Downloaded by [New York University] at 12:41 13 August 2016 The Interactive World of Severe Mental Illness In our society, medication is often seen as the treatment for severe mental illness, with psychotherapy a secondary treatment. However, quality social interaction may be as important for the recovery of those with severe mental illness as are treatments. This volume makes this point while describing the emotionally moving lives of eight individuals with severe mental illness as they exist in the U.S. mental health system. Offering social and psychologi- cal insight into their experiences, these stories demonstrate how patients can create meaningful lives in the face of great difficulties. Based on in-depth interviews with clients with severe mental illness, this volume explores which structures of interaction encourage growth for people with severe mental illness and which trigger psychological damage. It con- siders the clients’ relationships with friends, family, peers, spouses, lovers, co-workers, mental health professionals, institutions, the community, and society as a whole. It focuses specifically on how structures of social interac- tion can promote or harm psychological growth, and how interaction dynam- ics affect the psychological well-being of individuals with severe mental illness. Diana Semmelhack is Professor of Behavioral Medicine at Midwestern Uni- versity and a Board Certified Clinical Psychologist. She has done extensive research on group work. Larry Ende received his MSW from the Jane Addams College of Social Work in Chicago and specializes in psychodynamically oriented therapy with chil- dren and adolescents and with severely mentally ill adults. He has a Ph.D in Literature from SUNY Buffalo. Arthur (Art) Freeman is Professor of Psychology and Executive Program Direc- tor of the Clinical Psychology programs at Midwestern University (Downers Grove, IL, and Glendale, AZ). He has published seventy five professional books and over one hundred book chapters, reviews, and journal articles. Clive Hazell operates a private practice in Chicago and teaches at the School of the Art Institute of Chicago, and the National College of Naprapathic Medicine. Downloaded by [New York University] at 12:41 13 August 2016 Colleen L. Barron, M.S. is a mental health professional working with severely mentally ill adults. She graduated Magna Cum Laude from Domin- ican University in River Forest, IL. She received her Master of Science in Clinical Psychology at Benedictine University in Lisle, IL. She pursued her college education after working in the corporate arena for 20 year. Garry L. Treft, MA. is the Administrative Coordinator for the Department of Behavioral Medicine at Midwestern University in Downers Grove, IL. He has a B.S. from Union College in Lincoln, NE, and a M.A. from Andrews Univer- sity in Berrien Springs, MI. Garry has written for local, national and interna- tional publications with experience in the corporate and non-profit sectors. Explorations in Mental Health Series Books in this Series: New Law and Ethics in Mental The Philosophy, Theory and Health Advance Directives Methods of J. L. Moreno The Convention on the Rights of Persons The Man Who Tried with Disabilities and the Right to Choose to Become God Penelope Weller John Nolte The Clinician, the Brain, and I Psychological Approaches Neuroscientific Findings and the to Understanding and Subjective Self in Clinical Practice Treating Auditory Tony Schneider Hallucinations From Theory to Therapy A Psychological Perspective on Edited by Mark Hayward, Joy and Emotional Fulfillment Clara Strauss, and Simon Chris M. Meadows McCarthy-Jones Brain Evolution, Language and Primitive Expression and Psychopathology in Schizophrenia Dance Therapy Edited by Paolo Brambilla and When Dancing Heals Andrea Marini France Schott-Billmann Quantitative and Qualitative A Theory-based Approach Methods in Psychotherapy Research to Art Therapy Edited by Wolfgang Lutz and Sarah Implications for Teaching, Knox Research and Practice Ephrat Huss Downloaded by [New York University] at 12:41 13 August 2016 Trauma-Informed Care How Neuroscience Influences Practice The Interactive World Amanda Evans and Patricia Coccoma of Severe Mental Illness Case Studies from the Learning about Emotions in Illness U.S. Mental Health System Integrating Psychotherapeutic Diana J. Semmelhack, Larry Teaching into Medical Education Ende, Arthur Freeman, and Edited by Peter Shoenberg and Clive Hazell with Colleen L. Jessica Yakeley Barron and Garry L. Treft The Interactive World of Severe Mental Illness Case Studies from the U.S. Mental Health System Diana J. Semmelhack, Larry Ende, Arthur Freeman, and Clive Hazell with Colleen L. Barron and Garry L. Treft Downloaded by [New York University] at 12:41 13 August 2016 First published 2015 by Routledge 711 Third Avenue, New York, NY 10017 and by Routledge 2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN Routledge is an imprint of the Taylor & Francis Group, an informa business © 2015 Taylor & Francis The right of Diana Semmelhack, Larry Ende, Arthur Freeman, and Clive Hazell to be identified as authors of this work has been asserted by them in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act 1988. All rights reserved. No part of this book may be reprinted or reproduced or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers. Trademark notice: Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data The interactive world of severe mental illness : case studies of the U.S. mental health system / Diana Semmelhack [and five others]. pages cm. — (Explorations in mental health series) Includes bibliographical references and index. 1. Mentally ill—Rehabilitation—United States—Case studies. 2. Mental illness—Treatment—United States—Case studies. 3. People with disabilities—Rehabilitation—United States—Case studies. I. Semmelhack, Diana. RC439.5.I58 2015 362.20973—dc23 2015005690 ISBN: 978-0-415-74301-3 (hbk) Typeset in Sabon by Apex CoVantage, LLC Downloaded by [New York University] at 12:41 13 August 2016 To Marge and Goldie: and all others who have endured the struggle and succeeded. Downloaded by [New York University] at 12:41 13 August 2016 “Untitled” by Chelsey Wood Downloaded by [New York University] at 12:41 13 August 2016 Contents Introduction 1 1 Institutional Interaction Structures 12 2 Social Interactions With Families 34 3 Social Interactions With Friends 50 Introduction to the Cases 79 4 The Depersonalized Musician 81 5 The Woman Who Couldn’t Get Her Abuser Out of Her Head 89 6 The Depressed Man in Chronic Pain 108 122 7 The Last Train Out of Berlin Downloaded by [New York University] at 12:41 13 August 2016 8 The Woman Who Believed She had No Heart 135 9 Monster Woman 146 10 The Woman Who Never Mourned 158 11 The Man Who Lived in a Dumpster 170 viii Contents 12 The Tavistock Method: A Growth-Promoting Form of Group Interaction 187 13 Synthesis: Reflections on the Structure of Interaction 212 14 Conclusion 218 Epilogue 225 Index 229 Downloaded by [New York University] at 12:41 13 August 2016 Figures and Illustrations Illustration “Untitled” by Chelsey Wood vi 12.1 Hill Interaction Matrix 191 13.1 Institutional structures that hinder and promote growth 212 13.2 Family structures that hinder and promote growth 212 13.3 Friendship structures that hinder and promote growth 213 13.4 Interaction structures that tend to promote psychological damage for clients 214 13.5 Interaction structures that tend to promote psychological growth for clients 214 Downloaded by [New York University] at 12:41 13 August 2016 This page intentionally left blank Downloaded by [New York University] at 12:41 13 August 2016 Foreword It was with great pleasure that I accepted Dr. Semmelhack’s offer to write a foreword for this exceptional book. It is a rare opportunity to have in one volume the results of over 20 years of clinical practice and research on the ways that institutions, families, and friends work with individuals who experience severe mental illness. Through careful analysis of significant sto- ries of clients, the authors provide not only valuable information regarding the interaction of clients with the system, but also the opportunity to see both the intended and unintended consequences of prevailing methods of care for those with psychiatric disabilities. This book demonstrates how to move from a medically oriented or “pathologizing” paradigm to a recovery-oriented one. To validate this para- digm shift, and to show how it can improve the quality of life for the client, the authors present examples of therapy that responds to the specific experi- ences and worldview of the client, instead of treatment that is based on the perspective of “mental illness.” The focus is on success, and the case studies bring client-therapist interaction, the specific client-therapist interaction, into the foreground, thus demonstrating its centrality in fostering recovery and healing. The book exemplifies an attitude of respect and understanding toward the client that is similar to that of another doctor who worked with the severely mentally ill in Europe, Carl Gustav Jung. The great Swiss analyst C. G. Jung was adamant that the symptoms of severe mental illness must be seen from multiple perspectives. While recog- nizing the necessity of acknowledging the presence of deep psychopathol- Downloaded by [New York University] at 12:41 13 August 2016 ogy primarily for the purpose of establishing prognosis and determining the level of containment needed for effective treatment, Jung believed it was important to look at the meaning being expressed by the specific behav- iors of individuals diagnosed with schizophrenia (or, in his terminology, dementia praecox), not only functionally, but also from traditional Freud- ian perspectives and from the perspective of the collective unconscious.