“I am proposing a new approach to mental illness and to mental retardation. This approach is designed, in large measure, to use Federal resources to stimulate state, local, and private action. When carried out, reliance on the cold mercy of custodial isolation will be supplanted by the open warmth of community concern and capability. Emphasis on prevention, treatment, and rehabilitation will be substituted for a desultory interest in confining patients in an institution to wither away.” President John Fitzgerald Kennedy
In 1965, Congress approved the Medicaid Act, which offered higher reimbursement rates for community-based care, later the Supplemental Security Income (SSI) program provided financial support for people with mental illness who were trying to live in the community.
Passed in 1967, the Lanterman Petris Short Act prohibits involuntary civil commitments for the mentally ill in California unless a person is an immediate danger to himself and others, or is gravely disabled, generally defined as unable to access or make use of food and shelter.
The Community Mental Health System was supposed to replace or serve as an adjunct to State Hospitals.
By 1967 most cities in the United States had an active community mental health system.
Director Comey may not have committed a crime but he was careless if not negligent in the way he chose to handle a matter that was of the utmost importance to the American People and to our faith in the integrity of the political process.
The question is whether Comey is woman enough to apologize for his mistake as Hillary Clinton did.
This month’s featured blogger is writer and Mental Health Advocate
Kitt O’Malley. In this interview we talk about internalized stigma, learning
to accept and taking up the challenge of advocating for change.
Thank you for accepting my invitation Kitt, it’s an honor to have you as November’s featured blogger on Art by Rob Goldstein.
Tell the reader a little about where you are from and how that shaped your worldview.
As a child, I moved back and forth overseas (living five years in Saudi Arabia) and between the East and West Coasts. As an adult, I moved back and forth from Southern California and the San Francisco Bay Area, with one year in Eugene, Oregon and a couple of years in the Mojave Desert.
Moving often throughout my life has both positively and negatively affected me. I’m flexible, for I’ve lived in different cultures and subcultures. I’ve lived most of my life feeling like an outsider. Though, now, as a mature adult raising an adolescent, I see that everyone – no matter what culture, race, age, socioeconomic status, belief system, or diagnosis – has more in common than not. We all have the same basic needs – food, shelter, health (physical and mental), and love (a basic need of mammals to thrive).
What kind of psychotherapy did you practice?
I was educated in psychodynamic and family systems theory, with a sociopolitical slant. New College of California was a left-wing school – appropriate for someone planning on practicing in the Bay Area (well, at least San Francisco, Berkeley, or Oakland). To prepare for licensure, everyone must understand the basics about the major theories and modalities, so after graduation, I crash-studied other “types” of psychotherapy.
While in graduate school, I worked as an administrator at a battered women’s shelter. All staff members took shifts backing up our crisis line volunteers, and doing intake. My field placement involved doing play therapy with severely emotionally disturbed elementary and middle school-aged (latency aged) children. Working with children excited me. Object relations theory, or attachment theory, informed my work.
After graduation, I specialized in working with severely emotionally disturbed adolescents. I took additional training in sand tray therapy, similar in many ways to play therapy, as it is nonverbal. Sand tray therapy has its roots in Jungian theory. I worked for a residential facility which used a moral development model built upon the directors’ studies under Lawrence Kohlberg at Harvard.
To help my clients, I did whatever worked. Employed at non-profit agencies with multi-disciplinary treatment and education teams, I had the advantage of other professionals’ knowledge and training. I’m a huge believer in a multidisciplinary approach. The private practice model isolates and confuses individuals and families. As a mother, I can tell you first hand that I find coordinating my own son’s care (and my care) frustrating, to say the least.
As a child or adolescent’s psychotherapist, I worked with the parents and the child. On top of individual, family, and group psychotherapy, I did case management and coordinated care. Working with pregnant and parenting teens as a case manager and counselor, I coordinated care and, frankly, nagged young women to finish high school and get the job skills and/or university education that would enable them to rise above poverty.
The last position I had in the field was as a psychotherapist at a day treatment program for severely emotionally disturbed adolescents. The program heavily used behavioral modification techniques. My observation was that heavy use of such techniques taught the young men how to work the system. They were trained for a lifetime of external control. Insight is necessary for change.
I left the profession after an attempted rape by one of my adolescent male day treatment clients. Unfortunately, my position there started immediately after I lost a friend from high school to AIDs. The combination of both traumas threw me into a deep depression at the age of thirty. I have not practiced psychotherapy since then.
Does your knowledge in the field help or hinder the management of your illness?
At first, it hindered it. When I was first diagnosed bipolar type II at thirty-nine, I thought that I had a serious progressive mental illness. I had not realized the extent to which I had internalized stigma against bipolar disorder, as opposed to depression. The clients that I had worked with were so ill that they required residential or day treatment. All of the sudden, I thought of myself as not fit to be a mother. I put my son in daycare and returned to work, only to eventually fall apart and require hospitalization and partial hospitalization.
When you think of encounters with stigma, which stands out as the worst?
My own internalized stigma stands out. I thought my son better off without me. We stopped trying to have a second child. That’s some heavy stigma. My first psychiatrist, who was a woman, reassured me that I could have another child, just on different medication. We decided, though, that one was enough.
What prompted you to start a blog?
My father-in-law suffered sepsis while traveling. My husband and his siblings immediately joined his parents at the hospital. The incident, having someone I love on the precipice of death, triggered hypomania. I channeled my hypomanic energy and anxiety into writing. I simply had to. Many people prayed for my father-in-law’s healing. He is still with us today. For that I am grateful.
What specific kinds of skills do you think mental health advocates need to bring to their blog?
Self-care. The ability to see blogging for what it is and for what it is not. Not to expect writing to be a cure, even if it can be therapeutic. To realize that you may not get positive feedback for what you write. Realize that it may trigger symptoms. Be discerning as to whom you follow and to whom you listen. My best online mental health blogging friends have recommended that I see my mental health professional team when I appear to be symptomatic.
Medication has helped me to maintain stability. I am pro-science and pro-medication. My interest in the field of medicine preceded my interest in mental health. For those stable on medication, stay on your medication. Be skeptical of claims to “cure” mental illness. Vet sources. I like to rely on sources such as the National Institute of Mental Health. As a mental health advocate, what kind of policy changes do you want to see?
Multi-disciplinary treatment teams. Housing. Changes to privacy laws so family and friends can participate in treatment. Better health and medication coverage.
Is there anything you regret about the decision to go public with bi-polar illness?
For myself, no. For family members, perhaps. But, I’ve always been open. Just my personality.
What is the one thing people can do right now to combat stigma against people with mental illnesses.
Treat others kindly.
What is the question you would ask yourself as an interviewer and how would you answer it?
I have no clue. As I’m exhausted and overwhelmed, perhaps it would be: How do you deal with exhaustion and feeling overwhelmed? For which, I do not have an adequate answer. Figuring it out as I go…
Thank you Kitt!
If you check out Kitt O’Malley on LinkedIn, you’ll see that she has worked as a legal assistant, psychotherapist, and commercial real estate professional before reinventing herself as a mental health advocate. Nowadays she’s a mental health advocate, wife and mother, who neglects housework as she writes at kittomalley.com about living with bipolar disorder, parenting an adolescent migraineur with social anxiety, and being caregiver of aging parents – one with alcohol-related dementia and the other with vascular dementia secondary to stroke. She’s overwhelmed, to say the least.
I don’t do politics. Politics is ugly. Especially this election, yeesh. It seems, that one of the major divisive talking points is the pro-choice vs pro-life argument. The more and more rhetoric I hear, I want to ask you (challenge you even) Pro-Lifer, are you truly truly pro-life or are you simply anti-abortion?
What happens when this child you fought to be born needs routine well checks and immunizations and their parents need help affording it? What happens when the child turns out to have more complex medical needs like Down Syndrome, congenital heart defect, or osteogenesis imperfecta? Are you supporting programs like Medicaid? Are you supporting or contributing to local doctors who provide free or reduced services for low income families? You should be. Access to healthcare greatly increases one’s quality of life. And you said you were pro life.
What happens when this child you fought to be born grows into a toddler…