Exit Instructions

Upon leaving for the 2×2 group, the M.C.’s should say:

The organization of a system like Mental Health establishes expectations of performance and defines thereby the moral character of the system’s message. Qualitative upgrading of the work of the mental health system thus calls for a profound sharpening of the moral focus of the discourse of treatment. In a client-driven system, the clients work to become better organized and better at informing the system as to the standing of the treatment process. This calls for a system of administrative inclusion which can overcome the tendencies to bureaucratic isolation. The target is a more sensitive system in dialogue with independent client organization, a kind of ‘union recognition’ arrangement.

The dominant moral dilemma of the mental health environment today is the fact that discrimination is legally and theoretically sanctioned. The duress of the behavior management system oppresses the clients and renders the dialogue of clients and providers unbalanced. The clients experience this as degrading and an enduring drag on their work to construct real lives and live equally with others. Inasmuch as the imbalance of client-provider relations is not immediately rectifiable, the obligation falls on us to transcend this dilemma in the way we talk with each other. We need to privilege and sanction a conversation on discrimination, a ‘negotiation’ in the ‘union recognition’ model, which will support authentic dialogue.

We need to rework the dialogical ‘chasm’ between client and provider today and struggle to overcome the effects of the discriminatory context. The providers see in the structure of the conversation the problem of keeping things safe, but the clients typically experience the interaction as abusive and traumatizing. We will present an anecdotal case study of the experience of ‘trauma of treatment’. We will then present a possible model for how service delivery can be done in a way that is informed by this issue and finds a productive way through it. A persistent focus on ‘trauma of treatment’ has the potential for the continuing evolution of honest, meaningful, and uplifting provider-client interactions.

To render solid and coherent the moral imperative of this reformed treatment modality for the clients requires a persistent attention to reinforcing the values of the client culture. Learning how to manage the experience of exceptional sensitivity and madness requires that people take on the poetics necessary to face chaotic situations. The alternative to privileging rage (‘Bedlam’) or privileging control (‘Gulag’) is a kind of ‘middle way’ which we call ‘client psychology’. This leads to a philosophy of ‘accountability’ based on earning respect by way of adherence to the values of the client culture. In order for the ‘union recognition’ model to flourish, we must support the principle of independent client organizing on the basis of social accountability.