In summary, the purpose of these essays was to explain constructivism, and show something of the vast therapeutic interventions that arise from that perspective.
My first essay explained constructivism by referring to the anecdote of the three umpires. It highlighted that we make ‘reality’ by the parts of experience we select, emphasize and describe.
Next a case study showed the grave error of diagnosing a client (Josie) with schizophrenia, an error which is a direct consequence of not understanding constructivism.
The third and fourth essays gathered examples of therapy that I do not hear discussed in mental health services. They reveal more possibilities when working with those diagnosed with psychosis and other disorders.
The fifth essay raised questions about the efficacy of psychiatric medications. It suggested that review articles and meta-analyses are more trustworthy than individual studies. It encourages people to examine claims of efficacy rather than believing the information we are given is accurate and unbiased.
Essay six returns to constructivism. It questions the objectivity of psychiatric diagnoses, and uses more examples of therapy to show why therapy should be favoured as the first choice of treatment.
Essay seven summarises some of the harm that arises from the biological paradigm, and adds that we should be honest with clients about the diverse views regarding medication in this field.
Essay eight explains there are errors in thinking, which easily occur and lead people to think psychiatric medications are more effective than they are. Promoting medications, particularly as a first choice may diminish clients’ belief in their own capabilities.
Essay nine highlights the famous Pseudo-patient study and reminds us of the message of constructivism, that psychiatric labels are not objective and reliable. Doing without them might remove a cause of harm, and promote a focus on behaviours and difficulties, which are more solvable than an alleged ‘illness.’
I encourage you to spend 15 minutes watching the story this link takes you to…
Caroline Casey, talks about her life. She is inspiring and courageous. She shares something she discovered about herself at age 17 – it is amazing, unimaginable, and challenging. There are lessons for the listener about disability and how we handle it, and what we aim for in our lives. [Warning: the TED website is addictive!]
I wonder what it would be like to have this and similar stories playing in the waiting rooms of mental health offices; or run group discussions about finding meaning in our lives, about doing things regardless of disability, contributing to people’s lives.
Mental health services label people, causing harm. People are capable of so much more than the labels we give. Rather than correct what some claim to be some biological fault, how can we inspire them to dream of doing more?
If we see a person as a schizophrenic, (or “a person with schizophrenia”), we have already built a construction in our mind (and our client’s) of limitation.
If you have skipped over Caroline Casey’s talk, stop and listen to it now…J
People have the capacity to surprise us again and again. When we keep that alive in our minds, we can help them surprise us, and perhaps even themselves.
More than once a week (though it seems like a daily occurrence as I am much sensitised to this constructivist error) I hear staff in mental health services comment that one of the patients is refusing to admit s/he has a mental illness, which usually means s/he is reluctant to take medication. As with the pseudo patient study (Essay 9), patients are often required to conform to a belief system in order to gain something (eg discharge from hospital, support.)
Constructivism tells us ‘mental illness’ is just a construct, preferred by some… generally by those who have authority to control patients. This of course can lead to a struggle…staff may struggle to convince patients they are ‘ill’; patients may struggle to convince staff they are not. How do we maximise our connection with patients rather than battling to make them comply with a belief?
Struggles like these lose opportunities to collaborate in non-medication therapies that are consistent with constructivism. Struggles lose chances of engaging in discussions about meaning and passion that Caroline Casey’s talk illustrates. Clients who do not believe they are ‘ill’ have differing beliefs. There are many choices for collaborating on a meaningful and happier life.
I have written these essays, not as a final word, but rather a beginning. I wish constructivism becomes part of everyday thinking in mental health services. I wish we focus on people’s potential, keep exploring new ways to intervene, and inspire one another through our discoveries.
Solutions for everyone’s problems are not as simple as reading some essays or books. But these essays are to highlight information that is increasingly circulated.
By presenting stories of uncommon therapy examples I want to show possibilities.
If some practitioners get great results with therapy, how might we also achieve this with our clients? A small percentage of our workforce is devoted to exploring these? How much more can we achieve, if more are trained and encouraging each other?
What You Can Do
You can circulate these articles to your colleagues for broader discussion.
These articles will soon be posted onto www.tomblackford.com.au where there are further articles.
You can encourage discussion of such ideas in your professional training meetings.
Perhaps agencies could enlist the services of leading therapists (eg Nardone) to demonstrate and train staff; the costs could be recouped if just a few clients avoided a lifetime career as psychiatric patients.
I am interested to receive emails to let me know what you are doing, and what ideas you have for disseminating these ideas further. Email: email@example.com
At some point I may suggest a meeting of those interested, to exchange information, concerns, resources and ideas about how the public mental health services can be impacted by such perspectives. So let me know if you would like to be contacted.
Thankyou for reading.