiatric Incarceration

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ZINE: The Future of Mental Health is Mutual Aid

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The Realities of Mandated Reporting (and Thinking Through Anti-Carceral Alternatives)

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The Realities of Mandated Reporting (and Thinking Through Anti-Carceral Alternatives)

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THRIVE Lifeline's Non-Carceral Resource List (Crisis Lines, Helplines/ Warmlines, Other Peer Support, Self Help Skills/Tools)

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THRIVE Lifeline's Non-Carceral Resource List (Crisis Lines, Helplines/ Warmlines, Other Peer Support, Self Help Skills/Tools)

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Alternatives to Police in Providence, RI

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Alternatives to Police in Providence, RI

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Don’t Call The Police - Community-based alternatives to calling the Providence Police Department or 911 in Providence, RI

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Youth Pride, Inc. (Drop-in space for LGBTQ+ youth ages 9 – 24, with leadership and art programs, support groups, and more)

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Youth Pride, Inc. (Drop-in space for LGBTQ+ youth ages 9 – 24, with leadership and art programs, support groups, and more)

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Leadership.

Affirmation.

Community.

Outspoken is Youth Pride, Inc's leadership programs designed to create space for young people who are looking to dive into their own identity and experiences while learning how that information can impact their community. Youth can join us as a group of peers as we explore Gender, the Environment, Sexuality and the intersections of our ... Read more "

Connect With YPI From Home! In the wake of the Covid-19 pandemic YPI has been working diligently to roll out as many of it's services as it can virtually! Nothing can replace the connection and camaraderie of in-person space but we are going to bring you the next best thing. All groups are open to ... Read more "

Earlier this week Youth Pride, Inc. (YPI) closed our drop-in programs in response to COVID-19. While drop-in hours are suspended, use of our Basic Needs Pantry is now available by appointment only, and the space remains otherwise off-limits to anyone besides staff. If you need to utilize our Basic Needs Pantry, we will have premade bags for ... Read more "

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Outspoken is Youth Pride, Inc's leadership programs designed to create space for young people who are looking to dive into their own identity and experiences while learning how that information can impact their community. Youth can join us as a group of peers as we explore Gender, the Environment, Sexuality and the intersections of our ...

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Iden McCollum on "Recovery," Working through Trauma, and Starting a Peer Support Group

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Iden McCollum on "Recovery," Working through Trauma, and Starting a Peer Support Group

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This is meant to be an interactive flow chart for people who struggle with self care, executive dysfunction, and/or who have trouble reading internal signals. It's designed to take as much of the weight off of you as possible, so each decision is very easy and doesn't require much judgment.

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Do you have a resource that you’d like to see added? Fill out our
suggestion form.

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Stella Akua Mensah and Stefanie Lyn Kaufman-Mthimkhulu
Content notes: sanism, racism, violence, state violence, incarceration, institutionalization, forced 'treatment', torture, medical coercion, restraint, seclusion, abuse, sexual violence, settler colonialism
There is a dangerous tale in the United States, one based on a myth of the deinstitutionalization of psychiatric asylums¹. Through this story, we are told that the asylum died and is a thing of the past. We are told that, now, "patients" have rights, are treated with human dignity, and are not criminalized for their neurodivergence. We're told that restraints and forcible medication only happen in "extreme" cases. We're told that the mental health care system is here to help us, support us, and "treat" us. And now, when abolition has entered mainstream discourse, we're told that this very system should be considered an alternative to incarceration in jails and prisons. But those of us who have survived psychiatric incarceration know that not only did the asylum never die - it is, and always was, another prison. Knowing the truth of these myths, we work towards writing a new story.

As Hussein Abdilahi Bulhan states in his work Frantz Fanon: The Revolutionary Psychiatrist, "psychiatry like any therapy should be the meeting of two 'free' people." In our current society, this could not be further from the truth. Every state (and Washington DC) allows for a person to be involuntarily held for "treatment, observation, or stabilization ." Though specifications vary by state, the three main forms of commitment are: emergency hospitalization for evaluation, involuntary inpatient commitment, and "assisted" outpatient treatment. This means that other people may decide (without your consent) that you present a risk to yourself or others, and need to be removed from or surveilled within your community for "treatment." Though Disabled people have fought tirelessly for our right to live in the community , as we approach ADA 30, we must acknowledge the many existing loopholes that make our involuntary confinement in congregate settings a reality.

As we talk about prison Abolition, discourse that was largely founded and remains spearheaded by revolutionary Black Women , we must reckon with the history of psychiatry, and better understand how the mental health system perpetuates processes of criminalization, policing, and surveillance. When we look deeper, we can see striking similarities between prisons and psychiatric institutions. As Leah Ida Harris described , both prisons and psychiatric institutions: have an overrepresentation of BIPOC (Black, Indigenous, and people of color), disregard the rights and safety of TGNC (trans and gender non-conforming) folks, use law enforcement transport/response, use solitary confinement and seclusion in cells/"rooms", forcibly medicate folks (also known as chemical restraints), use physical restraints, offer extremely limited access to sunlight, fresh air, cell phones, news/media, and the outside world. In addition, sexual violence is routine, there is limited power to appeal legal/medical decisions, and the overwhelming majority of inmates are survivors of previous traumatic experiences. This year, the UN Special Rapporteur on Torture presented a report asserting that involuntary psychiatric interventions "may well amount to torture."

Prison culture is not solvable by 'funding the mental health system' more robustly. The mental 'health' system is fundamentally carceral, meaning that it is one of the many kindred systems that function to contain and surveil people, take away their locus of control, isolate them from their communities, and limit their freedom. As it functions in America and in all places touched by colonialism, psychiatry is rooted in torture , white supremacy, and a culture of shame and punishment. Yes, the asylum lives on - and the police love the asylum.
Abolition means that all the cages come down, including those that function under the guise of psychiatric 'care.'
The abolition of psychiatry does not mean that no one is allowed to identify with psychiatric diagnoses that they feel serve them, or that no one is allowed to continue taking psychiatric medications they find effective². It does mean, however, that the notion of 'mental illness' was invented to pathologize logical responses to the stress and trauma that are omnipresent in a world brutalized by colonialism and capitalism. Psychiatry has been described as a "medicalized colonizing of lands, peoples, bodies, and minds." A notable example of psychiatry's colonial intentions was the diagnosis of 'drapetomania': the mental 'disease' that explained why enslaved Black people in the Antebellum south ran away from their death camps (the 'treatment' for which was to treat them more 'like children'). As China Mills states in Globalizing Mental Health, "distress caused by socio-economic conditions (and often neoliberal economic reforms) comes to be rearticulated as 'mental illness', treatable using techniques that draw upon similar rationales to those that led to distress initially."

Psych abolition means that the intended and realized outcome of the advent of 'mental illness' as a signifier is to make folks feel like they will never get better and that their distress is inherent to their brain chemistry rather than a reaction to external stimuli. This logic is essentially victim-blaming and shifts responsibility away from cycles of violence that create the conditions for psychological suffering - not to mention that the "chemical imbalance" theory has been numerously . It means, too, that psychiatry was built with a core desire to dehumanize, drug, and discard those whose behavior and ways of being diverged from the status quo. This status quo was and is white, patriarchal, and absolutely enamored with respectability and compliance with the state's self-serving notions of "normalcy."

Many Psychiatric Survivors have made incredible strides in pursuit of justice, reform, and sometimes abolition. But the current nature of psych wards, which, for the most part, have remained violent, degrading prisons at which a majority of ex-inmates assert that they were not helped and were further traumatized , arguably indicates that the asylum never died. Why? Because it was never supposed to. Psychiatry IS the ethic of the asylum, and it will not fall until Psychiatry falls.

***

Our discussions of psychiatric abolition are deepened when we look to the history of prison culture in its many forms - policing, the death penalty, disposal of the divergent, and underneath it all, an allegiance to the binary notion that there are good people, and there are bad people. The punishment and disposal of the "bad" and divergent is not just an American problem, but its manifestations in this country are unique and inextricably rooted in the enslavement and genocide of Black and Indigenous folks. In Amerikkka, those who are 'good' adhere to (or fit naturally into) the state's status quo, and are useful cogs in the twin machines of white supremacy and capitalism. Within the state's 'bad' category are those whose utility to the state is questionable, which disproportionately includes BIPOC, TGNC folks, LGBTQIA2S+ folks, Disabled and Neurodivergent folks, poor folks, and those who attempt to hold the state accountable for its violence.

It's important, too, that we talk about harm. When many of us think of institutions, we think of keeping society safe from the most harmful among us. The truth is that we will all cause harm in our lives, and owning this rather than projecting it onto certain individuals is so important to abolition so that we can practice the antidote to punishment: accountability. Prison culture has put us in denial of our shared capacity for the full spectrum of harm, while prioritizing "crime" and defining it largely in terms of how we disrupt "order" rather than how we harm each other. The truth is that the structures to which we are supposed to adhere to be deemed "good" are at the very root of the cycles of violence that create our capacities for harm. Not only that, but our reasonable reactions to state-sanctioned violence are deemed "harmful," putting the blame on the victims. Yes, there is much harm in the world, but if we try to imagine a world in which colonial structures no longer abuse our communities while happily sponsoring cycles of violence within them, it is possible to see us healing interpersonally and communally in a way that has the potential to transform us beyond prison culture.

It's worthwhile to point out that prison culture has existed in our world for at least 4,000 years , with some anthropologists dating capital punishment back tens and even hundreds of thousands of years. All this to say: prison and punishment culture are fairly fundamental to humanity. Naming captivity for what it is - ancient - helps us face the colossal task of healing towards abolition. At the same time, there have been - and still are - societies and communities that resist harmful hierarchies and punishment. Indigenous peoples used talking circles for thousands of years, "which embodied hozjooji naat'aanii , a Navajo phrase meaning "something more like 'people talking together to re-form relationships with each other and the universe." We look to these Restorative Justice (RJ) practices as revered guides in our pursuit of abolition. Transformative Justice (TJ) is an evolution out of RJ that recognizes our need to also heal the systems of oppression that are us to harm our relationships in the first place.

Our world's widespread prison culture is largely the result of a hierarchy of human value that has long served to simplify our understandings of each other. If we actually share a capacity for harm, then we are all worthy of getting in touch with our shared capacities for transformation. If we share, too, a capacity for diverse manifestations of distress and neurology, we must do away with the "sane"/"insane" binary and give each other permission to be free and find healing. Grounded in the teachings of Restorative, Transformative, and Disability Justice, we firmly believe a post-institution world is both possible and happening.
There is no way for us all to be free without dismantling the reductive systems of control that enforce state-serving notions of normalcy and rightness, the consequences of which are fatal for so many of us. Spiritually, they may be fatal for us all.
Disability Justice and Restorative and Transformative Justice ask us to imagine the world we want to live in, collectively, and practice those ideas and values each day. These frameworks give us the tools needed to shape a society that supports our healing. When we think of a post-psychiatric and post-prison world, we see peers walking with each other through suffering and developing empathic skills that foster mutuality. We see TJ processes helping us resist shame and punishment, embrace accountability, and dismantle internalized tendencies towards harm and abuse. We see us knowing that our distress is an understandable response to cycles of harm and suffering³. We see us spending restful and formative time with loving people in loving spaces when we are in crisis. We see us healing our trauma at our own paces and in our own ways. We see us no longer pathologizing and vilifying beautiful and harmless manifestations of neurodiversity. We see us never, under any circumstances, putting psychiatric drugs into each other's bodies without (read: non-coerced) consent. And, perhaps most fundamentally, we see us taking actual care of each other, not paternalizing and imprisoning each other while referring to this violence as "care."4

Non-carceral, loving forms of community care and crisis response are already evolving around us, to help us write this post-prison story. Project LETS does this work every day, through our Peer Mental Health Advocate (PMHA) models that exist outside of the carceral-industrial complex. Other wonderful examples include: The Hearing Voices Network , Mad in America , Sins Invalid , Health Justice Commons , Western Mass Recovery Learning Community, HEARD, and many more. The foundation has been laid, but together, we must do the work of building, imagining, and creating the new worlds we want to live in. As Frantz Fanon brilliantly stated, "if it is society that is 'sick', then it is 'society that needs to be replaced."

Notes

1 We refer to deinstitutionalization as a myth because it was never fully realized. Though populations inside of institutions were reduced, many of our community members are still incarcerated in psychiatric institutions, prisons, nursing homes, residential homes, and other congregate settings used to disappear people. For further context, we recommend: Decarcerating Disability by Liat Ben-Moshe.

2 Though psychiatry is a fundamentally violent system, there are some psychiatric drugs that are effective for some folks (though the structural, cultural trauma creating distressed manifestations of neurodivergence needs to be prioritized). We are not anti-medication, and do not advocate people stop taking medications that are useful to them. We believe, however, that the creation and evolution of psych medications could feasibly be taken over by post-psychiatric entities that recognize/build upon the small wisdom that has incidentally come out of this violent structure.

3 Some manifestations of neurodivergence do not feel like responses to interpersonal trauma or stress. Sometimes this is because they are responses to systemic trauma and stress that are so ubiquitous, we don't realize their impact on our bodyminds. Sometimes, this is because the trauma and stress are inherited in the body from our parents and/or ancestors. Sometimes we don't know where our distressing neurodivergence came from, and therein lies the value of identifying with a 'mental illness.' Sometimes our neurodivergence is not distressing in any way, and therefore needs no explanation. You get to choose the language for your own experience. Our hope is that you'll allow yourself the exploration of how psychiatric diagnoses and mechanisms may be taking away your knowing of yourself, making choices for you, and categorizing your experiences in solely medical terms.

4 We would also like to validate that some folks have had good experiences in psych institutions. From an abolitionist lens, we believe that the good parts of those experiences could be replicated and improved upon within respite centers and other innovations in non-carceral healing spaces. Also, saying you had a good experience on a psych ward and therefore psychiatry shouldn't be abolished is like saying the police have helped you and therefore shouldn't be abolished-the point being that you are in the minority, and the wisdom of those who have suffered at the hands of these institutionally-backed harm-doers needs to be centered.

ABOUT

Stella Akua Mensah is a Black, Neurodivergent Peer Support Specialist, Psych Survivor, writer, Transformative Justice advocate, and artist from Chicago. She studied Literary Arts at Brown University, writing magical realism centering on themes of inherited trauma, Madwomanness, and Black Diasporic approaches to healing. Stella now serves as a Peer Support Housing Navigator for Homeless Women in Boston. Her ongoing passions center on transformative, decarceral, and communal care.

Twitter: @stellakuamensah

Stefanie Lyn Kaufman-Mthimkhulu (they/she) is a white, Latinx, and Jewish organizer and Director of Project LETS; a national grassroots organization led by and for folks with lived experience of mental illness, Disability, trauma, and neurodivergence. Their work specializes in building peer support collectives and community mental health care structures outside of state-sanctioned systems of "care" - grounded in principles of anti-racism and Disability/Transformative/and Healing Justice. Stefanie has extensive experience as a facilitator, curriculum developer, and consultant for mental health policies, program development, and accessibility. As a person with lived experience of madness, Disability, neurodivergence, and a survivor of psychiatric incarceration, they are invested in disrupting multiple carceral systems which disproportionately harm and kill our community members worldwide. They are also a graduate of Brown University's Medical Anthropology and Contemplative Studies program.

Twitter: @stefkaufman
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Abolition Must Include Psychiatry Stella Akua Mensah and Stefanie Lyn Kaufman-Mthimkhulu Content notes: sanism, racism, violence, state violence, incarceration, institutionalization, forced 'treatment', torture, medical coercion, restraint, seclusion, abuse, sexual violence, settler colonialism There is a dangerous tale in the United States, one based on a myth of the deinstitutionalization of psychiatric asylums¹.

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