The metaphor is and has been a useful technique for many of us trying to discuss issues concerning mental illness. For many years the metaphor was an easy way to present the depressing, often monstrous conditions associated with those suffering mental illnesses.
For example, during the 1940′s both print and film presented mental illness and its “treatment” utilizing the metaphor of “snake pit”. In the film “Snake Pit,” scenes of patients milling around the ward in a state mental hospital is alternately interposed with scenes of snakes also intermingling within each other in an equally haphazard way. The viewer is left with a decisive picture presenting the hopelessness and helplessness of those incarcerated in mental institutions. This view was further supported with the equally depressing picture presented in detail by Albert Deutsch in his journalistic expose series published in the PM Newspaper.
In 1969, Barbara Benziger coined a new metaphor for her own battle with mental illness. In her book, “A Prison of My Mind,” she movingly states: “I am locking myself up in a prison of my own making, a horrible painful prison, to which I have no key.” Her struggle to find that key and regain her “freedom” is made all the more clear by her use of this strong metaphor.
During this same time period Ken Kesey’s book “One Flew Over the Cuckoo’s Nest,” a psychiatric ward becomes a metaphor for the oppressive nature of American society. The medication is a way of controlling and keeping the patients stuck in the environment. The word “cuckoo” has been a term long identified with being insane. The cuckoo bird often lays eggs in another’s nest, thus providing Kesey with his metaphor.
In 1944, however, the beginnings of a more positive approach were underway. Interestingly enough this approach was initiated at Rockland (NY) State Hospital – at the same time and site identified by Deutsch in his PM exposé. A small group of patients formed the WANA (We Are Not Alone) Society, based on the newly identified AA model with its concept of self-help through mutual help.
As WANA Society patients were discharged from hospital, they continued to meet in New York City, leading to the opening of Fountain House in 1948. This name was the direct result of a different metaphor. In the back patio of Fountain House the fresh clean water spraying from a fountain provided both a non-psychiatric and positive image for the newly registered group of members.
The notion of membership led to the use of another positive metaphor. In describing Fountain House to both professional and community groups, the term “Clubhouse” was introduced. Typically, a clubhouse encourages work on projects related to its members own interests. It aims to create a sense of community in which members work together with support from mentors. A clubhouse is also dedicated to offering resources and opportunities to those who would not otherwise have access to them. Usually one thinks of a clubhouse as for the young, but in this case many individuals have been robbed of their youth and have had little contact with society at large. To a large measure this interpretation applies to both Fountain House and the some 350 similar community-based programs certified as clubhouses by the ICCD.
Over the years, additional metaphors have emerged which represent this move to more positive view of what is possible for those suffering through mental illnesses and attempting to achieve recovery.
In his remarks to the Fountain House community in 1990, the former Green Bay Packer, all-star Lionel Aldridge invoked the metaphor of football as a way of helping to understand and to view mental illness.
The reality that we would experience as football players if we allowed ourselves to experience ourselves as losers is that we would experience more losing as football players and I think the same thing applies here. Football is a game of inches and it becomes very difficult to win. The harder it becomes to win the more particular you have to be in participation.
They tell me schizophrenia is something they have no cure for. I’ve got it, I know I’m schizophrenic; don’t be telling me there’s no cure for it. You haven’t heard from me yet. I’ve had this since 1974; that gives me 16 years of experience with this illness. If you spend 16 years on anything you’re going to learn something about it.
So the experts went to school to learn about us. But what they learned is that all schizophrenics are about the same, and maybe the most they will say is that there are a variety of kinds of schizophrenia, they still aren’t able to say that each individual is uniquely sick and that his recovery process has to be as unique as his illness. If you took 10 people up here who have recovered from schizophrenia, they would have all arrived here from a different route because we are that unique.
But I think it is us, we the people who have it, who have the keys to recovery and with me, I like to get real personal and real responsible and say I created it, and I have the power to heal it. I’d like to see somebody join me in that thinking.
Over the years the metaphor has been a useful technique for many of us. For me, some of the most interesting interactions with deaf members focused on the conveying the core values and purposes of Fountain House using metaphors that they could understand. For example, presenting the notion of self-help through mutual-help to a group of deaf members was going absolutely nowhere, until somebody thought to focus on the table lamp in the room. By demonstrating that the light would only go on if the bulb, the cord, the prong, the switch, the base and the wall socket worked together, the group all suddenly smiled and figuratively gave the “aha” signal that they understood.
One member and I decided early on to identify our relationship in terms of a metaphor. He became the “Ace” and I, the “Coach”. He went on to describe his identification of Fountain House in other metaphoric terms:
I realized in a moment of enlightenment that the whole clubhouse was like one huge gymnasium for function, one great opportunity center, one huge arena for transformation. The more I did the more responsibility and the more work I took on, the stronger and more independent I became.
The story of the racehorse Seabiscuit has provided a useful metaphor for a number of people. In brief, Seabiscuit, while the offspring of great genes (Man o’ War), was considered a failure by the racing community because of his small size, odd gait, overeating, laziness and hostile behavior toward his handlers. That was the case until he came to the attention of an unusual trainer (Tom Smith), and later an equally unusual owner (Charles Howard) and a third person – a jockey (Red Pollard). Each had flaws that had held them back from achieving success if acting alone. When they combined their efforts around the horse, the result was the creation of the greatest money making racehorse of all time, controlling for inflation.
Summarizing this phenomenon historian David McCullough stated in the movie “Seabiscuit”:
It is a very American idea, that hidden inside you is huge potential, that is untapped or that is undiscovered, if only people had the understanding to explore it or to nurture it a little.
Drawing the connection to rehabilitation, combining a consumer (Seabiscuit) with a program (owner), a worker (jockey) and a clinician (trainer) can result in great success. One example of this relationship is provided by the rehabilitation alliance. In the early 1990’s, Fountain House contracted with the St. Luke’s/Roosevelt Medical Center to make psychiatric services more readily available to homeless members at a nearby storefront. The arrangement called for the meeting together of a member, that member’s staff worker and a psychiatrist to assess progress and plan for the future.
Initially, the rehabilitation alliance was presented in terms of a three-legged stool. It is easy to see that three legs make for a more stable piece than a two-legged one. An early basis for this paradigm is identified:
If we genuinely believe our highest priority is the full social and vocational reintegration of the ‘mentally ill,’ we would do well to remember how very important both professional and nonprofessional resources can be to the ‘non-mentally ill.’ Individuals in the fields of psychiatry, psychology, law, social work, mental health and advocacy can work together with patients in hospitals and former patients in the community on the basis of their aligned needs for productive, creative activities. In this endeavor, the patient’s rights to refusal share equally with rights to give assent. Professionals and patients united, as colleagues, will best ensure both rights are upheld.
One member specifically identifies this alliance in his speech at a regional clubhouse seminar held in Hong Kong:
Dr. Aquila, Tom Malamud and myself made a presentation about the rehabilitation alliance that we practice together. The three of us meet together once every four weeks. Dr. Aquila is my psychopharmacologist and Tom is my counselor. The benefit to the doctor and myself is that we get Tom’s added input at each session. A rehabilitation alliance can consist of any group of people meeting together at the behest of the consumer. My alliance is helping me continue on my full-time job as a peer advocate. I had never before held a job for a whole year, and now I have been working for almost three years.
Another member assesses the effect of the rehabilitation alliance this way:
Before this new doctor, there wasn’t such communication between my other doctor and Fountain House. In the past my medication continued to get raised without my input and without helping me. After my hospitalization…I didn’t do too well.
My new doctor, with the input of my staff worker, started me on a new medicine…, which helped me. Finally, I was feeling good and ready toget on with my life. The fact of the matter is I did just that.
It is clear that metaphors have proven to be extremely useful in discussing a variety of issuesrelating to the care, treatment and recovery of individuals with mental illness. We at TandC Associates would be most interested in hearing of other metaphors that have been helpful.
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