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  1. #1
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    How to care for the actively mentally ill?

    For those who deal with psychiatric illnesses, the question of civil commitment in the event of severe, breakthrough symptoms, 1st time manifestations, street-drug induced reactions and the myriad other causes of active mental illness is vital. The rough national consensus is that one must be a danger to ones self or others in order to receive mental health services.

    Essentially, one has to have a plan to kill/hurt themselves or others to get help. Otherwise they are deemed to have the right to refuse treatment, to refuse medication and to refuse therapy. Is this fair, rational or just? Does an ill person have the ability to make sound decisions for themselve? Shouldn't they be COMPASSIONATELY restored to wellness so they can make their own decisions? Or does one have the right to be ill, on their own terms?

    I'm going to a training on the new civil commitment laws in Virginia, and am trying to collect my thoughts for this. I'd like y'alls thoughts on the matter...

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    The Site Administrator: Currently at home recovering from a couple of strokes,please contact my assistnt admins for forum issues Tom Stormcrowe's Avatar
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    UNtil and unless there is a danger to self or others, then yeah, their civil rights need to be respected. The main point is that how well they are accommodating their symptoms and adapting is very subjective when viewed by others.

    Define the difference between a disorder and mere eccentricity..
    on light duty due to illness; please contact my assistants for forum issues. They are Siu Blue Wind, or CbadRider or the other 3 star folk. I am currently at home recovering from a couple of strokes. I am making good progress, happily.


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    i think that one only has access to the ability to understand ones civil rights if they are healthy (psychiatrically). If a person is not grounded (roughly) in the agreed upon reality we all live in, they may need help. If a person cannot clothe or feed themselves, they need help. If a person is living in constant fear of (insert paranoia here) then they should be helped.
    however, angry spouses, relatives who just think that "johnny" is being difficult and eccentric, should be ignored by trained psychiatric professionals.

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    by the by, to cma, "agreed upon reality" means the world where a moving car may be lethal, not transport to the dimension of fun.

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    Lanky Lass East Hill's Avatar
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    What if you are like me? When I have a migraine I apparently go into a dissociative fugue state for approximately 20 minutes after giving myself my shot of Imitrex.

    I could potentially be considered mentally ill for that 20 minutes, but not before or after.

    Should my civil rights be infringed?

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    I'm not the arbiter of should. i'm really sorry the fugue state happens. my opinion is that maybe a caring friend/family member could help out @ those times... but if I (i mean i) were to be in similar boots, and do something wrong/illegal/dangerous (to self especially), someone might hold me liable. so, being careful and taking responsibility for self (getting people to help out) would be my way to go...

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    Nookular Free Since '03 kingofchimps's Avatar
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    tough call

    My brother has been diagnosed as bi-polar and is no longer seeking/getting help. So the emails I get from him are a bit out there. When he has 'episodes', it can get really bad. He has made threats to myself and my parents, plus veiled threats about my sister's kids. Since then, I no longer speak to him (until he gets some treatment).

    So anyway - do I think he'll follow through with threats? Hopefully not, but when he's 'out there', he's not the person I grew up with. Completely nuts. So very capable indeed. And there's absolutely nothing we can do to 'make' him get help/get committed.

    So in my case, he really does need to get help and will not go. I would force him as I want to see him hopefully get well and rejoin society. But I see how that could be abused, as where do you draw the line? How nuts is nuts?

    Can someone create a test?

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    Senior Member randya's Avatar
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    I plead the fifth amendment.


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    Quote Originally Posted by kingofchimps View Post
    tough call

    My brother has been diagnosed as bi-polar and is no longer seeking/getting help. So the emails I get from him are a bit out there. When he has 'episodes', it can get really bad. He has made threats to myself and my parents, plus veiled threats about my sister's kids. Since then, I no longer speak to him (until he gets some treatment).

    So anyway - do I think he'll follow through with threats? Hopefully not, but when he's 'out there', he's not the person I grew up with. Completely nuts. So very capable indeed. And there's absolutely nothing we can do to 'make' him get help/get committed.

    So in my case, he really does need to get help and will not go. I would force him as I want to see him hopefully get well and rejoin society. But I see how that could be abused, as where do you draw the line? How nuts is nuts?

    Can someone create a test?
    If a person is well enough the could take the MMPI, some psychologist swear by it in terms of figuring out if a person is well or not. it measures lots of stuff, like psychopathy ( level of psychosis) and much more. Person tests high on psychosis, person may need to be helped. but if a person isn't well enough to be tested, then observational diagnosis might be needed.
    but yeah, oh yeah could it be abused.
    people do try to commit people all the time.
    political climates (see va. post cho) make peoples commitment finger itchy.
    its so hard to see loved ones ill.
    one way to create a "line" is to use consumers of mental health services who have their illnesses under control, along w/psychiatrist and psychologist, family members and interested compassionate parties convene to draw the line....
    there is a "recovery movement" in the mental health field that is beginning to recognize the value of patients who advocate for their bretheren.
    Last edited by evrknotfailsafe; 05-29-08 at 12:35 PM. Reason: misspelling

  10. #10
    Prefers Cicero cooker's Avatar
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    Quote Originally Posted by East Hill View Post
    I could potentially considered mentally ill for that 20 minutes, but not before or after.

    Should my civil rights be infringed?
    Are you a danger to yourself or others at that time?

    To the OP:

    The law in Ontario is that you can be taken to a hospital for up to a 72 hour assessment if you are deemed by a physician, who has seen you face to face within the past week, to be suffering from a mental illness and in imminent danger of harm to self or others including harm due to being unable to care for yourself such that it creates imminent risk. If no physician has seen you, your family or another party can ask a Justice of the Peace to order a 72 hour assessment, and would need pretty convincing evidence or testimony to make that happen. During that 72 hours, if you are further assessed by a physician and deemed still to be at risk, the involuntary hospitalization can be extended. There is a built in procedure for the patient to receive legal advice, and assistance with appealing their involuntary status to a committee composed of a lay person, a lawyer and an independent psychiatrist.

    Competency to consent to treatment is a separate issue. You could be involuntarily hospitalized but considered competent to refuse treatment, or alternatively not competent to make treatment decisions but not at imminent risk of harm and therefore not subject to involuntary admission. Competency decision also have a built in appeal mechanism.

    The question of whether this violates civil rights is determined by the legislative and judicial systems, not the health care system. In fact physicians don't necessarily want to be the ones deciding if someone needs to be involuntarily hospitalized, but are put in that position by the law.
    Last edited by cooker; 05-29-08 at 12:41 PM.

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    Quote Originally Posted by evrknotfailsafe View Post
    i think that one only has access to the ability to understand ones civil rights if they are healthy (psychiatrically). If a person is not grounded (roughly) in the agreed upon reality we all live in, they may need help. If a person cannot clothe or feed themselves, they need help. If a person is living in constant fear of (insert paranoia here) then they should be helped.
    however, angry spouses, relatives who just think that "johnny" is being difficult and eccentric, should be ignored by trained psychiatric professionals.
    Political and legal right have nothing to do with either health or cognitive ability. If you are sick or unconscious, your rights are still protected.

    Involuntary psychiatric commitment has been historically abused so many different ways that we now err on the side of caution. From a moral and political standpoint, I think this is a good thing. Giving the state the power to involuntarily commit individuals is a bad idea.

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    Here in Washington, the standards for a 72 hour hold, 14 day hold or involuntary commitment are such that it is exceedingly difficult to place someone in treatment against their will. Without commenting either way as to the appropriateness of these standards, we see a lot of patients who 'die with their rights on' as we say. In other words, the patient did not meet standards for a hold, would not agree to treatment, and then promptly go out and kill themselves, die from exposure or the like. They died with their rights fully protected but they died nonetheless.
    Regards, MillCreek
    Snohomish County, Washington USA

  13. #13
    Tiocfáidh ár Lá jfmckenna's Avatar
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    Quote Originally Posted by Tom Stormcrowe View Post
    UNtil and unless there is a danger to self or others, then yeah, their civil rights need to be respected. The main point is that how well they are accommodating their symptoms and adapting is very subjective when viewed by others.

    Define the difference between a disorder and mere eccentricity..
    Well this is very interesting indeed. And if you (OP) are going to attend training in Virginia surely they will bring up the case of Seung-Hui Cho who massacred 32 people at VT last year. It's near and dear to my heart since I knew some one killed and it happened right down the street from me. This guy was in my untrained but commonsensical opinion very mentally ill (I read his official biography compiled by the University and police). The failure point in this incident were that the laws of Virginia at the time aloud some one with previously treated mental illness to purchase a ***. Most folks in favour of *** ownership view it as a right as a citizen. So in this case the rights of one citizen were preserved but the lives of 32 were taken not to mention the 25 wounded.

    So it's walking a fine line indeed. Mental illness is still so misunderstood that professionals and common folk a like don't really know how to handle it. When does the state have the right to come in? Well for one I hope that it is in restricting rights to things like *** ownership, licenses to drive, ect... depending on the condition. But if it cannot be proven that the individual is a threat to others and or them selves then the state can't take action like forced hospitalization and what not. It's that proof thats tricky. In the case of Cho the guy literally never ever spoke to any one his entire life except when absolutely forced to and even then it was strained and brief. Should the State step in and take action because a child doesn't speak? I dunno? Should the parents be held responsible for not getting help for there child? I dunno.

  14. #14
    Senior Member hanshananigan's Avatar
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    *poof*
    Last edited by hanshananigan; 05-29-08 at 03:22 PM. Reason: not worth it
    Hi!

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    Lanky Lass East Hill's Avatar
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    Quote Originally Posted by cooker View Post
    Are you a danger to yourself or others at that time?
    Possibly. I normally tried to remain still, and undisturbed for that twenty minutes. However, I had on numerous occasions tried to work through this period, and apparently although I seemed competent to others, I was unable to remember anything which had happened. So, I could have hurt someone or myself, and never known it.


    By the way, the discovery of this caused my medication to be changed, and I no longer go through the fugue state (just in case anyone was wondering).

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  16. #16
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    Quote Originally Posted by evrknotfailsafe View Post
    For those who deal with psychiatric illnesses, the question of civil commitment in the event of severe, breakthrough symptoms, 1st time manifestations, street-drug induced reactions and the myriad other causes of active mental illness is vital. The rough national consensus is that one must be a danger to ones self or others in order to receive mental health services.

    Essentially, one has to have a plan to kill/hurt themselves or others to get help. Otherwise they are deemed to have the right to refuse treatment, to refuse medication and to refuse therapy. Is this fair, rational or just? Does an ill person have the ability to make sound decisions for themselve? Shouldn't they be COMPASSIONATELY restored to wellness so they can make their own decisions? Or does one have the right to be ill, on their own terms?

    I'm going to a training on the new civil commitment laws in Virginia, and am trying to collect my thoughts for this. I'd like y'alls thoughts on the matter...
    This is a very fuzzy issue indeed. But I'd agree with the sensible replies so far in this thread. You know the ones.

    It's going into dangerous territory for the state to mandate control of a person's health, thus should be done only in extraordinary circumstances such as when they pose a danger to others. I don't know what you mean by them being compassionately restored to wellness. Is that not a subjective thing as well?

    People have a right to harm themselves. I would say that it comes to a state where someone should be forcibly cared for when they are harming themselves and are not wholly sane. And that last bit is again somewhat difficult to prove. I leave it to professionals to have more quantifiable measures to judge these things, and trust that we have come a long way from the good old days when anyone acting strange was deemed insane.
    Quote Originally Posted by KrisPistofferson View Post
    Did you just say "minarchist?" I'm going to start a 10-page vaginathon because only Libertarians can define Libertarianism. Also, you're mean.

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    Quote Originally Posted by Nicodemus View Post
    This is a very fuzzy issue indeed. But I'd agree with the sensible replies so far in this thread. You know the ones.

    It's going into dangerous territory for the state to mandate control of a person's health, thus should be done only in extraordinary circumstances such as when they pose a danger to others. I don't know what you mean by them being compassionately restored to wellness. Is that not a subjective thing as well?

    People have a right to harm themselves. I would say that it comes to a state where someone should be forcibly cared for when they are harming themselves and are not wholly sane. And that last bit is again somewhat difficult to prove. I leave it to professionals to have more quantifiable measures to judge these things, and trust that we have come a long way from the good old days when anyone acting strange was deemed insane.
    I wouldn't say giving the state complete control is the ideal or idea. Virginias Civil Commitment laws are very similar to Ontarios. George Mason University Law had a program where law students acted as representatives for the families and friends of people whom they were trying to commit. This program ended when a particular professor left, but the intent was to give compassionate people even footing with a person resisting treatment. The patient is automatically provided with a lawyer who advocates on their behalf. The family/friend has, themselves. A judge then listens to each side. One side w/a lawyer, the other, often an emotional plea. This occurs within 24 of a forced hospitalization. If the patient chooses, he/she can choose to waive the hearing and only have to stay 72 total hours. if they are committed, the stay varies. Families and friends deserve more of a voice when trying to help someone they have known, and now isn't the same person because of mental illness. They deserve the opportunity to help someone who is exhibiting signs of helplessness. And yeah, someone can self harm or harm others w/their rights fully intact. Until they go to jail, forensic hospitals or worse...

    (I don't really want to deal w/this, but I agree w/kevorkian. people can end their suffering. but if someone is cutting, do they do it because its their right, or to relieve pain. what if there were other ways (dialectical therapies) to alleviate this. I had a friend, who used to sit on the edge of her bed gripping the mattress all night to keep from cutting. she also was a deans list student @ the same time, and a wonderful writer. she may have been sane, could do what she wanted, but she didn't seem to want to hurt herself....) i can't do more on this one............. dunno ........

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    Quote Originally Posted by jfmckenna View Post
    Well this is very interesting indeed. And if you (OP) are going to attend training in Virginia surely they will bring up the case of Seung-Hui Cho who massacred 32 people at VT last year. It's near and dear to my heart since I knew some one killed and it happened right down the street from me. This guy was in my untrained but commonsensical opinion very mentally ill (I read his official biography compiled by the University and police). The failure point in this incident were that the laws of Virginia at the time aloud some one with previously treated mental illness to purchase a ***. Most folks in favour of *** ownership view it as a right as a citizen. So in this case the rights of one citizen were preserved but the lives of 32 were taken not to mention the 25 wounded.

    So it's walking a fine line indeed. Mental illness is still so misunderstood that professionals and common folk a like don't really know how to handle it. When does the state have the right to come in? Well for one I hope that it is in restricting rights to things like *** ownership, licenses to drive, ect... depending on the condition. But if it cannot be proven that the individual is a threat to others and or them selves then the state can't take action like forced hospitalization and what not. It's that proof thats tricky. In the case of Cho the guy literally never ever spoke to any one his entire life except when absolutely forced to and even then it was strained and brief. Should the State step in and take action because a child doesn't speak? I dunno? Should the parents be held responsible for not getting help for there child? I dunno.

    I hope that we do discuss Cho. Sorry for your loss. On the real.
    I feel that people need to have the opportunity to be well, and make their own decisions. People have a right to protect themselves from others as well, societally speaking ( my view ). If we can offer help to people who are exhibiting all the signs of being ill, or masking them ineffectively, they could be helped.

    I haven't read to much about Cho, outside of people politicking on his name. I feel he needed help but wonder how complicit an overloaded, unconcerned mental health system was in the atrocity. Reforms need to be made in the mental health system in order to make them "compassionate" and effective...

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    I think the mental health system has swung from comitting people left and right to absolutely having zero interest in people, other than what type of health insurance is carried. Funding for public mental health resources in most areas has been cut, then cut again, and instead of comitting the mentally ill, they are arrested and tossed in jail then moved to prisons, with more charges pressed the more they say back. For example, a mentally ill person making random threats while in a fit will get 20 to life for felony charges instead of treatment.

    Basically instead of comitting people to sanitariums for the rest of their lives, the US prison system has replaced that aspect.

  20. #20
    Senior Member Buglady's Avatar
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    Quote Originally Posted by evrknotfailsafe View Post
    Does an ill person have the ability to make sound decisions for themselve? Shouldn't they be COMPASSIONATELY restored to wellness so they can make their own decisions? Or does one have the right to be ill, on their own terms?
    There has been much made of this over the last twenty years or so. It's rather telling, in my opinion, that almost everyone arguing the civil rights aspect has come from a background of law, rather than psychology or psychiatry, and the actual psychiatrists involved in that movement are few in number and not in active practice (Thomas Szazs refused new patients who had been "previously diagnosed.")

    I have strong feelings about it. I have dealt with mental illness both personally (severe anxiety disorder, ADHD, depression), in my immediate family (same), and in my circle of loved ones (above, plus intermittent explosive disorder, dissociative identity disorder, a couple of different personality disorders, PTSD, a psychotic episode that was thankfully never repeated). The thing is that mental illness TAKES AWAY one's capacity to decide - when you're in the pit of depression, you cannot imagine a world that contains light. How, then, can one ask a person to make a decision about what kind of light they want? It's a meaningless concept.

    I am not the same person as I was when I was at the worst of my depression. I am a stronger, more whole person. Depression and anxiety hijacked my life and my soul. Anyone speaking to me during that period was really speaking to a distorted, incomplete version of me. If they had left me in that pit, because that distorted "I" said I wanted to be there, that would have been tantamount to murder. These are strong words, I know. They may not be strong enough.

    There is an insidious element also of blaming the victim in the "let them choose" argument. By saying to ourselves, well, that person whose reality is evidently a very frightening and distorted one (based on the fact they're yelling at an invisible person), they must not really be that bad off, after all, they COULD get treament, they've obviously decided not to. NO. It is not that simple, and nobody gets away that easily. We have a responsibility to each other, as human beings, to help each other when the world is tough and frightening. That is part of what it means to be human. To turn away from suffering, to clutch at the excuse that it's a "choice," is at best cowardly and at worst outright cruel.

    If you have not read it already, I highly recommend the book "Madness in the streets: how psychiatry and the law abandoned the mentally ill."

    Due disclosure: I am now studying to become a counselling psychologist. I hope also to work in an advocacy position for mental health care.

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    Quote Originally Posted by Buglady View Post
    There has been much made of this over the last twenty years or so. It's rather telling, in my opinion, that almost everyone arguing the civil rights aspect has come from a background of law, rather than psychology or psychiatry, and the actual psychiatrists involved in that movement are few in number and not in active practice (Thomas Szazs refused new patients who had been "previously diagnosed.")

    I have strong feelings about it. I have dealt with mental illness both personally (severe anxiety disorder, ADHD, depression), in my immediate family (same), and in my circle of loved ones (above, plus intermittent explosive disorder, dissociative identity disorder, a couple of different personality disorders, PTSD, a psychotic episode that was thankfully never repeated). The thing is that mental illness TAKES AWAY one's capacity to decide - when you're in the pit of depression, you cannot imagine a world that contains light. How, then, can one ask a person to make a decision about what kind of light they want? It's a meaningless concept.

    I am not the same person as I was when I was at the worst of my depression. I am a stronger, more whole person. Depression and anxiety hijacked my life and my soul. Anyone speaking to me during that period was really speaking to a distorted, incomplete version of me. If they had left me in that pit, because that distorted "I" said I wanted to be there, that would have been tantamount to murder. These are strong words, I know. They may not be strong enough.

    There is an insidious element also of blaming the victim in the "let them choose" argument. By saying to ourselves, well, that person whose reality is evidently a very frightening and distorted one (based on the fact they're yelling at an invisible person), they must not really be that bad off, after all, they COULD get treament, they've obviously decided not to. NO. It is not that simple, and nobody gets away that easily. We have a responsibility to each other, as human beings, to help each other when the world is tough and frightening. That is part of what it means to be human. To turn away from suffering, to clutch at the excuse that it's a "choice," is at best cowardly and at worst outright cruel.

    If you have not read it already, I highly recommend the book "Madness in the streets: how psychiatry and the law abandoned the mentally ill."

    Due disclosure: I am now studying to become a counselling psychologist. I hope also to work in an advocacy position for mental health care.
    + a lot

    When I had a bad med reaction that nearly killed me several years ago, I went through a time like you described above before I came to my senses and was able to start getting my life back in order.

    The problem is that I have to convince people that knew me then that I'm not psycho. :/ Its something I'm embarrased about, but life goes on, and I'm about 6-7 months away from graduating college, which is a major thing, and hopefully I should have a fresh start in the job market... as well as be able to use a decade of IT experience as well.

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    Pete Early wrote "Crazy", a Fathers journey through the mental health system. A former Washington Post staff writer, his son became ill and ended up in a forensic hospital. This is his case study of the mental health system. He states that on the psych floor of the Miami Dade Jail, there were 92 patients when he visited. The treating psychiatrist spent 12.7 seconds (average) speaking to every patient. Yes the jails are the new "sanitariums".

    cool on becoming a counseling psychologist (therapist?), Buglady. I'm doing the same, and work as a coordinator for a wellness center for the mentally ill. i've also had a ton of losses, and my own problems....

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    Quote Originally Posted by mlts22 View Post
    + a lot

    When I had a bad med reaction that nearly killed me several years ago, I went through a time like you described above before I came to my senses and was able to start getting my life back in order.

    The problem is that I have to convince people that knew me then that I'm not psycho. :/ Its something I'm embarrased about, but life goes on, and I'm about 6-7 months away from graduating college, which is a major thing, and hopefully I should have a fresh start in the job market... as well as be able to use a decade of IT experience as well.

    I've had every diagnosis in the book, including the current "in remission". Stigma sucks.
    Even in this forum I'm a little guarded. People often don't want to understand that a neurochemical imbalance sometimes has influenced my behavior, not a defect of character or a weakness of mind.
    I've been taught that everyone has to find their own way of fighting stigma - regaining their self respect and the respect of others (even though it shouldn't have been lost based on uncontrollable reactions...). some work in the mental health field, helping others. some contribute financially. others find their own comfort zones. and some are just good, decent people in the day to day grind of life. whatever the path, the end is just. @ least in my book...

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    Senior Member Buglady's Avatar
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    Evrknotfailsafe, have you read "The Mark of Shame," by Hinshaw? It's a really interesting look at the social history and the social psychology of stigmatizing mental illness.

    http://www.amazon.com/Mark-Shame-Sti..._sim_b_title_4

    (Yes, I read a LOT. It's been my way of dealing with things. Eventually I figured, hey, I've read more than most actual grad students... maybe I should put it to practical use... )

    I still have a lot of vulnerabilities, but for me the cost of keeping emotions hidden was worse than that of showing them. So I took all my filters off and I am VERY open about where I am, where I've been, and so on. It's worked out well so far; people have commented that they feel honoured by my openness. As a way to learn compassion, such experiences are very effective, though definitely not the top recommendation on my list.

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    B-lady, i've not read either of the books you've mentioned, but I'll definitely take your recommendation. Experience is the best experience. damn good learning tool as well. i bet your insight is better than 95% of clinicians. just because you've come out on the otherside and want to give back....
    maybe me too...

    "we do not wish to forget the past, nor wish to shut the door on it" so that our past can help another.

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