Gail A. Hornstein - Agness Jacket: A Psychologists Search for the Meanings of Madness.Revised and Updated with a New Epilogue by the Author

First published 2009

By Transaction Publishers, New Jersey, USA

Published 2018

by Routledge

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and by Routledge

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The right of Gail A. Hornstein to be identified as author of this work has been asserted by her in accordance with sections 77 and 78 of the Copyright,Designs and Patents Act 1988.

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Library of Congress Cataloging-in-Publication Data

Names: Hornstein, Gail A., 1951 author.

Title: Agness jacket : a psychologists search for the meanings of madness /

Gail A. Hornstein ; revised and updated with a new epilogue by the author.

Description: Revised and updated with a new epilogue. | New York :

Routledge, 2018. | Includes bibliographical references.

Identifiers: LCCN 2017020239 | ISBN 9781138297418 (pbk. : alk. paper) |

ISBN 9781315083728 (ebk)

Subjects: LCSH: Mentally illInstitutional care. | Mental illnessAlternative

treatment. | Mental illnessPhilosophy. | Psychiatry.

Classification: LCC RC439 .H67 2018 | DDC 616.89dc23

LC record available at https://lccn.loc.gov/2017020239

ISBN: 978-1-59486-544-2 (hbk)

ISBN: 978-1-138-29741-8 (pbk)

ISBN: 978-1-315-08372-8 (ebk)

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In the introduction to How Doctors Think , Jerome Groopman makes a startling statement: I quickly realized that trying to assess how psychiatrists think was beyond my abilities. Unfortunately, many patients and their families would say the same thing. Simplistic theories of chemical imbalances and the rote administration of toxic and ineffective drugs make little sense as ways of understanding or responding to the intense fear or anguish that lead patients to seek help. But should psychiatrists lack of imagination continue to constrain our own thinking?

Its now absolutely clear that diagnosing people with schizophrenia or bipolar illness, giving them high doses of neuroleptic medications over long periods, and not talking to them about their experiences produces a chronically disabled population. Practically anything would be an improvement on this dismal situation; fortunately, many imaginative and exciting alternatives, based directly on patients own experiences, are emerging.

Some are described in a provocative book, Alternatives Beyond Psychiatry , in which sixty-one writers from all over the worldpatients, physicians, family members, social scientistsreport on new approaches to understanding and coping with madness. Here are just a few examples of the alternatives to conventional mental health programs that are operating right now in the United States, the United Kingdom, and Europe.

At the Runaway House in Berlin, Germany, people in acute emotional crises (psychotic states) can get the support and help they need without coercion or the stigma of psychiatric hospitalization. Hundreds of people have benefited from stays at this spacious and comfortable suburban house, which can accommodate up to thirteen residents for periods of several months.

The guiding framework of the Runaway House stands in striking contrast to conventional psychiatric practice. For us, crises are not an expression of a disease or a deficit, two of the staff wrote, but are rather excessive demands on a persons strategies for dealing with stressful situations and the social environment. Even unusual behavior has a function in the life of the person and can be an attempt to find a solution in conflict-ridden situations. There are always societal and interpersonal causes that contribute to a crisis. Crises are a normal part of life and an opportunity for constructive changes.

By seeing emotional distress as something that occurs in a context and is capable of being affected by a support structure, the Runaway House builds peoples resilience even as it helps them cope with crisis situations. The staff encourage residents to see themselves as adults capable of individuality and independence who temporarily need help from others. By offering calm support rather than dramatic emergency intervention, the goal is to keep a crisis from escalating into a chronic condition.

There are no doctors or nurses among the fifteen paid staff and students who provide twenty-four-hour-a-day support in a rotating on-call system. A formal requirement stipulates that at least half the staff must themselves be survivors of psychiatry. By offering a trusting atmosphere where people feel well looked after, people in crisis can get the companionship, care, and space they need to cope with overwhelming feelings. There is no prescribed structure for activities; the goal is simply to provide the residents with the best possible conditions for realizing their personal goals. Staff and residents divide up responsibilities for shopping, cooking, and cleaning, but do not impose a particular pattern of behavior on anyone. The garden and nearby open fields offer opportunities for walks and connection with the natural world. Because residents are free to leave at any time and space in the house is limited, people are acutely aware of the need to take an active role in their own recovery and not passively wait for others to intervene in their difficulties.

In Whitehorse, Canada, capital of the geographically isolated Yukon Territory, the Second Opinion Society (SOS) provides a drop-in center and resources for advocacy and support outside the conventional mental health system. Free and open to patients, families, and anyone else in the community, the SOS house offers, in the words of one of its founders, a place where feelings can be expressed freely without the threat of being shot down, drugged up, or locked up where people can work through emotional pain, with the support of others who are willing to be present, to listen, to validate. By guaranteeing freedom from coercion and short-term crisis support during evenings, weekends, and holidays, the SOS provides a crucial alternative to people who might otherwise end up on a locked ward.

In addition to its drop-in center, the SOS offers workshops on alternative ways of dealing with emotional distress (e.g., acupressure, yoga, writing as a tool for healing), as well as free community lunches that draw everyone from tourists to politicians to people with long histories in the mental health system. Unlike the group homes or halfway houses provided by government-run social services, which often stigmatize and segregate patients from their neighbors, the SOS sponsors holiday dinners and a community gardenamenities that are valued and appreciated by people in the area.