Changing the Conversation

Recovery outcomes are valued goals of services throughout the nation. Relationships that empower and encourage choice and self-direction are hallmarks of all activities that support recovery. 

It is a beautiful Sunday morning. A friendly visitor is coming to my house today. She is a young person studying at a university in Boston. I am looking forward to our meeting. She is just starting out in life. I am in the older stages of life. When we are having coffee, I realize we are speaking the same language. The generation gap is not evident in our communications. She reminds me to be energetic and hopeful. She makes me laugh. She is a bright spot in my day. I trail off in my thinking…I wish I had family and children in my life. I am alone most of the time. I actually like my company, but occasionally I lament that along the path to recovery I did not construct my own family. I realize the importance of relationships and quality of life in promoting recovery.

Research on “health care disparities,” the euphemism for unnecessary deaths and adverse outcomes among people from low socioeconomic groups and from communities of color, often attribute them to individual characteristics and structural barriers within mental health systems. Most often an individual’s use of services as well as the way services are arranged and delivered are cited as causes.

I want to begin by commenting on what is going wrong and then discuss what is hopeful in the provider-client relationship. Although research is taking place, there is little agreement about best practices and ethical standards in minority mental health care. The issues of staff bias, racism, institutional racism, prevailing practices, and methods of prioritizing who gets time and attention are omitted from the discussion. Also, questions of discrimination that stem from preconceived notions and racial profiling of African American people and/or questions of how stigma influences medical decisions are absent, if not actively avoided, in discussions of healthcare disparities.

Trigger Warning: Trauma re-enactment

I am 65 years old and a trauma survivor. When I entered therapy, I was labeled as having an adolescent adjustment reaction. Years later, the mental health label was changed repeatedly—from schizoaffective disorder to post-traumatic stress disorder (PTSD) and major depression and then later to dissociative identity disorder, paranoia, and bipolar disorder. It was clear to me that my trauma symptoms determined the diagnosis. I wanted a cure and a reduction of my symptoms, instead of a variety of methods to merely manage them.

My commitment to making therapy work was matched by the efforts of my therapist. She is a learner spirit and as tenacious as I am. Even so, it has taken a lifetime to arrive at an enduring sense of safety and freedom from the daily derailing of my consciousness by the intrusion of trauma memory content. Therapy changed as new knowledge of the impact of trauma emerged. I wondered if there was a way to combine therapies to improve the quality of my life and speed recovery.

We see the need almost every day. As we move through our daily routines, we encounter people who are experiencing homelessness. Occasionally we will drop change in their cup or walk on the other side of the street. On any particular day, we may be on our way to Starbucks or to the grocery store when we notice a person who is experiencing homelessness. We sadly lament…it is horrible that a person is elderly and homeless. We stop and think about the horrors of homelessness, especially for elders. Then we continue on our journey...