Friday, January 5, 2024

Self-Care: Sometimes Helpful, Sometimes a Tool of Oppression

This is an article I've been dreading and putting off for a while. Within my work on mad justice, this is one of the most pushed back on discussion areas. And I'll state up front, this is meant to be nuanced. This about real people sharing real stories of their own harm. Not an attack on your life story. But yes, an attack on what advice and expectations others are frequently offered and judged upon.

So, self-care then. Are you anxious? Distressed? Have you heard about self-care! Try self-care! Self-care is great! Live-laugh-self-care! 

I know I'm mocking a bit, but this is the climate at present when one reaches out for help. It's everywhere across mental health understanding. And that's .... a huge problem. Because it's basically never explained (and I've read literal hundreds of posts and seminars and books about the matter) about the limits and even dangers of this sometimes helpful tool and concept.

The main issue is how this tool places the onus of responsibility for management of distress on the individual and nowhere else. Abusive work environment? Self-care! Widespread economic collapse? Try self-care! Going through a famine? Self-care!

Note what's not there. Instead, think about this alternative framing. Abusive work environment? Yes, it makes sense to be suffering. That's a natural response. The response might likely stay until something ends the abuse. That something should not necessarily be your responsibility. Not even partially. The problem here is the abuser, not your inability to not tolerate abuse. 

Now, this isn't some binary. There's room for nuance. There's room for a mix of accountability. But across the vast majority of mental health discussion, nothing like that last paragraph, nothing even remotely close, in anywhere to be found. Our modern culture loves, to an oppressive, human-right violating, abusive level, assigning blame at the individual level instead of on abusive others / systems. That's why the current self-care craze is a problem. It faults individuals for things beyond their control, while simultaneously having those other factors avoid accountability entirely. As such, self-care goes from an actual resource and instead becomes a form of victim-blaming and an act of accountability avoiding oppression.

Why fix harsh working conditions when we can instead demand that abused workers work harder to take deep breaths and do some yoga at home. How about constantly, over and over, never mentioning that any other option or solution exists. How about moralizing failure to get better as "lack of effort pursuing self-care" instead of "self-care was never going to fix the pain of ongoing abuse". That's the problem. And no, self-care advocates never take responsibility for discussing this properly. They deny or downplay their role in this over-promotion. They reply with "of course we know it doesn't fix anything" instead of taking self-responsibility for noting "you're right, we didn't discuss or emphasize the limits. We didn't discuss placing partial or even full accountability at the hands of the root cause external stressor itself". They, like everyone else, want to say the problem wasn't them for not communicating clear, but instead blame you for not giving them a break or misunderstanding their point. Oh the irony in that. Or just, perhaps, expected? For them to never take on their own self-accountability while promoting advice that encourages you to never think of yourself as a disempowered victim of abuse, even as they too directly abuse you.

So, that's a first draft at attempting to explain this issue. Still a work in progress. For more on this, below are among the rare few articles I've found trying to also illustrate this point. This article is, itself, a work in progress. This is unfunded work. I've been harassed, berated, and banned from numerous social spaces for trying to make this point. Again, to the caveat at the top, I have never once faulted or questioned someone if self-help worked for them. But when I question pushing the advice on others, all hell breaks loose. Why? That's a whole topic to explore. One common answer is that you may feel these realities encourage hopelessness. I, and others in peer groups I've worked with, find it to be just the opposite. As Bernice King said...

“Being truthful about the state of our nation and world does not equal losing hope. Hope sees truth and still believes in better. That which dismisses or does not seek truth, but grins, saying "It will be okay," is naiveté, not hope.”

— Bernice King

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---- Further Reading on This Topic ----

1) We need to move on from self-care to something that cannot be captured by capitalism

"While looking after yourself is great, self-care is still an idea rooted in a neoliberal tradition of looking out for ourselves, rather than seeing ourselves, our health and our fates as inextricably linked to our fellow human beings. Wouldn’t it be great if this decade we took the self out of self-care and strived instead for communal care?"

2) We Need To Talk About Self-Care

"Refuse to settle for an environment that demands we each shoulder all our burdens in isolation. Insist on relationship, connection, undiminished interdependence as the way things are supposed to be."

3) From Self Care to Collective Caring

"Like many survivors, I can isolate myself while engaging in the stereotypes of self-care. I may look brave or even enlightened as I take up yoga or running, write glowing reviews of books on self-acceptance, and channel my emotions into elaborate art projects and self-revealing blog posts. This form of self-care can feel less like liberation and more like solitary confinement. Sometimes what I actually need is someone to show up at my house with take-out, sit there while I pick at my food, stay with me until I’m falling asleep sitting up on the couch, and then send me to bed and tuck the blankets around me."

Thursday, December 21, 2023

Evidence Against Mental Health First Aid - Not Helpful, Frequently Harmful

Article and literature review gallery about the problematic and harmful Mental Health First Aid mental health training course. 

The Problem with ‘Mental Health First Aid’

According to the Mental Health First Aid website it is an eight hour course that “teaches you how to identify, understand and respond to signs of mental illnesses and substance use disorders in your community.” It is geared particularly toward first responders, family, and others in the community who don’t typically offer support to people in distress for a living.

On the surface that doesn’t sound so bad. However, Mental Health First Aid is rife with problems. First, it is yet another approach that is largely absent any input from people who actually have psychiatric histories themselves. ... Mental Health First Aid does not do a good job of promoting genuine connection, listening, or supporting someone to make meaning of their experiences. It prioritizes referral into clinical services over all else*. Although, as with any approach, a participant’s experience may vary substantially based on the trainers and what they’ve decided to do with the material, it appears to be a tool to further entrench a medical model way of thinking about emotional distress, regardless of an individual’s personal beliefs, culture, or knowledge of what works for them. 

Unfortunately, Mental Health First Aid isn’t going anywhere soon. It is heavily funded, and has been promoted by both the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Council on Behavioral Health. Nonetheless, it is important that we determine for ourselves how we want to approach each other during times of struggle. We can (and need to) do better.

Inventing Mental Health First Aid: The Problem of Psychocentrism

The concept of psychocentrism, adopted as an analytical tool, critiques the problematic nature of MHFA premises and practices that automate, expedite, enforce, and normalize the global movement to psychiatrize human distress. Contesting MHFA’s international image as a benevolent, individual crisis intervention model, this essay discusses MHFA as a technique of neoliberal governance, moral surveillance, and social control, responsible for reinvigorating the psychiatric profession while dividing and demoting the populace.

Mental Health First Aid training: widely adopted, but is it evidence-based?

MHFA Australia estimates that over six million people worldwide have been trained, and that over 25 countries have now adopted MHFA training.

We found 21 studies including over 22,500 people that were relevant to our questions. Researchers worldwide had trialled MHFA in all sorts of settings, including schools, workplaces, and colleges. Disappointingly we only found five studies that had actually measured whether MHFA training improved mental health.

Our overall finding was that MHFA may result in little to no difference in the mental health of people in organizations that have adopted this training, but we had very little confidence in this result due to the problems with the evidence.

It is striking that a training program that has been so widely adopted is not better supported by solid evidence that it is effective in improving mental health. ... It is also concerning that there is no reliable evidence about whether it causes harm. 

Mental Health First Aid: Your Friendly Neighborhood Mental Illness Maker

It hit all the most stereotypical marks including a nod to the ‘chemical imbalance’ myth (absent the mentioning of the myth part, of course), ignored most environmental factors (homelessness, racism, poverty, and so on), and offered plentiful references to the value of psychiatric drugs (including some solid reassurances that at least the ‘anti-anxiety’ variety has supposedly “minimal side-effects”).

In fact, I might argue that it’s the guise of ‘teaching compassion’ (along with the few other benefits it might genuinely purport) that is precisely what makes it so dangerous for all the masked misinformation those benefits allow it to slip in unnoticed.  Haven’t we yet learned that teaching people that so much human distress boils down into illness does nothing to reduce ‘stigma,’ and in fact, makes discrimination worse?

Drug companies prey on children

Youth Mental Health First Training, sponsored by the National Council for Behavioral Health, is intended to enable teachers, parents and others in contact with young people to identify potential “mental illnesses” in order to facilitate early detection and treatment by our mental health care system.

Parents, teachers and other caretakers have been helping young people learn to cope with life’s vicissitudes since time immemorial. Why do they need help from the pharmaceutical companies to do this? Today, toddlers who throw temper tantrums are diagnosed with “bipolar disorder” and prescribed major tranquilizers, a process psychiatrist David Healy has likened to giving cancer chemotherapy to a child with a cold.

*Gallery Editor Note

Regarding the first article's statement that MHFA exists as "a tool to funnel more people into the mental health system without regard for efficacy" - many emotionally distressed individuals greatly disapprove of most to all mainstream mental health system resources. They are unhelpful to many. They actively harm many of us. These stories are widely suppressed but the voice of the failed grows louder every year, even while being wholesale ignored by the entities offering so-called "services". More on that topic can be found throughout this website's article archive and across the broader psychiatric survivor and mad justice community. 

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