[NYAPRS Enews] Vega: Self-Determination and Responsibility in Transformation

[Harvey Rosenthal]

Self-Determination and Responsibility in Transformation

Eduardo Vega, M.A., Executive Director, Mental Health Association of San
Francisco, Calif.

Recovery to Practice E News  April 29, 2011

 

When it comes to services and supports for people with mental health
challenges, implementing the values of self-determination and personal
responsibility presents both social and structural dilemmas. The issues
are central to recovery but challenging because, to many people, they
are paradoxical in the context of mental health services. 

 

Because of personal and social bias and stigma, many people feel, as I
once did, that seeking services or help represents giving up one's
self-determination and personal responsibility-that you become a "mental
patient" only when you are willing to say that you do not trust
yourself, and you are willing to give responsibility for your life to
someone else. By this viewpoint, simply by becoming a client, there is a
very real possibility that you are giving away the very things that can
help you recover. 

 

Research has shown that not everyone is so subject to stigma as I was,
and that many people's self-image is not tarnished by being a client.
For others, though, the moment they walk-or are taken-into a treatment
facility as a client, their concept of themselves as self-determining
people who are responsible for their own lives is fundamentally altered.


 

So we have the consumers, who may feel that their self-determination and
personal responsibility have failed them and who are looking to
professionals to make up for that failure. And we have the mental health
professionals and systems, who are given institutional power-and, I
would argue, a surplus of "perceived" power-over clients' lives by our
systems, society, families, and more. 

 

Power and responsibility go hand in hand, and self-determination exists
squarely at their center. So the crucial role that self-determination
plays in recovery must be made clearer for both clients (who may think
they are giving it away) and for mental health professionals (who are
inducted into a system in which they feel both the authority and the
responsibility to determine which decisions clients may make for
themselves). 

 

At root, many of our debates about how to balance the roles of mental
health professionals and clients rights and dignity center on two
issues: power over consumer's lives, and blame for the hope-robbing
stigma surrounding mental illness that undermines self-determination and
recovery. The mental health service provider system, because it is right
in between the consumer and society, probably gets too much of both of
these. 

 

It is too easy, though, to overlook the role of culture and society-the
effect of public stigma and the associations we tend to make between
mental illness symptoms and irresponsibility. We cannot escape, nor
should we avoid, the truth that our society-both in passive ways and
through the very active mechanisms of public policy, funding, and
more-is profoundly ambivalent about mental health and mental illness and
the people affected by it. Yes, power and responsibility are taken by
individuals, professionals, and systems-but in many ways, it is society
that gives it. 

 

Transformation to a recovery reality means each piece must be actively
changing-society's biased views; mental health systems' tendency to
support these view, avoid risk, or manage people through restrictions on
personal choices for consumers; and our (consumers') impulses to give
away more self-determination and thus more responsibility than we
should, thinking that our personal internal resources are not relevant
or insufficient. For recovery transformation to happen, action for
change in all three of these areas needs to happen, simultaneously and
continually. 

 

We can clarify how to this might occur by examining the role of each of
these players-the consumer, the mental health provider system, and
society-in preserving hope/countering stigma, providing truly beneficial
services and supports grounded in the principles of recovery, and
advancing opportunities for empowerment. Further, having clear examples
of practices that empower people and foster self-determination will
allow us to more easily perceive a different situation-one that aligns
with our program, advocate, and activist roles. (To view a table that
offers some examples of empowerment practices that consumers, mental
health providers, and society can implement, click here.) 

 

Power is needed to recover. Indeed, power over one's own life is the
only practice for an empowered life, and recovery is not real without
it. This does not mean that we live without symptoms, distress, or even
disability. It does mean, however, that systems, mental health
professionals, and clients must work actively together to continually
push power, choice, and responsibility back to the clients. And we must
collaborate to change the social environment, to engage in powerful
dialogue with our communities, our leaders, and social institutions to
reinforce the truth that mental health is a part of everyone's life and
that mental health challenges are, if not real positive opportunities,
at least a core piece of our human nature. 

 

My feeling is that in the end, recovery is about personal dignity. In
our culture, this is synonymous with self-determination and personal
responsibility. If we support the notion that mental health symptoms
degrade people and deprive them of these in an enduring way, we are
committing people to death and despair. But we can work to change this,
by shifting what we are doing and how we are doing it. We can support
this transformation by acknowledging our own role and taking the
challenge of personal responsibility one step further by embracing the
role of a "transformation agent" who seeks never to take power from
others, but to advance the effective, positive, and just use of it
everywhere. 

 

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